Biomedical subjects

J A Foster

Publications and source records attributed to J A Foster.

At least 37 records · Page 2Linked to original sources

PubMed2000

A comparison of manual kinetic and automated static perimetry in obtaining ptosis fields.

OBJECTIVE: To compare examination time and visual field loss for ptosis fields obtained with manual kinetic (Goldmann) perimetry and automated static (Humphrey) perimetry. METHODS: Both eyes of 12 patients with bilateral aponeurogenic ptosis were prospectively examined using Goldmann and Humphrey (ptosis protocol) perimetry with the eyelids ptotic and taped into a normal position. RESULTS: Bilateral examination time for Goldmann fields was 10 +/- 2 minutes and for Humphrey fields was 50 +/- 10 minutes (P<.001, n = 12). Superior fields at the 12:00 meridian were 46 degrees +/- 6 degrees taped, and 28 degrees +/- 12 degrees untaped for Goldmann perimetry (P<.001), and 38 degrees +/- 8 degrees taped, and 24 degrees +/- 12 degrees untaped for Humphrey perimetry P<.001). Goldmann field loss was 18 degrees +/- 9 degrees (taped minus untaped). Humphrey field loss was 14 degrees +/- 13 degrees (P<.04, n = 24). Mean Goldmann radial fields were 56 degrees +/- 6 degrees taped and 39 degrees +/- 13 degrees untaped (P<.001). Goldmann superior hemifield areas were 5,167 +/- 964 degrees2 taped and 2,830 +/- 1,466 degrees2 untaped (P<.001). Humphrey mean vertical superior hemifield was 37 degrees +/- 9 degrees taped and 21 degrees +/- 11 degrees untaped (P<.001). Mean sensitivity of Humphrey fields was 15 +/- 3 dB taped and 9 +/- 5 dB untaped (P<.001). Mean vertical center of gravity was 23 degrees +/- 3 degrees taped and 16 degrees +/- 5 degrees untaped (P <.001). CONCLUSION: Goldmann manual kinetic and Humphrey automated static visual field testing are both effective in documenting ptosis associated visual field loss. Humphrey automated ptosis fields, as performed in this study, require longer examination times than Goldmann manual fields and may be a less sensitive indicator of field loss.

Adult↗

PubMed2000

Blepharoptosis surgery complicated by late suture migration.

PURPOSE: To report late suture migration as a complication of blepharoptosis surgery. METHOD: Case reports. RESULTS: After upper eyelid blepharoptosis repair, two eyes of two patients developed unusual foreign body reactions and ulceration in the conjunctiva caused by migration of nonabsorbable suture from the levator aponeurosis to the upper conjunctival fornix. The foreign body caused eyelid edema, papillary changes in the upper tarsal conjunctiva, recurrent blepharoptosis, and a foreign body sensation that started more than 3 months after the surgery and persisted until the suture was removed. The sutures, hidden in edematous conjunctiva of the superior fornix, eluded detection. CONCLUSIONS: Foreign body reaction secondary to suture migration is an uncommon complication of blepharoptosis repair.

Adult↗

PubMed2000

Orbital compartment syndrome caused by intraorbital bacitracin ointment after endoscopic sinus surgery.

PURPOSE: To present an unusual case of orbital compartment syndrome after endoscopic sinus surgery. METHODS: Case report. RESULTS: Acute proptosis, chemosis, decreased vision, and ophthalmoplegia were found immediately after endoscopic sinus surgery. Ophthalmologic evaluation showed a tense orbit, and intraocular pressure increased to 54 mm Hg. Treatment was initiated and the intraocular pressure dropped. Computed tomography (CT) revealed the presence of bacitracin ointment in the orbit. CONCLUSION: Ophthalmic complications after sinus surgery are well identified. Postoperative orbital compartment syndrome may be caused by retrobulbar hemorrhage, edema, air (emphysema), or foreign material. In this case, the findings were caused by inadvertent injection of bacitracin ointment into the orbit.

Aged↗

PubMed2000

Oculoplastic surgical techniques for protection of the eye in facial nerve paralysis.

OBJECTIVE: To describe an algorithm for medical and surgical management of corneal exposure secondary to seventh cranial nerve paresis. STUDY DESIGN: A retrospective review of 54 patients requiring surgical intervention for seventh cranial nerve paresis was performed. SETTING: Patients underwent outpatient procedures at a tertiary care facility. RESULTS: 31 men and 23 women, with a mean age of 55.7 years, were included in this study. They included 45 patients with involvement of the facial nerve at the time of surgery, 3 with inflammatory processes, 2 with central palsies, 1 with a traumatic paralysis, and 3 with idiopathic palsies. All 54 patients were treated both medically and surgically. Fifty-two patients underwent gold weight placement, and 39 patients underwent surgical repositioning of their lower eyelids; 24 of those patients had supplemental ear cartilage grafts inserted as well. Five patients had brow ptosis repairs, and 13 had tarsorrhaphies (9 temporary and 4 permanent). Twelve patients had confluent epithelial defects of >50% of their corneal surface, and 33 patients had smaller disruptions of their corneal epithelium. Three patients had minor complications secondary to surgical intervention. Thirty-seven patients had isolated seventh nerve palsies, and 17 patients also had fifth nerve pareses affecting their ocular surfaces. The average preoperative lagophthalmos was 6.3 mm, and the average postoperative lagophthalmos after all ocular procedures was 1.6 mm. The mean follow-up time was 19.7 months. CONCLUSIONS: Treatment options for seventh cranial nerve deficits are reviewed. A decision-making process for the treatment steps is proposed and analyzed.

Adult↗

PubMed2000

Mohs surgery and processing: novel optimizations and enhancements.

OBJECTIVE: Simple yet effective modifications to Mohs surgery and processing may enhance procedural efficiency, ensure proper tissue orientation and tracking, while greatly reducing "recuts." Using the methods described, Mohs specimens no longer need to be incised or excised with any bevel, thus conserving tissue and facilitating closure. METHODS: A streamlined Mohs surgical tray is convertible to a closure tray within seconds. The excised tissue specimen is oriented on a sterile paper square on a reusable sterilized aluminum palette where partial thickness circumferential and radial scalpel cross-hatching allows epidermal edges complete freedom to later adhere to a flattening glass. The sterile paper can be labeled with patient name, stage number, and chuck number; then the specimen is inked. Rapid chuck freezing in a specially positioned liquid nitrogen immersion is followed by OCT (embedding compound) application. Uniquely numbered and modified cryostat chucks eliminate the possibility of OCT-chuck disunion. Rapid liquid nitrogen immersion of a glass surface allows the inked, cross-hatched specimen's epidermal edges and base to lay perfectly flat once forced against the supercooled glass surface using a special polymer glove. Inversion of the specimen-containing glass onto a frozen and gel state OCT interface of the chuck completes the embedding. RESULTS/CONCLUSION: These reproducible approaches to Mohs surgery described herein utilize multiple modifications that enhance the speed, efficiency, and reproducibility of Mohs specimen embedding, specimen preparation, while maintaining accuracy of interpretation.

Humans↗

PubMed2000

Browlift with botulinum toxin.

BACKGROUND: Botulinum toxin has been used successfully for the treatment of hyperfunctional facial lines. OBJECTIVE: To determine the alteration in brow position after botulinum toxin treatment of the brow depressor muscles. METHODS: Eleven women, 30-60 years old, were treated. Prior to treatment, brow position was measured relative to the pupil. Relaxed position and elevated position with frontalis contraction were evaluated. Botulinum toxin was injected into bilateral eyebrows. Each brow received one injection into the glabellar region (5 U) and four equally spaced injections along the lateral orbital rim below the brow (total of 10 U). Brow position was measured for postinjection relaxed and elevated positions at three points, from the central pupil to the nasal, central, and temporal brow. RESULTS: A statistically significant elevation of the right and left brows was observed in both relaxed and elevated positions. The largest mean elevations were noted in the right central brow position (relaxed 1.86 mm, elevated 2.09 mm) and the left central brow position (relaxed 3.06 mm, elevated 2.86 mm). CONCLUSION: Botulinum toxin is a safe and effective treatment for temporary browlift. The elevations produced in the nasal, central, and temporal brow can produce an aesthetically pleasing female brow with desirable shape and height.

Adult↗

PubMed2000

Electrosurgical suspension apparatus.

BACKGROUND: Dermatologic surgeons commonly employ electrosurgery. OBJECTIVE: We describe a novel, yet simple, electrosurgical suspension apparatus and variations that facilitate the performance of excision and repair, Mohs micrographic surgery, cosmetic surgery, and other forms of dermatologic surgery. METHODS: The described techniques result from more than a decade of use and refinements in electrosurgical suspension apparatuses. RESULTS: The use of an electrosurgical suspension device has eliminated electrosurgical needle stick injuries, facilitated surgery, and reduced the risk of surgical field contamination via the electrosurgical handpiece or wiring. CONCLUSION: The use of a suspended electrosurgical handpiece results in reduced surgical time, eliminates many of the inconveniences associated with the current use of electrosurgery, and facilitates the use of electrosurgery as a tool of the dermatologic surgeon.

Electrosurgery↗

PubMed2000

The liposuction apparatus "suspension device": hi-plane liposculpture.

BACKGROUND: The improvement of liposuction equipment and techniques has resulted in a cumbersome operating room array of aspirator hoses, irrigation/infiltration tubing, and the insulated command and control wiring of current ultrasonic or power liposuction devices. This situation is further complicated by the presence of a second surgeon, the concomitant use of additional traditional or ultrasonic cannulas, and the suction hose of a second aspirator. OBJECTIVE: To solve the problems of sterility and operating room organization, the authors describe a simple, releasable suspension design. METHOD: This apparatus can be temporarily or permanently installed in minutes and is easily maintained to control numerous sterile hoses and wires required for certain liposuction procedures. RESULTS: This suspension method appeared to enhance the efficiency and ease of use by single and dual surgeons during cases utilizing ultrasonic and nonultrasonic cannulas. The time savings and ease of use was most noticeable in cases of dual surgeons using both ultrasonic and nonultrasonic systems simultaneously. In addition, surgical personnel were freed for other tasks. Single-surgeon, traditional liposuction was less notably facilitated in terms of speed and fewer personnel. However, wiring and tubing control is facilitated in any case. CONCLUSION: A simple liposuction suspension system facilitates the liposuction procedure to varying degrees depending upon the number of surgeons and devices in simultaneous use.

Humans↗

PubMed2000

Pharmacology of botulinum toxin.

BACKGROUND: Botulinum toxin has a well-defined role among dermatologists for the treatment of facial wrinkling, brow position, and palmar and axillary hyperhidrosis. OBJECTIVE: The purpose of this study is to educate dermatologists on the pharmacology of botulinum toxin. METHODS: A retrospective review of the literature on botulinum toxin from 1962 to the present was conducted. We examined the clinical applications of botulinum toxin, cholinergic neuromuscular transmission, the toxin's structure and molecular actions, drug and disease interactions at the neuromuscular junction, toxin assays, determinants of clinical response, and adverse side effects. RESULTS: Botulinum toxin blocks the release of acetylcholine from the presynaptic terminal of the neuromuscular junction. Several drugs and diseases interfere with the neuromuscular junction and the effects of botulinum toxin. The mouse bioassay, the most sensitive and specific measurement of toxin activity, is the gold standard for botulinum toxin detection and standardization. The major determinants of clinical response to treatment are the toxin preparation, individual patient's anatomy, dose and response relationships, length of toxin storage after reconstitution, and immunogenicity. To minimize potential antibody resistance, one should use the smallest effective dose, utilize treatment intervals of more than 3 months, and avoid booster injections. Uncommon adverse effects include ptosis, ectropion, diplopia, bruising, eyelid drooping, hematoma formation, and temporary headaches. CONCLUSION: Botulinum toxin is a safe and effective treatment. Knowledge of the pharmacologic basis of therapy will be useful for standardizing techniques and achieving consistent therapeutic results in the future.

Acetylcholine↗

PubMed2000

Orbital extension of a frontal sinus osteoma in a thirteen-year-old girl.

Osteomas are uncommon, slow-growing, benign osteogenic neoplasms that arise most frequently in the craniofacial skeleton. (1,2) Osteoma is the most common benign tumor of the nose and paranasal sinuses and the most common neoplasm of the frontal sinus. (3-5) Paranasal sinus osteomas originate in the sinus wall, fill the lumen with well-defined mature osseous tissue, and occasionally extend into the orbit where they give rise to orbital signs and symptoms. Osteomas most commonly become symptomatic in the second to fifth decade in life, but orbital involvement has rarely been reported in patients aged 18 years and younger. (2,6-10) We report a case of a frontal sinus osteoma with orbital extension in a 13-year-old girl.

Adolescent↗

PubMed2000

DNA preparation method can influence outcome of transgenic animal experiments.

In our continuing quest to improve the efficiency of producing transgenic animals, we have compared the influence of two transgene purification techniques on the efficiency of creating transgenic sheep and mice. Three hundred eighty-seven sheep zygotes and 2,737 mouse zygotes were microinjected with one of four transgenes. Transgenes were isolated from plasmid sequences either by agarose gel electrophoresis followed by gel extraction or by a single step sodium chloride gradient fractionation technique. Four transgenic sheep and 61 transgenic mice were produced. Both sheep and mice embryos responded similarly to transgene preparation methods. Overall, pregnancy rate was higher for recipients that received embryos injected with NaCl purified DNA (mean +/- SEM: 64 +/- 7% vs. 38 +/- 7%). Furthermore, offspring per zygote transferred (NaCl, 22 +/- 3% vs. Gel, 12 +/- 3%) and transgenics born per zygote transferred (NaCl, 3.9 +/- 0.6% vs. Gel, 1.5 +/- 0.6%) were higher when the NaCl purified DNA was used. However, the proportion of offspring born that were identified as transgenic did not differ between transgene purification methods. Transgenes responded differently to methods of preparation. One of the four genes yielded a significantly higher proportion of transgenics when the transgene was prepared by NaCl purification. These data suggest that on average the NaCl gradient purification technique results in a higher embryo survival rate to term for both sheep and mice, but the technique has no influence on rate of transgene integration.

Animals↗

PubMed2000

Effects of perturbation of cell polarity on molecular markers of sperm-egg binding sites on mouse eggs.

The mouse germinal vesicle (GV)-intact oocyte is a symmetric cell, with the GV centrally localized and with components of the plasma membrane and cortex symmetrically distributed around the periphery of the oocyte. During oocyte maturation, two distinct regions of the egg plasma membrane and cortex develop: the amicrovillar region overlying the meiotic spindle and the microvillar region. The development of this polarity is significant, since sperm bind to and fuse with the microvillar region. We are interested in the development of egg polarity and have characterized the localizations of several markers for egg polarity in normal metaphase II eggs and GV-intact oocytes. The asymmetric distributions of these markers (including actin, cortical granules, binding sites for the sperm proteins fertilin alpha and fertilin beta, and two different beta(1) integrin epitopes) develop during oocyte maturation in vitro, and this polarity can be perturbed by treatments that disrupt the actin microfilaments or microtubules. In addition, immunoelectron microscopy reveals that binding sites for recombinant fertilin beta are specifically localized to the microvillar region, suggesting that the binding sites for this sperm ligand are either specifically localized or activated in this region. These results indicate that structural remodeling of the mouse egg plasma membrane is accompanied by molecular remodeling, resulting in the localization or activation of specific molecules in subdomains of the plasma membrane.

ADAM Proteins↗

PubMed2000

Electrosurgical modification of orbicularis oculi hypertrophy.

PURPOSE: To assess two electrosurgical approaches for the modification of orbicularis hypertrophy that may be used in conjunction with, or separate from, lower lid blepharoplasty. The hypothesis to be tested is that purely electrosurgical nonexcisional techniques may be used to modify orbicularis oculi muscle. METHODS: Electrosurgical techniques to treat orbicularis hypertrophy with an "open" and a "closed" technique are described. The open technique is performed in conjunction with transconjunctival blepharoplasty. The closed technique requires a 1-mm to 2-mm dermal incision, 2 minutes of surgical time per eyelid, and a specially insulated and formed electrosurgical needle. A review and case series are presented to illustrate and describe the techniques and results. RESULTS: Results for both techniques were rated by both patients and surgeons using the categories of poor, fair, good, or excellent. The open technique was performed in conjunction with transconjunctival blepharoplasty on 23 patients during 2 years with a minimum follow-up of 6 months. Results for the open technique were considered "excellent" by 14 patients and "good" by 9 patients. The operating surgeons evaluated the improvement as "excellent" in 4, "good" in 11, and "fair" in 8 patients. The closed technique was performed on eight patients. Results for patient satisfaction for the closed technique were considered "good" by 4, "excellent" by 2, "fair" by 1, and the final patient abstained from categorization. Operating surgeon evaluation of the closed technique revealed "excellent" outcomes in 3, "good" in 3, and "fair" for 2 patients. CONCLUSION: Electrosurgical techniques may be used to modify orbicularis hypertrophy. Drawbacks include a significant learning curve, potential cutaneous ulceration, and occasional temporary anatomic distortion as manifested by scleral show. Complications are minimal, and the technique was safe in all patients studied.

Adult↗

PubMed2000

Outpatient pediatric blood cultures: time to positivity.

OBJECTIVE: Using a continuously monitoring blood culture system, we determined the time to positivity of blood cultures performed on immunocompetent infants and children who were not receiving antibiotics at the time of culture. STUDY DESIGN: This study was conducted prospectively using blood cultures taken in the emergency department and outpatient clinics of an urban pediatric teaching hospital from February 1, 1993, through December 31, 1996. Cultures were excluded if obtained from patients receiving antibiotics, patients with a central line, patients with prosthetic devices, or those being followed by the oncology division. Our measures included: 1) recording the time to positive culture obtained by using a continuously monitoring blood culture instrument, 2) patient information derived from the hospital computer system concerning antibiotic use and the presence of indwelling central venous catheters and prosthetic devices, and 3) a chart review of 10% of patients from whom positive cultures were obtained. RESULTS: During the 47-month study period, 10 200 single bottle blood cultures were obtained, 711 (6.97%) of which became positive. Patients ranged in age from <1 week to 24 years (mean: 2.00 years). Two hundred fifty-eight cultures (36.3%) contained only pathogens, 370 (52%) contained only skin contaminants, and 83 (11.7%) contained a mixture of contaminant and pathogen. Of the 258 cultures containing only pathogens, 14% were positive by 12 hours, 87% by 24 hours, 92% by 36 hours, 95% by 48 hours, 98% by 60 hours, and 99.7% by 72 hours. Ninety-five percent of critical pediatric pathogens including Streptococcus pneumoniae, Salmonella and other Enterobacteriaceae, Neisseria meningitidis, and groups A and B streptococci were detected in <24 hours. CONCLUSION: Because 87% of all cultures containing pathogens were detected within the first 24 hours of incubation, this study can assist emergency department, clinic, and primary care clinicians when making critical decisions concerning patients on whom blood cultures were obtained. Data on time to positivity of blood cultures can be used in conjunction with clinical status to support clinicians in making patient management decisions. Use of short stay (</=24 hours) or extended care units requiring less patient supervision may be easier to justify when a continuously monitoring blood culture instrument is used in the microbiology laboratory.bacteremia, sepsis.

Adolescent↗

PubMed1999

Basic fibroblast growth factor decreases elastin gene transcription through an AP1/cAMP-response element hybrid site in the distal promoter.

Previous studies demonstrated that basic fibroblast growth factor (bFGF) decreases elastin gene transcription in pulmonary fibroblasts. In this study we pursue the identification of the element and the trans-acting factors responsible. Gel shift analyses show that bFGF increases protein binding to a sequence located at -564 to -558 base pairs (bp), which possesses homology to both AP1 and cAMP-response consensus elements yet displays a unique affinity for heterodimer binding. Site-directed mutation of the -564- to -558-bp sequence results in an increase in promoter activity and abrogates the effect of bFGF. Western blot analysis shows that bFGF induces a sustained increase in the steady-state levels of Fra 1, and co-transfection of a Fra 1 expression vector with an elastin promoter reporter construct results in an inhibition of elastin promoter activity. Overall the results suggest that bFGF represses elastin gene transcription by increasing the amount of the Fra 1 that subsequently binds to the -564- to -558-bp as a heterodimer with c-Jun to form an inhibitory complex. We propose that the identified bFGF response element can serve to down-regulate elastin transcription in elastogenic cells and, conversely, can serve to up-regulate elastogenesis in cells where endogenous bFGF signaling is attenuated or altered.

Animals↗

PubMed1999

Choreoathetoid movements in cocaine dependence.

BACKGROUND: To evaluate the severity of choreoathetoid movements in cocaine dependent (CD) subjects and age-matched normal control subjects. METHODS: Choreoathetoid movements were evaluated using the Abnormal Involuntary Movement Scale (AIMS) in samples of 71 CD, 56 normal control, and 9 amphetamine-dependent male subjects. RESULTS: The CD subjects had a significantly increased nonfacial (limbs plus body) AIMS subscore. When the nonfacial AIMS scores of the two groups were compared in relation to age, a significant age by diagnosis interaction was observed, indicating that the differences between groups were most marked in the younger age groups. The facial AIMS scores were also increased but only in the youngest CD cohort (under 32 years of age). The comparison group of 9 younger amphetamine-dependent subjects also showed increased AIMS scores. CONCLUSIONS: Increases in choreoathetoid movements in younger cocaine and amphetamine-dependent subjects may be related to their psychostimulant use. The absence of differences in choreoathetoid movements between the older CD subjects and normal control subjects may represent an age-related self-selection effect.

Adult↗

PubMed1999

Magnetic resonance imaging evidence of "silent" cerebrovascular toxicity in cocaine dependence.

BACKGROUND: Cocaine and its metabolites can produce vasospasm. Cocaine-dependent (CD) patients are at increased risk for stroke, and a high frequency of brain perfusion defects has been observed in clinically asymptomatic CD subjects. This is the first controlled magnetic resonance imaging (MRI) study of clinically asymptomatic CD subjects. METHODS: Two age-matched groups of male subjects (61 CD and 57 control) participated in the study. Subjects with a history of neurologic symptoms or major medical or neurologic illness, such as hypertension, diabetes, or significant head trauma, were excluded. The severity of hyperintense lesions observed on T2-weighted MRI images were rated on a 0-3-point scale by an experienced radiologist who was blind to all clinical data. Ratings of 3 were felt to be significant indicators of a possible disease process and were used in the data analysis. Three regions were separately rated: the cerebral white matter, subinsular white matter, and subcortical gray matter (basal ganglia and thalamus region). RESULTS: Despite the exclusion criteria minimizing risk factors for cerebrovascular events, 17 of the 61 (27.9%) CD subjects and 4 of 57 (7%) of the control subjects had severe hyperintense lesions suggestive of subclinical or "silent" anoxic vascular events. Significant group differences were observed in the two white matter regions but not in the subcortical gray matter region. The risk of severe white matter lesions in the CD group increased with age, reaching 50% in the oldest age quartile (46-58 years), and this increase was not related to the number of years cocaine was used. CONCLUSIONS: The data suggest that asymptomatic CD patients are a heterogeneous population with a significantly increased age-related risk of white matter neurovascular toxicity. Premature neurovascular damage may impact treatment outcomes and, as the CD population ages, may manifest as an increased incidence of cognitive deficits.

Adult↗

PubMed1999

The monomeric GTP binding protein, rab3a, is associated with the acrosome in mouse sperm.

Exocytosis of the sperm acrosome is an obligate precursor to successful egg penetration and subsequent fertilization. In most mammals, acrosomal exocytosis occurs at a precise time, after sperm binding to the zona pellucida of the egg, and is induced by a specific component of the zona pellucida. It may be considered an example of regulated secretion with the acrosome of the sperm analogous to a single secretory vesicle. Monomeric G proteins of the rab3 subfamily, specifically rab3a, have been shown to be important regulators of exocytosis in secretory cells, and we hypothesized that these proteins may regulate acrosomal exocytosis. Using alpha[32P] GTP binding to Immobilon blotted mouse sperm proteins, the presence of three or more monomeric GTP binding proteins was identified with Mr = 22, 24, and 26 x 10(3). Alpha[32P] GTP binding could be competed by GTP and GDP, but not GMP, ATP, or ADP. Anti-peptide antibodies specific for rab3a were used to identify the 24 kDa G protein as rab3a. Using immunocytochemistry, rab3a was localized to the head of acrosome-intact sperm and was lost during acrosomal exocytosis. It was identified in membrane and cytosolic fractions of sperm with the predominant form being membrane-bound, and its membrane association did not change upon capacitation. Immunogold labeling and electron microscopy demonstrated a subcellular localization in clusters to the periacrosomal membranes and cytoplasm. These data identify the presence of rab3a in acrosomal membranes of mouse sperm and suggest that rab3a plays a role in the regulation of zona pellucida -induced acrosomal exocytosis.

Acrosome↗