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Biomedical subjects

Morris E Hartstein

Publications and source records attributed to Morris E Hartstein.

12 recordsLinked to original sources
PubMed2006

Primary synovial sarcoma.

PURPOSE: To describe the clinicopathologic and immunohistochemical features and treatment of a rare case of primary synovial sarcoma of the orbit. DESIGN: Retrospective interventional case report. PARTICIPANT: A 14-year-old young man with histologically proven synovial sarcoma of the orbit. The diagnosis was confirmed by demonstration of a specific chromosomal translocation by polymerase chain reaction studies. METHODS: The patient was treated with orbital exenteration and followed up for 18 months at regular intervals. RESULTS: The tumor was excised completely, and the patient has done well during the initial 1-year follow-up with no sign of recurrence. CONCLUSIONS: We report the fourth case of synovial sarcoma of the orbit and, at 14 years of age, the youngest patient reported.

Adolescent↗
PubMed2006

Endoscopic orbital fracture repair.

Orbital fractures involving the middle or posterior third of the orbital floor are difficult to visualize with traditional surgical approaches. The authors describe their method of combining a transconjunctival incision with an endonasal endoscopic approach in the repair of orbital fractures. In their experience, this technique is especially useful in the treatment of posterior fractures or secondary repairs for residual enophthalmos. Besides better visualization, advantages include increased illumination; video projection for the rest of the surgical team and for documentation and recording; confirmation of correct implant placement; and, most importantly, precise and complete reduction of herniated orbital soft tissues.

Endoscopy↗
PubMed2004

Tarsal strip procedure for the correction of tearing.

PURPOSE: To evaluate the tarsal strip procedure in the treatment of tearing related to lacrimal pump failure. METHODS: A retrospective chart review of all tearing patients undergoing the tarsal strip procedure was done. Patients with ectropion, nasolacrimal duct obstruction, and punctal eversion and stenosis were excluded. Data collected included patient age, sex, procedures performed, follow-up, and resolution of tearing. The main outcome measure is resolution of tearing. RESULTS: Thirty-four eyelids of 21 patients underwent a tarsal strip procedure for the correction of tearing. Complete resolution of tearing was noted in 14 eyes. Seventeen eyes were partially improved and required no further intervention. Three eyes were unimproved over the follow-up period. Two eyes eventually required another procedure. CONCLUSIONS: Patients undergoing tarsal strip for tearing caused by presumed lacrimal pump failure showed a significant rate of improvement in their tearing symptom after the procedure. The tarsal strip procedure appears to be effective in the surgical treatment of tearing secondary to laxity of the lower eyelid.

Aged↗
PubMed2004

Small incision transcutaneous levator aponeurotic repair for blepharoptosis.

PURPOSE: Patients presenting with blepharoptosis due to disinsertion or thinning of the levator aponeurosis require surgical repair. A minimally invasive approach directed specifically at the levator aponeurotic anatomic defect may provide benefits to the patient. Proposed advantages of a small eyelid incision (8-13 mm) include less local anesthetic and tissue distortion, less ecchymosis and edema, decreased operative times, a shortened recovery period, and improved surgical results. We describe our results with the use of a small incision ptosis repair in select patients. SUBJECT AND METHODS: A retrospective chart review between January 2000 and September 2001 included 91 patients and 118 eyelids with blepharoptosis due to aponeurotic disinsertion, corrected by a minimally invasive approach. The small incision technique comprised levator aponeurotic resection and advancement. Pre- and postoperative upper eyelid marginal reflex distances (MRD1), eyelid contour, need for reoperation, and complications (overcorrection, undercorrection, hematoma, and infection) were recorded. RESULTS: The average preoperative MRD1 measured 0.5 +/- 1.1 mm, with a range of -2.0 to 2.5 mm. The average postoperative MRD1 measured 2.6 +/- 0.8 mm, with a range of 1 to 5.5 mm (P < 0.0001). Of the 118 eyelids corrected by a small incision technique, there were 4 overcorrections, 3 undercorrections, 1 failure, 1 postoperative ptosis procedure of the contralateral upper eyelid secondary to Hering's law ptosis, and 4 patients requesting surgical treatment of dermatochalasis. No symptomatic dry eye, exposure keratopathy, or other complication resulted in association with the overcorrections. No contour abnormalities, infections, hematomas, or other complications were noted. CONCLUSION: Our experience suggests that utilization of a small skin incision is safe, precise, and efficient and allows for more rapid recovery from surgery. The authors note a decreased incidence of reoperation and postoperative complaints compared with historical larger-incision cases.

Adult↗
PubMed2003

Periocular reconstruction.

The periocular area is a complex region with free margins and cosmetic landmarks that are easily distorted during surgical reconstruction. Repair of surgical defects should maintain both periorbital function and aesthetics. In this article we discuss the basic methods of closure (side-to-side closure, flaps, grafts and second intent healing) as they apply to the periocular area and suggest an algorhythmic approach to reconstruction by aesthetic subunit. Pertinent regional anatomy and perioperative management are also reviewed.

Algorithms↗
PubMed2003

Immunotherapy for melanoma metastatic to the orbit.

PURPOSE: To present 3 cases of melanoma metastatic to the orbit treated with various traditional modalities including surgery and chemotherapy and being treated with melanoma vaccines and to present background information on immunotherapy. METHODS: Retrospective review of 3 patients with melanoma metastatic to the orbit who were treated with melanoma vaccines along with conventional treatments. One patient had known orbital involvement before vaccine treatment; 2 patients had orbital metastases subsequent to vaccine administration. RESULTS: Patients survived at least 13 months after the diagnosis of metastatic melanoma, with 1 patient surviving 51 months after the onset of metastases and administration of melanoma vaccine. CONCLUSIONS: Although still unproven, immunotherapy with melanoma vaccines is a promising new treatment modality for metastatic melanoma with few side effects.

Adult↗
PubMed2002

Conservative management of necrotizing fasciitis of the eyelids.

OBJECTIVE: To describe the management of patients with necrotizing fasciitis of the eyelids. DESIGN: Retrospective, noncomparative interventional case series. PARTICIPANTS: Seven patients with necrotizing fasciitis limited to the eyelids. METHODS: Retrospective review of the charts and photographs of seven patients with necrotizing fasciitis limited to the eyelids. MAIN OUTCOME MEASURES: Eyelid function and appearance, mortality, and morbidity. RESULTS: Seven of seven patients had good eyelid function and adequate appearance without reconstruction after healing. No deaths occurred. CONCLUSIONS: Eyelid necrosis due to necrotizing fasciitis can be a devastating condition. The morbidity and mortality of selected cases are reduced with prompt and appropriate antimicrobial therapy and nonaggressive debridement of necrotic tissue after autodemarcation of the necrotic zone.

Adult↗
PubMedDate not supplied

Use of autologous platelet concentrate in blepharoplasty surgery.

PURPOSE: To evaluate postoperative edema and ecchymosis after blepharoplasty surgery with or without autologous platelet gel. METHODS: In this prospective, randomized, controlled trial, patients received autologous platelet concentrate in the eyelid incisions of one side during bilateral blepharoplasty surgery. The opposing eye was not treated and was used as a control. Autologous platelet concentrate was prepared by the Harvest system (Harvest Technologies, Plymouth, MA, U.S.A.). The blood was centrifuged and platelet-rich plasma isolated. Platelet-rich plasma was mixed with thrombin and instilled in the wound on a randomly selected side before wound closure. Patients were examined and completed a questionnaire at postoperative days 1, 3, 7, and 30. Photographs were taken at each visit and were graded by masked, trained observers for edema and ecchymosis. RESULTS: Significantly less edema (p<0.05) was noted by the photograders at day 1 and by the patients at day 30. There were non-statistically significant trends toward decreased ecchymosis and edema in the treated group. Questionnaire data showed no significant difference in postoperative pain between the treated and untreated sides. Photographic and questionnaire data showed no clinically meaningful difference between the treated and control sides. CONCLUSIONS: Although there were statistically significant differences in edema using autologous platelet gel in blepharoplasty surgery, trends toward improvement in postoperative edema and ecchymosis did not achieve clinical significance.

Adult↗
PubMedDate not supplied

Orbital desmoid tumor in a pediatric patient.

A 3-year-old girl with desmoid tumor of the right orbit initially presented with a 4-month history of unilateral ptosis and was subsequentially found to have fullness of the right upper eyelid. Computed tomography of the orbit revealed a soft tissue density in the superolateral quadrant of the right orbit. Histopathology from a biopsy revealed a desmoid tumor with positive margins. The patient subsequently underwent compete excision of the tumor and is presently doing well.

Biomarkers, Tumor↗
PubMedDate not supplied

The smooth surface tunnel porous polyethylene enucleation implant.

BACKGROUND AND OBJECTIVE: To describe early clinical results with the porous polyethylene smooth surface tunnel (SST) enucleation implant. PATIENTS AND METHODS: Uncontrolled, prospective interventional case series of patients undergoing enucleation with placement of the SST implant. This implant consists of a porous polyethylene sphere with a smooth anterior surface containing pre-drilled tunnels to facilitate direct suturing of the rectus muscles to the implant without use of an implant wrap. Postoperatively, socket healing was assessed, and prosthesis and socket motility were evaluated by the surgeon using an ordinal scale (0 = no motility to 4 = excellent motility). RESULTS: Thirty patients received the SST implant, with a mean follow-up of more than 23 months. Two cases of exposure occurred and were managed surgically without the need for explantation. Mean socket motility was 3.1 on a 0 to 4 ordinal scale, with mean prosthesis motility of 2.8. CONCLUSION: The SST implant provides satisfactory socket motility and is generally well tolerated in the anophthalmic socket without the need for wrapping material.

Adult↗