[Floppy eyelid syndrome: light and electron microscopy studies]

A 60-year-old patient with "Floppy Eyelid" syndrome was treated by wedge-shaped lid resection. The excised tissue was studied by light and electron microscopy. Apart from the signs of chronic inflammation already described no abnormality was found in the ultrastructure or distribution of the collagen and elastic fibers of the tarsus.

[An unusual cause of amblyopia ex anisometropia]

The case history is reported of an infant with a capillary haemangioma in the superior temporal quadrant of the anterior right orbit. Radiotherapy was not performed in view of the well-known tendency of these tumours to involute. Constant pressure on the globe led to marked oblique astigmatism of the eye with consequent amblyopia, in spite of complete regression of the lesion. The tendency of such tumours to regress must be weighed against possible irreversible functional impairment when a decision is made as regards treatment of neonatal haemangiomas in the region of the orbit.

[Post-traumatic endophthalmitis caused by Bacillus cereus]

A young man with severe endophthalmitis caused by B. cereus is described following a trauma with an intraocular foreign body. Although this organism was isolated from the aqueous with 18 hours and specific antibiotic therapy instituted, the eye subsequently lost all function and had to be enucleated because of severe pain. An extremely rapidly developing corneal ring abscess seems to be the hallmark of an intraocular infection with B. cereus organisms.

Fine structure of tapioca melanoma of the iris

A case of a tapioca melanoma of the iris is studied by light and electron microscopy. Nodular elevations of the tumour were composed of spindle B- and epitheloid cells and of what appeared to be intermediate types. Tiny structures scattered over the entire tumour consisted of smaller epitheloid cells, many of which were found around superficial tumour vessels. Evidently, tapioca melanoma of the iris does not represent any specific histopathological entity. Tapioca melanoma of the iris is a low-grade malignant, locally aggressive tumour with a chronic clinical course.

[Gonioscopic changes following cyclocryocoagulation]

Gonioscopic changes after cyclocryocoagulation are reported in 4 patients with angle-closure glaucoma resistant to all forms of therapy. During cryoapplication frozen aqueous humor was observed in the chamber angle near the treated area. Widening of the angle followed in the same place. Possible causes of this change are reported.

[Conjunctival replacement--comparative animal experiment study]

In a rabbit study a new material for conjunctival reconstruction was compared to lyophilized, amniotic membranes, which have been used for a long time. Standardized conjunctival defects were covered with thin, heterologous, glutaraldehyde-treated pericardium in one group, while in the other group lyophilized amnion grafts were used. In addition, conventional running suture fixation of the patches was compared to a fibrin sealing technique. The macroscopic findings during the follow-up period and the histological results are reported.

[Human corneal fibroblasts and a human conjunctival cell line (Chang) produce a thymocyte-activating factor (TAF) in vitro]

A variety of distinct cells such as fibroblasts, epidermal cells, glioblastoma cells and corneal epithelial cells have been shown to produce Interleukin 1-like thymocyte-activating factors. Under in vitro conditions these cytokines influence a multiplicity of different cell types, including lymphocytes, fibroblasts, PMN and hepatocytes. In the present study human corneal fibroblasts, as well as the human epitheloid conjunctival Chang cell line were found to produce thymocyte-activating factors (TAF). The molecular weight of the corneal fibroblasts-TAF was found in the 670 kD region, with minor peaks of activity at 30, 17 and 4 kD. TAF from the Chang-cell line eluted at 15-25 kD. Chromatofocusing revealed the pI of the fibroblast-TAF to be at 6.7 and 5.2 and the pI of the conjunctival cells to be at 7.0, 5.3 and 5.0. The latter cells produced prostaglandin E2 upon stimulation. The immunomodulating properties of these cytokines make an important in vivo role in the pathogenesis of inflammatory corneal and conjunctival diseases probable.

[Treatment of primary acquired melanosis of the conjunctiva]

The progression to malignancy of primary acquired melanosis of the conjunctiva with cytologic atypia is often insidious and may not be recognized clinically. Because of the bad prognosis of such melanomas, destruction of the intraepithelial lesion has been recommended. We have been freezing proliferative melanosis with the aid of a cryoprobe. A double freeze-thaw cycle at -70 degrees to -80 degrees was sufficient to destroy the epithelium and eradicate atypical melanocytes without serious complications. Focal nodules, arising in acquired melanosis representing invasive melanomas, however, should be excised initially. Cryotherapy may then be applied to the base and surroundings of the tumor.

[Treatment of venous thrombosis of the retina with prostacyclin]

Prostacyclin (PGI2) was used in the treatment of 10 patients with retinal venous thrombosis. All changes in 6 eyes with the non-ischaemic type of venous obstruction resolved completely, with marked visual improvement. The course of 3 ischaemic venous thromboses was unaffected by the treatment. In one eye ischaemic retinal areas were first noted months after therapy. All ischaemic fundi were subjected to adequate laser coagulation. In spite of the small number of patients it can be concluded that PGI2 does not seem to alter the course of the ischaemic type of retinal venous thrombosis.

Treatment of scaphoid nonunion by volar inlay distal radius bone graft

Volar inlay corticocancellous bone grafting is an accepted method of treatment for symptomatic nonunion of the carpal scaphoid. Performance of this procedure with a radial graft without styloidectomy yields results comparable to those obtained with iliac grafting. This permits the operation to be performed through a single incision. The elimination of the need for iliac dissection avoids morbidity associated with the iliac exposure.

Behavior and neurobehavioral teratology using the ferret

A behavioral profile of the ferret is presented for those who would like to use this animal in behavioral teratology and toxicology, or other disciplines involving behavior. We have reviewed neurobehavioral teratology of lisencephalic ferrets and neuropsychology of ferrets sustaining frontal lesions, as well as most of the studies of "normal" ferret behavior that have appeared in the research literature. Emphasis is placed on discussion of the tests used and how ferrets behaved on them. The behaviors discussed include spatial (maze) learning, delayed response, visual discrimination learning, discrimination learning sets, schedule maintained behavior, shock avoidance learning and spontaneously occurring behaviors, such as ambulation in open field, spontaneous alternation and species specific behaviors. Although the use of the ferret in behavioral experiments is not yet extensive and large gaps exist in our knowledge about the basic functional capacities of this animal, the ferret is unquestionably well suited for behavioral studies.

[Antiarrhythmic effect and side effects of amiodarone]

Amiodarone (AM) is one of the most potent antiarrhythmic drugs, the value of which is limited by reversible and irreversible side-effects (SE). 59 patients, 50 male, 9 female (age 33 to 81 years) entered the study with ventricular tachycardia (VT, 68%), WPW-tachycardia (12%), non-sustained VT (12%) or untreatable paroxysmal atrial fibrillation or supraventricular tachycardia (8%). Prior to AM the patients had received 1 to 8 different antiarrhythmic drugs (m 3.5) and maximal 9 different combinations of antiarrhythmics. The drug regimen started with a loading dose of 1200 mg/d for 1 to 2 weeks and was continued with a maintenance dose of 200 to 600 mg/d. The patients were followed up 1 to 41 months (m 14 m). The drug effect was evaluated using clinical criteria (recurrence of arrhythmias, death), computer-assisted analysis of several 24 hr long-term ECGs and programmed electrophysiological stimulation. Three- to six-monthly the patients were seen in our outpatient department for check up and blood-sample analysis (liver, thyroid gland etc.). Also in the majority of the patients frequent ophthalmological and dermatological investigations, as well as lung functions tests were carried out.

RESULTS

under AM therapy the initial arrhythmias were no longer detectable in 41% of the patients. In 37% a significant amelioration of the formerly life-threatening arrhythmias was found. 7 patients (12%), predominantly with reduced left ventricular function, died during follow up. No pulmonary, hepatotoxic or neurological SE were found. All patients developed reversible AM keratopathy. In 27% ETR and T4 were elevated, but only one patient developed hyperthyroidism with an increase in TT3. Another patient showed signs of hypothyroidism with an elevated TSH prior to TRH stimulation. Increased phototoxicity was found in 31%, whereas in two patients typical AM hyperpigmentation occurred, especially on the face. In conclusion, AM is a highly effective antiarrhythmic agent, despite a negatively selected collective, but it should only be used in patients with refractory arrhythmia in view of the SE.

EEG and seizure threshold in normal and lissencephalic ferrets

Changes in EEG and susceptibility to electrically induced seizures were examined in the ferret with lissencephaly produced by exposure to a single injection of methylazoxymethanol acetate (MAM Ac) given to the pregnant jill on gestation day 32. Ten lissencephalic and 11 normal ferrets were chronically implanted with 14 cortical stainless steel electrodes. EEG records were sampled from various stages of the sleep/awake cycle. Six of each group were subjected to electrical stimulation for seizure threshold. Although the number of stimulations and the current intensity required to produce epileptiform afterdischarges (AD) and seizures were not different between the two groups, the lissencephalic ferrets had significantly longer AD and seizures, and a greater number of generalized seizures, indicating an enhanced seizure susceptibility. The EEG of the lissencephalic ferrets was characterized by increased slow wave activity within the low theta band range, extreme spindle activity, focal or multifocal slow and sharp waves, spikes, or spike and slow wave complexes. The differences in the EEG were more pronounced during drowsiness and sleep stages. The brains of all of the treated animals were lissencephalic and hydrocephalic, and weighed significantly less than those of the normals. The cerebral cortex was thin and flattened, with the parieto-occipital region most severely affected. Heterotopic foci were found in the cerebellum as well as in the cerebral cortex. Abnormalities in the configuration of the cerebellar folia were also seen. Comparison between the electrophysiological and neuropathological data suggests that the extent of the extreme spindle activity, and longer AD and seizure duration depended on the degree of cerebellar dysplasia, whereas the EEG focal abnormalities were related to lesions in the cerebral hemispheres.

A complication of posterior glenoid osteotomy for recurrent posterior shoulder instability

Posterior glenoid osteotomy (posterior glenoplasty) is a standard surgical reconstructive operation for recurrent posterior instability of the shoulder. A 34-year-old man was treated by glenoid osteotomy and subsequently developed significant glenohumeral arthritis. Following several surgical procedures, only total shoulder arthroplasty gave substantial pain relief and restored stability. Inadvertent penetration of the glenohumeral joint at the time of osteotomy may have predisposed the patient to glenohumeral arthritis. Extreme care should be exercised not to damage the shoulder joint during this procedure.

Persistence of visna virus in cultured ferret brain cortex and fibroblasts

Cerebral cortex tissue fragments from newborn ferrets have been cultured in vitro and, when exposed to visna virus, failed to exhibit a cytopathic effect but retained the genome of the virus in a quiescent state for 46 d before synthesizing plaque-forming virus for the subsequent 26 d. In contrast, infection of an established line of cells derived from a ferret's brain with visna virus resulted in the formation of the polykaryocytes typically produced by this virus and a limited synthesis of plaque-forming virus. Ferret cerebral cortex cultures may be suitable in vitro hosts for studies to define the virus-host interactions that result in virus-induced demyelination.

Neurotransmitter chemistry of lissencephalic cortex induced in ferrets by fetal treatment with methylazoxymethanol acetate

Treatment of pregnant ferrets with 15 mg/kg of methylazoxymethanol acetate (MAM) at 33 days of fetal gestation results in offspring with cortical hypoplasia and lissencephally. Neurochemical analysis of 5 areas of cortex from 8-week-old offspring of MAM- or vehicle-treated jills indicated an overall enrichment in markers for catecholaminergic (tyrosine hydroxylase, norepinephrine) and cholinergic (choline acetyltransferase, acetylcholine) terminals but minimal change in the concentration of GABAergic markers (glutamate decarboxylase, gamma-aminobutyric acid); however, there did not appear to be a direct, inverse relationship between the concentration of catecholaminergic and cholinergic markers and the degree of hypoplasia in cortical subareas unlike what has been found previously in the rat.

[Lipogranulomatous inflammation of the caruncle (author's transl)]

A 40-year-old man developed a pea-sized nodular tumor of the caruncle with reddening of the inner canthus of one eye. Histological examination revealed a lipogranulomatous inflammation, similar to that commonly seen on the lid margin.

[The effect of neural mediation on the immediate rise in intraocular pressure in glaucomatous eyes after cyclocryotherapy (author's transl)]

As a rule, there is a transient rise in intraocular pressure following cyclocryotherapy. The preoperative administration of retrobulbar anaesthesia to a group of patients significantly reduced intraocular pressure after cyclocryotherapy in this group as compared with a control group without anaesthesia. These results imply that the temporary rise in intraocular pressure after cyclocryotherapy is mediated by a neural pathway.

The thymus and myasthenia gravis

The relationship between the thymus and the pathogenesis of myasthenia gravis is reviewed. Ten cases of myasthenia gravis who underwent thymectomy at the American University Hospital of Beirut are presented. The various pathologic features of the thymus encountered in myasthenia gravis are presented. The indications for thymectomy and the results of surgical intervention on the course of the disease are reviewed. The conclusion is made that thymectomy should be done on all patients with generalized myasthenia gravis irrespective of age, sex, duration of disease or pathological features of the thymus.

Mediation of the ocular response to cyclocryocoagulation

The possible roles of prostaglandins and a neural pathway in the disruption of the blood-aqueous barrier in the rabbit eye after cyclocryocoagulation were studied. Both the preoperative IV administration of the prostaglandin inhibitor acetylsalicylic acid and the application of retrobulbar and topical anesthesia reduced IOP and decreased breakdown of the blood-aqueous barrier, as measured by protein in the aqueous humour. These results imply that the acute response of the animal eye to cyclocryocoagulation is mediated partly by prostaglandins and partly by a neural component resistent an inhibitor of prostaglandin synthesis. When administered together, acetylsalicylic acid and ocular anesthesia yielded a further reduction in postoperative reactions and protein concentrations in the aqueous humour, but were unable to abolish the ocular response completely. The dual ocular mediation to cyclocryocoagulation is apparently due to the combined thermal and mechanical injury caused to ocular structures which synthesize prostaglandins and receive sensory innervation from the trigeminal nerve. The considerable breakdown of the blood-aqueous barrier in cyclocryocoagulation allows leakage of different molecular weight proteins, in equal ratio, into the aqueous humour.

Decompensation of chronic open-angle glaucoma following mydriasis-induced pigmentary dispersion into the aqueous humour: a light and electron microscopic study

A patient with well controlled chronic open-angle glaucoma developed after dilatation of both pupils persistent increase in intraocular pressure (IOP) due to extensive pigmentary dispersion into the aqueous humour. Trabeculectomy specimens obtained from both eyes after 3 and 7 weeks were studied by light and electron microscopy. It seems evident that the initial phase of raised IOP was caused by a clogging mechanism to the outflow channels by melanin and phagocytic cells. The permanent increase in IOP is attributed to the damage induced in the fibrous components of the trabecular sheets as a result of a complete breakdown of their endothelial covering.

[Arden test for early glaucomatous damage (author's transl)]

With the aid of the Arden grading test 27 eyes with early glaucomatous visual field defects and 80 normal control eyes were examined in a double-blind study. Eighteen eyes with early glaucomatous visual field defects had values which were clearly higher (83-130) than the control eyes. In nine of the diseased eyes Arden scores were 68-82, i.e., similar to those obtained in the normal eyes.

[Timolol in the treatment of glaucoma (author's transl)]

Untolerated or insufficiently effective Therapy in 32 patients (63 eyes) with primary open-angle glaucoma was discontinued and substituted with Timolol, and all patients were followed up over a period of 60 weeks. Timolol was well tolerated in all cases without any local or systemic side effects. Either alone or in combination with other medications Timolol brought about an adequate reduction in intraocular pressure in eyes which hitherto had no longer responded to conventional conservative therapy.

[Problems arising from the use of cosmetics on the lid margin (author's transl)]

Report on clinical and histopathological changes of the conjunctiva after long-term use of cosmetics containing carbon black (mascara, eyeliner) on the lid margin. Penetration of tiny pigmented particles into the stroma of the conjunctiva initially causes a follicular reaction which is evidently toxic, and later, results in a chronic follicular-papillary reaction.

[The gelatinous cystic nevus of the conjunctiva (author's transl)]

The gelatinous cystic nevus is both histologically and biomicroscopically a very typical form of conjunctival venus. A report on two cases serves to illustrate the indications for an operative procedure. In one case an incisional biopsy was performed, in the other an excisional biopsy. In neither case was there any histological evidence of malignancy.

[Intrabulbar and peribulbar reactive lymphoid hyperplasia]

Report on a 69-year-old woman with a choroidal and a large peribulbar tumor. A scan ultrasonography of the peribulbar mass revealed a homogeneous structure of the lymphoma/sarcoma/pseudo-tumor type. Histological examination disclosed a reactive lymphoid hyperplasia without "Dutcher bodies", and consistent with a benign lymphoma.

[Sclerocorneal cyst following squint operation (author's transl)]

In an 11-year-old girl the left eye developed a sclerocorneal cyst seven years after a bilateral squint operation. The cyst was excised and a lamellar corneal graft was performed. Histopathology revealed a cyst formed by nonkeratinizing stratified squamous epithelium.

Cyclocryokoagulation. Sequelae of induced alterations and effect of a prostaglandin-inhibitor on the breakdown of the blood-aqueous barrier

Histopathological changes following cyclocryokoagulation in a group of rabbits pretreated with acetylsalicyclic acid (ASA) were studied and compared with similar changes in a control group. As observed clinically, macroscopical and histological differences were only noted in the early phase after the procedure. In this phase, all operated eyes revealed an immense vascular response with edema, exudation and extravasation of blood cells. The treated animals, however, showed some reduction of tissue edema than the animals not treated. At a later stage there is an necrosis of the stroma with reduction of small vessels and tissue cells. The reparative process, tending to restore both epithelial and stromal lesions, begins already in the 3rd. week after cyclocryokoagulation. Neither the epithelial nor the stromal alterations differed significantly in any of the operated eyes at this stage. This indicates that ASA mainly affects an obviously prostaglandin-mediated acute vascular response. The disruption of the epithelial barrier may be aggravated by the subsequent stromal alterations, but does not seem to be influenced by ASA.

[On the distribution of fat in eyes and brain in experimental fat embolism (author's transl)]

In 18 rabbits a mixture of 131-J-labeled Triolein and purified olive oil was injected intravenously. Afterwards the radioactivity of the eyes and the brain was measured. The relation of distribution of fat between eye and brain differs markedly, even when the surface tension was controlledly altered by admission of essential phospholipids.

[Inhibition of secondary increase of intraocular pressure following cyclokryocoagulation (author's transl)]

Prostaglandin mediated transient increase in intraocular pressure following cryokoagulation of the ciliary body in rabbits was completely inhibited by preoperative administration of Aspisol (D, L-Lysin-mono-(acetylsalicylat)). To avoid additional increase in intraocular pressure in patients chosen for cyclocryotherapy, pretreatment with Aspisol could prove to be effective.

[Multiple conjunctival malignant melanomas (author's transl)]

5 1/2 years after excision of pigmented malignant melanoma which apparently arose in a nevus of the paralimbal bulbar conjunctiva, this 42-year-old male presented himself with a nonpigmented mass of the lid margin which also proved to be a malignant melanoma. "Acquired melanosis sine pigmento" was considered as a site of origin, but histopathologically there is more evidence that this melanoma arose in a non-pigmented compound nevus.

Metastatic calcification to the peripheral fundus in chronic renal failure

Report on massive deposition of calcium hydroxypatite in the eye of a 20-year-old woman who died as a result of chronic renal failure. Massive accumulation of this material within the previtreal space lead to an unusual finding in the peripheral fundus.

Benign adenoma of the ciliary epithelium with tumour seeding

Report on a benign epithelioma of the ciliar body which caused cataract and dislocation of the lens in a 44-year-old woman. Tumour seeding was a remarkable finding, and is a result of disruption of the epithelial lining due to active production of mucopolysaccharides by tumour cells.

Persistent hyperplastic primary vitreous. A clinicopathologic study of 62 cases and review of the literature

This is a clinicopathologic study of 62 cases of persistent hyperplastic primary vitreous (PHPV). The cases were divided into two main groups. Group 1 consisted of 55 unilateral cases not associated with any systemic abnormalities, including 36 eyes (58%) which were considered "pure cases" (Group 1A) and 19 (31%) which disclosed other ocular abnormalities in addition to PHPV (Group 1B). Group 2 consisted of 7 (11%) bilateral cases of PHPV accompanied by other ocular and systemic malformations. The most common presenting clinical signs are leukocoria, microphthalmia and cataract. The main histopathologic features of this condition are outlined, including those responsible for the disastrous results to the eye (retinal detachment, glaucoma, phthisis bulbi). Several clinical entities, usually mistaken for or associated with PHPV, such as retinoblastoma, congenital cataract, retinal dysplasia, trisomy 13 syndrome, and falciform retinal folds are discussed briefly.

[Doppler ultrasonography of orbital vessels in temporal arteritis (author's transl)]

Doppler Ultrasonography of the orbital vessels is a simple non invasive technique for the qualitative determination of velocity and direction of blood flow within the supratrochlear and supraorbital arteries. In temporal arteritis characteristic findings can be obtained with this method. The amplitudes of ultrasonograms are markedly reduced and the waveforms considerably distorted. Sometimes there is a complete absence of velocity signals from the orbital vessels. When the superficial temporal artery is compressed abnormal reactions are almost always elicited, whereas the compression of the homolateral carotid artery yields normal results. In temporal arteritis, the diagnostic value of Doppler ultrasonography of orbital vessels seems about as great as that of Hager ophtalmodynamography.

[The influence of gravity on the distribution of fat embolism in the eye (author's transl)]

In human fat embolism we often find different grades of changes in both eyes of a patient. This was experimentally verified in rabbits. The anesthetized animals were held in lateral position so that one eye was continuously higher than the other. Labelled fat was injected intravenously, and then the activity in each eye was measured by a scintillation-counter. By this method a significantly higher rate of fat embolism was found in the upper eye.

[An unusual eyelid tumor (author's transl)]

A 68-year-old man presented with a rapidly growing upperlid tumor which due to multiple recurrences was excised 5 times within 4 years; and ultimately invaded the orbit. An orbital exenteration was performed. The unusual clinical course and the A-Scan sonographical findings of this tumor were most probably due to its uncommon histological features which proved to be an undifferentiated squamous cell carcinoma with features of Epithelioma metatypique intermediaire Darier.

Unusual superficial variant of granular dystrophy of the cornea

Two patients with a superficial variant of granular dystrophy of the cornea occurring primarily in nongrafted eyes developed rapid progression of clinical manifestations and visual deterioration at an early age. No other members of their family were known to be affected. A clinical diagnosis of superficial corneal dystrophy, type undetermined, was made. The histopathologic features of the corneas resembled the findings seen in Reis-Bücklers dystrophy and led to some confusion in the differential diagnosis. Electron microscopic studies in both cases unequivocally established the diagnosis of granular dystrophy.

Cerebro-hepato-renal syndrome of Zellweger. Ocular histopathologic findings

An infant who was the product of a full-term pregnancy was born with multiple congenital defects, including diffuse bilateral corneal opacification. He failed to thrive and died at the age of 4 days. Autopsy findings were consistent with those seen in the cerebro-hepato-renal syndrome. Histopathologic examination of both eyes, obtained at autopsy, demonstrated similar changes. The main pathologic findings in the anterior segment were bilateral, diffuse corneal edema associated with paracentral iridocorneal adhesions and focal attenuation of Descemet membrane. Both retinas disclosed a selective degeneration of the outer nuclear layers and photoreceptors, confined mainly to the macular region. Atrophy of the optic disc and nerve, with reactive gliosis and demyelination, were consistent with findings in the central nervous system described in this syndrome.

Position reversal deficit in young ferrets

Young ferrets (6 and 10 weeks old at the start of the experiments) were compared to adult ferrets on learning (1) a Lashley III maze, (2) a left-right discrimination in T-maze with identical choice arms, and (3) a reversal of the left-right discrimination. The young were not inferior to the adults in learning either the Lashley III maze or the initial discrimination in the T-maze. However, the young were markedly (and significantly) inferior to the adults in learning to reverse.