Biomedical subjects
Publications and source records attributed to A W Lawton.
Giant cell arteritis (GCA) is an autoimmune condition with a predilection for the arteries of the head and neck. Because GCA may lead to permanent blindness, stroke, or death, it is critically important for all health care personnel, in particular ophthalmic nurses, to know about the presentation, diagnostic methods, and treatment modalities related to this disease. Prompt intervention may save a life.
A 31-year-old woman developed acute visual loss in her right eye immediately after a 5-day course of CC for primary infertility. Although she gradually recovered vision, she did not return to 20/20 acuity in that eye. As CC may cause vascular sludging, it is hypothesized that increased blood viscosity resulted in sufficiently reduced flow in a posterior ciliary artery to produce an anterior ischemic optic neuropathy. Patients experiencing visual symptoms while taking clomiphene should have their eyes examined promptly for evidence of visual changes or optic nerve injury.
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A 44-year-old immunosuppressed man developed initial symptoms of intermittent irritation of the left eye three months after cardiac transplantation. Symptoms increased, with decreased vision, photophobia, and lacrimation. Slit lamp examination showed slightly raised, swollen, grayish epithelium in a broad multibranching dendritic pattern associated with fine and medium punctate epithelial erosions that stained slightly with fluorescein. Histopathologic study of the corneal epithelial scraping demonstrated swollen epithelial cells with intranuclear and intracytoplasmic viral inclusions. Viral cultures manifested a cytopathic pattern characteristic of cytomegalovirus 14 days after inoculation on human embryonic lung cells (MRC-5). Pretransplantation cytomegalovirus IgM and IgG serologic titers were negative (less than 1:16 for IgG, no IgM noted) until the onset of symptoms. Subsequently, IgM titers rose against cytomegalovirus consistent with concurrent infection.
A 55-year-old woman presented with a mass of the optic nerve sheath suggestive of a meningioma. On excision, this proved to be amyloid. No systemic involvement could be found. Although amyloid may arise as a solitary lesion of the orbit or extraocular muscle, this "pseudomeningiomatous" pattern has not been previously noted. A magnetic resonance scan was helpful because the amyloid imaged at a density similar to vitreous and cerebral white matter, unlike meningiomas, which appear more like bone. The diagnosis of localized amyloidosis, however, still remains dependent on histopathology and cannot be made on a clinical basis.
We have described a patient with a biopsy-proven mucoepidermoid carcinoma of the orbit. Although it may have represented a metastasis from a malignancy of the upper respiratory tract, clinically it appeared to be a primary neoplasm of the lacrimal gland. This case emphasizes the value of transmission electron microscopy in diagnosing poorly differentiated orbital tumors.
The authors describe their experience with the use of impression cytology (IC) as a diagnostic aid in the evaluation of external eye disorders. IC is shown to be useful for diagnosis of epithelial cell storage disorders, infectious diseases, and allergic disorders.
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We examined two patients with orbital schwannomas (neurilemomas). The echographic findings, including a sharply outlined capsule, a well-defined central cystic space within the tumor with very low internal reflectivity surrounded by smaller cysts with variable reflectivity, slight or no compressibility, and blood flow, should help to differentiate these benign tumors from other orbital lesions. Histologic examination showed a combination of Antoni type A (dense and cellular) and Antoni type B (loose, edematous, or necrotic) patterns.
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Benign osteoblastoma is a rare lesion of the orbit--only five cases have been described previously. The usual location is in the vertebral column and to a lesser extent in the skull. Although it is an invasive lesion, recurrences have not been reported after en bloc excision. The authors report a 10-year-old boy who presented with upper lid swelling, proptosis, and hypophthalmia. A computed tomography (CT) scan showed a calcified mass in the superior orbit which had eroded through the roof, and magnetic resonance imaging (MRI) showed a well-circumscribed mass between the periorbita and dura. A transcranial approach was used to remove the tumor, and the roof reformed with polypropolene. He has been followed for 18 months without recurrence.
Two patients developed graft versus host disease (GvHD) following allogeneic bone marrow transplantation for leukemia. One patient developed acute GvHD 12 days after transplantation, and the second developed chronic GvHD 100 days after transplantation. Tear analysis and conjunctival impression cytology were performed. The results were compared to a normal control and to another patient who was 18 months status post bone marrow transplantation with successfully treated GvHD. Tear sampling on the patient with chronic GvHD revealed greatly elevated IgG levels with an inverse IgG to IgA ratio, as compared with normals. In addition, two of three leukemia patients demonstrated decreased mucin levels in tears. Conjunctival impression cytology from the patient with chronic GvHD revealed an abundance of plasma cells.
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We describe a 58-year-old woman who presented with proptosis, upward displacement, and decreased vision in her right eye. A computed tomography scan revealed a mass filling the right maxillary sinus, destroying bone and invading the inferolateral orbit. The tumor proved to be an inverted squamous papilloma with focal transformation to squamous cell carcinoma. Although a rare cause of proptosis, inverted papilloma with orbital invasion must be considered when a patient describes associated nasal or sinus disease.
Historically, the healing arts have been devoted to curing those already sick. Only in recent decades has disease prevention by vaccination, quarantine, regulation of food, water and drugs, proper garbage and water disposal and health education become procedures utilized by the medical and allied health practitioners. Today, maintenance of wellness is the novel but desirable role to be undertaken by health professionals. To do this, doctors and allied health personnel must become conversant with information from many scientific and social disciplines, must become skillful communicators and teachers, and must be personal examples of wellness. This role - especially of education and communication - must be carried out not only with clients but also with the family and contacts of patients.
A 2-year-old boy presented with a 3-month history of nontender masses involving the right superotemporal orbit and scalp. Over the three-week period before presentation he also developed nodules on his wrist, abdomen, and buttocks. The remainder of the ocular and general physical exam was unremarkable. A biopsy of the right orbital mass demonstrated stellate areas of collagen necrosis surrounded by pallisading epithelioid histiocytes and scattered multinucleated giant cells. Special stains for connective tissue mucin were positive in the areas of necrosis. The diagnosis reached pathologically and clinically were that of pseudorheumatoid nodules and granuloma annulare syndrome respectively. These two diagnostic terms have been used independently in the ophthalmologic and dermatologic literature, despite the identical histologic and clinical behaviors seen by both medical groups. A unified nomenclature system of pseudorheumatoid nodule for the histopathology of an individual lesion and granuloma annulare for the syndrome is suggested.
Sickle cell anemia and trait are highly prevalent within the African-American and other minority populations in the United States. As treatment modalities improve, these individuals will live longer, increasing the incidence of sickle-related eye disease. As blinding or life-threatening damage may occur to the retina, optic nerve and central nervous system, any nurse involved in the management of sickle cell must be aware of this critical public health issue. Appropriate screening and patient management are vital to the continued quality of life of these patients.