Christopher Van Issum

Ipswich Hospital NHS Trust, Ipswich, England, United Kingdom

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Publications (8)13.63 Total impact

  • Christopher van Issum, Delphine S Courvoisier, Paolo Scolozzi
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    ABSTRACT: OBJECTIVE: The aim of this study was to retrospectively evaluate the incidence of posttraumatic orbital emphysema (OE) and to propose a radiologic topographic classification as well as a possible pathophysiologic model. STUDY DESIGN: Orbital fine-cut (1 mm) computerized tomographic scan slices from 137 patients were used to assess the fracture's type, the presence and position of OE, and periorbital tissue herniation. The OE was categorized into the following 5 compartments: subcutaneous periorbital, peribulbar, retrobulbar extra- and intraconal, and pterygopalatine fossa. RESULTS: The incidence of OE was 61%. OE was more frequently associated with isolated medial wall (78%; P < .001) and combined medial wall/orbital floor (82%; P < .01) fractures. Palpable isolated subcutaneous eyelid emphysema was not related to fracture's type (P = .85). CONCLUSIONS: OE suggested medial wall fractures alone or combined with orbital floor fractures. Pathophysiologically, according to the Poiseuille law, the difference in length between the ethmoid and sinusal infundibulii could explain the increased incidence of OE when the medial wall is involved.
    01/2013; 115(6). DOI:10.1016/j.oooo.2012.10.021
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    ABSTRACT: To describe and evaluate the reliability and the accuracy of a specific computed tomography-based assessment in predicting treatment decisions for pure orbital floor blowout fractures (BOFs). In this retrospective cohort study, the charts of all patients presenting with isolated BOFs from January 2009 through April 2011 at the University Hospital of Geneva were reviewed. The systematic computed tomographic assessment included the following 3 parameters: 1) ratio of the fractured orbital floor; 2) maximal height of periorbital tissue herniation, and 3) a 4-grade muscular subscore describing the position of the inferior rectus muscle relative to the level of the orbital floor. The parameters' predictive value regarding the treatment decision (conservative vs surgical) was assessed by logistic regression and relative operating characteristic curves. Forty-eight patients (24 male) were included. The patients' mean age was 49.5 years. The ratio of the fractured orbital floor, the maximal height of periorbital tissue herniation, and the muscular subscore were significant predictors in univariate analysis (P = .02, P = .006, P = .001, respectively), whereas, in a multivariate analysis, only muscular subscore remained a significant predictor (P = .003) and reached a similar predictive ability as the 3 parameters together. The present study showed that the severity of inferior rectus muscle displacement is the most important independent predictive radiologic factor in the treatment decision-making process for pure BOFs. This systematic computed tomographic assessment is a valuable tool for a better understanding of BOF management overall. Further studies are needed to establish its clinical relevance.
    Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons 07/2012; 70(7):1627-32. DOI:10.1016/j.joms.2012.03.006 · 1.58 Impact Factor
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    ABSTRACT: Haemorrhoids are variceal dilatations of the anal and perianal venous plexus and often develop secondary to the persistently elevated venous pressure within the haemorrhoidal plexus (Kumar 2005). Phlebotonics are a heterogenous class of drugs consisting of plant extracts (i.e. flavonoids) and synthetic compounds (i.e. calcium dobesilate). Although their precise mechanism of action has not been fully established, they are known to improve venous tone, stabilize capillary permeability and increase lymphatic drainage. They have been used to treat a variety of conditions including chronic venous insufficiency, lymphoedema and haemorrhoids.Numerous trials assessing the effect of phlebotonics in treating the symptoms and signs of haemorrhoidal disease suggest that there is a potential benefit. The aim of this review was to investigate the efficacy of phlebotonics in alleviating the signs, symptoms and severity of haemorrhoidal disease and verify their effect post-haemorrhoidectomy. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library 2011 issue 9 , MEDLINE (1950 to September 2011) and EMBASE (1974 to September 2011). Only randomised controlled trials evaluating the use of phlebotonics in treating haemorrhoidal disease were used. No cross-over or cluster-randomized trials were included for analysis and any trial which had a quasi-random method of allocation was excluded. Two authors independently extracted the data and analysed the eligibility of the data for inclusion. Disagreements were resolved by meaningful discussion. We considered twenty-four studies for inclusion in the final analysis. Twenty of these studies (enrolling a total of 2344 participants) evaluated the use of phlebotonics versus a control intervention. One of these twenty studies evaluated the use of phlebotonics with a medical intervention and another study with rubber band ligation.The remaining four studies included two which compared different forms of phlebotonics with each other, one study which evaluated phlebotonics with a medical intervention and one study which compared the use of phlebotonics with infrared photocoagulation. Eight studies were excluded for various reasons including poor methodological quality.Phlebotonics demonstrated a statistically significant beneficial effect for the outcomes of pruritus (OR 0.23; 95% CI 0.07 to 0.79) (P=0.02), bleeding (OR 0.12; 95% CI 0.04 to 0.37) (P=0.0002), bleeding post-haemorrhoidectomy (OR 0.18; 95% 0.06 to 0.58)(P=0.004), discharge and leakage (OR 0.12; 95% CI 0.04 to 0.42) (P=0.0008) and overall symptom improvement (OR 15.99 95% CI 5.97 to 42.84) (P< 0.00001), in comparison with a control intervention. Although beneficial they did not show a statistically significant effect compared with a control intervention for pain (OR 0.11; 95% CI 0.01 to 1.11) (P=0.06), pain scores post-haemorrhoidectomy (SMD -1.04; 95% CI -3.21 to 1.12 ) (P= 0.35) or post-operative analgesic consumption (OR 0.54; 95% CI 0.30 to 0.99)(P=0.05). The evidence suggests that there is a potential benefit in using phlebotonics in treating haemorrhoidal disease as well as a benefit in alleviating post-haemorrhoidectomy symptoms. Outcomes such as bleeding and overall symptom improvement show a statistically significant beneficial effect and there were few concerns regarding their overall safety from the evidence presented in the clinical trials.However methodological limitations were encountered. In order to enhance our conclusion further, more robust clinical trials which take into account these limitations will need to be performed in the future.
    Cochrane database of systematic reviews (Online) 01/2012; 8(8):CD004322. DOI:10.1002/14651858.CD004322.pub3 · 5.94 Impact Factor
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    ABSTRACT: To evaluate the reliability, accuracy and rapidity of a specific computational method for assessing the orbital floor fracture area on a CT scan. A computer assessment of the area of the fracture, as well as that of the total orbital floor, was determined on CT scans taken from ten patients. The ratio of the fracture's area to the orbital floor area was also calculated. The test-retest precision of measurement calculations was estimated using the Intraclass Correlation Coefficient (ICC) and Dahlberg's formula to assess the agreement across observers and across measures. The time needed for the complete assessment was also evaluated. The Intraclass Correlation Coefficient across observers was 0.92 [0.85;0.96], and the precision of the measures across observers was 4.9%, according to Dahlberg's formula .The mean time needed to make one measurement was 2 min and 39 s (range, 1 min and 32 s to 4 min and 37 s). This study demonstrated that (1) the area of the orbital floor fracture can be rapidly and reliably assessed by using a specific computer system directly on CT scan images; (2) this method has the potential of being routinely used to standardize the post-traumatic evaluation of orbital fractures.
    European journal of radiology 06/2011; 81(9):2251-4. DOI:10.1016/j.ejrad.2011.06.024 · 2.65 Impact Factor
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    ABSTRACT: We report a case of acute phacolytic glaucoma in which only protein was present in the anterior chamber without macrophages. We propose that this study represents a type of phacolytic glaucoma characterized by a hyperacute presentation caused by rapid leakage of degenerated lens proteins into the aqueous humor as opposed to a second type with a more gradual onset and with phacolytic macrophages in the aqueous humor resulting from an immunologic response to liquefied lens proteins. Thus, 2 forms, perhaps at ends of a spectrum of clinical manifestations of phacolytic glaucoma, may exist with distinct characteristics and pathophysiology.
    Journal of glaucoma 03/2011; 21(4):248-9. DOI:10.1097/IJG.0b013e31820d7d2e · 1.74 Impact Factor
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    ABSTRACT: To discuss the unusual features of topiramate-induced acute angle closure glaucoma, its pathophysiologic mechanisms, and treatment controversies, and to report the first anterior segment optical coherence tomography (OCT) of this condition. Literature review and case report with OCT findings. Topiramate-induced angle closure is usually bilateral and associated with acute myopia; the ocular pressure is often not very highly elevated. Ciliochoroidal detachment with ciliary body anterior rotation is typically present and was demonstrated easily in our case with anterior segment OCT. Pilocarpine exacerbates this condition and peripheral iridotomy is not indicated, nor is iridoplasty. Treatment consists of replacing topiramate with appropriate medication, strong cycloplegia, and topical steroids. It is important to recognize this form of acute secondary angle closure in order to treat it properly, avoiding harmful medication and unnecessary surgery.
    European journal of ophthalmology 11/2010; 21(4):404-9. DOI:10.5301/EJO.2010.5979 · 1.06 Impact Factor
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    ABSTRACT: Spontaneous orbital haemorrhage can occur at any age. The clinical presentation is often dramatic with acute painful proptosis and nausea. Vision may be severely impaired. A 77 years old lady woke up with sudden retroocular pain, diplopia and proptosis. Her blood pressure was 235 / 95 mmHg. MRI showed a right retroocular mass, contiguous with the lateral rectus muscle and consistent with a haemorrhage. Vision was preserved in both eyes but the right visual field slightly altered. Motility of the right eye was severely impaired. The risks of surgical drainage were considered too high in a case of only slight visual field impairment, and a conservative attitude was decided. Evolution was good with antihypertensive treatment, the haemorrhage resorbed and diplopia improved. MRI showed no morphological orbital anomaly. Spontaneous orbital haemorrhage is a complication of a vascular orbital anomaly in most cases, more rarely due to a disturbance of coagulation. In our case arterial hypertension in association with antiaggregant intake explains the haemorrhage. Conservative treatment appears adequate with regard to the only slight visual field impairment. Close neuro-ophthalmological follow-up is, however, needed.
    Klinische Monatsblätter für Augenheilkunde 06/2008; 225(5):435-7. DOI:10.1055/s-2008-1027354 · 0.67 Impact Factor