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Biomedical subjects

R L Anderson

Publications and source records attributed to R L Anderson.

At least 199 records · Page 11Linked to original sources
PubMed1990

Lacrimal gland prolapse in craniosynostosis syndromes and poor function congenital ptosis.

Lacrimal gland prolapse is an important, though uncommon, feature found in craniofacial abnormalities as well as in cases of poor function congenital ptosis. It occurs secondary to a number of conditions, including increased posterior pressure secondary to decreased orbital volume; also, supportive structures of the gland often may be weak in conjunction with a poor function ptosis or as a result of trauma at the time of major reconstruction. Recognition of the prolapsed gland and its replacement into the lacrimal gland fossa in craniosynostosis syndromes, as well as in cases of poor function congenital ptosis in general, allows the temporal eyelid to approach a more normal position, yielding an improved functional and cosmetic result.

Blepharoptosis↗
PubMed1990

Motor nerve sprouting in human orbicularis muscle after botulinum A injection.

The paralytic properties of botulinum A toxin have led to its use in humans in the treatment of strabismus and facial dystonias such as essential blepharospasm. Examination of orbicularis muscle from 10 patients with essential blepharospasm who received 2-18 injections of botulinum toxin 6 weeks to 3 years prior to surgery revealed characteristic nodal, terminal and ultraterminal "sprouting" of the motor axons. Orbicularis muscle from five individuals never exposed to botulinum failed to demonstrate these changes. The significance of persistent motor nerve sprouting in response to botulinum exposure remains to be elucidated.

Adult↗
PubMed1990

Acquired oculomotor-abducens synkinesis.

The authors present a rare case of bilateral aberrant oculomotor regeneration following severe head trauma with the unusual finding of unilateral palpebral fissure widening on abduction with normal lateral rectus function (oculomotor-abducens synkinesis). The findings do not match the usual syndromes of either acquired oculomotor synkinesis or acquired Duane's retraction syndrome and seem to represent a unique case of aberrant regeneration involving the third and sixth cranial nerves.

Abducens Nerve↗
PubMed1990

The aponeurotic approach to congenital ptosis.

Using a surgical technique directed at the levator aponeurosis, we successfully corrected 228 cases of congenital ptosis. The advantages of this approach are: normal anatomic planes and structures of the eyelid are maintained; basic and reflex tear secretion, goblet cells, or meibomian glands remain undisturbed, allowing maintenance of the three-layered tear film; any aponeurotic defects may be explored and repaired relatively easily; all elevating structures are preserved (aponeurosis rather than muscular levator is removed, Mueller's muscle is left intact, Whitnall's ligament is not violated); posterior sutures, which may irritate the cornea, are avoided; no tarsus or conjunctiva are removed.

Blepharoptosis↗
PubMed1990

Apraxia of lid opening in blepharospasm.

Apraxia of lid opening is a nonparalytic motor abnormality characterized by difficulty in initiating the act of lid elevation. It has been reported with extrapyramidal disorders, including Parkinson's disease, Huntington's chorea, progressive supranuclear palsy, and Shy-Drager syndrome. We found seven cases (7%) of functionally disabling apraxia of lid opening in 100 consecutive blepharospasm patients studied. It is important for physicians treating blepharospasm to be aware of the association between these two visually debilitating disorders.

Apraxias↗
PubMed1989

The five-flap technique for blepharophimosis.

The correction of epicanthus associated with blepharophimosis is a difficult surgical problem. Most commonly used techniques, such as the Mustardé technique, require meticulous measurements, and their theoretical geometric basis and flap designs are often confusing. We present the five-flap technique utilizing logical flap design, which is a combination of a Y-to-V flap with double opposing Z-plasties on the apex, that is well suited to this difficult problem. It is important to remove excess muscle and deep tissues underlying the flaps in the medial canthal region, which are present in blepharophimosis cases and contribute to the deformity in these patients. Medial canthal tendon resection and tucks or transnasal wiring are then performed. The technique has been utilized in 14 patients with a minimum of one year of follow-up over the past six years with good results.

Adolescent↗
PubMed1989

Tarsoconjunctival flap for upper eyelid reconstruction.

Reconstruction of large, full-thickness upper eyelid defects is a challenge to the ophthalmic plastic surgeon. Ideally, the defect should be reconstructed with tissues similar or identical to those that have been lost. We present a procedure similar to the Hughes tarsoconjunctival flap technique for lower eyelid reconstruction. However, our technique was used for upper eyelid reconstruction. A remnant of tarsus at least 3 mm wide must be available to be advanced inferiorly in the upper eyelid. We have performed this procedure on 13 patients over ten years (1977 to 1987) with good to excellent results.

Conjunctiva↗
PubMed1989

The lateral tarsal strip revisited. The enhanced tarsal strip.

The lateral tarsal strip procedure was originally designed for the treatment of upper and lower eyelid laxity, or lateral canthal tendon laxity or malposition. Despite the excellent results with a standard tarsal strip procedure for those eyelids with laxity and excess skin, we have encountered a number of patients with lower eyelid or canthal malpositions or both who would benefit from a tarsal strip, but who do not have lax tissues (especially skin), and may in fact have a shortage of skin. These include cases of lower lid retraction or canthal malposition following trauma, blepharoplasty, or other operations, and patients with tendency toward or having cicatricial ectropion. Any anterior lamella removal in such patients would aggravate the lid malposition and weaken the lateral canthal tissues to be sutured. We suggest a modification of the tarsal strip (developed by one of us [R.L.A.]) to treat many such patients without requiring additional anterior lamella (skin graft) or more formidable procedures. We refer to this technique as the "enhanced tarsal strip" technique, and we use this technique more frequently than the original tarsal strip procedure.

Adult↗
PubMed1989

Epicanthal folds. A deep tissue approach.

Epicanthal folds are seen in infants and young children of all races, and they appear as a normal finding in Orientals of all ages. The formation of these folds seems to be related to tension from excessive underlying muscle in many cases. Surgically, a number of techniques have been suggested for their correction, but many of these techniques result in unsightly scars. A technique has been devised for the correction of epicanthal folds that involves an incision on the fold and removes muscle beneath the fold while attaching the skin edges to deep tissues in an attempt to create a crease, which may extend into normal creases. This technique has delivered good functional and cosmetic results in 9 of 10 consecutive cases treated in this manner.

Adolescent↗
PubMed1989

Fetal hydrops and death from sacrococcygeal teratoma: rationale for fetal surgery.

Most sacrococcygeal teratomas diagnosed before birth can be managed by planned delivery and postnatal surgery. However, large tumors early in gestation may result in placentomegaly, hydrops, and fetal death and a preeclampsia-like syndrome in the mother. This chain of events may result from high output cardiac failure in the fetus caused by arteriovenous shunting through the tumor. We recently encountered this situation in a fetus at 21 weeks' gestation and performed fetal surgery in an attempt to reverse the process. Excision of the teratoma resulted in reversal of hydrops, diminution of descending aortic flow on Doppler echocardiography, and decrease in placental thickness. Despite these changes, uterine irritability after hysterotomy resulted in labor and delivery of a nonviable premature infant. This case demonstrates that when fetal sacrococcygeal teratoma becomes very large early in gestation, high output cardiac failure can endanger both fetus and mother. In the future, use of Doppler echocardiography may allow appropriate selection of high-risk fetuses. Intervention to prevent arteriovenous shunting through the tumor may offer these fetuses an improved chance for survival.

Adult↗
PubMed1989

Effect of saccharin on the ATP-induced increase in Na+ permeability in isolated chicken intestinal epithelial cells.

When isolated intestinal cells from 3-wk-old chickens are treated with exogenous ATP they undergo a dramatic increase in permeability towards Na+. The increase occurs instantaneously and maximum cell loading with Na+ occurs within 2 min. The response is dose dependent (0.1-1.0 mM-ATP) and results in as much as a 10-fold increase in unidirectional influx of 22Na+ into the cells. The resting cellular Na+ gradient and membrane potential are partially dissipated and consequently Na+-dependent transport of sugars and amino acids is inhibited. Sodium saccharin (20 mM), added at the same time as ATP, completely blocks the effect of ATP on Na+ permeability and preserves the functional capacity of the cells for Na+-dependent sugar or amino acid transport. Partial protection is afforded by 10 mM-saccharin. Saccharin added 2 min after ATP will reverse the enhanced Na+ permeability that has already been induced. In cells that have not been treated with ATP, saccharin induces enhanced sugar and amino acid gradients (P less than 0.05 in paired comparisons from the same cell preparation), indicating that it may also inhibit Na+ permeability of the unperturbed membrane and allow cells to establish higher Na+ gradients and/or membrane potentials. The effect of saccharin in blocking ATP-induced Na+ permeability occurs within 10 sec and at a much lower dose than that required for blockade of facilitated diffusional sugar transfer in these cells.

Adenosine Triphosphate↗
PubMed1989

Comparison of the bladder response to indole and sodium saccharin ingestion by male rats.

To ascertain whether the bladder mass increase and epithelial hyperplasia induced by 5% dietary sodium saccharin (NaS) in short-term experiments with rats are caused by increased urinary excretion of indican associated with this treatment, the responses of the urine and bladder induced by 1.5% indole (Id) ingestion were compared with those induced by 5% NaS and 1.5% Id + 5% NaS. Id and NaS, when fed alone, produced equivalent increases in bladder mass and both compounds induced epithelial hyperplasia, but Id ingestion was associated with much greater urinary indican excretion (5 mg/g diet ingested) than was NaS (0.3 mg/g diet ingested). When Id and NaS were ingested together, the bladder mass increase was additive, but the epithelial hyperplasia was not exacerbated over that observed with each alone, and the urinary indican was equivalent to that produced by Id alone. These findings suggest that a high level of urinary indican excretion is associated with an increase in bladder mass and epithelial hyperplasia (Id treatment) but indicate that the relatively low urinary indican level obtained by NaS feeding alone is unlikely to be responsible for the bladder responses noted with this compound.

Animals↗