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Biomedical subjects

J C Flanagan

Publications and source records attributed to J C Flanagan.

At least 37 records · Page 2Linked to original sources
PubMed1989

Contact neodymium:YAG laser. Experimental studies and oculoplastic applications.

Contact Nd:YAG laser surgery offers a new method of delivering laser energy to a target tissue site. Nd:YAG, a near-infrared laser, can be transmitted through an optical fiber delivery system to a synthetic sapphire probe. This sapphire probe can be used as a surgical scalpel to cut, vaporize, or coagulate tissues. The contact laser scalpel offers many advantages over conventional steel scalpel surgery and the system overcomes many of the limitations encountered with noncontact Nd:YAG lasers. A review of the history, biophysics, and experimental studies is presented. Clinical oculoplastic applications are reviewed.

Aluminum Oxide↗
PubMed1987

Breast carcinoma metastatic to the orbit.

Breast carcinoma metastatic to the orbit presented in four patients as a diffuse mass lesion. Clinical findings included restricted ocular motility, palpable mass, enophthalmos, and ptosis. The delay in diagnosis in three cases was due to subtle early findings, the long time interval from the primary breast lesion, lack of other metastases, and, in each of the four cases, the patient's reluctance to disclose any history of breast disease. Pathologic examination of the orbital breast metastases revealed two types: an adenocarcinomatous pattern with nests of pleomorphic malignant appearing cells and a histiocytoid variant with bland, large cells similar to histiocytes.

Aged↗
PubMed1986

Ocular motility disturbances following cosmetic blepharoplasty.

Five patients developed diplopia following cosmetic blepharoplasty. While temporary diplopia and visual disturbances are known to occur following this type of surgery, the persistence of diplopia with demonstrable muscle imbalance is not common. We encountered ocular motility complications involving the inferior or oblique muscle, inferior rectus muscle, and superior oblique tendon.

Diplopia↗
PubMed1986

The association of congenital ptosis and congenital heart disease.

Congenital ptosis and congenital heart disease are known to occur simultaneously in the presence of several well-recognized clinical syndromes. We report seven cases of documented, structural congenital heart defects found among 156 consecutive congenital ptosis patients operated at the Wills Eye Hospital. The possibility that the concurrence found in the patients was a manifestation of a dysmorphic syndrome was carefully excluded by observers skilled in the recognition of such anomalies. The observed rate of congenital heart disease, in otherwise normal congenital ptosis patients, was five times the expected rate in the pediatric population at large. This should alert ophthalmologists examining pediatric ptosis patients to the possibility of a coexisting structural heart defect.

Adolescent↗
PubMed1985

Pediatric dacryocystorhinostomy.

Dacryocystorhinostomy (DCR) often has uncertain results in the pediatric age group. Poorly defined and rapidly changing anatomy, along with a tendency toward vigorous growth of scar tissue, may alter surgical results. We report our experience with 29 primary pediatric dacryocystorhinostomies and five reoperations. Strict attention to surgical anatomy allows attainment of success results (83%) comparable with those in adults in both traumatic and nontraumatic cases. Our results, surgical technique, and evaluation of failures are discussed. Meticulous suturing of anterior and posterior flaps is not necessary for good surgical results. Dacryocystorhinostomy is a successful therapeutic modality in childhood dacryostenosis with chronic dacryocystitis when medical therapy, probing, and silicone intubation have been unsuccessful.

Adolescent↗
PubMed1985

The histopathology of involutional ectropion.

Twenty eyelid specimens from patients with involutional ectropion, obtained by full-thickness horizontal shortening procedures, were examined histopathologically by light and electron microscopy and compared with six normal eyelids from exenteration specimens. Paralytic, cicatricial, and congenital ectropions were excluded from the study. The main histopathologic features included: (1) collagen degeneration and elastosis of the tarsal plate; (2) increased amounts of adipose tissue in the distal tarsus and capsulopalpebral fascia; (3) subacute inflammation and epidermidalization of the tarsal conjunctiva; (4) focal degeneration, fibrosis and elastosis of pretarsal orbicularis, and occasionally minimal change in the muscle of Riolan; and (5) arteriosclerosis of the marginal artery. The combination of these histopathologic changes characterize and may contribute to the development of ectropion of the eyelid associated with aging.

Aged↗
PubMed1984

Classification and incidence of space-occupying lesions of the orbit. A survey of 645 biopsies.

Six hundred forty-five consecutive biopsies of orbital lesions performed at a major ophthalmic hospital during a 20-year period were used to develop a comprehensive classification of orbital tumors and pseudotumors, excluding thyroid orbitopathy. Although this series has certain bias, it probably closely parallels the incidence of orbital lesions that would prompt a biopsy in an ophthalmic practice. It is hoped that this review, combined with a familiarity of the signs and symptoms of various orbital lesions, will aid the clinician in the diagnostic evaluation of the patient with an orbital mass.

Biopsy↗
PubMed1984

Treatment of congenital ptosis with frontalis suspension: a comparison of suspensory materials.

One hundred forty-five consecutive frontalis suspension procedures performed during the years 1976 to 1982 at the Wills Eye Hospital for the repair of congenital ptosis were reviewed. Results with nylon polyfilament cable-type suture ( Supramid Extra) as the suspensory material were compared to results with allogenic fascia lata. Forty-nine of the 121 polyfilament cable-type suture procedures (40.5%) were considered failures either because of ptosis recurrence (28.1%) or granuloma formation (12.4%). Only two of 24 (8.3%) of the fascia lata cases failed. No granuloma was associated with the use of fascia lata. The clinical and pathologic characteristics of ptosis recurrence and suture-rejection granuloma formation are discussed. Available preparations of allogenic fascia lata are reviewed and suggested as alternatives to the use of nylon polyfilament cable-type sutures for the repair of congenital ptosis.

Blepharoptosis↗
PubMed1984

An unusual late complication of orbital floor fracture repair.

Three patients developed unilateral proptosis 13, 16, and 20 years after repair of blow-out fracture with orbital floor Teflon implants. In one patient trauma preceded the onset of proptosis. In all three cases, the cause of the proptosis was probably hemorrhage of the capillaries in a fibrous capsule that surrounded the implant and that was evident on orbital CT scan. In two cases on CT scan, a retrobulbar cyst-like structure surrounded the implant, which was confirmed on ultrasonography. In the third case, an irregular soft-tissue density surrounded the implant. Histologically, a fibrous capsule surrounded the implant in all three cases, and in one case, the inner lining of the fibrous capsule was respiratory epithelium. The contents of the cyst-like structure, in two cases, were fresh blood and disintegrating red blood cells and blood products. In the third case, no cyst-like structure or "cyst" contents were identified; however, fibrous tissue containing hemosiderin-laden macrophages suggested the presence of an organized hemorrhage. The patients' proptosis resolved almost completely after surgical removal of the implant, decompression of the "cyst," and partial removal of the "cyst" wall in two cases. The same result followed removal of the implant and part of the fibrous capsule in the third case.

Adult↗
PubMed1983

Retrobulbar anesthesia and retinal vascular obstruction.

The cases of three patients who developed combined central retinal artery/vein obstruction secondary to retrobulbar anesthesia are presented. In one case the obstruction was presumably present immediately after surgery, while in the other two it was observed to evolve over a period of several days. A dilated optic nerve sheath was demonstrated by contact B-scan ultrasonography in two cases and by computerized tomography in the third case, suggesting intravaginal sheath hemorrhage as a common underlying pathophysiologic process. Partial return of vision was evident in the latter case following orbitotomy with optic nerve sheath decompression.

Aged↗
PubMed1983

Conjunctivodacryocystorhinostomy with mucous membrane graft.

Eleven patients with obstructed lacrimal canaliculi underwent conjunctivodacryocystorhinostomy modified by lining the fistula with buccal mucosa at the time of surgery. Four patients had the tube removed after six months. All four have parent mucous membrane lined fistulas with follow-up ranging from ten to 13 months. One patient removed his tube on the second post-operative day. His fistula closed immediately. For comparison, the remaining six patients retain their tubes. They are free from epiphora but suffer from some of the complications of the tube itself, namely tube extrusion, tube migration, and chronic conjunctival irritation and discharge. The surgical technique is described, histopathologic material is presented, and the initial results are discussed.

Adolescent↗
PubMed1982

Complications of orbital roof fractures.

A spectrum of complications of orbital roof fractures is discussed. The authors have had cooperation with the neurosurgical service in treating nine cases. Careful ocular and neurologic examination of the patient is emphasized in an attempt to avoid ocular complications, orbital deformities, ocular muscular imbalance, enophthalmos, blepharoptosis, and intracranial complications. With intracranial involvement, a combined neurosurgical and ophthalmologic approach is indicated. A superior orbitomy is indicated if there is a simple fracture of the orbital roof without involvement of the inner table of the skull.

Blepharoptosis↗
PubMed1982

Measurement of quality of life: current state of the art.

In recent years several investigators have developed procedures for measuring the quality of life of individuals. This paper focuses on an empirical approach to defining the main determinants of quality of life and the development and application of procedures for surveying the importance of each component in representative samples of 3 age groups of Americans. These age groups included those persons 30, 50, and 70 years of age. The survey also included reports by these persons concerning the extent to which their needs and wants were met with respect to each of these components. By using the critical incident technique it was found that there were 15 components that included all of the 6,500 activities and experiences reported by a wide variety of Americans from various geographic areas as contributing either positively or negatively to their quality of life. In the survey of 500 men and 500 women at each of the 3 age levels it was found that the 5 dimensions they most frequently described as important included: health, children, understanding yourself, work, and spouse. The 5 dimensions for which they reported their needs and wants were least well met were: participating in government, active recreation, learning and education, creative expression, and helping others. The 5 dimensions that correlated most highly with their reports of overall quality of life at present were: material comforts, work, health, active recreation, and learning and education. Suggestions are made for revising these procedures for use with persons with a disability to improve their quality of life.

Adult↗