RESUMEN
PURPOSE: We report the use of bovine pericardium as an alternative wrapping for porous orbital implants after enucleation. METHODS: We retrospectively reviewed the records of all patients who received a bovine pericardium-wrapped orbital implant after enucleation by the authors between August 1, 1996, and December 1, 1999. RESULTS: Eighty patients underwent placement of bovine pericardium-wrapped orbital implants. The average age at the time of implantation was 49.3 years (range, 5 years to 83 years). The mean follow-up interval was 11.8 months (range, 2 to 41 months). There were no intraoperative complications. No patient had secondary systemic infection or showed evidence of rejection. There was no clinical evidence to suggest that vascularization of the porous implant was unusually delayed, and there were no complications after secondary drilling and placement of a coupling post. Four (5%) of 80 patients had complications requiring removal of the spherical implant. All 4 patients had hydroxyapatite implants. Two patients had significant exposure requiring removal of the implant at 2 months after surgery; 1 patient had a chronic fistulous tract with secondary infection 3 years after surgery: and 1 patient had chronic orbital pain requiring removal of the implant at 1 year after surgery. CONCLUSIONS: The incidence of implant exposure was less than 4%. This compares favorably to the incidence of exposure of 9% to 21% reported in recent literature. Other complications were few and of minimal clinical significance. The authors conclude that bovine pericardium is a viable option to sclera as a wrapping for porous orbital implants.
Asunto(s)
Materiales Biocompatibles Revestidos , Órbita/cirugía , Implantes Orbitales , Pericardio , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Animales , Bovinos , Niño , Preescolar , Femenino , Estudios de Seguimiento , Reacción a Cuerpo Extraño/etiología , Supervivencia de Injerto , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Implantación de Prótesis , Estudios RetrospectivosRESUMEN
PURPOSE: To report the onset of malignant peripheral nerve sheath tumor of the orbit 8 years after irradiation in a patient with neurofibromatosis type-1. METHODS: Case report of a young man with neurofibromatosis type-1 who received irradiation for presumed bilateral optic nerve and chiasmal gliomas and in whom a malignant peripheral nerve sheath tumor later developed. Exenteration with extirpation of the entire contents of the orbit was performed 6 times. RESULTS: Complete recurrence of the tumor occurred after each surgical procedure until the patient died of malignancy. CONCLUSIONS: Our case underscores the risk of irradiation, especially in children with neurofibromatosis type-1, and emphasizes that radiotherapy should never be given as an empirical therapy. The authors believe that irradiation and neurofibromatosis type-1 may, in combination, pose a significant risk for the development of malignancies. Clear-cut indications and a precise tissue diagnosis are desirable before the initiation of radiotherapy, particularly in the pediatric population. We recommend that if irradiation is necessary in persons with neurofibromatosis type-1, regular follow-up is imperative. In view of the hostile nature of malignant peripheral nerve sheath tumor, early aggressive treatment appears to be the only viable alternative at present.
Asunto(s)
Recurrencia Local de Neoplasia/etiología , Neoplasias Inducidas por Radiación/etiología , Neoplasias de la Vaina del Nervio/etiología , Neoplasias Orbitales/etiología , Preescolar , Resultado Fatal , Glioma/radioterapia , Humanos , Imagen por Resonancia Magnética , Masculino , Recurrencia Local de Neoplasia/patología , Recurrencia Local de Neoplasia/cirugía , Neoplasias Inducidas por Radiación/patología , Neoplasias Inducidas por Radiación/cirugía , Neoplasias de la Vaina del Nervio/patología , Neoplasias de la Vaina del Nervio/cirugía , Neurofibromatosis 1/radioterapia , Quiasma Óptico/efectos de la radiación , Neoplasias del Nervio Óptico/radioterapia , Evisceración Orbitaria , Neoplasias Orbitales/patología , Neoplasias Orbitales/cirugíaRESUMEN
PURPOSE: To determine the effectiveness of using a radiofrequency instrument to resect a V-shaped tarsal wedge for the correction of cicatricial upper eyelid entropion. METHODS: Prospective evaluation of 16 upper eyelids of 11 consecutive patients. RESULTS: The operation was successful in all 16 eyelids, with excellent cosmetic and functional outcomes. CONCLUSIONS: Tarsal V-wedge resection is an effective alternative to other complicated techniques in the management of upper eyelid cicatricial entropion.
Asunto(s)
Enfermedades de la Conjuntiva/cirugía , Entropión/cirugía , Párpados/cirugía , Procedimientos Quirúrgicos Oftalmológicos , Penfigoide Benigno de la Membrana Mucosa/cirugía , Adulto , Anciano , Enfermedades de la Conjuntiva/complicaciones , Electrocoagulación/instrumentación , Entropión/etiología , Párpados/patología , Humanos , Persona de Mediana Edad , Penfigoide Benigno de la Membrana Mucosa/complicaciones , Estudios Prospectivos , Resultado del TratamientoRESUMEN
PURPOSE: To evaluate the success of internal eyelash bulb extirpation in the management of trichiasis. METHODS: The procedure was performed on 26 consecutive eyelids. RESULTS: Our technique was successful in all cases, with no recurrence of signs or symptoms. CONCLUSIONS: Internal eyelash bulb extirpation is a safe and effective technique to remove trichiatic lashes, while avoiding injury to the conjunctiva.
Asunto(s)
Pestañas/cirugía , Enfermedades de los Párpados/cirugía , Enfermedades del Cabello/cirugía , Folículo Piloso/cirugía , Remoción del Cabello/métodos , Humanos , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: Second primary malignancies are common after bilateral retinoblastoma; their estimated incidence has been as high as 51% 50 years after diagnosis. Fifteen patients who developed sebaceous gland carcinoma after radiation therapy have been reported in the literature, five of whom were treated for bilateral retinoblastoma. METHODS: The authors conducted a retrospective chart review of patients treated for bilateral retinoblastoma at Duke University Medical Center who later developed sebaceous gland carcinoma. RESULTS: This article reports two patients who developed sebaceous gland carcinoma after radiation therapy for bilateral retinoblastoma. CONCLUSIONS: Delay in diagnosis is often associated with sebaceous gland carcinoma. Because high mortality is observed with metastatic disease, the recognition of this association is important for anyone who follows patients with a history of bilateral retinoblastoma or prior cranial radiation therapy.
Asunto(s)
Neoplasias Inducidas por Radiación/etiología , Neoplasias Primarias Secundarias/etiología , Retinoblastoma/radioterapia , Neoplasias de las Glándulas Sebáceas/etiología , Adulto , Anciano , Anciano de 80 o más Años , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
We have studied changes in intraocular pressure (IOP) in 30 patients after succinylcholine (suxamethonium) and tracheal intubation following administration of propofol 2 mg kg-1 and either remifentanil 1 microgram kg-1 (group R) or saline (group S). IOP was measured before induction, before administration of succinylcholine and the study drug, before intubation and for every 1 min after intubation for 5 min. There was a significant decrease in IOP in group R compared with group S from the time of administration of the study drugs to the end of the study (P < 0.006).
Asunto(s)
Analgésicos Opioides/uso terapéutico , Intubación Intratraqueal/efectos adversos , Hipertensión Ocular/prevención & control , Piperidinas/uso terapéutico , Succinilcolina/efectos adversos , Adulto , Anciano , Anestésicos Intravenosos , Presión Sanguínea/efectos de los fármacos , Método Doble Ciego , Femenino , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Masculino , Persona de Mediana Edad , Fármacos Neuromusculares Despolarizantes/efectos adversos , Hipertensión Ocular/etiología , Procedimientos Quirúrgicos Oftalmológicos , Propofol , RemifentaniloRESUMEN
Hemorrhagic cyst formation may occur within months or years following repair of orbital fractures with alloplastic materials. Patients present with a sensation of pressure in the involved orbit, double vision, and globe displacement. Evaluation must rule out infectious, inflammatory, and vascular etiologies. Computerized tomography scans reveal a soft tissue density surrounding the alloplastic implant. Drainage of the cyst and fibrous capsule, with excision of the capsule and removal of the alloplastic implant, is curative. This article presents three clinical cases, highlighting the evaluation and management of this postsurgical development. Use of the protocol described resulted in complete resolution of all clinical symptoms, and the CT scans were normal. As these materials will continue to be utilized, surgeons should be aware of this potential delayed complication and its management.
Asunto(s)
Materiales Biocompatibles/efectos adversos , Quistes/etiología , Fracturas Orbitales/cirugía , Hemorragia Posoperatoria/etiología , Prótesis e Implantes/efectos adversos , Adulto , Remoción de Dispositivos , Diplopía/etiología , Drenaje , Exudados y Transudados , Oftalmopatías/etiología , Femenino , Humanos , Masculino , Enfermedades Orbitales/etiología , Presión , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND AND OBJECTIVE: Attention to the pathogenesis and clinical features of macular hole formation has increased with the advent of therapy. The purpose of this study is to present three cases that occurred in atypical settings that may have important pathogenic implications. PATIENTS AND METHODS: The authors conducted a retrospective study of three patients who presented with macular holes that developed 10 months to 5.5 years after previous vitrectomy. In each case, the cortical vitreous layer was absent in the region of the macula at the time of operation for the macular hole. RESULTS: The macular hole was successfully sealed and the visual acuity improved in all patients. All three cases in this report lacked an operculum, occurred long after vitreous removal, and had no evidence of any residual cortical vitreous. CONCLUSIONS: Macular hole formation in the absence of cortical vitreous suggests the possibility that the etiology of macular holes may involve a spontaneous umbo dehiscence rather than vitreous-induced surface traction. A mechanism involving a cystic degenerative process is proposed as the cause of atypical and typical macular hole formation.
Asunto(s)
Perforaciones de la Retina/etiología , Vitrectomía/efectos adversos , Anciano , Femenino , Fondo de Ojo , Humanos , Persona de Mediana Edad , Perforaciones de la Retina/patología , Perforaciones de la Retina/cirugía , Estudios Retrospectivos , Agudeza Visual , Cuerpo Vítreo/patologíaRESUMEN
Interphotoreceptor retinoid binding protein (IRBP) is a glycoprotein that localizes in the retina and induces inflammatory changes in this tissue in immunized animals. Certain IRBP-derived peptide determinants are also immunopathogenic, and we have previously shown that these determinants could be either immunodominant or cryptic. Lymphocytes sensitized against the cryptic peptides do not recognize whole IRBP in vitro, and yet these lymphocytes must recognize the protein in vivo to initiate the autoimmune pathogenic process. We have examined here two hypothetical explanations for this dissociation: 1) It is possible that when IRBP is processed in vitro, immunodominant peptide determinants compete with the cryptic ones and inhibit their interaction with the MHC molecules on the APC. This explanation was ruled out here by the finding that the immunodominant peptide 1179-1191 ("W10") did not inhibit the response to a cryptic one, 1158-1180 ("R4"), when added at equivalent and even moderately higher concentrations. 2) The second hypothesis proposes that the cryptic antigenic sites are not generated from IRBP by the APC in vitro, whereas enzymes in the retina digest the protein to yield fragments that generate these antigenic sites upon processing by the APC. In line with this hypothesis, we have found that cleavage of IRBP by certain endoproteinases (Asp-N, Glu-C, or V-8) produced molecules that were recognized in culture by lymphocytes sensitized to the immunopathogenic but cryptic peptide R4. This study, therefore, describes a putative Ag processing mechanism that results in IRBP recognition and, consequently, the initiation of an autoimmune process by lymphocytes sensitized against a cryptic peptide. Furthermore, experiments with R4 and other cryptic peptides have shown that cleavage fragments of up to 38 residues in length can be presented by APC, to stimulate lymphocytes sensitized against these peptides. No responses were stimulated, however, by fragments of 75 or more residues. The data thus provide new insights into the processing and presentation of cryptic peptide determinants by APC.
Asunto(s)
Enfermedades Autoinmunes/etiología , Proteínas del Ojo , Linfocitos/inmunología , Fragmentos de Péptidos/inmunología , Proteínas de Unión al Retinol/inmunología , Secuencia de Aminoácidos , Animales , Células Presentadoras de Antígenos/fisiología , Línea Celular , Epítopos/análisis , Activación de Linfocitos , Masculino , Datos de Secuencia Molecular , Ratas , Ratas Endogámicas LewRESUMEN
Interphotoreceptor retinoid-binding protein (IRBP) is a glycoprotein of 1264 residues (bovine) which localizes specifically in the retina and pineal gland and induces inflammatory changes in these organs (EAU and EAP, respectively) in immunized animals. We report here on differences between the immunological activities in Lewis rats of four IRBP-derived synthetic peptides. Only one of these peptides, designated R14 (residues: 1169-1191) is immunodominant, i.e., it has the capacity to stimulate lymphocytes sensitized against whole IRBP. The remaining peptides, R4 (1158-1180), R8 (1197-1209), and R12 (248-266), are non-dominant and are not recognized by IRBP-sensitized lymphocytes. R14 differed profoundly from the other peptides in its immunogenicity, inducing cellular immunity at the low dose of 0.1 nmol/rat, whereas the non-dominant peptides initiated immune responses at doses approximately 100 times higher. R14 was also superior to the non-dominant peptides in its antigenicity, as determined by the lowest concentration required to induce sensitized lymphocytes to proliferate. Responses were stimulated by R14 at a concentration of 10(-6) microM, while the three non-dominant peptides were stimulatory at the much higher concentration of 10(-1) microM. These data support the concept that immunodominance is linked to a high binding affinity of the peptide determinant to the major histocompatibility complex antigens on antigen-presenting cells.
Asunto(s)
Proteínas del Ojo , Péptidos/inmunología , Proteínas de Unión al Retinol/inmunología , Secuencia de Aminoácidos , Animales , Encefalopatías/etiología , Bovinos , Reacciones Cruzadas , Epítopos/inmunología , Inmunidad Celular/inmunología , Activación de Linfocitos/inmunología , Datos de Secuencia Molecular , Péptidos/síntesis química , Glándula Pineal , Ratas , Ratas Endogámicas Lew , Uveítis/etiologíaRESUMEN
Peripheral blood basophils were isolated from guinea pigs using a 2-step procedure. Initial enrichment of basophils was achieved by treating leukocyte preparations obtained from whole blood with antibody to contaminating granulocytes and mononuclear cells. Basophil populations of 82% purity (mean; range 65-99%) were obtained by subsequent application of the antibody treated preparation to discontinuous Percoll gradients. The isolated basophils were viable and shown to be functional by histamine release upon stimulation with various secretogogues.