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PubMed1986

The coincidence of glucose-6-phosphate dehydrogenase deficiency and hemoglobin S gene in Cukurova Province, Turkey.

A total of 1,582 subjects from 10 villages of different ethnic populations were screened for glucose-6-phosphate dehydrogenase (G6PD) deficiency (GdB-, Mediterranean variant) and hemoglobin S gene, and the coincidence of both abnormalities was determined. Although the prevalence of both abnormalities was found to be highest in an Eti-Turk group living in the Tarsus area, coincidence was not significant. In a single village of Adana Eti-Turks, however, coincidence was found to be significant, although neither the frequency of G6PD deficiency nor the existence of hemoglobin S gene was highest in that village.

Anemia, Sickle Cell↗
PubMed1997

Radiographic damage in large joints in early rheumatoid arthritis: relationship with radiographic damage in hands and feet, disease activity, and physical disability.

An assessment of the onset of radiographic damage in the large joints (hip, knees, shoulders, elbows, ankles and tarsus) in patients with early rheumatoid arthritis, and the relationship of the progression of large joint damage with joint damage in hands and feet, with physical disability, and with cumulative disease activity, was performed in a prospective 6 yr follow-up study. Large joint damage appeared to be an early phenomenon with 20% of the patients having some damage in at least one large joint within 1 yr, and 50% of the patients within 6 yr after disease onset. Radiographic damage in large joints was significantly related to the damage in hands and feet, the physical disability index, and the cumulative disease activity. The initial disease activity at study entry was the only prognostic factor that reached significance.

Adolescent↗
PubMed1997

Multiple sources of character information and the phylogeny of Hawaiian drosophilids.

Relationships among representatives of the five major Hawaiian Drosophila species groups were examined using data from eight different gene regions. A simultaneous analysis of these data resulted in a single most-parsimonious tree that (1) places the adiastola picture-winged subgroup as sister taxon to the other picture-winged subgroups, (2) unites the modified-tarsus species group with flies from the Antopocerus species group, and (3) places the white-tip scutellum species group as the most basal taxon. Because of the different gene sources used in this study, numerous process partitions can be erected within this data set. We examined the incongruence among these various partitions and the ramifications of these data for the taxonomic consensus, prior agreement, and simultaneous analysis approaches to phylogenetic reconstruction. Separate analyses and taxonomic consensus appear to be inadequate methods for dealing with the partitions in this study. Although detection of incongruence is possible and helps elucidate particular areas of disagreement among data sets, separation of partitions on the basis of incongruence is problematic for many reasons. First, analyzing all genes separately and then either presenting them all as possible hypotheses or taking their consensus provides virtually no information concerning the relationships among these flies. Second, despite some evidence of incongruence, there are no clear delineations among the various gene partitions that separate only heterogeneous data. Third, to the extent that problematic genes can be identified, these genes have nearly the same information content, within a combined analysis framework, as the remaining nonproblematic genes. Our data suggest that significant incongruence among data partitions may be isolated to specific relationships and the "false" signal creating this incongruence is most likely to be overcome by a simultaneous analysis. We present a new method, partitioned Bremer support, for examining the contribution of a particular data partition to the topological support of the simultaneous analysis tree.

Animals↗
PubMed1979

Experience with the Fasanella-Servat operation for ptosis of the upper eyelid.

A quick, simple, and reliable operation for the correction of mild to moderate ptosis in the presence of fair to good levator function was described by Fasanella and Servat nearly two decades ago. This operation consists of resection of the conjunctiva, tarsus, and müller's muscle using a conjunctival approach. We have performed this operation in 39 patients with good to excellent results in 38. Our criteria and experience are described.

Blepharoptosis↗
PubMed1990

Upper eyelid ptosis correction by a revised tarsal resection technique.

Many techniques have been developed for the correction of eyelid ptosis. A new tarsal plate resection technique is described for use in cases of minimal ptosis with fair to good levator function. The procedure involves a horizontal lenticular excision of the tarsal plate, placed so that equal amounts of tarsus remain above and below the excision. The height of the excision is equal to the amount of ptosis correction desired, as determined in the preoperative examination. This precision in surgical correction is the chief advantage of the procedure. The technique also spares Müller's muscle, thus retaining the lid-elevating action of that muscle. Good results have been achieved in 6 patients, some showing excellent results after nine years.

Adolescent↗
PubMed1994

Lower lid reconstruction with a chondromucosal alar graft and upper lid musculocutaneous flap.

Partial or total lower lid reconstruction implies the repair of three layers: the skin, the tarsus, and the conjunctiva. The method of reconstruction must, therefore, aim at three objectives: ensuring the stability of the lid by repairing the tarsoconjunctival layer, achieving an aesthetic result with the repair of the skin, and taking into consideration the primary role of the upper lid in the ocular protective system. We recommend a musculocutaneous flap, taken from the upper lid, with a single lateral or medial pedicle combined with a chondromucosal alar graft. During the last 10 years, 41 patients were operated on with malignant skin tumors requiring marginal, partial, and total lower lid reconstruction. The results were quite satisfactory from a functional and aesthetic point of view. We noticed two cases of partial flap necrosis and two cases of ectropion needing revision. We believe that the procedure described can be a tool in the armamentarium of the plastic surgeon involved in the field of the orbitopalpebral area.

Eyelid Neoplasms↗
PubMed2001

Oriental double eyelid: a limited-incision technique.

Although there are many procedures reported in the literature regarding the double-eyelid operation, they can be categorized basically into two groups: nonincision and incision. Conventionally, the nonincision technique has been shown to produce little postoperative edema. However, the probability of the fold disappearing is high, and this technique cannot be performed in patients with fatty eyelids. Conversely, the incision technique has contrary characteristics. As an alternative option, the author developed a limited-incision single-stitch technique that minimizes tissue injury and provides adequate adhesion for fold formation. With this method, a small single incision (3-4 mm) is made in the upper eyelid. Through the incision, the orbital fat can be removed, when indicated. Under direct vision, a levator aponeurosis or tarsus is attached to the muscle and the dermis of the pretarsal margin by a single stitch. This technique gives a durable, natural fold; has a short recovery time; and can be applied to patients with fatty eyelids. This method has the merits of both the incision and the nonincision techniques, and avoids the disadvantages of both procedures.

Adolescent↗
PubMed1987

Meibomian gland dysfunction in floppy eyelid syndrome.

A 41-year-old obese man presented with bilateral ocular irritation and clinical findings consistent with floppy eyelid syndrome. Light- and electron-microscopic examination of tarsus removed at surgical correction revealed cystic degeneration and squamous metaplasia of the meibomian glands, along with abnormal keratinization and granuloma formation. These findings, not reported before in this syndrome, suggest that meibomian gland dysfunction with attendant qualitative abnormalities of the tear film, may be partly responsible for the keratoconjunctivitis seen in this syndrome.

Adult↗
PubMed1989

Unusual complication of strabismus and lid surgery.

A patient with longstanding dysthyroid eye disease developed a broad adhesion between the globe and the upper eyelid following simultaneous surgery to recess the levator palpebrae superioris and lateral rectus muscles. This unusual complication may have developed as a consequence of failure to suture the conjuctiva of the upper fornix to the tarsus and also due to the prolonged static contact between the resulting adjacent raw areas due to postoperative eyelid traction and pressure dressings. Periods of such contact may have been further prolonged by the action of diazepam, which reduces the peak velocity of saccadic eye movements and suppresses rapid eye movement of sleep. Eyelid surgery should be performed as a separate procedure, under local anesthetic after healing of areas bare of conjunctiva from strabismus surgery utilizing the adjustable suture technique.

Conjunctiva↗
PubMed1989

Medical ectropion repair. A new procedure.

The lazy-T procedure described by Smith corrects medial ectropion of the lower lid by combining a horizontal full-thickness shortening of the lid with excision of conjunctiva and tarsus inferior to the punctum to invert the lid. However, some cases of senile medial ectropion involve an element of vertical traction on the skin as well as horizontal lid laxity. A new procedure is described that makes use of skin gained from horizontal lower lid shortening in the form of a medially based transposition flap to produce vertical skin lengthening. It is useful to treat medial ectropions that have horizontal laxity along with cicatricial components and has successfully relieved this condition in eight patients.

Conjunctiva↗
PubMed1990

Mideyelid entropion.

A distinct entity of entropion involving the middle portion of the lower eyelids is presented. This condition is not related to any local or systemic disorder and does not progress to entropion of the entire lower eyelid. Segmental atrophy of the lower lid tarsus is present.

Aged↗
PubMed1991

Double rhomboid silicone rod frontalis suspension.

The frontalis suspension operation has proven effective for patients with significant ptosis and poor levator function. In patients with poor eye protective mechanisms, silicone rods may be used since the material has enough tensile strength to raise the eyelids yet it is sufficiently elastic to allow closure via action of the orbicularis muscle. This article reports the technique and results of a modified operation that uses two silicone rods per upper eyelid and eliminates fixation sutures to tarsus inferiorly and frontalis muscle superiorly. The results obtained are discussed. This technique provides a better upper eyelid contour and is easily adjustable postoperatively.

Adult↗
PubMed1992

Eyelid reconstruction with hard palate mucosa grafts.

Hard palate mucosa grafts are an excellent replacement for tarsus and conjunctiva in eyelid reconstruction. Twenty-five eyelids from 18 patients underwent eyelid reconstruction using hard palate mucosa grafts. Patients were treated for a variety of disorders including postblepharoplasty lower eyelid retraction, cicatricial entropion, eyelid retraction secondary to thyroid eye disease, and lagophthalmos following surgery for paralytic ptosis. Surgical results were evaluated, grafts were measured for postoperative shrinkage, and donor site healing was recorded. Several patients had hard palate biopsy specimens evaluated. One of these patients also had a graft biopsied after it had been in place for 3 months. A review of hard palate anatomy and histology and a discussion of surgical technique are presented.

Adult↗
PubMed1994

Irradiated homologous aorta in eyelid reconstruction. Part 1: Technique and animal research.

Reconstruction of full thickness eyelid defects requires the correction of posterior lamella (tarsus, conjunctiva) and anterior lamella (skin, muscle). Various tarsal substitutes--conchal and nasal cartilage, banked sclera, hard palate, irradiated homologous tarsal plates, periosteum, temporalis fascia, and composite grafts from the opposite eyelid--have been used for posterior lamellar replacement over the years. Eyelid-sharing procedures and full thickness flaps have also been described. At times, because of extensive tissue loss, the eyelid reconstruction can be particularly challenging because of the shortage of tissue. We describe a new posterior lamellar technique using irradiated homologous aorta. The experimental surgical procedure in rabbits, the clinical response, and the histological fate of the donor aorta are described in Part 1 followed by our experience with four patients in Part 2.

Animals↗
PubMed1998

The arrowhead skin-muscle flap in the closure of lower eyelid defects.

Lower-lid defects can arise from many sources, but they are often the result of excision of lower-lid tumors. The excision of the lesion is often performed by means of a pentagonal wedge resection. After repair of the tarsus and reapproximation of the lid margin, the skin and orbicularis are usually closed in a vertical fashion, which is perpendicular to relaxed skin tension lines and may extend further down the lid than is optimal as a result of a dog-ear excision. The authors propose a new method for closure of skin and orbicularis muscle in repair of lower eyelid marginal defects. This method is simple and has several advantages over vertical closure: it follows relaxed skin tension lines, allows closure of the anterior lamella in the opposite direction from the posterior lamella, and leaves an infraciliary scar rather than a vertical scar extending down the cheek. This method has been used in over 100 patients during the past 8 years, and no significant complications have occurred. Potential disadvantages of the technique include increased vertical tension and a tendency for the lid to be pulled downward. For these reasons, the arrow-head flap would not be the best choice in patients with preexisting lower eyelid retraction, cicatricial ectropion, or vertically tight lower-lid skin.

Dermatologic Surgical Procedures↗
PubMed1999

Correction of eyelid anomalies in pachydermoperiostosis.

PURPOSE: Pachydermoperiostosis, or primary hypertrophic osteoarthropathy, is a rare disease, characterized by pachydermia, acropathy, and periostosis. The authors propose the surgical correction of the eyelid anomalies in one stage. METHODS: A 30-year-old patient with moderate blepharoptosis (3 mm) and increased vertical and horizontal dimensions of the upper eyelids underwent fusiform transverse excision of skin, orbicularis muscle, and tarsus; shortening of the levator palpebrae superioris apeoneurosis by 13 mm; and 8-mm-wide wedge excision. RESULTS: Histologic findings included hyperplasia of the tarso-conjunctival plate, obstructive cystic dilatation of the sebaceous glands, extensive fibrosis, and granulomatous reaction. Satisfactory functional and aesthetic results were observed after surgery. CONCLUSION: Upper eyelid anomalies in pachydermoperiostosis can be corrected in a single stage bilaterally with good results.

Adult↗
PubMed2000

Causes of involutional ectropion and entropion--age-related tarsal changes are the key.

PURPOSE: To measure tarsal plates across various age-groups, to determine whether tarsal size changes with increasing age and whether size correlates with involutional ectropion and entropion. METHODS: Comparative, observational, case-control study design. Data were obtained for length and height of tarsus in each of the four eyelids. The data were constructed to determine: (I) right-to-left-side comparison data, (II) sex difference data, (III) age normal data, (IV) involutional entropion data, (V) involutional ectropion data. RESULTS: (I) There is no difference in tarsal dimensions between right and left sides; (II) males have larger tarsal dimensions than females; (III) tarsal plates are on average smaller in older age ranges; (IV) patients with entropion have smaller than average age-normal tarsal plates; (V) patients with ectropion have larger than average age-normal tarsal plates. CONCLUSIONS: (I) Right and left tarsal plates have equal dimensions, and involutional changes likely occur on both right and left sides equally frequently; (II) males have larger tarsal plates than females and entropion is more frequent in females and ectropion in males; (III) tarsal plates may have a general tendency to atrophy or shrink with age; this may explain why some eyelids develop entropion and others ectropion; (IV) entropion results from the mechanical effect of an atrophied or smaller than age-normal, partially or fully disinserted, tarsal plate being overcome by the normal or increased tone of the preseptal/pretarsal orbicularis muscle; (V) ectropion results from an age-normal or larger than normal tarsal plate mechanically overcoming the normal or decreased tone of the preseptal/pretarsal orbicularis muscle in combination with medial/lateral canthal tendon laxity.

Adult↗
PubMed2001

An animal model of lower eyelid spacer grafting with acellular dermis.

PURPOSE: Lower eyelid retraction is common in patients with dysthyroid orbitopathy and is seen less commonly in other conditions. Treatment typically requires vertical augmentation of the posterior eyelid lamella with an interpositional graft. Several autologous, homologous, and alloplastic materials have been used. We investigated the gross and microscopic in vivo histology of acellular homologous dermis used as a structural interpositional graft in the lower eyelids of Yucatan minipigs. METHODS: This prospective, experimental study was designed as follows: Surgery was performed on the left lower eyelid of 4 Yucatan minipigs in accordance with the Massachusetts General Hospital Subcommittee on Research Animal Care guidelines. A 4 x 20-mm strip of acellular porcine dermis was prepared and sutured into place between the tarsus and conjunctiva/lower lid retractors. Tissues were harvested at 6 and 12 weeks and were evaluated histologically. RESULTS: Gross examination revealed vertical elongation of the palpebral conjunctival surface. Histologic evaluation was performed with hematoxylin and eosin and Verhoeff elastin stains. Serial sections demonstrated incorporation of grafted dermal matrix into native tissues without evidence of inflammation. Definitive differentiation between grafted dermis and native dermis was not possible with light microscopy. Portions of the graft appeared to be epithelialized, whereas other histologic regions showed poorly adhesive epithelium. Inflammatory infiltrates including lymphocytes and polymorphonuclear leukocytes were not seen. No epithelioid or giant cells were identified in the sections examined. CONCLUSIONS: Acellular homologous dermis produced no measurable untoward effects when implanted as an interpositional graft in the lower eyelid of Yucatan minipigs. On the basis of its material characteristics, it appears to be suitable for this purpose: It is readily available, easily stored, easy to manipulate, and produces minimal inflammation. Long-term persistence, early postoperative histology, and clinical eyelid elevation in humans remain to be evaluated.

Animals↗