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Biomedical subjects

R S Gonnering

Publications and source records attributed to R S Gonnering.

At least 37 records · Page 2Linked to original sources
PubMed1988

Negative antibody response to long-term treatment of facial spasm with botulinum toxin.

Over a period of 163 weeks, 223 injections of botulinum A toxin were administered to 38 patients with facial spasm syndromes. The maximum cumulative toxin dose was 553 units, the maximum number of injections in any given patient was 16, and the maximum dosage of any given injection was 52.5 units. Sera from these patients showed no antibody production when measured with a standard mouse lethality bioassay.

Adult↗
PubMed1988

Pseudoretraction of the eyelid in thyroid-associated orbitopathy.

Two patients with previously stable thyroid-associated orbitopathy presented with the fairly sudden onset of apparent upper eyelid retraction in their nondominant eye, accompanied by asymmetry of the eyebrows, with elevation on the side without the eyelid retraction. No other signs of worsening of the orbitopathy were present, and instillation of 2.5% phenylephrine hydrochloride in the contralateral, dominant eye relieved the eyelid retraction and normalized the eyebrow position. At surgery, both patients were found to have levator aponeurogenic ptosis in the eyelid that appeared to be "normal." This occurrence is explained by Hering's law and should be considered in planning surgery to reestablish palpebral fissure symmetry in such patients.

Blepharoptosis↗
PubMed1988

Epibulbar osseous choristomas with scleral involvement.

Epibulbar osseous choristomas are rare congenital collections of mature compact bone most often located in the superotemporal fornix. Most cases are not recognized preoperatively, as the lesion is usually felt to represent a dermatolipoma or epibulbar dermoid. Although most previous reports have described a loose attachment to the surrounding orbital structures, we report two cases in which intimate scleral incorporation was present. In one case, preoperative computerized tomography and echography allowed the diagnosis and probable scleral involvement to be considered preoperatively, and surgery was deferred. The embryogenesis of these lesions is uncertain, although they seem to correlate with the scleral ossicles seen in avian anatomy, and may represent abnormal activation of embryonic pluripotential mesenchymal cells.

Adolescent↗
PubMed1988

Extratarsal chalazia.

Three cases of atypical, extratarsal chalazia are presented. All three patients initially presented with a history of an inflammatory mass close to the lid margin. Inferior migration subsequently occurred, with loss of connection to the tarsus, causing confusion in the diagnosis. The basis for this migration is postulated to be the anatomical relationships of the tarsus, postorbicular fascia, and lower eyelid retractors. A good response was obtained with standard surgical therapy.

Adult↗
PubMed1988

Treatment of periorbital Molluscum contagiosum by incision and curettage.

Molluscum contagiosum, caused by a double-stranded DNA virus, is found world-wide, affecting humans as well as other primates and marsupials. In humans, a biphasic incidence occurs with peak infection rates among young children and young adults. In children, infection is spread by direct contact or through fomites, with lesions predominating on the trunk, extremities, and face. In young adults, this disease is spread primarily through sexual contact. Periocular infection can cause secondary chronic follicular conjunctivitis, superficial keratitis, and punctal occlusion. Although many modes of therapy are effective in destruction of the virus, some may have significant side effects when used in the periocular area. We describe treatment by incision and curettage, which we recommend as a simple, effective method of managing this problem.

Anti-Bacterial Agents↗
PubMed1987

Bilateral primary extramedullary orbital plasmacytomas.

An 81-year-old man presented with bilateral orbital tumors that were found to be extramedullary plasmacytomas. Immunoperoxidase staining of the tissue was positive for IgG-kappa; no lambda chains were seen. Results of serum immunoelectrophoresis were positive for monoclonal IgG-kappa. Test results of the urine were positive for Bence Jones protein; only kappa chains were seen on radial diffusion. Systemic evaluation failed to show tumor elsewhere. The patient was treated with radiation and low-dose melphalan/prednisone, with good response. Five years later, the results of immunoelectrophoresis are normal and there is no clinical evidence of tumor; however, a small amount of kappa light chains remains in the urine. This case supports the important therapeutic and prognostic differences among orbital involvement in extramedullary plasmacytoma, solitary myeloma of bone, and multiple myeloma.

Aged↗
PubMed1987

Orbital cellulitis with periosteal elevation.

Computerized tomography scan evidence of periosteal elevation in patients with orbital cellulitis is interpreted in the current medical literature as an indication of subperiosteal abscess. We present three such cases in which surgical drainage yielded clear fluid or granulation tissue rather than pus. A fourth case resolved on antibiotic therapy alone. Cases of periosteal elevation that resolve without surgery may represent inflammatory effusion, infections of lesser virulence, or propagation of granulation tissue rather than true abscesses. We suggest that periosteal elevation seen in patients with orbital cellulitis should represent a relative rather than an absolute indication for drainage surgery.

Abscess↗
PubMed1987

Coexistent orbital dermatofibrosarcoma protuberans and bilateral lymphoid hyperplasia.

A 72-year-old man had secondary orbital involvement with dermatofibrosarcoma protuberans 36 years after removal of the initial tumor on his forehead. In addition, multiple bilateral inferior orbital masses were present, which on pathologic examination proved to be reactive lymphoid hyperplasia. Serum immunoelectrophoresis revealed polyclonal elevations of IgG and IgA. Dermatofibrosarcoma protuberans is part of the spectrum of fibrohistiocytic tumors that also includes atypical fibroxanthoma and benign and malignant fibrous histiocytoma. The exact cell of origin of dermatofibrosarcoma protuberans is controversial, though immunohistochemical study of our specimen supports the fibroblast. The coexistence of this rare orbital tumor with noncontiguous reactive lymphoid hyperplasia is unique, and points out the fact that multiple orbital masses may indicate more than one underlying disease process.

Aged↗
PubMed1987

Meibomian gland dysfunction in floppy eyelid syndrome.

A 41-year-old obese man presented with bilateral ocular irritation and clinical findings consistent with floppy eyelid syndrome. Light- and electron-microscopic examination of tarsus removed at surgical correction revealed cystic degeneration and squamous metaplasia of the meibomian glands, along with abnormal keratinization and granuloma formation. These findings, not reported before in this syndrome, suggest that meibomian gland dysfunction with attendant qualitative abnormalities of the tear film, may be partly responsible for the keratoconjunctivitis seen in this syndrome.

Adult↗
PubMed1987

Bio-electric conductivity potentials in experimental skin grafts.

Prior investigations have established that changes in bio-electric potentials accompany the processes of wound creation and healing. In order to investigate these changes in an experimental full-thickness skin graft model, grafts were harvested from the dorsa of eight albino rabbits. Changes in potential were recorded over a period of 32 days, using silver-silver chloride electrodes and a recording polygraph. The potential measured across the skin graft became increasingly more electropositive until, between days 1 and 2, the potential abruptly reversed polarity. This negative potential lasted until day 4, when the conductivity again became positive, with a slow return to baseline measurements by day 32. Although these observations may indicate a bio-electric counterpart to the cellular events of wound healing, more study is needed.

Animals↗
PubMed1987

The anatomy and histology of the anophthalmic socket--is the myofibroblast present?

For some anophthalmic patients, the contracted socket is a severe problem that precludes the wearing of a prosthesis. A normal and cosmetically acceptable appearance is dependent on the ability of a socket to retain a prosthesis. The disfigurement and distress caused by the contracted socket and its inability to accommodate a prosthesis may have a profound detrimental effect on the patient's career, self-esteem, and psychosocial interactions. The tissue dynamics at work in the anophthalmic socket and in the contracting socket are not yet understood. There are many unanswered questions regarding the histology and anatomy of the normal, as well as the contracting, socket. The tissue responsible for clinical contraction has not been identified. This thesis, using the cynomolgus monkey socket as an experimental model, investigated healing in both the normal and contracting socket. Qualitative observations of the anatomy and histology of eight sockets were made. Two of the sockets were treated with Croton oil to induce contractions. Biopsy specimens from two human sockets, one contracted and the other merely volume deficient, were also examined. Histopathology of the normal and contracting sockets were compared. Myosin subfragment 1 staining of actin for electron microscopy and immunoperoxidase staining of actin for light microscopy were performed on selected specimens. The myofibroblast, probably a modified fibroblast, is known to be present in the early stages of open wound healing and in contracting scar tissue elsewhere in the body. The myofibroblast has been incriminated as an agent generating contractile force. Under the conditions of this experiment, cells with the characteristics of myofibroblasts were identified by both immunoperoxidase staining and electron microscopy. They were found in healing noncontracting and contracting sockets. Cytoplasmic actin was also distinguished in arterioles, venules, capillaries, myoepithelial cells, smooth muscle, and skeletal muscle.

Actins↗
PubMed1987

Ocular adnexal injury and complications in orbital dog bites.

Orbital dog bites, though statistically uncommon, occur most frequently in children and are associated with severe ocular adnexal injury. Of 16 victims, two-thirds were under 10 and over half under 5 years of age. The wounds consisted of numerous periorbital punctures, and in most cases, full-thickness lid lacerations involving the tear system. There were no serious injuries to the globe. Reversible amblyopia occurred in two children under 3 years of age with damage to the levator muscle. One child suffered a naso-orbital fracture. Because of the obvious nature of the injury, most patients present early and can be managed well with meticulous wound care and primary surgical repair. The use of prophylactic antibiotics, though controversial, appears prudent in such cases. Ophthalmologists treating these injuries must be aware of serious potential complications including occult facial fracture or intracranial penetration in young children, septicemia caused by bacillus DF-2 in patients with prior splenectomy, tetanus, and rabies.

Adolescent↗
PubMed1987

Ptosis and dermatochalasis as presenting signs in a case of occult primary systemic amyloidosis (AL).

Amyloidosis (AL) is a disease characterized by the extracellular deposition of a complex glycoprotein, part of which is derived from light chains of immunoglobulins. The ocular adnexa can be involved in both systemic primary amyloidosis (AL), usually associated with multiple myeloma or other immunologic disorders, or in a localized form without such systemic implications. We present the case report of a 65-year-old man in whom occult primary systemic amyloidosis (AL), associated with a monoclonal IgG-kappa gammopathy, occurred with presenting signs of ptosis and dermatochalasis secondary to infiltration of the extraocular and orbicularis oculi muscles with amyloid.

Aged↗
PubMed1987

Orbital and periorbital dog bites.

Although periorbital and orbital dog bites are rare, they most frequently occur in young children and commonly involve significant associated adnexal injuries. In most cases, the dog is either the family pet or is otherwise known to the victim. The exact precipitating event is usually unknown. Most victims are treated by a physician soon after injury, and can be reconstructed primarily following meticulous local wound care, including adequate irrigation. Infection is rare, but because of its potentially disastrous consequences, prophylactic treatment with penicillinase-resistant penicillin or cephalosporin seems indicated. Serious, potentially fatal consequences due to underlying intracranial injury in children under aged 2 years, fatal septicemia in splenectomized individuals, tetanus, and rabies must be considered by ophthalmologists who treat such patients.

Adolescent↗
PubMed1987

Oncocytic carcinoma of the plica semilunaris with orbital extension.

A 76-year-old male had orbital extension and regional lymph node involvement from an oncocytic carcinoma thought to have arisen in the plica semilunaris of the left eye. Declining early orbital exenteration and radical neck dissection, the patient received radiation therapy. Although initial palliation was achieved, the lesion recurred 1 year later, with massive orbital involvement. Despite exenteration and chemotherapy, the patient expired within 6 months. Oncocytomas arise from transformed epithelial cells, generally in the medial canthal region. Oncocytic carcinoma of the ocular adnexa is extremely rare and no such lesion of the plica semilunaris has been reported.

Aged↗
PubMed1986

Adjunct hyperbaric oxygen therapy in periorbital reconstruction.

The abundant blood supply normally found in the periorbital region grants the reconstructive surgeon many options for repair. When this blood supply is altered by such factors as thermal damage or scar formation, classic methods of lid reconstruction may not suffice. In such situations, treatment with hyperbaric oxygen accelerates the process of primary revascularization of full-thickness skin grafts and large composite grafts. Augmentation of capillary budding occurs because hyperbaric oxygen therapy raises the tissue oxygen tension in hypoxic areas to the level needed for extracellular deposition of collagen, which is needed for support of endothelial cells. Hyperbaric oxygen also appears to improve the survival of ischemic skin flaps of the face, although the exact mechanism of this action is unclear. Since 1982, a total of six patients needing periorbital reconstruction has been treated postoperatively with adjunct hyperbaric oxygen. Although the results have been uniformly favorable, a matched series comparing the results with and without hyperbaric oxygen therapy will be required to prove the efficacy of this treatment regimen.

Adolescent↗