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 11,717 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 52-year-old woman with chronic progressive external ophthalmoplegia (CPEO) with familial hypercholesterolemia (FH) was reported. Her mother died from heart disease, and her elder sister has hypercholesterolemia with swelling of Achilles tendons. She had slowly progressive external ophthalmoplegia, bilateral ptosis, swelling of Achilles tendons since twenties. At 40 years of age, she was pointed out hypercholesterolemia. Physical examination was within normal limits except for bilateral swelling of Achilles tendons. Neurological findings showed bilateral ptosis, disturbance of eye movements, mild proximal muscle weakness and dysesthesia in bilateral hands. Routine laboratory findings were within normal limits except for high serum cholesterol level (512 mg/dl). In the biopsied muscle, there was mild variation in fiber size with several ragged-red fibers and focal cytochrome c oxidase defective fibers. Biochemical analysis of the biopsied muscle revealed normal values in the mitochondrial fraction. Southern blot analysis of the mitochondrial DNA (mtDNA) of the muscle disclosed mixed population of mtDNA, consisting of the normal one and partially deleted (4.9-kilobase). Southern blot analysis of the leukocytes from the patient against the cDNA of LDL receptor was normal at least using the restriction enzyme of BglII, XbaI, EcoRI, PvuII and BamHI. This case has CPEO with deleted mtDNA associated with familial hypercholesterolemia, which is caused to nuclear DNA abnormalities, and is thought to be an important case for us to study the relationship between deleted mtDNA and abnormal nuclear DNA in CPEO.
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PMID:[A case of chronic progressive external ophthalmoplegia associated with familial hypercholesterolemia]. 162 35

A 55-year-old woman noticed progressive hearing loss, earache and tinnitus in the left side in December 1988, followed by dysesthesia of the left face and hypogeusia. Those symptoms did not respond to the otological treatment of otitis media. In addition, the left eyelid ptosis, double vision and dysphagia appeared in May 1989. On admission, cranial nerves from III to XII were affected exclusively in the left side. The cell counts and the protein levels in the CSF were elevated. The MRI of the head showed hypertrophic dura mater at the left base of the skull covering the temporal lobe. No bone destruction was found in CT. The biopsy revealed the thickened dura mater with microabscess containing Langhans giant cells and lymphocytes. A diagnosis of pachymeningitis was made. After the therapy with antibiotics and then with prednisolone for several months, cranial nerve disturbances disappeared except hearing loss with decrease in cell counts and protein levels of the CSF. The follow-up MRI after one year showed decrease in thickness of dura mater. The MRI, particularly using enhancement with Gd-DTPA, was useful to make a diagnosis of hypertrophic pachymeningitis. It is suggested that the administration of antibiotics should be considered in the treatment of the pachymeningitis even if the causative agents were not identified.
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PMID:[A case of Garcin's syndrome caused by pachymeningitis secondary to otitis media, responsive to antibiotic therapy]. 176 59

We report the procedure and the results of a new surgical technique for adult rectal prolapse by left inguinal ligament rectopexy. Seven patients were operated on, and presented with total rectal prolapse (n = 6) or internal procidentia associated with a solitary rectal ulcer syndrome (n = 1). Mean follow-up was 64 months (56-78 months). One patient experienced a postoperative complication: a regressive temporary dysesthesia of the left lateral femoral cutaneous nerve. Three patients had mild postoperative constipation. There was no recurrence. Preliminary results show that it is a suitable procedure. It may be successfully applied to the treatment of rectal prolapse and internal procidentia complicated by a solitary rectal ulcer syndrome, particularly when the use of synthetic material is precluded after a rectal wound. Further studies are required to confirm these preliminary results.
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PMID:[Rectopexy to the left inguinal ligament. Technique and preliminary results]. 876 78

A 63-year-old man was admitted to our hospital because of left back pain and dysesthesia in his left arm. On physical examination, the patient had ptosis, myosis, and anhydrosis on the left side, suggesting Horner's syndrome. A chest computed tomographic scan disclosed a mass lesion adjoining to the left posterior mediastinum. Although the mass lesion showed a slight decrease in size after the systemic administration of corticosteroids, no further improvement was obtained. Open chest examination revealed extended thickening of the parietal pleura with massive involvement of the upper thoracic sympathetic trunk. The diagnosis was malignant mesothelioma of sarcomatous type. Horner's syndrome is a rare but possible complication in the clinical course of malignant pleural mesothelioma.
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PMID:[Horner's syndrome in a patient with diffuse malignant pleural mesothelioma]. 1039 Sep 66

Since its introduction in 1992, endoscopic brow lift has gained tremendous recognition because it has been promoted as a novel technique to correct brow ptosis as well as glabella rhytids in a minimally invasive manner with fewer complications than the classic coronal brow lift method. In this retrospective study, 628 endoscopic brow lift procedures performed over a 5-year period (1997-2001) at Manhattan Eye Ear and Throat Hospital were reviewed. The number of endoscopic brow lift procedures performed at this institution has declined 70 percent. The purpose of this study was to elucidate the causes of this striking trend by soliciting the opinions of 21 New York plastic surgeons on their current brow ptosis management. The response rate was 84 percent (21 of 25 surgeons contacted). Currently, 25 percent of the interviewed plastic surgeons perform endoscopic brow lift regularly, 50 percent of the plastic surgeons perform endoscopic brow lift occasionally, and 25 percent of the participants no longer perform endoscopic brow lift. While most patients (70 percent) were satisfied with their results, only 50 percent of the plastic surgeons were pleased with the long-term results (after more than 2 years of follow-up). Observed postsurgical complications of endoscopic brow lift included alopecia, hairline changes, infected hardware, brow asymmetry requiring surgical revision, prolonged forehead/brow paresthesia, frontal branch nerve paralysis, and scalp dysesthesia. These complications were similar to those resulting from open brow lifts. Seventy-one percent of the surveyed New York plastic surgeons routinely administered botulinum toxin type A (Botox) within 6 months of the endoscopic brow lift procedure. Possible explanations for the decline in the overall number of endoscopic brow lift procedures include the following: (1) the selection criteria for the ideal endoscopic brow lift patients are currently more limited; (2) other techniques equal or surpass endoscopic brow lift in effectiveness and predictability; and (3) endoscopic brow lift is ineffective in the majority of patients. There is no single superior surgical procedure for brow ptosis management available at this time.
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PMID:Endoscopic brow lift: a retrospective review of 628 consecutive cases over 5 years. 1525 22

A 45-year-old female developed mild dysesthesia and swelling, followed by ptosisand trigeminal pain, in the right side of the face. Her past medical history was unremarkable, and she had not been aware of any infectious sign. A local otolaryngologist administered glucocorticoid therapy that resolved the face pain, but the ptosis persisted. Neurological examination found complete right oculomotor nerve paresis and mild sensory loss in the first and second segments of the right trigeminal nerve. Blood examination found no abnormalities. Neuroimaging revealed a saccular aneurysm at the branching site of the posterior communicating artery, projecting posteriorly and adjacent to the dorsum sellae, without other intracranial abnormalities. Cerebral angiography demonstrated poor opacification of the superior ophthalmic vein and cavernous sinus on the right side. The patient underwent coil embolization under a diagnosis of symptomatic aneurysm, but her oculomotor neuropathy was only partially improved. We thought that the impairment of the oculomotor function by inflammatory reaction in the cavernous sinus and mechanical compression by the aneurysm had already persisted for too long for post-treatment recovery. We think that the simultaneous occurrence of Tolosa-Hunt syndrome and oculomotor nerve palsy may have resulted because trigeminal neuralgia had increased the blood pressure to induce rapid growth of the preexisting aneurysm, or the inflammatory reaction in the cavernous sinus had promoted the growth of the aneurysm, or that the association was by chance.
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PMID:[Simultaneous presentation of Tolosa-Hunt syndrome and oculomotor nerve palsy due to the nonruptured internal carotid-posterior communicating artery aneurysm: a case report]. 1936 32

A 25-year-old male presented with unilateral retroorbital dysesthesia persisting for 2 weeks followed by progressive palpebral ptosis without preceding trauma, paranasal sinus surgery, or infectious signs. Neuroophthalmological inspection revealed mildly increased intraocular pressure and exophthalmos on the affected side, without conjunctival chemosis, restriction of the extraocular movements, double vision, or visual impairment. These symptoms did not vary with posture, straining, and Valsalva maneuver. Neuroimaging showed an irregularly-shaped orbital mass without enhancement mainly situated in the medial compartment of the orbit and encasing the optic nerve. Bruit was not audible and abnormal vasculatures were not identified in and around the affected orbit. Transcranial surgical exploration through the surgical window formed by the superior and medial rectus muscles revealed a purplish elastic-soft mass, heterogeneous in consistency and tightly adhering to the surrounding tissue, so cryoprobe-assisted radical tumor resection could not be completed without jeopardizing the optic nerve. The mass was subtotally resected piecemeal without postoperative visual impairment. The histological diagnosis was cavernous hemangioma. Orbital cavernous hemangiomas may present with an atypical appearance which confuses pretreatment diagnosis and makes surgical extirpation more hazardous. Conservative surgery should be indicated for poorly demarcated orbital cavernous hemangiomas considering the usual benign clinical course and postoperative sequelae.
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PMID:Orbital cavernous hemangioma presenting with atypical appearance: case report. 1946 92

Endocrine orbitopathy is a systemic complex disease that involves the orbital contents. The symptoms are exophthalmos and correlated. The surgical techniques used to correct this condition can be fat decompression by the Olivari technique, 3-wall bony decompression, or the combination of these 2 surgical strategies, the ancillary procedure. Fat decompression is indicated when the intraconal and extraconal fat tissue is increased, whereas bony decompression is used in the presence of extraocular muscle involvement, associated with a normal quantity of intraconal-extraconal fat. Surgical techniques include the transconjunctival approach and ostectomy of the medial wall (when possible through endoscopy), orbital floor, and lateral wall of the orbit.Complications of this type of intervention are often represented by sensitivity disorders of the second branch of the trigeminal nerve, compressed by the intraorbital contents when they prolapse into the sinus. Possible sensitivity disorders are paresthesia, anesthesia, hypoaesthesia, dysesthesia, and hyperesthesia.The innovation introduced by the first author in 2007 consists of a mini ostectomy around the infraorbital foramen with removal of bone fragment. This determines relaxation of the nerve and makes easier the descent toward the sinus, allowing a larger expansion of the orbit contents. The absence of compression significantly reduces the sensitive complications. After treatment of the basic disease, surgical indications should be given according to the Werner classification. Fat decompression with the coronal approach is almost entirely abandoned for the transconjunctival approach, which allows adequate exposure of the lower orbit.The use of mini ostectomy of the infraorbital foramen combined with a 3-wall bony expansion showed a significant reduction of sensitive complications that often cause patient discomfort.
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PMID:New mini-osteotomy of the infraorbital nerve in bony decompression for endocrine orbitopathy. 2007 6

Resection of lesions in the cavernous sinus remains a challenge to neurosurgeons due to its complex anatomy. This video (Video 1) presents the most relevant landmarks of the cavernous sinus region, helping to understand the surgical anatomy. A 55-year-old female presented with diplopia, partial ptosis, and facial dysesthesia in the left ophthalmic territory. Magnetic resonance imaging revealed a lesion in the left cavernous sinus. Microsurgical resection was performed through an approach that included a fronto-orbital craniotomy, an extradural clinoidectomy, and intradural resection of the lesion through the anteromedial triangle. This maneuver expands the optic-carotid and carotid-oculomotor space, therefore the operative corridor.1,2 Both the carotid and optic nerves are untethering and can be gently and safely mobilized. The result of the histopathologic study was hemangioma. Despite the complex anatomy and surgical challenges, it is possible to treat lesions in the cavernous sinus region without causing major deficits, mainly in the nonmeningioma tumors. This is why it is important to choose a safe route to the sinus, such as the anteromedial or Parkinson triangle.3.
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PMID:Cavernous Sinus Hemangioma: Surgical Aspects. 3048 36