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Biomedical subjects

J J Dutton

Publications and source records attributed to J J Dutton.

At least 37 records · Page 2Linked to original sources
PubMed1994

Hürthle cell carcinoma metastatic to the uvea.

BACKGROUND: The authors present a case of Hürthle cell carcinoma metastatic to the uvea in a patient with known Hürthle cell tumor of the thyroid. The fluorescein angiogram suggested a neoplastic lesion, and the collar-button configuration resembled a malignant melanoma. However, standardized echography revealed high internal reflectivity and an irregular acoustic structure suggestive of a metastatic carcinoma. METHODS: The clinical history and examination were consistent with the diagnosis of metastatic Hürthle cell carcinoma of the eye. Results of a fine-needle aspiration biopsy and histopathology of the intraocular lesion confirmed the diagnosis. RESULTS: Because this was the patient's better-seeing eye, the tumor was treated with an 125I radioactive episcleral plaque. Over the subsequent 27 months, the lesion demonstrated a gradual regression. CONCLUSIONS: We have not found any previously reported cases of Hürthle cell carcinoma of the thyroid metastatic to the eye. The diagnosis may be confirmed safely by intraocular aspiration biopsy. The lesion is responsive to radioactive plaque application. The origin, pathology, and management of this unusual tumor are reviewed.

Adenocarcinoma↗
PubMed1992

Rate of vascularization of coralline hydroxyapatite ocular implants.

Twelve patients received a coralline hydroxyapatite sphere as a buried integrated ocular implant after enucleation surgery. The implant was modified by drilling 5 access holes, 1 mm in diameter, to the center of the sphere to allow more rapid host tissue ingrowth. 99Tc MDP static and dynamic bone scan studies were performed at various intervals after implantation to confirm the time course for vascularization. Complete vascularization was noted in 1 of 2 patients at 8 weeks after surgery, in 7 of 7 patients at 10 to 12 weeks, and in 3 of 3 patients at 16 weeks. This modified technique allows the hydroxyapatite ocular implants to be drilled for the final motility peg at an earlier time than currently possible, thereby resulting in more rapid cosmetic rehabilitation and obviating the need for secondary modification or replacement of the prosthesis.

Bone and Bones↗
PubMed1992

Influence of coralline hydroxyapatite used as an ocular implant on the dose distribution of external beam photon radiation therapy.

Coralline hydroxyapatite spheres are used as buried integrated ocular implants after enucleation or evisceration surgery. Because such implants are used after surgery for intraocular malignancy and because some patients may require postoperative radiation therapy for orbital tumor recurrence, the radiation attenuation characteristics of the implant are of interest. The authors evaluated the attenuation and scattering properties of coralline hydroxyapatite implants using a 4 MV photon beam and film dosimetry. Optical density analyses indicate that coralline hydroxyapatite implants have no significant influence on the attenuation or scattering properties of the photon beam. As such, there is no basis for concern that such implants might adversely affect external beam photon irradiation.

Absorptiometry, Photon↗
PubMed1991

A 20-year series of orbital exenteration.

We reviewed patient records of 99 consecutive orbital exenterations performed between 1969 and 1988. Patients ranged in age from 2 to 86 years (mean, 55.9 years). Classification of cases on histopathologic criteria showed 32 exenterations were performed for squamous cell carcinoma originating in the paranasal sinus (13), skin (12), conjunctiva (six), and lacrimal sac (one). Orbital exenteration was performed for treatment of other epithelial malignancy in basal cell carcinoma (eight), sebaceous carcinoma (six), adenoid cystic carcinoma (five), undifferentiated carcinoma (four), adenocarcinoma (two), intraepithelial carcinoma of the conjunctiva (two), benign mixed tumor (one), and transitional cell carcinoma (one). Exenterations were performed for melanoma of the conjunctiva (ten), nasosinus (three), skin (two), orbit (two), and choroid (one). Exenterations were also performed as treatment for mucormycosis (five), meningioma (three), fibrosarcoma (two), rhabdomyosarcoma (two), hemangiopericytoma (two), orbital cellulitis (one), fibrous histiocytoma (one), schwannoma (one), lymphangioma (one), benign lymphoepithelial lesion (one), and undifferentiated malignancy (one).

Adolescent↗
PubMed1991

Coralline hydroxyapatite as an ocular implant.

Fifty patients received a coralline hydroxyapatite sphere as a buried integrated ocular implant after enucleation or evisceration surgery. The surgical technique is described and the results discussed. All patients obtained final prosthetic motility superior to that possible with simple spherical methylmethacrylate implants. After a follow-up of 2 to 27 months (mean, 10.4 months) there have been no cases of migration or extrusion. Complications have been minimal and easily managed. The hydroxyapatite implant appears to offer excellent cosmetic reconstruction without the unacceptable infection and extrusion rates seen with other integrated implants.

Durapatite↗
PubMed1991

Optic nerve gliomas and meningiomas.

Optic nerve gliomas are benign astrocytic neoplasms that primarily affect children. The ultimate prognosis for vision is poor. For lesions confined to the optic nerves, long-term survival is excellent, but with involvement of the chiasm and especially of the hypothalamus or third ventricle, prognosis falls significantly. For this group, no form of therapy has proven to be of any benefit. Optic sheath meningiomas are neoplasms arising from arachnoid cap cells. They primarily affect middle-aged adults. Like gliomas, the prognosis for vision is poor, but unlike gliomas, prognosis for life is excellent.

Cranial Nerve Neoplasms↗
PubMed1990

Polytef (polytetrafluoroethylene) alloplastic grafting as a substitute for mucous membrane.

Nine patients with contracted sockets, cicatricial conjunctival shortening, or severe symblepharon formation were treated by temporary grafting with polytef (polytetrafluoroethylene) alloplastic surgical membrane in place of autogenous mucous membrane. Within 2 weeks of the grafting, the patients' residual conjunctival epithelium grew beneath the alloplastic membrane and covered the raw surfaces of the reconstructed socket. The procedure produced satisfactory results in eight of nine patients without the need for harvesting mucous membrane from the mouth or nose. Healing was rapid and without the discomfort and potential complications associated with grafting of autogenous mucosa.

Aged↗
PubMed1990

Whitnall's sling for poor function ptosis.

Severe unilateral ptosis with poor levator function has previously been treated with maximal levator muscle resection or bilateral or unilateral frontalis suspension. One of us (R.L.A.) has developed a technique called "Whitnall's sling," where only the levator aponeurosis is resected, preserving Whitnall's ligament and its attachments. Whitnall's ligament and the underlying resected levator muscle are sutured to the superior portion of the tarsal plate. This surgery preserves levator muscle, Müller's muscle, and Whitnall's ligament without altering the structures that produce the three-layer tear film. In 69 eyelids operated on between July 1976 and July 1986, in which a minimum of 1 year of follow-up by one of use was obtained, results have been satisfactory and directly related to levator function. We believe this technique to be anatomically and physiologically superior to "maximal levator resection" with similar long-term results. More recent results have shown that the addition of a 5-mm superior tarsectomy provides an additional elevation of 1 to 1.5 mm. Whitnall's sling is best suited for cases where the opposite fissure height is 9 mm or less and levator function of the ptotic eyelid is 3 to 5 mm.

Adolescent↗
PubMed1990

Presumed choroidal metastasis of Merkel cell carcinoma.

Merkel cell carcinoma is a rare skin tumor of neural crest origin and is part of the amine precursor uptake and decarboxylase system. It typically occurs on the face of elderly people. Distant metastasis is almost uniformly fatal. Choroidal metastasis, to our knowledge, has not been described. We report a patient with Merkel cell carcinoma who had a synchronous solid choroidal tumor and a biopsy-proven brain metastasis. Our 56-year-old patient presented with a rapidly growing, violaceous preauricular skin tumor. Computed tomography of the head disclosed incidental brain and choroidal tumors. Light and electron microscopy of biopsy specimens of both the skin and the brain lesions showed Merkel cell carcinoma. Ophthalmoscopy, fluorescein angiography, and A and B echography revealed a solid choroidal mass. The brain and skin tumors responded well to irradiation. A radioactive episcleral plaque was applied subsequently to the choroidal tumor. All tumors regressed, and the patient was doing well 28 months later. To our knowledge this is the first case of presumed choroidal metastasis of Merkel cell carcinoma.

Biopsy↗
PubMed1989

Standardized echography in the diagnosis of lacrimal drainage dysfunction.

Fifteen patients with symptoms of nasolacrimal duct obstruction were evaluated with B-scan and standardized A-scan ultrasonography. Results were correlated with findings on routine clinical tests of lacrimal drainage function, and echographic findings were confirmed at surgery in all cases. Ten normal lacrimal systems were also examined. In all patients the lacrimal sac and duct were easily visualized as an echolucent defect bounded by the bony lacrimal crests. Abnormal dilatation, diverticuli, and inflammatory exudates were readily detected. Surgically created dacryocystorhinostomy ostia were imaged on both A- and B-scans, as were obstructing membranes seen before surgical revision. Physiologic lacrimal pump failure could not be evaluated, and the exact site of obstruction could not be determined.

Adolescent↗
PubMed1989

Gasserian ganglion schwannoma with orbital extension.

A patient with painless proptosis and no associated neurologic symptoms was found to have a cystic retrobulbar orbital mass. The initial computed tomography (CT) scan did not demonstrate any intracranial involvement. On orbital biopsy a schwannoma was encountered and repeat CT scan with contrast revealed a large middle cranial fossa mass with extension into the orbit through the optic canal and superior orbital fissure. On lateral transfrontal craniotomy the lesion was noted to arise from the gasserian ganglion and to involve the right cavernous sinus. Subtotal resection was performed, and the patient has remained asymptomatic and free of recurrence for 18 months.

Cranial Nerve Neoplasms↗
PubMed1988

Primary orbital leiomyosarcoma. A case report and review of the literature.

An 82-year-old woman presented with a five-week history of painless proptosis. Results of clinical evaluation, including computed tomography, were consistent with a benign orbital tumor. Biopsy followed by surgical resection disclosed leiomyosarcoma. We reviewed the literature and studied the clinical spectrum of this rare disease of the orbit.

Aged↗
PubMed1988

Photochemical initiation of thrombosis. Fluorescein angiographic, histologic, and ultrastructural alterations in the choroid, retinal pigment epithelium, and retina.

A new method of producing vascular occlusion, photochemical activation of intravenously injected rose bengal, was used to produce experimental thrombosis of the preretinal and choroidal blood vessels in rabbit eyes. Fluorescein angiography and light and electron microscopy were used to describe the resultant pathologic alterations over time. As early as one hour after treatment, the endothelium of both preretinal and choroidal blood vessels was severely damaged or completely obliterated, and platelet aggregates occluded the vascular lumina. Occlusion of the preretinal and choroidal blood vessels persisted for up to three days; however, endothelial regeneration and reperfusion had occurred in both vascular beds by seven days. In addition, the retinal pigment epithelium and myelin wings suffered ischemic damage. The retinal pigment epithelium began to recover by seven days, but the myelin wings appeared to be irreversibly damaged.

Animals↗
PubMed1988

Long-term results and complications of botulinum A toxin in the treatment of blepharospasm.

The authors review their long-term results and complications with the use of botulinum A toxin in the treatment of facial dystonias. Two hundred thirty-two patients in three diagnostic groups--essential blepharospasm, hemifacial spasm, and Meige's syndrome--were treated with botulinum A toxin. A total of 1044 treatments were given over a 4-year period. A reduction in orbicularis spasm intensity was noted in 1012 (96.9%) treatments (mean duration, 13.3 weeks). There was no clear relationship between toxin dose and the amount of spasm reduction or duration of response, and average duration of beneficial effect remained constant from the first through the twelfth injections. Complications occurred in 236 (22.6%) treatments. In most cases, these were local and transient. Symptomatic dry eye was the most common side effect, noted in 7.5% of cases. Ptosis was reported in 7.3% of treatments and photophobia in 2.5%. Diplopia involving the inferior oblique or lateral rectus muscles was seen in less than 1% of cases. There were no differences in degree of response or in complications among the three diagnostic groups, although there was a slight difference in duration of effect. Patients who had undergone previous eyelid surgery for blepharospasm did not respond differently from those without prior surgery.

Adult↗
PubMed1988

Chronic hematic cyst of the orbit.

Three middle-aged male patients had painless superior temporal orbital tumor causing globe displacement. Roentgenograms revealed superior temporal orbital tumor with lysis of bone. Surgical excision and curettage completely removed the lesions, which extended from the frontal bone to the periorbita and the dura. Histologically, these were cystic lesions containing a granulomatous reaction to blood breakdown products, including cholesterol clefts, hemosiderin, giant cells, and hematodin, consistent with chronic hematic cyst. A fibrous pseudocapsule formed the cyst wall.

Adult↗
PubMed1987

A new method for vascular occlusion. Photochemical initiation of thrombosis.

A new photochemical method has been used to produce focal thrombosis and occlusion of the blood vessels on the surface of the myelin wings of rabbit retinas. Following intravenous injection of rose bengal, the vessels next to the disc on the nasal wing were exposed to filtered light (550 nm, the absorption maximum of rose bengal) for four minutes. As a control, the vessels on the temporal wing of each rabbit eye were exposed to filtered light for four minutes before the injection of rose bengal. Complete vascular occlusion was produced on the nasal wing in all eyes, with no visible alterations on the temporal wing. Progressive reopening of the arteries on the nasal wing was observed at three days, with reopening of the veins visible by seven days. Reperfusion of capillaries had occurred by 21 days. Light and electron microscopic examination of blood vessels on the nasal wing after light exposure with rose bengal showed disrupted endothelial cells in all exposed blood vessels and platelet aggregates in the arteries and arterioles. No morphologic abnormalities were observed in the temporal wings. This method should be useful in studying the effects of vascular occlusion in the retina and could lead to a new treatment modality for subretinal, iris, or corneal neovascularization.

Animals↗
PubMed1986

Botulinum toxin in the management of blepharospasm.

Seventy-seven patients with blepharospasm unresponsive to other forms of therapy were treated with botulinum A toxin. The drug was injected into the orbicularis oculi muscle of both upper and lower eyelids and, in some patients, into the brows and upper part of the face as well. A total of 192 treatment sessions were given, with follow-up ranging from four weeks to 18 months. Orbicularis muscle spasms decreased markedly over the first five days following injection, both in patients with essential blepharospasm and in those with hemifacial spasm. Beneficial effect was temporary, however, and repeated injections were required for sustained relief. Fifty-two patients received multiple treatments, ranging from two to eight injections each, with a mean duration of benefit of 11.8 weeks. Results of subsequent injections were similar to the first in rapidity of onset, degree of benefit, and duration of effect. Complications were local, mild, and transient, and no systemic side effects were encountered.

Adult↗