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Biomedical subjects

D M Reifler

Publications and source records attributed to D M Reifler.

At least 37 records · Page 2Linked to original sources

Tricholemmoma of the eyelid.

Tricholemmoma is a benign cutaneous tumor that shows differentiation characteristic of the outer hair sheath. The usual site of occurrence is the face, including the nose and eyelid. Four cases of tricholemmoma involving the eyelid margin to a variable extent are presented and the clinical and pathologic findings are reviewed. In three of the four cases, a histopathologic misdiagnosis of squamous cell carcinoma was initially made. In one case, this resulted in a greater sacrifice of normal lid tissue than was necessary, although the reconstruction yielded a good result. In the subsequent cases, the entity of tricholemmoma was well appreciated before definitive oculoplastic surgery and the referring diagnosis of squamous cell carcinoma was refuted.

Aged↗

A review of chemical eye burns referred to the Blodgett Regional Poison Center.

We reviewed a random sampling of 500 cases of chemical eye exposures referred to the Blodgett Regional Poison Center from July 1, 1986 to December 31, 1986. While some injuries were encountered in laboratories and industrial plants, the great majority originated in the home (84.4%) and involved commonly used household products. Most exposures were acute and reported within minutes to 1 hr. Cases predominantly involved children suffering accidental exposure. The most common symptoms were eye discomfort (56.2%) and redness (26.4%), but many patients were completely asymptomatic (11.4%). The reported injuries included corneal burns or abrasions (23 cases), and conjunctivitis (7 cases). Only 8 cases (1.6%) were initially seen by an ophthalmologist. In virtually all cases, the recommended emergency treatment was immediate prolonged rinsing of the eye.

Accidents, Home↗

Histochemical analysis of breast carcinoma metastatic to the orbit.

A 62-year-old woman was seen for evaluation of an orbital tumor. Recognition of a relatively rare syndrome of pain, ptosis, and a progressively immobilized globe with enophthalmos suggested the diagnosis of metastatic carcinoma to the left orbit. In this case, this was confirmed by open breast and orbital biopsies, revealing infiltrating lobular breast carcinoma. This is the first reported case where estrogen and progesterone receptors were identified in a metastatic orbital tumor using fluorescent histochemical techniques. This technique was of value in confirming the diagnosis and providing direction for subsequent endocrinologic palliative therapy.

Biopsy↗

Surgical management of squamous cell carcinoma of the lid.

A series of 12 patients with eyelid squamous cell carcinoma was studied retrospectively with emphasis on the clinical presentation, management, and results. Of the five cases that constituted our personal experience, surgical excision with frozen-section control was an efficacious mode of treatment. In the overall series, there were no cases of regional lymph node metastasis and no tumor deaths. One patient required orbital exenteration. The methods of surgical extirpation of the tumor with frozen-section control, as advocated by the authors, are similar to those used in the management of basal cell carcinoma and other eyelid neoplasms. Because of the potential lethality of squamous cell carcinoma, a wider excision than that usually performed for basal cell carcinoma is recommended, as is close postoperative follow-up.

Aged↗

Ectopic epibulbar Fordyce nodules in a buccal mucous membrane graft.

A 70-year-old man underwent oral mucous membrane grafts to the right eye for presumed trachoma at the ages 26 and 32 years. A superior limbic mass within the site of the graft was found in 1983; the mass was composed of mature sebaceous glands compatible with the lesions called Fordyce nodules when located in the buccal mucosa. Recession of the levator aponeurosis and partial excision of the mass restored the upper eyelid's normal position, and visual acuity in this eye improved from 20/300 to 20/40.

Aged↗

Ablepharon macrostomia syndrome.

The ablepharon macrostomia syndrome is a severe congenital condition that includes total absence of the upper and lower eyelids, failure of lip fusion that results in an enlarged, fish-like mouth, abnormally shaped ears and nose, absence of lanugo, ventral hernia, and ambiguous genitalia. In one such patient we were able to reconstruct the eyelids in a three-stage procedure. Redundant skin from the retroauricular area was used to create full-thickness grafts. The child later underwent successful mouth reconstruction. Although developmentally delayed, the child was eventually able to sit unassisted, to grasp objects, and to follow light with some fixation. Nystagmus was severe. The retina was attached in one eye and detached in the other. Corneal opacities present initially improved in one eye, allowing a view of the pupil and a normal anterior chamber.

Cornea↗

Orbital metastasis from prostatic carcinoma. Identification by immunocytology.

We report a case in which the diagnosis of prostatic carcinoma, metastatic to the orbit, was confirmed using an immunoperoxidase technique on cytologic specimens obtained by fine-needle aspiration. Computed tomography was valuable in localizing the tumor for biopsy and subsequent radiation therapy. The results of these studies correlated with the clinical history and other evidence of widespread metastatic disease. Ironically, the first evidence of malignancy in this patient was possibly also ophthalmologic, manifesting 14 months earlier with hemorrhagic retinopathy associated with thrombocytopenia. To our knowledge, this is the first report describing the combination of an immunoperoxidase technique with the fine-needle aspiration biopsy of an orbital tumor.

Adenocarcinoma↗

Squamous cell carcinoma of the eyelid.

The occurrence of squamous cell carcinoma of the lid is reviewed with emphasis upon the incidence, clinical presentation, pathophysiology and methods of treatment. Squamous cell carcinoma accounts for about 9% of all eyelid malignancies, although it is frequently over-diagnosed by pathologists and confused histologically with other benign entities. This lesion occurs most commonly in elderly, fair-complexioned individuals with a history of chronic sun exposure and skin damage. In the lids, squamous cell carcinoma shows a variety of clinical appearances although it usually presents as a painless, hyperkeratotic lesion that gradually enlarges and eventually ulcerates. There is a tendency for lower lid and lid margin involvement. This potentially lethal neoplasm is capable of aggressive local spread or metastasis to regional lymph nodes. The development of squamous cell carcinoma is thought to progress through phases of intraepithelial squamous dysplasia and intraepidermal squamous cell carcinoma before invasive squamous cell carcinoma occurs. Various treatment modalities have been advocated including surgical extirpation with histologic control, radiation therapy and cryotherapy.

Aged↗