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Biomedical subjects

J A Nerad

Publications and source records attributed to J A Nerad.

At least 19 recordsLinked to original sources
PubMed1992

Clinical characteristics associated with orbital invasion of cutaneous basal cell and squamous cell tumors of the eyelid.

Over a six-year period, between 1984 and 1990, 622 patients with basal cell and squamous cell carcinoma of the eyelids were examined at our institution. Thirteen patients had orbital invasion at initial examination. The average age of patients at orbital invasion was 75.8 years. Ten patients were men, eight of whom had basal cell carcinoma and two of whom had squamous cell carcinoma. Most patients had an orbital mass and incomitant strabismus at initial examination. Invasive basal cell carcinoma developed in 11 patients, and squamous cell carcinoma developed in two patients. Ten patients were treated for cutaneous carcinoma at the site of invasion before examination at our institution. The average duration between onset of a cutaneous lesion and our examination for orbital invasion was 9.8 years for basal cell carcinoma and one year for squamous cell carcinoma. Radiologic and histopathologic features were reviewed. The clinical characteristics of these patients were reviewed and orbital exenteration was recommended to all 13 patients. Nine patients underwent exenteration and four refused the operation.

Aged↗
PubMed1992

Medial canthoplasty with microplate fixation.

Six patients with malpositioned or surgically excised medial canthal tendons underwent repair with titanium microplate, and two patients underwent repair with titanium miniplate fixation. The T-shaped rigid fixation plates were chosen for medial canthal reconstruction to allow for stabilization of the plate along the anterior lacrimal crest and extension of the plate over the posterior lacrimal crest. The medial canthal tissue was reattached to the titanium plate with 3.0 polypropylene (Prolene) suture. This technique appears to be safer, faster, and, in many cases, more effective than traditional techniques for reconstruction of the medial canthus after tendon avulsion or loss from excision of cutaneous carcinoma.

Aged↗
PubMed1992

Complications associated with alloplastic implants used in orbital fracture repair.

BACKGROUND: The treatment of orbital wall fractures involves observation and/or surgical reduction with repositioning of herniated orbital tissues. To prevent reherniation of tissue and development of enophthalmos, the orbital floor or wall defect is commonly covered with an alloplastic implant. Complications associated with these implants are infrequent and generally appear as isolated case reports. METHODS: The authors reviewed the files of four consultative oculoplastic surgeons and searched for individuals with complications secondary to their alloplastic implants used during orbital fracture repair. FINDINGS: Seventeen patients were identified with a variety of complications related to their alloplastic implant. CONCLUSION: Although these implants are relatively inert and develop a fibrous capsule walling them off from the surrounding orbit, they remain foreign bodies and are thus subject to possible complications at any time. The authors review the spectrum of complications occurring with various alloplastic implants.

Adult↗
PubMed1992

Phakomatous choristoma of the orbit: a case report.

We report the case of a 3-month-old infant with a rare phakomatous choristoma of the orbit. This lesion is believed to be a congenital neoplasm of lenticular anlage. The clinical, radiological, and histopathological findings are presented.

Choristoma↗
PubMed1991

Congenital entropion with intact lower eyelid retractor insertion.

Congenital lower eyelid entropion is generally considered to result from improper development of the retractor aponeurosis insertion to the inferior portion of the tarsal plate. We treated three patients with this uncommon disorder. At operation, aponeurotic defects were anticipated and specifically sought, but in each case the lower eyelid retractors were inserted normally. In two patients, entropion was relieved by surgical disinsertion and then advancement of the retractors. In the third patient, who also had multiple concomitant facial and systemic developmental anomalies, improvement in the lower eyelid malpositions required a combination of procedures. The intraoperative findings in our patients demonstrate that disinsertion of the lower eyelid retractors is not a universal etiologic mechanism in congenital entropion.

Entropion↗
PubMed1991

The osseointegration technique for the rehabilitation of the exenterated orbit.

Osseointegrated implants can be used successfully to support maxillofacial prostheses. Six patients (aged 37 to 80 years; average age, 68 years) underwent orbital exenteration for eyelid neoplasms infiltrating into the orbit. Each patient underwent a two-stage osseointegration procedure in preparation for fitting an orbital prosthesis. In the first stage, three or four bone-anchored fixtures were placed into the bony orbital rim. Skin penetration and abutment placement were performed in the second-stage operation, performed 3 to 6 months later. Successful osseointegration was achieved in 17 (94.4%) of 18 fixtures in five nonirradiated patients. All five patients were successfully fitted with an implant-retained prosthesis. One patient who underwent irradiation lost all four fixtures that had been placed. This patient chose to wear a black patch rather than a conventional prosthesis held in with adhesive. Average follow-up was 16 months for the five patients who were successfully fitted with orbital prostheses (range, 6 to 30 months).

Adult↗
PubMed1991

Congenital macronodular juvenile xanthogranuloma of the eyelid.

A large congenital eyelid mass prevented an infant from elevating his eyelid successfully. A small punch biopsy was initially interpreted as "consistent with a dermatofibrosarcoma protuberans." On the basis of this diagnosis, radical surgery was advised. Dermatofibrosarcoma protuberans, however, rarely affects children and seldom appears in the head and neck area. Because of the discrepancy between clinical and pathologic diagnoses, additional biopsies were performed, which disclosed the lesion to be a juvenile xanthogranuloma. The mass regressed after intralesional injections of corticosteroids. This is the first clinicopathologic description of congenital macronodular juvenile xanthogranuloma affecting the eyelids. The variability in the histologic composition of this large lesion may lead to a mistaken diagnosis of an aggressive condition that may provoke unnecessary radical surgery.

Adrenal Cortex Hormones↗
PubMed1991

Long-term follow-up of severely injured eyes following globe rupture.

There is little information concerning the outcome of severely traumatized eyes, with little visual potential, which are not removed. We studied 50 eyes, which had suffered severe globe rupture, had visual acuities of no better than hand motion, and were not removed within 2 weeks of injury. Seventeen (34%) of the 50 eyes were later removed. Of the 17, nine had become painful. The other 33 eyes, which were not removed, remained comfortable over a mean follow-up of 66 months (12-161 months). Thirty (70%) of 43 eyes, which had follow-up of at least two months, became phthisical. There were no cases of sympathetic ophthalmia. These results suggest that the majority of severely-injured eyes become phthisical, but do not require removal for pain.

Adolescent↗
PubMed1990

Management of congenital lacrimal sac fistula.

Fourteen patients who were treated for symptomatic congenital lacrimal sac fistula were retrospectively reviewed to evaluate surgical success. Excision of the fistula alone was performed on 9 patients and excision with nasolacrimal intubation on 5 patients (to our knowledge, the latter has not been previously described in the English literature). None of the 14 patients were symptomatic postoperatively during a mean follow-up of 16 months, with a range from 3 to 39 months. We conclude that dacryocystorhinostomy is usually not necessary to successfully treat symptomatic congenital lacrimal sac fistula.

Adolescent↗
PubMed1990

Ocular manifestations of patients with circulating antineutrophil cytoplasmic antibodies.

Antineutrophil cytoplasmic antibodies are seen in patients with systemic vasculitides, especially Wegener's granulomatosis. Antineutrophil cytoplasmic antibodies are helpful laboratory markers for these disease. We report on the ocular findings of six patients with systemic vasculitis who had antineutrophil cytoplasmic antibodies. Four patients had systemic Wegener's granulomatosis, one had microscopic polyarteritis, and in one a specific histopathologic diagnosis could not be made. Two patients were first evaluated for systemic vasculitis because of their ocular manifestations. Ocular findings included ptosis, bilateral lacrimal gland masses, proptosis, choroidal folds, episcleritis, phlebitis, retinal and vitreous hemorrhage, keratitis sicca, and bilateral central scotomas. It was difficult to make a systemic diagnosis in all cases. If systemic vasculitis is in the differential diagnosis of a patient with suggestive ocular findings, antineutrophil cytoplasmic antibody testing should be considered. A prospective study of antineutrophil cytoplasmic antibody testing should be considered in patients with ocular findings that suggest the possibility of vasculitis.

Adolescent↗
PubMed1990

Intraorbital tumor as the initial symptom of childhood acute lymphoblastic leukemia. Magnetic resonance imaging findings.

Orbital involvement in leukemia is usually of myelogenous origin and is frequently the initial presentation. Orbital tumor due to lymphocytic leukemia is rare and only one case has been reported as the initial symptom. We report magnetic resonance imaging (MRI) findings of a case of acute lymphocytic leukemia with orbital mass as the initial symptom. The usefulness of MRI, including signal intensity and extent of involvement, is discussed.

Child, Preschool↗
PubMed1990

Intraorbital wood. Detection by magnetic resonance imaging.

The authors present two cases in which intraorbital wooden foreign bodies remained undetected after initial ophthalmologic examination and radiologic investigation which included plain orbital x-rays, orbital computed tomography (CT) scans, and, in one case, orbital ultrasound. In each case, subsequent magnetic resonance imaging (MRI) showed a well-delineated low-intensity lesion suggestive of a retained foreign body. Investigation of a case of suspected wooden foreign body in the orbit should include an MRI scan if there is no contraindication, and no foreign body has been defined on CT scan, ultrasound, or plain orbital films.

Adolescent↗
PubMed1990

The pigtail probe, revisited.

Choosing a method for repair of a canalicular laceration can be a challenge for the ophthalmic surgeon. Important principles to consider include direct anastomosis of the severed canalicular ends, endocanalicular support, and avoiding trauma to the uninvolved portions of the nasolacrimal system. The round-tipped, eyed pigtail probe has been found to be a safe, effective instrument in identifying and repairing a canalicular laceration. The authors also found it helpful in reconstructing partially excised canaliculi after tumor removal with Mohs' surgery. A high degree of anatomic and functional success was achieved using this instrument in a careful and meticulous technique.

Anastomosis, Surgical↗