Manual chest compression for total bronchospasm.
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Biomedical subjects
Publications and source records attributed to C Beard.
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A new method of surgical treatment for cicatricial eyelid retraction involves grafts placed in both the anterior and posterior lamellae of the upper eyelid, when there is a shortage of tissue in both layers, caused by previous surgical procedures. The anterior lamellar graft is of postauricular skin and the posterior graft is of buccal mucosa. The two grafts are placed at different levels in the eyelid so that each has a viable vascular bed. The procedure, called the split-level full-thickness eyelid graft, is not designed to correct problems involving only the eyelid retractors, such as retraction secondary to thyroid disease.
Electron microscopic, histochemical fluorescence, and pharmacologic evidence suggested that, in the rhesus monkey, Müller's muscle was not totally denervated either by cutting the levator palpebrae superioris muscle or by a Fasanella-Servat procedure. We examined the terminal course of the sympathetic nerve supply and the potential for preserving Müller's muscle in blepharoptosis surgery.
The condition of blepharochalasis and its treatment are discussed. Four cases are presented which show a physical sign that may help in its diagnosis.
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Radiographic and electron microscopic evidence showed that the upper eyelid skin crease is formed by the insertion of the levator palpebrae superioris muscle into the septa between the orbicularis muscle into the septa between the orbicularis muscle bundles and not into the skin itself. Experiments on monkeys showed that the insertions of the aponeurosis and of Müller's muscle both contribute to normal eyelid elevation. No histologic evidence was found for a disinsertion of Müller's muscle in 20 cases of blepharoptosis. This, with other evidence discussed, supports the functional importance of the human aponeurotic insertions in eyelid elevation.
A well-trained surgeon is capable of improving the facial appearance of many people by revision of aging lower eyelids. A knowledge of the anatomy, pathology, and physiology of the area is essential. By a careful preoperative examination, determination of the proper procedure, and by skillfully performed surgery much can be done for patients seeking this procedure. Methods of examination and suggested techniques for surgery have been outlined.
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Some aspects of the surgical, radiotherapeutic, chemotherapeutic, cryosurgical, and immunological aspects of eyelid and adnexal malignancy have been discussed. Possibilities for future developments have been mentioned and even rationalized. Oncology is a constantly changing field. It is important for the oculoplastic surgeon to keep abreast of the changes. It is also important for him to be innovative and progressive in the area of possible improvements. It is not for those of us in the rank and file of ophthalmology to try all possibilities, but at least we should be aware of the new techniques and should support their trial.
Ptosis has been treated in the past by vertical lid shortening, true levator resection or tucking, brow suspension, and superior rectus suspension. The last mentioned type of repair has all but been abandoned. Advances in vertical shortening procedures have been many. I have included those that seem to me to be significant. True levator surgery has not changed substantially, but the few changes have been good ones. Brow suspension material has been varied. Popularity is returning to autogenous fascia lata, as it should. Postoperative control of lid level when fascia lata is being used is discussed. Future advancements will probably center on the preservation of the effect of Müller's sympathetic muscle. This valuable asset to ptosis surgery has been largely neglected in the past.
A detailed knowledge of the anatomy of the levator aponeurosis is required for the aponeurotic approach to ptosis. Yet, many misconceptions regarding the insertional attachments of this important structure are found in the literature. The levator aponeurosis inserts via a fan of fibers. The first insertional attachment curves anteriorly around the orbital septum to form the lid crease. Approximately the anterior half of the aponeurosis inserts into pretarsal orbicularis and the overlying subcutaneous tissue. The remaining posterior half inserts firmly on the lower portion of the tarsus.
Cryotherapy was an effective modality in the treatment of basal cell carcinoma in the eyelid and periorbital area and cured 93% of the 29 lesions in 25 patients. This method was especially advantageous in patients with blood clotting disorders; those with medical contraindications to, or who refused, classical surgery; patients who had prior radiation or surgery; patients with the basal cell nevus syndrome or xeroderma pigmentosa; and in patients with medial canthal tumors. Experimental cryotherapy in the albino rabbit showed their lacrimal system is not adversely affected by freezing in the temperature range required for tumor death.
We reconstructed the lower eyelids of 13 patients using a tarsoconjunctival flap from the upper eyelid. The laterally based pedicle flap permitted a one-stage repair without prolonged occlusion of the eye. The technique was best suited to lesions involving the lateral aspect of the lower eyelid, but can be applied to lesions of the central and medial eyelid. The functional and cosmetic results were equal or superior to tarsoconjunctival advancement flaps.
We cryosurgically destroyed eyelashes in rabbits and applied the technique to treat 23 selected patients with trichiasis. Liquid nitrogen was sprayed on the eyelid margin by using a double, rapid-freeze, slow-thaw cycle monitored by a subcutaneous thermocouple to -30 degrees C. It was an improvement on electrolysis and a simple alternative to surgery.
We cryosurgically destroyed eyelashes in rabbits and applied the technique to treat 23 selected patients with trichiasis. Liquid nitrogen was sprayed on the eyelid margin by using a double, rapid-freeze, slow-thaw cycle monitored by a subcutaneous thermocouple to -30 degrees C. It was an improvement on electrolysis and a simple alternative to surgery.