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Biomedical subjects

Dinesh Selva

Publications and source records attributed to Dinesh Selva.

At least 55 records · Page 3Linked to original sources
PubMed2005

Orbital eosinophilic angiocentric fibrosis case report and review of the literature.

OBJECTIVES: To report a patient with a rare case of orbital eosinophilic angiocentric fibrosis (EAF) and to review the literature. DESIGN: Interventional case report. METHODS: A 61-year-old man presented with a 6-week history of right periorbital edema and painless proptosis. Examination revealed a nonaxial proptosis, lateral globe displacement, and mild limitation in right eye adduction. MAIN OUTCOME MEASURES: Clinical course and radiological and histological findings. RESULTS: Orbital imaging revealed a right medial orbital mass with involvement of middle ethmoidal air cells. An orbital biopsy of the mass demonstrated an inflammatory infiltrate with a marked eosinophilic component, onion skinning of vessels, and surrounding fibrosis. The diagnosis of orbital EAF was made. There was no response to a 3-month treatment course with systemic steroids, but the patient did not want any further surgical interventions. CONCLUSION: Although orbital EAF is rare, ophthalmologists need to be aware of this entity, as it may invade the orbit from the sinonasal tract or present as a localized orbital mass. The presence of even minimal sinus involvement and the characteristic histopathology are useful in establishing the correct diagnosis.

Eosinophilic Granuloma↗
PubMed2005

Orbital cellulitis: a rare complication after orbital blowout fracture.

PURPOSE: To report the incidence of orbital cellulitis after orbital blowout fracture. DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: All patients with orbital cellulitis and a history of recent orbital fracture. METHODS: A medical record review of clinical history, imaging studies, and surgical and treatment outcome was performed. MAIN OUTCOME MEASURES: Resolution of orbital cellulitis and surgical and imaging findings. RESULTS: Four patients (3 male; mean age, 30 years [range, 4.5-58]) were treated for orbital cellulitis complicating orbital fracture. All patients had evidence of paranasal sinusitis before or after the orbital injury, and 2 also reported forceful nose blowing after sustaining orbital trauma. Although 3 patients received prophylactic oral antibiotics after the fracture, this failed to prevent infection. Sinusitis commenced 1 to 2 weeks before and as late as 5 weeks after orbital injury. All patients were treated with IV antibiotics. Two developed an orbital abscess that required surgical drainage; 1 patient improved after an endonasal maxillary antrostomy. One patient improved on IV antibiotics alone and underwent fracture repair at a later stage. These 4 patients represent 0.8% of all cases of orbital fractures treated in the study period. CONCLUSIONS: Orbital cellulitis is a rare complication of orbital fracture, and seems to be more common when paranasal sinus infection preexists or occurs within several weeks of the injury. Oral antibiotics given after the orbital injury may not prevent orbital cellulitis or abscess formation. Surgery may be required to drain orbital abscess or in nonresolving cellulitis to drain the paranasal sinuses. Fracture repair, if indicated, should be delayed, particularly if an alloplastic implant is used.

Acute Disease↗
PubMed2005

Basosquamous carcinoma: treatment with Mohs micrographic surgery.

BACKGROUND: Basosquamous carcinoma (BSC) is a rare tumor defined as a basal cell carcinoma (BCC) differentiating into squamous cell carcinoma (SCC). It is reported to have a high rate of recurrence with standard wide local excision. The aim of the current study was to report a large series of patients with BSC treated with Mohs micrographic surgery (MMS). METHODS: The prospective, multicenter case series included all patients in Australia treated with MMS for BSC, who were monitored by the Skin and Cancer Foundation Australia between 1993 and 2002. RESULTS: Most of the 178 tumors (95.6%) were located in the head and neck area. Recurrent tumors occurred in 47.8% of patients. The tumors were diagnosed initially as BCC in 87.4% and as SCC in 12.0% of patients. Perineural invasion was recorded in 7.9% of patients with data available. Most of these (69.0%) were previously recurrent tumors. Of 98 patients who completed a 5-year follow-up period after MMS, 4 (4.1%) had disease recurrence. CONCLUSIONS: The low 5-year disease recurrence rate of BSC with MMS emphasized the importance of margin-controlled excision using MMS.

Adult↗
PubMed2005

Lash ptosis caused by latanoprost.

PURPOSE: To report a case of lash ptosis caused by latanoprost. DESIGN: Observational case report. METHODS: Retrospective chart review. RESULTS: A 61-year-old, ocular hypertensive man who was using latanoprost OU presented with trichomegaly and bilateral lash ptosis. The lash ptosis had not resolved 6 months after stopping latanoprost, and anterior lamellar repositions were performed. At last follow-up, 8 months after surgery, the lids were in a normal position, but the trichomegaly had reduced only slightly. CONCLUSIONS: Lash ptosis should be considered as a possible complication of latanoprost therapy.

Antihypertensive Agents↗
PubMed2005

Microcystic adnexal carcinoma: treatment with Mohs micrographic surgery.

BACKGROUND: Microcystic adnexal carcinoma (MAC) is reported to have a high rate of recurrence with standard wide local excision. OBJECTIVE: To report a large series of patients with MAC treated with Mohs micrographic surgery (MMS). METHODS: This prospective, multi-center case series included all patients in Australia treated with MMS for MAC, who were monitored by the Skin and Cancer Foundation between 1993 and 2002. RESULTS: There were 44 cases; most of them (90.9%) were located in the head and neck area. In 31.8% of cases it was a recurrent tumor. In 32.5% of cases the tumor was initially misdiagnosed as basal cell carcinoma or squamous cell carcinoma. Perineural invasion was recorded in 17.5% of cases; most of them (85.7%) were previously recurrent tumors. There was only one case of recurrence (5%) out of 20 patients who completed a 5 year follow-up period after MMS. CONCLUSION: The low 5-year recurrence rate of MAC with MMS emphasizes the importance of margin-controlled excision.

Adolescent↗
PubMed2005

Cutaneous squamous carcinoma in situ (Bowen's disease): treatment with Mohs micrographic surgery.

BACKGROUND: Bowen's disease (BD), also known as squamous intraepidermal carcinoma, is a malignant skin tumor with a potential to progress to invasive carcinoma. OBJECTIVE: We sought to report a large series of patients with BD treated with Mohs micrographic surgery (MMS). METHODS: This prospective, multicenter, case series included all patients in Australia treated with MMS for BD, who were monitored by the Skin and Cancer Foundation between 1993 and 2002. RESULTS: There were 270 cases; the majority (93.4%) were located in the head and neck area. In 50.7% of cases it was a recurrent tumor. In 20% the tumor was initially misdiagnosed as basal cell carcinoma or squamous cell carcinoma. No cases with perineural invasion were diagnosed. There were 6 cases of recurrence (6.3%) of 95 patients who completed a 5-year follow-up period after MMS. CONCLUSION: The low 5-year recurrence rate of BD with MMS emphasizes the importance of margin-controlled excision, especially in the head and neck area where tissue preservation is essential.

Adult↗
PubMed2005

Cutaneous squamous cell carcinoma treated with Mohs micrographic surgery in Australia I. Experience over 10 years.

BACKGROUND: Only a few reports have been published on the long-term outcome of surgical excision of cutaneous squamous cell carcinoma (SCC). OBJECTIVE: Our purpose was to report the clinical findings and 5-year recurrence rate of all patients with cutaneous SCC treated with Mohs micrographic surgery (MMS) in Australia between 1993 and 2002. METHOD: This prospective, multicenter case series included all patients with SCC who were monitored by the Skin and Cancer Foundation. The main outcome measures were patient demographics, reason for referral, duration of tumor, site, preoperative tumor size, postoperative defect size, recurrences before MMS, histological subtypes, and 5-year recurrence after MMS. RESULTS: The case series comprised 1263 patients (25.7% female and 74.3% male; P < .0001) with a mean age of 66 +/- 13 years. In 61.1% of cases the lesion was a primary tumor, and in 38.9% it was a recurrent tumor. Most of the tumors (96.5%) were on the head and neck area. Recurrent tumors were larger than primary tumors (P < .0001), had a larger postexcision defect (P < .0001), required more levels of excision (P < .0001), and had more cases of subclinical extension (P = .002). Recurrence after MMS was diagnosed in 15 of the 381 patients (3.9%) who completed the 5-year follow-up after MMS. The recurrence rate was 2.6% in patients with primary SCC and 5.9% in patients with previously recurrent SCC (P < .001). CONCLUSION: This large prospective series of SCC managed by MMS is characterized by a high percentage of high-risk tumors. The low 5-year recurrence rate with MMS emphasizes the importance of margin-controlled excision.

Adult↗
PubMed2005

Cutaneous squamous cell carcinoma treated with Mohs micrographic surgery in Australia II. Perineural invasion.

BACKGROUND: Perineural invasion (PNI) is an important histologic factor that plays a significant role in cutaneous tumors' aggressiveness. OBJECTIVES: We sought to evaluate the incidence, features, and outcomes of cutaneous squamous cell carcinoma with PNI in patients treated with Mohs micrographic surgery (MMS). METHOD: This prospective, multicenter, case series included all patients in Australia treated with MMS for squamous cell carcinoma with PNI who were monitored by the Skin and Cancer Foundation Australia between 1993 and 2002. The parameters recorded were patient demographics, duration of tumor, site, preoperative tumor size, recurrence before MMS, histologic subtypes, postoperative defect size, and recurrence at 5 years after MMS. RESULTS: Seventy patients were given a diagnosis of PNI. PNI was more common in men (77.1%) and in previously recurrent tumors (P = .04). The moderately and poorly differentiated histologic subtypes were more likely to be associated with PNI (P < .0001). Tumor sizes before excision, postoperative defect sizes, subclinical extension, and mean number of MMS levels were significantly larger in cases with PNI compared with cases without PNI (P < .0001, P < .0001, P = .002, and P < .0001, respectively). Most patients with PNI (52.9%) were treated with adjunctive radiotherapy. In all, 25 patients completed a 5-year follow-up post-MMS, and two of them (8.0%) were given a diagnosis of recurrence. CONCLUSION: Although PNI is an uncommon feature of cutaneous squamous cell carcinoma, when present, it is associated with larger, more aggressive tumors, and the risk of recurrence is higher. This emphasizes the importance of tumor excision with margin control and long-term patient monitoring.

Adult↗
PubMed2005

Basal cell carcinoma treated with Mohs surgery in Australia I. Experience over 10 years.

BACKGROUND: Only a few prospective studies have been published on surgical treatments for cutaneous basal cell carcinoma (BCC). OBJECTIVE: Our purpose was to report the clinical findings of all patients with BCC treated with Mohs micrographic surgery (MMS) in Australia between 1993 and 2002. METHOD: This prospective, multicenter case series included all patients in Australia treated with MMS for BCC, who were monitored by the Skin and Cancer Foundation between 1993 and 2002. The main outcome measures were patient demographics, reason for referral, duration of tumor, site, preoperative tumor size, recurrences before MMS, histologic classification of malignancy, and postoperative defect size. RESULTS: The study included 11,127 patients (47% females and 53% males) with a mean age of 62 years (range, 15-98 years). In 43.8% of cases BCC was a recurrent tumor. Most of the tumors (98.3%) were on the head and neck area, most commonly on the nose (39%), cheek and maxilla (16.5%), periocular area (12.7%), and auricular region (11.4%). The most common histologic subtypes were infiltrating (30.7%), nodulocystic (24.2%), and superficial (13.6%). Previously recurrent tumors were larger than primary tumors (P < .001), had a larger postexcision defect and more subclinical extension, and required more levels of excision (P < .001). LIMITATIONS: Data were missing for some outcome measures. CONCLUSION: This large prospective series of BCC managed by MMS is characterized by a high percentage of high-risk tumors. Most tumors were located in the mid-facial area and the histologic subtype was mainly infiltrating or nodulocystic. That previously recurrent tumors were larger and demonstrated a more extensive subclinical extension compared with primary tumors emphasizes the importance of initial tumor eradication with margin control.

Adolescent↗
PubMed2005

Basal cell carcinoma treated with Mohs surgery in Australia II. Outcome at 5-year follow-up.

BACKGROUND: Long-term follow-up is essential to evaluate the role of Mohs micrographic surgery (MMS) in the treatment for cutaneous basal cell carcinoma (BCC). OBJECTIVE: Our purpose was to report the 5-year follow-up outcome of patients treated with MMS for BCC. METHOD: This prospective, multicenter case series included all patients in Australia treated with MMS for BCC, who were monitored by the Skin and Cancer Foundation between 1993 and 2002. Parameters recorded were patient demographics, duration of tumor, site, preoperative tumor size, recurrences before MMS, histologic classification of malignancy, postoperative defect size, and 5-year recurrence after MMS. RESULTS: Three thousand three hundred seventy (3370) patients (1594 female and 1776 male patients) completed a 5-year follow-up period. Fifty-six percent of the tumors were primary and 44% were previously recurrent. Most of them (98.4%) were located on the head and neck, and the most common histologic subtypes were nodulocystic (29.3%) and infiltrating (28.3%). Recurrence at 5 years was diagnosed in 1.4% of primary and in 4% of recurrent tumors. Previous tumor recurrence (P < .001), longer tumor duration before MMS (P = .015), infiltrating histology (P = .13), and more levels for tumor (P < .001) were the main predictors for tumor recurrence after MMS. LIMITATION: Data were missing for some outcome measures. CONCLUSION: The low 5-year recurrence rate of BCC with MMS emphasizes the importance of margin-controlled excision.

Adolescent↗
PubMed2005

Basal cell carcinoma treated with Mohs surgery in Australia III. Perineural invasion.

BACKGROUND: Perineural invasion (PNI) is an important factor may possibly influence the aggressiveness of basal cell carcinoma (BCC). OBJECTIVE: Our purpose was to evaluate the incidence, features, and outcomes of BCC with PNI in patients treated with Mohs micrographic surgery (MMS). METHOD: This prospective, multicenter case series included all patients in Australia treated with MMS for BCC with PNI, who were monitored by the Skin and Cancer Foundation Australia between 1993 and 2002. The parameters recorded were patient demographics, reason for referral, duration of tumor, site, preoperative tumor size, recurrence before MMS, histologic subtypes, postoperative defect size, and recurrence at 5 years after MMS. RESULTS: Two-hundred eighty-three patients were diagnosed with PNI. Most cases occurred in male patients (61%; P = .006) and in previously recurrent tumors (60.4%; P < .001). The infiltrating, morpheic, and basosquamous subtypes were more likely to be associated with PNI (P < .0001). Tumor sizes before excision and postoperative defect sizes were significantly larger in cases with PNI compared with cases with no PNI (P < .001 for both parameters), as was the mean number of Mohs excision levels. Seventy-eight patients completed a 5-year follow-up period after MMS, and 6 of them (7.7%) were diagnosed with recurrence. LIMITATIONS: Data were missing for some outcome measures. CONCLUSION: PNI is an uncommon feature of BCC. When present, PNI is associated with larger, more aggressive tumors, and the risk of 5-year recurrence is higher. This emphasizes the importance of tumor excision with margin control and long-term patient monitoring.

Adult↗
PubMed2005

Orbital invasion by periocular basal cell carcinoma.

OBJECTIVES: To present a large series of patients with orbital invasion by periocular basal cell carcinoma (BCC). DESIGN: Retrospective, noncomparative, interventional case series. PATIENTS: All cases diagnosed with orbital invasion by periocular BCC between January 1985 and July 2004 in 3 Orbital Units in Australia. METHODS: The clinical records of all patients were reviewed. MAIN OUTCOME MEASURES: Patients' demographics, clinical presentation, histologic subtypes, treatment modalities, recurrence rate, and tumor-related death. RESULTS: There were 64 patients (49 males) with a mean age of 70+/-13 years. Most tumors (84.4%) were recurrent or previously incompletely excised, and the medial canthus was most frequently involved (56.2%). Signs suggestive of orbital involvement included a mass with bone fixation (35.7%), limitation of ocular motility (30.4%), and globe displacement (17.6%). There were no signs suggestive of orbital invasion in 35.7%. Most patients (51.6%) had infiltrative histologic findings, and perineural invasion was present in 19.3%. Treatment modalities were mainly exenteration alone or combined with radiotherapy. During a mean follow-up period of 3.6 years, 3 cases of recurrence (4.7%) were diagnosed. Only 1 patient (1.6%) died from tumor-related causes. CONCLUSIONS: Orbital invasion by periocular BCC is an uncommon event that may be associated with significant ocular morbidity and, rarely, death. Because orbital invasion may often be clinically silent, clinicians need to be alert to the possibility in high-risk tumors and consider appropriate imaging. Surgical treatment with exenteration or excision, with or without radiotherapy, results in a low recurrence and mortality rate.

Adult↗
PubMed2005

Ophthalmic sequelae of Crouzon syndrome.

PURPOSE: To document the frequency of ophthalmic sequelae in patients with Crouzon syndrome before the influence of craniofacial surgery. DESIGN: Retrospective observational case series. PARTICIPANTS: Seventy-one consecutive patients with a clinical diagnosis of Crouzon syndrome assessed before craniofacial or ophthalmic surgery at the Australian Craniofacial Unit between 1984 and 2000. METHODS: Review of clinical records with documentation of patient age, gender, visual acuity, refractive error, diagnosis of amblyopia, squint, eye movement dysfunction, nystagmus, fundus examination, examination of the anterior segment, interpupillary distance, and intercanthal distance. MAIN OUTCOME MEASURES: The frequency of ophthalmic signs and visual impairment, defined as a visual acuity of 6/12 or less. RESULTS: Visual impairment in at least 1 eye occurred in 35% of patients and was bilateral in 9%. The most common cause of visual impairment was amblyopia, which was present in 21% of patients, followed by optic atrophy in 7%. Ametropia occurred in 77% of patients; 57% had hypermetropia of > or =+2 diopters (D) and 20% had myopia of > or =-0.5 D. Strabismus occurred in 39% of patients. Although exposure keratopathy was observed in 15% of patients, this complication was well managed and caused no reduction in visual acuity. CONCLUSIONS: Early detection to reduce amblyopia by correction of refractive errors, timely treatment of strabismus, and patching should be a priority for ophthalmologists and a goal of the craniofacial teams managing patients with Crouzon syndrome. Optic atrophy remains an important cause of visual impairment in these patients before decompressive craniectomy.

Adolescent↗
PubMed2005

Pyodermatitis-pyostomatitis vegetans of the eyelids case report and review of the literature.

OBJECTIVES: To present the first reported case of eyelid involvement in pyodermatitis-pyostomatitis vegetans (PDPSV) leading to the diagnosis of ulcerative colitis, and to review the literature. DESIGN: Interventional case report. METHODS: A 29-year-old man presented with a 4-week history of severe bilateral upper and lower eyelid margin ulceration and pustules unresponsive to topical and systemic broad-spectrum antibiotic treatment. Further questioning revealed the existence of skin and oral lesions. MAIN OUTCOME MEASURES: Clinical course, histological findings, and response to treatment. RESULTS: The histological and immunofluorescence studies were suggestive of PDPSV. Colonoscopy showed significant chronic active ulcerative colitis. Treatment with systemic steroids and sulfasalazine resulted in complete resolution of eyelid, oral, and skin lesions. However, stopping the steroids resulted in recurrence of eyelid and oral lesions and required recommencement of treatment. CONCLUSION: It is important to be familiar with this pustular skin condition, as correct diagnosis may lead to the diagnosis of inflammatory bowel disease. Although periocular involvement is probably rare, the combined typical skin and oral lesions and the characteristic histological and immunofluorescence tests should suggest the correct diagnosis.

Adult↗
PubMed2005

Endonasal endoscopic assisted replacement of lacrimal drainage tubes.

PURPOSE: To describe an endonasal endoscopic assisted replacement of migrated or lost Lester-Jones (LJ) tubes. METHODS: In three consecutive cases of LJ tube migration or loss and an absent obvious transconjunctival tract, a curved paediatric Lusk ball-probe was passed under endoscopic visualization to the conjunctival surface through the internal nasal osteum. The drainage tube was then passed over the tip of the probe and replaced by retracting the probe back into the nose. RESULTS: In all cases, the drainage tube was successfully replaced using an endonasal endoscopic assisted technique. None of the cases, done 1-7 weeks after tube migration or loss, required the use of a K-wire and trephine for tube re-insertion. CONCLUSION: The conjunctivodacryocystorhinostomy tract appears to be retained following LJ tube migration or loss in selected cases. It can be accessed endonasally, allowing external tube replacement without the need for a repeat trephine.

Aged↗
PubMed2005

Video-endoscope assisted teaching during sub-periosteal orbital surgery.

PURPOSE: The authors report the novel use of the video-endoscope as an adjunct in teaching orbital surgery, in particular within the sub-periosteal orbital space. This is of most use during situations where visualisation is of critical importance and direct supervision is not possible. MATERIALS AND METHODS: This technique was used for 16 cases of orbital surgery during a 12-month period. There were 5 orbital fracture repairs, 8 orbital decompressions (4 via a swinging eyelid and 4 via a transcaruncular approach), an infraorbital nerve biopsy, an eosinophilic granuloma and an orbitofrontal cholesterol granuloma. All procedures were performed by the trainee under consultant supervision with the endoscope being used when direct visualisation was not possible for the consultant. A rigid Storz 3-chip video-endoscope with 0, 30 and 70-degree tips was used to enable visual supervision. RESULTS: The endoscope was of particular use in procedures involving the posterior orbital floor, orbital roof and medial orbital wall. It also enabled safe supervision of curettage of an orbital roof lesion which abutted the dura. The technique was easy to use; it provided good local illumination and a magnified view for supervision. CONCLUSION: This technique is a valuable adjunct in allowing the trainee to safely perform selected complex orbital surgery under video-endoscopic supervision.

Endoscopy↗
PubMed2005

Malignant fibrous histiocytoma of the eyelid: differential diagnosis and management.

PURPOSE: Malignant fibrous histiocytoma (MFH) is a pleomorphic soft tissue sarcoma that occurs rarely in the periocular region. The purpose of this study was to present a case series of periocular MFH and to discuss the differential diagnosis and management. METHODS: This is a retrospective case review of patients diagnosed with periocular MFH from tertiary hospitals and private practices. RESULTS: Four patients, two women and two men with periocular MFH, had a mean age of 81 years (range, 72 to 85 years). All tumors were <5 cm in diameter and of storiform pleomorphic histologic subtype. One was located deep and 3 presented superficially. The initial diagnoses were sarcomatoid carcinoma, atypical fibroxanthoma, and leiomyosarcoma that were subsequently reclassified as MFH. One patient had a frozen section, 1 had fast track paraffin section margin control, and 2 had no frozen section margins at the initial excisions. Histology showed 2 negative margins, 1 close margin, and 1 positive margin that were cleared with wide local excision. Local recurrence occurred in 3 cases, and of these, 1 required orbital exenteration. Adjuvant radiotherapy was given to 3 patients. One had regional node metastases. There were no distant metastases or tumor-related deaths. Mean follow-up period was 36 +/- 35 months (median, 30; range, 1 to 84 months). CONCLUSIONS: This study highlights the difficulties in the clinicopathologic diagnosis of periocular MFH and in particular the distinction of more superficial tumors from atypical fibroxanthoma. The mainstay of treatment is complete surgical excision with wide margins, and consideration should be given to histologic margin control in addition to adjuvant radiotherapy.

Aged↗