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Biomedical subjects

W B Wilson

Publications and source records attributed to W B Wilson.

At least 19 recordsLinked to original sources
PubMed1995

Radiotherapy for thyroid orbitopathy. Effects on extraocular muscle balance.

OBJECTIVE: To investigate the effects of radiotherapy on the restrictive ophthalmopathy and strabismus that occur with Graves' orbitopathy. DESIGN: A prospective study of patients with motility disturbances due to thyroid orbitopathy, followed by serial quantitative measurements of ocular restrictions and deviations, both before and at 1 and 6 months after treatment with high-energy radiotherapy. SETTING: Urban subspecialty private practice. PATIENTS: Thirty-three consecutive patients with restricted extraocular movements and diplopia secondary to thyroid orbitopathy who were treated with radiotherapy were seen during an 8-year period. MEASURES: Maximal horizontal and vertical ductions, plus ocular deviations in primary and reading positions of gaze, were quantitatively evaluated by one clinical investigator to ensure consistency. RESULTS: Statistically significant improvement in gaze restriction on supraduction and improvement of vertical and horizontal strabismus were demonstrated at follow-up visits after treatment. CONCLUSIONS: Although statistically significant improvement of motility disturbances were demonstrated after radiotherapy, there was less than desirable functional improvement of restrictive ophthalmopathy and strabismus; thus the usefulness of radiotherapy was limited when it was used alone to treat diplopia.

Adult↗
PubMed1995

Neuro-ophthalmic manifestations of meningocerebral inflammation from the limited form of Wegener's granulomatosis.

PURPOSE: Wegener's granulomatosis is classically a systemic necrotizing granulomatous vasculitis that involves the upper and lower respiratory tracts and kidneys. Ophthalmologic and neurologic manifestations are common. The limited form of Wegener's granulomatosis may have pathologic characteristics consistent with the disease but lacks the complete clinical triad. We studied the clinical, pathologic, laboratory, and radiologic findings of four patients with Wegener's granulomatosis so that others will recognize the disease, even when it occurs in its limited form. METHODS: From three clinical centers, a chart review disclosed four patients with neuro-ophthalmic findings and the limited form of Wegener's granulomatosis. RESULTS: Three men and one woman, ranging in age from 40 to 73 years, were studied. All four patients had ocular motor abnormalities (one with oculomotor and trochlear nerve palsies, one with oculomotor nerve palsy, one with trochlear and abducens nerve palsies, and one with horizontal gaze deviation) in addition to other cranial nerve and cerebral abnormalities. Neuroimaging showed prominent meningeal, as well as intraparenchymal, abnormalities. In all patients, results of antineutrophil cytoplasmic antibody tests were initially negative but in one patient were positive at a late stage of the disease. In all patients, results of a biopsy demonstrated necrotizing granulomatous inflammation consistent with Wegener's granulomatosis. CONCLUSIONS: Neuro-ophthalmic findings may be the earliest manifestations of the limited form of Wegener's granulomatosis. Extensive meningocerebral inflammation can occur before systemic involvement or laboratory confirmation. Early diagnosis by biopsy of affected tissues may facilitate appropriate treatment and prevent progression of the disease.

Adult↗
PubMed1995

Steam sterilization of laparoscopic instruments.

Because of the intricate internal parts of laparoscopic instruments, questions have been raised about the efficacy of cleaning and sterilization techniques. To assess these risks, hamburger meat was inoculated with high concentrations of vegetative pathogens and packed into laparoscopic cannulas. All openings of the cannulas were sealed during steam sterilization cycles ranging from 3 to 10 min in different experiments; cultures were obtained after cooling. Experiments were then performed using heat-resistant spore forms. Our studies showed that both the standard 10-min cycle and the 3-min "flash" were uniformly successful in killing all pathogenic microorganisms. A 7-min steam sterilization was necessary to kill spores within sealed cannulas. We conclude that a standard 10-min cycle within the steam autoclave provides complete sterilization of laparoscopic instruments; the 3-min "flash" sterilization is appropriate and safe for instruments that have been inadvertently contaminated or dropped during a surgical procedure.

Equipment Contamination↗
PubMed1991

Orbital decompression in Graves' disease. The predictability of reduction of proptosis.

We studied 42 orbits of 23 patients with Graves' disease who had proptosis secondary to the orbitopathy of their disease and had undergone decompressive operations. The patients were evaluated preoperatively and underwent computed tomography. They were also examined frequently during the first postoperative year and the computed tomography was repeated at 6 months. Three variables correlated well with the reduction in proptosis: the percentage of increase in orbital volume after surgery, the absolute increase in orbital volume, and the degree of orbital "stiffness" as measured preoperatively. The first two variables have an inverse correlation with the third. We refer to the loss of resilience of orbital tissues and the increase in adherence between tissue planes, collectively, as orbital "stiffness." While other factors, such as the size of the anterior opening of the orbit, the resistance of the lid diaphragm, and pressure changes within the orbit, may affect the resultant reduction in proptosis, we did not attempt to measure these factors.

Exophthalmos↗
PubMed1990

Large cystic optic glioma.

A 5 1/2-year-old boy developed a huge cyst in his chiasmal glioma 4 years after radiation therapy. The cyst produced obtundation but was successfully treated.

Child, Preschool↗
PubMed1990

Diffusely infiltrating brainstem gliomas: a report of the diagnostic difficulties in 2 cases.

Brainstem gliomas seem to present in 2 distinct ways. More commonly they are localized to 1 portion of the brainstem and present with signs that are both localizing and lateralizing. These are usually fairly easy to image neuroradiologically. The rarer diffusely infiltrating variety manifest a slowly building array of findings pointing to all levels and both sides of the brainstem. Our 2 cases exemplify the diffuse variety. They were clinically typical, and the CSF pressure and protein were elevated but the neuroimaging abnormalities were so subtle that they were originally overlooked. This subtlety of neuroradiologic abnormality resembles that found in gliomatosis cerebri.

Adult↗
PubMed1989

Transient ocular motor paresis associated with acute internal carotid artery occlusion.

While sudden monocular blindness and occlusion of the central retinal artery associated with acute thrombosis of the internal carotid artery are well reported, concurrent unilateral ophthalmoparesis is not. We studied 3 adult men who did not have other major signs of vascular disease but who exhibited the complete syndrome. The initial paresis of the oculomotor, trochlear, and abducens nerves varied in each individual and slowly cleared over days to weeks in all, but vision did not return in any. Each had mild-to-moderate signs of hemispheric dysfunction. In each, the thrombus extended from the origin of the internal carotid to its intracranial bifurcation into the anterior and middle cerebral arteries. It also occluded the proximal one-half to two-thirds of the ophthalmic artery. None had evidence of vasculitis or compromise of the posterior circulation.

Adult↗
PubMed1988

Primary peripheral neuroepithelioma of the orbit with intracranial extension.

A 7-year-old girl with clinical signs limited to moderate unilateral proptosis of 2 weeks duration and ipsilateral disc edema was found to have a contiguous orbital and subfrontal intracranial tumor best characterized as a peripheral neuroepithelioma by recent studies. Previously this tumor would have been called an extraosseous Ewing's sarcoma. The tumor had a significant lobular component on either side of the orbital roof. The patient is still alive 24 months posttreatment with multimodal excisional surgery, radiation, and chemotherapy.

Child, Preschool↗
PubMed1988

Magnetic resonance imaging of nonmetallic orbital foreign bodies.

We studied a cadaver head model in which we inserted three orbital foreign bodies. We chose these foreign bodies because of their similarity to substances found in orbital trauma. Teflon and Lucite were used to represent synthetic materials, and dry pine was chosen as a type of organic material. Lucite is similar in radiographic density to plastics used in interior trim for automobiles and spectacle frames. While both orbital ultrasound and plain skull films failed to detect the foreign bodies consistently, both computed tomography and magnetic resonance imaging detected and localized the foreign bodies relatively well. Computed tomography was better in delineating shape and characterizing composition.

Foreign Bodies↗
PubMed1988

Ophthalmic complications with disseminated intravascular coagulation.

Massive lid oedema, ecchymosis, proptosis with a total restriction of extraocular movement, markedly raised intraocular pressure, and occlusion of the central retinal artery developed acutely in the right eye of a 26-year-old woman with a past history of disseminated intravascular coagulation. She had been admitted to hospital for symptoms of abdominal pain and bleeding from multiple sites a few hours earlier. Five days previously she had some proptosis of the other eye and had been treated with antibiotics for suspected orbital cellulitis at another hospital. The oedema and proptosis resolved on high-dose intravenous corticosteroid therapy. Despite attempts to relieve the orbital oedema and raised intraocular pressure with a lateral canthotomy and antiglaucoma medications, the patient lost all perception of light in the right eye and has subsequently developed an optic nerve atrophy.

Adult↗
PubMed1988

Sneddon's disease presenting with visual loss and dementia.

A 51-year-old woman with Sneddon's disease presented with transient right hemifield loss of vision and transient right-sided weakness. Over the preceding decade she had experienced a slow decline in mental function. She also had hypertension, migraine, and a mixed seizure disorder. She had skin changes typical for generalized livedo reticularis but she did not have Raynaud's phenomenon or winter ulcerations. Her disease was not understood until the stroke-related symptoms were associated with the skin abnormalities. We review the neuro-ophthalmic manifestations of Sneddon's disease and add data from our case to the growing body of fact that suggests that Sneddon's disease may be an immunologically mediated vasculopathy.

Cerebrovascular Disorders↗
PubMed1988

Isolated vitamin E deficiency in the absence of fat malabsorption--familial and sporadic cases: characterization and investigation of causes.

We observed four young adults, including three siblings, with a progressive neurologic disorder that developed over the first two decades. Electrophysiologic studies revealed mildly delayed nerve conduction, decreased amplitudes of sensory action potentials, and sensory delay in the posterior columns. Known causes of similar neurologic disorders were excluded. Although vitamin E deficiency was well documented, intestinal absorption and plasma lipoprotein transport of vitamin E were normal. Incubation studies in vitro failed to identify a plasma factor causing destruction of circulating vitamin E. There was no clinical or laboratory evidence of steatorrhea caused by gastrointestinal, hepatic, or pancreatic disease. Plasma lipoproteins, apolipoprotein B, and adipose tissue fatty acid composition were normal. Oral vitamin E therapy restored serum levels to normal and caused neurologic improvement in two patients. We postulate that an inherited defect in hepatocyte secretion of vitamin E into lipoproteins may account for this disorder, which occurs in sporadic cases as well as in siblings.

Absorption↗