Biomedical subjects
Publications and source records attributed to R Y Foos.
Magnetic resonance imaging is a relatively new diagnostic modality that is used to an increasing extent as an aid to increase clinical diagnostic accuracy. We report a case of an erroneous diagnosis of malignant melanoma of the choroid associated with magnetic resonance imaging.
Explore the source record for details and available documents.
Herpes simplex virus-1 (HSV) infection of trigeminal and dorsal root ganglia was established in mice via corneal scarification and footpad injection, respectively. Trigeminal and dorsal root ganglia were removed during the acute and latent stages of infection and processed for the immediate-early HSV polypeptide ICP4 (VP175) using both a monoclonal reagent and polyclonal antiserum and the avidin biotin complex immunoperoxidase method. ICP4 (VP175) antigen was readily detected during the acute infection of both dorsal and trigeminal ganglia, but not during latency. This antigen could again be detected by reactivation of the latent virus by explanation and organ culture. The detection of ICP4 (VP175) during latency in a rabbit model but not in a murine model may correlate with biologic differences in each system (e.g., rabbits spontaneously reactivate). Alternatively, the discrepancy could reflect viral strain characteristics or may imply that ICP4 (VP175) need not be constitutively expressed (at detectable levels) in all models of latent infection.
A clinicopathologic study of multiple extramacular drusen (MED) was performed on 784 eyes of 412 consecutive autopsies and on 100 eyes of 50 consecutive patients with MED. The clinical and histopathologic characteristics of MED and its correlation with reticular degeneration of the pigment epithelium (RDPE) and with macular degenerative abnormalities are presented. Multiple extramacular drusen was associated with macular degenerative abnormalities in 88% of autopsy cases, in contrast to 2% of cases in a control population without MED or RDPE. Multiple extramacular drusen and macular degenerative abnormalities are associated findings and apparently have similar pathogenetic mechanisms.
We studied reticular degeneration of the pigment epithelium by fluorescein angiography in 32 eyes of 50 consecutive patients who had ophthalmoscopic indications of this aging-related entity. In this type of degeneration, fluorescein angiography delineated extensive abnormalities of the retinal pigment epithelium and demonstrated normal-appearing retinal vessels and choriocapillaries in the affected areas.
Explore the source record for details and available documents.
We utilized the leu series of monoclonal antibodies and an indirect immunoperoxidase technique to quantitate the cellular infiltrates in seven rejected human corneal allografts and compared them to nine identically processed corneas from patients with chronic herpetic stromal keratitis and to three control corneas. The cellular infiltrates in the rejected allografts were of mixed composition, comprised predominantly of leu-1 positive T-lymphocytes and leu-M3 positive macrophages. Both helper and cytotoxic-suppressor T-cells were identified in the stromal lesions. Statistically significant differences were noted in the absolute number of mononuclear cells and macrophages seen infiltrating the rejected corneal allografts compared to the herpetic corneas. We discuss the implications of these findings with regard to possible mechanisms underlying corneal allograft rejection in man.
A clinicopathologic study of reticular degeneration of the pigment epithelium (RDPE) was done on 750 eyes of 396 consecutive autopsy cases and on 100 eyes of 50 consecutive patients with RDPE. The clinical, angiographic, macroscopic, and histopathologic characteristics of RDPE and its correlation with macular degenerative abnormalities in the autopsy and clinical eyes are presented. Reticular degeneration of the pigment epithelium and macular degeneration were found to be concomitant manifestations of the aging process, and RDPE may be a significant risk factor associated with age-related macular degeneration. Evaluation of the peripheral fundus is of value in assessing patients with macular degenerative abnormalities.
We compared the distribution of HLA-ABC (class I) and HLA-DR (class II) antigens on fresh human donor corneal tissue, donor corneas following a 72-hour storage in McCarey-Kaufman (M-K) medium, and corneal buttons from patients with allograft rejection and with chronic herpetic stromal keratitis. Incubation in M-K media had little or no effect on the distribution of HLA antigens as compared with fresh tissue. In contrast to control corneas, both HLA class I and II antigens were detected on corneal endothelial cells, cells in the stroma, and on basal epithelial cells in rejected allografts. Corneal endothelium in herpetic buttons did not express detectable HLA antigens. HLA-DR positive Langerhan's cells were demonstrated in the central corneal epithelium of rejected allografts, as well as in herpetic corneas, but not in control corneas except at the limbus. Based upon these observations, a theory of corneal allograft rejection in humans is proposed based upon the induction of class I HLA-ABC and class II HLA-DR antigens on cells in the donor button by a factor(s) associated with cellular inflammation.
A pathologic analysis of 40 autopsy cases of chronic retinopathy of prematurity is presented. The type of retinal detachment in chronic retinopathy is unique, resulting from progressive changes in the peripheral retina: folding at the site of extraretinal vasoproliferation; scroll-like rolling anteriorly towards the lens; foreshortening of entire retina with detachment; and closure of the retinal "funnel." The biomechanical intraretinal and extraretinal factors operating during this process are discussed. Also presented are some interesting atypical features found in this series: arrested retinopathy; "sea fan" extraretinal vascular fronds; retinopathy in anencephaly; cribriform vanguard; and extramedullary erythropoiesis.
A gross, light, and electron microscopic study of the eyes from 35 consecutive autopsy cases of the acquired immune deficiency syndrome revealed cotton-wool spots (71% of cases), retinal hemorrhage in areas without cytomegalovirus infection (40%), cytomegalovirus retinitis (34%) with associated retinal detachment, Roth's spots (23%), retinal microaneurysms (20%), papilledema (14%), conjunctival Kaposi's sarcoma (9%), cryptococcal chorioretinitis (6%), Mycobacterium avium-intracellulare in retina and in choroidal granulomas (6%), ischemic maculopathy (6%), bilateral keratitis (3%), and herpes simplex retinitis (3%). Ocular infection with candida or toxoplasmosis were not found in this autopsy series. Immunocytologic studies demonstrated deposition of immunoglobulins in arteriolar walls, consistent with immune complex mediated disease. Ultrastructural studies showed a vasculopathy in the areas near cotton-wool spots. A mechanism is proposed linking the deposition of immune complexes with subsequent small vessel lesions, ischemia, cotton-wool spots and later spread of cytomegalovirus to retina via damaged vascular endothelium.
Two cases of carcinoma metastatic to the eyelid are described. The first was derived from a lung primary diagnosed two months prior and presented as a solitary tender mass mimicking an acutely inflamed recurrent chalazion. The second case was the initial manifestation of a stomach carcinoma, presenting as a solitary painless nodule. Both were part of generalized metastatic disease; survival was six weeks and five months, respectively, after eyelid tumor presentation. Excisional biopsy was effective palliation in the first case, but multiple operations were required in the second. The clinicopathologic features are discussed and the prior reported cases reviewed.
An immunoperoxidase technique was utilized to identify herpes simplex type I viral antigens in the retina, optic nerve and brain of an adult with herpetic retinitis and encephalitis. Viral antigens were demonstrated in all layers of retina, retinal pigment epithelium and to a lesser extent, in choroid. Oligodendroglia in the right optic nerve and neuronal and glial cells in the grey and white matter of the left frontal, inferior parietal and temporal lobes of the brain also expressed herpes simplex antigens. The sensitive immunoperoxidase method allowed detection of viral antigens in many cells without intranuclear inclusions or surrounding inflammation, and thereby added valuable information regarding the anatomic and cellular localization of herpetic infection. The clinicopathologic features that characterize herpes simplex retinitis in the adult are compared to cytomegalovirus retinopathy.
Cataract disrupts the crystalline lens, a transparent, elastic, avascular, biconvex structure composed of a capsule, lens epithelium, and lens fiber cells. Many factors contribute to the progression of lens opacity, but aging is most frequently associated with cataract. As aging-related cataract develops, many biochemical and biophysical changes occur, most notably a marked increase in the insolubilization of the crystallin and extensive oxidation damage to many of the lens constituents. Cataract management should include ophthalmologic history and examination, medical evaluation, optical correction, control of ocular and systemic disease that may contribute to cataract, discontinuation of cataractogenic drugs, and periodic reexamination. Surgery is indicated when cataract is associated with vision decrease interfering with activities important to the patient, intraocular inflammation or glaucoma, or interference with management of posterior segment disease. More than 600 000 cataract operations are done in the United States each year; in 1982 an estimated 496 000 cataract operations were combined with intraocular lens implantation.
An 81-year-old man was examined on referral with the presenting complaint of decreased vision in one eye. Tentative diagnosis, later confirmed by pathology evaluation, was malignant melanoma of the ciliary body.
Retinas from 14 comatose patients, who had been sustained with a respirator for one or more days before death, had selective characteristic alterations (ie, autophagy, cell swelling, and coagulation necrosis) of inner nuclear layer in a patchy pattern in posterior fundus. Bipolar cells were most often affected, but amacrine and horizontal cells also were substantially damaged. Cells of Müller and vascular cells were largely spared. These lesions are ascribed to oligemia (ischemia) since the inner nuclear layer is a microscopic vascular watershed (boundary zone) between the choroidal and retinal circulations.
A 27-year-old woman with the syndrome characterized by ectrodactyly, ectodermal dysplasia, and cleft lip-palate had an absent lacrimal punctum in each eye, with signs and symptoms of nasolacrimal obstruction during childhood. Examination disclosed bilateral corneal vascularization and opacification, with diffuse superficial punctate staining of the ocular surface epithelium by fluorescein, an instantaneous tear film break-up time, and normal Schirmer tear measurements. A full-thickness biopsy specimen of the eyelid confirmed the absence of meibomian glands that had been suspected because of absent meibomian gland orifices and secretions. The total absence of meibomian gland secretions in this patient may be a primary feature of this case and may contribute to a lipid-deficient and unstable tear film with resultant desiccation and destruction of the ocular surface epithelium. Breakdown of the corneal epithelium in association with obstruction and infection of the nasolacrimal system may be a particularly disastrous combination for the cornea that resulted in the recurrent, severe bacterial corneal ulcers found in our patient.
We present a case of bilateral herpes simplex and cytomegalovirus retinitis and concurrent encephalitis following acyclovir therapy in a homosexual male with the acquired immune deficiency syndrome (AIDS). At autopsy, herpes simplex virus antigens were readily detected in all retinal layers, retinal pigment epithelium, and choriocapillaris, using an immunoperoxidase technique, whereas herpes simplex antigens in the brain were localized in restricted foci of vascular and subependymal parenchymal cells. Cytomegalovirus antigens were identified in cells in all layers of retina, in retinal pigment epithelium, and in subependymal parenchymal cells in the brain. No cytomegalovirus antigens were detected in any vascular endothelium, in choroid, or anterior to the ora serrata. The widespread expression of herpes simplex virus antigens in this patient's retinas is in marked contrast to the restricted foci of herpes simplex antigens limited to the subependymal region of the brain, and is similar to that seen in murine models of herpes simplex retinitis produced by acyclovir-resistant viral mutants.