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Biomedical subjects

S Brownstein

Publications and source records attributed to S Brownstein.

At least 37 records · Page 2Linked to original sources
PubMed1998

The synthetic hydroxyapatite implant: a report on 65 patients.

Sixty-five patients receiving the FCI synthetic hydroxyapatite implant (FCI3, FCI, Issy-Les-Moulineaux, France) after enucleation, evisceration, or as a secondary implant were studied under human trial guidelines established by Health and Welfare Canada. The implant is chemically identical to the original coralline Bio Eye (Integrated Orbital Implants Inc., San Diego, CA, U.S.A.), is easy to work with, and was implanted without difficulty using a wrap of polygalactin 910 (Vicryl mesh, Ethicon, Inc.) in the majority of patients. Postoperative drilling was carried out at approximately 6 months and found to be much easier than drilling of the Bio Eye. The implant could be hand drilled using drill bits rolled between the thumb and index finger. Postoperatively, patients were followed-up from 7 to 24 months and did not have any problems different from those associated with the original hydroxyapatite implant derived from sea coral (Bio Eye). One case of conjunctival dehiscence occurred at 4 weeks and required a temporalis fascia patch graft to repair. One implant became infected after drilling and had to be removed. The motility obtained with the third-generation FCI implant (FCI3) was similar to that seen with the Bio Eye, in comparable patients. That is, those receiving implants after an evisceration, on the whole, had better motility than those receiving an implant after primary enucleation or secondary implantation. The FCI3 hydroxyapatite implant is a viable alternative to the original Bio Eye hydroxyapatite implant. It's advantages are: 1) reduced cost, and 2) ease of drilling (a motorized drill is not required). The implant was given Health and Welfare approval in Canada on February 26, 1997.

Biocompatible Materials↗
PubMed1998

An unusual complication associated with hard palate mucosal grafts: presumed minor salivary gland secretion.

Hard palate grafts are commonly used in eyelid reconstructive procedures as a replacement for posterior lamellar defects. Four patients are presented with an unusual complication after placement of a hard palate graft: presumed minor salivary gland secretion. They were experiencing stringy mucous discharge over the graft and along the eyelids, causing visual blurring. Removal of the graft in one patient and cryotherapy to the grafts in the others (presumably causing atrophy of the minor salivary gland tissue found within the grafts) allowed resolution of symptoms. The authors propose the application of cryotherapy to the graft surface to atrophy the salivary glands, prevent any further production of mucus, and return the tear film to a more normal consistency. Alternatively, surgical removal of the grafts can be performed. To our knowledge, this complication (saliva-like mucoid discharge) has not been previously reported.

Adult↗
PubMed1997

Ptosis secondary to amyloidosis of the tarsal conjunctiva and tarsus.

PURPOSE: To report a case of chronic unilateral ptosis in a 63-year-old, otherwise healthy woman with visual restriction. METHODS: We performed a biopsy on an enlarged tarsal plate that we believed had caused ptosis. A levator aponeurotic advancement was performed subsequently. RESULTS: Histologic and ultrastructural examination of the biopsy specimen disclosed amyloidosis of the tarsal conjunctiva and tarsus. There was no evidence of systemic amyloidosis. CONCLUSION: Localized amyloidosis involving the tarsal conjunctiva and tarsus is a rare cause of chronic eyelid thickening and ptosis.

Amyloidosis↗
PubMed1997

Post-traumatic corneal mucormycosis caused by Absidia corymbifera.

OBJECTIVE: The purpose of the study was to report a case of mycotic keratitis caused by the organism Absidia corymbifera (class Zygomycetes, order Mucorales, family Mucoraceae). DESIGN: Case report. PARTICIPANT: A healthy 37-year-old farmer scratched his left cornea on a galvanized nail while working in his barn. Within 24 hours, an infiltrate in the interior cornea developed that advanced superiorly, reducing the vision to hand motion by the following day. He was treated with topical and systemic antibiotics and antifungal medications, but the infiltrate spread to the adjacent nasal limbus. INTERVENTION: An 11-mm penetrating keratoplasty was performed with an adjacent nasal 7-mm superficial lamellar sclerectomy. MAIN OUTCOME MEASURES: Pathologic examination of the keratoplasty specimen. RESULTS: Corneal cultures grew A. corymbifera. The organisms were identified in tissue sections by light, fluorescent, electron, and immunoelectron microscopy. CONCLUSIONS: The authors believe that this is the first reported case of keratitis caused by an Absidia species and, as such, represents an unusual form of mucormycosis in an otherwise healthy individual.

Adult↗
PubMed1997

George III: a revised view of the royal malady.

George III of England's episodic psychotic illness is described. The data has previously been used to substantiate the diagnosis of an unlikely hereditary metabolic disease, porphyria. A scientific perspective, aimed at removing psychiatric diagnosis from dependence on subjective evaluations, is corrected by the diagnosis of a mood disorder. His unipolar mania of late onset is a syndrome, the sine qua non of bipolar disorder, in this instance complicated by the toxicity of quinine, antimony, and purgatives.

Bipolar Disorder↗
PubMed1996

Abscessed hydroxyapatite orbital implants. A report of two cases.

PURPOSE: The authors describe the rare condition of an abscess within a hydroxyapatite orbital implant in two patients who had undergone seemingly uncomplicated enucleation and orbital implant surgery. METHODS: In the first patient, 14 weeks postoperatively, a chronic discharge developed and the socket became uncomfortable. A pyogenic granuloma was present, occurring over an area of dehiscence. The hydroxyapatite orbital implant was removed 10 months postoperatively. In the second patient, moderate orbital discomfort was noted during the first week postoperatively along with a temporal shift of the implant. The discomfort persisted, and 1 week later a discharge began. The implant was removed 9 weeks after implantation. At the time of surgery, an unsuspected pyogenic granuloma was found in the medial conjunctival formix overlying a small area of implant dehiscence. RESULTS: Conjunctival and implant cultures grew Staphylococcus aureus in our first patient, whereas coagulase-negative staphylococci were cultured from the conjunctiva and implant in our second patient. Results of histopathologic examination of both implants disclosed an abscess cavity containing clusters of gram-positive cocci. CONCLUSION: Persistent orbital discomfort, discharge, and the development of a pyogenic granuloma after hydroxyapatite implant should warn the ophthalmic surgeon of potential implant infection.

Abscess↗
PubMed1996

A histopathological, ultrastructural and immunohistochemical study of congenital hereditary retinoschisis.

OBJECTIVE: To confirm our earlier histopathological and electron microscopic findings in congenital hereditary retinoschisis (CHRS) in two additional globes and to further evaluate the nature and origin of the intraretinal filaments by means of immunohistochemical analysis. PATIENTS: Three white men with CHRS, aged 83 years (patient I) (two globes), 55 years (patient 2) (two globes) and 33 years (patient 3, nephew of patient 2) (one globe). OUTCOME MEASURES: Findings on histopathological study and electron microscopy (patient I) and immunohistochemical analysis (all five globes). RESULTS: Histopathological examination showed extensive extracellular deposition of amorphous material positive for periodic acid-Schiff reagent in the outer schisis layer and focally in the macula. Ultrastructurally, the amorphous material represented filaments measuring 8 to 12 nm in diameter within degenerated Müller cells, with accumulation of these filaments in adjacent extracellular spaces. Similar, less severe changes were seen in the superonasal retina. Immunohistochemical studies showed focal reactivity for glial fibrillary acidic protein (GFAP) in the retina adjacent to the schisis cavity in all five globes, focal reactivity for S-100 protein in four retinas, rare focal staining for vimentin and neurofilaments in two retinas each and no reactivity for type I keratin or actin. CONCLUSIONS: The present study corroborates our previous work and provides pathological evidence that the retinal disorder extends beyond the limits of the schisis. The results of the immunohistochemical analysis are consistent with a glial cell origin of the filaments. We postulate that defective Müller cells produce GFAP and possibly S-100 protein, which accumulate within the retina and secondarily result in degeneration of these cells and schisis formation.

Adult↗
PubMed1995

The use of Vicryl mesh (polyglactin 910) for implantation of hydroxyapatite orbital implants.

Hydroxyapatite (HA) implants currently are most commonly wrapped in donor sclera before implantation to facilitate placement within the orbit and allow attachment of the extraocular muscles. Although the risk of acquiring a transmittable disease through donor sclera is extremely low, some individuals remain concerned about receiving nonautologous material. As an alternative to sclera, autologous temporalis fascia, or autologous fascia lata, we have been wrapping HA in "Vicryl mesh" before insertion into the orbit. The Vicryl mesh-wrapped implant goes into the socket readily, allows one to easily attach the extraocular muscles, and has no risk of transmittable disease. In addition, the Vicryl mesh is readily available at most hospitals and is dissolvable.

Durapatite↗
PubMed1995

DNA index and S phase fraction in uveal malignant melanomas.

AIMS: To predict 5 year survival in patients with uveal malignant melanomas DNA indices were studied. METHODS: Using 45 paraffin embedded uveal malignant melanomas, the DNA index and S phase fraction of each tumour were the predictor variables recorded. RESULTS: Using the Cox proportional hazards model, aneuploid tumours and tumours which had an S phase fraction greater than 4% were significant predictors of early death. In order to demonstrate a biological gradient between a larger DNA index and shorter survival time, linear regression and transformed linear regression models were used. However, no such gradient could be demonstrated. CONCLUSION: Although this study shows promise for the use of DNA studies in the prognosis of uveal malignant melanoma, the exact role of these techniques remains to be determined.

Adult↗
PubMed1995

Air guns: the main cause of enucleation secondary to trauma in children and young adults in the greater Ottawa area in 1974-93.

OBJECTIVES: To determine the proportion of enucleation procedures attributable to injuries from air guns in people aged 18 years or less and to identify the associated pathological findings. DESIGN: Case series. SETTING: Ophthalmic Pathology Registry, University of Ottawa, and affiliated Children's Hospital of Eastern Ontario (Ottawa), Ottawa General Hospital and Ottawa Civic Hospital. In addition, information on air gun injuries from April 1990 to December 1993 was obtained from the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) database, with data from 10 pediatric and 5 general hospitals across Canada. PATIENTS: All patients aged 18 years or less who underwent enucleation between Jan. 1, 1974, and Dec. 31, 1993. RESULTS: Eighty-five patients were identified as having undergone enucleation. Trauma accounted for 51 cases (60%), of which 13 (25%) were caused by air guns, the largest single cause of enucleation secondary to trauma. Overall, air gun injuries accounted for 15% of enucleation procedures, whereas retinoblastoma accounted for 21%. All air gun injuries were in boys (median age 14 years, range 9 to 16 years). Of the 13 eyes with air gun injuries 7 had ocular perforation and 6 had ocular penetration. In all cases the intraocular structures were severely disrupted. The CHIRPP database included 165 air gun injuries; 32 were to the eye or ocular adnexa, resulting in 26 hospital admissions. CONCLUSIONS: Air guns were the largest single cause of enucleation secondary to trauma in our study. These guns are widely available in Canada and are unrestricted at muzzle velocities capable of causing death or serious injury, especially to the eye. We feel that air guns should be licensed only to people aged 16 to 18 years or older and that education in their use should be mandatory.

Adolescent↗