Conjunctival prolapse.
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Chondrodysplasia Punctata↗
Biomedical subjects
G Buckman
Publications and source records attributed to G Buckman.
Central venous stasis retinopathy following the use of tranexamic acid.
Central venous stasis retinopathy (CVSR) was observed in two young women following the administration of oral tranexamic acid (TA) for the treatment of menorrhagia. Clinical and laboratory parameters were normal. Withdrawal of the drug and treatment with systemic steroids and fibrinolytic drugs resulted in improvement of visual acuity to 6/6. The pathogenesis of the CVSR in these cases is suggested, and the rationale of systemic treatment is discussed.
Adult↗
Metastatic melanoma within and to the conjunctiva.
Two patients with epibulbar juxtalimbal primary conjunctival melanomas experienced local intralymphatic metastases to the inferior cul-de-sac, and a hematogenous metastasis to the conjunctiva developed in five other patients with cutaneous melanomas. Whether reflective of a local or distant metastasis, all of the lesions histopathologically were located in the substantia propria, and were separated from the overlying epithelium by a thin mantle of collagen. There was no evidence of atypical intraepithelial melanocytic proliferation, as would be expected in association with a primary conjunctival melanoma. Two of the cutaneous metastases exhibited a binodular or multinodular appearance that correlated histopathologically with variably confluent micronodules suggestive of the origin of the clinical lesion from a shower of tumor cell emboli. Patients with local intralymphatic spread from a primary conjunctival melanoma may experience additional lesions in the conjunctival sac or eyelid skin and are at risk for regional or distant metastases. They should be examined closely several times a year. The patients with the distant metastases all had their previously diagnosed primary cutaneous tumors on the truncal skin (a similar tendency emerges from a review of previous ocular cases), typically had myriad other cutaneous lesions, and two of them had a neoplastic iridocyclitis and vitreitis. These patients tended to die of the disseminated tumors within 1 year after conjunctival metastases developed.
Adult↗
Success of the Fasanella-Servat operation independent of Müller's smooth muscle excision.
In an attempt to elucidate the mechanism whereby the Fasanella-Servat operation corrects ptosis, the authors examined the histopathologic features of 40 consecutive surgical specimens from 37 patients. Because all specimens contained tarsus, this tissue was graded into two groups according to vertical height: (1) minimal (30%) and (2) moderate (70%). Müller's smooth muscle was graded into four groups: (1) absent to negligible (42.5%); (2) minimal (45%); (3) moderate (10%); and (4) large (2.5%). Levator aponeurosis was absent, and conjunctive was present, in all resections. Accessory lacrimal gland tissue was present in 42.5% of cases and did not cause decreased tear production. Although 87.5% of cases had absent to minimal smooth muscle resections, these patients had equally successful results in comparison to patients with moderate to large amounts of smooth muscle resections. Based on these data, the authors have concluded that the effectiveness of the Fasanella-Servat operation does not depend on a Müllerectomy, but instead is probably due to a combination of other factors: (1) a vertical posterior lamellar shortening; (2) secondary contractile cicatrization of the wound; and (3) plication or advancement of the Müller's smooth muscle-levator aponeurosis complex on the tarsus.
Adolescent↗
Postoperative refractive changes in children with congenital esotropia: a preliminary study.
A transient myopic inclination was found 2 months postoperatively in 23 children who had undergone surgery for congenital esotropia. Neither the age of the children at the time of surgery nor the length of muscle recession/resection influenced these refractive myopic changes. Early postoperative refractive correction with periodic follow-up is essential in preventing amblyopia. In 21 of the 23 children, visual acuity was 6/10 or better at last examination.
Child, Preschool↗
Melanocytic nevi of the palpebral conjunctiva. An extremely rare location usually signifying melanoma.
Nevi of the conjunctiva generally develop during the first 2 decades of life, and are almost entirely restricted to the epibulbar surface, the plica, the caruncle, and the lid margin. Therefore, any elevated pigmented lesion of the forniceal or tarsal conjunctiva acquired later in life must be regarded with suspicion as a melanoma or melanoma precursor, and a biopsy should be done routinely. This report is, to the best of the authors' knowledge, the first histopathologic documentation of nevi located in the palpebral conjunctiva. One nevus was acquired and the other was probably congenital.
Biopsy↗
Semicircular flap revisited.
The semicircular flap of Tenzel has proved to be an excellent reconstructive procedure for central eyelid defects. Although originally described for defects measuring half of the eyelid, we have found that it may be used for defects greater than 60% in the lower eyelid, if the lower eyelid retractors and inferior orbital septum are identified and severed from their attachments. This is the key factor in the mobilization and advancement of this flap. It may, in many circumstances, obviate the need for a more complicated reconstructive procedure.
Abnormalities, Multiple↗
The negative impact of government regulation on medicine.
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Delivery of Health Care↗
Trichoepithelioma.
Trichoepithelioma histologically resembles basal cell epithelioma, but only rarely do the two lesions coexist. The case reported here documents a patient with hereditary trichoepithelioma who presented with a basal cell epithelioma of the medial canthus invading the lower eyelid. The clinical and histologic features of both entities will be discussed, as well as the possibility of malignant transformation of a trichoepithelioma to a basal cell epithelioma.
Adult↗
Treatment of prolapsed conjunctiva.
Prolapse of conjunctiva from the superior cul-de-sac, an infrequent complication of levator resection surgery, has been observed by us to have occurred following craniofacial reconstruction for craniostenosis. Three cases of conjunctival prolapse are presented: two that followed maximal external levator resections, and one that occurred after a supraorbital rim advancement and a subsequent cerebrospinal fluid leak. The causes of conjunctival prolapse and its appropriate treatment are reviewed.
Blepharoptosis↗
Primary localized orbital amyloidosis.
A rare case of primary amyloidosis of the lacrimal gland and orbit is described with correlate CT-scan findings. Differentiation of this lesion from other lacrimal gland masses is discussed.
Amyloidosis↗
Retinal hemorrhages in the newborn following labor induced by oxytocin or dinoprostone.
We examined the fundi of 100 newborns following labor induced by intravenous oxytocin or by oral dinoprostone. Retinal hemorrhage was observed in 40% of neonates in the dinoprostone treatment group, as compared with 28% in the oxytocin treatment group. The accumulation of prostaglandins in the fetal circulation may be responsible for the hemorrhages, which clear spontaneously once the noxious agent is metabolized. Other organ systems must be carefully examined in the neonate to detect other possible untoward effects.
Dinoprostone↗
Ethical dilemmas of the doctors' strike in Israel.
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Ethics↗
Retinal manifestations of thrombotic thrombocytopenic purpura (TTP) following use of contraceptive treatment.
An 18-year old woman, suffering from thrombotic thrombocytopenic purpura (TTP) disease after taking an oral contraceptive, developed bilateral retinal elevations in the posterior pole with Elschnig spot formation without visual acuity impairment. Clinical and laboratory evaluation combined with intensive medical and surgical therapy (splenectomy) caused regression of the ocular and general findings. We believe that the ocular pathologic findings in this clinical case are due to injury in the choroidal vasculature and the pe layer as a manifestation of the TTP disease.
Adolescent↗
Dimeric ("big") human placental lactogen. Immunological and biological activity.
Dimeric ("big") human placental lactogen has been isolated in near homogeneous form from placental tissue. It consists of a disulfide-linked (stable) form and a noncovalently associated (unstable) form of the native hormone. The two forms were separated by exposure to denaturing conditions and resolution by gel exclusion chromatography. Both forms retained immunological activity, ability to bind mammary membranes, and ability to induce mammary N-acetyllactosamine synthetase in vitro. On a molar basis, stable dimeric placental lactogen was more active than placental lactogen in the radioimmunoassay indicating that the immunological determinants on both monomeric units could bind to antibody. On a molar basis, stable dimeric placental lactogen was equally active with monomeric placental lactogen in competing for mammary gland membrane binding sites, indicating that only one active site in the molecule could interact with the membrane at a time. Stable dimeric placental lactogen was also active in an in vitro bioassay using the induction of N-acetyllactosamine synthetase. It is concluded that dimer formation does not alter the biologically active portion of the placental lactogen molecule. Since the carboxyl-terminal region (residues 182-191) is involved in the interchain disulfide bonds of dimeric placental lactogen, this portion of the molecule is probably not necessary for its biological activity.
Animals↗