Distichiasis and cleft palate.

A patient with the unusual coexistence of distichiasis and cleft palate is described. Distichiasis is a rare congenital eyelid anomaly in which accessory eyelashes are present in the meibomian gland orifices. Its association with other systemic abnormalities is reviewed; the distinctions among distichiasis, trichiasis, entropion, and epiblepharon are outlined; and methods of treatment for distichiasis are described.

Posterior lamellar eyelid reconstruction with a hard palate mucosal graft.

A graft of hard palate mucosa is a satisfactory substitute for the posterior lamella of tarsus and conjunctiva in eyelid reconstruction. The graft may be harvested after administration of local anesthesia in adults, provides structural support as well as a mucosal surface, and contracts minimally. The palatal donor site heals with a minimum of postoperative care.

Orbital exenteration at the Mayo Clinic. 1967-1986.

Orbital exenteration was performed in 102 patients at the Mayo Clinic during the 20-year period from 1967 through 1986. The surgical procedure was performed for mucormycosis in one patient and for pain and deformity after a severe facial burn in another; in the remaining 100 patients, exenteration was used to treat a neoplastic disorder. Although 19 different neoplasms were encountered, squamous cell carcinoma, basal cell carcinoma, and melanoma constituted 70% of the total.

Immunohistochemical staining of sebaceous cell carcinoma of the eyelid.

We characterized the inflammatory infiltrate of two sebaceous cell carcinomas of the eyelid with immunohistochemical staining to determine the functional class of the mononuclear cells associated with the tumor. The results were compared with the inflammatory infiltrate associated with basal cell carcinomas. The subepithelial spaces and the area immediately surrounding the sebaceous cell neoplasms were free of mononuclear inflammatory cells, in contrast to the basal cell tumors, which had large numbers of subepithelial inflammatory cells and inflammatory cells in intimate contact with the neoplastic cells as previously reported.

An anomalous trochlea-levator "tendon" observed during congenital blepharoptosis surgery.

An unusual tendinous band extending from the region of the trochlea to the anterior inferior surface of the levator palpebrae superioris aponeurosis was observed during an operation to correct unilateral congenital blepharoptosis. This structure may be related to a supernumerary muscle described in the past as the musculus tensor trochlea of Budge and more recently renamed as the levator-trochlear muscle.

Diagnostic evaluation of Graves' ophthalmopathy.

The important questions to be answered in the course of decision-making in patients with Graves' ophthalmopathy include the following: 1. Is the eye problem owing to Graves' ophthalmopathy? If not, the cause of the eye problem must be sought. 2.

Ophthalmic findings of hydranencephaly.

Hydranencephaly is a rare developmental disorder in which the cerebral hemispheres are replaced by a cystic space filled with cerebrospinal fluid and covered by intact meninges. Ophthalmic findings include pupillary abnormalities, strabismus, nystagmus, ptosis, optic nerve hypoplasia, chorioretinitis, retinal vessel attenuation, and incomplete anterior chamber cleavage.

Strengthening the weak superior oblique muscle.

Tucking of the superior oblique tendon is an effective strengthening procedure, but it invariably results in at least transient postoperative Brown's syndrome. This complication may be avoided by using a modification of the Harada-Ito procedure, in which the entire superior oblique tendon is advanced anterolaterally without disinsertion or resection. The operation is easy to perform and may be used with adjustable sutures if desired.

An experimental study to compare methods of eyelash ablation.

Epilation, electrolysis, cryotherapy, and argon laser thermal ablation were used to remove eyelashes of rabbits. Epilation and electrolysis were done in the standard fashion. Nitrous oxide cryotherapy was applied in a double rapid-freeze/slow-thaw manner for either 30 or 60 seconds.

The treatment of animal bite injuries of the eye and ocular adnexa.

Animal bites to the eye and ocular adnexa may result in significant morbidity. Management includes wound care and surgical repair of traumatized tissue, treatment of infection (most commonly Pasteurella multocida), appropriate tetanus and rabies prophylaxis, and notification of state public health officials.

Necrobiotic xanthogranuloma with paraproteinemia. Case report and a pathogenetic theory.

Necrobiotic xanthogranuloma with paraproteinemia is a clinical and histopathological entity characterized by xanthelasma-like lesions in the periorbital region and elsewhere, paraproteinemia, leukopenia, and an elevated erythrocyte sedimentation rate. Multiple myeloma has been reported as an accompanying feature in several cases. We examined a patient with necrobiotic xanthogranuloma and multiple myeloma in whom an IgG kappa monoclonal protein was identified in serum, urine, bone marrow, and bilateral periorbital lesions.

Dynamic proptosis.

Dynamic proptosis can be defined as exophthalmos occurring when a variable force is applied to the orbital contents. In a series of 26 patients (13 males and 13 females, 1 to 82 years old), the causes of dynamic proptosis included neurofibromatosis (nine cases), fistulas (three cases), malignancies (three cases), meningoencephaloceles (two cases), mucoceles (two cases), surgery (two cases), orbital varix (two cases), dermoid cysts (two cases), and aneurysm (one case). Dynamic proptosis can be either spontaneous or induced, and can occur either with an intact or an incompetent bony orbit.

Expression of the NKTa clonotype in a series of human natural killer clones with identical cytotoxic specificity.

Over a period of 3 yr, a series of ten NK clones that express a unique clonotypic T cell receptor-like structure, termed NKTa, has been generated from a single individual. These clones were derived from either peripheral blood nonadherent cell fractions (JT9, JT10, JT11), NKH2-purified cells (CNK8, CNK9), or NKTa-purified cells (CNK11, CNK12, CNK13, CNK14, CNK15). Flow cytometric analysis of peripheral blood mononuclear cells from this individual showed that NKTa+ cells occur with a frequency of approximately 0.

The Tensilon test using a three-way stopcock and double syringe.

The use of Tensilon (edrophonium chloride) is important in the diagnostic evaluation of many ptosis patients. A three-way stopcock with double syringe allows concomitant administration of atropine to counteract the cholinergic side effects of edrophonium.

Proteoglycans in cell-mediated cytotoxicity. Identification, localization, and exocytosis of a chondroitin sulfate proteoglycan from human cloned natural killer cells during target cell lysis.

A clone of natural killer (NK) cells (JTB18) was found to be ultrastructurally similar to peripheral blood large granular lymphocytes (LGL). These cells incorporated [35S]sulfate into cell-associated proteoglycan molecules, which were then isolated by CsCl density gradient centrifugation. As assessed by gel filtration chromatography, the native 35S-labeled proteoglycan and its beta-eliminated 35S-labeled glycosaminoglycans were of Mr approximately 200,000 and 50,000, respectively.

Specific release of proteoglycans from human natural killer cells during target lysis.

Natural killer (NK) activity is mediated by a small population of peripheral blood cells that exhibit the homogeneous morphology of large granular lymphocytes (LGL). In recent studies, human NK cell clones have been shown to contain a 200,000-Mr (relative molecular mass) protease-resistant chondroitin sulphate A proteoglycan, which has been localized to the secretory granule by X-ray dispersive analysis and by its resistance to cleavage by extracellular addition of chondroitinase AC or ABC (ref. 7).

Spindle cell lipoma of the orbit.

A spindle cell lipoma was partially removed from the left orbit of a 27-year-old man. Computed tomography showed a large, mildly enhancing, primarily intraconal mass. The circumscribed, nonencapsulated mass was composed of mature adult lipocytes, spindle cells, and capillaries.

Functional characterization of LFA-1 antigens in the interaction of human NK clones and target cells.

In the present studies we analyzed the role of LFA-1 antigens in the interaction between NK clones and target cells. The use of various cloned NK cell lines allowed us to analyze homogeneous populations of NK cells which ordinarily comprise only a small fraction of peripheral blood lymphocytes and are extremely heterogeneous with respect to phenotype and specificity. Indirect immunofluorescence with monoclonal antibodies against the alpha (MHM24) and beta (MHM23) chains of the LFA-1 antigen revealed similar patterns of positive reactivity with all NK clones.