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Biomedical subjects

R L Lesser

Publications and source records attributed to R L Lesser.

24 records · Page 2Linked to original sources

Orbitofacial mucormycosis with unusual pathological features.

A 52-year-old man with mild diabetes and acute stem cell leukaemia developed an orbitofacial mucormycosis. Cultures showed the fungus to be Rhizopus oryzae. Vigorous treatment with amphotericin B and other bactericidal and bacteriostatic antibiotics for a concurrent sepsis failed to suppress the infections, and the patient died. On post-mortem examination characteristic haematoxylin-staining, broad, aseptate fungal hyphae were found in the right eye, orbit, and lung. A striking and unusual feature of this case is the presence of brightly birefringent crystals within the severely degenerated eye. These were found by histochemical staining and x-ray diffraction studies to be calcium salts of fatty acids, apparently liberated from necrotic adipose tissue of the orbit.

Calcinosis↗

Ocular myasthenia: a protean disorder.

Ocular myasthenia is a localized form of myasthenia clinically involving only the extraocular, levator palpebrae superioris, and/or orbicularis oculi muscles. Ocular manifestations can masquerade as a variety of ocular motility disorders, including cranial nerve and gaze palsies. A history of variable and fatiguable muscle weakness suggests this diagnosis, which may be confirmed by the edrophonium (Tensilon) test and acetylcholine receptor antibody titer. Anticholinesterases, corticosteroids and other immunosuppressive agents, and other therapeutic modalities, including thymectomy and plasmapheresis, are used in treatment. As the pathophysiology of myasthenia has been elucidated in recent years, newer treatment strategies have evolved, resulting in a much more favorable prognosis than several decades ago. This review provides historical background, pathophysiology, immuno-genetics, diagnostic testing, and treatment options for ocular myasthenia, as well as a discussion of drug-induced myasthenic syndromes.

Circadian Rhythm↗

Staphyloma: a complication of surgery for hyphema.

Anterior staphylomas developed in two young patients as a postoperative complication of hyphema extractions through corneoscleral sections. The patients, aged five and nine years, underwent evacuation of the hyphemas after rebleeding caused medically unmanageable intraocular pressure elevations. Postoperatively, both patients received corticosteroids and had elevation of intraocular pressure. To repair the staphyloma, a scleral overlay patch graft was performed in one patient, but the intraocular pressure remained elevated and the staphyloma gradually recurred. Enucleation of the eye was eventually required. Resection of the staphylomatous area with lensectomy and complete vitrectomy was performed in the second patient. After four years of follow-up this patient continues to do well.

Child↗