Biomedical subjects
Publications and source records attributed to M Hatt.
In a 55-year-old woman patient with congenital Horner's syndrome the ptosis and miosis disappeared completely for a short time after a bout of coughing. Pharmacologically the defect was localized in the second neuron. No etiology or pathogenetic mechanism of the phenomenon could be identified.
The eye is an effective and frequently used means of communication. Innate ocular signals express basic feelings and are identical all over the world. Acquired signals depend on cultural status, intelligence, and education. Eye diseases and orbital anomalies can provide misleading impressions, because they can be confused with true eye signals or because they can trigger innate reaction mechanisms. Surgically, the eye can often be improved as an emittor of signals; the message, however, has to be composed by the patient.
Intubation keeps the lacrimal system patent, and frequent irrigation removes detained debris. A temporary drainage and irrigation system was designed and led to a permanent success after revision of very complicated dacryocystorhinostomy obstruction recurrences in five of six cases.
Three unusual cases of posttraumatic upper eyelid retraction are described. They were observed following orbital trauma without apparent involvement of the superior rectus muscle after latency periods ranging from several months to years. As other reasons for the lid retraction were ruled out the question arises as to whether peripheral neurogenic or muscular upper eyelid retraction must be assumed to be a consequence of trauma, although this has never been described before.
The technique of intubation of the lacrimal system is described. A silicone tube with stainless steel probes on either end is used. Special emphasis is placed on management of difficulties in finding the probe in the nose and guiding it with a lacrimal groove director.
From the anatomical and physiological point of view th eyelid may be divided into three layers: a deep layer, comprising the tarsi and the canthal tendons with the levator aponeurosis and the lower lid retractors, the orbicularis muscle layer, and the skin. The surgical particularities of each of these layers are outlined. In the management of eyelid injuries the meticulous reconstruction of the medial canthal tendon and canthus is of paramount importance. Only after this are the lids closed from medially to laterally and from deep to superficial tissues.
In order to achieve an optimal combination of principal and side effects of the various drugs used in local anesthesia, a thorough knowledge of pharmacology, anatomy and physiology is essential. The properties of the most commonly used short-acting (Lidocain) medium (Mepivacain) and long-acting (Bupivacain) local anesthetics are described, as well as the effect of the vasoconstrictors Adrenalin and Ornipressin, and of hyaluronidase. The advantages and drawbacks of the different application modalities are discussed. In clinical practice, the surgeon has to be aware of his particular local anesthetic needs at any given time and any stage of the operation, and should attempt to create ideal conditions by careful selection, combination and application of the different drugs. The choice is relatively easy in operations on the globe, the eye muscles and the lacrimal drainage system. In major lid operations, however, greater differentiation in the selection of drugs and methods of application is advisable.
Twenty patients underwent intubation of the lacrimal system with silicone stents. The preliminary results are favourable. New indications for intubation in lacrimal surgery are discussed.
A simplified method for ptosis surgery has been used in 33 patients. The levator aponeurosis is exposed by the anterior approach. It is folded or excised and reattached to the anterior surface of the tarsus, matching the level and the contour of the two upper lids. The cosmetic appearance of the lid is improved by the skin closure technique. This method for ptosis surgery meets the anatomical and physiological needs best. It has given very satisfactory functional and cosmetic results.
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35 patients, most of whom had recurrent or large malignant eyelid tumors (33 basal cell carcinomas and 2 squamous cell carcinomas), underwent microscopically controlled excision (Mohs' fresh tissue technique). This approach guarantees a complete removal of the tumor, while conserving as much healthy tissue as possible. Short time follow-up studies have shown that plastic reconstruction gave good functional and cosmetic results.
Bovine nasal cartilage was extracted with 0.5 M LaCl3 and the extract then diluted with nine volumes of water. The resulting precipitated (PLaCl3) contained the proteoglycan subunits, together with minor protein components, but was essentially free from hyaluronic acid. The properties of PLaCl3 were investigated by chemical analysis, electrophoresis, viscometry and analytical ultracentrifugation, and the results compared with those for proteoglycan obtained by caesium chloride density gradient centrifugation of 2 M CaCl2 cartilage extracts. Proteoglycan subunits (A1D1) prepared from PLaCl3 showed identical properties to those obtained from other high ionic strength cartilage extracts.
Rod- and cone-system electroretinograms from 16 patients suffering of recurrent posterior uveitis and one or more symptoms of Behçet's disease were studied. On the basis of an evaluation of the clinical picture and of the progression three stages of the disease were distinguished. These stages were compared to the changes in amplitude of the b-waves of the ERGs (Fig 1). The findings in this group of patients were also compared to those from 11 patients with "simple" posterior uveitis (Fig. 2). The electroretinographic results in both these groups were highly similar: in all patients progression of the ocular disease was accompanied by parallel reduction in amplitude of the b-wave of the ERG. All ERG responses were affected in a similar way: the rod-system was in general more severly affected than the cone-system in both groups of patients. On the basis of these data it appears that the ERG indicates the stage of retinal damage in posterior uveitis. However, we could not detect ERG changes characteristic for the Behçet type of uveitis.
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