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Fenestrated epithelium of the pelvic recess wall on the lateral parenchymal tissue in the dog kidney.

The epithelium of the pelvic recess separating the urine and the lateral parenchym of the dog kidney was examined by scanning and transmission electron microscopy (SEM and TEM) to try and identify the epithelial structures permitting filtration of urine substances. In cross sections through of the renal hilus, recesses were found in the pelvic space extending along the internal surface of the lateral parenchym. Light microscopy (LM) showed the external wall of the recess facing the parenchymal tissue to be a thin squamous epithelium underlined with a layer of smooth muscle cells. The cytoplasm of epithelial cells observed by TEM was extremely thin in comparison to the epithelia on other parts of the pelvic wall. Their peripheral cytoplasm usually demonstrated interdigitations or showed overlapping of cytoplasm of neighboring cells in two or three laminae. Distinct junctional structures were observed but no distension of the intercellular space was seen. The lumenal cell surface was relatively smooth, but the peripheral cytoplasm was equipped with either angular or stumped processes and deep cavae. In addition to a small number of cell organellae, numerous vesicles and vacuoles of varying sizes were conspicuously observed. The vacuoles contained flucculent materials and were fenestrated by pores closed by a diaphragm at fused potions of their limiting membrane with the adluminal and abluminal plasma membrane. The openings of the vacuoles were also seen at the basal cytoplasm. Similar fenestrations also occurred between the neighboring vacuoles in chains or conglomerations. Attenuated epithelial cytoplasm in close association with urinary tubules was also fenestrated by uniformly sized pores closed by thin diaphragm with punctuate central thickening. The fenestrations through the cytoplasm and between the chained vacuoles may thus be structures which have yet to be previously identified, and this finding seems to indicate that the filtration of urine substances occurs across the epithelial lining of the pelvic wall. Layers of thin smooth muscle cells with mutual connections are seen to underline the epithelium. The innermost muscle cells penetrated the basal lamina and thus come in contact with epithelial cells. However, their significance could not be clearly determined.

Animals↗

Conjoined lumbosacral nerve roots. Management of herniated discs and lateral recess stenosis in patients with this anomaly.

Anomalous L-5 and S-1 nerve roots occur infrequently. If not properly recognized, surgery for entrapment disorders may result in serious neural injury because of an improper surgical approach in exposure and in removing the underlying herniated discs. The diagnosis has been made preoperatively since the introduction of water-soluble myelography because of improved filling of the nerve roots. A herniated disc beneath the bifid root causes extreme pain and disability with marked signs of entrapment because of firm fixation of the conjoined root in the lateral recess between the two pedicles. An underlying herniated disc may not be recognized because of the unique anatomical changes. To properly identify the nature of the lesion, wide exposure by hemilaminectomy is preferred, with unroofing of the lateral recesses and wide foraminal decompression. Eight such patients are reported: seven had herniated discs, and one had lateral recess stenosis with superior facet entrapment. With adequate decompression, all patients made a rapid, uneventful recovery.

Adult↗

Transforaminal arthroscopic decompression of lateral recess stenosis.

The purpose of this study was to evaluate the feasibility and efficacy of arthroscopic decompression of lateral recess stenosis, determine potential associated complications, and present an alternative method to access the lateral recess of the lumbar spine. Forty patients were selected in whom the authors found clinical and computerized tomography evidence of lateral recess stenosis and sequestered foraminal herniations. All 40 were treated with a posterolateral arthroscopic technique, and 38 were available for this follow-up evaluation. A satisfactory result was obtained in 31 patients (82%). No neurovascular complications were encountered; however, other complications included an infection of the disc space in one patient and a causalgic-type pain in the involved extremity in four patients. The associated postoperative morbidity in this group of patients was minimal and resulted in rapid rehabilitation and return of patients to preoperative functioning level.

Adult↗

Suprapineal recess: an alternate site for third ventriculostomy? Case report.

This 30-year-old woman presented with clinical symptoms and signs of intracranial hypertension and Parinaud syndrome secondary to ventriculoperitoneal shunt dysfunction. Magnetic resonance (MR) imaging revealed gross triventricular hydrocephalus with a large suprapineal recess due to aqueductal stenosis. Using an endoscopic approach, a ventriculostomy was performed within the floor of the dilated suprapineal recess. Following this procedure the patient experienced alleviation of all her neurological symptoms and signs. Postoperative MR imaging and cerebrospinal fluid flow studies demonstrated a functioning ventriculostomy. The anatomy of the suprapineal recess and its suitability for endoscopic ventriculostomy are discussed.

Adult↗

Residual incomitant DVD following large bilateral superior rectus recession.

A recent survey of 25 experienced strabismus surgeons indicated that a very large superior rectus recession is the procedure of choice for DVD. We report a series of seven patients who exhibited a persistent DVD following large superior rectus recession. Furthermore, the DVD was markedly incomitant, much greater in adduction than in abduction. This residual DVD would mimic inferior oblique overaction on version testing, although proving to be purely DVD on critical observation. This "overaction" is apparently due to the marked weakening of the superior rectus and was not always predictive of the location and amount of persistent DVD. This previously unreported complication of large superior rectus recession is important to recognize so that alternative surgical approaches may be contemplated. It is hoped that more accurate observations and measurements both preoperatively and postoperatively will lead to a more orderly approach to DVD surgery.

Child↗

The site of reattachment of the extraocular muscle following hang-back recession.

The use of "hang-back" suspensions has been shown to be an effective means of weakening rectus muscles. The exact position where the muscle reattaches to the globe has, however, been questioned. We performed eight large hang-back recessions on the rectus muscles of cynomolgus monkeys. Eight weeks postoperatively the attachment sites were determined by reexploration. Six of the recessions were within 0.5 mm of the intended site. The muscles were found an average of 0.4 mm anterior to the intended position. These results confirm that the muscle reattaches close to the intended location. Eight exaggerated recessions were similarly performed; these were more variable in the site of reattachment. Only three muscles were reattached within 0.5 mm of the intended site. There was a mean forward reattachment of 1.1 mm. Four of the 16 muscles were found reattached by a pseudotendon rather than directly to the sclera.

Animals↗

Large recession nystagmus surgery in albinos: effect on acuity.

PURPOSE: To evaluate the effect of large muscle recessions on visual acuity in albinos with nystagmus. METHODS: This is a retrospective, unmasked, chart review of 12 patients with ocular or oculocutaneous albinism demonstrating nystagmus who underwent four horizontal rectus muscle retroequatorial recessions. Pre- and postoperative visual acuity were measured. RESULTS: Best corrected visual acuity improved postoperatively by two or more Snellen lines in 7 of 12 patients (58%). Subjective improvement of vision and nystagmus was noted by patients and examiners. Follow up was performed between 3 and 41 months; 25% of patients required reoperation for ocular alignment. CONCLUSION: Large four-muscle horizontal rectus recessions may improve uniocular and binocular visual acuities in albinos with nystagmus as measured by Snellen acuity. Patients may note a qualitative decrease in the severity of their nystagmus.

Albinism, Ocular↗

Recession of the inferior rectus muscle under topical anesthesia in thyroid ophthalmopathy.

PURPOSE: To evaluate the results of inferior rectus muscle recession with adjustable loop suture under topical anesthesia for vertical deviations secondary to thyroid ophthalmopathy. PATIENTS AND METHODS: Five patients with a vertical deviation greater than 15 PD and severe limitation of upgaze were enrolled in the study. Before proceeding with corrective strabismus surgery, we waited at least 6 months after stabilization of ocular alignment and normalization of thyroid chemistries. All patients underwent inferior rectus muscle recession with adjustable loop suture under topical anesthesia. The postsurgical follow-up was at least 12 months. RESULTS: Preoperatively, the mean vertical deviation was 24 PD. At 1 year postoperatively, it had decreased to 2.4 PD. Two patients were orthotropic and 3 patients had residual hypotropia ranging from 2 to 6 PD. The limitation of upgaze was relieved significantly in the postoperative period. Two patients had minimal limitation of downgaze, but none complained of diplopia in the primary or reading positions. Surgery did not trigger a flare-up of orbital inflammation in the early postoperative period. CONCLUSION: We advocate that recession of the inferior rectus muscle with adjustable loop suture under topical anesthesia is safe and effective in patients with thyroid ophthalmopathy.

Adult↗

Long-term results of hemihang-back lateral rectus recession.

PURPOSE: To report our long-term results with the hemihang-back technique for lateral rectus muscle recession in moderate- and large-angle exotropia. PATIENTS AND METHODS: The medical records of 144 consecutive patients who underwent unilateral or bilateral hemihang-back lateral rectus recession between 1999 and 2002 were reviewed. The amount of surgery performed was based on the distance exotropic deviation. Surgical outcomes were analyzed for all patients included in the study. RESULTS: A total of 66 patients met the inclusion criteria. Sixteen patients had undercorrection, but 6 of these patients redeveloped an exodeviation 6 months after the surgery. No overcorrections were observed in this study. CONCLUSION: The hemihang-back technique is a safe and effective alternative to conventional lateral rectus recession in patients with moderate- or large-angle exotropia.

Adolescent↗

Long-term results of bilateral medial rectus recession for congenital esotropia.

PURPOSE: This study assessed the long-term results of orthophoria obtained with bilateral medial rectus recession for congenital esotropia. PATIENTS AND METHODS: The medical records of 214 patients who underwent bilateral medial rectus muscle recession between January 1995 and January 2000 were reviewed. Patients were excluded if neurological abnormalities or developmental delays were documented and if structural eye abnormalities were present. Mean follow up was 54.2 months (range, 36 to 96 months). Rates of reoperation for residual esotropia, consecutive exotropia, oblique muscle overaction, or dissociated vertical deviation were determined. RESULTS: Forty-five (21%) patients underwent surgery for residual esotropia, 32 (15%) underwent surgery for consecutive exotropia or dissociated horizontal deviation, and 39 (18%) underwent surgery for oblique muscle overaction and dissociated vertical deviation. CONCLUSION: To maintain long-term alignment of congenital esotropia, additional surgical procedures may be required. The success rate of bilateral medial rectus recession for ocular realignment with one operation is approximately 50%. This method is quicker, simpler, and less traumatic than three or four muscle operations. In addition, the lateral rectus and oblique muscle are left unoperated for future surgeries if necessary.

Child, Preschool↗

Long-term results of hang-back lateral rectus recession.

PURPOSE: To report long-term results of the hang-back technique for lateral rectus muscle recession. PATIENTS AND METHODS: The medical records of 79 consecutive patients who underwent unilateral or bilateral hang-back lateral rectus recession were reviewed. The amount of surgery performed was based on the distance exotropic deviation. Surgical outcomes were analyzed for all patients included in the study. RESULTS: Forty-two patients met the inclusion criteria. Four of the patients were not orthophoric: three had recurrent exotropia and one had a consecutive esotropia. The average interval prior to the second procedure was 9 months. CONCLUSION: The hang-back technique is a safe and effective alternative to conventional lateral rectus recession.

Adolescent↗

A three dimensional surgical dose-response schedule for lateral rectus resections for residual congenital/infantile esotropia after large bilateral medial rectus recessions.

PROBLEM: A series of overcorrections after this surgical sequence. SUBJECTS & METHODS: Forward stepwise multiple regression analysis of the effect of bilateral lateral rectus resections, retrieved and tabulated retrospectively from the clinical charts of 50 children with infantile esotropia who had significant residual non- accommodative esotropia after bilateral medial rectus recessions. Analysis allowed for selection among linear and quadratic forms of two relevant predictor variables: the mm of previous bilateral medial rectus recession and the prism diopters of residual esotropia. RESULTS: We found a correlation between the effect of the second surgery (bilateral LR resections) and the two variables. This relation could be expressed by a surgical dose-response schedule-surface with the formula: [2.39 + 0.26 (mm MR recession) Squared + 0.41 (mm LR Resection) Squared = prism diopters of effect]. A corresponding schedule (table) with these two parameters was developed to facilitate clinical application. To test and prove this schedule, we re-studied 19 of the 50 original cases who had had surgery, fortuitously, +/-0.3 mm of our new surgical dose- response surface-schedule plus 10 new cases performed according to the new surface-schedule. For these 29 cases there was only one "failure" at 6 months postop' (3%). As a control, for the 31 cases of the original 50 whose surgery had not been within +/- 0.3 mm of the new schedule, 7/31 (23%) were "failures", all overcorrections. ("Failure" vs. "success" - there were only two categories of outcome - was defined as an esotropia over 8 PD or exophoria over 6 PD.) CONCLUSION: This difference in results, expressed as "successes" of 28/29 vs 24/31, or 97% vs 77% gave, on statistical analysis, a p=0. 053 of rejecting the null hypothesis, which is considered a valid "trend" or marginally "statistically significant" and definitely "clinically-medically significant". We have adopted the regular application of our new surgical dose- response schedule in these cases and recommend it for all such cases. binocular vision; complications, surgical; dose-response surgical schedule; esotropia, congenital/infantile; lateral rectus muscle, resection; outcomes; overcorrections; strabismus surgery; study, retrospective, clinical; surgery, strabismus.

Accommodation, Ocular↗

A novel mutation in the NADH-cytochrome b5 reductase gene of a Chinese patient with recessive congenital methemoglobinemia.

Recessive congenital methemoglobinemia due to nicotinamide adenine dinucleotide (NADH)-cytochrome b5 reductase (b5R) deficiency is classified into 2 clinical types: type 1 (erythrocyte type) and type 2 (generalized type). We found a Chinese family with type 1 recessive congenital methemoglobinemia, the patients from which were diagnosed according to clinical symptoms and b5R enzyme activity in the blood cells. To learn the molecular basis of type 1 recessive congenital methemoglobinemia in this Chinese family, we isolated total RNA from the peripheral leukocytes of the propositus and b5R complementary DNA (cDNA) by reverse transcription- polymerase chain reaction (RT-PCR). The coding region of the b5R cDNA was analyzed by sequencing the cloned PCR products. The results showed that the propositus was homozygous for a G-->A transition at codon 203 in exon 7, changing a cysteine to a tyrosine (Cys203Tyr). To characterize the mutant enzyme, both glutathione S-transferase (GST)-fused wild-type b5R and GST-fused mutant Cys203Tyr b5R were expressed in Escherichia coli and affinity purified. The results showed that the catalytic activity of the enzyme was not much affected by this amino acid substitution, but the mutant enzyme exhibited decreased heat stability and increased susceptibility to trypsin. These properties of the mutant enzyme would account for the restricted b5R deficiency and mild clinical manifestations of these type 1 patients. The finding of this novel mutation makes codon 203 the only position within the b5R gene at which more than 1 mutation has been found.

Aged↗

A nonsense mutation (W9X) in CRYAA causes autosomal recessive cataract in an inbred Jewish Persian family.

PURPOSE: To identify the genetic defect causing autosomal recessive cataract in two inbred families. METHODS: Linkage analysis was performed with polymorphic markers close to 14 loci previously shown to be involved in autosomal dominant congenital cataract. In one of the families a gene segregating with the disease was analyzed by single-strand conformation polymorphism (SSCP) and eventually sequenced. RESULTS: Three polymorphic markers close to the CRYAA gene located on chromosome 21q segregated with the disease phenotype in one of the families, but not in the other. Sequencing of the CRYAA in this Jewish Persian family revealed a G-to-A substitution, resulting in the formation of a premature stop codon (W9X). CONCLUSIONS: A nonsense mutation in the CRYAA gene causes autosomal recessive cataract in one family. This constitutes the first description of the molecular defect underlying nonsyndromic autosomal recessive congenital cataract. That there was no linkage to this locus in another family provides evidence for genetic heterogeneity.

Cataract↗

A gene causing autosomal recessive cataract maps to the short arm of chromosome 3.

BACKGROUND: Fourteen loci have been associated with autosomal dominant cataract, but only one with the recessive form of the disease. OBJECTIVES: To find the chromosomal location of a gene causing autosomal recessive cataract in three inbred Arab families. METHODS: A single nucleotide polymorphism-based genome-wide search, with the Effvmetrix GeneChip HuSNP genotyping array, was performed on a pooled DNA sample from six affected family members in a search for regions showing homozygosity. Using conventional microsatellite markers, regions of homozygosity were further analyzed in all the families. RESULTS: A region on chromosome 3p spanning 43 megabases showed homozygosity with 13 consecutive SNPs. Three microsatellite markers from this region yielded lod scores > 3.00. A maximal two-point lod of 4.83 was obtained with the marker D3S1298 at theta = 0.004. Haplotype analysis placed the disease gene in a 20 Mb interval between D3S1768 and D3S2409. CONCLUSIONS: A gene causing autosomal recessive cataract maps to the short arm of chromosome 3.

Arabs↗

Primary inferior oblique overaction-management by inferior oblique recession.

PURPOSE: To evaluate the effect of 10 mm inferior oblique recession in horizontal strabismus with V pattern and primary inferior oblique overaction. METHODS: Ten patients of V esotropia and exotropia with primary inferior oblique overaction underwent 10 mm inferior oblique recession by the methods described by Park and Stallard. Pre- and postoperative V pattern, inferior oblique overaction and binocularity were assessed. Patients were followed up for 3 months. RESULTS: The mean preoperative V pattern was 38.3 PD and the mean inferior oblique overaction was 22 PD. After surgery the mean correction of the V pattern was 26.9 PD and the mean residual V pattern was 11.4 PD. None of the patients had inferior oblique overaction postoperatively. 70% of the patients showed improvement in binocularity. CONCLUSION: 10 mm Inferior oblique recession by the described technique is a simple, safe and effective method for the cosmetic and functional treatment of horizontal deviation and V pattern with primary inferior oblique overaction.

Adolescent↗

Some clinical characteristics of V-pattern exotropia and surgical outcome after bilateral recession of the inferior oblique muscle: a retrospective study of 22 consecutive patients and a comparison with V-pattern esotropia.

BACKGROUND AND PURPOSE: A V-pattern exotropia (XT) with bilateral overaction of the inferior obliques (IO) and/or underaction of the superior obliques (SO) is a common finding. The clinical characteristics of this condition in a large series are not available in the scientific literature. Also, data is lacking about the surgical outcome of graded bilateral IO recession. Lastly, a comparison of the pre- and postoperative findings of a V-pattern exotropia population with those of a V-pattern esotropia population is also lacking in the literature. SUBJECTS AND METHODS: Twenty-two consecutive patients without complicating factors were fully evaluated and submitted to bilateral graded recessions of the IO; 19 were also operated for a horizontal binocular alignment imbalance. RESULTS: Preoperative findings: The distribution of V patterns showed 77.2% in the range of 15 to 25 prism diopters (PD) and 22.8% in the range 26 to 35 PD. An overaction of the IO was present bilaterally in 86.4% of the patients and unilaterally in 4.5%. Bilateral underaction of the SO was observed in 4.5% and unilateral in 13.6%. Bilateral overaction of the SO was seen in 18.2% and unilateral in 31.8%. Elevation in adduction was observed bilaterally in 13.6% and unilaterally in 31.8%. A vertical deviation was seen in 50.0% and a marked tendency of it to vanish or diminish in the up- and down positions, as well as at near, was observed. After surgery, 72.7% had less than 15 PD of V pattern or less than 10 PD of A pattern; 36.4% had the V pattern fully corrected. Surgery eliminated a vertical imbalance in 72.7% of the patients, reduced in 9.1%, left unchanged in 9.1% and increased in 9.1% Of the 11 patients devoid of vertical deviation, 72.7% remained so and in 27.3% a vertical deviation was created. Binocularity: There was an improvement of the fusional status with surgery, (ascertained with the Worth Four Dot Test and the major amblyoscope measurement). CONCLUSION: All cases were in the range of 15-35 PD preop'. Overaction of the IO was a prominent finding. Underaction of the SO was less prevalent as compared with a V-ET population. Overaction of the SO was observed bilaterally in 18.2% and unilaterally in 31.8%, a finding never detected in a V-ET population. A vertical imbalance was observed in one-half of the cases. A good outcome (collapse of the V pattern) was obtained with bilateral graded recession of the IO, This procedure is relatively safe concerning the vertical alignment.

Adolescent↗

Nd:YAG laser trabeculopuncture in angle-recession glaucoma.

Nd:YAG laser trabeculopuncture (YLT) was performed in 12 eyes of 12 patients with angle-recession glaucoma. Confluent, 1-clock-hour trabeculotomy was attempted in all eyes. The calculated average laser energy was 181 +/- 86 mJ. Where possible, the midtrabecular meshwork was treated, preferably at the superior half. After a mean follow up of 12.0 +/- 5.6 months, intraocular pressure (IOP) was controlled (less than or equal to 19 mm Hg) in five eyes (41.7%). YLT was associated with blood reflux during or after treatment in all successfully treated eyes. In eyes that failed, blood reflux could be detected in only two of seven eyes (28.6%). YLT failed to control IOP in all five eyes that had angle-recession for 360 degrees. Following YLT, IOP rose in two eyes (16.6%), minimal hyphema occurred in one eye, and temporary flare and cells developed in the anterior chamber in all eyes. Six eyes (50%) required glaucoma surgery (four had trabeculectomy and two had Molteno implant surgery). We recommend YLT only for selected cases of uncontrolled angle-recession glaucoma in which at least part of the trabecular meshwork by gonioscopy appears to maintain its anatomical structure, permitting penetration into Schlemm's canal.

Adolescent↗