Orbital exenteration and reconstruction in a tertiary UK institution: a 5-year experience.

PURPOSE: Orbital exenteration is a radical oncological surgery that is usually indicated for advanced primary orbital tumors or invasion from local malignancy. We report a 5-year series from a tertiary head and neck center with particular focus on our ablative and reconstructive approach. METHODS: We performed a clinicopathological review of patients referred to Guy's and St Thomas' NHS Foundation Trust Head and Neck multidisciplinary team for management input of an orbital malignancy during the period of 2013 to 2018. Cases involving local invasion from sinonasal malignancy were excluded. The reconstructive approach, perioperative complications, disease-free and overall survival were analyzed. RESULTS: 27 patients were identified and of those treated surgically, a radical extended orbital exenteration was required in almost half (44.4%), with squamous cell carcinoma being the most common pathology (55.6%). A concurrent neck dissection and parotidectomy were commonly performed with confirmed or suspected regional disease, or in the presence of high-risk pathological features. This approach resulted in favourable 2-year overall survival in these advanced stage cases of 84.6% and disease-free survival of 73.2%, with 92% achieving a negative surgical margin. The majority of treated patients required a free flap reconstruction, especially when an extended exenteration defect or adjuvant treatment was anticipated. The anterolateral thigh flap was the most commonly used donor site, and we present our algorithm for reconstruction of these defects. CONCLUSIONS: A multidisciplinary approach to advanced orbital malignancy with a comprehensive approach to surgical resection and reconstruction results in favorable oncological outcomes and addresses functional and cosmetic patient rehabilitation.

Shame and non-disclosure: a study of the emotional isolation of people referred for psychotherapy.

Thirty-four people referred to an NHS psychotherapy department were given a modified form of Oatley and Duncan's (1992) emotion diary which included questions about whether each recorded emotion had been subsequently disclosed to anyone (for example a partner, friend or professional). One week later the diaries were collected and participants interviewed. Interviews focused, among other things, on reasons for nondisclosure of recorded emotional experiences and the relationship between shame and non-disclosure. The results indicated that a majority of the emotional incidents recorded in the diaries were not disclosed (68%). This result contrasts with studies on non-clinical samples in which only approximately 10% of everyday emotions are kept secret. Qualitative analysis of the interview data revealed that participants appeared to be habitual non-disclosers of emotional and personal experiences and that non-disclosure was related to the anticipation of negative interpersonal responses to disclosure (in particular labelling and judging responses) in addition to more self-critical factors including shame. It is suggested that these results add to the existing literature on shame by illustrating the interpersonal effects of shame in a clinical sample.

Debating goodwill.

Despite its intangible and ephemeral nature, goodwill, alongside the building, equipment, and fixtures and fittings, is now accepted as one of the four principal elements in the valuation of any established dental practice.

Estimating the outcome of a pregnancy test: women's judgements in foresight and hindsight.

Previous research on judgement under uncertainty has suggested that, when we know the outcome of some event, we perceive that outcome as more likely than when we do not have outcome knowledge. That is, in comparison with judgements made in foresight, judgements made in hindsight are biased in the direction of the outcome the judge believes to have happened. While the effect appears to be robust in the laboratory, it has very seldom been tested in real life. This experiment therefore went outside the laboratory, and examined women's estimates of the outcome of a pregnacy test. It was predicted that those who knew the result of their test (hindsight) would perceive that outcome as more likely than those asked to make the estimate before they knew the result (foresight). The prediction was supported only for women whose result was positive and, furthermore, the positive group made consistently higher estimates than the negative group, both in hindsight and foresight. The findings were therefore less marked and more complex than in previous laboratory research, and support the argument that experiments and materials must be constructed with salience for the subjects. The findings are interpreted in the light ot Tversky & Kahneman's (1974) work on heuristic rules of thinking.