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Khan JA, Doane JF, Grove AS. Sebaceous and meibomian carcinomas of the eyelid. Recognition, diagnosis, and management. Ophthalmic Plast Reconstr Surg 1991; 7:61-6. [PMID: 2018750 DOI: 10.1097/00002341-199103000-00008] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Sebaceous carcinoma of the eyelid is frequently misdiagnosed clinically and histopathologically. The tumor may present as a lid mass, recurrent chalazion, or diffuse unilateral blepharoconjunctivitis. Fifty percent of cases are misdiagnosed, often by an inexperienced general pathologist interpreting the initial biopsy. Frozen-section monitoring of surgical margins has been reported unreliable in 25% of cases. Mohs surgery is also unreliable in cases where there is pagetoid intraepithelial spread or skip lesions. This tumor may spread regionally into the lacrimal secretory and excretory systems, to regional lymph nodes, and rarely disseminate hematogenously. Guidelines for management are discussed.
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Khan JA. Sub-cilial sliding skin-muscle flap repair of anterior lamella lower eyelid defects. THE JOURNAL OF DERMATOLOGIC SURGERY AND ONCOLOGY 1991; 17:167-70. [PMID: 2002162 DOI: 10.1111/j.1524-4725.1991.tb01610.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Defects of the anterior lamella of the lower eyelid are common following Mohs micrographic surgery. Often, such defects are repaired with free skin grafts. The author reviews the treatment of such defects utilizing a single subcilial incision to develop a sliding blepharoplasty-type flap, which is advanced medially or laterally, as needed, into the defect. Larger defects may require Putterman's modified Tenzel flap. Final lid function, position, and cosmesis were superior to the results expected from free skin grafts alone in four of the author's five cases. Indications, limitations, modifications, technical aspects, benefits and potential pitfalls of reconstructive subcilial flaps are discussed.
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128
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Khan JA. Dermal graft. Alternative to Gunderson flap allows fitting scleral shell over sensitive cornea. Ophthalmic Plast Reconstr Surg 1990; 6:260-4. [PMID: 2271482 DOI: 10.1097/00002341-199012000-00006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Corneal discomfort often prevents the successful wearing of a cosmetic scleral shell. Such sensitive corneas are traditionally covered with a Gunderson conjunctival flap. I describe two patients in whom preexisting severe conjunctival scarring precluded the possibility of developing a Gunderson flap. An alternative procedure in which autogenous split-thickness dermal grafts were sutured over the sensitive cornea was utilized in each patient. The dermal grafts reepithelialized with mucosa within 4 weeks, and both patients were then able to retain an ocular prosthesis without discomfort. I conclude that satisfactory corneal coverage may be obtained with a dermal graft when conjunctival scarring precludes the use of a Gunderson flap.
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O'Connor VM, de Alwis MA, Khan JA, Fry JP. Chemical modification of spinal cord membranes reveals [3H]strychnine binding sites that are not located on the 48 kDa subunit of the synaptic glycine receptor. Biochem Soc Trans 1990; 18:893. [PMID: 1964652 DOI: 10.1042/bst0180893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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131
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Khan JA, Jafri SM, Khan MA. Obstructive jaundice: an unusual presentation of amoebic liver abscess. THE JOURNAL OF TROPICAL MEDICINE AND HYGIENE 1990; 93:194-6. [PMID: 2190004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A case of amoebic liver abscess with obstructive jaundice is described. Treatment with metronidazole resulted in improved general condition while the jaundice continued to increase. The abscess was twice aspirated and a total of 500 ml fluid was obtained with no improvement in the jaundice. A percutaneous catheter was introduced and drained 300-400 ml bile a day, decreasing and stopping over a week. The jaundice progressively improved.
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132
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Khan JA, Jafri W, Sheikh H, Khan A. A case of ulcerative colitis with amyloidosis presenting as fever of unknown origin. J PAK MED ASSOC 1990; 40:112-3. [PMID: 2115603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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133
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Khan AJ, Khan JA, Akbar M, Addiss DG. Acute respiratory infections in children: a case management intervention in Abbottabad District, Pakistan. Bull World Health Organ 1990; 68:577-85. [PMID: 2289294 PMCID: PMC2393200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Between 1985 and 1987, a community-based case-management programme for acute lower respiratory infection (ALRI) was conducted in a rural district of northern Pakistan. The impact on infant and child mortality of this programme, which included active case-finding and maternal health education, was evaluated. In 1985-86, the ALRI-specific mortality rate among children less than 5 years old in 31 intervention villages was 6.3 deaths per 1000 children per year, compared with 14.4 in seven control villages (P = 0.0001). Within one year of the interventions being extended to the control villages in 1987, the ALRI-specific mortality rate in these villages dropped by 55% to 6.5 per 1000 children per year (P = 0.06). The total child mortality rate in 1985-86 was 29.0 per 1000 children per year in the intervention villages and 39.4 per 1000 children in the control villages, a difference of 26% (P = 0.01). With the interventions in 1987, the total child mortality rate in the control villages declined by 29% to 27.8 per 1000 children per year (P = 0.09). Similar intervention-associated declines in the infant mortality rate were also observed. Case management of acute respiratory infection by village-level community health workers backed up by local health centre staff appeared to significantly reduce both ALRI-specific and total infant and child mortality rates in this setting.
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134
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Khan JA, Grove AS, Joseph MP, Goodman M. Sebaceous carcinoma. Diuretic use, lacrimal system spread, and surgical margins. Ophthalmic Plast Reconstr Surg 1989; 5:227-34. [PMID: 2487228 DOI: 10.1097/00002341-198912000-00001] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Twenty cases of adnexal sebaceous carcinoma managed by contemporary methods, including monitoring of surgical margins, were reviewed. Eight of 20 patients were taking diuretic medications. The initial clinical diagnosis was incorrect in all cases, and 50% of cases were misdiagnosed by the pathologist interpreting the initial biopsy. The canaliculus was identified in 7 cases, and was involved by tumor in 3 cases. Tumor was identified in the lacrimal sac and inferior turbinate in an additional case. Thus, tumor spread into the lacrimal excretory system was documented by histologic findings in 4 cases.
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Abstract
The Tono-Pen was used to determine the reliability of intraocular pressure readings obtained through bandage contact lenses in 48 eyes of 24 healthy volunteers. The mean difference between readings obtained before lens insertion and readings obtained with the lens in place was 0.27 mm Hg and was not statistically significant (P greater than .2). The mean difference between readings obtained with the lens in place and readings obtained after lens removal was 0.85 mm Hg and was statistically significant (P less than .01). Ninety-five percent confidence intervals suggest that the true difference between mean Tono-Pen readings obtained with and without the lens in place ranges from -0.3 to +1.5 mm Hg. Our results suggest that the Tono-Pen is probably an effective way to estimate intraocular pressure through bandage contact lenses, with a probable true mean difference of less than 1.5 mm Hg and a standard deviation of about 2 mm Hg.
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Khan JA, Kresie RJ. Tandem Jaffe lid specula for external approach to the orbital floor. ARCHIVES OF OPHTHALMOLOGY (CHICAGO, ILL. : 1960) 1989; 107:791-2. [PMID: 2730389 DOI: 10.1001/archopht.1989.01070010813009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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137
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Blinder KJ, Khan JA, Giangiacomo J, Ide CH. Optociliary veins and visual prognosis after central retinal vein occlusion. ANNALS OF OPHTHALMOLOGY 1989; 21:192-4, 197. [PMID: 2742293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The effect of acquired optociliary veins on visual acuity after ischemic central retinal vein occlusion in patients 45 years of age or older was assessed retrospectively. Fundus photographs and medical records of 21 patients, 45 years of age or older, with photographically documented central retinal vein occlusion and at least six-months follow-up were analyzed. Eleven of 21 patients developed acquired optociliary veins. Patients with acquired optociliary veins were more likely to experience stable or improved visual acuity (nine of 11 patients) than were patients without them (four of ten patients) over a mean follow-up period of 30 months (P = .049).
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139
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Abstract
There are few records detailing the techniques and tribulations of early American surgeons who dared venture into the treacherous recess of the human orbit. The authors present a recently discovered letter written by a young woman who in 1841 underwent an orbital operation performed by the prominent New York City surgeon, Willard Parker. The letter details the patient's experiences in an era without anesthesia or antibiotics, and her subsequent development of conjunctival adhesions.
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Giangiacomo J, Khan JA, Levine C, Thompson VM. Sequential cranial computed tomography in infants with retinal hemorrhages. Ophthalmology 1988; 95:295-9. [PMID: 3262849 DOI: 10.1016/s0161-6420(88)33170-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Five whiplash-shaken infants presented initially with lethargy, vomiting, irritability, and intraocular hemorrhage and had sequential cranial computed tomography (CT). In three of the five infants, results of the initial CT scans of the head were either normal or demonstrated subtle abnormalities. However, significant subdural hemorrhages which were demonstrated by subdural aspiration developed subsequently in all three infants. Results of repeat CTs of the head showed progressive ventricular dilation and symmetrical bilateral fronto-parietal subdural hematomas. The retinal hemorrhages preceded both the clinical and radiologic recognition of subdural hematoma. Results of the initial head CT of the remaining two children showed intracerebral hemorrhages, cerebral edema and subsequently subdural hematoma. The finding of unexplained retinal hemorrhages in some infants, even though the initial CT head scan may show only minimal changes, warrants monitoring of the head circumference, fundus, and repeat head CT as indicated.
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Abstract
Coats'-like changes (i.e., retinal telangiectasia and/or exudative detachment) have been reported in as many as 1.2 to 3.6 percent of patients with retinitis pigmentosa. In severe cases this disorder may progress to total retinal detachment and visual loss in the context of longstanding retinitis pigmentosa. Forty-six cases of Coats'-type retinitis pigmentosa gathered from the literature are reviewed. Historical and epidemiological features, hereditary factors, clinical features, histopathological findings, pathogenesis, differential diagnosis, prognosis and possible treatment are discussed.
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Khan JA, Sutula FC, Pilch BZ, Joseph MP. Mucoepidermoid carcinoma involving the lacrimal sac. Ophthalmic Plast Reconstr Surg 1988; 4:153-7. [PMID: 3154735 DOI: 10.1097/00002341-198804030-00006] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Mucoepidermoid carcinoma of the lacrimal sac was diagnosed in a 62-year-old woman who presented with epiphora and a fixed painless mass in the area of the lacrimal sac. Histopathologic findings included nests and islands of neoplastic cells in a fibrotic stroma. The tumor nests contained both glandular spaces and solid epithelial areas. Treatment entailed dacryocystectomy with silastic intubation and subsequent medial maxillectomy and ethmoidectomy. The patient was tumor free on 1-year follow-up. Clinical features, histopathological findings, prognosis, and management of this rare tumor are reviewed in this article.
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Ide CH, Khan JA, Podolsky TL, Strickland MP, Wilson RJ. [Coat's type retinitis pigmentosa]. Klin Monbl Augenheilkd 1987; 190:205-6. [PMID: 3586543 DOI: 10.1055/s-2008-1050359] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
A twenty-two-year-old woman with a history of long-Standing retinitis pigmentosa and recently discovered bilateral exudative retinal detachments of the Coats' type is described. This widely unrecognized association has been reported to occur in up to 2% of patients with retinitis pigmentosa. Unlike the usual Coats' syndrome, it is more often bilateral, shows no sex preference and occurs in older individuals. Heightened awareness of this potentially treatable complication of retinitis pigmentosa may facilitate earlier recognition of the problem, which may lead to more timely treatment and a better prognosis.
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Parisi JT, Lampson BC, Hoover DL, Khan JA. Comparison of epidemiologic markers for Staphylococcus epidermidis. J Clin Microbiol 1986; 24:56-60. [PMID: 3722366 PMCID: PMC268831 DOI: 10.1128/jcm.24.1.56-60.1986] [Citation(s) in RCA: 33] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Cultures of Staphylococcus epidermidis from the eyes or nose of the same individual were compared by their antimicrobial phenotype, Staph-Ident (Analytab Products, Inc., Plainview, N.Y.) profile number, phage type, and plasmid profile to determine which parameters provide the most compelling data for their identity. None of the parameters alone provided this type of information. The most conclusive data for the identity of strains resulted when two cultures had the same long phage type and identical or similar plasmid profiles. The presence of a large, slowly migrating plasmid band(s) in a culture that agreed with its pair in all other parameters and, in all likelihood, was the same strain casts doubt in some instances on the reliability of the plasmid profile alone for strain identification in an epidemiologic study.
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Abstract
Orbital infiltration, anterior uveitis, disc edema, choroiditis, erythema nodosum, and polyarticular arthritis due to sarcoidosis occurred in a five-year-old child who presented with unilateral proptosis. Diagnosis was enhanced by computerized tomography of the orbit, and confirmed by synovial biopsy findings. This patient's course illustrates the importance of thorough and frequent ocular examinations in childhood uveitis associated with systemic disease and demonstrates an unusual finding of orbital sarcoidosis. Childhood sarcoid arthritis may be misdiagnosed as juvenile rheumatoid arthritis. Familiarity with the ocular and systemic findings may lead to the correct diagnosis.
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Fleischer AB, Hoover DL, Khan JA, Parisi JT, Burns RP. Topical vancomycin formulation for methicillin-resistant Staphylococcus epidermidis blepharoconjunctivitis. Am J Ophthalmol 1986; 101:283-7. [PMID: 3633699 DOI: 10.1016/0002-9394(86)90820-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
We successfully treated two patients with severe Staphylococcus epidermidis blepharoconjunctivitis by means of a topical vancomycin hydrochloride solution (50 mg/ml) prepared with sterile water. Aqueous vancomycin preparations, however, cause significant ocular irritation probably because of low pH and osmolality values. Solutions prepared with normal saline (5 mg/ml) and phosphate-buffered artificial tears (5 mg/ml and 50 mg/ml) were significantly less irritating and possessed equivalent in vitro antimicrobial activity. Topical vancomycin should be used only when commercially available antibiotics are inadequate.
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Abstract
Kingella species are rarely reported as a cause of endocarditis. We report two cases of K. denitrificans endocarditis occurring in patients with prosthetic valves. K. denitrificans has not been previously reported to cause prosthetic valve endocarditis. Both patients may have developed bacteremia from altered upper respiratory or oral mucosa with subsequent prosthetic valve infection. Treatment with penicillin G and streptomycin was successful in the first patient, whereas ampicillin alone resulted in clinical cure in the second case. Neither patient required further surgery. In vitro antibiotic susceptibility testing indicated that both organisms were highly sensitive to cefotaxime and ampicillin.
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Abstract
Sarcoidosis is an uncommon cause of childhood uveitis. However, the ophthalmologist familiar with the clinical features of childhood sarcoidosis can play a key role in the diagnosis and treatment of this disorder. Two subsets of pediatric sarcoidosis are identified. The 8-15 year age group has almost universal lung involvement, with the eye, skin, liver, and spleen involved in 30-40% of cases. Children 5 years of age and under are characterized by the triad of uveitis, arthropathy, and skin rash. The epidemiology, clinical features, diagnostic evaluation, and ocular management of pediatric sarcoidosis are reviewed. The clinical and laboratory findings that distinguish sarcoidosis from other causes of childhood uveitis are discussed.
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149
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Khan JA, Buescher L, Ide CH, Pettigrove B. Medical management of self-enucleation. ARCHIVES OF OPHTHALMOLOGY (CHICAGO, ILL. : 1960) 1985; 103:386-9. [PMID: 3977713 DOI: 10.1001/archopht.1985.01050030082027] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Self-enucleation or oedipism is a specific manifestation of psychiatric illness distinct from the milder forms of self-inflicted ocular injury. In this article, we discuss the previously unreported medical complication of subarachnoid hemorrhage accompanying self-enucleation. The diagnosis was suspected from the patient's history and was confirmed by computed tomographic scan of the head. This complication may be easily missed in the overtly psychotic patient. Specific steps in the medical management of self-enucleation are discussed, and medical complications of self-enucleation are reviewed.
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Abstract
Blepharoconjunctivitis caused by methicillin-resistant strains of Staphylococcus epidermidis occurred in two hospitalized patients, a 74-year-old man and a 19-year-old man. Both strains were resistant to multiple courses of topical antibiotic therapy. Successful treatment in both cases depended upon antibiotic sensitivity testing. These methicillin-resistant strains of S. epidermidis, like methicillin-resistant strains of Staphylococcus aureus, demonstrated almost complete cross-resistance to cephalosporins despite apparent sensitivity on Kirby-Bauer disk sensitivity testing. Topical vancomycin was curative in one case. In the other case, treatment with topical gentamicin, intravenous cefoperazone, and oral rifampin led to resolution of the symptoms.
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