Congenital heart disease
Authors: Antonetti I, Lorch D, Coe B, Maxey TS, Nallamshetty L, Dadlani GH, Berlowitz MS, Cohen AJ, Guglin ME,
Tetralogy of Fallot is characterized by a ventricular septal defect, a large, overriding aorta, subpulmonic stenosis, and right ventricular hypertrophy. These lesions can be associated with abnormal development of the pulmonary vasculature. This can include peripheral pulmonic stenosis, discontinuous pulmonary arteries, anomalous pulmonary venous return, and the development of aortopulmonary collateral vessels. Aortopulmonary collateral vessels develop to supply underperfused areas of the pulmonary bed and pose a unique and challenging problem at the time of surgical repair, which involves closure of the ventricular septal defect, relief of right ventricular outflow tract obstruction, maintenance of pulmonary valve competency when possible, and establishment of laminar pulmonary blood flow to all segments of the pulmonary bed. We describe a 36-year-old man with unrepaired tetralogy of Fallot with distinctive aortopulmonary collaterals, who underwent complete surgical repair with good outcome. Two-dimensional echocardiogram, cardiac magnetic resonance imaging, and cardiac catheterization each provided vital details allowing a stepwise approach to defining his unique anatomy for surgical correction.
PMID: 22176554 [PubMed - as supplied by publisher]
Survey of ophthalmology
Authors: Freedman JR, Markert MS, Cohen AJ,
Canaliculitis is an uncommon inflammation of the proximal lacrimal drainage system that is frequently misdiagnosed. It classically presents with symptoms of unilateral conjunctivitis, mucopurulent discharge, medial canthal inflammation, epiphora, and a red, pouting punctum. We summarize the literature on canaliculitis published from antiquity to the modern era and explore therapeutic options.
PMID: 21620429 [PubMed - as supplied by publisher]
Ophthalmic plastic and reconstructive surgery
Authors: Cohen AJ,
To describe anterior lamellar lower eyelid reconstruction with a laterally based bilobed flap.
A retrospective study of 11 patients who underwent lower eyelid anterior lamellar reconstruction with or without posterior lamellar grafting following tumor excision within a 2-year timeframe were reviewed.
Seven women and 4 men (age range, 46.8-95.3 years; mean age, 74.1 years) were included in the study. Nine patients had basal cell carcinoma, and 2 patients had squamous cell carcinoma. The mean defect size was 5.2 cm. Four patients who underwent concomitant posterior lamellae reconstruction were included. Follow-up averaged 10.2 months. No infections, flap failure, or lagophthalmos were found postoperatively. One patient developed medial ectropion.
A laterally based bilobed flap should be thought of as an effective choice for lower eyelid anterior lamellar reconstruction.
PMID: 20305503 [PubMed - as supplied by publisher]
The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry 2009 Feb
Authors: Weinberg DA, Tham V, Hardin N, Antley C, Cohen AJ, Hunt K, Glasgow BJ, Baylis HI, Shorr N, Goldberg RA,
To histologically evaluate the outcome of mucous membrane grafts to the eyelid.
Case series of 31 eyes from 24 patients who underwent transplantation of hard palate (25 eyes), buccal (1 eye), or nasal turbinate (5 eyes) mucosa to the posterior eyelid surface. These grafts were biopsied at 0.5 months to 84 months (mean, 20 months) postoperatively. They were examined with light microscopy and compared with either the donor mucosa from the same patient (2 patients) or the typical donor site histology (22 patients).
Graft biopsies revealed general epithelial morphology that was quite similar to the respective donor sites in virtually all cases. Six (25%) of 24 hard palate graft biopsies, which were obtained at 8 months to 49 months (mean, 22 months) postoperatively, displayed orthokeratosis alternating with parakeratosis, while 12 (50%) demonstrated parakeratosis alone, and another 6 (25%) showed adjacent regions of parakeratotic and nonkeratinized epithelium. No hard palate grafts showed complete absence of keratinization after transplantation. Other significant findings included loss of goblet cells in nasal turbinate grafts and few submucosal glands remaining in any specimen.
Full-thickness mucosal grafts typically maintain their native epithelial morphology following transplantation to the ocular surface. Submucosal glands usually do not survive transplantation, which could be the result of intentional thinning of the graft at the time of transplantation. Contrary to the opinion that hard palate graft epithelium usually undergoes metaplasia from keratinized to nonkeratinized within 6 months following transplantation to the eye, all hard palate grafts in this study remained orthokeratotic and/or parakeratotic.
PMID: 19155750 [PubMed - as supplied by publisher]
Ophthalmology clinics of North America 2006 Jun
Authors: Cohen AJ,
Familiarity with facial anatomy, anesthetic agents, and techniques allows the surgeon to maximize his or her surgical success. Reduction of perioperative complications such as an uncooperative or agitated patient may be reduced with proper anesthesia techniques. This ultimately leads to higher success rates and increased patient and physician satisfaction.
PMID: 16701163 [PubMed - as supplied by publisher]
The Journal of craniofacial surgery 2005 Jan
Authors: Kelly CP, Cohen AJ, Yavuzer R, Jackson IT,
A variety of etiologies may result in functional and aesthetic deficiencies requiring orbital reconstruction. These are discussed, as are some of the possible repair techniques. In the current study, a randomized, retrospective chart review of one surgeon's experience with orbital reconstruction using cranial bone grafts was performed. The results of the chart reviews are presented, including preoperative diagnosis, clinical signs and symptoms, and postoperative findings. This study allowed a comparison and contrast to be made between exogenous materials and autogenous bone for orbital reconstruction. The differences between cranial and iliac bone as autogenous sources of reconstructive material were examined. The study indicates that cranial bone grafting for reconstruction of the orbit remains the material of choice.
PMID: 15699673 [PubMed - as supplied by publisher]
Ophthalmic plastic and reconstructive surgery 2004 Sep
Authors: Kelly CP, Cohen AJ, Yavuzer R, Moreira-Gonzalez A, Jackson IT,
The medial canthus comprises three limbs and functions to maintain the shape of the eye and to assist in drainage of the lacrimal sac. Repair of the medial canthal tendon is often complicated by canthal drift, extrusion of wires or sutures, and in-fracture of the contralateral orbital bones from pressure by transnasal wires. A technique used successfully for more than 25 years with a low rate of complications is described in a stepwise manner. The long-term outcomes of using this technique are reviewed. Thirty-three patient charts were reviewed. The mean age of patients was 22.4 years (range, 3 to 59 years). The surgical indications were trauma, neoplasm, and congenital deformity. Only 2 cases of canthal drift were noted after this procedure and were corrected with the same technique without recurrence. Traditional methods of medial canthopexy frequently result in complications; the technique described eliminates most if not all of these.
PMID: 15377919 [PubMed - as supplied by publisher]
Ophthalmic surgery and lasers
Authors: Cohen AJ, Weinberg DA,
We describe a patient with blepharoptosis, poor levator function, and a positive phenylephrine test who responded favorably to Müller's muscle-conjunctival resection, alleviating the need for a frontalis suspension ptosis repair in the presence of very deep superior sulci.
PMID: 12449225 [PubMed - as supplied by publisher]