Endoscopic endonasal management of prolapsed silicone tubes after dacryocystorhinostomy.

BACKGROUND: Loss or prolapse of silicone tubes at the medial canthus may occur after dacryocystorhinostomy (DCR) surgery. Repositioning of the prolapsed tubes is often difficult and can necessitate early removal of tubes. The goal of this study was to determine the incidence of tube prolapse after DCR, review the methods used to reposition them, and identify the optimum management. DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: A total of 205 adults patients who had DCR with intubation by a specialist lacrimal service in West London over a 3-year period. METHODS: Patients with spontaneous tube loss or prolapse were identified from clinic attendance and case note review. MAIN OUTCOME MEASURES: Incidence and timing of prolapse, techniques used for repositioning and success, whether prolapse recurred, and further intervention necessary. RESULTS: Five (2.5%) had tube loss or prolapse or both, all within the first month after surgery. The tubes were repositioned initially in four patients, but prolapse recurred in two patients necessitating further intervention. Only nasal endoscopy enabled precise tube visualization and endonasal manipulation with eventual tube stability. CONCLUSIONS: Tube prolapse is rare after DCR surgery. The tubes can be pushed back in, but prolapse may recur unless the endonasal aspect is addressed. The position of the tie or knots should be inspected endonasally and the tubes further secured if indicated. Repositioning is best managed with endoscopic assistance, which is a simple office procedure.

Adjustment to the psychological and social sequelae of recurrent genital herpes simplex infection.

OBJECTIVE: To investigate whether adverse psychological consequences and impaired sexual and interpersonal functioning are present in individuals suffering from recurrent genital herpes simplex infection (HSV). DESIGN: A questionnaire-based study completed by subjects defined as having more than one episode of HSV infection. SUBJECTS: Completed questionnaires were returned from 90 subjects; 40 from the department of genitourinary medicine at our hospital and 50 from members of the Herpes Association. RESULTS: Stress and being physically run-down were identified as provoking factors by the majority of individuals (78% and 56% respectively). The frequency of sexual activity was not different when comparing rates before and after infection (p < 0.001) and the majority of subjects had told partners of their infection. Women reported significantly greater disturbances in several psychological variables and reported a greater decrement in their general health. However, overall there were no differences in the psychological sequelae following herpes infection. CONCLUSIONS: The study suggests that, given time, most people are able to adjust psychologically to having recurrent herpes infection. However, for a minority of subjects this is not the case and these individuals may require psychotherapeutic intervention.