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Biomedical subjects

A M Putterman

Publications and source records attributed to A M Putterman.

At least 19 recordsLinked to original sources
PubMed2001

Glabellar rhytids in thyroid-associated orbitopathy.

PURPOSE: To correlate the presence and severity of glabellar rhytids with disease severity in patients with thyroid-associated orbitopathy (TAO). METHODS: Retrospective, noncomparative medical record review of 113 consecutive new patient visits with the clinical diagnosis of TAO. Ocular examination features studied included assessment of visual acuity, optic nerve appearance and function, proptosis, strabismus, eyelid position, and exposure keratopathy. These features were correlated with graded clinical photographs evaluating rhytid severity using the Fisher exact text. RESULTS: Eighty of 97 patients included in the study (82.5%) had glabellar rhytids. Eyelid retraction was present in 95 of the 97 patients (98%). Patients with diplopia had more severe rhytids (p < 0.05). Patients with at least three abnormal clinical findings tended to have more severe rhytids. CONCLUSIONS: Glabellar rhytids are a common finding in patients with TAO, and tend to be present in patients with diplopia and multiple stigmata of the disease.

Adult↗
PubMed2000

The effect of upper blepharoplasty on eyelid position when performed concomitantly with Müller muscle-conjunctival resection.

PURPOSE: To determine the effect on eyelid elevation of excising excess skin, orbicularis oculi muscle, and herniated orbital fat and reconstructing the upper eyelid crease (blepharoplasty) concomitant with a Müller muscle-conjunctival resection. METHODS: The charts of 202 patients who had undergone Müller muscle-conjunctival resection during an 8-year interval were reviewed. Three hundred forty-five eyelids were divided into two groups. Group 1 (n = 162) underwent a Müller muscle-conjunctival resection only, and group 2 (n = 183) had this procedure combined with excision of skin, orbicularis muscle, and herniated orbital fat with upper eyelid crease reconstruction. Each group was divided into three subgroups based on the amount of Müller muscle-conjunctival resection. Subgroup A had resection less than 7.75 mm; subgroup B, resection of 7.75 to 8.75 mm; and subgroup C, resection greater than 8.75 mm. The change in margin reflex distance-1 (MRD1) measurements of the upper eyelid levels (postoperative MRD1 minus preoperative MRD1) were calculated and compared between groups. RESULTS: The mean (+/- standard deviation) change in MRD1 was, respectively, 2.3 +/-1.0 mm and 1.9+/-1.0 mm for groups 1A and 2A; 3.1+/-1.3 mm and 2.1+/-1.2 mm for groups 1B and 2B; and 3.4+/-1.2 mm and 2.8+/-1.3 for groups 1C and 2C. CONCLUSIONS: Blepharoplasty performed concomitant with a Müller muscle-conjunctival resection reduced the anticipated postoperative eyelid elevation by as much as 1 mm. Surgeons who perform these procedures together should be aware that a larger Müller muscle-conjunctival resection may be required to obtain the desired increase in eyelid height postoperatively.

Blepharoplasty↗
PubMed1999

Upper blepharoplasty: a novel approach to improving progressive myopathic blepharoptosis.

OBJECTIVE: To describe the results of upper blepharoplasty for the treatment of progressive myopathic upper eyelid blepharoptosis. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: Six consecutive patients treated bilaterally. INTERVENTION: Upper blepharoplasty in 6 patients (12 eyelids) with progressive myopathic ptosis. MAIN OUTCOME MEASURES: Subjective visual improvement, ocular comfort, preoperative and postoperative margin reflex distances, lagophthalmos, and degree of corneal keratopathy at last follow-up date. RESULTS: All patients had subjective visual improvement and denied ocular discomfort. Upper eyelid ptosis, measured by margin reflex distances, was improved. No worsening of lagophthalmos or corneal keratopathy was noted. CONCLUSIONS: Upper blepharoplasty may be an excellent alternative for ptosis treatment in patients with progressive myopathies. Improvement in ptosis, margin reflex distance, without concomitant lagophthalmos, and corneal keratopathy can be achieved.

Blepharoplasty↗
PubMed1998

Age-related changes in type-I collagen synthesis in human eyelid skin.

PURPOSE: This study was to determine whether age-related decrements in type I collagen synthesis occur in human eyelid skin. METHODS: Using an antibody to procollagen I, we investigated collagen synthetic activity in skin removed for cosmetic purposes from 10 white patients between the ages of 4 and 77 years. Eleven masked referees graded the immunostaining on a scale of 1 (most intense) to 10 (least intense). RESULTS: The multiple range test for rank by group demonstrated more intense staining in younger patients compared with older patients. An average correlation coefficient of 0.8432 (p < 0.05) existed between each of the referee's rankings. CONCLUSION: Type I collagen synthesis diminishes with age in eyelid skin.

Adolescent↗
PubMed1997

Predictability of magnetic resonance imaging in differentiation of orbital lymphoma from orbital inflammatory syndrome.

Twenty-two patients with clinical presentations of either orbital lymphoma or orbital inflammatory syndrome (OIS) involving 25 orbits were examined by magnetic resonance imaging (MRI) before biopsy. To determine whether MRI adds specificity to radiographic diagnosis, the MRI signal characteristics of all tumors were examined. Attention was focused on the signal intensity of each tumor on T1- and T2-weighted images. In nine of 12 (75%) orbital lymphomas, the tumors appeared hyperintense to fat on T2-weighted images and became brighter relative to their appearance on T1-weighted images. In 11 of 13 (85%) orbital infiltrates with OIS, the tumors appeared isointense to fat on T2-weighted images and became slightly darker or unchanged relative to their appearance on T1-weighted images. Tumor density and homogeneity were fairly similar in all 25 lesions and were therefore not useful for further differentiation. Similarly, the presence of moderate enhancement with gadopentetate dimeglumine was seen in all but one tumor, and it was therefore not useful for further differentiation.

Adult↗
PubMed1997

The effect of hyperthyroidism on Müller's muscle contractility in rats.

The objective of this study was to determine if hyperthyroidism affects the responses of Müller's muscle to alpha-1 adrenoceptor agonists and consequently, if these responses might explain thyroid eyelid retraction. Sprague-Dawley adult rats (n = 37) were divided into control and treated groups and given either placebo or intraperitoneal triiodothyronine (250 micrograms/kg/d) for 1, 2, or 3 weeks. A suture was passed through their upper eyelid and connected to a force transducer that measured Müller's muscle contractions. Responses to phenylephrine (0.015-0.61 mmol) were compared with respect to peak amplitude and 50% duration of action. Mean maximum force values [+/-1 standard error of the mean (SEM)] in response to phenylephrine were 1.254 +/- 0.071 gr for controls and 0.963 +/- 0.062 gr for thyroid-treated subjects (p = 0.005). Mean 50% duration of response values (+/-1 SEM) were 9.143 +/- 1.108 min for controls and 5.763 +/- 0.973 min for thyroid-treated subjects (p = 0.014). Hyperthyroid rats had a significantly lower Müller's muscle response amplitude than control rats; however, duration of response was not significantly different between the groups. We believe that hyperthyroidism caused intrinsic changes in Müller's muscle that resulted in eyelid retraction. Based on hypotheses discussed in this article, we expect that further studies will localize these changes to the thyroid hormone receptor on Müller's muscle or calcium-triggered intracellular second messengers. Clinical significance would then be the ability to treat hyperthyroid eyelid retraction with drugs. This study provides the first evidence of functional impairment of Müller's muscle due to hyperthyroidism in an animal model.

Adrenergic alpha-Agonists↗
PubMed1997

Intraoperatively controlled small-incision forehead and brow lift.

Placement of screws at the posterior aspect of the incision sites and the gradual placement and removal of staples behind the screws allow for a controlled and titrated elevation of the forehead and brows. This technique does require the patient's acceptance of the temporary placement of screws and staples into the scalp, which in my experience has not been a problem. By seating the patient upright on the operating table, the surgeon can intraoperatively make a direct evaluation and adjustments (removal or addition of staples). This approach leads to a more controlled elevation of the forehead and brows and the potential of a more symmetrical and satisfactory result.

Anesthesia, Local↗
PubMed1996

Solitary fibrous tumor of the orbit.

PURPOSE: We studied a case of solitary fibrous tumor of the orbit in a 75-year-old man. METHODS: The patient had painless, slowly progressive proptosis of eight months' duration. He underwent magnetic resonance imaging, which showed a well-circumscribed retrobulbar mass. The tumor was excised. RESULTS: Examination of the tumor disclosed haphazardly arranged spindle cells alternating with collagenous, hypocellular areas in a richly vascular background without necrosis. Immunoperoxidase stains showed characteristic expression of CD34 and vimentin. CONCLUSION: Solitary fibrous tumor can infrequently involve the orbit and may recur locally and metastasize, necessitating long-term follow-up.

Aged↗
PubMed1996

Multiple periorbital cutaneous myxomas progressing to scleromyxedema.

Myxomas are rare cutaneous tumors that have been associated with a variety of other abnormalities including atrial myxomas, endocrine abnormalities, and bone malformations. We describe a 38-year-old white man with multiple periorbital myxomas in whom myalgias, fatigue, and more diffuse cutaneous involvement developed. These findings were consistent with scleromyxedema. He also had an associated left subclavian deep venous thrombosis. The patient responded well to therapy with cyclophosphamide.

Adult↗
PubMed1995

Wedge resection of eyelid margin in the treatment of abnormal eyelid margins.

Widened, hypertrophic, erythematous eyelid margins occasionally occur secondary to congenital anomalies or previous surgical procedures. When a full-thickness resection of the eyelid is not possible because of horizontal tightness of the lid, it is possible to excise a wedge of the eyelid margin itself. This procedure was successful in decreasing widened, hypertrophic, erythematous eyelid margins in three patients.

Adult↗
PubMed1995

A minor modification of the Hughes' operation for lower eyelid reconstruction.

PURPOSE/METHODS: We modified the Hughes' technique to decrease the frequency of persistent conjunctival hyperemia on the reconstructed lower eyelid margin. RESULTS/CONCLUSION: When the conjunctival flap is divided at the second stage of the operation, the tissue is trimmed flush with the reconstructed lower eyelid margin rather than advancing the flap over the eyelid margin. This minor modification has yielded satisfactory functional and aesthetic results in 70 patients.

Conjunctiva↗