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Biomedical subjects

A M Putterman

Publications and source records attributed to A M Putterman.

At least 19 recordsLinked to original sources
PubMed1992

Treatment and prognosis of orbital non-Hodgkin's lymphomas.

Twenty patients with orbital lymphomas were treated and followed over a 14-year period. Ten of these patients had well-differentiated lymphocytic lymphoma (WDL), and all of them were clinical stage IE. Five patients had nodular poorly differentiated lymphocytic lymphomas (NPDL), three patients had diffuse histiocytic lymphomas (DHL), one had nodular mixed-cell lymphoma, and one had diffused mixed-cell lymphoma. The patients with WDL received local radiation therapy, and all of them entered completed remissions. The projected survival at 10 years was 100% for these patients. The patients with low-grade lymphomas with advanced disease were treated with chlorambucil and prednisone or cytoxan and vincristine. The patients with high-grade lymphomas received treatment with methotrexate, cyclophosphamide, doxorubicin, vincristine, bleomycin, dexamethasone (mBACOD) or cyclophosphamide, vincristine, methotrexate, cytosine arabinoside, leucovorin (COMLA). The overall survival estimate for all patients was 63% at 10 years. The disease-free survival was 49% at 10 years. The patients with high-grade lymphomas had a poor prognosis, with no survivors after 4 years. This study suggests that patients with WDL usually present with localized disease to the involved orbit, and have an excellent prognosis with radiation therapy alone. Patients with high-grade orbital non-Hodgkin's lymphomas have a poor outcome despite use of aggressive combination chemotherapy regimens.

Aged↗
PubMed1992

Surgical treatment of thyroid-related lower eyelid retraction: a modified approach.

A 15-year retrospective study was performed in 68 patients who underwent scleral implantation for correction of lower eyelid retraction related to Graves' disease. Three variations of the scleral implantation procedure were used over three time periods. Scleral grafting alone ("old" procedure) was performed in 53 patients from 1974 to 1985. Because of persistent lower lid retraction postoperatively, this procedure was modified. Beginning in 1986, a lateral canthal suspension consisting of either a lateral tarsal strip or a lateral tarsorrhaphy was added to the scleral implantation ("intermediate" procedure) and was performed in seven patients. Since 1988, the procedure has been further modified to include both a lateral tarsal strip and a lateral tarsorrhaphy ("new" procedure). Eight patients underwent this procedure. Analysis with Student's t test indicated a statistically significant reduction in lower lid retraction when using the new procedure, as measured by a reduction in the margin reflex distance-2, the distance from the corneal light reflex to the central lower lid (p = 0.02), and by a reduction in inferior central scleral show, the distance from the central lower lid to the inferior limbus (p = 0.02). An analysis of covariance, controlling for age, Hertel exophthalmometry readings, and length of follow-up, also indicated that the reduction in the postoperative margin reflex distance-2 was significant (p = 0.04).

Adult↗
PubMed1992

Bilateral dacryocystitis after punctal occlusion with thermal cautery.

A 61-year-old woman developed acute bilateral dacryocystitis secondary to Staphylococcus aureus 3 weeks after undergoing punctal occlusion with thermal cautery for keratoconjunctivitis sicca. The dacryocystitis resolved with intravenous antibiotics, aspiration of the lacrimal sacs, injection of sulfacetamide into the lacrimal sacs, and bilateral dacryocystorhinostomy. Preexisting bilateral nasolacrimal duct obstruction was postulated as the underlying cause. In these cases, irrigation of the lacrimal system is recommended before proceeding with punctal occlusion.

Anti-Bacterial Agents↗
PubMed1992

Conventional frozen sections in periocular basal-cell carcinoma: a review of 236 cases.

Two hundred thirty-six periocular basal-cell carcinomas were resected under conventional frozen-section control. Only two tumors recurred, yielding a success rate of 99.2%. The mean follow up was 56 months. Eighty-one of the 236 patients were followed for at least 5 years; the 5-year cure rate was 97.5%. To our knowledge, this is the largest reported series of periocular basal-cell carcinoma resected under conventional frozen-section control; also, we believe the follow-up data are superior to those of previous series. The high success rates with conventional frozen-section techniques in this and other series are comparable to those reported for the Mohs micrographic techniques.

Adult↗
PubMed1979

Müller's muscle excision and levator recession in retracted upper lid. Treatment of thyroid-related retraction.

The results of excision of Müller's muscle with or without recession of the levator palpebrae superioris aponeurosis were examined in 61 upper eyelids of 40 patients. The cosmetic results were acceptable in 35 patients (56 upper eyelids). Another five patients had a subsequent unilateral partial (nasal) or total ptosis, which was successfully treated with additional surgery. Overcorrections (ptosis) have ceased to be a problem since modifications to the original technique have been used. Only one undercorrection was encountered, and it was treated successfully with a simple surgical procedure. We believe that the described procedure is desirable for the treatment of thyroid-related upper eyelid retraction because it is simple, is based on anatomic and physiologic principles, is tailored to the individual patient intraoperatively and yields consistently good results.

Adult↗
PubMed1979

Frozen section control in the surgery of basal cell carcinoma of the eyelid.

Two groups of patients, 37 with primary basal cell carcinoma of the eyelid and 16 with basal cell carcinoma of the eyelid previously treated by other physicians were reviewed. All of the tumors were excised with at least 3 to 4 mm of normal-appearing tissue at each margin of resection. All of the excised specimens were submitted for frozen section studies of the margins. A total of 20 (54.04%) of the previously untreated tumors and eight of the previously treated tumors had at least one margin involved with tumor cells. Repeated excisions under frozen section control were done until all of the margins were free of tumor cells. To date, none of the patients treated in this manner had a recurrence of the tumor.

Adult↗
PubMed1979

Lower eyelid full-thickness vertical lengthening.

Two cases of lower eyelid retraction caused by loss of full-thickness eyelid components were successfully treated with a tarsal-confunctival flap and skin graft procedure. One patient also had upper eyelid retraction, which was decreased by excising Müller's muscle and recessing the levator aponeurosis simultaneously with the lower eyelid surgery.

Adult↗
PubMed1979

Ocular asymmetry measuring device.

An instrument that measures ocular, eyebrow, canthal, and lower eyelid asymmetries accurately is useful for evaluating various deformities before oculoplastic surgery is performed. The ocular asymmetry measuring device comprises a headband, a ruler, and a T-shaped crosspiece. When the band is placed around the patient's head at forehead level, it fixes the ruler vertically over the midforehead. The metal rod is aligned with whatever eyelid, eyebrow, eye, or canthus is lower and is then elevated until it transects a similar structure on the opposite side. The degree of asymmetry is measured in millimeters. The device is useful in determining the degree of correction needed in various conditions that result from orbital fracture, facial paralysis, and congenital anomalies.

Eye Abnormalities↗
PubMed1979

Orbital tumor evaluation.

The key tests in the evaluation of orbital pathology--orbital roentgenograms, CT scans, and ultrasonography--are defined.

Humans↗
PubMed1979

Reconstruction of absent lacrimal puncta.

A previously described technique to isolate absent lacrimal puncta is reemphasized. The procedure has been modified, whereby the entire punctal and vertical canalicular walls are removed with a Holth sclerectomy punch and by silastic intubation of the passages. This has led to increased permanent patency of the lacrimal puncta and a greater, successful resolution of epiphora. A modified pigtail probe with a narrowed tip has been developed to facilitate passage of the silastic tubing without it slipping off the probe.

Humans↗
PubMed1978

Viable composite grafting in eyelid reconstruction.

I reconstructed eyelids in two patients by successfully using a new technique to increase the viability of a composite, full-thickness eyelid graft. Splitting the graft into two components of tarsal-conjunctival-margin and skin and placing each component against a viable skin and orbicularis flap, respectively, facilitated the acceptance of the graft and increased the success of the reconstruction.

Adult↗
PubMed1978

Ectropion of the lower eyelid secondary to Müller's muscle-capsulopalpebral fascia detachment.

A patient developed severe lower eyelid ectropion after a bilateral levator aponeurosis and Müller's muscle advancement-and-truck blepharoptosis procedure and bilateral attachment of the lateral canthi to the lateral canthal tendons. The cause of this ectropion was detachment of Müller's muscle and capsulopalpebral fascia from the inferior tarsus and recession of these tissues into the orbit. This left the inferior tarsal border with only redundant conjunctiva attached to it, which could not maintain it in a downward direction; thus, an ectropion occurred. Müller's muscle and capsulopalpebral fascia were detached from the inferior tarsus and recessed 15 mm into the orbit. Reattaching Müller's muscle and capsulopalpebral fascia to the inferior tarsus relieved the ectropion.

Aged↗
PubMed1978

Müller's muscle-conjunctival resection ptosis procedure.

The Müller's muscle-conjunctival resection procedure is a relatively simple means of relieving ptosis in patients whose upper eyelids elevate to a normal level with phenylephrine instillation. The Müller's muscle-conjunctival resection procedure has advantages over the Fasanella operation because tarsus is preserved, and over the levator aponeurosis advancement and tuck operation because the results are more predictable.

Adult↗
PubMed1977

Deep ocular socket reconstruction.

A technique to reconstruct totally contracted sockets forms spacious, deep ocular fornices to accommodate ocular prostheses. Fixation of the midperiphery of mucous-membrane-lined, custommade conformers to the superior and inferior orbital rims secures the posterior periphery of the conformer deep in the orbit. The method restores the normal anatomy of the ocular fornices that not only extends to the orbital rims but also penetrates deeply into the orbit along its roof and floor. The procedure contrasts with conventional, frequently unsuccessful methods of socket reconstruction that form fornices only to the superior and inferior orbital rims without extending posteriorly into the orbit. Using this technique, we reconstructed deep, spacious sockets in five patients with serious socket contracture, allowing the patients to retain cosmetically acceptable artificial eyes. The principles advocated apply to all contracted sockets.

Adolescent↗