Lower Eyelid Contour in Graves Orbitopathy.

Purpose: The aim of the present study was to analyze quantitively the lower lid contour of patients with Graves orbitopathy.Methods: Bézier curves were manually adjusted to the ciliated and nasal (or lacrimal) portions of the lower lid contour of 41 patients with Graves orbitopathy and 43 normal subjects using National Institute of Health (NIH) ImageJ software. Considering the main coordinates of the Bézier functions, the Matlab software was employed to express the lid contours with 1000 points. The first order numerical derivative of the curves was calculated in order to compare the curvature of the whole lid contour of patients and controls. The same comparison was made for the temporal and nasal contour segments. Other parameters measured included the location of the lowest point on the contours (contour peak); the position of the lateral and medial canthi, as well as the angle formed by the lower lacrimal punctum and the vertex of the inner canthus.Results: The curvature of the temporal portion of the lid contours of patients and controls correlated with both the height of the lateral canthus and the magnitude of the MRD2. Graves retraction affects the medial and lateral portion of the lid. Both segments were more curved in patients than in controls. The lower punctum was significantly lowered, increasing the angle between the lower punctum and the medial canthus.Conclusions: The increased lateral curvature of the lower lid seen in patients with Graves disease is a natural geometric effect of the increment of MRD2. The nasal portion of the lid is also significantly lowered by retraction.

Fibroma de Tarso / Tarsal Fibroma

RESUMO O objetivo dos autores é relatar um caso de fibroma de tarso, uma tumoração na reborda orbitária súpero-temporal direita com crescimento lento ao longo de anos. A análise da peça obtida da região tarsal mostrou uma lesão bem delimitada, constituída por deposição de fibras colágenas densas, com proliferação de células fusiformes, sem atipias, com revestimento de células conjuntivais, caracterizando fibroma da placa tarsal.

ABSTRACT The objective of the authors is to report the case of a tarsal fibroma, a tumoration on the superotemporal side of the right orbit with slow growth over the years. Analysis of the anatomical specimen obtained from the tarsal region showed a well-defined lesion, consisting of deposition of dense collagen fibers, with fusiform cells without atypia, with coating conjunctival cells, featuring fibroma of the tarsal plate.

Globe Protrusion and Interorbital Divergence in Syndromic Faciocraniosynostoses.

PURPOSE: The aim of this study was to quantify the relationship between globe protrusion (GP), length of medial and lateral walls, interzygomatic distance, and interorbital angle in syndromic faciocraniosynostoses. METHODS: The axial slices of computed tomography of the orbits of 43 patients with faciocraniosynostosis (31 with Crouzon syndrome and 12 with Apert syndrome) and 23 control subjects were measured with the Image J software. The following 5 variables were quantified: the degree of GP, the length of the medial and lateral walls, the interzygomatic distance, and the interorbital angle. RESULTS: Independent t-tests revealed significant differences between the patients and the controls regarding the mean values of all variables measured. The degree of GP was better correlated with the interorbital angle (r = 0.81) than with the medial wall length (r = 0.73). No correlation was found between GP and lateral orbital wall length. CONCLUSIONS: In syndromic faciocraniosynostoses, GP is highly correlated with the interorbital angle. The increment in the interorbital angle is a natural geometric consequence of the fact that a decrease in the orbital depth is not adequately compensated by an increase in the distance between the lateral orbit rims.

Lateral and medial upper eyelid contour abnormalities in graves orbitopathy: the influence of the degree of retraction.

PURPOSE: To determine the location of contour abnormalities in Graves upper eyelid retraction. METHODS: Multiple midpupil angular eyelid distances of 75 upper eyelids of 55 patients (mean age = 41.7 ± 13.3 SD years) in the inactive phase of Graves orbitopathy were measured with a recently developed custom-made software. Sixty eyelids of 60 normal subjects were also measured as a control group. A contour peak was defined by the highest midpupil angular eyelid distance normalized (divided) by the superior limit of normality (mean + 2SD). RESULTS: In 45 eyelids (60%), the peaks were lateral between 120° and 150°. For high levels of retraction, the peaks tended to be centrally located with a substantial number of medial deformities (30 eyelids). Although the lateral and medial peaks were not affected by exophthalmometry, there was a statistically significant increase of medial peaks when midpupil eyelid distance was greater than 6.75 mm (χ = 5.20, p = 0.02). CONCLUSIONS: Lateral contour abnormalities are more frequent than medial deformities. With minor degrees of retraction, there is a predominance of lateral peaks. With higher degrees of retraction, the number of medial abnormalities is similar to the lateral ones.

Orbital invasion by squamous cell carcinoma arising in multiple epidermoid cysts.

Epidermal or epidermoid cysts usually are benign, solitary-growing masses located in the mid- or lower dermis. They are believed to derive from pilosebaceous units and are lined with an epidermis-like epithelium including a granular cell layer. The occurrence of multiple epidermal cysts on the scalp of nonsyndromic patients is extremely rare. Although the presence of squamous cell carcinoma in the wall of an isolated epidermoid cysts is well documented in the dermatological literature,, the authors are not aware of any article in the English literature describing orbital invasion by a carcinoma developed in isolated or multiple epidermoid cysts.

Retinal vasculitis in Susac syndrome: case report.

A 29 year old male was admitted at the emergency room suffering from gradually worsening headache followed by nausea. In the hospital patient presented with lethargy, reduction of consciousness level and bilateral hypoacusis. Ophthalmic examination and fluorescein angiography showed retinal vasculitis. This finding was crucial to the diagnosis of Susac syndrome, a rare disease characterized by vasculopathy of retina, encephalic tissues and cochlea. Patient was treated with immunosuppressors to prevent him from developing severe sequelae of this disease.

Retinal vasculitis in Susac syndrome: case report / Vasculite retiniana na síndrome de Susac: relato de caso

A 29 year old male was admitted at the emergency room suffering from gradually worsening headache followed by nausea. In the hospital patient presented with lethargy, reduction of consciousness level and bilateral hypoacusis. Ophthalmic examination and fluorescein angiography showed retinal vasculitis. This finding was crucial to the diagnosis of Susac syndrome, a rare disease characterized by vasculopathy of retina, encephalic tissues and cochlea. Patient was treated with immunosuppressors to prevent him from developing severe sequelae of this disease.

Paciente masculino de 29 anos foi admitido em pronto-socorro com quadro de cefaléia progressiva há 10 dias seguida de náuseas. Durante internação evoluiu com letargia, redução do nível de consciência e hipoacusia bilateral. Exame oftalmológico e angiofluoresceinografia evidenciaram vasculite retiniana. Este achado foi essencial para o diagnóstico de síndrome de Susac, uma patologia rara caracterizada por vasculopatia de retina, encéfalo e cóclea. Tratamento imunossupressor foi instituído, prevenindo sequelas graves da doença.

O adesivo tecidual glutaraldeído-albumina (BioGlue®) como reforço de sutura duodenal em ratos Wistar: análise pelo métodode pressão de ruptura / The glutaraldehyde-albumin tissue adhesive (BioGlue®) as a duodenal suture reinforcement in Wistar rats: analysis by the bursting-pressure method

Existe considerável morbi-mortalidade associada às deiscências de suturas, principalmente as duodenais. Os bioadesivos surgiram como materiais para reforçar ou substituir suturas. BioGlue® é um adesivo cirúrgico que tem sido utilizado como reforço de suturas e anastomoses principalmente em cirurgia cardiotorácica. Nenhum relato do uso do adesivo BioGlue® no trato alimentar foi encontrado na literatura nas bases de dados Medline e Lilacs. Objetivo: avaliar se a aplicação de BioGlue® confere maior resistência às suturas duodenais utilizando o teste de pressão de ruptura (PR) imediatamente após a aplicação do adesivo e no terceiro dia pós-operatório (PO). Método: foram utilizadas 40 ratas Wistar sendo 20 animais em cada experimento. Experimento 1: No grupo sutura realizou-se duodenotomia e sutura. No grupo sutura + cola foram realizadas duodenotomia e sutura com aplicação de BioGlue®. O teste de PR era feito de imediato. Experimento 2: No grupo sutura realizou-se duodenotomia e sutura. No grupo sutura + cola foram realizadas duodenotomia e sutura com aplicação de BioGlue®. O teste de PR era feito no 3° PO. Resultados: no Experimento 1 a média dos valores da pressão de ruptura do grupo sutura foi de 92,60mmHg e a média do grupo sutura + cola foi de 158,80mmHg (p=0,001932). No experimento 2 a média dos valores da pressão de ruptura do grupo sutura foi de 141mmHg e a média do grupo sutura + cola de 70,9mmHg (p=0,000024).Conclusões: a análise dos dados dos dois experimentos mostrou que o adesivo BioGlue® protegeu a sutura duodenal de imediato entretanto não mostrou esse mesmo efeito no 3° PO...

There is considerable morbi-mortality related to suture dehiscence mainly in the duodenum. Surgical adhesives have been developed to reinforce or replace sutures. BioGlue® is a surgical adhesive that has been used as suture reinforcement especially in cardiothoracic surgery. The use of BioGlue® in the alimentary tract has not been reported in the literature until now.Objective: To evaluate if the application of the surgical adhesive BioGlue® gives better resistance to a duodenal suture using the bursting pressure test (BP) immediately after the surgery and in the third post operative (PO) day.Methods: Forty Wistar rats were used being 20 animals in each experiment.Experiment 1:In the suture group duodenotomy and suture were performed. In the suture + glue group a duodenotomy and suture with BioGlue® application were done. BP test was performed immediately. Experiment 2: In the suture group duodenotomy and suture were performed. In the suture + glue group a duodenotomy and suture with BioGlue® application were done. BP test was performed in the third PO day. Results: In experiment 1 the mean BP values of the suture group was 92,60mmHg and the values of the suture + glue group was 158,80mmHg (p=0,001932). In Experiment 2 the mean BP values of the suture group was 141mmHg and the values of the suture + glue was 70,9mm Hg (p=0,000024).Conclusions: Data analysis in experiments 1 and 2 showed that BioGlue® protected the suture immediately however this effect was not obtained in the third PO day...