Biomedical subjects
Publications and source records attributed to D M Albert.
Carcinoma of the sebaceous glands of the eyelid is a malignant lesion bearing a close resemblance to other less aggressive lid lesions. A long period of time often elapses between initial presentation and correct diagnosis and treatment. Three cases are presented to illustrate common presentations of sebaceous gland carcinoma.
Mucoepidermoid carcinoma is a tumor arising in the ductal epithelial cells of the salivary and lacrimal glands, containing both mucin-producing cells and epidermoid cells with various degrees of squamous differentiation. While mucoepidermoid carcinoma has been reported frequently in the salivary glands, 1,2 it has been infrequently reported in the lacrimal gland, 3-5 with a total of just nine cases found, to our knowledge; we are reporting two additional cases.
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Retinal hemorrhages may occur at high altitudes. They occur more commonly in association with acute mountain sickness and particularly with high-altitude cerebral edema. We describe a 27-year-old man who experienced retinal hemorrhages as well as papilledema and coma at 5,330-m altitude and who died four days later, one day after evacuation to 1,300-m altitude. At autopsy, we found papilledema and hemorrhages in the nerve fiber layer. These were sometimes distant from areas where there were arterioles and venules. There was perivascular red cell infiltration. Deeper layers of the retina were intact. We conclude that the hemorrhages were form both retinal capillaries and veins and we speculate that hypoxia, with or without the Valsalva effect, was the cause of the endothelial damage.
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The therapeutic efficacy of three new antiviral agents-5-iodo-3',5'-diacetyl-2'-deoxyuridine (diacetylidoxuridine, 1% Ac2IDU), E-5-(2-bromovinyl)-2'-deoxyuridine (0.25% BVDU), and 3% thymine arabinoside-is compared with available antivirals in an experimental model of herpes simplex virus type 1 (HSV-1) keratitis in New Zealand white rabbits. Compared with placebo, Ac2IDU significantly reduced ulcerative keratitis on days 4 through 8 after inoculation with virus and iritis on day 8 after inoculation. Compared with placebo, thymine arabinoside reduced ulcerative keratitis but not significantly. Thymine arabinoside caused significant iritis in all eyes. The epithelial disease in BVDU-treated eyes was significantly less than that in placebo-treated eyes on days 5 through 8 after inoculation. The results indicate that 1% Ac2IDU and 0.25% BVDU were effective in our ocular model of HSV-1 keratitis, whereas thymine arabinoside was not.
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Tumors of sweat gland origin are not uncommon in the periocular region. These tumors frequently pose diagnostic difficulty due to the wide range of histopathological patterns, and to the fact that they may be infiltrative or have metastatic potential despite their relatively benign appearance. This report discusses the classification and diagnosis of five sweat gland tumors with variable histological appearance, including syringoma, mixed tumors, adenoma of ductal origin, and mucinous adenocarcinoma of sweat gland origin.
We studied two children who died of suspected familial erythrophagic lymphohistiocytosis. The first child, a 7-year-old boy, had fever, diffuse pulmonary infiltrates, bilateral choroidal effusions, diabetes insipidus, and marked meningitis with increased cerebrospinal fluid protein. Ocular histologic studies disclosed diffuse choroidal infiltrates consisting of atypical mononuclear cells with foamy cytoplasm. Similar histologic changes were seen in the lungs, liver, brain, and kidneys. The second child, the 5-year-old male cousin of Patient 1, had fever, hepatosplenomegaly, pulmonary infiltrates, and cerebrospinal fluid pleocytosis. Histologic changes were similar to those in the first case, but viral particles of the herpes simplex virus group were noted in brain tissue as well. The findings of virus particles in this histiocytic proliferative disease suggested a defect in the inflammatory response in these patients.
von Hippel-Lindau disease is a phakomatosis that is characterized by multiple angiomatous hamartomas located in the retina, central nervous system (CNS),and visceral organs. Retinal angiomas causing blindness and CNS angiomas causing death are familiar consequences of this disease. In certain cases, early detection and treatment of these lesions may prevent their disastrous effects. Since this disease is considered to have an autosomal dominant inheritance pattern, the physician should initiate a systematic examination of all the patient's family members.
A 4-year-old white female presented with leukocoria of the right eye. White punctate lesions were observed posterior to the retrolental membrane, which suggested retinoblastoma of some examiners. A full history, physical examination, ultrasonography, and CT scan failed to rule the diagnosis of retinoblastoma in or out. A serum ELISA titer was 1:4, which was considered nondiagnostic. Examination of the enucleated eye revealed a midsegment of the second stage larva of Toxocara canis. The strengths and weaknesses of various diagnostic modalities used to differentiate leukocoria caused by retinoblastoma and T canis are discussed.
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A 59-year-old Caucasian male presented with a darkly pigmented inner canthal tumor with a six-month history of rapid growth. Histopathologic examination demonstrated to be a pigmented basal cell epithelioma. While basal cell epitheliomas of the eyelids are common ophthalmic disorders, pigmented lesions are unusual. Pigmented basal cell epitheliomas pose a difficulty in clinical diagnosis because of their resemblance to melanomas and pigmented nevi. The differential diagnosis and treatment of this lesion is reviewed.
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A healthy 48-year-old man developed Aspergillus keratitis following mild corneal trauma. Intensive medical therapy, initially empirical, then guided by in vitro sensitivity testing, as well as attempts at surgical excision of the infection, were ultimately unsuccessful. The poor therapeutic response may have been due to fungal penetration of the deep corneal stromal before treatment was initiated. The clinical and histologic features of A keratitis are described and related to fungal keratitis in general. The strengths and limitations of laboratory diagnostic aids are discussed. Fungal keratitis may follow a disarmingly mild early clinical course, but requires prompt, aggressive therapy if serious complications are to be avoided.
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The authors conducted the first long-range study to demonstrate possible negative effects on the recipients of corneal transplantation from donors who had died of a systemic malignancy or of chronic neurologic disease. The results are reported of a long-term retrospective analysis of 73 patients who received 86 grafts from donors with various systemic malignancies. These patients were followed for a mean of 127 months. There was no evidence of the transfer of the same malignancy to any of the recipients. There was no increased incidence of malignancy or earlier mortality in our patient population when compared with a reference population. Graft infection, endophthalmitis, or local tumor growth was not observed. The authors state that at the present time there is no basis for excluding donors dying of systemic malignancy as a source of material for use in keratoplasty. The authors examined the case histories of six patients who received grafts from donors who had died of a neurological disease with a suspected viral etiology. In a follow-up period ranging from 120 to 174 months, no evidence of neurologic disease developed in any of the patients. The sample was too small to provide data necessary for drawing conclusions concerning the safety of the use of material from this source. The authors strongly advise excluding any patient with a neurologic disease of suspected viral etiology as a source of corneal donor material.
The introduction and use of newer surgical materials, better surgical instruments, finer suture materials, and improved optical equipment have allowed us to advance certain techniques in ophthalmic surgery and ophthalmic plastic surgery. In oculoplastic surgery, fascia lata and sclera are but a few of these materials used with greater frequency. In this paper, a number of techniques are described depicting the use of fascia lata and sclera. A histologic study of these materials after variable periods of implantation is presented.