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PubMed2003

An evaluation of two commonly used tests of unfamiliar face recognition.

The Warrington Recognition Memory for Faces (RMF) and the Benton Facial Recognition Test (BFRT) are commercially available tests that are commonly used by clinicians and cognitive neuropsychologists to evaluate unfamiliar face recognition. Yet, it is not clear that a normal score on either instrument demonstrates normal unfamiliar face recognition. Because the RMFs stimuli contain abundant non-internal facial feature information, subjects may be able to score in the normal range without using internal facial features. On the BFRT, subjects commonly rely on feature matching strategies using the hairline and eyebrows rather than recognizing the facial configuration. To test whether these routes to recognition can support normal performance, normal subjects were tested with versions of the RMF and the BFRT in which the faces had been painted over in a way that prevented the operation of some of the procedures normally involved with face recognition. Even though these modifications removed all of the internal feature information in the RMF, many subjects scored in the normal range, and despite precluding the use of configural processing in the BFRT, many of the scores were in the normal range. As a result, it is apparent that normal scores on these tests do not demonstrate normal unfamiliar face recognition and so clinicians should be cautious in interpreting scores in the normal range. Finally, these results place in question models supported by dissociations involving normal performance on these tests.

Adult↗
PubMed2001

Forehead and temple reconstruction.

Reconstruction of the forehead and temple region poses special aesthetic challenges for maintaining eyebrow symmetry and hairline. The preservation of motor and sensory function is also important. There are a wide variety of techniques available to the reconstructive surgeon, and these methods are compared and discussed with specific reference to the forehead and temple region.

Forehead↗
PubMedDate not supplied

"Eyes" on the thrones: imperial ophthalmologic nicknames.

Several Greek and Byzantine sovereigns are known in history by nicknames that are of ophthalmologic origin; the sobriquets derive from characteristics of their eyes or their actions in relation to the eyes. The first was Antigonos I Monophthalmus (the One-eyed), who was the most eminent successor of Alexander the Great and Sovereign of Eastern Mediterranean Asia. He obtained his nickname at an early age when he lost one eye fighting at the seige of Perinthos, as a general of King Philip of Macedon (father of Alexander the Great). Several Byzantine emperors also have a number of similar nicknames, such as Anastasius I Dicoros (with Heterochromia Iridis), Alexius V Ducas Murtzuphlus (with Scowling Eyebrows), and Andronicus I Comnenus Misophaes (Hater of Sunlight, since he blinded a great number of his opponents). To these must be added the Byzantine Empress Zoe Carvounopsina (with Coal-black Eyes).

Byzantium↗
PubMed2001

Lead and traditional Moroccan pharmacopoeia.

The use of traditional cosmetics and remedies such as kohl and henna is very common in Morocco, especially among women, children and babies. Kohl is a dangerous eye cosmetic. It is usually mixed with other harmful substances, then applied on women's eyebrows and used in skin treatments for infants. Henna is another traditional product, with religious associations, which has been widely used over the centuries for cosmetic and medical purposes. Many people add various herbs or other substances to the henna in order to strengthen it or to give it a stronger colour. Our results were reassuring in that the concentrations of lead found in non-elaborate (henna only) samples of henna were low. However, when henna was mixed with other products (elaborate henna), these concentrations increased. Lead concentrations in kohl were very high however, unlike henna, were lower in mixed kohl as mixing with other products diluted the concentration of lead. Nevertheless, in both types of kohl, lead concentrations were very high and consequently constitute a risk for public health, particularly for children.

Adult↗
PubMed1997

Operation on high-lying basilar bifurcation aneurysms.

BACKGROUND: The surgical approach to basilar bifurcation aneurysms is a complicated procedure, especially with those located high in the interpeduncular cistern. We have developed a surgical approach to these aneurysms involving only a small anterior temporal craniotomy and detachment of the zygomatic arch. METHODS: The skin incision is placed 5 mm below the inferior border of the zygomatic arch and 5 mm anterior to the tragus, extending on towards the eyebrow but well within the hairline. The zygomatic arch is detached on either side followed by a small temporal craniotomy exposing the anterior temporal lobe. The temporal lobe is retracted and the internal carotid artery, posterior cerebral artery, posterior communicating artery, and inferior aspect of the optic chiasma are exposed. RESULTS: We have performed a transzygomatic anterior subtemporal approach in 12 patients with high-lying basilar bifurcation aneurysm. Eight patients demonstrated a good recovery as per the Glasgow outcome scale and four patients had a moderate disability that correlated with a poor WFNS grade preoperatively. One patient had an oculomotor palsy and another experienced a small infarction postoperatively. CONCLUSIONS: This approach is a suitable procedure for high-lying basilar bifurcation aneurysms in the interpeduncular cistern and 1.2 cm above the clinoid process.

Aged↗
PubMed1999

Transcutaneous cranial electrical stimulation (TCES): a review 1998.

The Transcutaneous Cranial Electrical Stimulation (TCES) technique appeared at the beginning of the 1960s and is aimed to act at the level of the central nervous system. The current, composed of high frequency pulses interrupted with a repetitive low frequency, is delivered through three electrodes (a negative electrode placed between the eyebrows while two positive electrodes are located in the retro-mastoid region). Due to the characteristics of the current delivered, shortcomings encountered with previous electrical stimulation techniques are avoided. The main property of TCES is to potentiate some drug effects, especially opiates and neuroleptics, during anesthetic clinical procedures. This potentiation effect permits drastic reduction of pharmacological anesthetic agent and reduces post-operative complications. Animal studies performed with TCES demonstrated that this stimulation releases 5-hydroxy-indol-acetic acid and enkephalins. Despite numerous clinical and animal studies performed with this technique for several decades, TCES mechanisms are not completely elucidated but results obtained without undesirable effect are encouraging signs to continue investigations of this particular technique.

Animals↗
PubMed2004

[Neurotropic metastasis of squamous cell carcinoma].

INTRODUCTION: Epidermoid skin carcinoma is the second most frequent skin cancer. It is rarely considered as aggressive. Other than its extension through the blood of lymph circulation, perineural invasion is also a significant form of tumoral invasion. We report a case of recurrent epidermoid skin carcinoma beginning with a neurological symptomatology. OBSERVATION: A 77 year-old man with a history of right fronto-temporal epidermoid skin carcinoma turned up at our clinic with a ptosis of the right eyelid and hypoesthesia in the nerve VI area. He later developed pain in the arch of the eyebrow and diplopia. Five weeks later, two subcutaneous nodules appeared. Histology revealed a neuro-invasive epidermoid carcinoma explaining the clinical picture. Re-loading of the histological sections of the first injury confirmed the clearly differentiated invasive epidermoid carcinoma. However, renewed classified sections revealed neoplastic cells surrounding the nerve branches in the deep dermis. DISCUSSION: Other than the extension through the blood or lymph circulation, epidermoid cutaneous cancers exhibit varying invasion of the nerve structures. Neurotropism is an aggressiveness marker. Only the pathologico-anatomic investigation enables an early diagnosis. In the case of recurrence, neurological symptomatology can precede skin injuries and make diagnosis difficult. The follow-up of the carriers of this type of tumor must include a neurological examination.

Aged↗
PubMed2003

Do motor vehicle airbags increase risk of ocular injuries in adults?

PURPOSE: This study was undertaken to evaluate the risk of eye injury in motor vehicle accidents in which airbags deploy. An attempt was made to assess the possible associations between eye injuries and eyewear in these accidents. DESIGN: Retrospective observational case series and literature review with analysis. PARTICIPANTS/METHODS: We conducted a literature review of 62 case reports and articles describing 110 adult cases of eye injury after deployment of an airbag and examined two Finnish accident cohorts. The fatal accident series (FAS; fatal injuries with one or more cars involved) included 121 individuals sitting behind an airbag that deployed (65 survivors), and the Airbag study (AB; nonfatal, relatively serious accidents) included 210 individuals (survivors). MAIN OUTCOME MEASURES: The type of eye injury, eyewear, and crash dynamics were studied in each of the reviewed case reports. The fatal accident series and AB studies were analyzed to disclose the eye injuries and use of eyewear and to estimate their possible relation to deployment of airbags. RESULTS: Analysis of the published reports revealed that airbag-induced eye injuries were not more frequently reported among wearers of eyeglasses than among nonwearers. However, open-eye injuries were reported three times more often among eyeglass wearers (P = 0.04), whereas all injuries from airbag chemicals occurred among nonwearers. With the exception of one orbital fracture with hyphema, all eye traumas (n = 7) in the FAS and AB cohorts were mild (eyebrow laceration, lid contusion, bruising). The risk of airbag-related eye injury was 2.5% for any eye injury and 0.4% for severe eye injury. In single accidents when seat belts were used, the risks were 2.0% and 0.5%, respectively. In the accidents from the FAS data no difference was observed in the risk for eye injury between survivors in incidents involving airbag deployment and incidents not involving airbags. This risk was not found to be greater among eyeglass wearers. CONCLUSIONS: Despite reported cases in the literature, we found that the risk of severe eye injury from airbags was very low (0.4%) in fatal or relatively serious accidents. Eyewear did not seem to increase this risk but might interfere with the injury pattern.

Accidents, Traffic↗
PubMed1978

Eyelid reconstruction by the semicircle flap technique.

The semicircle flap technique of eyelid reconstruction is a modified lateral advancement-rotation flap. The procedure combines the use of selective lysis of the limbs of the lateral canthal tendon with a semicircular skin-muscle flap confined to the region of the lateral canthus within the boundary established by the lateral eyebrow and the arc it defines. Reconstruction of one half to more than three fourths of the lower or upper eyelid can be accomplished without borrowing tissue from the eyelids, nose, ear, or mouth. Large forehead, brow, or cheek flaps are elininated, as is the need for closure of the palpebral fissure during the early healing course. The procedure has been used in the reconstruction of 36 lower eyelids and five upper eyelids in 40 patients, with a follow-up period of six months to six years. The usual indication for the use of this procedure is reconstruction of a central, marginal lid defect following the excision of a neoplasm. However, it may also be useful in cases of tissue loss caused by trauma, or for severe lid malpositions for which major kid reconstruction is necessary. The early and long-term cosmetic and functional results have been gratifying.

Eyelids↗
PubMed1994

Ophthalmic findings in scleromyxedema.

PURPOSE: To catalog ophthalmic findings in a cohort of patients with scleromyxedema. METHODS: Thirty-five biopsy-proven patients with scleromyxedema evaluated at the Mayo Clinic in Rochester, Minnesota, from 1960 to 1991 were identified. Eye examinations were performed on 17 of the patients. Ophthalmic findings not attributable to other systemic or ocular disease were recorded. RESULTS: The following abnormalities were considered secondary to scleromyxedema: corneal opacities (2 patients), thickened eyebrow or eyelid skin (4 patients), lagophthalmos (1 patient), and ectropion (2 patients). One patient who had concurrent polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes (POEMS) syndrome also had choroidal folds and papilledema. A corneal biopsy in one patient disclosed deposits of acid mucopolysaccharide, consistent with one of two previously published cases. CONCLUSION: A series of patients with scleromyxedema was reviewed. This systemic disorder infrequently may cause visually significant ophthalmic manifestations, including eyelid changes and corneal deposits. Further study is needed to characterize better the nature of the corneal opacities.

Adult↗
PubMed1997

Perineural spread of cutaneous squamous cell carcinoma via the orbit. Clinical features and outcome in 21 cases.

OBJECTIVE: To describe the clinical features, treatment, and outcome of a series of patients with perineural spread (PNS) of cutaneous squamous cell carcinoma (SCC) via the orbit. DESIGN: A cohort study. PARTICIPANTS: Twenty-one patients identified with PNS of cutaneous SCC via the orbit. INTERVENTION: Patients were treated with various combinations of conservative or radical surgery, external beam radiation therapy, and chemotherapy. RESULTS: Of 21 cases, 17 (81%) were male. Age at presentation with PNS ranged from 38 to 82 years (median, 66 years). The forehead and eyebrow were the most common site of the primary lesion. All but one had altered or decreased sensation, but only nine presented with pain. Fourteen (67%) had ophthalmoplegia at presentation, and 14 (67%) had evidence of PNS involving branches of the facial nerve. Despite combinations of radical surgery, conservative surgery, and radiation therapy, no method of treatment appeared more effective, and 14 patients died from 9 months to 5 years after presentation with PNS (median, 3 years), usually from local and intracranial disease. Two survived to 14 and 18 years, one is alive at 3 years with recurrent local and distant disease, and four are alive without evidence of disease at 2, 3, 4 and 12 months after radiation therapy. CONCLUSIONS: Perineural spread of cutaneous SCC via the orbit carries a poor prognosis. Early radiation therapy may offer the best form of palliation. The role of radical surgery probably is limited once orbital involvement is apparent, as the cavernous sinus and facial nerve branches usually are involved.

Adult↗
PubMed2004

A case report of Kabuki make-up syndrome with cytomegalovirus infection.

An 8-month-male infant was admitted to our institute in order to investigate his developmental delay. He had facial features-long palpebral fissures with eversion of the lower lateral eyelids, arched eyebrows with lateral sparseness, depressed nasal tip, large, prominent and cupped ears. From these characteristical features, he was diagnosed as having Kabuki make-up syndrome (KS). When he was 2 months old, he was admitted to our institute because of intractable stridor and liver dysfunction associated with cytomegalovirus (CMV) infection. In KS, increased susceptibility to infection is described. We suspected persistent CMV infection because of an increased susceptibility to infection in KS. Recently acute idiopathic thrombocytopenic purpura (ITP) was diagnosed. According to the correlation between the number of CMV DNA copies and his platelet count, it is speculated that ITP would occur when the number of CMV DNA copies was elevated.

Abnormalities, Multiple↗
PubMed1984

Waardenburg's syndrome: a case report with CT scanning and cochleovestibular evaluation.

The Waardenburg's syndrome, a congenital ectodermal germ layer defect of autosomal dominant inheritance with variable phenotypic expressivity consists of 6 major characteristics: dystopia canthorum, broad nasal root, hypoplasia of the medial eyebrow, heterochromia irides, white forelock, and congenital deafness. Twelve additional characteristics have been reported including meningocele, atresia of the esophagus, and Hirshsprung's disease supporting an early hypothesis that the neural crest is the embryonic site linking defects of the cervical sympathic system with pigmentary abnormalities and inner ear anomalies. Congenital deafness reported in 20% of Waardenburg patients, and the most disabling characteristic, has been associated with ENG abnormalities in 30% of these deaf patients. A congenitally deaf young person with Waardenburg's syndrome is examined for basic cause of episodic vertiginous symptoms. Diagnostic assistance from previous investigations is lacking because they have not involved state-of-the-art functional evaluations or correlations of behavioral and radiographic findings. In this patient, high-resolution computerized tomography failed to demonstrate bony labyrinthine anomalies. Functional cochleovestibular analysis revealed a bilateral profound sensorineural hearing loss and a unilateral weakness in oculomotor responses to caloric stimulations. Repeated measurements of ocular counterroll show variations compatible with intermittent otolithic dysfunctioning. These findings are consistent with a diagnosis of an acquired active unilateral peripheral vestibular disorder. Some of the technical issues underlying the derivation of this conclusion are discussed.

Abnormalities, Multiple↗
PubMed1979

Bowen's disease and 5-fluorouracil.

Sixty-six confirmed cases of Bowen's disease (intraepidermal squamous cell carcinoma) were seen from 1965 through 1976: twenty-four cases were treated surgically-four by excision (two recurrences) and twenty by desiccation and curettage (four recurrences); one was treated with x-ray radiation; and forty-one were treated with topical 5-fluorouracil (5-FU) (three recurrences). Of the six surgical recurrences (25% recurrence), one was retreated by desiccation and curettage and five with 5-FU. Of the three recurrences after 5-FU (8% recurrence), all three were successfully retreated with 5-FU. In view of the generally high recurrence rate after all treatment modalities in Bowen's disease, related to both the ill-defined lateral margins and the frequent follicular involvement with the Bowen's process, prolonged treatment time is required for success with 5-FU. Treatment times employed were 4 to 12 weeks, with a median of 9 weeks. 5-FU concentration ranged from 1% to 3 % in propylene glycol. A 1% concentration of 5-FU was generally adequate on the face, except for occasional recalcitrant areas, such as the nose and eyebrow. A concentration of 2.5% to 3.0% was usually necessary for treatment of Bowen's disease on the other body areas.

Administration, Topical↗
PubMed1986

Structural and functional changes of normal aging skin.

Solar-induced cutaneous changes are more prevalent and profound in older persons and, thus, are often inappropriately attributed to the aging process, per se. Structural and functional alterations caused by intrinsic aging and independent of environmental insults are now recognized in the skin of elderly individuals. Structurally the aged epidermis likely becomes thinner, the corneocytes become less adherent to one another, and there is flattening of the dermoepidermal interface. The number of melanocytes and Langerhans cells is decreased. The dermis becomes atrophic and it is relatively acellular and avascular. Dermal collagen, elastin, and glycosaminoglycans are altered. The subcutaneous tissue is diminished in some areas, especially the face, shins, hands, and feet, while in others, particularly the abdomen in men and the thighs in women, it is increased. The number of eccrine glands is reduced and both the eccrine and apocrine glands undergo attenuation. Sebaceous glands tend to increase in size but paradoxically their secretory output is lessened. The nail plate is generally thinned, the surface ridged and lusterless, and the lunula decreased in size. There is a progressive reduction in the density of hair follicles per unit area on the face and scalp, independent of male-pattern alopecia. The hair shaft diameter is generally reduced but in some areas, especially the ears, nose, and eyebrows of men and the upper lip and chin in women, it is increased as vellus hairs convert to cosmetically compromising terminal hairs. Functional alterations noted in the skin of elderly persons include a decreased growth rate of the epidermis, hair, and nails, delayed wound healing, reduced dermal clearance of fluids and foreign materials, and compromised vascular responsiveness. Eccrine and apocrine secretions are diminished. The cutaneous immune and inflammatory responses are impaired, particularly cell-mediated immunity. Clinical correlates of these intrinsic aging changes of the skin include alopecia, pallor, xerosis, an increased number of benign and malignant epidermal neoplasms, increased susceptibility to blister formation, predisposition to injury of the dermis and underlying tissues, delayed onset and resolution of blisters and wheals, persistent contact dermatitis, impaired tanning response to ultraviolet light, increased risk for wound infections, prolongation of therapy necessary for onychomycosis, and thermoregulatory disturbances.

Adult↗
PubMed1986

Generalized trichoepitheliomas with alopecia and myasthenia gravis: clinicopathologic and immunohistochemical study and comparison with classic and desmoplastic trichoepithelioma.

We report on a patient with a syndrome characterized by smooth facial papules and nodules; alopecia of the eyebrows, eyelashes, and most body hair; mild alopecia of scalp hair; possibly hypohidrosis; and myasthenia gravis. The clinical, histologic, and immunohistochemical findings are compared with classic and desmoplastic trichoepitheliomas. All fourteen biopsy specimens of the patient showed a lacelike network of basaloid cells with follicular differentiation and a prominent stroma with focal alkaline phosphatase activity, as in fourteen comparison specimens of classic trichoepithelioma. Studies with antikeratin antibodies of various specificities also revealed similar patterns. The tumor cells showed a keratin phenotype characteristic of cells of the infrainfundibular outer root sheath, that is, positive staining with basal keratinocyte markers, negative staining with suprabasal keratinocyte markers, and patchy staining with LP2K (against keratin 19). beta 2-Microglobulin expression was partially or totally absent. It is concluded that the lesions in our patient actually are trichoepitheliomas. The condition may represent a new syndrome that either is closely related to the generalized hair follicle hamartoma (basaloid follicular hamartoma) or is a variant. The finding of generalized trichoepitheliomas with clinical and microscopic alopecia should alert one to the possibility of myasthenia gravis.

Adult↗
PubMed1989

Mucocutaneous complications of intraarterial 5-bromodeoxyuridine and radiation.

5-Bromodeoxyuridine (BUDR), a halopyrimidine thymidine analogue, is incorporated into the DNA of dividing cells and causes photoradiosensitization. Twenty-five patients with malignant astrocytomas were treated with continuous intracarotid BUDR radiosensitization and radiotherapy for 8 1/2 weeks. Unique dose-limiting mucocutaneous complications were encountered. Ipsilateral facial dermatitis with epilation of eyebrows and eyelashes, ocular irritation, and bilateral nail dystrophy developed in all patients. Less common reactions included oral ulceration in six patients, body exanthem on the trunk in five, and atypical erythema multiforme major in one.

Alopecia↗
PubMed1996

Diffuse heterochromia of scalp hair.

Heterochromia of hair is the presence of more than one distinct color of hair in the same person. A color difference between scalp hair and a mustache or sideburns is not uncommon. Pubic and axillary hair and eyebrows and eyelashes are often darker than scalp hair in a fair-haired person. Rarely, a circumscribed patch of hair of different colors occurs. However, diffuse heterochromia of black and red scalp hair has not been previously reported. We describe a father and son with this condition.

Adolescent↗