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PubMed1998

Ocular medications in children.

Many ocular medications are used by pediatricians or ophthalmologists caring for pediatric patients. Topical antibiotics are commonly prescribed for bacterial conjunctivitis, nasolacrimal duct obstructions, and ophthalmia neonatorum. Many new antiallergy eye drops are now available for the treatment of seasonal (hay fever) conjunctivitis. Dilating eye drops and antiglaucoma medications are generally used or prescribed by ophthalmologists, but pediatricians must be aware of their potentially serious systemic side effects. Before initiating treatment, physicians should evaluate the risks and benefits of ophthalmic medications, establish minimum dosages necessary to achieve a therapeutic benefit, and monitor children for local and systemic side effects.

Anti-Allergic Agents↗
PubMedDate not supplied

Cytokeratin expression patterns in the rat respiratory tract as markers of epithelial differentiation in inhalation toxicology. I. Determination of normal cytokeratin expression patterns in nose, larynx, trachea, and lung.

Cytokeratin (CK) polypeptides constitute the intermediate filament cytoskeleton of epithelial cells. The patterns of CK expression can be regarded as specific markers for the epithelial differentiation status. Our objective was to map the cell type-specific CK expression patterns at all representative sites of the respiratory tract of untreated rats to use as a base for the detection of inhalation exposure-related differentiation changes. Using routine paraffin-embedded sections and a panel of well-characterized monoclonal antibodies for immunohistochemistry, we obtained CK staining patterns as follows. Nasal cavity: respiratory epithelium CK18, CK19 (basal, ciliated, nonciliated cells), CK14, and/or CK15 (basal and nonciliated cells); olfactory epithelium CK18 (basal, mid, apical zones and Bowman's glands), CK14, and CK15 (basal zone); squamous epithelium of ventral meatus CK14, CK15 (basal and suprabasal cells), CK1, 10/11, and CK13 (suprabasal cells); glands and columnar epithelia of vomeronasal organ and nasolacrimal duct CK7 and CK13 in addition to respiratory epithelial CK pattern. Trachea: similar to nasal respiratory epithelium with pronounced CK15 and additional CK7. Larynx: CK14, CK15 (basal, ciliated, nonciliated cells), CK8, CK18, CK19 (not in basal cells), CK4, and CK13 (cuboidal and squamoid cells of ventral half). Lung: bronchial epithelium CK14 and CK15 (basal cells only); bronchial and alveolar epithelium CK7, CK8, CK18, and CK19; bronchiolar epithelium similar but less CK8 and no CK7; pleural mesothelium CK7, CK8, and CK19. This inventory of complex CK expression patterns provides the basis for investigating test substance-related effects in inhalation toxicology, e.g., cigarette smoke-induced changes.

Animals↗
PubMedDate not supplied

Cytokeratin expression patterns in the rat respiratory tract as markers of epithelial differentiation in inhalation toxicology. II. Changes in cytokeratin expression patterns following 8-day exposure to room-aged cigarette sidestream smoke.

The expression of specific cytokeratin (CK) polypeptide patterns is a sensitive marker of the cytoskeletal differentiation of epithelial cells. We developed an immunohistochemical method to assess CK expression patterns in the rat respiratory tract using serial paraffin-embedded sections from the nasal cavity, trachea, and lung. In the present study, this method was used to detect exposure-related differences in CK expression patterns in adult Wistar rats following inhalation of room-aged sidestream smoke (11 mg total particulate matter/m3 air, 8 days, 12 hr/day, whole body). In the anterior nasal cavity level 1 (NL1), changes in CK expression patterns were observed in the respiratory epithelium of the lateral wall and the maxilloturbinate (CK14, CK15, and CK18) and in the squamous epithelium of the ventral meatus (CK13). At nasal cavity level 2 (NL2), immediately behind NL1, changes were observed in the olfactory epithelium (CK13, CK14, and CK18) and in the respiratory epithelium of the septum (CK7 and CK19), the lateral wall (CK7 and CK13), and the lateral aspect of the maxilloturbinate (CK14). Changes were also observed in the submucosal glands, nasolacrimal duct, and vomeronasal organ. In the trachea only CK7 expression changed, and in the lung expression of CK7 (bronchioli) and CK8 (bronchus) changed; the expression of other CK polypeptides did not change. The observed changes in CK expression at NL1 correlated with the histomorphological changes, whereas CK expression changes were also seen in the olfactory and respiratory epithelia at NL2 and in the trachea and lung, where no histomorphological changes were seen. These findings indicate that changes in CK expression in respiratory tract epithelial cells are a sensitive marker for cellular stress response.

Animals↗
PubMed1993

Orbital complications in functional endoscopic sinus surgery.

Endoscopic sinus surgery can result in both minor and major complications. Among these, orbital complications--including retroorbital hematoma--are among the most feared. Injuries can be direct or indirect from pulling on diseased structures. A retrospective chart review of 616 endoscopic sinus procedures revealed eight orbital complications in seven patients. These included two medial rectus injuries, five orbital hemorrhages, and one nasolacrimal duct injury. Predisposing factors may include hypertension, lamina papyracia dehiscences, extensive polypoid disease, previous surgery, inability to visualize the maxillary ostia, violent coughing or sneezing, and chronic steroid use. Suggested management in the literature includes lateral canthotomy, steroids, and mannitol with ophthalmologic consultation. Opening of the wound by means of an external ethmoidectomy incision has also been suggested. We suggest that adding orbital decompression by means of multiple incisions into the periorbita should be added for fully effective relief. A "management" tree of decision parameters relevant to orbital complications is presented.

Adolescent↗
PubMed1996

Cellular hyperplasia in rats following continuous intravenous infusion of recombinant human epidermal growth factor.

In this study, we determined in vivo morphologic effects of continuous intravenous infusion of recombinant human epidermal growth factor (EGF) in adult Wistar rats. The EGF used consisted of the amino acid residues 1-48 of the human 53-amino-acid EGF molecule, purified from transfected Escherichia coli. Doses of 25, 100, or 250 micrograms/kg body weight were administered using Harvard digital syringe infusion pumps for 4 weeks. At necropsy, the submandibular salivary glands, Harderian glands, liver, kidneys (females only), and ovaries were enlarged and urinary bladders were thickened in 100- and 250-micrograms/kg rats. Numerous tissues of the 100- and 250-micrograms/kg rats contained hyperplastic epithelial cells, and selected organs also had mesenchymal cell proliferation. Epithelial proliferation was most pronounced in the trachea, nasal cavity, nasolacrimal duct, tongue, stomach, small intestine, large intestine, urinary tract, salivary gland ducts, and Harderian gland. Periportal hepatocytes were hypertrophic, correlating with increased liver weight. In addition, mesenchymal cell proliferation was evident in the gastric mucosa lamina propria and in heart valves in 100- and 250-micrograms/kg rats. Increased ovarian weight correlated with increased number and size of corpora lutea and an increased incidence of luteal cysts. Continuous systemic exposure of adult Wistar rats to high doses of EGF resulted in generalized epithelial hyperplasia and tissue-selective mesenchymal proliferation.

Amino Acid Sequence↗
PubMedDate not supplied

Dacryoliths in chronic dacryocystitis and their composition (spectrophotometric analysis).

PURPOSE: To present the findings from histological and chemical analysis of large dacryoliths and correlate them with previous reports. MATERIALS AND METHODS: Dacryoliths were found in 8% of 216 dacryocystorhinostomy operations. In two cases with mild chronic dacryocystitis, large dacryoliths were extracted. The first case was a 42-year-old male with three dacryoliths in a lacrimal sac, presenting diverticulum-like formations, the second was a 22-year-old woman with one dacryolith at the entrance of the nasolacrimal duct. Chemical analysis was based on atomic absorption spectrophotometry (F.AAS) and on atomic emission spectrometry (AES). Light histological examination was also done. RESULTS/CONCLUSIONS: The findings were the same in both cases. Histological examination revealed amorphous organic material, and limited areas with the characteristics of calcium salt depositions. Chemical analysis showed mainly organic material with only minimal inorganic material. Explanations are offered about the formation of these dacryoliths.

Adult↗
PubMed2004

Masquerade syndrome: sebaceous carcinoma presenting as an unknown primary with pagetoid spread to the nasal cavity.

Sebaceous carcinoma of the eyelid is an uncommon tumour with unusual modes of presentation. It can remain occult at the primary site, without producing any mass, masquerading as chronic blepharoconjunctivitis, while setting up metastases in the regional lymph nodes especially in the pre-auricular group. We report here a case that not only masqueraded as chronic blepharoconjunctivitis with nodal metastases from an 'unknown primary' in the neck, but whose tumour spread in a pagetoid manner along the nasolacrimal duct producing a nasal tumour that was believed to be the 'unknown primary'. This case emphasizes the need for ophthalmologists, ENT surgeons and pathologists to keep sebaceous carcinoma in mind while evaluating patients with chronic blepharoconjunctivitis and cervical node metastases from 'unknown primary'. Histological clues for picking up a sebaceous carcinoma at a metastatic site include a tumour with comedo or ductal growth pattern and intracytoplasmic lipid.

Adenocarcinoma, Sebaceous↗
PubMed2005

Proboscis lateralis: clinical and radiological features.

Proboscis lateralis is one of the rare craniofacial congenital anomalies which presents as an obvious deformity of the nose. It tends to occur in male offspring of consanguineous marriages. This is a report of computerized tomography of this rare anomaly. In proboscis lateralis, the nasal cavity on one side is completely normal, while on the affected side it is replaced by a trunk-like process attached to the medial portion of the orbital roof. This anomaly occurs sporadically as an isolated defect or in association with other anomalies. It is usually associated with developmental failure of the paranasal sinuses and the nasolacrimal duct.

Coloboma↗
PubMed2005

Bilateral nasolabial cysts associated with recurrent dacryocystitis.

OBJECTIVE: Nasolabial cysts are rare, nonodontogenic, soft-tissue, developmental cysts occurring inferior to the nasal alar region. They are thought to arise from remnants of the nasolacrimal ducts and they are frequently asymptomatic. We report a rare case of bilateral nasolabial cysts accompanied by bilateral chronic dacryocystitis. CASE REPORT: A 48-year-old woman suffering from bilateral chronic dacryocystitis was referred to our department for endonasal dacryocystorhinostomy. She had undergone external dacryocystorhinostomy on the left side a few years earlier. Physical examination and computed tomography scan revealed nasolabial cysts bilaterally inferior to the nasal alar region. The cysts were removed via a sublabial approach and endoscopic dacryocystorhinostomy was performed on the right side. Ten months after surgery, the patient was asymptomatic. CONCLUSION: There may be a correlation, due to embryological reasons, between the presence of nasolabial cysts and the presence of chronic dacryocystitis. Both can be corrected surgically, under the same anaesthesia, without visible scar formation.

Chronic Disease↗
PubMed1995

Technical note: non-surgical treatment of epiphora by balloon dacryocystoplasty--the technique.

Dacryocystoplasty (DCP) was offered as an alternative to patients waiting for dacryocystorhinostomy (DCR) for epiphora. 31 procedures were undertaken with a technical success rate of 93% and a clinical improvement in 89% of these patients. It is concluded that DCP should be the technique of choice in the initial management of epiphora due to stenosis or occlusions of the nasolacrimal ducts before contemplating a DCR.

Adult↗
PubMed1981

Rare complications following ethmoidectomies: a report of eleven cases.

Intranasal ethmoidectomy is one of the most difficult operations to teach residents. An accurate knowledge of the regional topographic anatomy is of utmost importance. Friedman and Kerr reported complications of 1000 cases of consecutive intranasal ethmoidectomies performed at the Mayo Clinic from 1957 to 1972. The complication rate was 2.8%. Meningitis, cerebrospinal fluid rhinorrhea, loss of olfaction, and nasolacrimal duct obstruction were reported. No blindness, loss of occular motility, excision of brain tissue or intracranial vessel damage occurred in their series. We are reporting a series of 8 cases of very rare complications following intranasal ethmoidectomies: 1. Optic nerve damage resulting in total blindness (3 cases). 2. Loss of occular motility (2 cases). 3. Cerebrospinal fluid leak resulting in 8 episodes of pseudomonas meningitis and epidural abscess (1 case). 4. Cavernous sinus--internal carotid artery fistula (1 case). 5. Anterior cranial fossa brain damage resulting in death (1 case). These cases, which were either referred to us or came up for our review, are described in detail. A search of the world literature demonstrates a lack of emphasis on such complications. The pitfalls of intranasal ethmoidectomy are considered and ways to avoid such dreadful complications are discussed.

Adult↗
PubMed1994

Endoscopic laser dacryocystorhinostomy.

Endoscopic laser dacryocystorhinostomy (DCR) enables an obstructed lacrimal sac to be opened through an intranasal approach, avoiding the need for a skin incision. The holmium:yttrium aluminum garnet (holmium:YAG) laser is well-suited for this procedure because of its properties of fiberoptic delivery, effective bone cutting, and precise soft-tissue coagulation. Efficient bone ablation is particularly important for primary DCR which requires removal of relatively thick bone along the lateral nasal wall to expose the lacrimal sac. Forty-six endoscopic laser DCRs were performed on 40 patients. There were no intraoperative or postoperative complications. The surgery successfully relieved lacrimal obstruction in 85% of patients. Endoscopic instrumentation allowed for the rapid identification and correction of intranasal causes of DCR failure, including ethmoid sinus disease and middle turbinate hypertrophy. Endoscopic laser DCR appears to be a safe and effective procedure which should be considered as an alternative to external DCR for the surgical treatment of nasolacrimal duct obstruction.

Adolescent↗
PubMed2005

[Dacryocystography in adult lacrimal system evaluation].

PURPOSE: To evaluate dacrycystographic examination in patients with suspicion of lacrimal apparatus obstruction. METHODS: A retrospective study was performed to evaluate dacryocystographies of 100 adults suspected of nasolacrimal duct obstruction at the "Faculdade de Medicina de Botucatu-UNESP". The data were submitted to descriptive statistical analysis and chi-square test. RESULTS: The patients were mainly female, over 60 years old, presenting a low obstruction located at Arlt's sinus, with a grade 2 or 3 lacrimal sac. Lacrimal pathways with normal tear drainage, with or without dilatation and nasal alterations such as concha hypertrophy were also observed. CONCLUSION: Dacryocystographic evaluation was important to show the level of obstruction, the presence of dilatation of the lacrimal sac, as well as alterations in nearby structure. This information might influence the adopted surgical technique and the final treatment results.

Adult↗
PubMed1983

High-resolution CT analysis of facial struts in trauma: 2. Osseous and soft-tissue complications.

In six cadavers, high-resolution thin-section computed tomography (CT) was used to evaluate the sequelae of experimentally produced facial trauma. As confirmed by pluridirectional tomography, CT was an effective imaging method for the detection and classification of facial fractures. The ability of CT to simultaneously depict both osseous and soft-tissue structures expands the role that diagnostic radiology can play in the evaluation of the traumatized face. A method of evaluation is presented in which the face is geometrically conceptualized as a series of triplanar (horizontal, sagittal, and coronal) osseous struts. Sequential, systematic assessment of each strut for fracture and its adjacent soft tissue for injury can facilitate evaluation of the traumatized face. Using this approach the osseous and soft-tissue complications arising from experimentally produced trauma are reviewed and illustrated with CT. Examples of potential soft-tissue complications that may occur with fractures of the horizontal group of struts include disruption of the dura matter at the cribiform plate, involvement of the structures of the anterior cranial fossa, injury to the optic nerve, and involvement of the superior and inferior groups of extraocular muscles. Injury to the nasolacrimal duct, maxillary sinus ostium, medial and lateral rectus muscles, or the soft-tissue structures in the superior and inferior orbital fissures may arise from disruption of the sagittal struts. Fractures of the coronal struts may involve the frontal sinus, anterior cranial fossa, lacrimal gland, nasofrontal duct, lacrimal sac, or the soft tissues of the pterygopalatine fossa.

Face↗
PubMed1985

CT of the inferomedial orbit and the lacrimal drainage apparatus: normal and pathologic anatomy.

The normal and pathologic CT anatomy of the lacrimal drainage apparatus was examined during study of the orbits, nasal cavity, and paranasal sinuses in 100 patients with a variety of clinical complaints related to the inferomedial orbit. The bony lacrimal fossa, the nasolacrimal canal, and the fluid- or air-filled lacrimal sac and nasolacrimal duct were readily recognized in all cases. The lacrimal fossa and sac are found at the inferomedial orbit and are preseptal structures. Cystic expansion of the lacrimal sac (dacryocystitis) may mimic orbital abscess clinically; however, the radiographic recognition of a cystic, peripherally enhancing mass centered at the lacrimal fossa should exclude postseptal abscess and permit more conservative therapy. Obstruction or invasion of the drainage apparatus by tumor, infection, or posttraumatic scarring is readily depicted by CT. Sagittal/coronal images reformatted from thin transverse axial sections are often useful in defining the origin of an inferomedial orbital mass and its relation to the lacrimal sac when clinical studies and axial CT findings are equivocal.

Adult↗
PubMedDate not supplied

Dilated pupil during endoscopic sinus surgery: what does it mean?

Endoscopic sinus surgery has become the standard of care for the surgical management of chronic sinus disease. Sinus disease and its surgical treatment carry the risk of orbital complications, irrespective of the approach. Orbital complications associated with sinus surgery include nasolacrimal duct damage, extraocular muscle injury, intraorbital hemorrhage/emphysema, and direct optic nerve damage, resulting in blindness. The finding of an unequal pupil at the end of a procedure would be a cause of considerable concern, but it is most likely due to the topical contamination of the eye with a mydriatic pharmacological agent commonly used in endoscopic sinus surgery.

Chronic Disease↗