The survival of moraxella on the conjunctiva in pyridoxine deficiency.
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A 65-year-old white man had an unusual disseminated lymphoid tumor that first appeared in the subconjunctival tissues of the right eye. The tumor later appeared in the skin, lymph nodes, and left upper eyelid and orbit. A monoclonal serum IgA spike was present although the urine did not contain Bence Jones proteins. The cells of the tumor appeared to be plasmacytoid lymphocytes. Prominent intranuclear inclusions, or Dutcher bodies, were present. Throughtout the 11-year history, the patient has been treated only with local excision and radiation.
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Four patients with carcinoma in situ were treated with strontium-90 beta ray application. The dose used was 4,500 rads after surgical removal or with small recurrent tumor and 7,000 rads for primary treatment. All patients were disease-free at follow-up periods of 48 to 320 months after treatment. One patient required superficial x-ray treatment for recurrent disease. No serious complications developed with the treatment and no progressive cataracts have occurred.
Six patients underwent combined Jones tube-canalicular intubation and conjunctival dacryocystorhinostomy. These patients had epiphora secondary to partial obstruction of the upper and lower canaliculi, complete obstruction of the common canaliculus or a single canaliculus, or paresis of the orbicularis oculi muscle. In these patients we would have performed a dacryocystorhinostomy with silicone elastic intubation, risking recurrent obstruction, or a conjunctival dacryocystorhinostomy with placement of a Jones tube, risking failure of the procedure and complete obstruction of patent canaliculi by placement of the tube. The combined Jones tube-canalicular silicone elastic intubation and conjunctival dacryocystorhinostomy ensured successful treatment of epiphora for this group of patients. Intubating the canaliculi with Bowman probes during placement of the Jones tube avoids injury and subsequent postoperative canalicular obstruction. After several months, the silicone elastic tubing is removed and the Jones tube is plugged. If the patient is asymptomatic and the canaliculi are patent and can be irrigated freely to the nasal cavity, the Jones tube can be removed. However, if epiphora occurs, the plug can be removed and the tube left in place to drain the tears without additional surgery.
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Platelet-activating factor (PAF) (1-O-hexadecyl-2-acetyl-sn-glyceryl-3-phosphorylcholine) produced dose-dependent depletion of the goblet cell population associated with the conjunctival epithelium. Reductions in goblet cell numbers did not correspond to leukocyte infiltration and were consistent with a direct effect of PAF. In contrast, LTD4 and LTE4 did not affect the goblet cell population although they caused massive eosinophil infiltration into the conjunctival epithelium. Histamine also produced conjunctival goblet cell depletion, but this appeared secondary to eosinophil degranulation and resultant epithelial desquamation. In addition to goblet cell expulsion, PAF produced an increase in conjunctival microvascular permeability over an identical dose-range. PAF-induced leukocyte emigration was small or absent and comprised a neutrophil infiltrate which exhibited no clear dose-dependent relationship. Lyso-PAF produced effects only at the highest dose employed where pathological changes and a distinct increase in conjunctival microvascular permeability were evident. Lyso-PAF- and PAF-induced increases in conjunctival microvascular permeability were virtually abolished by the PAF antagonist CV-6209. The pronounced inhibitory activity of CV-6209 suggests that high doses of lyso-PAF may either weakly stimulate conjunctival PAF receptors or that there may be sufficient conversion of lyso-PAF to biologically active levels of PAF.
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Paraffin-embedded and frozen biopsies from the human conjunctival epithelium were examined by fluorescence microscopy after labeling with eight fluorescein-conjugated lectins: wheat germ agglutinin; soybean agglutinin; peanut agglutinin; Ricinus communis agglutinin-1; Limulus polyphemus agglutinin; Ulex europaeus agglutinin-1; Dolichos biflorus agglutinin; concanavalin A. The lectins were used as specific molecular probes to detect carbohydrate composition of glycoproteins secreted from the conjunctival goblet cells. The labeling pattern of goblet cells and conjunctival epithelial surfaces with various lectins suggested that N-acetyl-glucosamine, galactose, N-acetyl-galactosamine and sialic acid are contained in goblet cells and contribute to the formation of tear mucus glycoprotein. Fucose and mannose, which are present in the tear mucus, were not detectable in goblet cells.
The rate of disappearance from the tear film of fluorescein and rhodamine dextran instilled together into the human eye was compared. In many cases fluorescein disappeared more rapidly, which was attributed to its penetration across the conjunctival surface. A corresponding mean fluorescein permeability across this surface of 2.5 x 10(-5) cm min-1 was calculated. This route of loss of fluorescein from the tears leads to an average overestimate of tear turnover of 25%.
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