Biomedical subjects
Publications and source records attributed to R S Bartholomew.
A case of carcinoid tumour in the lacrimal gland is described, thought to be a metastasis from a known primary lesion in the mediastinum. The results of light and transmission electron microscopic examination are presented, and the possibility of the lesion representing a second primary tumour discussed.
The factors responsible for postoperative astigmatism--wound compression and wound gape--are discussed and illustrated for a number of suture incision combinations. Variability is pronounced. Mid-limbal incisions sutured with 8-0 virgin silk had a range of 8D at four days, 8.5D at four weeks and 9D at three months. Nylon 9-0 double continuous, tied normally, had 8D at four days, 7D at four weeks and 7.5D at three months. The same suture tied tightly gave a range of 5D at four days, 7.5D at four weeks and 6D at three months. Methods of control and correction are discussed and illustrated with case histories.
We found octohedral crystals in the aqueous of a patient with phacolytic glaucoma. They were identified as calcium oxalate by their physical and chemical characteristics.
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Implants with a regime of fibrosis suppression (prednisolone 30 mg daily plus fluphenamic acid 200 mg three times a day for 6 to 8 weeks) controlled the intraocular pressure (applanation tonometry (AT) less than 21 mm Hg) in seven out of ten patients with different types of glaucoma. One implant was removed after erosion of the conjunctiva and sclera; there were no other serious complications. Use of the implant is indicated after failed drainage operations or as a primary procedure in glaucoma associated with aphakia, chronic uveitis, vitreous in the anterior chamber, and scarring of the conjunctiva.
A sample of 2,427 South African Negroes of the Pondo tribe was specifically examined for spheroidal degeneration of the cornea (S.D.C.). The prevalence of S.D.C. was 7.0% for the whole sample. It was twice as prevalent in men (9.9%) as in women (4.3%) and the prevalence increased with age over 50 for both sexes. The risk of having developed Stage II and III S.D.C. increased with age for men but not for women. The risk of having developed Stage III S.D.C. was not related to age or sex. No significant associations were found between S.D.C. and pterygium, cortical or nuclear cataract and glaucoma (all types and absolute glaucoma). There was a significant association between S.D.C. and pseudocapsular exfoliation for elderly men but elderly men with arcus senilis were less likely to have developed S.D.C. Poor corneal nutrition or metabolism are possible aetiological factors in the progression of S.D.C. to Stages II and III.
The implant design, surgical technique, and pharmacological methods of controlling bleb fibrosis, used to treat neovascular glaucoma, are described, together with the results of 14 operations performed on 12 eyes.
A series of 21 patients with herpetic corneal ulcers was treated by photodynamic inactivation (using a single application of neutral red 1 per cent solution followed by a 15-min exposure to a 40 watt light of 440--550 nm), carbolization, or idoxuridine (IDU) ointment. No significant difference was found in the number that healed, the mean healing time, or the number of recurrences after any of the three treatments.
In a controlled, randomized trial in 45 cataract operations a new synthetic absorbable suture (8-0 monofilament Vicryl, made by Ethicon), was compared with monofilament nylon or virgin silk normally used. There was a higher incidence of early complications-hyphaema, shallow anterior chamber, and choroidal detachment (15-4 per cent v. 0 per cent)-with the absorbable suture. But these differences were not significant at the 0-05 level and might well disappear with more operative experience, particularly the modified technique of knot-tying. In handling qualities Vicryl was superior to both 10-0 monofilament nylon and 8-0 virgin silk with the exception of knot-tying, in which it was inferior to 8-0 virgin silk. Vicryl is considered to be a useful absorbable suture in cataract surgery but knot-tying requires modification of technique.
Three severe cases of sympathetic ophthalmitis, which presented late for treatment, are described. The response to prolonged treatment with systemic prednisolone was unexpectedly good, occurring as long as 70 days after starting treatment and continuing up to 16 months.
A Stryker turning frame was used during surgical removal of a posterior displaced lens. Its use had the following advantages over other methods: simplified management of the patient under general anaesthesia; constant stability of the eye and transfixing needle during the procedure and the maintenance of sterility in the operating area.
A tape/slide course in ophthalmology was used for fifth year medical students at the University of Edinburgh. A statistical comparison between the tape/slide and lecture method of teaching showed no significant difference in examination results: means mark (P greater than 0-50), spread of mark (P greater than 0-05), or in question consistency (P greater than 0-40). The tape/slide method is initially time consuming to produce but has clear advantages in the long term, being of a consistently high standard, easy to present and repeat, useful in revision, for student electives and in lecturers' absence.
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A sector shaped membranous defect of the lens is described. Possible causes for the defect are discussed. An injury to a small area of the anterior layer of epithelial cells plus a localized rupture of the capsule occurring between the third and eighth months of development might account for this defect.