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Biomedical subjects

S L Forstot

Publications and source records attributed to S L Forstot.

At least 37 records · Page 2Linked to original sources
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therapy died during the ten-year follow-up period, and this death occurred after cytotoxic therapy was withdrawn.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

X-ray epilation for the treatment of trichiasis.

.richiasis is a complication of many different disorders of the eyelids. Treatment is difficult and painful when conventional methods of plucking, surgical excision, electrolysis, or cryotherapy are employed. Since superficial x-ray therapy for the treatment of eyelid skin cancers causes permanent loss of the eyelashes in the irradiated field, we attempted to exploit this observation for the treatment of trichiasis. A rabbit model was used to determine the minimum permanent epilating dose. The dose was found to be approximately 4,000 rad of superficial radiation along with the following factors: 110 kV, 10 mamp, a target skin distance of 20 cm, a half-value layer of 1.0 mm of aluminum, and no filter. The dosage schedule used was 300 rad given three times per week. Two patients with severe scarring trichiasis were treated with the same factors and a total dose of 4,000 rad; excellent results were achieved. We believe that x-ray therapy is an easy, safe, and painless method for the management and cure of chronic trichiasis.

Animals↗
PubMed1982

The incidence of Sjögren's sicca complex in a population of patients with keratoconjunctivitis sicca.

A prospective study was performed on patients who came to a university ophthalmology outpatient clinic with the complaint of dry eyes and who were documented to have keratoconjunctivitis sicca (KCS). Of 45 patients studied 1 had primary amyloidosis, and another 10 had KCS with a previously diagnosed connective tissue disease. Of the remaining 34 patients, 19 had KCS alone without xerostomia, and the remaining 15 had KCS in association with subjective or objective xerostomia. Eight of these 15 patients were subsequently shown to have clinical Sjögren's syndrome--sicca complex, and for the majority, serologic and biopsy findings supported this diagnosis.

Adult↗
PubMed1982

Filamentary keratitis following penetrating keratoplasty.

Filamentary keratitis is a problem associated with a wide variety of ocular conditions. Of 114 patients receiving penetrating keratoplasty, 31 (27.2%) were noted to have filaments. Those patients receiving transplants for keratoconus were noted to have the highest incidence (12 of 31, 39%), while transplants following herpetic scars were not associated with filaments (0 of 11) in this series. Suturing technique or relation of donor button-to-graft site were not apparently important factors in the development of postoperative filamentary keratitis.

Corneal Diseases↗
PubMed1981

Serologic studies in patients with keratoconjunctivitis sicca.

Thirty-two patients with keratoconjunctivitis sicca (KCS) were screened for the presence of antinuclear antibodies, rheumatoid factor, and autoantibodies associated with Sjögren's syndrome (designated SS-A and SS-B). None of these patients had or were found to have clinical evidence of connective-tissue disease. The conditions of 19 (59%) patients were antinuclear-antibody-positive and 18 (56%) were rheumatoid-factor-positive. We found SS-A and/or SS-B autoantibodies in ten (31%) patients. There seems to be a high incidence of serologic abnormalities in patients with KCS, even when those patients with connective-tissue disease are excluded. Serologic testing seems to be a useful adjunct in the early diagnosis of primary Sjögren's syndrome. The presence of SS-A and SS-B autoantibodies correlated well with the clinical diagnosis of Sjögren's syndrome and seemed to identify the conditions of patients who may have a higher incidence of systemic complications with KCS.

Adult↗
PubMed1981

Effect of blunt trauma on the corneal endothelium.

Specular microscopy of central corneal endothelium was performed on 26 patients with a history of blunt uniocular trauma with hyphema. Compared with the uninjured fellow eye, the injured eye had a mean decrease in endothelial cell density (ECD) of 6.4%. In 12 patients with angle recession, the decrease in ECD was 12.2%, compared with 14 patients without angle recession with a decrease in ECD of 1.2%. In five patients with greater than 180 degrees of angle recession, the mean decrease in ECD was 21.2%. No significant decrease in ECD was noted to be associated with size of hyphema, iridodialysis, vitreoretinal abnormalities, or transiently increased intraocular pressure.

Adolescent↗
PubMed1981

Autoantibodies directed against sicca syndrome antigens in the neonatal lupus syndrome.

Clinical and serologic studies on three infants who had the neonatal lupus syndrome and studies on their mothers revealed an association with antibodies to sicca syndrome antigens. From initial studies and a 2-year follow-up, there is evidence that indicates transplacental passage of autoantibodies directed against Sjögren's (sicca) syndrome-associated nuclear antigens from asymptomatic mothers to newborns who subsequently developed neonatal lupus. Besides the presence of antinuclear antibodies, the mothers of these infants also showed high rheumatoid factor titers, and two had evidence of mild decreasing tearing on ophthalmologic examination. On follow-up examination 2 to 3 years later, both infants and mothers lacked evidence of active disease, and only the mothers continued to demonstrate the serologic abnormalities seen initially. Based on our findings, we postulate newborns of mothers with serologic or clinical evidence of Sjögren's (sicca) syndrome may be at greater risk for developing neonatal lupus.

Adult↗
PubMed1981

Restriction endonuclease cleavage of DNA obtained from herpes simplex isolates of two patients with bilateral herpetic disease.

Restriction enzyme analysis was utilized to investigate HSV isolates from bilateral lesions of skin and/or cornea. In the first case (DM) type 1 HSV was obtained from a lesion on the right eye lid in 1977 and from a recurrence in 1979 consisting of dendritic lesions on the left cornea as well as skin lesions on the right naris. HSV virus was isolated in the second case (BL) from a right corneal lesion in 1979. Ten months later HSV was again isolated from a recurrence on the right cornea and from multiple skin lesions on the left cheek. DNA obtained from all HSV isolates were cleaved with Hpa I, Bgl II, Kpn I, Hind III, and Eco RI. A comparison of DNA cleavage patterns following agarose electrophoresis revealed that the virus isolates from DM were different from those of BL. However, all of the isolates obtained from each patient were identical. Therefore, these type 1 isolates obtained from anatomical sites supplied by contralateral trigeminal nerves were due to reactivation and/or reinfection with endogenous virus rather than exogenous infection.

Adolescent↗
PubMed1980

Scanning electron microscopy of posterior polymorphous corneal dystrophy.

An 8 1/2-year-old girl had posterior polymorphous dystrophy that required keratoplasty. Similar lesions were found in the patient's mother, thus establishing the genetic trend of the disease. Scanning electron microscopy studies showed areas of endothelial cell degeneration and multiple depressions or pits. These seemed the most advanced and characteristic lesions of posterior polymorphous dystrophy. Transmission electron microscopy studies in areas adjacent to the pits showed an abnormally developed Descemet's membrane covered by two or more layers of elongated endothelial-like cells. Cells over Descemet's membrane seemed to deposit some Descemet's membrane material and both fine and coarse collagen fibrils. Cells had prominent mitochondria, normal endoplasmic reticulum, and desmosomal attachments. Cytoplasmic fibrils and microvilli were usually found in cells lining the anterior chamber. Specular microscopy and scanning electron microscopy recorded the image of only the innermost cells and these appeared as endothelium.

Child↗
PubMed1980

Cardiac complications of Wegener granulomatosis: a case report of complete heart block and review of the literature.

Wegener granulomatosis is a necrotizing vasculitis whose target organs are classically the upper and lower respiratory tracts and the kidneys. There has been other end-organ involvement documentation, emphasizing the disseminated nature of this disease, but the literature concerning cardiac involvement is limited. The few case reports and general reviews show that the two most common histologic cardiac manifestations are pericarditis and coronary arteritis, each occurring in 50% of the reported cases. The most frequent clinical manifestation is cardiac arrhythmias that are manifested as supraventricular tachyarrhythmias. We report an unusual cardiac manifestation, a case of complete heart block, occurring during the active stage of Wegener granulomatosis. The problem this case presented and the management are reported. The literature dealing with the cardiac involvement in Wegener granulomatosis is reviewed, and the specific histopathologic findings and the pathophysiologic mechanisms of this involvement are discussed.

Adult↗
PubMed1979

Treatment of Thygeson's superficial punctate keratopathy with soft contact lenses.

Three patients had Thygeson's superficial punctate keratopathy; two of whom previously had required prolonged topical corticosteroid therapy for symptomatic relief. The use of therapeutic soft contact lenses provided improved visual acuity as well as symptomatic relief in all three patients. Corneal opacities faded while the soft contact lenses were in place. One patient who had been on long-term topical corticosteroids was gradually taken off this medication with the use of soft contact lens. Another patient noted only mild symptoms from acute episodes while wearing soft contact lenses; only minimal topical corticosteroids were required to control her symptoms. Two additional patients were treated with soft contact lenses. One could not tolerate soft lens wear and the other chose corticosteroid therapy instead of soft lens wear. Soft contact lenses are an acceptable alternative to topical corticosteroid therapy in the treatment of Thygeson's superficial punctate keratopathy.

Adolescent↗
PubMed1978

Scanning electron microscopy of intraocular lens and endothelial cell interaction.

Scanning electron microscopic evaluation of two intraocular lenses removed at keratoplasty for pseudophakie bullous keratopathy demonstrated apparently viable endothelial cells adherent to their surfaces. These presumably adhered to the lens implants at the time of their insertion and confirm this as a mechanism for endothelial damage and subsequent corneal edema from intraocular lens implantation.

Aged↗
PubMed1975

Bacterial endophthalmitis following suture removal after penetrating keratoplasty.

Of three cases of bacterial endophthalmitis occurring after removal of corneal sutures following penetrating keratoplasty, two were associated with wound dehiscence and one was not. Factors that may predispose to wound dehiscence and subsequent infection are: use of fine suture material, corticosteroids, and chronic topical antibiotics; early removal of corneal sutures; lack of adherence to strict asepsis prior to and after suture removal; and open suture tracts that may be kept open by incarceration of vitreous strands. Late corneal wound dehiscence may occur with subsequent development of endophthalmitis as long as three days after suture removal. The use of topical antibiotics before and after suture removal may decrease the potential for infection. In addition, early recognition of intraocular infection by the patient and the surgeon for immediate institution of antimicrobial and anti-inflammatory therapy may preserve useful vision.

Administration, Topical↗
PubMed1975

The incidence of retinal detachment after penetrating keratoplasty.

Of 610 penetrating keratoplasties reviewed, retinal detachments did not occur after any phakic graft, or after aphakic or combined (keratoplasty and cataract extraction) procedures unless these were associated with vitreous manipulation. A 5.4% incidence of retinal detachment occurred after keratoplasty that involved vitrectomy. The resultant detachments had a poor prognosis probably because of delayd diagnosis and difficulties in visualization. Vitreous manipulation, therefore, may be essential to graft clarity but it is hazardous.

Cataract Extraction↗