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Biomedical subjects

B C Patel

Publications and source records attributed to B C Patel.

At least 19 recordsLinked to original sources
PubMed1998

Cutaneous malignant melanoma and oculodermal melanocytosis (nevus of Ota): report of a case and review of the literature.

A 29-year-old white man, with oculodermal melanocytosis, had a rapidly enlarging, erythematous, painful nodule over his left brow, within the nevus. The lesion was excised and diagnosed as a malignant melanoma. Systemic evaluation showed no evidence of distant disease. This is the tenth case reported of a cutaneous melanoma developing in a nevus of Ota. Melanoma arising in the choroid, brain, orbit, iris, ciliary body, or optic nerve in association with a nevus of Ota is well documented. Careful observation is necessary in patients with a nevus of Ota, particularly in white patients, in whom malignant degeneration seems to occur with a disproportionate frequency.

Adult↗
PubMed1998

Prospective evaluation of topical versus retrobulbar anesthesia: a converting surgeon's experience.

PURPOSE: To evaluate and compare the efficacy of topical versus retrobulbar anesthesia for cataract surgery performed by a surgeon newly converting to the topical technique. SETTING: Department of Ophthalmology, Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. METHODS: Ninety patients were prospectively assigned by permuted block restricted randomization to receive topical (Group 1; n = 45) or retrobulbar (Group 2; n = 45) anesthesia. Group 1 received topical bupivacaine 0.75% and intravenous midazolam and fentanyl for anesthesia. Group 2 received intravenous methohexital followed by retrobulbar block with an equal mixture of lidocaine 2% and bupivacaine 0.75% plus hyaluronidase 150 units. A visual pain analog scale was used to assess the degree of pain during anesthesia administration and surgery and postoperatively. The degree to which eye movement, touch, and light caused patient discomfort was assessed. Intraoperative conditions and complications were recorded. RESULTS: Intraoperative operating conditions were significantly better in Group 2 (P < .05). There was a small but statistically significant difference in the degree of discomfort during anesthesia administration and surgery (P < .05). There was no difference in postoperative discomfort. Chemosis, subconjunctival hemorrhage, and eyelid hemorrhage occurred only in Group 2, in which there was one retrobulbar hemorrhage. Although eyelid squeezing and ocular motility were present more frequently in Group 1, neither was a problem to the surgeon. CONCLUSION: Cataract surgery was safely performed by a surgeon converting to topical anesthesia. After a distinct learning curve, the procedure was performed with minimal patient discomfort. Surgical training and patient preparation are the key to safe use of topical anesthesia.

Administration, Topical↗
PubMed1998

Standardized range of conformers and symblepharon rings.

Conformers and symblepharon rings are routinely used to keep fornices formed after socket surgery or in the presence of conjunctival cicatricial disease. However, there is no accepted standard size or shape of conformers or symblepharon rings. We measured the ideal conformer and symblepharon sizes in patients undergoing socket surgery and designed six conformer and symblepharon sizes. The full set of six conformers and symblepharon rings is available to the surgeon at the end of surgery. We have successfully used these conformers and symblepharon rings in over 600 cases during the last 7 years. These standardized sizes allow more accurate fitting of conformers and symblepharon rings.

Eye Enucleation↗
PubMed1997

Serogroups/types and antibiotic resistance of referred isolates of Streptococcus pneumoniae: 1993 to 1995.

Surveillance of prevalent serogroups/types of Streptococcus pneumoniae and their susceptibility to antimicrobial agents is important for understanding the epidemiology of pneumococcal infections and for guiding empirical treatment. Current vaccines for prevention of pneumococcal infection utilise serotype specific antigens, so knowledge of the prevalence of particular serotypes is relevant to vaccine use and development. Five thousand seven hundred and ninety-six isolates of S. pneumoniae from separate patients were serogrouped or serotyped by the Streptococcus and Diphtheria Reference Unit between 1993 and 1995. Antibiotic susceptibility testing was carried out by the Antibiotic Reference Unit on 3821 (65.9%) of these isolates. A total of 40 distinct serogroups/types, together with a small number of non-typable isolates, were noted over the three year period. The same five serogroups/types (6, 9, 14, 19, and 23) occurred most commonly in each year of the study, not only in the total population of isolates studied, but also in isolates obtained from blood or cerebrospinal fluid, and among isolates with antibiotic resistance. Ninety-six per cent of the isolates belonged to serogroups/types included in the currently available 23-valent capsular polysaccharide pneumococcal vaccine; the conjugate petna-, hepta-, and nonavalent vaccines covered 51%, 75%, and 80% of isolates respectively. The nonavalent vaccine offers the most promise as 74% of all blood and cerebrospinal fluid isolates and 90% of antibiotic resistant isolates belonged to serogroups or types included in this formulation.

Anti-Bacterial Agents↗
PubMed1997

Morphological changes induced by short pulse hydrogen fluoride laser radiation on dental hard tissue and restorative materials.

BACKGROUND AND OBJECTIVE: The potential benefits of the effects of lasers on dental tissues have yet to be realized but may be brought closer through the availability of a suitable laser. The objective of this project is to examine the surface morphological changes resulting from hydrogen fluoride (HF) laser radiation on tooth and restorative material surfaces. STUDY DESIGN/MATERIALS AND METHODS: A hydrogen fluoride laser emitting at 2.9 microns is used to interact with a range of dental hard tissue and restorative materials. The surface morphological changes induced by 100 mJ pulses of < 1 microsecond duration is studied using a SEM. RESULTS: The irradiated surfaces displayed microstructures similar to those of a mechanically fractured surface with no evidence of melting. CONCLUSION: This study suggests that tissue is removed by microexplosion, leaving a surface free from thermal damage with surface characteristics that would appear to facilitate the adhesion of restorative materials.

Composite Resins↗
PubMed1997

Transcanalicular neodymium: YAG laser for revision of dacryocystorhinostomy.

BACKGROUND: Laser-assisted dacryocystorhinostomy (DCR) has failed to match the success rates of external DCR. It has been suggested that this technology may be best suited for revision of failed DCR cases. The authors prospectively evaluated the efficacy of transcanalicular laser-assisted revision DCR (TCLARDCR). METHODS: A neodymium:YAG (Nd:YAG) laser was used for transcanalicular revision of 24 failed DCRs. Failure had followed one (n = 15), two (n = 7), or three (n = 2) previous external DCRs. RESULTS: Mean duration of the surgery was 78.2 minutes. Success was achieved in 11 cases (46%; mean follow-up, 20 months). There was no correlation between early loss of stents and failure. Three cases had partial relief of symptoms. Three of the failures unsuccessfully underwent further TCLARDCR. CONCLUSIONS: The authors' success rate of 46% with TCLARDCR compares poorly with the 85% success for external revision DCR. With TCLARDCR, specific anomalies like the sump syndrome cannot be addressed adequately. There is a theoretical risk of canalicular injury. Laser lacrimal surgery also is equipment dependent and more costly than external DCR. The TCLARDCR cannot be recommended for revision DCR using the Nd:YAG laser (Lasersonics, Milpitas, CA).

Adult↗
PubMed1997

Atypical lymphoid hyperplasia of the eyelids manifesting as xanthelasma-like lesions.

We describe a patient who had bilateral, yellow papules of the upper eyelids. This proved to be the clinical manifestation of an atypical lymphoid hyperplasia of the orbits. We describe this clinical presentation as a new sign of this condition. This finding serves to broaden the differential diagnosis of yellow papules on the eyelids. Atypical lymphoid hyperplasia of the orbits poses a challenging problem. Their benign or malignant nature cannot usually be determined by clinical and radiologic criteria. Most of these infiltrates result in extraocular lymphoma. We describe a patient with bilateral, yellow papules of the upper eyelids that proved to be a manifestation of an atypical lymphoid hyperplasia of the orbits.

Adult↗
PubMed1997

Management of postblepharoplasty lower eyelid retraction with hard palate grafts and lateral tarsal strip.

Lower eyelid malposition is the most common long-term complication following transcutaneous lower eyelid blepharoplasty. The malposition may include rounding of the lateral canthal angle, lower eyelid retraction with inferior scleral show, or frank ectropion. The result is cosmetically unacceptable and may be associated with tearing, irritation, and other exposure keratitis symptoms. Multiple factors, including lower eyelid laxity, shortage of skin, and scarring of the middle lamella, may be responsible for this malposition. A systematic examination of the lower eyelid, as presented, helps to assess the degree to which each of these factors is responsible for the malposition. Patients with the most severe degree of lower eyelid malposition generally have middle lamella scarring. If this abnormality is not addressed, lower eyelid procedures aimed at correcting the malposition are doomed to failure. In the presence of significant middle lamella scarring, a spacer is required to provide vertical height and stiffness to support the lower eyelid following release of the cicatrix. A systematic approach aimed at addressing the underlying abnormalities was developed. In patients with significant middle lamella scarring, hard palate mucosa grafts were used as spacers in 29 eyelids (17 patients). A lateral canthotomy and transconjunctival incision allow access to the scarring in the lower eyelid retractors and septum. After careful release of all cicatrix, a hard palate mucosa graft is inserted between the lower border of the tarsal plate and the recessed conjunctiva, lower eyelid retractors, and septum. Horizontal lower eyelid laxity, when present, is corrected by performing a lateral tarsal strip. Most patients do not have a true deficiency of the anterior lamella (skin and orbicularis oculi muscle). When a moderate amount of anterior lamella deficiency is present with significant scarring of the middle lamella, the technique we describe allows correction of the lower eyelid malposition without a skin graft. After a follow-up interval of 6 to 30 months (mean 14 months), excellent results were obtained in all eyelids. Complications included corneal abrasions in two eyes before routine use of bandage cornea contact lenses at the end of surgery and a secondary bleed from the roof of the mouth in one patient. Palate mucosa closely resembles tarsus and provides excellent vertical support to the eyelid. It is stiff enough to maintain eyelid contour without causing a cosmetically unacceptable bump. Tissue can be obtained with ease. The technique, as described, addresses the underlying causes of lower eyelid malposition and gives excellent functional and cosmetic results.

Adult↗
PubMed1997

Cosmetic conformers.

The loss of an eye is an emotionally traumatic event. A prosthetic eye is usually not fitted until the socket has healed (about 6 weeks after surgery). This period, during which a clear conformer is fitted, can be particularly traumatic, especially for the newly anophthalmic patient. The authors have designed interim acrylic prosthetic conformers to help patients overcome some of these problems while preserving the necessary characteristics of ideal postoperative conformers.

Adult↗
PubMed1997

"Pneumofornix" (air under the eyelid): a normal finding.

Normal pockets of air under the eyelids have not been previously described in the literature. To assess the incidence and patterns of normal air bubbles in the region of the eyelid, computed tomography (CT) scans of 126 normal orbits and 36 orbits of patients with thyroid orbitopathy were assessed. Twenty-eight (22%) of the normal orbits and 14 (39%) of the thyroid orbits had a well-defined medial or lateral air bubble (or both) on axial views (.1 > P > .05). Oval central or paracentral air bubbles in sections through the superior or inferior fornix were seen in 19 (15%) of the normal orbits and 10 (28%) of the thyroid orbits (.1 > P > .05). It is important to be aware of the incidence and patterns of these normal air bubbles to ensure their accurate differentiation from pathologic air bubbles.

Adolescent↗
PubMed1997

An orbital abscess secondary to acute dacryocystitis.

An orbital abscess is an ophthalmic surgical emergency that is typically caused by the spread of bacteria from adjacent structures, such as the sinuses, eyelids, or teeth. Although acute dacryocystitis is commonly associated with preseptal cellulitis, it rarely causes orbital infection. Infection of the lacrimal sac will typically localize in the preseptal space because the lacrimal sac lies anterior to the orbital septum. To the authors' knowledge, this is the first report of an intraconal abscess secondary to acute dacryocystitis. The key points in the surgical management of this entity are discussed.

Abscess↗
PubMed1996

A comparison of topical and retrobulbar anesthesia for cataract surgery.

PURPOSE: To evaluate and compare the efficacy of topical and retrobulbar anesthesia for cataract extraction with intraocular lens implantation. METHODS: One hundred thirty-eight patients prospectively were assigned to the topical (group 1; n = 69) or retrobulbar (group 2; n = 69) anesthesia groups by permuted block restricted randomization. Group 1 received topical 0.75% bupivacaine and intravenous midazolam and fentanyl for anesthesia. Group 2 received intravenous methohexital followed by retrobulbar block with an equal mixture of 2% lidocaine and 0.75% bupivacaine plus hyaluronidase (150 U). A visual pain analogue scale was used to assess the degree of pain during the administration of anesthesia, during surgery, and post-operatively. The degree to which eye movement, touch, and light caused patient discomfort was assessed. Complications and surgical conditions were recorded. RESULTS: There was no difference in the surgical conditions (P = 0.5) or pain during surgery (P = 0.35) between the two groups. There was more discomfort during administration of topical anesthesia (P < 0.0001) and postoperatively (P < 0.05) in the topical group. Chemosis, subconjunctival hemorrhage, and eyelid hemorrhage were seen almost exclusively in the retrobulbar group. One patient in group 2 had a retrobulbar hemorrhage. Although eyeball movement and squeezing of the eyelids were present more frequently in the topical group, neither was a problem to the surgeon. CONCLUSION: Topical anesthesia can be used safely for cataract extraction. The degree of patient discomfort is only marginally higher during administration of the anesthesia and postoperatively. However, surgical training and patient preparation are the keys to the safe use of topical anesthesia.

Administration, Topical↗
PubMed1995

Extracapsular cataract surgery with and without intraocular lens implantation in Fuchs heterochromic cyclitis.

PURPOSE: To compare the surgical and postoperative complications and visual outcome of extracapsular cataract extraction (ECCE) with and without intraocular lens (IOL) implant in Fuchs heterochromic cyclitis. METHODS: The records of 77 patients with Fuchs heterochromic cyclitis who had undergone ECCE were reviewed. Of a total of 77 eyes, a posterior chamber IOL (PC IOL) was implanted in 43 eyes, whereas 34 eyes did not receive an implant. RESULTS: In the pseudophakic group, 40 (93%) eyes achieved 20/40 or better. This level also was achieved in 29 (85%) eyes not receiving an implant. Intraoperative anterior chamber hemorrhage was documented in 18 eyes but there was no correlation with preoperative gonioscopic findings. A temporary or permanent elevation of intraocular pressure was noted in five of eight eyes that had marked anterior chamber hemorrhage. Severe postoperative uveitis occurred in ten eyes and was more common in patients with glaucoma who had PC IOL implantation, but this did not adversely affect the visual outcome. Of 40 eyes with PC IOL implant, severe postoperative uveitis developed in 7. In six of these seven eyes, the implant was a three-piece lens with polypropylene haptics. Severe postoperative uveitis developed in 6 of 16 eyes with preoperative glaucoma. Five of these six eyes had a PC IOL implant. Of the 34 aphakic patients, 10 (29%) were intolerant of contact lens correction. There was no difference in the incidence of postoperative uveitis, cystoid macular edema, and development of glaucoma between the two groups. CONCLUSION: Implantation of PC IOLs in ECCE in patients with Fuchs heterochromic cyclitis appears to a safe procedure, but careful postoperative follow-up of intraocular pressure, particularly in patients with intraoperative hemorrhage or postoperative uveitis, is indicated.

Adolescent↗