Use of Frost sutures in an orbital trauma patient with extensive conjunctival oedema and pseudoproptosis.

Frost sutures are temporary suspension sutures conventionally used in oculoplastics. The case is presented here of a patient with multiple orbital fractures who developed worsening conjunctival chemosis and pseudoproptosis. This patient was managed successfully with Frost sutures. To the best of the authors' knowledge, there is no documented use of Frost sutures in this type of case. It is emphasized that this technique should only be considered following rigorous exclusion of retrobulbar pathology and careful attention towards early detection of raised intraocular pressure.

Echovirus keratoconjunctivitis.

PURPOSE: To investigate an outbreak of echovirus-related keratoconjunctivitis. METHODS: We undertook a retrospective study of recent cases of echovirus infection with recall and further evaluation of conjunctivitis patients. All patients from whom an echovirus was isolated in Liverpool during 1995 were included. The natural course of ocular echovirus disease was studied, including the likelihood of echovirus keratoconjunctivitis being linked with meningitis and the risk of long-term carriage of the virus in the conjunctiva. RESULTS: Of 10 unrelated patients with echovirus conjunctivitis, six also had a mild keratitis. None of these patients developed meningitis, and no cases of long-term carriage in the conjunctiva were encountered. There was no link between cases of echovirus meningitis and conjunctivitis. There was no corresponding increase in other ocular viral isolates. CONCLUSIONS: Echovirus is a relatively unrecognized cause of keratoconjunctivitis. Echoviral keratoconjunctivitis appears to be an independent ocular event unassociated with systemic sequelae. Long-term carriage in the conjunctiva does not appear to occur.

Atraumatic transfer of the donor corneal button.

PURPOSE: To devise a method for atraumatic transfer of the donor corneal button by using a corneal shovel. METHOD: The donor cornea is lifted with a microcorneal shovel, and the epithelial surface dried with a microsponge applied to the corneal shovel to create a seal. This allows the shovel to be rotated through 180 degrees over the host eye with no movement of the donor cornea. The seal is then broken by applying a drop(s) of fluid onto the epithelial surface of the donor cornea or by touching the edge of the donor cornea to the edge of the host cornea. The donor cornea then slides or is floated onto the host eye. RESULTS: This technique has been performed on 52 corneal transplants with no complications such as slippage or falling off of the donor corneal button during transfer. CONCLUSION: This method provides a useful atraumatic surgical procedure for stabilising and transferring the donor cornea during corneal transplantation.

Per-nasal swabbing as an aid to the diagnosis of chlamydial and adenovirus conjunctivitis.

Two hundred and thirty four patients (adults and babies) with conjunctivitis were investigated by taking eye swabs and in addition by taking per-nasal swabs. Chlamydia trachomatis was isolated from 20 patients and adenovirus from 14 patients. Per-nasal swabbing led to a 53% increase in chlamydia diagnosis and a 27% increase in the diagnosis of adenovirus infection. It is suggested that per-nasal swabbing has an important role to play in detecting chlamydial conjunctivitis which itself may be an indicator for high morbidity in patients and their contacts.

A problem encountered using staphylococcus/streptococcus supplement.

A problem was encountered while using a commercial staphylococcus/streptococcus selective supplement in blood agar culture medium. A number of strains of Staphylococcus aureus failed to grow, although they grew well on non-selective media. The phenomenon was shown to be a result of a pH change caused by incubation in a carbon dioxide-enriched atmosphere, potentiating the activity of the nalidixic acid component. It is recommended that media containing this supplement are not incubated in CO2 enriched atmospheres.

Cost containment with the use of "mini-cholecystectomy" and intraoperative cholangiography.

During an era when cost containment has become increasingly important, a new approach to elective cholecystectomies through a 4 to 5 cm incision is reported. Over an approximately 2-year period, 96 patients have undergone "mini-cholecystectomies" with intraoperative cholangiograms. Six of these patients have had concomitant common bile duct explorations. The average postoperative stay was 2.5 days. The average procedure lasted 45 minutes. Pain medication postoperatively was required less frequently than with the routine subcostal incision. Time away from work was greatly reduced. No complications were encountered. When a more complicated cholecystectomy is discovered, which may place the patient in danger, the small incision can be easily lengthened in order to provide better exposure and thus aid in dissection. On the basis of almost 600,000 cholecystectomies performed per year, hospital costs ranging from $100 to $150 per day, and the procedure being acceptable in 80 per cent of the elective procedures, the potential yearly cost-savings could range up to $250,000,000 per year when this procedure is used.

Malignant melanoma metastatic to the gastrointestinal tract from an occult primary tumor.

We have described two cases of malignant melanoma of the small bowel which metastasized from occult primaries. Malignant melanoma in the bowel is more common than one might think, being third only to adenocarcinoma of the kidneys and squamous cell carcinoma of the cervix. It appears at this time that palliative resection, along with chemotherapy and immunotherapy, is the procedure of choice in patients with this condition.