Biomedical subjects
J S Weiss
Publications and source records attributed to J S Weiss.
Bacteriology of pustules occurring during treatment of psoriasis.
Pustular lesions developed in 16% of our psoriatic inpatients treated with a modified Goeckerman regimen. The role of bacterial infection in the development of these lesions remains controversial. Representative lesions were cultured, and the recovered organisms were quantitated. We were not able to culture a significant number of bacteria from these lesions. Pustules were prone to develop during the summer months in hirsute patients, in patients with hyperhidrosis, and in patients in whom topical treatment of a more occlusive nature was applied. The male-female ratio was 4.8:1. Topical antibiotic treatment of these pustules in psoriatic patients appeared to be unwarranted since the lesions resolved when topical therapy was discontinued. These pustules appeared to be distinct from pustular psoriasis.
Power spectral analysis of heart rate variability in sudden cardiac death: comparison to other methods.
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Choroidal metastasis of adenocystic carcinoma of the salivary gland.
A case of adenocystic carcinoma of the salivary gland arising in the hard palate metastatic to the choroid is presented. The histopathology of the tumour is discussed.
A comparison of the Tzanck smear and viral isolation in varicella and herpes zoster.
We compared the usefulness of the Tzanck smear to viral culture in patients with varicella and herpes zoster. All 11 patients with early lesions of varicella had a positive Tzanck preparation, while only seven (64%) of 11 had a positive culture. Twelve (80%) of 15 patients with zoster had a positive Tzanck preparation, while only nine (60%) of 15 had a positive culture. The predominance of the Tzanck yield over the culture is probably due to the increased difficulty in isolation of the varicella zoster virus. These results suggest that the Tzanck preparation is a valuable tool in the diagnosis of patients with varicella and zoster and offers a much more immediate answer than does viral culture, which often takes one to two weeks. These results contrast with those of our previous study of the Tzanck preparation and herpes simplex, in which the viral culture was more accurate than the Tzanck preparation.
Dental mirror for goniosynechialysis during penetrating keratoplasty.
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Ocular findings in a new heritable syndrome of brain, eye, and urogenital abnormalities.
We studied the clinical and histopathologic ocular findings in four related males with a newly recognized syndrome consisting of microphthalmos, microencephaly, mental retardation, agenesis of the corpus callosum, hypospadius, and cryptorchidism with X-linked recessive inheritance. The ocular abnormalities include microphthalmos, corneal pannus and hypoplasia, cataracts, uveal hypoplasia, retinal dysplasia, optic nerve hypoplasia, and congenital blepharoptosis. In case 4, a female twin who died in utero (at 15 weeks' gestation) showed none of the ocular abnormalities.
Histopathologic condition of fascia lata implant 42 years after ptosis repair.
Fascia lata implants have been employed since the early part of this century in the repair of blepharoptosis. Although much has been written concerning surgical techniques and results of implanting different preparations of fascia lata, there are relatively few reports of long-term histopathologic follow-up of recovered tissue. In the case described herein, autogenous fascia lata was recovered at the time of repeated surgery and examined 42 years later. On microscopic examination the tissue was viable but demonstrated significantly more vascularization, fibroblastic infiltration, and incorporation with surrounding structures than previously reported implants.
Maxillary ameloblastoma with orbital invasion. A clinicopathologic study.
A 72-year-old white man presented to Massachusetts Eye and Ear Infirmary with proptosis of the right eye. Computerized tomography (CT) scan revealed a mass which filled the right maxillary sinus and invaded the orbital and middle cranial cavities. Six years earlier, the patient had excision of an ameloblastoma of the right maxillary antrum. The tumor recurred, requiring maxillectomy, local radiotherapy and finally exenteration. Ameloblastoma is a relatively rare epithelial tumor arising from embryonal tooth elements. It is locally invasive and recurrent but rarely metastasizes and extension to the orbit is extremely unusual. The clinical features, histopathologic findings and treatment of this tumor are discussed. Differential diagnosis of jaw tumors, which may invade the orbit, is reviewed.
Histopathologic study of changes occurring in eyes with intraocular lens implantation: autopsy eyes, enucleated eyes and corneal buttons.
The clinicopathologic findings in 17 eyes which were surgically enucleated or removed at autopsy as well as the histopathology of 72 corneal buttons removed from eyes with intraocular lenses are described. In four of five autopsy eyes the intraocular lens was well tolerated; however, in all cases, changes related to the pseudophakos were found. In seven of 12 surgically enucleated eyes, postsurgical bacterial or fungal endophthalmitis had developed. On histopathological examination, one eye revealed clinically unsuspected endophthalmitis phacoanaphylactica after extracapsular cataract extraction and intraocular lens implantation. In two cases, choroidal melanoma became evident after cataract extraction and insertion of a pseudophakos. In both cases preoperative ultrasonography was limited to A-scan axial measurements. The 72 corneal buttons were removed from patients with pseudophakic bullous keratopathy; histologically the most striking findings were guttata-like changes in 50% of the specimens and retrocorneal membranes in 13.9% of the specimens.
Clinically unsuspected phacoanaphylaxis after extracapsular cataract extraction with intraocular lens implantation.
We describe the histopathological findings of an enucleation specimen from a clinically undiagnosed case of phacoanaphylaxis which occurred after extracapsular cataract extraction with intraocular lens implantation. Phacoanaphylaxis, a granulomatous inflammatory response to liberated lens protein, is potentially curable by prompt removal of residual lens material. This case emphasises that the diagnosis of phacoanaphylactic endophthalmitis should be considered in any case of extracapsular cataract extraction complicated by granulomatous intraocular inflammation.
Histopathological findings in necropsy eyes with intraocular lenses.
The histopathological findings in five post-mortem eyes with anterior chamber and iris fixation intraocular lenses (IOLS) are discussed. The interval between lens insertion and death ranged from 3 1/2 to 52 months. Clinically the lenses were well tolerated and the surgery was considered to be successful. In one case a vitrectomy was required. Prominent histopathological features included reduced corneal endothelium (five cases), central cornea guttata (one case), dislocation of an anterior chamber IOL (one case), abnormalities of the filtration angle (five cases), non-granulomatous iritis (two cases), and iris atrophy and erosion (five cases).
Diazo-based assay for total bilirubin in a coated thin film evaluated.
We compared results for total bilirubin as measured on a coated thin film and by the Evelyn-Malloy and Jendrassik-Gróf methods. We examined serum samples from patients and studied the effects of protein, hemoglobin, and lipids on bilirubin measurement. Results from the thin-film assay compared favorably with those of the other methods. Total and within-day precision (CV), assessed over a one-year period, were better than 6% and 3%, respectively, at all concentrations. Analytical recovery was 99 +/- 3%. Samples from individuals having a wide range of liver diseases demonstrated, by linear regression, good correlation between the thin-film method and the two wet-chemistry methods (correlation coefficients of 0.990 and 0.994). We conclude that the thin-film method offers a valid alternative assay for total bilirubin.
Estimation of unconjugated, conjugated, and "delta" bilirubin fractions in serum by use of two coated thin films.
We used two coated thin films to measure the concentrations of unconjugated, conjugated, and total bilirubin as well as bilirubin covalently bound to albumin ("delta" bilirubin) in more than 400 serum samples. We measured the unconjugated and conjugated species by determining their reflection densities at two wavelengths (400 and 460 nm) on a coating designed for the enhanced spectral measurement of bilirubin but which does not register the delta form. Total bilirubin was measured by use of a diazo-based thin film (Clin Chem 29: 37-41, 1983). We estimated the concentration of delta bilirubin by subtracting the sum of unconjugated and conjugated bilirubin from the concentration of total bilirubin. All measurements agree well with those by comparative methods, as shown by linear regression. Slopes ranged from 0.92 to 1.02, correlation coefficients from 0.935 and 0.998. Linear combinations of these values can also be used to compute other results; e.g., the sum of conjugated and delta bilirubin can be considered to be an estimate of "direct"-reacting bilirubin.
The clinical importance of a protein-bound fraction of serum bilirubin in patients with hyperbilirubinemia.
A directly reacting fraction of bilirubin that is probably covalently bound to albumin (albumin-bound bilirubin) has recently been described. To determine its clinical importance we used a new high-performance liquid-chromatography technique to measure it in the serum of 200 patients with hyperbilirubinemia from various causes. Albumin-bound bilirubin was an important fraction (8 to 90 per cent) of total bilirubin in patients with hepatocellular and cholestatic jaundice as well as in patients with the Dubin-Johnson syndrome. It was not detected in normal volunteers, neonates with physiologic jaundice, or patients with Gilbert's disease or hemolysis. Thus, albumin-bound bilirubin appears in serum when hepatic excretion of conjugated bilirubin is impaired. It becomes a larger component of serum bilirubin as jaundice subsides, delaying resolution of this disorder and causing bilirubin to persist in plasma after it has disappeared from the urine.
Posterior corneal pigmentation in melanosis oculi.
A 5-year-old girl was seen with findings consistent with melanosis oculi and notably decreased vision secondary to dense corneal pigmentation. A penetrating keratoplasty was performed without complications. Light microscopy disclosed dense pigment granules layered in deep stroma just anterior to Descemet's membrane. Electron microscopy revealed these to be melanocytes, without evidence of phagocytic activity. The corneal pigmentation may have resulted from a misdirection of melanocytes in embryogenesis. To our knowledge, the finding of visually notable corneal pigmentation has not been previously reported in association with the syndrome of melanosis oculi.
Experimental Creutzfeldt-Jakob disease: clue to etiology of certain human retinal degenerative diseases.
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Surgical therapy of traumatic hyphema.
The usual management of traumatic hyphemas in our institution has been to avoid or delay surgery until absolutely demanded by the clinical course. Despite this, most (73%) of our in-patients with total hyphema underwent surgery before leaving the hospital. In those who required surgery, 43% developed corneal staining. Optic nerve damage occurred in half of the patients whose surgery was performed eight or more days after the hyphema occurred, but was absent in those undergoing earlier surgery. The usual procedure used in this series was a trabeculectomy with iridectomy and gentle irrigation of the anterior chamber, and no surgical complications occurred. We believe that surgery, being relatively safe, should be performed early in cases of total hyphema unless the elevated intraocular pressure is controlled medically and spontaneous resolution is clearly imminent. For cases in which surgery is nearly inevitable, we suggest that earlier surgery might reduce the incidence of optic nerve damage and corneal staining.