: The aim of this study is to report outcomes of eyelid full-thickness skin grafting augmentation in facial nerve palsy (FNP) patients younger than 50 years of age.
: In a retrospective, consecutive ...case series, nine eyelid skin grafts performed on eight FNP patients with skin contraction (five females; median age 42 years range, 17-47) are presented. In most cases, upper eyelid skin grafting was combined with levator recession and anterior lamellar repositioning. Lower eyelid skin grafting was combined with lower retractors recession in all cases. Functional and cosmetic outcomes were measured preoperatively and at early (1-3 months), intermediate (3-6 months), and late (≥12 months) follow-up.
: The corneal score improved at early follow-up (
= 0.03) and remained improved at late follow-up (
= 0.042). The gentle closure lagophthalmos was improved at late follow-up (
= 0.042). (
= 0.048). The grades of graft color, edge/skin interface, and size improved at 3-6 months post-grafting and remained improved at late follow-up (
< 0.05). Over the follow-up, four patients (50%) were recommended to have further surgical procedures.
: The preliminary results from this small cohort suggest that eyelid skin grafting is a viable option for young patients prioritizing cosmesis. This technique warrants consideration for its functional benefits.
To quantify cataract in lens-backscatter metrics derived from Pentacam Scheimpflug photographs and determine the most predictive metrics for lens grading and visual performance measures.
Large ...tertiary referral hospital in South Australia.
Evaluation of diagnostic test or technology.
In patients attending a cataract clinic between 2005 and 2008, standardized clinical assessments were performed and Scheimpflug photographs taken. Thirteen measures of cataract backscatter were drawn from the images of nuclear and cortical cataract, including new metrics for cortical cataract. The relationships between lens-scatter metrics, visual performance, and lens grades were determined with stepwise multiple linear regression.
The study enrolled 342 eyes (177 patients). The Lens Opacities Classification System III (LOCS III) nuclear opalescence was best predicted by the average backscatter in the anterior half of the nucleus and the whole nucleus average (r(2) = 0.59). The LOCS III cortical grade was best predicted by the number of slices with significant cortical cataract (r(2) = 0.52), as was Pelli-Robson contrast sensitivity (r(2) = 0.16). Visual acuity was best predicted by the combined anterior half and whole nucleus averages (r(2) = 0.20). Pelli-Robson contrast sensitivity under glare was best predicted by a combination of the anterior half and whole nucleus averages and the calculated percentage of cortical cataract (r(2) = 0.16).
Scheimpflug image-derived metrics of nuclear scatter were predictive of visual acuity and contrast sensitivity, whereas metrics of cortical cataract were predictive of visual performance under glare. Automated reporting of cataract severity from Scheimpflug images could be useful clinically and should include measurements of cortical cataract.
Neither author has a financial or proprietary interest in any material or method mentioned.
Speech-/language-impaired (SL)-children face problems in school and later life. The significance of "non-cognitive, social-emotional skills" (NCSES) in these children is often underestimated.
Aim: ...Present study of affected SL-children was assessed to analyse the influence of NCSES for long-term school education.
Methods: Nineteen severely SL-impaired children (7 girls, 12 boys) from a specialised kindergarten were followed; follow-up period: Up to 12 years; the different skills or parameters were known.
Results: Fourteen children visited successfully a regular secondary school (RS), five children a "school focussing on learning problems" (SFL). SL-differences between the children attending RS and SFL were small; differences in "IQ" and "self-confidence" were significant, smaller differences were observed concerning "skills at crafts/construction" and "auditory-visual perception".
Summary: Although the study group is small, results give evidence that beside SL- and "cognitive" skills "non-cognitive, social-emotional skills" are of major importance for long-term school education of SL-impaired children. These soft skills seem to be particularly important for "special need children" with SL-impairment.
We revisit the evolution of posterior approach ptosis surgery. We address the early attempts at ptosis surgery, assess the more modern approach by de Blaskovics, followed by the division into “open ...sky” and “closed” techniques. The simultaneous developments occurring in America and Europe are described, along with refinement of surgical approaches such as conjunctival‐sparing posterior approach ptosis surgery.
Background: Facial nerve palsy (FNP) is known to worsen Meibomian gland dysfunction on the affected side. Chronic Meibomian gland dysfunction leads to a variant of upper eyelid marginal entropion ...associated with excessive tarsal curling, termed Meibomian gland inversion (MGI). Surgical correction with grey line split, tarsoplasty and anterior lamellar repositioning (GLS surgery) appears to further improve the ocular surface in these patients who have previously undergone upper eyelid loading.
Methods: Retrospective, 3 year, non-comparative, single-centre study of patients with FNP identified as having MGI and treated by GLS surgery under the supervision of a single surgeon. We present specific examination findings and a useful test (cotton tip test) to determine suitability for GLS surgery. We assessed changes in symptoms and CADS (Cornea, static Asymmetry, Dynamic function and Synkinesis) score, along with cosmetic grading of lash loss and contour and report complications.
Results: 23 patients with acquired FNP underwent GLS surgery for MGI with or without lash ptosis. 17 out of the 23 patients (74%) demonstrated an improvement in their CADS score after GLS surgery. Seven patients had insufficient records with scores missing and no conclusion could be reached for this group. Improvement of corneal staining, static and dynamic symmetry were all statistically significant. No patient worsened. The cosmetic outcome including lashes, lid contour and lid margin appearance is acceptable. Whilst it is possible to achieve minimal difference between the operated and unoperated eyelids, many patients will have a small difference.
Conclusion: We report outcomes of MGI treatment and useful diagnostic features.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
1
The effects of cannabinoid subtype 1 (CB1) receptor activation were determined on smooth muscle, inhibitory and excitatory motorneuronal function in strips of human colonic longitudinal muscle (LM) ...and circular muscle (CM) in vitro.
2
Electrical field stimulation (EFS; 0.5–20 Hz, 50 V) evoked a relaxation in LM and CM precontracted with a neurokinin‐2 (NK‐2) selective receptor agonist (β‐ala8‐neurokinin A; 10−6 M) in the presence of atropine (10−6 M); this was unaltered following pretreatment with the CB1‐receptor selective agonist arachidonyl‐2‐chloroethylamide (ACEA; 10−6 M).
3
In the presence of nitric oxide synthase blockade with N‐nitro‐L‐arginine (10−4 M), EFS evoked a frequency‐dependent ‘on‐contraction’ during stimulation and an ‘off‐contraction’ following stimulus cessation. On‐contractions were significantly inhibited in CM strips by pretreatment with ACEA (10−6 M). These inhibitory effects were reversed in the presence of the CB1 receptor‐selective antagonist N‐(piperidine‐1‐yl)‐5‐(4‐iodophenyl)‐1‐(2,4‐dichlorophenyl)‐4‐methyl‐1H‐pyrazole‐3‐carboxamide (10−7 M).
4
ACEA did not alter LM or CM contractile responses to acetylcholine or NK‐2 receptor‐evoked contraction.
5
Immunohistochemical studies revealed a colocalisation of CB1 receptors to cholinergic neurones in the human colon based on colabelling with choline acetyltransferase, in addition to CB1 receptor labelling in unidentified structures in the CM.
6
In conclusion, activation of CB1 receptors coupled to cholinergic motorneurones selectively and reversibly inhibits excitatory nerve transmission in colonic human colonic CM. These results provide evidence of a direct role for cannabinoids in the modulation of motor activity in the human colon by coupling to cholinergic motorneurones.
British Journal of Pharmacology (2006) 148, 191–199. doi:10.1038/sj.bjp.0706710
To compare the unique experiences related to artificial eye (AE) versus cosmetic shell (CS) wear.
In this observational, cross-sectional study, the National Artificial Eye Questionnaire was employed ...nationwide within the National Health Service England. This second part of the study assesses daily management and care experiences, as well as visual function and quality of life aspects.
Overall, 951 respondents wore an AE, while 238 wore a CS. Both AE and CS respondents rated a relatively high score for a beneficial effect of prosthesis polishing, with an average score of 80.08±0.87 versus 77.17±1.73 (p=0.13, respectively). CS respondents removed and cleaned their prosthesis more frequently than AE respondents (p<0.0001, p=0.002, respectively). CS respondents instilled lubrication more frequently than AE respondents (p=0.022) with 33.3% versus 43.7% of AE and CS wearers, respectively, lubricating on at least a daily basis. The overall QOL composite score was similar in both AE and CS groups (approximately 77%, p=0.74). Social functioning was similar, and relatively high in both groups (approximately 86%, p=0.77).
This study characterises unique aspects of CSs versus AEs in a large national cohort. The results should provide reinforcement to the gain in popularity of CSs.
To compare the unique experiences related to artificial eye (AE) versus cosmetic shell (CS) wear.
In this observational, cross-sectional study, the National Artificial Eye Questionnaire (NAEQ) was ...employed nationwide within the National Health Service England. The proportions or mean values of the aetiology of sight or eye loss, demographics, length of prosthesis wear, reported adjustment time to the prosthesis, comfort, discharge and satisfaction of appearance were compared between AE and CS respondents.
Overall, 951 respondents wore an AE, while 238 wore a CS. In both, trauma was the leading cause for the prosthesis (47.6% and 44.1%, respectively); however, these groups differed in the proportions of the other aetiologies (p<0.0001). AE respondents were generally older (p=0.002) and had longer overall prosthesis wear (p<0.0001) compared with CS respondents. The overall comfort score was similarly, relatively high in both AE and CS respondents (80.4±0.73 vs 81.41±1.45; p=0.51). The discharge-related patient satisfaction ranking was relatively low, in both groups, with a small trend towards worse discharge scores among AE wearers (59.41±0.76 vs 62.26±1.52, p=0.094). Self-reported length of time that has taken to adjust to wearing the prosthesis was not significantly different (p=0.17). Appearance of the eye (p=0.032) and motility of the prosthesis (p<0.0001) were ranked superior by CS respondents compared with AE.
This study characterises unique aspects of CS versus AE in a large national cohort. The results should provide reinforcement to the gain in popularity of CS.
The submental and neck regions share cutaneous features with the face and are suitable donor sites for facial full-thickness skin grafts (FTSGs). Age-related laxity and skin redundancy in the ...cervicomental region may be an additional motivator to use its skin. We aim to describe, raise awareness, and remind surgeons of the utilization of submental and anterior neck as sources of FTSG for the periocular region, particularly when traditional donor sites are unavailable.
Retrospective case series of 5 patients who underwent periocular FTSG from anterior neck and submental regions between January 2017 and January 2019. All patients had contraindications to the usually preferred graft donor sites. Main outcome measures were surgical functional results and cosmesis.
Five patients (all female) received FTSGs using anterior neck and submental regions as donor sites. Two patients required skin grafts due to eyelid retraction and anterior lamella shortening; one due to previous multiple basal cell carcinoma excisions with FTSG reconstructions and the other due to chronic Bell's palsy. Three patients required skin grafts for Hughes flap reconstruction after excision of lower eyelid basal cell carcinoma. In all patients, conventional skin donor sites were unavailable or unsuitable due to previous skin grafting, actinic changes, postauricular situated hearing aids or patient's preference. All patients achieved good cosmesis and functional results. None of the patients experienced donor site morbidities.
Submental and anterior neck regions are useful FTSG donor sites for periocular procedures, particularly in elderly female patients with submental fullness and neck skin redundancy.
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