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Biomedical subjects

J J Hurwitz

Publications and source records attributed to J J Hurwitz.

At least 37 records · Page 2Linked to original sources

Buccal mucous membrane-fat graft in the management of the contracted socket.

A new surgical technique for reconstructing severely contracted sockets using an autogenous buccal mucous membrane-fat graft is presented. The buccal mucosa provides replacement of deficient conjunctival surface area; the fat in the underlying substantia propria of the buccal mucosa replenishes moderate volume deficiency in a single procedure. A custom-designed conformer is used in the immediate postoperative period to maintain reconstructed vertical fornices. We present four consecutive patients with contracted sockets having both a volume deficit and severe conjunctival contracture who were successfully rehabilitated using this technique.

Adipose Tissue↗

High-frequency radio wave electrosection of full-thickness eyelid tissues.

The Ellman Surgitron, commonly used in dermatology practice, is an electrosurgical instrument with a high-frequency waveform that is modified by filtering and undamping the current so that an almost pure cut is possible, yet with a small amount of coagulation. This device was used in six patients undergoing full-thickness eyelid resection (unilateral in three and bilateral in three) for involutional entropion or ectropion. Nine lid margins were cut with scissors, and nine with the electrosurgical instrument. The latter was found to cause minimal tissue damage and to modify the superficial epithelial cell layer very slightly, without causing it to slough. The tissue was cut cleanly, with less bleeding than occurred with scissors incision.

Cautery↗

Experimental treatment of eyelashes with high-frequency radio wave electrosurgery.

Apart from mechanical epilation, which is a nuisance to both the patient and the ophthalmologist, standard techniques for removing unwanted eyelashes, such as electrosurgery (Hyfrecator) and cryosurgery, may cause eyelid tissue damage and other complications. Refinements in electrosurgical techniques have enabled production of a machine that can provide high-frequency radio waves with a modification of the waveform to produce a blended cut-coagulation effect (Ellman Surgitron). Treatment of hairs in fresh calf skin with the Ellman Surgitron resulted in destruction of the germinal cells of the hair follicle, with only a small amount of tissue change lateral to the track of the electrode; the Hyfrecator caused total sloughing of the epithelial cells, with marked superficial tissue changes due to heat spread. In six eyelids of six patients undergoing eyelid excision the Ellman Surgitron was effective in causing destruction of the germinal cells of the hair follicle, with very little lateral heat spread in the tissues or destruction of the skin epithelial cells. As well, there was no tissue damage anywhere near the conjunctival surface.

Animals↗

Ethmoidectomy decompression for the treatment of Graves' optic neuropathy.

When orbital decompression becomes necessary in Graves' optic neuropathy, medial wall decompression is a necessary component of the decompression procedure. The ethmoidectomy approach allows more direct visualization of the posterior ethmoids and sphenoids to effect maximum decompression. This is particularly important in cases in which computed tomography shows the medial rectus muscle to be enlarged posteriorly in the orbit. The procedure provides excellent visualization of the medial rectus. As with any medial wall decompression procedure, postoperative restriction of horizontal motility is a frequent complication, often necessitating more than one subsequent operation. The authors describe their experience with the procedure in 25 patients with Graves' optic neuropathy.

Adult↗

Orbital hemorrhage during dacryocystorhinostomy.

Orbital hemorrhage during dacryocystorhinostomy (DCR) is a very rare but potentially devastating complication of this procedure. It is probably due to trauma to the anterior ethmoidal artery, which has a variable course and may have branches close to or in the surgical site. Increasing resistance to retropulsion of the globe is an important sign of orbital hemorrhage. If the hemorrhage does not resolve spontaneously, direct decompression of the blood within the orbit is necessary. The authors review their experience with this complication of DCR.

Dacryocystorhinostomy↗

Orbital angiolymphoid hyperplasia with eosinophilia. Presentation as chalazion.

Angiolymphoid hyperplasia with eosinophilia (ALHE) is an uncommon, benign slow-growing lesion primarily found in the head and neck region, with onset between the third and fourth decades, and a female predominance in the nonOriental population. Kimura's disease, occurring primarily in young Oriental males, is a similar lesion with peripheral blood eosinophilia, regional lymphadenopathy, and occasional nephrotic syndrome. Orbital ALHE is rare, previously reported in only nine patients. Orbital ALHE is a solitary lesion, with an older age of onset, between the fourth and eighth decades, than ALHE elsewhere. There is a male predominance, in contradistinction to ALHE elsewhere in nonOrientals. Orbital ALHE demonstrates the same histology as other locations, with exuberant capillary proliferation and an inflammatory infiltrate of eosinophils, lymphocytes, plasma cells, and mast cells. The maturity of the lesion, not necessarily the duration, determines the presence of lymphoid follicles and germinal centers. A distinctive endothelial cell lines and even extends into the vascular lumens. Peripheral blood eosinophilia occasionally occurs, and a few cases have been reported in conjunction with asthma. Therapeutic regimens for ALHE include excision, carbon dioxide and argon laser, irradiation, steroids, electrodesiccation, and cytotoxic agents. Orbital lesions have been treated successfully with excision, or biopsy with debulking, or steroids.

Angiolymphoid Hyperplasia with Eosinophilia↗

Lacrimal canaliculoscopy: development of the instrument.

We have developed an endoscopic device for use in the lacrimal drainage system. The device employs a flexible, small-calibre fibreoptic cable that can easily negotiate the canalicular system. The device can be used in conjunction with a video camera and monitor for simultaneous viewing. The endoscope can be used alone for the diagnosis of lacrimal disorders. Possible future applications include laser treatment of lacrimal disorders.

Dacryocystorhinostomy↗

Dog and human bites of the eyelid repaired with retrieved autogenous tissue.

Two cases of traumatic avulsion of the upper eyelid were surgically repaired with retrieved autogenous tissue. Both injuries were caused by bites, canine in one case and human in the other. Surgical repair consisted of débridement of the retrieved tissue and layered closure of the wound 17 and 40 hours after the injury occurred. Good functional results were obtained in both cases. In both patients mild lid retraction and loss of cilia were noted. One of the patients underwent a secondary lid-lengthening procedure with scleral grafting for optimal cosmesis.

Adolescent↗

Modified Tessier flap for reconstruction of the upper eyelid.

We present a modification of the Tessier or orbitonasojugal flap for use in upper eyelid reconstruction. It is suitable for repairing full-thickness defects involving 60% or more of the lid margin and has the advantage of being a one-step procedure.

Aged↗

Combined computed tomography and dacryocystography for complex lacrimal problems.

Two imaging modalities, computed tomography (CT) and dacryocystography (DCG), were combined to demonstrate the relationships between the lacrimal system and the surrounding soft-tissue structures. In selected cases, such as those involving severe facial trauma, midfacial tumours, significant sinus disease, or previous lacrimal, nasal or sinus surgery, this imaging technique may be useful in better evaluating the anatomy of the lacrimal system and planning a surgical approach.

Adult↗

A spindle-cell myoepithelioma of the lacrimal gland.

A middle-aged woman developed unilateral, painless proptosis that increased slowly over 1 year. A clinical diagnosis of pleomorphic adenoma of the lacrimal gland was supported by computed tomographic scanning and the tumor was excised. On histological examination the tumor proved to be a benign, myxoid myoepithelioma of spindle-cell type. Although occasionally seen in the salivary glands, to our knowledge, this tumor has not previously been described in the lacrimal gland.

Female↗

Association of entropion with cataract surgery.

Ptosis may develop after cataract surgery because of a dehiscence of the levator aponeurosis. A series of patients undergoing entropion repair was examined in order to determine the mechanism of entropion and the correlation with cataract surgery. It is suggested that involutional senile entropion may develop related to cataract surgery, on the same basis as ptosis, due to disinsertion of the capsulopalpebral fascia. It is suggested that the cataract surgeon should examine the patient closely for preoperative entropion to prevent or anticipate the development of frank entropion after the cataract surgery.

Adult↗

The true canalicular angle: a mathematical model.

A mathematical formula that allows for the computation of the true angle between the upper and lower canaliculi using dacryocystograms is described. It was used to determine the true canalicular angle in 33 patients. The mean calculated angle at the 1.0 mm distance was 57.2 degrees +/- 13.0 degrees, and at the 0.5 mm distance was 65.2 degrees +/- 16.2 degrees. The true calculated angle was highly correlated with the angle measured in the Waters view. There was no statistically significant correlation between the right and left sides in the same patient. There was no statistically significant difference between the canalicular angle in males and females, and there was no correlation between canalicular angle and patient's age. A clinical application of this model is discussed.

Adult↗

Isolated blow-in fracture of the lateral orbit causing globe rupture.

A blow-in fracture is a less common consequence of orbital trauma. Fragments of orbital bone may increase the orbital pressure, causing direct or indirect damage to the globe. This paper describes a blow-in fracture where a bone fragment perforated the globe causing globe disorganization and necessitating enucleation.

Accidents, Traffic↗

Lacrimal surgery.

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Dacryocystorhinostomy↗