Abstract 2620: The Cancer Cell Line Encyclopedia project: From integrative cancer genomics to personalized cancer therapy

Cancer genome characterization efforts such as The Cancer Genome Atlas project are rapidly improving our knowledge of tumor genetic alterations. With the expanded use of massively parallel sequencing, the catalogue of known genetic alterations in cancer is expected to expand at an accelerating rate. In this context, the emphasis is shifting towards systematic identification of the genes and pathways targeted by recurrent genetic alterations, their functional impact in tumor biology, and the resulting cellular dependencies that might be exploited therapeutically. Anticipating the need for a companion resource to systematically probe tumor biology armed with cancer genomics knowledge, we have assembled a compendium of experimentally tractable cancer model systems consisting of ∼1000 human cancer cell lines and performed extensive genomic analysis (at the level of gene expression, DNA copy number and mutations) coupled with pharmacological profiling. This resource, which we call the Cancer Cell Line Encyclopedia (CCLE), is being used not only to identify the putative targets of prevalent genetic alterations, but also to systematically link the presence or absence of certain genetic alterations to drug sensitivity or resistance.

To date, we have identified several previously unappreciated genomic predictors of response or intrinsic resistance to targeted anticancer agents. For instance, through integrative analysis, we have discovered additional mechanisms that may underlie sensitivity to MET inhibitors, beyond amplification of the MET receptor, highlighting the fact that response prediction in the clinic may require assessment of multiple variables. We have also broadened the potential relevance of known predictive biomarkers that might provide a rationale for future genotype-driven clinical trials. As an example, we have expanded on existing knowledge of resistance to receptor tyrosine kinase (RTK) inhibitors, showing that the presence of RAS mutations may predict lack of response to a broad spectrum of RTK inhibitors in addition to EGFR inhibitors. This work demonstrates that pharmacological profiling of large, genomically-annotated cancer model systems may uncover new tumor dependencies as well as positive and negative predictors of drug response. The results of this study are being made publicly available at a CCLE online portal, with the hope they will become a valuable resource for the cancer community to propel translation of the knowledge generated through in vitro integrative genomics into personalized cancer medicine.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 2620.

Hemorrhagic stroke in the Stroke Prevention by Aggressive Reduction in Cholesterol Levels study

BACKGROUND

In the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) study, atorvastatin 80 mg/day reduced the risk of stroke in patients with recent stroke or TIA. Post hoc analysis found this overall benefit included an increase in the numbers of treated patients having hemorrhagic stroke (n = 55 for active treatment vs n = 33 for placebo).

METHODS

We explored the relationships between hemorrhage risk and treatment, baseline patient characteristics, most recent blood pressure, and most recent low-density lipoprotein (LDL) cholesterol levels prior to the hemorrhage.

RESULTS

Of 4,731 patients, 67% had ischemic strokes, 31% TIAs, and 2% hemorrhagic strokes as entry events. In addition to atorvastatin treatment (HR 1.68, 95% CI 1.09 to 2.59, p = 0.02), Cox multivariable regression including baseline variables significant in univariable analyses showed that hemorrhagic stroke risk was higher in those having a hemorrhagic stroke as the entry event (HR 5.65, 95% CI 2.82 to 11.30, p < 0.001), in men (HR 1.79, 95% CI 1.13 to 2.84, p = 0.01), and with age (10 y increments, HR 1.42, 95% CI 1.16 to 1.74, p = 0.001). There were no statistical interactions between these factors and treatment. Multivariable analyses also found that having Stage 2 (JNC-7) hypertension at the last study visit before a hemorrhagic stroke increased risk (HR 6.19, 95% CI 1.47 to 26.11, p = 0.01), but there was no effect of most recent LDL-cholesterol level in those treated with atorvastatin.

CONCLUSIONS

Hemorrhagic stroke was more frequent in those treated with atorvastatin, in those with a hemorrhagic stroke as an entry event, in men, and increased with age. Those with Stage 2 hypertension at the last visit prior to the hemorrhagic stroke were also at increased risk. Treatment did not disproportionately affect the hemorrhagic stroke risk associated with these other factors. There were no relationships between hemorrhage risk and baseline low-density lipoprotein (LDL) cholesterol level or recent LDL cholesterol level in treated patients.

Cerebrovascular disease and statins: a potential addition to the therapeutic armamentarium for stroke prevention

Cerebrovascular disease is the leading cause of disability in Western societies. In the United States, it has been estimated that a stroke occurs every 53 seconds. Consequently, the societal costs attributable to cerebrovascular disease are immense and encourage the medical community to seek new therapies that can reduce stroke's frequency and impact. Although serum lipid levels have not been shown to act as a surrogate marker for stroke, in landmark lipid-lowering trials, statin therapy has been associated with reductions in the incidence of ischemic stroke in patient populations with manifest ischemic heart disease. This observation is supported by a recently published meta-analysis of statin trials that reported an average reduction of about 30% in the incidence of cerebrovascular disease. However, to date, statin studies have only been conducted in patients with, or at high risk for coronary artery disease, who are not truly representative of the overall stroke population. The ongoing Stroke Prevention by Aggressive Reduction of Cholesterol Levels (SPARCL) trial has been designed to prospectively evaluate the benefits of aggressive lipid-lowering therapy on cerebrovascular events in patients who have had a previous stroke or transient ischemic attack, but who have no prior history of coronary artery disease.

Post-transcriptional gene silencing in plum pox virus resistant transgenic European plum containing the plum pox potyvirus coat protein gene

Transgenic plums containing the plum pox potyvirus coat protein (PPV-CP) gene were inoculated with PPV. Infection was monitored by evaluating symptoms, ELISA, and IC-RT-PCR. Transgenic clone C5 was highly resistant to PPV during four years of testing and displayed characteristics typical of post-transcriptional gene silencing (PTGS), including a high level of transgene transcription in the nucleus, low levels of transgene mRNA in the cytoplasm, a complex multicopy transgene insertion with aberrant copies, and methylation of the silenced PPV-CP transgene. The PPV-CP transgene was also methylated in seedlings of C5 and these seedlings were resistant to PPV. Our results show, for the first time, that PTGS functions as a mechanism for virus resistance in a woody perennial species.

The use of transgenic fruit trees as a resistance strategy for virus epidemics: the plum pox (sharka) model

Sharka or plum pox, caused by Plum pox virus (PPV: genus Potyvirus; Family Potyviridae), is the most serious disease of Prunus. Most cultivated Prunus species are highly susceptible and conventional breeding has not produced highly resistant and commercially acceptable varieties. Success in developing virus-resistant herbaceous crops through genetic engineering led us to investigate this approach for resistance to PPV. Our programme aims to develop a biotechnological approach to PPV control that is effective and shown to be environmentally safe. The programme began with the cloning of the PPV coat protein (CP) gene and the development of a transformation system for plum (Prunus domestica). The CP construct was first tested in Nicotiana benthamiana in which it proved effective in producing transgenic plants with varying levels of CP expression. Some of these plants, particularly low PPV CP expressers, were resistant to PPV, or recovered from initial infection. Based on these results plum was transformed using the Agrobacterium tumefaciens system and both low and high PPV CP-expressing transgenic plum lines were obtained. These were inoculated with PPV by bud grafts in the greenhouse. Line C-5 proved to be highly resistant. It contained multiple copies of the insert, produced low levels of PPV CP mRNA, no detectable CP and the insert appeared to be methylated. These characteristics all suggest that the resistance of the C-5 clone is based on post-transcriptional gene silencing (PTGS). Field tests of C-5 and other transgenic lines in Poland, Romania and Spain have demonstrated that such trees when inoculated by bud-grafts allow a low level of PPV multiplication, from which they rapidly recover. C-5 plants exposed to natural infection for 3 years did not become infected, whereas control trees were infected in the first year. Hybrid plums having the C-5 PPV CP insert inherited from C-5 are virus-resistant, demonstrating the usefulness of C-5 as a parent in developing new PPV-resistant plum varieties. Research is in progress on the biorisks of PPV CP transgenic plants. Gene constructs that either produce no CP or CP that cannot be transmitted by aphids have been developed, tested in N. benthamiana and transferred to plum. Studies have begun on the potential for synergistic interactions between the PPV CP gene and the other common viruses of Prunus spp. In the future we will be participating in investigating the toxicity or/and the allergenicity of transgenic fruit products and, more importantly, transgenic lines will be developed that express transgenes only in vegetative parts of the plant and not in the fruit.

Serum cholesterol and impulsivity in personality disorders

Decreased serum cholesterol has been associated with impulsive aggressive behaviors. This study was designed to explore the relationship between serum cholesterol levels and measures of impulsive aggression in personality disordered patients. Forty-two personality disordered patients (14 borderline personality disorder, 28 other personality disorders) were included. Fasting serum cholesterol was measured by standard enzymatic assay. An ANOVA was performed with factors of gender and diagnosis, looking at two-way interactions between the factors and serum cholesterol. Patients with borderline personality disorder were found to have significantly lower serum cholesterol than non-borderline personality disorders. A significant interaction effect was also seen between gender and diagnosis with the male patients having lower cholesterol levels. This study suggests there may be a relationship between borderline personality disorder and low serum cholesterol.

Relationships between thyroid hormone and antidepressant responses to total sleep deprivation in mood disorder patients

BACKGROUND

Acute transient antidepressant effects of sleep deprivation are consistently observed in 50% of depressed patients, but the mechanisms of these, at times, dramatic improvements in mood have not been adequately elucidated. Some, but not all, studies suggest a relationship to increased thyroid-stimulating hormone (TSH) secretion.

METHODS

TSH and other thyroid indices were measured at 8:00 AM after a baseline night's sleep and at 8:00 AM following a night of total sleep deprivation (S.D.) in 34 medication-free, affective disorder patients assessed with Hamilton, Beck, and Bunney-Hamburg depression ratings as well as two hourly self-ratings on a visual analog scale.

RESULTS

Compared with baseline, S.D. induced highly significant increases in TSH, levothyroxine, free levothyroxine, and triiodothyronine. The 12 S.D. responders tended to have greater TSH increases than the 15 nonresponders (p < .10). The change in Beck depression ratings significantly correlated with the change in TSH (r = -.40, p = .0496, n = 24).

CONCLUSIONS

These data are consistent with several other reports of a significant relationship between degree of antidepressant response to S.D. and increases in TSH measured at 8:00 AM near their usual nadir. Acute removal of the sleep-related break on the hypothalamic-pituitary-thyroid axis remains a promising candidate for the mechanism of sleep deprivation-induced improvement in mood in depressed patients.

Rational polypharmacy in the bipolar affective disorders

Bipolar affective illness represents a syndrome not readily treated by single agents. Approximately 50% of patients are inadequately responsive to lithium and the majority of patients require supplemental antidepressants, antimanic, antipsychotic or hypnotic medications. These traditional adjunctive medications are associated with potential problems. Antidepressants may precipitate mania (at a rate about double that of placebo) or cause cycle acceleration. Neuroleptics may be associated with either more profound or longer depressive phases, and clearly increase the risk of tardive dyskinesia, to which bipolar patients appear particularly predisposed. Moreover, there are subgroups of patients who are known to be poorly responsive to lithium. These include patients with rapid cycling, dysphoric mania, co-morbid drug or alcohol abuse, a pattern of depression-mania-well interval (D-M-I as opposed to the M-D-I pattern), and patients without a family history of bipolar illness in first-degree relatives. There is increasing recognition that the anticonvulsants carbamazepine and valproate are effective alternatives or adjuncts to lithium in the acute and long-term treatment of bipolar illness. Ideally, one would want to assess whether patients who were unresponsive to lithium were responsive to an anticonvulsant alone prior to utilizing lithium in addition to anticonvulsant combination therapy. However, from the clinical perspective, it is often more expedient to use an anticonvulsant adjunctively to lithium to assess the efficacy of this combination and establish mood stabilization. When lithium is not discontinued, the increased morbidity during lithium withdrawal also would not occur and would not confound the evaluation of the new agent. We suggest the initial use of acute adjuncts to lithium with the anticonvulsants carbamazepine or valproate (instead of neuroleptics) so that their efficacy can be assessed in the individual's acute episode, with the likelihood of a positive response in longer-term prophylaxis. Hypnotic benzodiazepines with anticonvulsant properties, such as clonazepam or lorazepam, are often used to help to induce sleep in escalating bipolar patients, and may be useful adjuncts as well. Patients who were inadequately responsive to either carbamazepine or valproate alone may be responsive to the anticonvulsant combination. In a similar fashion, one can also utilize several mood-stabilizing drugs (lithium and an anticonvulsant such as carbamazepine or valproate) in the treatment of depressive breakthroughs, and then augment this combination (if necessary) with a catecholamine-active antidepressant such as bupropion or a serotonin-selective reuptake inhibitor (SSRI) such as fluoxetine, paroxetine, sertraline or if necessary a monoamine oxidase inhibitor (MAOI). Once the patient has responded to a combination of drugs, it becomes problematic to decide whether the last agent added was the crucial ingredient in helping the patient achieve remission or that remission might have occurred with this agent alone. A conservative approach would have merit in patients who are finally stabilized on complex polypharmacy regimens only after many years of sequential trials; in this instance, the potential risk of re-exacerbating the illness with a taper of one of the drugs in the regimen. Rational polypharmacy should thus be implemented with careful delineation of the prior course of illness (typically using life chart methodology) and targeted treatment outcomes titrated against side effects, using sequential clinical trials in individual patients who have not adequately responded to monotherapy. In this fashion, it is hoped that pharmacodynamic differences among agents can be maximized and pharmacokinetic and side effects minimized.

Daily repetitive transcranial magnetic stimulation (rTMS) improves mood in depression

Converging evidence points to hypofunction of the left prefrontal cortex in depression. Repetitive transcranial magnetic stimulation (rTMS) activates neurons near the surface of the brain. We questioned whether daily left prefrontal rTMS might improve mood in depressed subjects and report a pilot study of such treatment in six highly medication-resistant depressed inpatients. Depression scores significantly improved for the group as a whole (Hamilton Depression Scores decreased from 23.8 +/- 4.2 (s.d.) at baseline to 17.5 +/- 8.4 after treatment; t = 3.03, 5DF, p = 0.02, two-tailed paired t-test). Two subjects showed robust mood improvement which occurred progressively over the course of several weeks. In one subject, depression symptoms completely remitted for the first time in 3 years. Daily left prefrontal rTMS appears to be safe, well tolerated and may alleviate depression.

Genetic linkage mapping in peach using morphological, RFLP and RAPD markers

We have constructed a genetic linkage map of peach [Prunus persica (L.) Batsch] consisting of RFLP, RAPD and morphological markers, based on 71 F2 individuals derived from the self-fertilization of four F1 individuals of a cross between 'New Jersey Pillar' and KV 77119. This progeny, designated as the West Virginia (WV) family, segregates for genes controlling canopy shape, fruit flesh color, and flower petal color, size and number. The segregation of 65 markers, comprising 46 RFLP loci, 12 RAPD loci and seven morphological loci, was analyzed. Low-copy genomic and cDNA probes were used in the RFLP analysis. The current genetic map for the WV family contains 47 markers assigned to eight linkage groups covering 332 centi Morgans (cM) of the peach nuclear genome. The average distance between two adjacent markers is 8 cM. Linkage was detected between Pillar (Pi) and double flowers (Dl) RFLP markers linked to Pi and flesh color (γ) loci were also found. Eighteen markers remain unassigned. The individuals analyzed for linkage were not a random sample of all F2 trees, as an excess of pillar trees were chosen for analysis. Because of this, Pi and eight other markers that deviated significantly from the expected Mendelian ratios (e.g., 1∶2∶1 or 3∶1) were not eliminated from the linkage analysis. Genomic clones that detect RFLPs in the WV family also detect significant levels of polymorphism among the 34 peach cultivars examined. Unique fingerprint patterns were created for all the cultivars using only six clones detecting nine RFLP fragments. This suggests that RFLP markers from the WV family have a high probability of being polymorphic in crosses generated with other peach cultivars, making them ideal for anchor loci. This possibility was examined by testing RFLP markers developed with the WV family in three other unrelated peach families. In each of these three peach families respectively 43%, 54% and 36% of RFLP loci detected in the WV family were also polymorphic. This finding supports the possibility that these RFLP markers may serve as anchor loci in many other peach crosses.

Parental age in the blepharophimosis, ptosis, epicanthus inversus, telecanthus complex

Maternal and paternal age and birth order of 14 sporadic cases of the autosomal dominant blepharophimosis-ptosis-epicanthus inversus-telecanthus (BPEI) phenotype were compared to similar statistics from control individuals. Correlation coefficients were determined for paternal age and incidence, maternal age and incidence, and birth order and incidence. The partial correlation coefficient of the father's age and incidence with maternal age and birth order held constant was -0.02 and that for the mother's age and incidence with paternal age and birth order held constant was 0.57. Maternal age seems to have a stronger influence than the paternal age in this group of BPEI patients.

Mohs micrographic surgery for periorbital skin cancer

The authors have illustrated the use of the Mohs technique on periorbital skin cancer. The indications for the technique are documented for eyelid and canthal neoplasia, and the case histories illustrate the potential danger of skin cancer in this area. It is the well balanced team of micrographic surgeons and reconstructive surgeons that will give the patient the best result.

Induction of 33-kD and 60-kD Peroxidases during Ethylene-Induced Senescence of Cucumber Cotyledons

Ethylene enhanced the senescence of cucumber (Cucumis sativus L. cv ;Poinsett 76') cotyledons. The effect of 10 microliters per liter ethylene was inhibited by 1 millimolar silver thiosulfate, an inhibitor of ethylene action. An increase in proteins with molecular weights of 33 to 30 kilodaltons and lower molecular weights (25, 23, 20, 16, 12, and 10 kilodaltons) were observed in sodium dodecyl sulfate-polyacrylamide gel electrophoresis gels after ethylene enhanced senescence. The measurement of DNase and RNase activity in gels indicated that these new proteins were not nucleases. Two proteins from ethylene-treated cotyledons were purified on the basis of their association with a red chromaphore and subsequently were identified as peroxidases. The molecular weights and isoelectric points (pI) of two of these peroxidases were 33 kilodaltons (cationic, pI = 8.9) and 60 kilodaltons (anionic, pI = 4.0). The observation that [(35)S]Na(2)SO(4) was incorporated into these proteins during ethylene-enhanced senescence suggests that these peroxidases represent newly synthesized proteins. Antibodies to the 33-kilodalton peroxidase precipitated two in vitro translation products from RNA isolated from ethylene-treated but not from control cucumber seedlings. This indicates that the increase in 33-kilodalton peroxidase activity represents de novo protein synthesis. Both forms of peroxidase degraded chlorophyll in vitro, which is consistent with the hypothesis that peroxidases have catabolic or scavenging functions in senescent tissues.

Complications following enucleation and implantation of multiple glass spheres in the orbit

The technique of subperiosteal implantation of multiple, small glass beads for correction of enophthalmos associated with anophthalmos was first described in 1967. Reported complications of this procedure include ptosis, anesthesia of the distribution of the supraorbital or infraorbital nerve, and migration of the implants into the orbit or sinuses. A case of orbital cellulitis has been reported. We now report a case in which the extremely serious complication of intracranial migration of glass bead implants, with subsequent cerebrospinal fluid leak, occurred 17 years postimplantation.

The power spectrum analyser as an indicator of cerebral ischaemia during carotid endarterectomy

Stroke is a potential major complication of carotid endarterectomy and may be caused by cerebral ischaemia or embolisation from the operative site. Conventional EEG monitoring has been used intraoperatively to identify periods of cerebral ischaemia, but this monitoring technique can be difficult to operate and interpret in the operating room. This study reports the use of a new signal analyser, the power spectrum analyser (PSA-1, Neurologics, Inc., Nashville, Tennessee), and its impact on active patient management. Thirty-six patients undergoing carotid endarterectomies were monitored with the PSA-1 in conjunction with routine EEG. Eight patients (22%) showed evidence of ischaemia 22 times on both PSA-1 and routine EEG. At no time did the routine EEG show evidence of ischaemia when the PSA-1 did not. The PSA-1 has proven to be a reliable neurophysiologic monitor for the identification of periods of cerebral ischaemia. Use of this small, easily operated and interpreted machine could enhance safety in operating rooms lacking sufficient resources to use conventional EEG machines.

The critical manipulable variables of hemispheric low flow during carotid surgery

A significant EEG change, 40% power attentuation in anesthetic-induced fast activity, was documented with a tracing record, compressed spectral analysis, and PSA-1 in this series of 195 patients. Interpretation of the change was simplified by the use of the compressed spectral analysis or PSA-1. Quantification of the change was aided by use of the PSA-1, and the graphic output form of this instrument minimized user error. Also, it provided the needed information to those members of the operative team not skilled in EEG interpretation. No immediate postoperative deficits were missed by the monitoring technique. There were no postoperative deficits upon awakening in the 138 patients without processed EEG change. Shunt placement, depth of anesthesia, and intraoperative blood pressure levels were accurately guided throughout the operative procedure by these monitoring techniques. Accurate documentation of an acute significant change permits prompt treatment for restoration of necessary collateral flow. The monitoring technique described continuously provides information for efficacy of treatment. Attention to blood pressure level, which seems to passively determine cerebral collateral flow during clamping, was a very important clinically manipulable variable. Manipulation of this variable with processed EEG control may prove efficacious not only in patients undergoing carotid procedures but in nonsurgical cases of acute carotid occlusion or middle cerebral stem occlusion. Manipulation of identifiable critical variables has a positive impact on the clinical outcome when continuous monitoring is employed. The detection of hemispheric low flow in 34 patients during the preclamp, clamp, and postclamp periods suggests that shunting will not prevent all low flow deficits. Finally, perfection of surgical therapy for stroke prevention necessitates detection and treatment of hemispheric low flow.

Mustardé flap lower lid reconstruction after malignancy

The Mustardé rotational cheek flap has been used to reconstruct the lower eyelids of 55 patients since 1964. Results and complications were well-documented with preoperative and postoperative photographs, and the patients have been followed from one to 14 years with a mean age follow-up of seven years. The most frequent complications were downward contraction and sagging of the flap and ectropion of the lid margin. To prevent them, the zygomatico-cheek flap must be carefully designed, rotated, and sutured as high as possible so that immediately postoperatively, the palpebral fissure is only a narrow slit. The flap's lining should be of nasal septal mucosa and cartilage joined with permanent sutures to the medial and lateral canthal tendons.

Blepharospasm

Blepharospasm is a cranial nerve dysfunction in which involuntary and uncontrollable forcible lid closure occurs. Surgical treatment is far from ideal, but the condition can be improved by sectioning the branches of the facial nerve plexus which supply the orbicularis oculi, the frontalis and corrugator muscles, and the midfacial muscles. Not all patients with blepharospasm should be operated upon, since they may expect too much or may enjoy the attention their invalidism has given them. Ectropion of one or both lower lids may occur, and the most severe of all complications is recurrence. This may happen despite a careful microscopic search for the nerve fibers and their division and avulsion. Blepharospasm patients often require considerable psychological support.

Correction of facial contour deformities resulting from loss of soft tissue or bone

Two methods of recovering normal contour of the orbit are presented in which ocularists and ophthalmologists equally participate. One method is for correction of the deep supratarsal retraction following soft tissue atrophy; the other technique is indicated when there has been loss of or major displacement of bone of the orbital rim. Frequently, these two techniques must be used concomitantly in complex reconstructive cases.

Correction of entropion from Stevens-Johnson syndrome: use of nasal septum and mucosa for severely cicatrized eyelid entropion

The resistant entropion, especially of the upper lid, that results from the persistent contraction of the conjunctiva after Stevens-Johnson syndrome is difficult to correct. Grafts of buccal mucosa have relieved this condition for only a few weeks or months. Because of the rigidity of the nasal septum, a sector of this structure, with the perichondrium and mucosa intact on one side, has been grafted into the posterior layer of the upper lid at the margin to turn the lashes and skin away from the globe. For more than two years postoperatively, this graft of septal mucosa has relieved patients of their entropion, and from all indications this correction will be permanent.

A profile of patients with intractable blepharospasm

Of those patients seeking surgical correction for intractable blepharopasm, the spasm was more commonly bilateral than unilateral by a ratio of about 7:1 and the bilateral form was more common in women than men by a ratio of about 3:1. The unilateral disease had an equal sex incidence. The disease seemed to be the same in men and women. The median age of onset was 59 years old, and the median interval between onset of symptoms and surgery was three years. Most of these patients had seen many physicians, and all prior medical and surgical treatments had been unsuccessful.

Reconstruction of the eyelids with cartilage and mucosa from the nasal septum

Four examples are shown of lid reconstruction using grafts from the septum mucosa and pedicle flaps. These examples provide adequate data for the use of this technique in almost any major lid reconstruction procedure. The fifth case illustrates the exception; a wide pedicle is rotated in from the temporal region to construct the lower lid and the lower lid is transferred to act as the upper lid. The posterior surface of the buccal mucosa is adequate for this last procedure.

Massive orbital invasion by small malignant lesions

In diagnosing and treating small malignant lesions of the eyelids, physicians should be alert for possible extension of the cancer into the orbit, endangering not only the patient's sight but his life as well. Important signs and symptoms include bone thickening, disturbances of ocular motility, intermittent epiphora, and positive results of radiologic studies. From histopathologic study of the resected carcinomatous tissues, it is apparent that the creeping, cicatrizing, ulcerated, and invasive patterns of basal cell carcinoma predominate in this group of eyelid tumors, all of which are aggressive lesions; however, the histologic type is quite variable and no definite trends can be established.