Publications by authors named "Paul W Mallory"

5 Publications

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Cancer-Associated Retinopathy due to Clear Cell Renal Carcinoma.

Ocul Oncol Pathol 2021 Mar 18;7(1):31-35. Epub 2020 Dec 18.

Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota, USA.

An 84-year-old female presented with bilateral scotomas and progressive nyctalopia over 1 year. Best-corrected visual acuity was 20/50 in both eyes with reduced color vision. Goldmann visual field showed bilateral cecocentral scotomas and generalized constriction of the visual fields. This led to an electroretinogram showing an electronegative pattern consistent with autoimmune retinopathies. Infectious workup was negative. Anti-retinal antibodies were positive, leading to a presumed diagnosis of cancer-associated retinopathy (CAR). Imaging showed a previously unknown left renal lower pole mass, and she underwent a radical nephrectomy. Biopsy showed nuclear grade-3 clear cell renal carcinoma staged T1. The patient was treated with oral prednisone with no ocular improvement. We report on a rare case of clear cell renal carcinoma causing CAR. CAR is an important paraneoplastic syndrome to diagnose since the majority of ocular cases precede other manifestations of malignancy. Therefore, a timely diagnosis of CAR can be lifesaving or at least life-extending.
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http://dx.doi.org/10.1159/000511189DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7989776PMC
March 2021

Bilateral Ocular Ischemic Syndrome in the Setting of Chronic Angle Closure Glaucoma.

J Glaucoma 2021 05;30(5):e262-e264

Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, MN.

We report novel case of a 57-year-old woman who developed bilateral ocular ischemic syndrome in the setting of chronic angle closure glaucoma without associated angle neovascularization. Detailed is a course in which markedly prolonged, elevated intraocular pressure led to significantly reduced arterial perfusion at the level of the central retinal artery, leading to the clinical picture of ocular ischemic syndrome.
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http://dx.doi.org/10.1097/IJG.0000000000001767DOI Listing
May 2021

Inpatient Adherence to Topical Glaucoma Medications before and after an Educational Intervention.

Ophthalmol Glaucoma 2020 Sep - Oct;3(5):339-342. Epub 2020 Apr 23.

Department of Ophthalmology & Visual Neurosciences, University of Minnesota-Minneapolis, Minneapolis, Minnesota.

Purpose: To assess the inpatient adherence rate and factors associated with adherence to topical glaucoma medications (TGMs) at a single academic institution throughout hospitalization before and after an educational intervention.

Design: Nonrandomized, comparative, retrospective study.

Participants: Inpatients 18 years of age and older admitted to a single academic hospital from January 2014 through June 2019 with a diagnosis of glaucoma who also received TGMs.

Methods: The medication administration record during admission was examined closely to determine if the TGMs were reconciled and administered correctly before and after an educational intervention with inpatient providers. A simple intervention reached various health care providers through an educational e-mail, communication in a weekly newsletter, and a morning report presentation. Adherence was defined as administration of more than 75% of recommended doses during the inpatient stay. Other collected variables included length of stay and primary diagnosis on admission.

Main Outcome Measures: Adherence rate to inpatient administration of TGMs.

Results: One hundred eighty-four patients (n = 142 before intervention; n = 42 after intervention) were included. The preintervention group had a total of 275 TGMs, of which 207 (75.3%) were administered in accordance with the adherence definition of this study. After the intervention phase, 49 of 56 (87.5%) TGMs were administered with appropriate adherence (P = 0.047). Adherence was associated significantly with a known outpatient medication regimen (P = 0.006) and correct admission reconciliation (P < 0.001).

Conclusions: When glaucoma patients requiring topical treatment are admitted, approximately one quarter of patients seem to not receive their medications appropriately. In this study, a simple educational intervention was able to improve adherence. To prevent daily fluctuations in intraocular pressure for vulnerable glaucoma patients, inpatient adherence to appropriate medication administration should be stressed continuously. While in the care of health care providers, inpatients should be afforded at least the opportunity to maintain adequate adherence, just as is carried out for other medications related to other chronic medical conditions.
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http://dx.doi.org/10.1016/j.ogla.2020.04.007DOI Listing
April 2020

Bilateral Ocular Necrotizing Fasciitis in an Immunosuppressed Patient on Prescription Eye Drops.

Cureus 2020 Jul 11;12(7):e9129. Epub 2020 Jul 11.

Otolaryngology, University of Cincinnati College of Medicine, Cincinnati, USA.

Preseptal cellulitis is an infection of ocular tissue that is often unilateral and caused by extension of sinonasal disease. In rare instances it can lead to life-threatening necrotizing fasciitis. We present here a unique case of bilateral preseptal cellulitis incited by local conjunctivitis caused by prescription eye drops. The patient was immunosuppressed, which allowed her local inflammation to progress to severe infection and, ultimately, to necrotizing fasciitis. This necessitated serial debridement by ophthalmology and otolaryngology teams and a prolonged course of intravenous antibiotics monitored by an infectious disease team. Despite these interventions, the patient's vision did not return to baseline and she had persistent cosmetic and functional deformity. This case is unique due to the inciting incident of new prescription eye drops, the patient's immunosuppressed state leading to severity of infection, and the severe bilateral disease burden.
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http://dx.doi.org/10.7759/cureus.9129DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7417090PMC
July 2020

Vaginal cuff dehiscence: a randomized trial comparing robotic vaginal cuff closure methods.

J Robot Surg 2016 Dec 2;10(4):337-341. Epub 2016 Jun 2.

Sanford School of Medicine of The University of South Dakota, Sioux Falls, SD, USA.

The purpose of this study is to compare the rate of vaginal cuff dehiscence between two different methods of closure in patients undergoing robotic-assisted total laparoscopic hysterectomy and explore variables related to postoperative breakdown. This was a prospective, randomized controlled study with two arms. The control group (Arm 1) underwent single-layer continuous closure while the study group (Arm 2) had three additional imbricating figure-of-X sutures placed in addition to the standard protocol. Of the 263 patients who completed the study, 4 patients (1.49 %) experienced dehiscence of the vaginal cuff. Three of the four patients with dehiscence received the standard single vaginal cuff closure (Arm 1) and the one remaining case of dehiscence underwent the protocol with additional sutures (Arm 2). All patients who experienced dehiscence were current smokers. Our study suggests that there may be benefit in adding additional sutures to the standard single-layer vaginal cuff closure procedure. Physicians should evaluate smoking status before deciding on a vaginal cuff closure method.
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http://dx.doi.org/10.1007/s11701-016-0604-xDOI Listing
December 2016