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PubMed1979

Prenatal diethylstilbestrol exposure and human genital tract abnormalities.

The incidence of clear cell adenocarcinoma of the vagina and cervix associated with intrauterine exposure to DES and similar compounds during the first half of pregnancy has increased. Ninety percent of these cancers have occurred in patients 14 years of age or older. Although these carcinomas are exceedingly rare, nonneoplastic abnormalities including vaginal adenosis, cervical eversion (ectropion), and transverse cervical and vaginal ridges are frequent in the exposed population, particularly if the drug was administered early in pregnancy. Current evidence favors a disturbance in development of the müllerian duct as the explanation of these changes. Whether DES is only a teratogen or also a carcinogen is unknown, as is the possible role of other factors in the development of cancer. An increased incidence of cancer among exposed males has not been documented.

Adenocarcinoma↗
PubMed1979

Orbital decompression.

A new technique for exposure of the orbit for decompression of the orbit is described. It may be used for other purposes such as orbital fracture repair, orbital exploration for tumors in the inferior orbit, or reconstruction of the orbit by a variety of methods. The technique provides ready, broad exposure. The approach also avoids not uncommon complications of the eyelid, approaches to the orbit such as skin shrinkage and ectropion of the lower lid. It also results in minimal cosmetic deformity.

Fractures, Bone↗
PubMed1979

Blepharospasm.

Blepharospasm is a cranial nerve dysfunction in which involuntary and uncontrollable forcible lid closure occurs. Surgical treatment is far from ideal, but the condition can be improved by sectioning the branches of the facial nerve plexus which supply the orbicularis oculi, the frontalis and corrugator muscles, and the midfacial muscles. Not all patients with blepharospasm should be operated upon, since they may expect too much or may enjoy the attention their invalidism has given them. Ectropion of one or both lower lids may occur, and the most severe of all complications is recurrence. This may happen despite a careful microscopic search for the nerve fibers and their division and avulsion. Blepharospasm patients often require considerable psychological support.

Adult↗
PubMed1978

[X-ray irradiation of basaliomas on the eyelids. Irradiation technic and results].

98 patients suffering from basal cell carcinomas near the eye and treated with X-rays between 1962-1972 were followed up. The cure rate was 96%. The functional result was good in 86%. Nine patients suffered from epiphora. In four patients an ectropion had developed. The cosmetric result was excellent to satifactory in 98%. The advantages of X-ray therapy are not only the high cure rate but also the ease of ambulatory treatment.

Basal Cell Carcinoma↗
PubMed1984

[Upper anal imperforation, treatment and results].

As shown by Stephens the only element of the sphincteric mechanism which persists in case of high imperforate anus is the pubo rectalis sling of the levator. It is essential that the néo rectum be brought down to the perineum throught the sling which must be meticulously dissected and preserved. An operative technique with definition of the sling by an anterior perineal approach was described by the author. Results of the procedure in 43 patients are reported: early post operative complications (1 death, 4 occlusions, 2 ischemia of the neo rectum), anal complications (stricture, prolapses and ectropion) and urinary complications. Concerning the continence the author studied 19 patients: 16 children operated over 10 years ago and 3 adults. Of these 19: 2 are failures with stool incontinence, 10 are excellent and 7 fair. A "perfect" result was never obtained but many are compatible with a normal social life. Age is of great importance (our 3 adults became continent within several months), morning evacuations, diet, cleanliners, some drugs such a imodium are helpful adjuncts. Then the paper discusses 16 patients with desastrous results after previous surgery in another hospital. In 10 patients the new ano-rectum has been placed some that it missed a portion or all of the pubo-rectalis muscule. A further operation with re-routing resulted in marked improvement in 7 patients. A poor result with the neo-rectum in a good position means that the incontinence is related to a hypoplastic or denervated sling. A free autogenous muscle transplantation (Hakelius and Grotte) gave 4 excellent, 2 fair and 2 poor results.

Abnormalities, Multiple↗
PubMed1984

Eye changes after forty.

The most common "physiologic" change that occurs in the eyes after age 40 is loss of elasticity of the lens, resulting in presbyopia. Xanthelasmas commonly occur at this age and should be removed only for cosmetic reasons. Entropion and ectropion can be quite irritating; both results from laxity of the eyelid tissues. Relaxation of eyelid tissues also contributes to blepharochalasis. Glaucoma and formation of cataracts are not normal changes but do appear with increasing frequency in persons over 40.

Adult↗
PubMed1980

Variations on the theme of involutional entropion and the Quickert repair.

The late Marvin Quickert originated a lower lid entropion repair successful especially in recurrent cases. Probable reasons for its success is correction of all three main conditions predisposing to entropion, namely increased horizontal length, excessive vertically mobile preseptal orbicularis, and lax retractors, whereas other entropion procedures correct only one or two factors. A bridge flap of lid is created by an incision at the base of the tarsus, and this is then transected vertically in its outer third. The amount of horizontal redundance determined, a rectangle of full thickness lid is excised, and the ends reapproximated. Wies type sutures are placed approximating superior anterior lamella to inferior posterior lamella. Redundant skin is excised laterally and the entire skin incision closed. A Wies procedure resulting in immediate ectropion can easily be converted to this procedure.

Anesthesia, Local↗
PubMed1983

Complications in primary anterior chamber pseudophakic eyes after intracapsular cataract extraction.

The principles of the authors' intracapsular cataract extraction technique, with and without pseudophakos, are outlined. The histopathological examination (2--6 years after surgery) confirms the accuracy of the clear corneal section, and the potential, although minor risks, of anterior chamber pseudophakos implantation: a multilaminar fibrous plaque covering intraocular tissue and pseudophakos surfaces often occurred. Ectropion uveae, as observed in a few cases, is a new symptom. Fuchs's keratopathy was exceptional and endothelial cell loss was unremarkable in our series compared to age-matched aphakic eyes. Cystoid edema and retinal detachment did not occur more frequently than in ordinary aphakic eyes. Retinal angiomatous changes with edema may develop and are another, not described symptom.

Aged↗
PubMed1981

Diethylstilbestrol and other sex hormones during pregnancy.

Intrauterine exposure to diethylstilbestrol (DES) has been associated with ths subsequent rare development of clear cell adenocarcinoma of the vagina and cervix in exposed female progeny. These tumors have been seen thus far in patients between the ages of 7 and 29 years. In addition, nonmalignant epithelial and structural genital alterations have been frequently observed. The epithelial changes of adenosis, ectropion, metaplasia, and potential neoplasia are considered. Thus far, no increased risk of squamous cell neoplasia has been demonstrated in DES-exposed subjects. However, increased pregnancy wastage, including premature birth, does appear to be more common among DES-exposed women; this increase may be related to the structural uterine and cervical changes that have occurred. DES-exposed men have been demonstrated to have anatomic genital changes, but the effects of these changes, if any, on male infertility are not known. Masculinization of the female external genitalia, including phallic enlargement and labioscrotal fusion, has been reported following intrauterine exposure to certain progestational agents and androgens.

Abnormalities, Drug-Induced↗
PubMed1978

Comparison of histologic and colposcopic findings in DES-exposed females.

A study was undertaken to evaluate the histologic alterations associated with two of the most abnormal colposcopic findings, mosaicism and punctation, that are commonly found in the vaginas and cervices of young women who have been exposed prenatally to diethylstilbestrol (DES). Four-fifths of 215 biopsy specimens from 171 exposed subjects with mosaicism or punctation disclosed metaplastic squamous epithelium, the presence of which is thought to reflect the repair of vaginal adenosis and cervical ectropion. Hyperkeratosis was observed in one-fifth of the specimens and was more frequent in lesions colposcopically graded I than II. Mild dysplasia was encountered in only one specimen. The findings indicate that the presence of squamous cell dysplasia cannot be predicted by the finding of Grade I or II mosaicism or punctation in the DES-exposed female despite the fact that these abnormal colposcopic patterns are associated with dysplasia in about 10% of cases when encountered in the cervix of the unexposed woman.

Colposcopy↗
PubMed1981

[Eruptive keratoacanthoma].

A 74 year old woman showed typical symptoms of eruptive keratoacanthomas since three years: exanthematic sudden appearance of numberless papules, few millimeters in diameter with central keratinization, masked facies, ectropion of the eyelids and pruritus. Histology revealed the characteristic architecture of keratoacanthoma. Proliferation kinetics were characterized by increase of cell division within the basal cell layer, prolongation of time for DNA-synthesis (15,7 h) and moderate decrease of generation time. The reactive inflammatory dermal infiltrate mainly consists of lymphocytes. Ultrastructural features comprise occurrence of intracellular desmosomes and elastic and collagen fibers between the tumor cells. Therapeutically a good response was observed to aromatic retinoid Ro 10-9359.

Aged↗
PubMed1995

Subciliary malar augmentation and cheek advancement: a 6-year study in 22 patients undergoing blepharoplasty.

Twenty-two patients seeking aesthetic improvement of their eyelid and orbital-cheek region underwent malar augmentation and cheek advancement in conjunction with lower eyelid blepharoplasty by means of a subciliary incision. The follow-up ranged from 12 to 78 months, with a mean follow-up of 44 months. Concomitant other aesthetic procedures were performed in 27 percent of the patients. Satisfactory goals of lower eyelid aesthetic improvement and malar augmentation with cheek advancement were achieved in 21 of 22 patients. A single patient had her implants removed within 3 weeks of her initial operation, at her request. Complications included hematoma formation in two patients, transient ectropion in two patients, and a palpable implant edge in a single patient. There were no long-term functional or aesthetic sequelae. Malar augmentation and cheek advancement have been found to be a significant adjunct to lower eyelid blepharoplasty because they improve the appearance of the cheek region and add a youthful contour to the malar area. These straightforward procedures add an effective dimension to blepharoplasty in appropriately selected patients.

Adult↗
PubMed1995

[Floppy eyelid syndrome. Apropos of 4 cases and review of the literature].

Often unrecognized, Floppy eyelid syndrome is an impairment of the eyelid statics with marked conjunctival signs. Over-weight middle aged men are principally concerned. Excessive eyelid laxity in the Floppy eyelid syndrome is responsible for a night ectropion of the upper lid, creating the clinical manifestations. We report four cases of Floppy eyelid syndrome to illustrate our work and discuss the clinical and therapeutic aspects.

Aged↗
PubMed1995

[Eyelid burns. An 11-year retrospective evaluation].

This retrospective study has concerned 1115 adults burns patients hospitalized between January 1, 1984 and December 31, 1994 in the CHU Trousseau Burns Centre in Tours. 448 patients who suffered from facial burns were treated in the centre. The rate of facial burns and association with hand burns were observed as usually described, as well as the severity of chemical injuries and prolonged exposure to a heat source. 87 patients underwent grafting of the face and 33 of these patients, were grafted on the eyelids with or without grafts on other areas of the face. Grafting procedures on the eyelids were performed an average of 23.4 days after the injury although the medical staff of the centre had always emphasized the importance of early excision followed by grafting during the same procedure. However, the data showed that grafting was performed significantly earlier when good results (no functional disorders, no chronic conjunctivitis, no ectropion, good mobility) were obtained: 21.6 days versus 34.3, p < 0.05. The causes of the surgical delays observed and the various surgical methods are discussed.

Adult↗
PubMed1995

[The reconstruction of facial burn and deformity from burn scar].

Thirty-seven patients with facial full-deep burn and burn scar contructure were treated in our department. The operation included transplantation, of whole piece of full thickness skin (3 patients), transplantation of whole piece of full thickness skin with subdermal vascular rete a (1), transplantation of improved whole piece of full thickness skin (26), and separated transplantation of large piece of partial thickness skin (7). Follow-up from 3 to 15 years showed that the facial skin of whole piece of full thickness skin was soft, smooth, and had natural facial expression. The facial skin of separated transplantation had slight scar and pigmentation. The improved whole piece of full thickness skin was recommendable for avoiding the secondary ectropion of eyelid and lip.

Adolescent↗
PubMed1995

Autosomal dominant keratitis: a possible aniridia variant.

OBJECTIVE: To describe the findings in a family with hereditary keratitis. DESIGN: Case series. SETTING: Eye genetics clinic at a university-affiliated hospital in Edmonton. PATIENTS: Fifteen affected members, nine female and six male, of a four-generation family with hereditary keratitis. RESULTS: The pattern of transmission was consistent with autosomal dominant inheritance. The disorder was characterized by the presence of a circumferential band of opacification and vascularization at the level of Bowman's membrane adjacent to the limbus. Progression toward the central cornea occurred in some instances. Penetrating keratoplasty was performed in certain cases when the visual axis was involved and the acuity deteriorated. Histopathological studies confirmed the inflammatory nature and the anterior stromal localization of the keratitis. Thirteen of the affected members in whom a detailed fundus examination was possible had macular hypoplasia. Several had abnormalities of the iris, including iris stromal defects and ectropion uveae. CONCLUSIONS: The presence of macular hypoplasia in association with the iris and corneal changes suggests that autosomal dominant keratitis is likely a variant of aniridia.

Adolescent↗
PubMed1976

[Around the sphincter: problems of continence in surgery of the large intestine].

Anatomy and physiology of anal continence and incontinence are described. The surgeon's first main task is the prevention of incontinence, e.g. in the treatment of the small and mobile carcinoma of the rectum, the wide pedunculated papilloma, the fistula in ano, haemorrhoids and anal fissure. The second main task is the reconstruction of continence of rectal prolapse, ectropion, third grade rupture of the perineum and perineal injuries. The possibilities for reconstruction, reinforcement and replacement of the sphincter are described.

Fecal Incontinence↗
PubMed1994

[Death to Whitehead, hurray for Toupet! or total circular hemorrhoidectomy revisited. Its technique, their indications and their results].

For surgical excision of hemorrhoids, the Whitehead procedure is considered a poor technique responsible for anal stenosis, anal incontinence, prolapse, and mucous ectropion. However, with the modifications suggested by André Toupet, these complications do not occur. The Whitehead procedure as modified by A. Toupet requires considerable experience in anorectal surgery. Indications include total hemorrhoid prolapse, in particular with thrombosis, and mucous prolapse.

Adult↗