Heterotopic brain tissue in the orbit.

A 3-month-old female infant with Turner's syndrome was noted to have progressive swelling of the left upper lid at the age of 1 month. A computed tomogram demonstrated a well-circumscribed, low-density, homogeneous orbital mass. Initially, the main clinical differential diagnosis included dermoid cyst, hemangioma, and encephalocele. Medial orbitotomy followed by histopathologic examination disclosed a cystic choristomatous malformation containing brain tissue. No choroid plexuses within the mass were demonstrated on microscopic examination. Aspiration of fluid from the cystic mass and subsequent biochemical studies unequivocally demonstrated that the mass was filled with cerebrospinal fluid. Despite five surgical procedures, including two frontal craniotomies, and specialized roentgenographic studies, no communication could be demonstrated between the orbital mass and the central nervous system. We postulate that the cerebrospinal fluid was produced within the orbital mass, which represented ectopic brain tissue. Problems in diagnosis and management of this unusual orbital malformation are discussed.

Monozygotic twins concordant for bilateral Duane's retraction syndrome.

Duane's retraction syndrome applies to a wide spectrum of motility disturbances associated with retraction of the globe and narrowing of the palpebral fissure. Although many different anatomic and physiologic disturbances of the oculomotor system are implicated, the underlying cause remains obscure. Twin studies are often useful in determining the contribution of genetics or heredity to disease, but the occurrence of Duane's retraction syndrome in twins is rare. One of a pair of monozygotic twins concordant for bilateral Duane's retraction syndrome developed a 12-diopter esotropia in primary gaze but the other has not. Neither child has a head tilt and both can fix and follow with either eye.

Reconstructing, recognizing, and reproducing object figures: a fixed order.

In this study it is hypothesized that there are three distinct levels of representation and that these levels are hierarchical. The hypothesis was tested by having 100 six-year old boys and girls represent one of the most basic Bender-Gestalt figures. It was demonstrated that a representation of this figure through object reconstruction is prerequisite to recognizing the object figure from a collection of figures which in turn is prerequisite to representing the object figure using a pencil-and-paper reproduction.

Brief Report: On the Proportionate Contributions of Transformed Factors to Common Variance.

A generalized matrix procedure is developed for computing the proportionate contribution of a factor, either orthogonal or oblique, to the total common variance of a factor solution.

Raking A Garden Factor Solution.

In this article some of the causes of matrix singularity are discussed. A relatively simple multivariate procedure is developed to study the variable structure of singular data. This procedure, referred to as data raking, identifies the variable(s) causing singularity. Once identified the variable(s) may be eliminated from the data resulting in the desired non-singular data set that is usually assumed by most multivariate procedures. The logic of the procedure is clarified with illustrative examples using both singular and non-singular data.

The Orthotran Solution.

A computational algorithm, the orthotran solution, is developed for determining oblique factor analytic solutions utilizing orthogonal transformation matrices. Using a simple structure criterion orthotran solutions are determined for 17 illustrative data sets and compared with their subjective solutions. The orthotran solution defines transformation solutions that are relatively congruent with the subjective solutions, thereby suggesting that it has considerable data generalizability.

Complexity And Simplicity As Objective Indices Descriptive Of Factor Solutions.

Kaiser's simplicity index is compared and contrasted with Hofmann's complexity index. It is noted that at the variable level one index may be derived algebraically from the other; however, each provides different descriptive information with regard to a factor solution. Furthermore it is suggested that when used together they provide an objective basis for comparing different factor solutions for the same data set.

In-office temporal artery biopsy.

Biopsy is essential in the diagnosis of temporal arteritis. Temporal artery biopsy done in the office has many advantages. Patients tolerate the procedure well with little anxiety. There is greater convenience for the patient and ease of scheduling for the referring physician. It can be done promptly and is far more cost-effective than performing the procedure in a surgical center or hospital. Finally, and perhaps most importantly, because the in-office procedure is safe, more convenient, less stressful, and less expensive, clinicians are more likely to obtain a temporal artery biopsy when the diagnosis of temporal arteritis is even a remote possibility. Contrariwise, there is evidence to indicate that many cases of temporal arteritis are not diagnosed because of reluctance to schedule a biopsy. The ophthalmologist is in a unique position to provide help in the diagnosis and follow-up care of the patient with suspected temporal arteritis. Ophthalmologists are familiar with the disease, its treatment, and particularly its ocular manifestations. In addition to the baseline ophthalmic examination to help reveal subclinical pathology, ophthalmologists can evaluate the patient as subsequent visual complaints arise. Finally, by offering a convenient biopsy procedure, the diagnosis can be accurately and promptly confirmed.

Treatment of Frey's syndrome (gustatory sweating) and 'crocodile tears' (gustatory epiphora) with purified botulinum toxin.

PURPOSE: To determine whether purified botulinum toxin might be as effective in the treatment of "crocodile tears" (gustatory epiphora) as it has been in the treatment of other hypersecretion syndromes such as Frey's syndrome (gustatory sweating). METHODS: One patient with Frey's syndrome (gustatory sweating) was successfully treated with botulinum toxin. After this, two patients with chronic symptomatic crocodile tears (related to previous facial palsy) were treated with botulinum toxin injections into and around the lacrimal gland. RESULTS: Both patients reported remarkable relief from symptoms and were observed to have no tearing while eating. CONCLUSIONS: Purified botulinum toxin appears to be an effective treatment for crocodile tears.

On Partialing A Simplex Out Of Binary Data.

Using four illustrative data sets, the procedure developed by Horst for partialing a simplex out of a binary data matrix is shown to result in poorer factor recovery than if the procedure were not applied to the data set.

Comparison of the effects of enucleation and orbital reconstruction using free-fat grafts, dermis grafts, and porous polyethylene implants in infant rabbits.

Twenty-nine infant rabbits from four litters were randomly assigned to three groups. No surgery was performed on left eyes. All right eyes were enucleated. Group 1, the control group, had no right-socket reconstruction. Group 2 had reconstruction using free-fat and dermis grafts. Group 3 had reconstruction using porous polyethylene implants. On attaining adult size, rabbits were killed, decapitated, and prepared for measurements. Orbital volume measurements were performed twice and orbital entrance areas were determined once. No significant differences were noted between first and second measurements of orbital volumes. Right orbital volumes were significantly smaller than left orbits in all groups except for the second measurement of the polyethylene implant group. Right orbital entrance areas were significantly smaller than left areas in the control and the free-fat and dermis graft groups. Right orbital entrance areas of the polyethylene group were not significantly smaller than the corresponding left orbital entrance areas. The use of free-fat and dermis grafts for orbital reconstruction in anophthalmic infant rabbits did not significantly stimulate orbital bone growth. In one trial, the polyethylene implant group displayed right orbital volumes and orbital entrance areas that were not significantly smaller than controls.

Effectiveness of botulinum toxin therapy for essential blepharospasm.

The effectiveness of Botulinum toxin (Oculinum) therapy in 76 patients with the diagnosis of essential blepharospasm was analyzed. Botulinum offers relief to almost all patients suffering from essential blepharospasm, however, this relief is usually temporary. The response time for repeated treatments tended to be longer than the first treatment. Patients with mild blepharospasm responded significantly longer to Botulinum injection, than those with severe spasms. The response to Botulinum was not significantly different in patients with Meige syndrome than in patients with only essential blepharospasm. Patients previously treated surgically for essential blepharospasm did not respond differently than those patients with no previous surgical therapy. The authors believe that Botulinum toxin injection is an effective, although temporary, mode of therapy for the signs and symptoms of this focal dystonia. The authors recognize that there may be psychologic factors affecting the response.