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PubMed1994

Androgen action in cultured dermal papilla cells from human hair follicles.

Androgens are major regulators of human hair growth with paradoxically different effects on hair follicles depending on their body site. They stimulate terminal growth in many regions including the face, have no effect on eyelashes, but may cause inhibition and balding on the scalp in genetically disposed individuals. How this occurs is unknown. However, androgens may act on the hair follicle via the cells of the dermal papilla; these would then influence the other cells of the hair follicle by altering the production of regulatory substances such as growth factors and/or extracellular matrix components. Therefore, primary lines of dermal papilla cells have been established from androgen-sensitive hair follicles, such as beard, and control, relatively androgen-independent, non-balding scalp cells and their mechanism of androgen action has been compared. Isolated beard dermal papillae were larger than those from scalp follicles. Although dermal papilla cells did not respond to in vitro androgens by alterations in growth, androgen-dependent dermal papilla cells contained higher levels of specific, low capacity, high affinity androgen receptors than non-balding scalp cells. The ability of the cells to metabolise testosterone to 5 alpha-dihydrotestosterone in culture also varied in parallel to that predicted from studies of hair growth in the 5 alpha-reductase deficiency syndrome. These results support the hypothesis that androgens act via the dermal papilla. They also show that dermal papilla cells retain differences in gene expression in culture which appear to correspond with their androgenic response in vivo. Further studies of such cells should help elucidate why bald men can grow beards!

Androgens↗
PubMed1995

Hereditary hypotrichosis simplex of the scalp.

We report on a female aged 13 years, whose scalp hair began to disappear at the age of 9 years, leaving only sparse wispy hairs in the parietal-occipital region. Eyelashes, eyebrows and body hair were unaffected. There were no signs of ectodermal dysplasia on the skin, nails, teeth and eyes nor other congenital abnormalities. The family pedigree showed 15 relatives similarly affected according to an autosomal dominant mode of transmission. Clinical, genetic, histological and ultrastructural aspects led to a diagnosis of hereditary hypotrichosis simplex of the scalp (Toribio-Quiñones type).

Adolescent↗
PubMed1992

Atrichia and papular lesions: report of a case.

We report a case of atrichia with papular lesions in a 4-year-old girl. The scalp was completely hairless since birth, except for dark, shiny, coarse hair on the frontoparietal region. Eyelashes and eyebrows were sparse. Numerous papular lesions developed on the hairless scalp, cheeks and neck during the second year of life. Teeth and sweating function were normal. The family history was negative. Histologic examination of a papular lesion showed the presence of a keratin-filled cyst in contact with the overlying epidermis. The pathology of the bald scalp showed the presence of tubular epithelial structures devoid of hair bulbs extending from the epidermis to the deep dermis and the superficial hypodermis. Sebaceous and outer root sheath differentiation was evident in most of the tubular structures that also frequently contained small ducts surrounded by two or three layers of flat epithelial cells. The superficial dermis contained horny cysts, similar to those present on the cheeks.

Alopecia↗
PubMed1992

Comparative study of ketoconazole 2% foaming gel and betamethasone dipropionate 0.05% lotion in the treatment of seborrhoeic dermatitis in adults.

Sixty-two patients with seborrhoeic dermatitis were treated topically with a 2% ketoconazole foaming gel or with a 0.05% betamethasone dipropionate lotion in a single-blind study for 4 months. Changes in the number of Pityrosporum ovale were scored by a mycologist. The investigator rated the severity of erythema, scaling and itching of the patients' scalp, eyelashes, nasolabial folds and thorax. In addition, both the investigator and the patients evaluated the treatments globally. At the end of treatment, the response rate for ketoconazole 2% foaming gel was significantly higher than that for betamethasone dipropionate 0.05% lotion according to the global evaluation by the physician (89 vs. 62%, p less than 0.05) and the patient (89 vs. 65%, p less than 0.05). Ketoconazole was also superior to betamethasone with reference to the evolution of the symptoms, irrespective of their localization. This efficacy manifested itself by a significant reduction of the number of P. ovale on the scalp in the ketoconazole group (p less than 0.001) compared to the betamethasone group, in which the count was hardly changed during therapy. The treatment was also better tolerated in the ketoconazole group (5 vs. 16 patients with side-effects, p less than 0.001). It is concluded that ketoconazole 2% foaming gel offers an excellent alternative to local corticosteroids in the treatment of seborrhoeic dermatitis.

Administration, Topical↗
PubMed1992

Comparison of the Nidek EAS 1000 system and the Topcon SL-45 in clinical application.

Some years ago, Nidek developed a new imaging system for the anterior eye segment, which offers the possibility of recording Scheimpflug and retroillumination images. The system consists of 2 different technical units, a camera unit for image recording and a computer unit for storage, system operation and image analysis. To evaluate the clinical use of the system and its reproducibility, a study with 31 volunteers/patients was performed that were photographed with the Nidek EAS 1000 at the meridians 0 degree, 45 degrees and 180 degrees. Two examinations with a 1-week interval were performed. In addition, a direct comparison of the EAS 1000 with the Topcon SL-45 was carried out with 32 volunteers that were photographed at 0 degree and 45 degrees; a retroillumination photo was additionally recorded. The video images were evaluated with the computer software, the SL-45 negatives were standardly measured with a Joyce-Loebl densitometer. The handling of the EAS 1000 in clinical use was found to be easy and comfortable for the patient, as the alignment is done with infrared light. Difficulties occur only with the retroillumination photography in that the infrared light for imaging may outshine the red fixation light during exposure. However, shadowing problems due to the eyelashes occur in oblique slit positions, especially in those patients with a pronounced front head. In studying the reproducibility, the mean values of the individual coefficients of variation for light scattering (density) were in a range between 3.6 and 5.06%, but more than 35% of the single values show a variation coefficient above 5% (maximum 20.3%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1975

[Our further experiences with pathogenesis of pterigia].

Description of three pterygia in a patient, two of them on temporal side. In neighbourhood of the latters large prominent concrements were present in Meibaumian glands which were rubbing conjunctiva and cornea at each eye movement. They were thought to be the cause of these pterygia. On further examinations of pterygia and their surroundings it was found that besides hairs on caruncle and eyelashes in inner canthus also other pathological changes on eyelids may be the cause. Basing on findings in further 253 pterygia it may be accepted that pterygia occur after permanent microtrauma of conjunctiva and cornea. Those microtrauma may be due to pathological hairs on caruncle or in inner canthus and rarely due to concretion of Meibaumian glands, granulomas, Meibaumian cysts, lacrymal points, cysts and warts. In this way all the doubts about origin of pterygia may be explained. Knowledge of the causal factors may help prophylaxis and therapy of pterygium.

Conjunctiva↗
PubMed1985

[Unusual ocular anomaly in 9 p trisomy: retinal depigmentation].

A new case of 9 p trisomy is reported in a 7-month-girl having typical morphological abnormalities and a mental retardation. During the examination, unusual ocular abnormalities were observed: pigmented linear dots of the mid peripheral retinal. Strabismus and hypertelorism were present. However, the other ocular features, blepharophimosis, correctopia, ptosis, microphthalmia, iris coloboma, unusual position of the eyelashes were not observed.

Chromosomes, Human, 6-12 and X↗
PubMed1995

Ocular involvement in keratosis follicularis associated with retinitis pigmentosa. Clinicopathological case report.

In 1988, Itin et al. published the combination of keratosis follicularis (KF; Darier-White disease), an autosomal-dominantly transmitted genodermatosis, and retinitis pigmentosa (RP) in two brothers. One of these patients died unexpectedly at the age of 54 years. His eyelids and globes were histologically studied post mortem. Involvement of the eyelids has rarely been described clinically and not at all histologically. The skin and the intermarginal zone of the lids exhibited the typical changes of this cutaneous disease involving the follicles of the eyelashes. Focal keratinizations of the limbal conjunctiva, a regional increase in conjunctival goblet cells and a diffuse thickening of the basement membrane of the corneal epithelium were present. They are probably not specific for KF. The retinal findings were those of a typical late stage of RP. The combination of both genetically transmitted disorders could point to a damage in neighbouring gene loci. An abnormality of the metabolism of vitamin A was supposed to play a pathogenetic role in both diseases but remains speculative, as does a genetic linkage.

Conjunctival Diseases↗
PubMed2004

Anaesthesia for electroconvulsive therapy: a comparison of sevoflurane with propofol.

This study was a prospective audit of patients receiving either intravenous induction of anaesthesia with propofol 2 mg/kg or inhalational induction using 8% sevoflurane for patients undergoing electroconvulsive therapy (ECT). All patients received inhaled 50% nitrous oxide. The anaesthetic agent was determined by psychiatrist preference. Each psychiatrist nominated only one induction technique for all his or her patients. Seventy treatments were studied in each group. Induction time was longer in the sevoflurane group. The time from commencing induction to loss of verbal contact was [mean (SD)] 64 (29.9) seconds for sevoflurane and 36 (33.6) seconds for propofol (P=0.001). Time to loss of eyelash reflex was 82 (32.6)s for sevoflurane and 44 (17.9)s for propofol (P<0.001). The duration of seizure activity was longer in sevoflurane patients, 35 (17.8)s, compared with 20 (9.8)s in the propofol group (P< 0.001). Discharge times were similar Minor adverse effects occurred in three patients, all in the sevoflurane group (one bradycardia and two episodes of post-procedural nausea). There were no major adverse events in either group. Propofol and sevoflurane both appear to be suitable agents for induction of anaesthesia for ECT.

Adult↗
PubMedDate not supplied

Eyelid hypertrichosis associated with latanoprost is reversible.

A 56-year-old woman with primary open-angle glaucoma in an only eye presented with hypertrichosis after using Latanoprost to lower IOP. After trabeculectomy with adjunctive Mitomycin C, IOP was well controlled and antiglaucoma medications could be discontinued. At eight-month follow-up the abnormal eyelashes had disappeared.

Antihypertensive Agents↗
PubMedDate not supplied

Ocular manifestations of congenital lamellar ichthyosis.

PURPOSE: To describe the ophthalmic manifestations in a series of children with congenital lamellar ichthyosis. These cases presented with varying types of eyelid abnormality associated with the systemic disease. The clinical features and ophthalmic management were studied. METHODS: The case histories of three children presenting to the oculoplastic clinic were reviewed. All were diagnosed with congenital lamellar ichthyosis and under the care of the Dermatology department. Family history and pedigree analysis was performed to determine mode of genetic inheritance. Ocular examination for visual acuity, eyelid and eyelash malposition, lid function and closure were carried out. Corneal examination including tests for exposure was also done. RESULTS: All three patients had eyelid position abnormalities from the systemic disease. There was no clinical evidence of conjunctival involvement. One patient required full thickness skin grafts to treat corneal exposure secondary to lower lid ectropion. One had mild lower lid ectropion but without corneal exposure. The third case had the unusual finding of inward turning of the anterior lamella of the upper eyelid with a marked lash ptosis and only mild ectropion of the lower lid. CONCLUSIONS: Congenital lamellar ichthyosis is a heterogeneous disorder with phenotypic variability. The most common eyelid abnormality is cicatricial ectropion of the upper and mainly lower eyelids. Most cases are managed conservatively although in severe cases secondary corneal exposure may require surgical correction. In this condition, to the best of our knowledge, the tendency for the eyelids to turn inwards has not previously been described.

Child↗
PubMedDate not supplied

Efficacy and safety of bimatoprost in patients with uncontrolled glaucoma as alternative to filtration surgery.

PURPOSE: To evaluate the efficacy and safety of bimatoprost 0.03% as an alternative to filtration surgery in patients with uncontrolled glaucoma. DESIGN: Interventional study. METHODS: A total of 83 consecutive patients (83 eyes) awaiting glaucoma surgery were enrolled in eight ophthalmic centers. Reasons for listing were inadequate intraocular pressure (IOP) control despite medical therapy and documented progression of visual field loss. All patients discontinued the previous treatment and were switched to bimatoprost 0.03% QD (one drop at 9 pm). The primary efficacy outcome was a 20% IOP reduction from baseline at each timepoint. IOP was measured at day 7, day 30, day 60, and day 90 of treatment; less than 20% IOP reduction was considered as a failure. RESULTS: An IOP reduction of at least 20% was achieved in 74 patients (89.1%) after 7 days and in 64 patients (86.5%) after 30 days. Sixty-two patients (74.6%) maintained IOP readings 20% lower than baseline after 60 and 90 days. In these patients, visual field indices improved in 8 eyes (13%), and remained unchanged in 54 eyes (87%). Ocular side effects were conjunctival injection (15.6%), burning sensation (9.6%), foreign body sensation (4.8%), and eyelash growth (2.4%). CONCLUSIONS: This preliminary study shows that bimatoprost 0.03% could represent a useful therapeutic tool that might defer filtration surgery.

Aged↗
PubMedDate not supplied

Limbal stem cell deficiency in the context of autoimmune polyendocrinopathy.

PURPOSE: To report two sisters with bilateral progressive visual loss and photophobia secondary to stem cell deficiency due to multiple endocrine deficiency. METHODS: Case reports and review of medical literature. RESULTS: The younger sister had severe photophobia and decreased visual acuity since May 2000. Despite multiple outpatient visits no definite cause was found and conservative treatments failed. On slit lamp examination severe meibomian gland dysfunction, loss of eyelashes, decreased tear meniscus, diffuse corneal vascularization, and delayed punctate fluorescein staining of corneal epithelium were detected. She also had episodes of hypotension, oral candidiasis, and seizures. Her systemic workup revealed multiple endocrine deficiency (Addison's disease and hypoparathyroidism). Hormone replacement therapy with fludrocortisone and oral calcium accompanied by punctual occlusion led to significant clinical recovery . The older sister showed a similar pattern but interestingly the onset was later and the signs and symptoms were milder. CONCLUSIONS: In the pediatric age group with diffuse corneal vascularization and no definite cause, systemic workup should be done to rule out multiple endocrine deficiencies. The therapy consists of hormone replacement therapy and management of dry eye.

Adolescent↗
PubMed1994

Progressively intractable seizures, focal alopecia, and hemimegalencephaly.

We report a 3-year-old boy with the neurocutaneous combination of unilateral alopecia, ipsilateral hemimegalencephaly, and intractable seizures. He was born with an asymmetric hair pattern consisting of absent patches of hair, a small left eyebrow, and less eyelashes on the left eye; he had normal development until age 17 months, when he experienced right focal seizures with fever. Two months later, fever triggered new seizures characterized by flurries of head and body flexion and adduction of the right arm. He had left hand preference and language regression. EEG manifested left hemihypsarrhythmia, and MRI showed left hemimegalencephaly with marked enlargement of the temporal lobe with ventriculomegaly. Seizures were refractory to treatment with phenobarbital, adrenocorticotropic hormone, pyridoxine, sodium valproate, clonazepam, carbamazepine, phenytoin, and felbamate. This may represent a previously undescribed neurocutaneous syndrome.

Alopecia↗
PubMed1993

Adequacy of general anesthesia for cesarean section.

To assess the adequacy of the general anesthesia commonly employed for Cesarean section, we used isolated forearm technique to study 30 parturients (physical status ASA I/II, aged 17-35 yr) scheduled for nonemergent abdominal delivery. Anesthesia was induced with intravenous thiopental (3 mg/kg, 250 mg maximum) and succinylcholine (1.5 mg/kg), and then proceeded with a mixture of 50% N2O, 50% O2, and 0.5% halothane at a flow of 5 L/min and end-tidal CO2 at 40 mm Hg. Paralysis was maintained with a 0.1% succinylcholine infusion. When eyelash reflex disappeared, patients received taped instruction via headphones at 1-min intervals for 10 min. The tapes instructed patients to flex fingers if they were able to hear, to make a fist or squeeze the investigator's hand if they felt pain, to remember six target words, and to respond with specific physical signals during later interviews. Three sets of tapes assigned at random were used in the study. For signs of inadequate anesthesia, other variables such as eye centering, pupil size, sweating, and lacrimation were concomitantly monitored at the time of induction, laryngoscopy/intubation, and skin incision, and then at 1-min intervals for 10 min. Brain activity was also monitored by means of computerized aperiodic analysis of electroencephalogram Lifescan). Patients were interviewed in the postanesthesia recovery room and again 24 h later. At the time of skin incision, 96.7% of patients (29/30) signaled awareness by flexing fingers, 86.7% (26/30) exhibited lacrimation, and 80% (24/30) made a fist or squeezed the investigator's hand, indicating pain perception.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Oxygen leakage around the laryngeal mask airway during laser treatment of port-wine stains in children.

The flash-lamp pumped pulsed dye laser is the current treatment of choice for cutaneous port-wine stains. In our practice, most children with these lesions are treated under general anesthesia. At energy levels used clinically, it is possible to ignite hair in the presence of supplemental oxygen; we are aware of four cases in which either the eyebrows or eyelashes were ignited during the administration of general anesthesia via a face mask. The laryngeal mask airway (LMA) recently has become widely available and this device might decrease the risk of fire during treatment of these lesions. We therefore designed this study to examine the extent of oxygen leakage under the mask during clinical cases, and to compare this with the leakage present with the LMA. A total of 20 patients aged 4 mo to 16 yr were studied on 26 separate occasions. During spontaneous ventilation, high concentrations of oxygen leaked around the mask in every case (mean 63% +/- 16%), but in only one case was a concentration more than 21% detected around the LMA (P < 0.001). During controlled ventilation with the LMA, oxygen leaked around the mask in 19% of cases. Use of the LMA markedly decreases the incidence of potential oxygen leakage into the laser field, and is recommended for use, with preservation of spontaneous ventilation, during these cases. We suggest measuring oxygen concentrations at the mouth for laser treatment of facial port-wine stains to confirm that the larynx has been isolated.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Clonidine decreases the dose of thiamylal required to induce anesthesia in children.

Clonidine is a useful drug to give preoperatively because it produces anxiolysis, sedation, and hemodynamic stability, and reduces intravenous and volatile anesthetic requirements. Several premedicants, including midazolam and diazepam, have been shown to reduce the induction dose of intravenous anesthetics, such as thiopental, ketamine, or propofol. A randomized, double-blind controlled study was conducted to evaluate the effect of premedication with oral clonidine on thiamylal requirement for the induction of anesthesia and on associated hemodynamic changes in children. Sixty children (ASA grades I-II, 7-12 yr old) were assigned randomly to receive one of three treatments (n = 20, for each group): placebo (control), clonidine 2 micrograms/kg, or clonidine 4 micrograms/kg 105 min before the induction of anesthesia. Thiamylal was injected at a dose of 1 mg/kg every 15 s until loss of the eyelash reflex and the dose was recorded. Blood pressure (BP), heart rate (HR), and arterial oxygen saturation were recorded every minute from the beginning of injection of thiamylal for 5 min. Significant decreases in thiamylal dose were observed in patients receiving clonidine. The induction dose of thiamylal (mean +/- SD) was 5.4 +/- 0.9, 4.5 +/- 1.1, and 3.4 +/- 0.9 mg/kg for patients receiving placebo, clonidine 2 micrograms/kg, and clonidine 4 micrograms/kg, respectively (P < 0.05). Systolic BP decreased by 6.8%, 5.6%, and 6.6% and HR increased by 5.7%, 4.8%, and 4.1% after administration of thiamylal in the control (placebo) group and the clonidine 2 micrograms/kg and clonidine 4 micrograms/kg groups, respectively (P > 0.05). Premedication with oral clonidine reduced the dose of intravenous thiamylal required for the induction of anesthesia in children.

Anesthesia, Intravenous↗
PubMed2003

Fiberoptic tracheal intubation through a laryngeal mask airway in a child with Treacher Collins syndrome.

Treacher Collins syndrome (TCS) is a rare inherited condition characterized by bilateral and symmetric abnormalities of structures within the first and second bronchial arches. The mechanism of inheritance is autosomal dominant with variable expressivity. Because of this variability in expression, some affected individuals exhibit virtually no overt clinical manifestations. However, most children with TCS present with the following classic facial features: down-sloping palpebral fissures, colobomata of the lower eyelid, scanty lower eyelashes, malar hypoplasia, and micro- or retrognathia. Cleft palate is present in up to 35% of patients and an additional 30-40% have congenital palatopharyngeal incompetence. Abnormalities of the ear are very common and vary from minor malformations to severe microtia and hearing loss. Hearing loss may be due to atresia of the auditory canals or ossicular malformation of the middle ear. Despite these many development abnormalities, TCS patients are usually of normal intelligence. We report the case of a 3 1/2-yr-old patient with TCS undergoing cleft palate repair and discuss fiberoptic intubation through a laryngeal mask airway using two endotracheal (ETT) tubes secured via an ETT connector.

Bronchoscopes↗