Pre- and Postoperative Quantitative Analysis of Contour Abnormalities in Graves Upper Eyelid Retraction

Purpose: One of the most common problems of the surgical management of Graves upper eyelid retraction is the occurrence of eyelid contour abnormalities. In the present study, the postoperative contour of a large sample of eyelids of patients with Graves orbitopathy was measured. Methods: The postoperative upper eyelid contour of 62 eyes of 43 patients with Graves orbitopathy was subjectively classified by 3 experienced surgeons in 3 categories: poor, fair, and good. The shape of the eyelid contours in each category was then measured with a recently developed custom-made software by measuring multiple midpupil eyelid distances each 15 degrees along the palpebral fissure. The upper eyelid contour of 60 normal subjects was also quantified as a control group. Results: The mean ratio between the sum of the lateral and medial midpupil eyelid distances (lateral/medial ratio) was 1.10 +/- 0.11 standard deviation in controls and 1.15 +/- 0.13 standard deviation in patients. Postoperatively, the mean midpupil eyelid distance at 90 degrees was 4.16 +/- 1.13 mm standard deviation. The distribution lateral/medial ratios of the eyelids judged as having good contours was similar to the distribution of the controls with a modal value centered on the interval between 1.0 and 1.10. The distribution of lateral/medial ratios of the eyelids judged as having poor contour was bimodal, with eyelids with low and high lateral/medial ratios. Low lateral/medial ratios occurred when there was a lateral overcorrection, giving the eyelid a flat or a medial ptosis appearance. High lateral/medial ratios were due to a central or medial overcorrection or a lateral peak maintenance. Conclusions: Postoperative upper eyelid contour abnormalities can be quantified by comparing the sum of multiple midpupil eyelid distances of the lateral and medial sectors of the eyelid. Low and high lateral/medial ratios are anomalous and judged as unpleasant. (Ophthal Plast Reconstr Surg 2012;28:429-433)

Correction of Severe Ptosis with a Silicone Implant Suspensor: 22 Years of Experience

Background: Patients with severe ptosis caused by poor or absent function of the levator muscle but with good frontalis muscle excursion usually benefit from a frontalis sling procedure. This is currently carried out using organic or inorganic material to connect the upper eyelid to the frontalis muscle. Methods: The aim of this study was to evaluate retrospectively 112 patients who underwent frontalis sling procedures between 1989 and 2011 using a preformed silicone implant suspensor to correct severe ptosis. Results: The results obtained using this technique were good or fair in 95.54 percent of the cases and poor in 4.46 percent of the cases. The authors discuss the results of the study and the cases in which the procedure should be indicated and highlight the advantages of the method. Conclusion: The availability of this low-cost sterile device, together with the fact that it is ready to use, requires less invasive surgery, saves time, and is sufficiently versatile to allow adjustments to be made at any time, makes the silicone eyelid sling an attractive choice for correcting ptosis. (Plast. Reconstr. Surg. 129: 453e, 2012.)

Multiple Radial Midpupil Lid Distances: A Simple Method for Lid Contour Analysis

Purpose: To describe a new computerized method for the analysis of lid contour based on the measurement of multiple radial midpupil lid distances. Design: Evaluation of diagnostic technology. Participants and Controls: Monocular palpebral fissure images of 35 patients with Graves' upper eyelid retraction and of 30 normal subjects. Methods: Custom software was used to measure the conventional midpupil upper lid distance (MPLD) and 12 oblique MPLDs on each 15 degrees across the temporal (105 degrees, 120 degrees, 135 degrees, 150 degrees, 165 degrees, and 180 degrees) and nasal (75 degrees, 60 degrees, 45 degrees, 30 degrees, 15 degrees, and 0 degrees) sectors of the lid fissure. Main Outcome Measures: Mean, standard deviation, 5th and 95th percentiles of the oblique MPLDs obtained for patients and controls. Temporal/nasal MPLD ratios of the same angles with respect to the midline. Results: The MPLDs increased from the vertical midline in both nasal and temporal sectors of the fissure. In the control group the differences between the mean central MPLD (90 degrees) and those up to 30 degrees in the nasal (75 degrees and 60 degrees) and temporal sectors (105 degrees and 120 degrees) were not significant. For greater eccentricities, all temporal and nasal mean MPLDs increased significantly. When the MPLDs of the same angles were compared between groups, the mean values of the Graves' patients differed from control at all angles (F = 4192; P<0.0001). The greatest temporal/nasal asymmetry occurred 60 degrees from the vertical midline. Conclusions: The measurement of radial MPLD is a simple and effective way to characterize lid contour abnormalities. In patients with Graves' upper eyelid retraction, the method demonstrated that the maximum amplitude of the lateral lid flare sign occurred at 60 degrees from the vertical midline. Financial Disclosure(s): The authors have no proprietary or commercial interest in any of the materials discussed in this article. Ophthalmology 2012; 119: 625-628 (C) 2012 by the American Academy of Ophthalmology.

Surgical treatment of globe subluxation in the active phase of the myogenic type of Graves orbitopathy: case reports

The purpose of the present article is to present and discuss two cases of globe subluxation in the active phase of myogenic Graves' orbitopathy and to evaluate the prevalence of this phenomenon. Two patients with the myogenic variant of Graves' orbitopathy that had being treated with oral and intravenous steroid pulses developed globe subluxation. Both had to have urgent eyelid and orbital decompression. After these observations, we reviewed the medical records of a sample of 284 patients (482 orbits) who had had orbital decompression at our Institution from 1992 to 2010, with a search for cases presenting severe proptosis or globe subluxation in the active phase of myogenic Graves' orbitopathy. No patient had to have decompression for globe subluxation in the active phase of Graves' orbitopathy. The prevalence of this event as an indication for surgery in the myogenic variant of Graves' orbitopathy was therefore 0.7% (2/284) or even less. The combination of lowering the upper eyelid and orbital decompression had a dramatic therapeutic effect on these patients despite the presence of intense inflammatory signs in the orbits. In conclusion, patients affected with the myogenic variant of Graves' orbitopathy may develop globe subluxation. Urgent surgical treatments should not be postponed despite the presence of active inflammation.

PALEOPRODUCTIVITY CHANGES DURING THE LATE QUATERNARY IN THE SOUTHEASTERN BRAZILIAN UPPER CONTINENTAL MARGIN OF THE SOUTHWESTERN ATLANTIC

Changes in the Brazilian continental margin`s oceanic productivity and circulation over the last 27,000 years were reconstructed based on sedimentological and microfaunal analyses. Our results suggest that oceanic paleoproductivity and the supply of terrigenous sediments to the Brazilian continental margin were higher during the Last Glacial Maximum (LGM) than during the Holocene. These changes may have been primarily influenced by significant sea level fluctuations that have occurred since the late Pleistocene. During the LGM, the lower sea level, higher productivity and lower sea-surface paleotemperatures may have been the result of the offshore displacement of the main flow of the Brazil Current. However, during the Holocene, the warm waters of the Brazil Current were displaced toward the coast. This displacement contributed to the increase in water temperature and prevented an increase in oceanic productivity. The decrease in terrigenous supply since the LGM could be related to the increase of the extension of the continental shelf and/or drier climatic conditions.

Deep chlorophyll maximum and upper ocean structure interactions: Case of the Guinea Thermal Dome

Deep Chlorophyll Maximum (DCM) modifies the upper ocean heat capture distribution and thus impacts water column temperature and stratification, as well as biogeochemical processes. This energetical role of the DCM is assessed using a 1 m-resolution 1D physical-biogeochemical model of the upper ocean, using climatological forcing conditions of the Guinea Dome (GD). This zone has been chosen among others because a strong and shallow DCM is present all year round. The results show that the DCM warms the seasonal thermocline by +2 degrees C in September/October and causes an increase of heat transfer from below into the mixed layer (ML) by vertical diffusion and entrainment, leading to a ML warming of about 0.3 degrees C in October. In the permanent thermocline, temperature decreases by up to 2 degrees C. The result is a stratification increase of the water column by 0.3 degrees C m(-1) which improves the thermocline realism when compared with observations. At the same time, the heating associated with the DCM is responsible for an increase of nitrate (+300%, 0.024 mu M), chlorophyll (+50%, 0.02 mu g l(-1)) and primary production (+45%: 10 mg C m(-2) day(-1)) in the ML during the entrainment period of October. The considered concentrations are small but this mechanism could be potentially important to give a better explanation of why there is a significant amount of nitrate in the ML. The mechanisms associated with the DCM presence, no matter which temperature or biogeochemical tracers are concerned, are likely to occur in a wide range of tropical or subpolar regions; in these zones a pronounced DCM is present at least episodically at shallow or moderate depths. These results can be generalized to other thermal dome regions where relatively similar physical and biogeochemical structures are encountered. After testing different vertical resolutions (10 m, 5 m, 2.5 m, 1 m and 0.5 m), we show that using at least a 1 to vertical resolution model is mandatory to assess the energetical importance of the DCM.

Benthic foraminiferal distribution on the southeastern Brazilian shelf and upper slope

Foraminiferal data were obtained from 66 samples of box cores on the southeastern Brazilian upper margin (between 23.8A degrees-25.9A degrees S and 42.8A degrees-46.13A degrees W) to evaluate the benthic foraminiferal fauna distribution and its relation to some selected abiotic parameters. We focused on areas with different primary production regimes on the southern Brazilian margin, which is generally considered as an oligotrophic region. The total density (D), richness (R), mean diversity (H) over bar`, average living depth (ALD(X) ) and percentages of specimens of different microhabitats (epifauna, shallow infauna, intermediate infauna and deep infauna) were analyzed. The dominant species identified were Uvigerina spp., Globocassidulina subglobosa, Bulimina marginata, Adercotryma wrighti, Islandiella norcrossi, Rhizammina spp. and Brizalina sp.. We also established a set of mathematical functions for analyzing the vertical foraminiferal distribution patterns, providing a quantitative tool that allows correlating the microfaunal density distributions with abiotic factors. In general, the cores that fit with pure exponential decaying functions were related to the oligotrophic conditions prevalent on the Brazilian margin and to the flow of the Brazilian Current (BC). Different foraminiferal responses were identified in cores located in higher productivity zones, such as the northern and the southern region of the study area, where high percentages of infauna were encountered in these cores, and the functions used to fit these profiles differ appreciably from a pure exponential function, as a response of the significant living fauna in deeper layers of the sediment. One of the main factors supporting the different foraminiferal assemblage responses may be related to the differences in primary productivity of the water column and, consequently, in the estimated carbon flux to the sea floor. Nevertheless, also bottom water velocities, substrate type and water depth need to be considered.

The anatomy of the upper cretaceous snake Najash rionegrina Apesteguia & Zaher, 2006, and the evolution of limblessness in snakes

Najash rionegrina Apesteguia & Zaher, 2006, a terrestrial fossil snake from the Upper Cretaceous of Argentina, represents the first known snake with a sacrum associated with robust, well-developed hind limbs. Najash rionegrina documents an important gap in the evolutionary development towards limblessness, because its phylogenetic affinities suggest that it is the sister group of all modern snakes, including the limbed Tethyan snakes Pachyrhachis, Haasiophis, and Eupodophis. The latter three limbed marine fossil snakes are shown to be more derived morphologically, because they lack a sacrum, but have articulated lymphapophyses, and their appendicular skeleton is enclosed by the rib cage, as in modern snakes.

A new species of Hemigrammus from the upper Rio Tapajos basin in Brazil (Teleostei : Characiformes : Characidae)

Hemigrommus silimoni is described from the Rio Juruena, upper Rio Tapajos basin, Mato Grosso State, Brazil. The new species is distinguished from all congeners, and in fact from the remaining Characidae, by the autapomorphic presence of an ocellus-like blotch on the caudal-fin dorsal lobe. The high level of fish endemicity In the Rio Juruena (upper Rio Tapajos basin) is discussed.

A new distinctively banded species of Pseudolithoxus (Siluriformes: Loricariidae) from the upper Orinoco River

Pseudolithoxus kelsorum is described as a new species based on type material from the upper Orinoco in Amazonas State, Venezuela. Pseudolithoxus kelsorum is diagnosed from all other Pseudolithoxus by having dark brown to black base color with eight to 11 (usually nine) light yellow vertical or oblique transversal bands between orbits and caudal fin, bands wide and rarely but sometimes incomplete or contorted as swirls (vs. dark brown to black base color with 18 or more thin, light yellow, frequently contorted transversal bands between orbits and caudal fin in P. tigris; black base color with small white spots in P. anthrax and P. nicoi; and light brown base color with dark brown to black spots in P. dumus). Distributions of P. kelsorum and other Ancistrini taxa support the presence of a zoogeographic filter limiting fish distributions across a reach of the Orinoco River between the Ventuari-Orinoco confluence and the Maipures rapids.

An additional basal sauropodomorph specimen from the Upper Triassic Caturrita Formation, southern Brazil, with comments on the biogeography of plateosaurids

We describe an additional saurischian specimen from the Caturrita Formation (Norian) of the Parana Basin, southern Brazil. This material was collected in the 1950s and remained unstudied due to its fragmentary condition. Detailed comparisons with other saurischians worldwide reveal that some characters of the ilium, including the low ventral projection of the medial wall of the acetabulum and its concave ventral margin, together with the short triangular shape of the pre-acetabular process and its mound-like dorsocaudal edge, resemble those of sauropodomorphs such as Plateosaurus and Riojasaurus. This set of traits suggests that MN 1326-V has affinities with basal Sauropodomorpha, probably closer to plateosaurians than to Saturnalia-like taxa. Previous records of this clade in the Caturrita Formation include Unaysaurus, which has been related to Plateosaurus within Plateosauridae. Alternative schemes suggest that plateosaurids include Plateosaurus plus the Argentinean 'prosauropods' Coloradisaurus and Riojasaurus. Both hypotheses raise biogeographic questions, as a close relationship between faunas from South America and Europe excluding Africa and North America is not supported by geological and biostratigraphical evidence. Additionally, the absence of plateosaurids in other continents suggests that the geographical distribution of this taxon is inconsistent with the geological history of western Pangaea, and this demands further investigations of the phylogeny of sauropodomorphs or improved sampling.

Error Upper Bounds for a Computational Method for Nonlinear Boundary and Initial-Value Problems

This work develops a computational approach for boundary and initial-value problems by using operational matrices, in order to run an evolutive process in a Hilbert space. Besides, upper bounds for errors in the solutions and in their derivatives can be estimated providing accuracy measures.

A heat transfer model of the human upper limbs

A steady state multi-segmented heat transfer model of the human upper limbs was developed. The main purpose was to evaluate the impact of blood flow through superficial veins and subcutaneous vascular structures in the palm of the hands over the heat transfer between the limbs and the environment. The distinguishing feature of the model is the inclusion of a detailed circulatory network composed of vessels with diameter larger than 1 mm. The model was validated by comparing its results from exposures to a hot, a neutral, and a cold environment to experimental data presented in the literature. (C) 2011 Elsevier Ltd. All rights reserved.