Novel use of an autologous scleral button graft to close the anterior defect in evisceration surgery.

PURPOSE: To present an alternative evisceration technique with long-term follow-up data. This technique involves the insertion of an acrylic implant into a modified scleral shell which is closed using an autologous scleral graft. METHODS: This was a retrospective analysis of eviscerations performed in a district-general hospital in the UK. All patients underwent conventional ocular evisceration after total keratectomy. A full thickness scleral graft is harvested from the posterior sclera, using an internal approach, with an 8 mm dermatological punch. An 18-20 mm acrylic implant is placed into the shell, and the scleral graft is used to close the anterior defect. Demographic characteristics, implant size and type, and cosmetic results from pictures of all patients were recorded. All patients were invited for a review to measure motility, eyelid height, patient recorded satisfaction and complications. RESULTS: Of the five patients identified, one had since died. The remaining four attended a review in person. The mean time between surgery and review was 48 months. The mean implant size was 19 mm. There were no cases of implant extrusion or infection. All four had a <1 mm asymmetry in measured eyelid height and ≥5 mm horizontal gaze motility. All patients self-reported "good" cosmesis. An independent assessment identified "mild asymmetry" in two cases and "moderate" in the other two. CONCLUSION: Evisceration with this novel autologous scleral graft technique restores volume in the anterior orbit with good cosmetic results, and with no cases of implant exposure reported in this small case series. This technique should be compared prospectively to established techniques.

8-0 polyglactin 910 suture in entropion repair: long term follow up and rates of recurrence.

OBJECTIVES: The choice of suture is an important consideration in entropion repair, with implications on wound strength, inflammation and scar formation. There is no consensus on the best suture material or gauge of suture at present. We aim to assess the long-term outcome of entropion repair using 8-0 polyglactin sutures, with specific focus on rates of recurrence, wound dehiscence, infection and scarring. METHODS: This retrospective case series included consecutive patients from two institutions (84 eyes) undergoing entropion repair using a subciliary incision and a lateral wedge resection. Patients were invited for follow up review and patient records were evaluated to assess for cosmetic and functional outcome, complications and patient satisfaction. RESULTS: The median follow-up time from surgery was 48 months (range 20-100). There were five cases of entropion recurrence (5.9%), taking place between 8 months to 4 years after surgery, two cases required further surgery, while three were conservatively treated. There was no wound dehiscence. Two cases (2.4%) of mild superficial wound infections occurred which were successfully treated with topical antibiotics, 1 case (1.2%) of mild lid notching, and 1 case (1.2%) of scarring were recorded. 97% of patients reported to be satisfied with the outcome of their surgery. CONCLUSIONS: The use of 8-0 polyglactin suture in entropion repair has resulted in good aesthetic and functional outcome in this case series, with low rates of recurrence, complications, and no case of wound dehiscence, suggesting this suture provides sufficient tensile strength to enable wound closure and healing.

Expression of a rlf/L-myc minigene inhibits differentiation of embryonic stem cells and embroid body formation.

Rearrangements of the L-myc proto-oncogene with the cellular gene rlf occur in a subset of human small cell lung carcinoma (SCLC) resulting in the expression of a fusion protein. To investigate whether expression of such a rlf/L-myc fusion protein could contribute to the development of SCLC we constructed a chimeric minigene where the rlf first exon and the L-myc second and third exon are under the control of the rlf promoter thereby recapitulating the events of the rearrangement. Attempts to generate transgenic mice with this minigene showed that mouse embryos containing high copy numbers of the rlf/L-myc minigene fail to develop, suggesting that the expression of a rlf/L-myc fusion protein interferes with early differentiation processes. To investigate the nature of this potential embryonic lethality further, we transfected the rlf/L-myc construct stably into embryonic stem (ES) cells. Transfected ES lines that express the rlf/L-myc construct do not show a higher proliferation rate than the parental ES line but fail to properly develop embroid bodies. In addition, outgrowth and differentiation of cells from embroid bodies was severely impaired in ES cells expressing the rlf/L-myc construct when compared to normal ES cells, again suggesting an interference of rlf/L-myc expression with proper differentiation. Expression of a rlf/L-myc fusion may therefore be of critical importance in tumorigenesis by blocking differentiation and thereby allowing continued proliferation of cells and the acquisition of further mutations leading to a fully malignant tumor.

Cloning of embryonal stem cell-specific genes: characterization of the transcriptionally controlled gene esg-1.

We have isolated, by differential library screening, eight cDNAs representing genes that are specifically expressed in the embryonal stem cell line IMT-11, when compared to the parietal endoderm-like cell line PYS-2 or to NIH3T3 fibroblasts. One of these genes, embryonal stem cell gene 1 (esg-1), was analyzed in detail. esg-1 mRNA is found at high levels in both IMT-11 and F9 embryonal carcinoma cells and disappears during the differentiation of the stem cells. Furthermore, expression of the gene was found to be extremely low in, or absent from, oocytes and fertilized eggs, but it is strongly induced at the 2-cell stage, reaching maximum levels at the 4-cell stage. In contrast, esg-1 expression is detectable neither in midgestation embryos nor in neonatal tissues. These results strongly suggest that esg-1 is expressed specifically or at least predominantly in embryonal stem cells. Antibodies directed against a glutathione S-transferase-esg-1 fusion product detect a protein of M(r) approximately 14,000 in F9 embryonal carcinoma cells, but not in differentiated cells. Apart from the esg-1 gene, which contains two introns, there are at least seven esg-1-related pseudogenes in the mouse genome that differ from the esg-1 gene by the presence of multiple point mutations, by the lack of intervening sequences, and/or by the presence of a polyadenylated stretch at the 3' end. The esg-1 gene is under stringent transcriptional control in differentiating and differentiated cells, as shown by both nuclear run-on assays and the transient F9 stem cell-specific expression of constructs consisting of esg-1 upstream sequences fused to a luciferase reporter gene.