Biomedical subjects
Publications and source records attributed to H A Beaver.
Patients often present to primary care physicians with acute or chronic red eyes. Benign conditions may be evaluated and treated by primary care practitioners. Red eyes due to serious conditions may be vision threatening and require early detection and referral.
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BACKGROUND: Current enucleation and socket reconstruction techniques often require reinforcement of an orbital implant or wound by the use of a tissue graft. Commonly, allograft tissue (cadaveric sclera, fascia, etc.) is used. Disadvantages of allografts include possible inflammatory reaction, unpredictable vascularization rate, variable resorption, antigenicity, and cost. Another alternative to implant reinforcement is autogenous tissue which usually is harvested from a remote site (fascia lata, split dermis, temporalis fascia, pericranium, etc.). An overlooked source of readily available autogenous grafts is the connective tissue in the periorbital region and the enucleated eye itself. These sources include autogenous lamellar sclera, the corneoscleral button, capsular tissue from a migrated implant, and orbital rim periosteum. METHODS: The authors used periocular autografts in primary and secondary socket reconstructions in 24 patients, with excellent success over a 2-year period. Seven autogenous corneoscleral buttons and two autogenous scleral grafts were used to cover biointegrated implant spheres. Ten implant capsules from migrated nonintegrated spheres were used to cover and reinforce secondary implants. In five patients, an autogenous periosteal graft was taken from the supraorbital rim and used to cover an exposed implant. RESULTS: Complications included one pyogenic granuloma, one conjunctival inclusion cyst, and one recurrent exposure after a periosteal graft, which necessitated explanation and a dermis fat graft. Postoperative motility was judged to be good to excellent in 21 patients. CONCLUSIONS: These techniques are presented as a new alternative to using human bank tissue or remote incision autografts for reconstruction of the anophthalmic socket.
This controlled prospective study assesses the relative risks of first trimester chorionic villus sampling (CVS) versus mid-trimester gentic amniocentesis (GA). CVS subjects and amniocentesis controls were comparable with regard to several confounding variables which might influence the risk of pregnancy loss including maternal age, smoking, alcohol consumption, gestational age at study entry, and history of vaginal bleeding or poor prior reproductive outcome. The most common indication for prenatal diagnosis was advanced maternal age (n = 511). In this subgroup, spontaneous abortion (less than 24 weeks) occurred in 2.9 per cent of CVS subjects versus 4.3 per cent of amniocentesis controls. The sum of spontaneous and therapeutic abortions (less than 24 weeks) was identical (5.3 per cent) in both groups. Therefore, intervention in the CVS group (i.e., therapeutic abortion for cytogenetic abnormalities) did not influence the observed risk of pregnancy loss. Overall perinatal mortality rates were also similar in both groups. No significant differences were identified for a number of pregnancy outcome parameters including 5 min Apgar score, birth weight, body length, head circumference, gestational age at delivery, preterm delivery, fetal growth retardation, congenital malformations, and neonatal complications. Preliminary results of this controlled prospective study suggest that chorionic villus sampling carries a low and acceptable risk.
While chorionic villus sampling allows both early and rapid prenatal diagnosis of chromosome disorders, the accuracy of this technique has not been fully established. Maternal cell contamination and pseudomosaicism represent two major sources of diagnostic error. Combined use of both direct chromosome preparations and villus cultures is important in overcoming these problems. Direct preparations of villus tissue allow recognition of maternal cell contamination of villus cultures. Conversely, villus cultures yield higher resolution chromosomes and may be helpful in differentiating between true versus pseudomosaicism when two or more cell lines are identified in direct chromosome preparations. Preliminary data suggest that analysis of direct preparations from multiple individually processed villus fragments may also be of value in this regard. Until more experience is gained, mid-trimester amniocentesis should be offered to CVS patients when mosaicism is encountered.
Two fetuses at risk for mandibulofacial dysostosis (MFD) were monitored sonographically during the midtrimester of pregnancy. Normal facial and auricular structure were identified in one fetus, and a healthy infant was subsequently delivered. Severe microtia and micrognathia were apparent in the second fetus and a diagnosis of MFD was made and confirmed at delivery. These observations indicate that midtrimester sonographic diagnosis of severe MFD is possible.
Although commonly encountered in spontaneous abortions, triploidy is rarely seen in fetuses surviving beyond mid-pregnancy. Mid-trimester sonographic findings in three triploid fetuses are described and compared with those reported in six prior cases. While sonographic characteristics are variable, common features include: 1) second trimester-onset fetal growth retardation with a reduced growth potential pattern of anthropometric growth, 2) body asymmetry with relative macrocephaly and an elevated head:abdominal circumference ratio, 3) hydrocephalus, 4) oligohydramnios, and 5) an abnormally large and/or hydropic placenta (in cases of paternal origin). Genetic amniocentesis and amniotic fluid chromosome studies should be performed when ultrasound findings suggestive of fetal triploidy are identified.
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