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PubMed1991

Propofol: effective dose and induction characteristics in unpremedicated children.

The induction dose, induction characteristics, and cardiovascular and respiratory effects of propofol were studied in 90 unpremedicated children 3-12 yr old. Propofol in a dose of 1-3 mg.kg-1 was injected in an antecubital vein over 10-30 s. Successful induction was defined by loss of eyelash reflex occurring within 50 s of the conclusion of propofol injection and followed by subsequent acceptance of face mask without excessive movement. The effective dose of propofol resulting in loss of eyelash reflex in 50% (ED50) and 95% (ED95) of children were 1.3 (1.1-1.4) and 2.0 (1.7-2.6) mg.kg-1 (95% confidence interval). The corresponding ED50 and ED95 for a successful induction that included acceptance of face mask were 1.5 (1.3-1.7) and 2.3 (2.1-3.0), respectively. There was a 6.6% incidence of mild to moderate pain on injection and a 12.7% incidence of involuntary movement. Apnea (cessation of breathing greater than 20 s) was seen in 21% of patients. Blood pressure decreased by more than 20% of baseline value in 48% of patients who received halothane (1-3%) after the bolus injection of propofol. It is concluded that propofol is an effective induction agent in children. A dose of 2.5-3.0 mg.kg-1 is recommended to ensure a smooth transition to an inhalational maintenance technique. The use of antecubital veins is associated with a low incidence of pain on injection.

Anesthesia, Intravenous↗
PubMed1985

Induction dose-response curves for midazolam and ketamine in premedicated ASA class III and IV patients.

Using probit analysis, dose-response curves for induction of anesthesia with midazolam or ketamine were constructed in ASA class III and IV patients premedicated with morphine, 0.1 mg/kg, and glycopyrrolate, 4 micrograms/kg. For ketamine, ED50 values for abolition of the response to verbal commands, eyelash stimulation, and painful stimulation were 0.9, 1.3, and 1.3 mg/kg, respectively; corresponding ED95 values were 1.6, 2.3, and 4.3 mg/kg, which are within the range of clinically recommended doses. For midazolam, ED50 values for verbal commands, eyelash stimulation, and painful stimulation were 0.19, 0.24, and 0.36 mg/kg, significantly greater than those previously reported for unpremedicated ASA class I and II patients. The corresponding ED95 values, 0.35, 0.43, and 1.04 mg/kg exceed previously reported values and are appreciably greater than the doses used in most previous studies of midazolam induction. Midazolam decreased systolic blood pressure slightly but significantly (from 138 +/- 4 to 128 +/- 4 mm Hg, mean +/- SEM, P less than 0.005), while diastolic blood pressure and heart rate remained unchanged. In contrast, ketamine increased systolic blood pressure (from 141 +/- 4 to 164 +/- 5 mm Hg, P less than 0.005), diastolic blood pressure (from 71 +/- 3 to 88 +/- 4 mm Hg, P less than 0.005), and heart rate (from 84 +/- 2 to 102 +/- 4 beats/min, P less than 0.005). On the basis of these data, we conclude that in ASA class III and IV patients, midazolam induction allows for hemodynamic stability and avoids the significant tachycardia and hypertension associated with equipotent doses of ketamine.

Anesthesia, Inhalation↗
PubMed1981

Induction of cleft lip in cultured rat embryos by localized administration of tunicamycin.

Whole-embryo culture techniques have advanced to the point where the study of normal and abnormal primary palate development in vitro is possible. The purpose of this study was to ascertain whether localized administration of tunicamycin (TM) an inhibitor of protein glycosylation, into the region of the developing primary palate would induce cleft lip in culture. Rat embryos were explanted on late day 11 of gestation and cultured with open yolk sacs for 40 h. TM was administered by implanting a sterile eyelash soaked in TM into the nasal placode region. The contralateral placode was used as the control by implanting an eyelash lacking TM. Under these conditions, TM-treated placodes were found to develop cleft lip in 14 out of 15 embryos compared to 0 for the controls. These experiments demonstrate that localized administration of TM results in cleft lip formation in whole embryo culture. The technique of localized administration of drugs and teratogens in whole embryo culture should prove useful for similar studies on embryonic development.

Animals↗
PubMed1993

[Quality of induction and adrenocortical function. A clinical comparison of Etomidate-Lipuro and Hypnomidate].

UNLABELLED: The purpose of this study was to compare etomidate in a lipid emulsion (Etomidat-Lipuro; Braun, Melsungen) and in propylene glycol (Hypnomidate, Janssen Pharmaceutica) in 90 patients in terms of anaesthetic induction characteristics with special reference to injection side effects, haemodynamic changes, and quality of induction. Adrenocortical hormones were determined in 30 patients who received either Etomidat-Lipuro, Hypnomidate, or propofol (Diprivan, ICI Pharma) for induction of anaesthesia. METHODS: One hundred twenty patients gave their informed consent to the study. In the first part, 90 patients were assigned at random to two groups in which induction of anaesthesia was performed either with Etomidat-Lipuro or Hypnomidate. Anaesthesia was started by i.v. injection of 25 micrograms/kg alfentanil (Rapifen, Janssen Pharmaceutica). One minute later, the hypnotic agent was injected into a freely running i.v. line (18 Gcannula) that was used only for the hypnotic and was removed 15 min later. During injection, the patients were asked to inform the anaesthesiologist spontaneously and on request about their sensations at the injection site. The time from the beginning of anaesthesia until the disappearance of the eyelash reflex was measured. The patients were ventilated and vecuronium was administered to allow good intubation conditions 2-3 min later. For the first 10 min, blood pressure and heart rate were measured every minute. Postoperatively, the same investigator made rounds once a day and examined the injection sites. Signs of pain, redness, swelling, induration, thrombophlebitis, or thrombosis were noted. In the second part of the study, 30 patients were investigated for endocrinological changes after induction of anaesthesia with Etomidat-Lipuro, Hypnomidate, or Diprivan. The patients were allocated to the groups at random. A radial artery catheter was inserted in every patient. Sampling took place 30 min before and 1 and 2 h after induction. Additional samples were drawn 30 min and 1, 2, and 22 h after i.v. administration of 0.25 mg ACTH (Synacthen, Ciba-Geigy). The plasma concentrations of cortisol, 17 alpha-OH-progesterone, and aldosterone and the renin activity were determined by high-performance liquid chromatography. RESULTS: The loss of the eyelash reflex occurred 42.9 +/- 8.7 and 42.2 +/- 11.0 s after the administration of Etomidat-Lipuro and Hypnomidate. The haemodynamic changes were minimal in both groups. After administration of alfentanil, local side effects of the hypnotics were scarce, with a tendency to be weaker and more seldom after Etomidat-Lipuro (3/55 versus 8/55). The postoperative vein reactions were generally mild and occurred in 17 out of 55 patients after Etomidat-Lipuro and 15 out of 55 patients after Hypnomidate. In most cases these signs were no longer present on the 2nd day after the procedure. Cortisol levels were depressed initially by all the hypnotic drugs used. While there was spontaneous recovery in the Diprivan group after 2 h combined with a positive overshooting response to ACTH stimulation, in the etomidate groups cortisol could not be stimulated; it normalized slowly during the following 24 h. The 17 alpha-OH-progesterone increase was significant in the etomidate groups after the administration of ACTH. The aldosterone levels decreased after etomidate injection and had not normalized 24 h later, while there was a normal response to ACTH in the propofol group. There was a normal decrease in renin activity in all three groups after the administration of ACTH. CONCLUSION: Local side effects are minimal after the administration of Etomidat-Lipuro and Hypnomidate. Alfentanil reduces the injection pain of etomidate induction agents. Cortisol and aldosterone are depressed by etomidate, but the clinical relevance is minimal after a single bolus injection.

Adolescent↗
PubMed1998

Generalized atrophic benign epidermolysis bullosa in 2 siblings complicated by multiple squamous cell carcinomas.

BACKGROUND: Generalized atrophic benign epidermolysis bullosa is a form of junctional epidermolysis bullosa characterized by skin fragility; atrophic alopecia; sparse eyebrows, eyelashes, and axillary and pubic hair; dystrophic fingernails and toenails; and enamel defects in decidual and permanent teeth. Substantial progress was recently made elucidating the genetic defects underlying this disorder. In affected persons, pathogenetic mutations were identified in the genes encoding the beta 3 chain of laminin 5 (LAMB3) or the 180-kd bullous pemphigoid antigen (BPAG2/COL17A1). OBSERVATIONS: Two brothers, aged 39 and 32 years, had characteristic clinical features of generalized atrophic benign epidermolysis bullosa. By electron microscopy, dermoepidermal separation was seen at the level of the lamina lucida, establishing a diagnosis of junctional epidermolysis bullosa. Lesional and clinically unaffected skin showed basal keratinocytes with hypoplastic hemidesmosomes, possibly indicating a defect of hemidesmosomal or associated proteins. Both patients presented with multiple fungating tumors on atrophic and scarred skin on their lower legs; 2 tumors in the older sibling and 4 tumors in the younger sibling were diagnosed as well-differentiated squamous cell carcinomas. Tumor staging elicited no evidence of regional lymph node involvement or systemic disease. Treatment was by microscopically controlled surgery. All wounds were allowed to heal by secondary intention. In both patients, wound healing was markedly delayed and characterized by the formation of abundant granulation tissue and poor re-epithelialization. CONCLUSIONS: In the absence of other apparent risk factors for the development of squamous cell carcinomas, chronic wounding resulting from recurrent skin blistering probably provided an important prerequisite for tumor promotion in these patients. The 2 cases presented herein provide evidence that the development of malignant skin tumors in patients with epidermolysis bullosa is not confined to the dystrophic forms but also may occur in some variants of junctional epidermolysis bullosa, such as generalized atrophic benign epidermolysis bullosa.

Adult↗
PubMed1999

Ocular findings in ichthyosis follicularis, atrichia, and photophobia syndrome.

Ichthyosis follicularis, atrichia, and photophobia (IFAP) are typical features of a rare neuroichthyosis termed IFAP syndrome. We demonstrate the ultrastructural findings of the eyes from a 33-year-old patient with IFAP syndrome. Clinically, eyebrows and eyelashes were absent from birth, and photophobia was noted at the age of 1 year. The globes measured 28 and 29 mm, respectively, and both eyes showed a posterior staphyloma. Histopathologically, bilateral centrally located subepithelial avascular corneal scarring with secondary corneal amyloid deposition was found. In addition to already described ocular abnormalities in IFAP syndrome we demonstrate ultrastructural anomalies of desmosomes and tonofilaments in corneal epithelium; defects of basement membrane, Bowman layer, and anchoring fibrils; secondary corneal amyloid deposition; and keratocyte degeneration. A defective tear film, recurrent atopic keratoconjunctival inflammations, or a primary anomaly of corneal epithelial adhesion are potential causes for the corneal defects. Photophobia is most likely due to corneal abnormalities.

Abnormalities, Multiple↗
PubMed2004

Risk factors for recurrence of postoperative trichiasis: implications for trachoma blindness prevention.

BACKGROUND: Trachoma is the leading worldwide cause of preventable blindness. Surgery can alleviate trachomatous trichiasis (TT), the blinding sequelae of trachoma, but recurrence rates are high. OBJECTIVE: To investigate risk factors for TT recurrence. METHODS: We conducted a prospective case-control cohort study in Nepal that included patients with TT who were undergoing bilamellar tarsal-rotation surgery and control subjects who have scarring but no TT. Conjunctivae were graded for trachoma and swabbed to detect Chlamydia trachomatis by in-house and commercial (Roche Amplicor; Roche Diagnostics Corp, Indianapolis, Ind)-polymerase chain reaction. Univariate and multivariate analyses were performed for associations with chlamydiae and other risk factors. RESULTS: Postoperative TT recurrence rates were 11.1% (4 cases) at 6 months and 25.0% (11 cases) at 12 months while no controls developed TT. Significantly, 5 (45.5%) of 11 patients with TT recurrences at 12 months had chlamydial infection at baseline (odds ratio, 6.0; 95% confidence interval, 1.5-24.3; P =.01), 8 (72.7%) at 6 months (odds ratio, 28; 95% confidence interval, 4.3-181.0; P <.001), and 9 (81.8%) at 12 months (odds ratio, 48; 95% confidence interval, 7.5-302.6; P =.00). No controls were infected during this time. Active trachoma and the baseline number of eyelashes touching the globe were also risk factors for TT recurrence. MAIN OUTCOME MEASURES: The outcome variable was TT recurrence at 6 and 12 months. CONCLUSION: To our knowledge, this is the first study to demonstrate that chlamydial infection at the time of surgery and at follow-up is a significant risk factor for postoperative TT recurrence.

Adult↗
PubMed1996

Botryomycosis of limbal conjunctiva with Splendore-Hoeppli phenomenon.

An 84-year-old man complained of irritation of the left eye of several months' duration. He had had several previous surgical procedures including removal of bilateral pterygia and bilateral cataract extraction. Examination of the bulbar conjunctiva on the left eye disclosed a collection of cilia (eyelashes) located adjacent to the limbus at the 11:30-o'clock position. This aggregate of cilia was associated with irregular yellowish deposits 1.5 mm in diameter. The cilia and redundant conjunctival tissues were surgically excised. Histopathologic examination showed a botryomycotic granule surrounded by a prominent acidophilic ring (Splendore-Hoeppli phenomenon). Gram stains demonstrated the presence of microcolonies of gram-positive cocci and gram-negative rods within the granule. We postulate that the entrapment of displaced cilia provided a nidus for the bacterial colonization forming the botryomycotic granule. To our knowledge, botryomycosis of the conjunctiva has not been reported previously.

Aged↗
PubMed1998

Acquired hypertrichosis lanuginosa: case report and review of the literature.

Acquired hypertrichosis lanuginosa is a rare cutaneous disorder usually associated with internal malignancy that consists of the development of abnormal hair growth of the lanugo type, often confined to the skin of the face and neck, although other areas also may be involved. We report on a 66-year-old woman with a metastatic ductal infiltrating carcinoma of the breast who developed growth of fine lanugo type hair on her face and progressive growth of the hair of eyebrows and eyelashes. We review the literature on this uncommon paraneoplastic cutaneous disorder emphasizing the pathogenic mechanisms that have been proposed to explain the striking overgrowth of lanugo type hair.

Aged↗
PubMed1995

Autosomal dominant inheritance in Setleis syndrome.

Setleis syndrome is characterized by bitemporal skin depressions resembling forceps marks, abnormalities of the eyelashes, and "leonine" facial appearance. The cause is unknown, although autosomal recessive inheritance has been proposed. Recently, two families were reported in which one of the parents of a patient with Setleis syndrome showed mild manifestations, suggesting autosomal dominant inheritance. We describe a 9-month-old Japanese boy with typical Setleis syndrome. His father, who has normal intelligence, has bitemporal focal dermal dysplasia but a normal face. His paternal second cousin also has Setleis syndrome. This family shows autosomal dominant inheritance including father-to-son transmission of Setleis syndrome with variable expressivity and reduced penetrance. Careful examination of the relatives of patients with Setleis syndrome is recommended.

Adult↗
PubMed2005

Autosomal recessive Oliver-McFarlane syndrome: retinitis pigmentosa, short stature (GH deficiency), trichomegaly, and hair anomalies or CPD syndrome (chorioretinopathy-pituitary dysfunction).

We describe a brother and sister with retinitis pigmentosa (RP), growth failure, long eyelashes, and sparse hair. They were born to young healthy consanguineous parents and presented at birth with IUGR. Evolving pigmentary retinopathy was diagnosed at the age of 5 years. A similar condition (Oliver-McFarlane) syndrome was reported previously. Our two sibs confirm the existence of this autosomal recessive syndrome.

Adolescent↗
PubMed1980

Hereditary spinal arachnoid cysts, distichiasis, and lymphedema.

Familial congenital spinal arachnoid cysts causing progressive paraplegia are reported in two adolescent siblings as part of a hereditary syndrome. The other features of this unusual dominantly inherited disorder include double rows of eyelashes, partial ectropion of the lower eyelids, and acquired late-onset lymphedema of the lower extremities. The siblings' mother, who had roentgenographic evidence of a similar intraspinal lesion, was free of neurological symptoms but had the other characteristic features. Surgical treatment of the arachnoid cysts improves the progressive paraplegia.

Adolescent↗
PubMed1980

Syndrome of lymphoedema and distichiasis.

A family of ten members in three generations who were affected by lymphoedema with or without distichiasis (extra rows of eyelashes) was observed. This combination of symptoms can be presumed to represent a rare but well-defined hereditary syndrome transmitted by an autosomal dominant gene. Some years ago the published pedigrees of congenital hereditary lymphoedema were reviewed and analysed genetically by Esterly (1965). Recently papers have been published on the association of lymphostasis with congenital distichiasis (Falls and Kertesz, 1964; Robinow et al., 1970; Jester, 1977). We report here a family with ten members in three generations affected by lymphoedema with or without distichiasis.

Adolescent↗
PubMed2005

Eyelid splitting with follicular extirpation using a monopolar cautery for the treatment of trichiasis and distichiasis.

PURPOSE: To assess the efficacy of eyelid splitting coupled with follicular extirpation via monopolar cautery in the treatment of trichiasis and distichiasis. METHODS: Between March 2000 and October 2003, this surgery was performed on 52 eyelids from 45 patients, with a mean follow-up period of 14.3 months (ranging from 12.3 to 17.6 months) . Under local anesthesia and a surgical microscope, a chalazion clamp is positioned on the eyelid, and a no. 11 scalpel is employed to make an incision located immediately anterior and parallel to the abnormal eyelash line. Each of the abnormal hair follicles is then removed via cautery with a monopolar needle. No sutures are involved in this procedure. RESULTS: Forty-four eyelids of 40 patients (84.6%) were successfully treated without recurrence or any residual symptoms. Repeat surgery was then performed on eight eyelids, with successful results in six cases. The cumulative success rate for this procedure was 96.1%. No complications were noted in the treated area, including lid deformities, granuloma formation, infections, and others. CONCLUSIONS: Eyelid splitting coupled with follicular extirpation via cautery with a monopolar needle, a procedure which requires no sutures, constitutes a simple and effective method for the treatment of both trichiasis and distichiasis and is associated with favorable functional and cosmetic results.

Adolescent↗
PubMed1976

An accidental tarsorrhaphy caused by acrylic adhesive.

A 10-year old boy accidently splashed acrylic adhesive in his left eye. I separated the eyelids by cutting adherent eyelashes with the use of a biomicroscope for magnification illumination. Tests with rabbits demonstrated that the solvent nitromethane dissolved the adhesions but diluted the glue and led to adhesions between the tarsal portion of the eyelid and the cornea. I used acrylic adhesions successfully for a temporary relief of irritation in a patient with Bell's palsy.

Accidents, Home↗
PubMed1976

Cryosurgery for treatment of trichiasis.

We cryosurgically destroyed eyelashes in rabbits and applied the technique to treat 23 selected patients with trichiasis. Liquid nitrogen was sprayed on the eyelid margin by using a double, rapid-freeze, slow-thaw cycle monitored by a subcutaneous thermocouple to -30 degrees C. It was an improvement on electrolysis and a simple alternative to surgery.

Animals↗
PubMedDate not supplied

Diagnosing and treating Phthirus pubis palpebrarum.

Phthiriasis palpebrarum is an uncommon cause of blepharitis and conjunctivitis and may easily be overlooked. A high index of suspicion and careful examination of the patient's lid margins and eyelashes will lead to the proper diagnosis. Treatment is best accomplished by careful removal of the lice and nits (louse eggs) from the patient's lashes. Local application of a pediculocide such as yellow mercuric oxide N.F. 1% ophthalmic ointment applied twice daily for one week or 0.25% physostigmine (Eserine) ointment applied twice daily for a minimum of ten days, to the lid margins should be considered when the total removal of Phthirus pubis and nits is not possible mechanically. Body hair should be examined for infestation with lice and treated with gamma benzene hexachloride shampoo. This medication should be used with caution in infants, children and pregnant women. Family members, sexual contacts, and close companions should be examined and treated appropriately; clothing, linen and personal items should be disinfected with heat of 50 degrees C for 30 minutes.

Adult↗