Biomedical subjects
Publications and source records attributed to P G Watson.
Cancer rehabilitation is a practical attempt to maximize independence and dignity and to reduce the extent to which cancer interferes with an individual's physical, psychosocial, and economic functioning. The rehabilitation process should begin at the time of diagnosis or definitive medical intervention and should continue until the individual is able to maintain the desirable level of independence.
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A 66-year-old man presented with massive bilateral scleral thickening and calcification associated with a unilateral exudative retinal detachment which did not respond to systemic anti-inflammatory agents including steroids and cyclophosphamide but improved with scleral resection. This patient shows the features of both posterior scleritis and the uveal effusion syndrome, providing further evidence for the role of a thickened sclera and interference with the trans-scleral flow of fluid in the formation of such an exudative retinal detachment.
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Individuals with cancer should be assisted to achieve optimal levels of functioning before, during, and after cancer treatment. However, to reach optimal functioning a well-defined plan of action is required. This article presents an Optimal Functioning Plan (OFP) aimed at attaining the best possible outcomes for all individuals treated for cancer. The OFP centers on physical functioning, nutritional adequacy, a practical level of independence in activities of daily living, self-care competence, a realistic optimistic outlook, and effective management of side effects. The OFP is a key element of cancer rehabilitation. It represents a way of packaging cancer care in a health-oriented framework.
A randomised double blind trial of 2-(2-Hydroxy-4-methylphenyl) Aminothiazole Hydrochloride 0.1% (CBS 113A) versus placebo was carried out in 43 eyes with episcleritis. Our results show that CBS 113A is effective in reducing the signs of conjunctival and episcleral inflammation in mild episcleritis within the first week of administration of the drug (Day 3: Total Score p = 0.0013, Conjunctival Injection p = 0.017, Episcleral Injection p = 0.0018 and Day 7: Total Score p = 0.01, Conjunctival Injection p = 0.014, Episcleral Injection p = 0.027). CBS 113A was not effective against severe episcleritis. No significant side effects were found apart from a stinging sensation. There was no effect on intraocular pressure. The potential use of this new drug is discussed.
In corneal graft rejection, rapid reversal of the rejection process is necessary to minimise endothelial cell loss. Ten consecutive patients with acute endothelial rejection were treated with a single 500 mg pulse of methylprednisolone intravenously and topical prednisolone 1% drops hourly. The rejection episode was successfully reversed in eight (80%) of the 10 grafts. This preliminary trial indicates that cortico-steroid pulse therapy may be beneficial in the management of severe corneal graft rejection with the advantage of avoiding prolonged oral corticosteroid therapy.
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The ocular and systemic features of 10 patients whose Wegener's granulomatosis presented with corneoscleral inflammatory disease are described. Marginal corneal infiltrates were seen in all patients with anterior scleritis and were a valuable sign of disease activity. Nine out of 10 patients had symptoms of systemic vasculitis on presentation; seven had renal impairment; three had chest x-ray abnormalities. Autoantibodies against neutrophil cytoplasmic determinants (ANCA) were present in all cases. In seven patients the scleritis responded well to pulsed immunosuppressive therapy followed by long term oral steroids and cyclophosphamide. Oral steroid therapy alone failed to control severe disease. Corneoscleral disease was not a cause of visual loss. It is important to realise that inflammatory corneoscleral disease may be the presenting feature of a severe systemic vasculitis.
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Rabbits were sensitized over a prolonged period to ovalbumin by intradermal injection. Ovalbumin was then injected into the limbus of the eye. A corneoscleral lesion, similar to necrotizing scleritis in humans, was produced. The clinical progression of the lesion is described and its histologic appearance discussed in relation to the human disease.
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For the past 12 years peripheral iridectomy has been used as the initial surgical procedure after an acute attack of angle-closure glaucoma. The operation has been performed 2 to 5 days after the pressure has been controlled medically and has been followed routinely by prophylactic peripheral iridectomy in the fellow eye. Peripheral iridectomy for primary acute angle-closure glaucoma controlled the condition without any need for further medical or surgical therapy in 72% of cases. Careful and frequent follow-up within the first 4 postoperative months is essential to prevent further field loss, which can occur very rapidly if the pressure is not adequately controlled. If the pressure remains uncontrolled, further surgery should not be delayed. It was impossible to decide which patients would eventually need trabeculectomy when they first attended in the acute attack. Peripheral iridectomy as a prophylactic procedure was entirely effective in preventing an acute angle-closure attack in the fellow eye.
Patients presenting with either intermittent closed-angle glaucoma which gave to subacute congestive attacks or with chronic angle-closure glaucoma were followed up over 12 years. Peripheral iridectomy was performed as a primary procedure on these patients during this period. It was found to be a highly effective procedure in those patients without field loss at the time of presentation, but because of the figures presented here we would recommend that any patient presenting with angle closure and disc and field changes should have a trabeculectomy performed as a primary procedure. We found no way of predicting which patients would require further surgery from the history, initial intraocular pressure, or the gonioscopic findings. No patient in this series developed malignant glaucoma after trabeculectomy although it occurred in 2 eyes after peripheral iridectomy.
Fifty-one patients were investigated by subtraction macrodacryocystography (SMDCG, 103 systems) and by lacrimal scintigraphy (LS, 105 systems). It was found that these investigations complemented each other and between them the precise site of obstruction in the lacrimal drainage apparatus could be determined in 80%. The radiation dosage to the lens in SMDCG significant, and it is therefore recommended that the patients with lacrimal obstruction should: (1) have lacrimal puncta dilated with a probe to No. 1 diameter and be forbstruction is still uncertain, then and only then should SMDCG be performed.
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One hundred patients (66 women and 34 men) who presented consecutively to Moorfields Eye Hospital with scleral disease underwent medical examination. Thirteen were found to have seropositive rheumatoid arthritis and another 16 also had rheumatoid factor present (Rheumaton test). Autoantibodies were present in 35% of patients, being most common in the elderly and most frequent in cases of necrotising and diffuse scleritis. Although scleral disease is uncommon, it is associated with connective-tissue disorders. Scleritis may be severe and destructive locally, and one series showed that 27% of patients who develop necrotising scleritis are dead from systemic complications within five years. It is therefore important for it to be correctly diagnosed and effectively treated at an early stage.