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Biomedical subjects

L A Wilson

Publications and source records attributed to L A Wilson.

At least 127 records · Page 7Linked to original sources
PubMed1984

Stellate iron lines in the corneal epithelium after radial keratotomy.

Biomicroscopic examinations of the corneal epithelium of 54 patients who had consecutive radial keratotomy operations in the National Eye Institute Prospective Evaluation of Radial Keratotomy (PERK) study showed that abnormal stellate epithelial iron lines had appeared at the junction of the middle and inferior thirds of the cornea in 13 of 16 eyes (81%) examined six months after surgery, in 43 of 50 eyes (86%) examined 12 months after surgery, and in seven of nine eyes (78%) examined 24 months after surgery. The density and pattern of the deposits varied from a faint tan horizontal iron line studded with small branches to a dense yellow-brown deposit with eight radiating arms that extended between all of the incisions. Analysis of the configuration of the iron line and the central keratometric readings 12 months after surgery showed that the greater the reduction in the central keratometric measurement postoperatively, the more prominent the iron line. We attribute the occurrence and variation of the stellate epithelial iron line to irregularities in the surface of the cornea present in the first year after radial keratotomy.

Adult↗
PubMed1984

Penetrating keratoplasty for exogenous Paecilomyces keratitis followed by postoperative endophthalmitis.

Three patients developed Paecilomyces lilacinus keratitis while being treated with topical corticosteroids and antibiotics. The first patient, a diabetic man, suffered superficial ocular trauma while being treated for recurrent anterior uveitis related to an iris-fixated intraocular lens. The second patient developed keratitis while being treated for anterior segment inflammation associated with herpes zoster ophthalmicus. The third patient, a woman with chronic lymphoma in remission, was receiving topical antibiotics and corticosteroids for a corneal transplant performed one year previously. All three patients underwent penetrating keratoplasty after progression to perforation or failure of medical therapy. Two eyes (cases 1 and 2) eventually required enucleation. The fungal isolates demonstrated in vitro resistance to amphotericin and natamycin with greater sensitivity to imidazole derivatives. Thus, we recommend prompt and prolonged topical treatment with miconazole or other imidazole derivatives along with avoidance of penetrating keratoplasty and corticosteroids.

Aged↗
PubMed1984

A cluster of cases of Mycobacterium chelonei keratitis associated with outpatient office procedures.

We studied three cases of keratitis caused by Mycobacterium chelonei, a nontuberculous mycobacterial species. The cases occurred in two women, 76 and 80 years old, and one man, 67 years old, treated as outpatients in the same office. One case followed suture removal and the other two occurred after posterior capsulotomy. Corneal lesions appeared within two to three weeks of trauma and were white, round infiltrates with indistinct margins and radiating projections. The lesions were found at all levels of the stroma and were associated with an epithelial defect. Anterior chamber reaction varied from a minimal response to a hypopyon. One patient responded to topical therapy with amikacin and erythromycin, but the other two patients required penetrating keratoplasties because of deep abscesses, which progressed toward the sclera despite therapy. These cases emphasized the possibility of rapidly growing nontuberculous mycobacteria producing serious ocular infections.

Aged↗
PubMed1984

Mortality rate in rheumatoid arthritis patients developing necrotizing scleritis or peripheral ulcerative keratitis. Effects of systemic immunosuppression.

We performed a nonrandomized clinical trial comparing the ocular and systemic efficacy of cytotoxic immunosuppression with steroidal and nonsteroidal anti-inflammatory therapy in the care of 34 patients with rheumatoid arthritis who developed peripheral ulcerative keratitis and/or necrotizing scleritis. Nine of the 17 patients managed with conventional therapy died of a vascular-related event during the ten-year period of the study. In 13 of the 17 patients, the ocular inflammatory process progressed, and in 5 patients extraocular, although nonlethal, vasculitic lesions developed. One of 17 patients treated with long-term immunosuppressive therapy died during the ten-year follow-up period, and this death occurred after cytotoxic therapy was withdrawn. None of the patients on immunosuppressive regimens developed extraocular vasculitis while taking the drug, and none had progression of the ocular destructive lesion. The results of this study emphasize that the eye is a sensitive indicator for potentially lethal occult systemic vasculitis in patients with rheumatoid arthritis who develop peripheral ulcerative keratitis or necrotizing scleritis. Our mortality data strongly suggest that the use of cytotoxic drugs may alter favorably the general as well as the ocular prognosis in these patients.

Aged↗
PubMed1984

Results of penetrating keratoplasty for pseudophakic corneal edema with retention of intraocular lens.

We reviewed the records of 26 consecutive patients undergoing penetrating keratoplasty for pseudophakic corneal edema in which the original intraocular lens was retained. The average interval between lens implantation and penetrating keratoplasty was 31.5 months. Follow-up after keratoplasty ranged from 11 to 59 months, with an average of 24.5 months. Six patients had anterior chamber lenses; sixteen, iris or iridocapsular lenses; and four, posterior chamber lenses. A vitrectomy was performed in 14 (54%) patients. Of the 21 patients with clear grafts (80%), 8 (38%) had vision of 20/40 or better while 7 (33%) had acuities of 20/200 or worse. Visual acuity of 20/40 or better was attained by 3 of 4 (75%) patients with posterior chamber lenses but only 3 of 16 (19%) patients with iris-supported lenses. Cystoid macular edema was the principal cause of decreased acuity in 12 of the 13 patients with clear grafts and acuity less than 20/40. Angiographic confirmation was obtained in 7 of 12 patients. Overall, the results are similar to those reported for pseudophakic keratoplasty with intraocular lens removal. No adverse effect of retaining a securely fixated intraocular lens was demonstrated.

Cataract Extraction↗
PubMed1984

Gram-negative corneal ulcers in elderly aphakic eyes with extended-wear lenses.

We report 13 cases of corneal ulcers caused by gram-negative bacteria. These cases occurred in aphakic eyes wearing hydrophilic contact lenses on an extended-wear basis. The risks for infection in the elderly aphakic eye with extended-wear hydrophilic lenses are increased by delay in removal of the lens. Caution in the use of these lenses is urged. The ability of either the patient or an attendant to remove the lens as soon as redness, diminished vision, or pain presents itself is essential in minimizing the risks for serious infection.

Aged↗
PubMed1984

Neurotoxicity associated with adenine arabinoside monophosphate in the treatment of chronic hepatitis B virus infection.

Thirty-one patients with chronic HBV infection were randomized to receive a short or long course of ARA-AMP. Fifteen completed a 4 week course of treatment and 16 completed longer courses varying from 7 to 12 weeks. Eighteen patients did not experience any neurological side effects. Six patients had myalgia. This was not associated with any neurological deficit. Seven patients developed a sensory neuropathy with distressing pain and dysesthesiae in the feet and abnormalities in nerve conduction. The development of neurotoxicity was related to a long duration of treatment and a correspondingly higher total dose but there was no association with the severity of liver disease.

Adolescent↗
PubMed1984

Corneal ulcer due to Achromobacter xylosoxidans.

We report a case of corneal ulcer caused by the opportunistic organism Achromobacter xylosoxidans which developed during chronic topical steroid treatment of an eye with neovascular glaucoma. A. xylosoxidans has probably been underreported as a cause of ocular infection because of confusion between this organism and other Gram-negative organisms, particularly pseudomonas. A. xylosoxidans is resistant to aminoglycosides and some cephalosporins but not carbenicillin. This difference in antibiotic sensitivity patterns between A. xylosoxidans and pseudomonas makes an accurate differentiation between the 2 organisms important. This case was successfully treated after substituting topical carbenicillin for topical gentamicin and amikacin.

Administration, Topical↗
PubMed1984

Modified-self-induced modulation of the immune response to herpes simplex virus: effect on antibody formation, cytotoxic T lymphocyte induction, and survival.

C3H/HeJ mice were injected i.v. with soluble herpes simplex virus (HSV) envelope antigens coupled to syngeneic splenocytes 7 days before challenge i.p. with either soluble HSV antigens in complete Freund's adjuvant or infectious HSV. Fourteen days post challenge, and anti-HSV antibody hyporesponsiveness was observed in the HSV modified-self pretreated animals that was 50% or less than the control response. Both forms of HSV challenge were equally effective. This unresponsiveness was specific for HSV when compared with a concomitant response to chicken red blood cell (CRBC) challenge. Challenge with infectious HSV afforded us the opportunity to investigate the effect of HSV modified-self pretreatment on the induction of HSV-specific cytotoxic T lymphocytes (CTL). In vitro restimulation of in vivo-primed splenocytes with infectious HSV generated HSV-specific CTL. The degree of HSV-specific CTL response was found to be variable in animals that received the HSV modified-self pretreatment with respect to control animals. Survival was significantly greater in HSV modified-self pretreated mice after infectious HSV challenge than in control animals.

Animals↗
PubMed1984

Complement potentiation of phagocyte-mediated ADCC of HSV-infected corneal cells.

The authors have shown previously that rabbit alveolar macrophages, peritoneal exudate macrophages, and polymorphonuclear leukocytes are highly effective mediators of antibody-dependent cellular cytotoxicity (ADCC) against herpes simplex virus (HSV)-infected rabbit stromal keratocytes. Using a completely homologous system of nonimmune rabbit phagocytes, anti-HSV serum, complement, and HSV-infected stromal keratocyte targets, the authors have found significant potentiation of ADCC by complement. Lymphocyte-mediated ADCC, on the other hand, was not potentiated by complement. Using a 1:100 dilution of complement (noncytolytic in antibody-mediated lysis) and a 1:10 dilution of antiserum obtained from rabbits undergoing stromal keratitis, ADCC mediated by the three phagocytic cell types was augmented by approximately 22%. For example, using alveolar macrophages as effector cells, the addition of complement increased the level of ADCC From 40% to 60%, a 20% increase. Percent ADCC was augmented less by complement at higher antiserum dilutions. However, the percent of the total ADCC attributable to complement potentiation increased at these higher antiserum dilutions. In some cases, ADCC was not detectable at these high antiserum dilutions without the added complement. The potentiating effect was observed at complement dilutions as high as 1:400. Further dilution or heat-inactivation resulted in ADCC values comparable to those obtained without complement. Target cells exposed to complement alone were not killed by phagocytes.

Animals↗
PubMed1983

Results of penetrating keratoplasty in 123 eyes with pseudophakic or aphakic corneal edema.

The clinical records of 123 eyes that received a penetrating keratoplasty for aphakic or pseudophakic corneal edema with a mean follow-up time of 18 months were studied retrospectively. Thirty-five eyes from which an intraocular lens (IOL--85% iris fixated) was removed at the time of keratoplasty were compared with 88 eyes that never had an IOL. The mean interval between initial cataract surgery and penetrating keratoplasty was 28 months for the pseudophakic group from which the IOL was removed and 67 months for the aphakic group without IOL. In both groups, 97% had an anterior vitrectomy. Corneal grafts remained clear in 91% of the previously pseudophakic eyes and in 81% of the aphakic eyes (P less than or equal to 0.05). The final corrected visual acuity was worse in the pseudophakic eyes with IOL removed (16% saw 6/6 to 6/12 while 22% saw worse than 6/60) than in the aphakic eyes (34% saw 6/6 to 6/12 while 7% saw worse than 6/60). Postoperative maculopathy occurred in 43% of eyes from which IOLs were removed and in 22% of aphakic eyes.

Aged↗
PubMed1983

Alteration of rabbit alveolar and peritoneal macrophage function by herpes simplex virus.

Exposure of rabbit alveolar and peritoneal macrophages to infectious herpes simplex virus resulted in inhibition of antibody-dependent cellular cytotoxicity and either enhancement or inhibition of phagocytosis. At all times after exposure, virus was inhibitory to peritoneal macrophage phagocytosis. Alveolar macrophages showed enhanced phagocytic activity in the early stages of virus exposure and inhibition at later time points.

Animals↗
PubMed1983

The medical record as a teaching medium.

A major objective of clinical teaching to medical students is that they should see medical practice at its best and should be inspired to emulate and, indeed, improve on this. Medicine in old age is so complex that the medical record, a basis of good practice, is even more essential than in other fields of medicine. The Aberdeen medical record with its problem-orientated approach is described and examples given on the way in which this is used together with the relevance of these examples to undergraduate teaching. The system is particularly relevant to long-stay patients. The medical record is so important a part of the practice of medicine that there should be formal teaching on it in medical schools.

Education, Medical↗
PubMed1982

Acquired toxoplasmosis.

An outbreak of systemic toxoplasmosis occurred in October 1977 in Atlanta, Georgia. Thirty-seven people became ill and/or had serologic evidence of acute infection. Epidemiologic study by the Center for Disease Control (CDC) suggested that toxoplasma oocysts from infected cats in a riding stable were the source of infection. Aerolization of oocysts or hand-to-mouth contact were the presumptive means of transmission. All patients were examined and followed for over a year, without evidence of toxoplasma retinochoroiditis. In a four-year follow-up study, only one patient had shown evidence of ocular disease. This suggests that at least some sporadic cases are due to acquired toxoplasmosis.

Animals↗
PubMed1982

Immunosuppressive therapy for progressive ocular cicatricial pemphigoid.

In a controlled, nonrandomized, longitudinal cohort study, we studied the efficacy of systemic immunosuppression in treatment of progressive cicatricial pemphigoid affecting the eyes. Twenty-six patients were studied; 18 received systemic immunosuppressive drugs, and eight received conventional therapy. Three patients who received cytotoxic agents withdrew from the study with intolerable gastrointestinal distress. Fourteen of the 15 patients who were immunosuppressed successfully for prolonged periods experienced a cessation of their episodic ocular inflammation and a halting of their progressive conjunctival cicatrization. They maintained vision at least as good as that present when disease activity was brought under control; in two patients vision improved. The one patient who was adequately immunosuppressed and successfully maintained in such a state for two years but who had progressive ocular surface pathology with eventual blindness had concomitant rheumatoid arthritis and severe sicca syndrome. The three patients who withdrew from immunosuppressive therapy and the eight concomitant controls all showed continued episodic conjunctival inflammation and conjunctival cicatrization with development of severe keratopathy and profound visual loss. Complications in this series included alopecia (100%), anemia (78%), gastrointestinal distress (22%), hemorrhagic cystitis (11.1%), and severe leukopenia (5.5%). These results support the notion that abnormal immunoregulatory mechanisms are involved in the progressive disease activity in cicatricial pemphigoid and that systemic immunosuppression may have an appropriate role in the treatment of this disease.

Adult↗
PubMed1982

Permissiveness of rabbit monocytes and macrophages for herpes simplex virus type 1.

The permissiveness of rabbit monocytes and macrophages for herpes simplex virus was examined. Peripheral blood monocytes, alveolar macrophages, and peritoneal exudate macrophages were studied for their ability to replicate herpes simplex virus strains RE and KOS. Results indicated different degrees of interaction with virus depending on the macrophage type. Only peritoneal exudate macrophages showed evidence of virus replication. Productive infection was limited, with only a small number of cells (0.02%) yielding infectious virus. Higher numbers of cells appeared to be abortively infected. Approximately 40% expressed antigens, whereas virtually all were killed by exposure to virus. Coreless particles were seen by electron microscopy in about one-third. Alveolar macrophages were also killed by virus and showed evidence of virus adsorption, but showed no indication of productive or abortive infection. Monocytes neither adsorbed nor replicated virus, and viability was unaffected. Results suggest that differences in degrees of cellular maturation or differentiation, or both, account for the spectrum of interactions seen between herpes simplex virus and rabbit macrophages.

Adsorption↗
PubMed1982

Patterns of sensory loss following fractional posterior fossa Vth nerve section for trigeminal neuralgia.

Twenty-five patients with trigeminal neuralgia have been treated by fractional posterior fossa Vth nerve section. The procedure is shown to be effective in relieving pain, preserving corneal sensation and the motor root. Nineteen patients showed little loss of light touch sensation, and in 15 of these there was dissociation of sensory loss to pinprick and light touch. The results support the concept that there is some anatomical separation of fibres subserving light touch and pain in the posterior root of the nerve.

Adult↗