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Biomedical subjects

J S Kennerdell

Publications and source records attributed to J S Kennerdell.

At least 19 recordsLinked to original sources
PubMed1992

Choristoma of the optic nerve and chiasm.

A 21-year-old patient with a biopsy-proved choristomatous malformation of the optic nerve and chiasm is presented. The patient experienced progressive unilateral vision loss and optic atrophy. A gadolinium-enhanced magnetic resonance image demonstrated chiasmal involvement that was not evident on computed tomographic scan or visual field testing. We believe this is the third reported case of a choristomatous malformation of the optic nerve and chiasm and the first report of magnetic resonance imaging findings.

Adult↗
PubMed1992

Orbital lymphangioma. Correlation of magnetic resonance images and intraoperative findings.

BACKGROUND: Orbital lymphangiomas generally are invasive, slow-growing lesions that can produce proptosis, motility impairment, and compressive optic neuropathy. Successful surgical management requires detailed preoperative radiologic imaging with the capacity to determine the location and size of the tumors, the presence of cystic or solid components, and extent of infiltration of the tumor into normal orbital structures. METHODS: The records of 12 patients with orbital lymphangioma were reviewed with attention to the clinical, radiologic, operative, and histologic findings. RESULTS: Preoperative magnetic resonance imaging (MRI) produced highly detailed renderings of the orbital mass that were both diagnostic and predictive of the intraoperative findings. Magnetic resonance imaging was particularly sensitive to the presence of cysts within the tumor and was able to predict the contents of the cysts. CONCLUSION: Using preoperative MRI, a more detailed and accurate surgical plan can be formulated than with any other noninvasive technique.

Adolescent↗
PubMed1992

Immunohistochemical evidence for C3bi involvement in Graves ophthalmopathy.

PURPOSE: To determine by immunohistochemical methods if components of the complement system are present in Graves ophthalmopathy extraocular and periocular tissues compared with non-Graves ophthalmopathy ocular tissues, and, if so, whether a qualitative difference exists. METHODS: Orbital muscle, periorbital muscle, and adipose tissue from 10 Graves ophthalmopathy patients were studied with in situ assays using monoclonal antibodies for C3bi and C5b-9 (the terminal attack complex) complement components. Extraocular muscle, periocular muscle, and adipose tissue from 12 patients treated for unrelated orbital disorders were used as controls. RESULTS: All nine Graves extraocular and periocular muscle tissues exhibited C3bi positive staining in an intense, localized oval- to spindle-shaped reaction that appeared to represent cells on a diffuse staining background of the endomysial and perimysial connective tissues with no staining of the muscle fibers themselves. Some reactivity was seen in 6 of the 12 control muscles, but this was much less intense than that of Graves ocular muscle tissue. Only two Graves muscle samples stained minimally with the monoclonal antibody for the C5b-9 terminal attack complex while none of the control muscle samples demonstrated reactivity. Orbital fat from Graves and control patients did not demonstrate any reactivity for C3bi or C5b-9. CONCLUSION: C3bi and not C5b-9 (the terminal attack complex) is present in Graves ophthalmopathy extraocular and periocular tissues in a qualitatively greater way than in control non-Graves ophthalmopathy ocular tissue. Consequently, C3bi may contribute to the pathophysiology of Graves ophthalmopathy.

Adult↗
PubMed1992

Correlation of serum immunoglobulin E elevations with clinical stages of dysthyroid orbitopathy.

Total immunoglobulin E (IgE) was measured by an enzyme-linked immunoassay in serum samples from patients with dysthyroid orbitopathy and from a group of healthy volunteers. All the serum donors had no symptoms of allergy or infection and were not given any immunoregulative treatments for at least 6 months before the sampling. One hundred thirty-seven dysthyroid orbitopathy patients were rated clinically as belonging to one of the following groups: (1) stable dysthyroid orbitopathy; (2) active dysthyroid orbitopathy; (3) chronic or recurrent dysthyroid orbitopathy; or (4) dysthyroid orbitopathy characterized by limited myopathy. The serum IgE levels of all these groups were compared with 26 healthy, nonatopic volunteers. The mean IgE levels of groups 3 and 4 were significantly higher than the mean IgE level of the control group as well as that of the group with stable dysthyroid orbitopathy. Furthermore, serial readings on several patients were consistent with the hypothesis that serum IgE is elevated in connection with certain stages of rapid dysthyroid orbitopathy progression and also with two unusual clinical forms of dysthyroid orbitopathy.

Enzyme-Linked Immunosorbent Assay↗
PubMed1992

Immunohistochemical evidence for IgA1 involvement in Graves ophthalmopathy.

Orbital muscle, adipose tissues, and periorbital muscle from 11 patients with Graves ophthalmopathy were studied with in situ assays using monoclonal antibodies for IgA1, IgA2, IgM, and IgG. Tissue biopsies were taken from varied extraocular muscles and orbital sites. All cases were from patients with severe disease or disease of long duration. Control specimens of extraocular muscle tissues were obtained from nine patients treated for unrelated orbital disorders. Only connective tissue associated with the extraorbital muscles and periorbital muscles showed any reactivity. Of the muscle tissue obtained from patients with Graves disease all exhibited IgA1 positive staining of the endomysium and perimysium, without staining of the muscle fibers themselves. Parallel sections of orbital muscles reacted with anti-IgA2 or anti-IgM antibody failed to demonstrate staining. Control extraocular muscle tissue did not stain with anti-IgM and one control muscle of seven reacted minimally with anti-IgA2. Some reactivity with anti-IgA1 was seen in four of the seven control muscles but this was qualitatively much less than that of muscle tissue from patients with Graves disease. Monoclonal anti-IgG did not stain tissue from the six Graves specimens and three control specimens tested.

Adipose Tissue↗
PubMed1992

Cryosurgery re-visited for the removal and destruction of brain, spinal and orbital tumours.

Advances in neuroimaging and cryosurgical techniques have prompted us to re-evaluate the potential of cryosurgical techniques for the removal and the destruction of various neoplasms. We have used cryosurgical instrumentation to remove tumours in the brain, spine and orbit in 71 patients without complications. Cryosurgery was used to facilitate removal and extraction in 64 and to destroy residual neoplasms when removal was incomplete in 7. Intraoperative real time ultrasonic imaging permitted precise delimitation of tumours from surrounding tissues and allowed monitoring during the production of cryosurgical lesions thus permitting heretofore unavailable visualization of the production of cryogenic lesions in the central nervous system. New cryosurgical instrumentation was used to produce lesions up to three times larger than similar sized probes previously available. Our results reconfirm that cryosurgery facilitates the removal of tumours in the brain, spinal cord and orbit, reduces blood loss in vascular tumours, and is effective in ablating residual neoplasms involving the superior sagittal sinus, torcula and parasagittal areas. A Doppler flowmeter proved useful for monitoring sagittal sinus blood flow during the production of cryosurgical ablation of residual tumour attached to the walls of the sagittal sinus. Recent advances in ultrasonic and neuroimaging coupled with stereotactic techniques and improvements in cryosurgical instrumentation may prove useful in the future percutaneous destruction of selective intracranial neoplasms.

Adult↗
PubMed1992

Treatment of dysthyroid lower lid retraction with autogenous tarsus transplants.

Lower lid retraction is commonly seen in dysthyroid orbitopathy. We have treated 55 lower lids in 38 patients with lower lid retraction by a tarsal transplant from the upper lid to the lower lid. An overall effect of 2-mm improvement +/- 0.7 mm occurred. Eighty-nine percent of the lids achieved the position of the lower lid within 1 mm of the limbus. We think that the upper to lower tarsal transplant offers a technically easy and reasonable solution to moderate lower lid retraction associated with dysthyroid orbitopathy.

Adult↗
PubMed1992

Re-examination of peripheral blood T cell subsets in dysthyroid orbitopathy.

Patients with dysthyroid orbitopathy (DO) were grouped according to a multifactorial assessment of disease severity and the rate of disease progression. Using this system and flow cytometric measurements of T cell subsets in the peripheral blood, a significant increase in the percentage of CD4+ lymphocytes correlated with disease severity in DO patients with progressive disease. These observations are consistent with the hypothesis that the CD4+ peripheral blood T helper cells play a significant role in the progression of DO.

Adult↗
PubMed1991

The management of sclerosing nonspecific orbital inflammation.

Five cases representing varied presentation and treatment of the sclerosing type of nonspecific orbital inflammation are presented. Rapid identification and vigorous, individualized treatment are recommended: for local lesions, removal; for diffuse lesions, debulking, and/or steroid treatment, followed by radiation therapy.

Adolescent↗
PubMed1979

Medial rectus injury from intranasal surgery.

Severe medial rectus injury occurred in two cases following intranasal sinus surgery. In the first case a scarred medial rectus muscle was found at the time of corrective surgery. Reexamination of the surgical specimen in the second case confirmed our finding of medial rectus transection. Both patients had good cosmetic and functional improvement by means of vertical recti transposition to correct their large angle, fixed exotropias. A review of the literature indicates that this is, to our knowledge, a previously unreported complication of intranasal sinus surgery.

Adult↗
PubMed1979

Fine-needle aspiration biopsy. Its use in orbital tumors.

Fifteen orbital tumors have been evaluated with the fine-needle aspiration biopsy (FNAB) technique. The best indication for FNAB is supposed malignant orbital disease. The technique has not been helpful in tumors or inflammatory disease with a high fibrous content. Lesions that are suspected of being pseudotumors are not recommended for FNAB since, even in histologic sections, they are notoriously difficult to distinguish from well-differentiated lymphocytic malignant lymphoma. Benign encapsulated tumors should not be subjected to FNAB.

Adult↗
PubMed1979

Advantages of a fourth generation CT scanner in the management of patients with orbital mass lesions.

This presentation demonstrates the advantages of a fourth generation CT scanner in prognosis and localization of orbital space taking lesions, including its use as a localization guide for fine needle aspiration biopsy. It also provides an accurate means of follow-up of orbital lesions which have been either left in situ, partially excised, or excised. Six patients with difficult orbital problems of various types have been described to demonstrate how this high resolution CT scanner was utilized to improve the recognition and management of these problems.

Adult↗
PubMed1979

Radiation treatment of orbital lymphoid hyperplasia.

Ten patients with biopsy-proved lymphoid hyperplasia (pseudotumor) of the orbit were treated with radiation therapy individed sose ranging from 2,500 to 3,000 rads. Five of the ten patients had prior treatment with corticosteroids in high dosages with only partial or no response. All ten patients had clinical resolution of the lymphoid hyperplasia orbital mass within three weeks following radiation therapy. A follow-up period of six months to five years has demonstrated no recurrences. There were no discernible complications from the radiation therapy. We believe that radiation therapy should be considered as a primary treatment of benign lymphoid hyperplasia of the orbit.

Aged↗
PubMed1979

Microsurgical approach to orbital tumors.

Neurodiagnostic techniques now permit precise localization of intraorbital tumors relative to the optic nerve and intracranial compartment. With such localization, surgical procedures may be planned along more anatomical lines. Those circumscribed tumors may be planned along more anatomical lines. Those circumscribed tumors lateral, superior, and inferior to the optic nerve may well be approached by a lateral orbitotomy using microdissecting techniques. Those tumors medial to the optic nerve deep in the apex and those with possible intracranial extension should be approached transfrontally. In both surgical approaches, precise anatomical knowledge and microdissecting techniques are needed.

Biopsy↗
PubMed1979

Thyroid carcinoma metastatic to the globe.

We report a case of thyroid carcinoma metastatic to the globe. In our survey we found thyroid carcinomas to metastasise to the eye rarely. In addition, we found metastases from the thyroid to be more common to the orbit than to the globe--a reverse of the pattern noted with tumours in general.

Adenocarcinoma↗