Analysis of contemporary tools for the measurement of enophthalmos: a PRISMA-driven systematic review.

Enophthalmos has many causes, and serious post-traumatic cases indicate the need for operation. Such diagnoses should be made objectively, and a robust method for quantifying the degree to which the globe has been displaced is key. Current methods of measurement, however, have long been considered unreliable and inconsistent, in particular with regard to interobserver variability. The aim of this paper therefore was to review all these methods systematically, to analyse their reliability, and to compare them with others. The paper also includes a proposed protocol for the accurate and reliable measurement of protrusion of an eye, which aims to standardise the assessment of patients and to create a uniform approach that will enable the selection of those who are most likely to benefit from surgical treatment. Analysis of the data showed that computed tomographic (CT) exophthalmometry is the most reliable, followed by the Mourits' exophthalmometer, which performed better than the other clinical methods. In the acute phase of orbital blowout fractures, the measurement of herniated tissue through a fracture defect may give a good prediction of the degree of enophthalmos that is likely to occur without surgical correction. Measurement of the herniated volume and CT exophthalmometry should be the foundation for diagnosis and the planning of treatment. Three-dimensional imaging or Mourits' exophthalmometers (which are reliable non-radiological methods) could be used in a follow-up protocol.

Contextual and stress process factors associated with head and neck cancer caregivers' physical and psychological well-being.

Head and neck cancer (HNC) caregivers are especially vulnerable to poor outcomes because the HNC patients are at high risk for physical and functional impairments. This study examines contextual and stress process variables potentially associated with HNC caregivers' physical and psychological well-being. Patient-caregiver variables included socio-demographics, primary stressors (caregiving, patient clinical characteristics, HNC-related symptoms/dysfunction), secondary stressors (caregiver employment, childcare responsibilities and sleep duration <7 hr), appraisal, and response (physical activity). General linear models modeled caregiver well-being, along with depression and anxiety. A total of 33 patient-caregiver dyads were included. Most caregivers were female (81.8%) and patient spouses/partners (72.7%). Factors significantly associated with better caregiver physical well-being included caregiver older age, <2 comorbidities, ≥7 hr of sleep, ≥3 days/week physical activity, and patient swallowing and speech dysfunction. Factors significantly associated with better caregiver mental health functioning were less patient social dysfunction and less perceived caregiving burden. Short nighttime sleep, higher caregiver burden, and <3 days/week physical activity were also significantly related to caregivers' depression and anxiety. Results suggested caregiver behaviors and perceived burden, along with patient HNC concerns are linked with caregiver well-being. These behavioral, cognitive, and patient factors should be incorporated into caregiver screening tools or targeted with behavioral interventions to improve caregiver well-being.

The three-dimensional relationship between acetabular rim morphology and the severity of femoral cam lesions.

We examined the relationship between the size of the femoral cam in femoroacetabular impingement (FAI) and acetabular pathomorphology to establish if pincer impingement exists in patients with a femoral cam. CT scans of 37 symptomatic impinging hips with a femoral cam were analysed in a three-dimensional study and were compared with 34 normal hips. The inclination and version of the acetabulum as well as the acetabular rim angle and the bony acetabular coverage were calculated. These measurements were correlated with the size and shape of the femoral cams. While the size of the femoral cam varied characteristically, the acetabular morphology of the two groups was similar in terms of version (normal mean 23° (sd 7°); cam mean 22° (sd 9°)), inclination (normal mean 57° (sd 5°); cam mean 56° (sd 5°)), acetabular coverage (normal mean 41% (sd 5%); cam mean 42% (sd 4%)) and the mean acetabular rim angle (normal mean 82° (sd 5°); cam mean 83° (sd 4°)). We found no correlation between acetabular morphology and the severity of cam lesion and no evidence of either global or focal over-coverage to support the diagnosis of 'mixed' FAI. The femoral cam may provoke edge loading but removal of any acetabular bearing surface when treating cam FAI might induce accelerated wear.