Modified lacrimal system intubation.

A modified technique for silicone intubation of the lacrimal system is presented to eliminate the two major postoperative problems of punctal erosion and loop retraction.

Cerebrospinal fluid leakage after dacryocystorhinostomy.

The authors have encountered two presumptive cases of cerebrospinal fluid leakage associated with dacryocystorhinostomy. To understand better the pathophysiology, bilateral dacryocystorhinostomies and anatomic dissections were performed on three fresh cadaver specimens. The average distance from the superior bony nasal window to the floor of the anterior cranial fossa was 5.

Penetrating orbital trauma.

A small number of patients suffer penetrating injury to the orbit in the absence of trauma to the globe. Hospital records from the Jules Stein Eye Institute and affiliated hospitals were reviewed to obtain such cases. Five cases of penetrating orbital trauma, in which the globe was spared, are discussed.

Cataract surgery with intraocular lens implantation by ophthalmology resident surgeons.

Cataract surgery with intraocular lens implantation (cataract-IOL surgery) performed by ophthalmology residents under supervision of experienced surgeons in 1974-1978 was analyzed. Retrospective evaluation of 32 cases noted patient age and sex distribution, preoperative ophthalmic examination findings, technique for cataract surgery with implantation of iris support intraocular lenses, postoperative complications, and visual acuity with best correction 30 months after surgery as well as on the last examination. Postoperative follow-up, ranging from one to 84 months, recorded a visual acuity with best correction of 20/40 or better in 87.

Use of temporal fascia and muscle as an autograft.

A wide variety of materials have been used for reconstruction around the eyelids and orbit, including alloplastic materials, such as polyfilament surgical suture (Supramid), silicone, and Teflon, that have a tendency toward early infection or late extrusion. Preserved homografts, such as sclera or fascia lata, are unlikely to extrude but have variable absorption rates. Autografts have proved over the years to be the best, most reliable, and least reactive material for reconstruction.

Obtaining auricular cartilage for reconstructive surgery.

The cartilage in the scaphoid fossa between the helix laterally and the antihelix medially provides excellent underlying support for soft-tissue eyelid and nasal reconstruction. After subcutaneous infiltration anesthesia is administered through both the anterior and posterior auricular skin, an incision is made along the posterior rim of the helix. A dissection plane between the perichondrium and skin exposes the cartilage.

Complications at mucous membrane donor sites.

Full-thickness mucous membrane is an acceptable autogenous graft to replace the deficient conjunctiva resulting from intrinsic disease, surgical resection for carcinoma, or reconstruction of contracted sockets. The mouth provides an excellent source of mucous membrane graft material with few donor site complications. However, we encountered four cases of donor site complications after full-thickness mucous membrane grafting.

Ocular motility problems after orbital decompression for dysthyroid ophthalmopathy.

Ocular motility problems of 50 consecutive patients following orbital decompression for dysthyroid (Graves') ophthalmopathy were analyzed retrospectively. No significant relationship to the development of postoperative diplopia was seen in the amount of retrodisplacement of the globe, the anatomical approach for orbital decompression, or the indication for decompression. Several clinical observations were made.

Parotid duct injury as a complication of differential seventh nerve ablation.

A 68-year-old man with intermittent blepharospasm complained of pain and induration after undergoing differential ablation of the seventh nerve. Because radiation therapy was ineffective, we inserted a 5-mm silicone tube into a serous cyst in the parotid gland. The induration subsided and the patient's recovery was uneventful.

The technique of kidney transplantation in rhesus monkeys.

The technique of kidney transplantation in rhesus monkeys is described in detail. The rate of successful transplantations can be increased to 90-100% if several technical aspects are considered. These include adequate perfusion of the organ to be preserved, measures to prevent a sharp decrease in body temperature, doing the arterial anastomosis with interrupted sutures and prevention of low blood pressure after revascularization.

An alternative technique of biliary reconstruction after liver transplantation.

In ten pigs ligature dissection and side-to-side reanastomosis was performed as a model for biliary reconstruction after liver transplantation. Results were satisfying with no complications, such as bile leakage, cholangitis, obstruction, or stenosis in a follow-up of 3-12 months. The same technique was used in a transplantation program with rhesus monkeys so far showing the same good results.

Analysis of microdissected cataractous human lenses.

The potential of high-performance liquid chromatography (HPLC) as a technique for studying human cataractogenesis by analyzing minute quantities of lens proteins was demonstrated in a human retinitis pigmentosa (RP) lens. Individual human cortical cataractous lenses were microdissected. A well-defined opaque section was identified, the lens capsule was cut, and the section was removed.

[Respiratory training with intermittent positive pressure in acute respiratory disturbances (author's transl)].

In a clinical study the applicability and effectiveness of breathing therapy with intermittent positive pressure in cases of incipient or already established pulmonary complications are evaluated. The case material was divided into four groups: 1. Imminent respiratory complications (haemorrhagic shock, flail chest); 2.

Chest pain in the postoperative ophthalmic patient.

A retrospective analysis of the postoperative ophthalmic surgical mortality during the 20-year period ending in 1974 at the Jules Stein Eye Institute was performed. Eleven of 17,632 patients died following ophthalmic surgery (0.062%).

[Epidural morphine analgesia. Postoperative period (author's transl)].

50 patients after abdominal surgery received peridural morphine for postoperative pain relief. At the end of operation, 2-3 mg morphine in 10-15 ml 0,9% saline were injected peridurally by a catheter, which was placed preoperatively. The injection was followed by a dissociated analgesia.

[Pheochromocytoma in pregnancy--pathophysiology and therapy (author's transl)].

In this paper pathophysiology of pheochromocytoma and its modern diagnostic and therapeutic management are discussed with special regard to the combination of pheochromocytoma and pregnancy. The preoperative treatment with phenoxybenzamine is evaluated. As for the anesthetic management barbiturates and neurolept anesthesia are recommended.

Mydriatic effect of phenylephrine 10% (aq) vs phenylephrine 2.5% (aq).

Pupil dilation from commercially available phenylephrine compounds was studied in a group of 11 subjects. Phenylephrine 10% (aq) did not produce significantly more mydriasis than phenylephrine 2.5% (aq) in the general population (P less than 0.

Myocardial oxygen consumption and regulation of coronary blood flow during stepped relief of the left ventricle.

In 25 calves an atrio-ventriculo-aortic bypass was performed and the metabolism and the regulation of coronary blood flow during stepped assistance of the left ventricle was studied. With mean aortic blood pressure kept constant stepped decrease in left ventricular pressure from 120 to 0 mmHg diminished myocardial oxygen consumption from 7.7 to 1.