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PubMed1990

[Eyelid injuries].

The eyelids not only protect the ocular globe, but also keep it wet and transparent. In the case of a palpebral wound the survival of the ocular globe is perhaps at stake. Corrective reconstruction of a palpebral wound must be considered as quickly as possible in order to restore eyelid shape and mobility. A facial emergency must be treated along the lines of an immediate reconstruction. A completely successful restoration must see to the prevention of complications associated, on one hand to poor adaptation of the wounded edge engendering a deformed eyelid, a coloboma at the free edge, malpositioning (entropion or ectropion), or an acquired ptosis. On the other hand, stenosis of the lacrymal canaliculus will lead to epiphora. Both complications present later difficulties for treatment.

Eyelids↗
PubMed1990

[Blepharoplasties. Different techniques of surgery].

The authors, reviewing their own experience of Blepharoplasty (92 cases) since ten years, discuss the principal approaches used depending on the age of the patient, the amount of adipose tissue, the lower lid tarsal and muscular laxity and the quality of the skin excess. On the lower eye lid they emphasize the interest of the transconjunctival approach in young an or coloured people and they undermine a cutaneo-muscular flap in the classical technique. On the upper eye lid, they combine the skin excision with an orbicular muscle strip and in old people with a suspension of the lateral canthus. A good choice between these different approaches avoid the rare complications (ectropion and scleral show) because blepharoplasty must be considered like a "variable geometry" operation.

Age Factors↗
PubMedDate not supplied

[Dynamics of the cervical mucosae during hormonal contraception by low-dose estrogens. A controlled prospective clinical study].

The Authors report the results of a prospective clinical study by means of colposcopy, planimetric measurements of iodine-light areas, cytology and target biopsy on 140 women taking low-dosage oral contraceptives and 140 controls. A basal examination and a follow up control at a mean interval of 13 months (min. 6, max. 30 months) have been performed. Colposcopy has shown no qualitative changes during follow up, neither in cases nor in controls. Planimetric measurements have shown a significant reduction of Ectropion and AnTZ in cases in comparison to controls, and more NTZ both in cases and controls. Cytology has shown at follow up a higher and significant reduction of phlogosis and viral cytopathic effect in cases. The results related to CIN, although non significant because of the small case group and the relatively short follow up, appeared more favorable in cases. In conclusion, oral contraception appears not to negatively affect the uterine cervix as far as cervical cancer is concerned but possibly to be protective. Nevertheless a longer follow up and a wider case group are needed in order to reach definitive results.

Biopsy↗
PubMedDate not supplied

Prevalence and epidemiologic correlates of Chlamydia trachomatis in rural and urban populations.

In two rural and two urban family planning clinics in central Pennsylvania, the authors screened 889 women making routine visits for Chlamydia trachomatis using the Chlamydiazyme immunoassay method (Abbott Laboratories; North Chicago, IL). C. trachomatis antigens were detected in 11.2% of the women; they found no differences in prevalence between rural and urban clinics. Among 21 clinical characteristics and seven risk factors, younger age (younger than 25), oral contraceptive use, gonococcal infection, mucopurulent exudate, abnormal vaginal discharge, and cervical ectropion were associated with chlamydial infection. Logistic regression revealed that age alone was independently associated with infection. The authors found that screening criteria derived from other epidemiologic studies generally did not predict the presence of C. trachomatis in the present sample. In a follow-up study performed at least one year later, 169 patients were re-screened; 47 tested positive and 122 negatives for C. trachomatis. Overall, 11.8% were infected, which was 12.4% of those who originally tested negative and 10.6% of those who originally tested positive.

Chlamydia trachomatis↗
PubMed1990

[Iris nevus (Cogan-Reese) syndrome--clinicopathological correlations].

Clinicopathological correlations of iris nevus (Cogan-Reese) syndrome were studied by light and electron microscopy, using tissues obtained surgically by trabeculectomy and peripheral iridectomy. The patient was a 52-year-old female, who had a typical appearance of the disease with nodular iris nevi, distorted pupil, ectropion uveae, peripheral anterior synechia, and intractable glaucoma. The histopathological studies of the specimen revealed abnormal corneal endothelialization and basal lamina formation continuously covering the peripheral cornea, trabecular meshwork, and anterior iris surface. Lymphocyte infiltration was found in the layer of the endothelialization and in the anterior iris stroma. The nodular iris nevi were found to consist of mainly integration of degenerated iris melanocytes and clump cells of Koganei. Neovascularization associated with infiltration of lymphocytes and macrophages was also observed in the trabecular meshwork. The present study suggests that the disease might occur by chronic inflammation primarily as corneal endothelitis and iritis.

Endothelium, Corneal↗
PubMedDate not supplied

Total circular hemorrhoidectomy.

For the surgical treatment of hemorrhoids, the Whitehead-operation is considered bad because it leads to complications like anal stenosis, incontinence and mucous ectropion or prolapsus. Modifications suggested by A. Toupet help to avoid these inconveniencies. But it still requires excellent understanding and training in ano-rectal surgery. The Whitehead-operation, modified by A. Toupet, is indicated in the following cases total hemorrhoidal prolapsus, especially with thrombosis and mucous prolapsus.

Adult↗
PubMed1989

Conjunctivochalasis: a surgical technique.

Conjunctivochalasis can be surgically corrected when it gives an appearance of a moist eye, produces tearing by mechanical obstruction of the lower punctum, or if it impedes the normal outflow of the lacrimal film. We present a surgical technique that provides a satisfactory anatomical reconstruction, does not leave a deformity, and will not lead to a retraction that could produce a cicatricial ectropion. We stress the importance of a complete ophthalmologic examination to rule out more common causes of tearing.

Conjunctival Diseases↗
PubMedDate not supplied

[Colposcopic evaluation of cervical epithelium during oral contraception. A controlled clinical study].

The Authors report the results of a controlled clinical study by means of colposcopy, cytology and target biopsy on 525 oral contraceptive (O.C.) users and 519 controls. Except for age class 31-35, more iodine dark cervices are found in cases, more iodine light (AnTZ and/or ectropion) in controls. The difference, although not statistically significant, suggests a protective role of O.C. on cervical epithelia. In 34 women (15 cases and 19 controls) CIN has been diagnosed. O.C. users show a more favorable situation, except for ages over 30 exposed to O.C. for less than 24 months. The Authors hypothesize a protective role of O.C. in younger women. While women aged 30 or more still appear protected when exposed to O.C. for more than two years (possibly from younger ages), these results suggest some caution in beginning oral contraception after the 30th year of age.

Adult↗
PubMed1989

[Harlequin fetus--a case report].

A one-day-old male premature baby was born to a G4P4 mother with the gestation age of 30 weeks. His birth weight was 2000 gm. He was noted to be covered with a thick, armor-like skin which is split by deep fissures and makes the feature of Ectropion and eclabium. His nose was flattened, only the nostrils were visible, and the external ears were underdeveloped. The hands and feet appeared to be swollen and crumpled. The genital organ was covered with thick fissured skin and it was impossible to distinguish sex by external appearance. Three days after delivery, the patient died of respiratory distress. He was found normal through general laboratory and chromosome study. However, dermatohistology showed hyperkeratosis, focal parakeratosis and hypogranulosis. Pathology showed PDA (patent ductus arteriosus), enlarged thymus and congestion of internal organs. Its etiology and pathogenesis somehow remain unknown. We hereby reported this harlequin fetus, the most severe type of lamellar ichthyosis, and discussed its incidence, pathogenesis, pathohistology, prognosis and the recent development in treatment.

Abnormalities, Multiple↗
PubMed1988

Iris nevus syndrome.

A case of iris nevus (Cogan-Reese) syndrome is presented. Our patient's condition was recognized clinically and followed for many years. The unusual amount of proliferated endothelium and abnormal basement membrane and the pedunculated pigment nodules and ectropion uvea were most interesting. If there is a spectrum of disease that includes essential iris atrophy, Chandler's syndrome, and iris nevus syndrome, one would have to say this case fits at the iris nevus end.

Adult↗
PubMed1988

[Basal cell epithelioma of the eyelids].

UNLABELLED: The purpose of this study of 36 patients was to assess the oncological, functional and cosmetic results of surgery in the treatment of basal cell carcinoma of the eyelid and to compare them with those obtained with other possible therapeutic methods. MATERIAL AND METHODS: We report a series of 36 cases of histologically proven basal cell carcinoma principally located on the lower eyelid and the inner canthus. 27 p. 100 of the patients had previously been treated and presented with a recurrent tumour. Mean age was 61 years. Minimum follow-up was 5 years. Reinforced and potentiated local anaesthesia was given in most cases. Tumoral excision was complete in 31 patients, insufficient or borderline in 5 patients. Intraoperative extemporaneous biopsy was performed in 8 p. 100 of the cases. Repair was carried out by direct suture or by grafting, the flap being simple or combined with a mucosal or chondromucosal graft. The lacrymal passages were destroyed in 5 cases and were not reconstructed in 4 of them. There was no postsurgical therapy. RESULTS: As regards the malignancy itself, the recurrence rate was 6 p. 100 and affected patients who had previously been treated. The cure rate was 100 p. 100 in patients for whom surgery was the first treatment, and 94 p. 100 in the totality of patients. Functionally, there was one case of ectropion, and epiphora developed in 7.4 p. 100 of the cases. In this series epiphora was associated with destruction of the lacrymal passages in only one patient. Satisfactory cosmetic results were obtained in 85 p. 100 of the cases, bearing in mind that the assessment was necessarily subjective. DISCUSSION: Treatments of basal cell carcinoma are numerous. We shall analyze their results, advantages and drawbacks compared with those of surgery. Cryotherapy raises technical problems of execution which are responsible for an excessively high recurrence rate. Chemotherapy has recently been enriched with the introduction of Solcoderm, but the follow-up is still too short. Electrocoagulation gives good oncological results, but it can only be used for small lesions. Radiotherapy (contact, penetrating or semi-penetrating X-ray therapy, electron therapy) has a cure rate of 95 p. 100 and gives acceptable cosmetic results. However, it requires numerous sessions, cannot be repeated if it fails and complicates surgical treatment; in the long term, it carries a risk of radiodystrophy. Its functional and ocular complications have been estimated at 9 p. 100. Epiphora is present in 2 to 19 p. 100 of the cases.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1977

[The neurovascular island pedicle: basic considerations and its application in the face (author's transl)].

The island pedicle flap has in comparison with other skin flaps a number of important advantages which include elasticity, minimal shrinkage, absence of dog ears, success in irradiated areas and innecessity of a second stage procedure. On the head the most common donor areas for an island flap are postauricular, nasolabial, submental, and less cosmetically satisfying frontal and temporal regions. For large reconstrictions, however, only those pedicles which contain a branch of the superficial temporal or frontal arteries suffice. The major indications for an island pedicle flap include defects of the auricle, stenosis of the external auditory canal, through and through defects of the nose and paranasal region, in combination with other methods of skin grafting, and soft tissue loss and ectropion of the lower lid.

Cleft Palate↗
PubMed1987

Factors influencing corneal involvement in leprosy.

Corneal involvement in leprosy is known to be influenced by factors such as lagophthalmos, ectropion, and corneal anesthesia. In the present study conducted on 400 eyes of leprosy patients, observations were made on tear film abnormalities, and their relation to the above-mentioned factors was analyzed. The abnormality of tear film breakup time (BKUT) was found to be clinically more significant (47.2%) than a Schirmer's test alone (24.5%), and this finding was of greater significance in the lepromatous form of leprosy. An abnormal BKUT reflects a decreased mucin secretion by the conjunctival goblet cells. Tear film abnormalities in association with lagophthalmos, corneal anesthesia, concomitant ocular diseases, and environmental factors such as high relative humidity have been identified as factors contributing to corneal involvement in leprosy in India. It is not surprising that with so many mechanisms of corneal involvement the clinical manifestations are diverse, and all forms of pathological changes may contribute to corneal morbidity.

Cornea↗
PubMed1987

The fornix approach to the inferior orbit.

The fornix or transconjunctival approach to the orbital floor and inferior orbit provides excellent exposure for the surgeon managing orbital fractures. The technique is ideally suited for patients with isolated blowout fractures; however, it can be combined with other surgical incisions to provide wide exposure of the inferior orbit, zygoma, and maxilla for the repair of more complex midfacial fractures. The surgical technique provides excellent access to the inferior orbit for biopsy or excision of orbital tumors and excellent opportunity for surgically augmenting orbits with posttraumatic enophthalmos or enophthalmos associated with anophthalmic sockets. Orbital decompression into the maxillary antrum and ethmoid sinus is easily accomplished through this incision. By avoiding a cutaneous incision in the lower eyelid, one reduces the risk for development of postoperative ectropion. During wound closure, the lower eyelid can be elevated and tightened and the canthal angle can be restored if necessary.

Eyelids↗
PubMed1986

The collagen eye patch: a preliminary report.

This study is a preliminary report on the use of freeze-dried-collagen eye patches in the treatment of a selected group of inflammatory eye conditions. The early responses to treatment have been encouraging in cases of allergic conjunctivitis, blepharitis, and pterygium. In addition, the collagen patches have exhibited a significant beneficial effect in the resolution of ectropion.

Adult↗
PubMed1986

[Curietherapy of palpebral epithelioma with iridium-192. Method and results apropos of 192 cases treated at the Claudius-Regaud Center].

Authors report a series of 192 eyelid epithelial tumors (187 patients) treated by curietherapy (192 iridium) at the Centre Claudius-Regaud, from January 1977 to December 1982. Curietherapy is an interstitial radiotherapy technique which inserts radio-active lines directly in the epithelial area. The first part of treatment consisted in using disposable vascular catheters as after loading procedure. In 90% of the cases, lesions were either on the lower lid or on the inner canthus. Tumors were mainly of basal cell type (77%). One thousand forty one tumors occurred in untreated patients: treatment was made for local recurrences in 51 cases. The control rate was 97% (186/192). Six recurrences were all observed in basal cell carcinoma. Four of them were cured by a second curietherapy, the two others needed a large surgical enucleation followed in one case by external radiotherapy. Late side effects essentially were functional and ocular. Functional side effects (19% of the series) consisted in eyelid hole reduction (5%), epiphora stenosis (6%), ectropion (4%) and loss of substance (4%). Ocular complications (3% of the series), were ulcerated cornea (one case) hypertrophic conjunctivitis (one case), iatrogenic cataract (two cases) and enucleation for recurrence (two cases). Iridium 192 curietherapy allowed a high local control rate. The best results were seen in untreated patients. Iatrogenic cataract eventually would be avoided by the use of lead contact lenses (recent utilisation not included in this series).

Adult↗
PubMed1985

Lacrimal gland duct cysts.

Lacrimal gland duct cysts develop insidiously in the superotemporal cul de sac. They may be preceded by trauma, infection, or inflammation of the conjunctiva. They are often asymptomatic but may induce discomfort, a sensation of fullness, a visible mass, lid distortion or ectropion. Fluctuation in size with weeping or environmental stimuli is seen. Histopathology is variable. Six cases are described to demonstrate the features. Complete excision of each cyst by meticulous dissection through a conjunctival approach was performed. Total resection is the optimal technique to prevent recurrence.

Adult↗
PubMed1979

[Extended prevention of uterine cervix cancer].

A transverse-oval os uteri or Emmet' tear are the result of a tear at the mouth of the womb during final cervical dilatation. Furthermore, they are the cause of a more or less developed ectopia and combined cervical and vaginal fluor with concomitant colpitis. These alterations also represent the foundation not the cause, of a development of cervical carcinoma. In the sense of prophylactic reasoning the elimination of the symptoms mentioned above should be considered. -- The use of the speculum and care of the suture of the nearly always torn os uteri after each delivery must be the first step to avoid the development of a collum carcinoma. -- In the second place, electrocoagulation or shallow conisation with subsequent coagulation and cryo-surgical treatment of the ectopia has to be carried out. -- Therefore the obstetrician decides whether the patient -- in view of developing a collum carcinoma -- becomes a risk patient. He has to ensure that an almost normal portio uteri returns without ectropion and Emmet'tear and also without cervical and vaginal fluor, which could trouble the patient considerably. -- After every delivery, therefore, the speculum should be used. At the same time a cervix tear haemorrhage, one of the most frequent exsanguinations, can be avoided.

Adult↗