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Introduction : The aim of this paper is to highlight the use of the Holmium YAG laser in the endoscopic placement of Lester Jones tubes in patients with a blocked canaliculus or failed lacrimal pump function. Materials and methods : Sixteen cases with a non-functional canaliculus were included over a one-year period. Following caruncle excision, a 19G needle is inserted through the medial canthal tissues into the nasal space. Nasal endoscopy confirms the accurate positioning in relation to the nasal anatomy. With the Holmium YAG laser, a tissue channel is fashioned around the guide needle through the structures of the lateral nasal wall to facilitate an accurate and secure placement of the Jones tube. Results : The endoscopic, laser-assisted placement reduces the operating time to less than 20 minutes, minimizes tissue trauma and does not require the initial surgical steps of an open DCR procedure. There were 14 cases (87.5%) with securely retained tubes and two cases (12.5%) that required tube replacement. The advantage of the procedure is especially great in revision surgery where the ostium is opened through scar tissue. Conclusions : Nasal endoscopy with the assistance of the Holmium YAG laser offers simplicity and precision in the placement of Jones tubes. It minimizes tissue trauma and increases the surgical success rate. [ABSTRACT FROM AUTHOR]

Examines the ways in which US industries conquered the Brazilian transportation market in the early 1900s, supplanting the British. New demands on Brazil's transportation sector in the early 1900s; Overtaxes transportation system; Impact of World War I on transportation sector's efficiency and financial stability; Brazilian-US road-building campaign; Arrival of US automobile companies; British-US business rivalry in Brazil; Conclusions.

Purpose: A retrospective case note review was undertaken to elucidate any differences in the cosmetic results and rate of serious complications between hydroxyapatite (HA) and porous polyethylene (PP) orbital implants. Methods: Patients who had undergone orbital implant surgery during the period 1993 to 1997 by a single surgeon were identified. Twenty-six patients had an HA implant and twenty-six had received a PP implant. All patients were reviewed in the ocular prosthetics department in a masked manner. The orbits were scored for post-enucleation socket syndrome (PESS) score, and quantification of implant mobility was done. Data analysis was conducted using Mann-Whitney U test for two independent samples. Results: There was no significant difference in PESS scores in patients with an HA or a PP implant. Implant elevation was better in patients with secondary (p = 0.029) and exchange (p = 0.042) PP implants. Only one patient in each of the HA and PP groups suffered significant implant exposure that required dermis fat and mucous membrane graft cover. Conclusions: The complication rates and PESS scores were identical between the HA and PP implant groups. The implant mobility was better in the PP group. In clinical practice, the choice of the type of orbital implant inserted may also be governed by other factors such as surgeon experience, ease of use, and cost. [ABSTRACT FROM AUTHOR]