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Biomedical subjects

R R Waller

Publications and source records attributed to R R Waller.

At least 37 records · Page 2Linked to original sources
PubMed1985

Management of blepharospasm.

From 1950 through 1984, 123 patients underwent surgical treatment of blepharospasm at the Mayo Clinic. During this period, four different operations (proximal and distal neurectomy and two types of myectomy) were used. Significant recurrent or residual blepharospasm was observed more frequently (P less than 0.01), and need for subsequent operations was greater (P less than 0.01), among patients who had undergone distal neurectomy than among those who had had myectomy. These data support the view that myectomy is a more effective procedure than neurectomy. Initial results with botulinum toxin injection seem to indicate that it is an effective short-term treatment for blepharospasm. However, its long-term efficacy and safety need further study, as does the role it should play in combination with myectomy.

Adult↗
PubMed1984

The effect of sodium hyaluronate on endothelial cell damage during extracapsular cataract extraction and posterior chamber lens implantation.

We conducted a prospective, randomized clinical trial of the use of 1% sodium hyaluronate (Healon) in the anterior chamber during anterior capsulotomy and nuclear expression in extracapsular cataract extraction with posterior chamber lens implantation. Two months postoperatively, the mean (+/- standard deviation) central endothelial cell loss was 6.1% +/- 11.4% in 92 eyes in which sodium hyaluronate was used for the capsulotomy and nuclear expression and 7.6% +/- 14.7% in 89 eyes in which it was not used (P greater than .6). Sodium hyaluronate was also used later in the procedure in all eyes to expand the capsular bag to facilitate lens implantation. No significant difference was noted between the two groups in the increase in intraocular pressure on the first postoperative day (mean increase, 4 mm Hg in each group) or in the corneal thicknesses preoperatively and two months postoperatively (no significant change in either group). Sodium hyaluronate was useful in maintaining the anterior chamber during difficult surgical cases.

Aged↗
PubMed1984

Sebaceous carcinoma of the eyelid. Errors in clinical and pathologic diagnosis.

Sebaceous carcinoma of the eyelid is commonly misdiagnosed because it simulates other entities both clinically and pathologically. In a review of all pathologic material removed from the eyelids of patients at the Mayo Clinic between 1905 and 1981, 43 sebaceous carcinomas were discovered. The tumors manifested most frequently on the upper eyelid; the onset of symptoms occurred in 31 women and 12 men at a mean age of 61.5 years (range, 28-82 years). Of the 43 patients, 11 had an associated second malignant tumor or exposure to irradiation. The microscopic diagnosis was based on finding a proliferation of basophilic neoplastic cells with foamy cytoplasm and a positive fat stain. Intraepithelial neoplasia in the form of pagetoid change or carcinoma in situ was found in more than 80% of cases. Histologically, the tumor tended to be moderately differentiated. A high degree of infiltration was frequently observed cases with metastases. When intraepithelial neoplasia is observed microscopically, we recommend a fat stain on a frozen section and a full-thickness eyelid biopsy to exclude sebaceous carcinoma.

Adult↗
PubMed1984

Suppurative interstitial ring keratitis due to streptococcus.

Three cases of interstitial ring abscess of the cornea caused by different strains of streptococcus are described. These infections occurred in three different clinical settings: after penetrating trauma at the limbus, after a cataract operation, and in conjunction with keratoconjunctivitis sicca. The acute appearance of a light, interstitial ring not extending to the limbus in the post-traumatized eye should alert the clinician to the possibility that a streptococcus may be responsible. The ring frequently progresses rapidly to a total ring abscess with intraocular extension. The outcome was poor in all three patients.

Aged↗
PubMed1983

Optic nerve meningioma.

An obese white woman presented with a 10-month history of progressive loss of vision in the right eye associated with a moderate proptosis. Examination of the fundus revealed marked congestion of the retinal vasculature with dilation of both the arteries and the veins. Numerous blot hemorrhages were scattered throughout the retina. The retina was elevated and appeared to be displaced anteriorly by solid tissue, but B-scan ultrasonography demonstrated only a serous detachment of a thickened, markedly convoluted retina. A diagnosis of optic nerve meningioma was considered, but definitive treatment was deferred because of medical problems. One month later the patient returned with a blind, painful right eye associated with neovascular glaucoma. High resolution CT coronal sections of the orbit showed generalized thickening of the optic nerve. The blind eye was enucleated facilitating exposure of the optic nerve which was found to be diffusely thickened by meningioma. The orbital portion of the optic nerve was subsequently removed and meningioma was demonstrated along its entire length to the bony optic canal. A transfrontal craniotomy was later performed to rid the patient of residual tumor.

Adult↗
PubMed1982

Computed tomography of orbital tumors, including late-generation scanning techniques.

The role of computed tomography (CT) in the detection and diagnosis of orbital tumors at the Mayo Clinic is reviewed. Special techniques of late-generation scanners, including multiplane reformatted imaging, off-axis projections, high-resolution retrospective analysis, and thin-section scanning, have been evaluated in various ways for their clinical application in 42 recent cases. The overall series involved 133 proved orbital tumors. The detection rate and information obtained established CT as the method of choice for diagnosis of tumors of the orbit.

Adolescent↗
PubMed1981

Corneal trauma in intracapsular and extracapsular cataract extraction with lens implantation.

We examined the central corneal endothelium before and eight weeks after cataract extraction and lens implantation in 99 consecutive intracapsular and extracapsular extractions each. There was no statistically significant different between the mean endothelial cell loss of 17.1% in the intracapsular group and 13.6% in the extracapsular group. The variation in individual endothelial cell sizes was less postoperatively in the extracapsular extractions. The central corneal thickness were the same in the two groups. There was no statistically significant difference between the mean endothelial cell loss of 17.0% in 24 posterior chamber lenses and 12.1% in 69 transiridectomy clip lenses, both with extracapsular cataract extraction. When combined with intraocular lens implantation, extracapsular cataract extraction, even when performed by surgeons inexperienced with extracapsular techniques, caused no greater corneal endothelial damage than intracapsular extraction.

Aged↗
PubMed1981

Ocular malformation in association with ipsilateral facial nevus of Jadassohn.

A 13-year-old boy had ocular malformations and a sebaceous nevus of Jadassohn. The salient features included left frontoparietal alopecia, a pigmented flat nevus anterior to the left tragus, and a left-sided fleshy corneoscleral limbal mass. Histopathologic analysis showed a complex choristoma of lacrimal tissue and cartilage, together with intrascleral cartilage and bone. Deformity of the left sphenoid bone, dilatation of the left lateral ventricle, and localized atrophy of the left cerebral hemisphere were evident, but the patient had no history of seizures, no neurologic deficit, and normal mentality. Patients with a sebaceous nevus of Jadassohn should be examined for ocular malformations and watched closely for the development of malignant nevoid tumors within the area of the nevus.

Bone and Bones↗
PubMed1980

Orbital carcinoid tumor metastatic from the colon.

Acute exophthalmos and ophthalmoplegia of the left eye developed in a 58-year-old woman convalescing from a right hemicolectomy for a carcinoid tumor of the colon. Roentgenograms of the orbit and computed tomograms showed a large posterior left orbital mass. Lateral orbitotomy and biopsy confirmed the diagnosis of metastatic carcinoid tumor. Irradiation with radioactive cobalt (60Co) resulted in early relief of the ocular symptoms. To the best of our knowledge, this is the second documented case of orbital metastatic carcinoid tumor and the first patient with orbital involvement from a primary carcinoid tumor of the colon. Orbital irradiation for metastatic orbital carcinoid tumor has not been previously reported and should be used for symptomatic relief, because long-term survival is possible in patients with metastatic carcinoid tumors.

Carcinoid Tumor↗
PubMed1980

Orbital tumors evaluated by computed tomography.

Computed tomography (CT) of more than 90 orbital tumors revealed both benign and malignant neoplasms, including hemangiomas, lacrimal gland tumors, lymphomas, carcinomas, metastases, pseudotumors, and optic nerve tumors. Detection of orbital tumors was better and the information gained more complete with CT than with any other modality.

Adolescent↗
PubMed1979

Sterilization of scleral homografts with ionizing irradiation.

We devised a method of sterilization and preservation of sclera that we have found reliable and convenient. Gamma irradiation is a highly effective method of sterilization. Airtight, watertight, plastic packaging of frozen irradiated sclera allows for safe long-term storage and for convenient use in the operating room.

Freezing↗
PubMed1979

Nasolacrimal duct obstruction following transantral-ethmoidal orbital decompression.

Of 200 patients undergoing bilateral transantral-ethmoidal orbital decompression for Graves' ophthalmopathy, nine suffered symptomatic postoperative obstruction of the lower nasolacrimal excretory system. Five of the nine patients had persistent symptoms of epiphora or repeated episodes of dacryocystitis that necessitated dacryocystorhinostomy. Dacryocystorhinostomy relieved symptoms and objective evidence of obstruction in these five patients. We believe that nasolacrimal duct obstruction occurred in these patients as a complication of nasoantral window construction.

Dacryocystitis↗
PubMed1978

Is blindness a realistic complication in blepharoplasty procedures?

Blindness is a rare but realistic complication in blepharoplasty procedures. Review of 55 case reports in the literature supports this view. The cause or causes of blindness are not precisely clear, but orbital hemorrhage after removal of fat seems to be the most common event associated with visual loss. Preoperative ophthalmologic assessment is highly desirable to document preexistent eye and systemic disease. Exquisite care with removal of fat is essential. Careful postoperative observation without patching is necessary. Management of acute visual loss may be medical, surgical, or both.

Adipose Tissue↗
PubMed1978

Lower eyelid retraction: management.

A surgical technique for the management of lower eyelid retraction caused by vertical shortening of the posterior layers of the lid is presented. This technique, developed during the course of our experience with 48 procedures on lower eyelids, is a modification of that originally proposed by Quickert and Dryden. Results have been satisfactory to date, with minimal morbidity and complications.

Anesthesia, Local↗
PubMed1977

Calcification in retinoblastoma.

Review of 40 cases of retinoblastoma revealed that histologic evidence of calcification was noted in 38 of the 40 tumors, whereas only three of 16 roentgenograms were positive for calcium. Calcificaton detected by roentgenograms and histopathologic examination correlated poorly with quantitative determination for tumor calcium. Compared to control eyes, however, eyes with retinoblastoma contain large amounts of calcium (1.2 vs. 218 mug/ml. ash). This calcification, though frequently not observed in standard roentgenograms, should be detected by the newer diagnostic modalities such as hypocycloidal polytomography, computerized transaxial tomography, ultrasonography, and radionuclide scintigraphy with technetium diphosphonate, a bone-scanning agent.

Adolescent↗
PubMed1975

Financial record-keeping simulation in the dental auxiliary utilization clinic.

A financial record-keeping and billing simulation program which is part of the Dental Auxiliary Utilization (DAU) didactic and clinical experiences has been reported. Evaluation of student performance has demonstrated a satisfactory level of accomplishment. The students' performance may reflect their awareness regarding the importance of understanding the management of the financial affairs of a dental practice.

Curriculum↗