Lacrimal obstruction after migration of orbital floor implant

A 7-year-old girl developed epiphora, recurrent purulent conjunctivitis, and dacryocystitis 32 months after the repair of a traumatic orbital floor fracture. Dacryocystography and surgical exploration revealed that migration of the orbital floor implant had caused obstruction of the nasolacrimal duct at the sac. Migration of the implant was probably due to a failure to anchor the implant properly to bone.     

Euryblepharon with associated ocular anomalies

Two cases of euryblepharon with other associated ocular abnormalities have been described. Case one showed flattening of the bridge of the nose and an abnormally large distance between the two medial canthi. Case two showed congenital ptosis in one eye and concomitant alternating divergent squint.     

Lacrimal gland inflammation is responsible for ocular pathology in TGF-beta 1 null mice

Mice homozygous for a nonfunctional transforming growth factor-beta 1 gene develop rampant inflammation in vital organs that contributes to a shortened life span. The presence of circulating anti-nuclear anti-bodies, immune deposits in tissues, leukocyte infiltration, and increased major histocompatibility complex antigen expression resembles an autoimmune-like syndrome. One of the overt symptoms that appears in these mice lacking transforming growth factor-beta 1 is the development of dry crusty eyes that close persistently as their health declines. Histologically, the eyes appear normal with little or no inflammation. However, inflammatory lesions, predominantly lymphocytic, develop in the lacrimal glands, disrupting their structure and function and severely limiting their ability to generate tears. This histopathology and aberrant function mimic that of Sj?gren's syndrome, a human autoimmune disease characterized by dry eyes and dry mouth. Impeding the leukocyte infiltration into the glands with synthetic fibronectin peptides, which block adhesion, not only prevents the inflammatory pathology but also prevents the persistent eye closure characteristic of these mice.     

Chronic ocular ischemia associated with the Eisenmenger's syndrome

We studied the ocular findings of two adult patients with the Eisenmenger's syndrome who had atrial septal defects that were diagnosed before the age of 10 years but not operated on and pulmonary hypertension. Both eyes of these patients showed microaneurysms, multiple small blot hemorrhages, or capillary dilation in the temporal peripheral fundus. Multiple microaneurysms and retinal collaterals were confirmed by fluorescein angiography. One of the patients developed bilateral rubeosis iridis with slow progression. These retinal lesions and the rubeosis iridis are probably related to chronic ocular ischemia caused by chronic systemic hypoxia.     

Treatment of upper airway obstruction associated with goiter

The authors examined the resolution of spirometric indices of upper airway obstruction (UAO) following surgical treatment for goiter. The results of a recent study suggest that the integrity of the upper airway remains intact but prolonged recovery is required.     

Systemic toxicity of cyclopentolate hydrochloride in adults following topical ocular instillation

A case reported of a 27-year-old white woman who developed systemic toxicity after the local instillation of one drop of 2% cyclopentolate solution in each eye. The usefulness and toxic reactions of this very valuable drug are discussed. It is recommended that every ophthalmologist should warn not only the parents of the children, but also the adult patients about the possibility of systemic reaction before this drug is used and where possible the lowest concentration of solution be used. It is also suggested that a sufficient amount of injectable physostigmine salicylate be kept handy in the office emergency kit.     

Headaches associated with nasal obstruction due to deviated nasal septum

A deviated nasal septum not only can cause a blocked nose, but may also be associated with headaches. This study evaluates the nature of these headaches, the effect of submucous resection of the nasal septum, and the factors associated with postoperative headache relief. Deviated nasal septa were corrected by submucous resection in 99 men and 17 women. Patients were studied at 4 to 48 months (mean 18 months) postoperatively. Fifty-five of the 116 patients studied (47.4%) had preoperative recurring headaches. Thirty-five of the 55 patients with headaches (63.6%) experienced relief (complete or partial) of their headaches at a mean follow-up period of 18 months. Patients were more likely to be relieved of their headaches following submucous resection if the headaches were most intense over the frontal region, pressurelike in nature, and if the submucous resection resulted in relief of nasal obstruction. It is possible that headaches recur in the long term, and it is postulated that central mechanisms play a role.     

Mucinous biliary obstruction associated with a cystic adenocarcinoma of the pancreas

Obstruction of the biliary tree by large amounts of mucinous material is reported in a patient with a mucin-producing cystic adenocarcinoma of the pancreas invading the common bile duct. Although preoperative endoscopic retrograde cholangiography suggested bile duct invasion, mucinous obstruction, as in the previous cases in which it has been reported, was not suspected. Mucinous obstruction, although unusual, should be considered in patients with cystic carcinomas of the pancreas in the presence of jaundice or episodes of cholangitis.     

Additional cases of ureteral obstruction associated with Henoch-Sch?nlein purpura

AIMS: There is controversy regarding the potential antioxidant effect of captopril, therefore this study was performed to compare the in vitro antioxidant power of captopril with other angiotensin-converting enzyme (ACE) inhibitors. METHODS: Antioxidant power of captopril, enalapril, fosinopril, perindopril, quinapril and ramipril in aqueous solution was measured using the ferric reducing (antioxidant) power (FRAP) assay; captopril was also measured in ethanolic solution. RESULTS: Only captopril showed significant antioxidant power, demonstrating a stoichiometric factor of 1.0 in this assay. Concentration-related antioxidant power was seen in both aqueous and ethanolic solutions. CONCLUSIONS: Captopril shows antioxidant activity in vitro. This property could be relevant in vivo if captopril is concentrated in membranes, lipoproteins or at other important sites.     

Idiosyncratic ocular symptoms associated with the estradiol transdermal estrogen replacement patch system

BACKGROUND: The medical review officer is a position established by federal statute in 1988. The role of the medical review officer is to interpret positive urine drug tests in view of the donor's medical history. With more than 4 million workers affected by the Department of Transportation guidelines for workplace drug testing, and many private employers having urine drug screening programs, there is a need for medical review officers. METHODS: Materials for this report were collected while the first author was pursuing certification from the Medical Review Officer Certification Council. Much of the data was published in the Federal Register from 1988 through 1993. RESULTS AND CONCLUSIONS: Urine drug testing is divided into three stages: collection, laboratory analysis,and medical review of results. Because the workplace urine drug test is a forensic test, the urine is collected under strict chain of custody. Analysis of specimens is conducted by laboratories that have met stringent technical criteria and are approved by the Substance Abuse and Mental Health Services Administration (formerly the National Institute on Drug Abuse). Family physicians are in a unique position to become medical review officers because of their training and professional roles. Educational programs are available for physicians interested in becoming a medical review officer.     

Successful treatment with topical PUVA of nodular cutaneous plasmacytosis associated with alopecia of the scalp

We obtained a successful response to PUVA therapy in a 51-year-old Japanese man who had multiple nodules of the trunk, extremities and scalp along with polyclonal hypergammaglobulinaemia; the scalp lesions were associated with extensive alopecia. Examination of skin biopsies showed a dense infiltrate of mature plasma cells in the dermis and hair follicles; no systemic disease or functional involvement of other organs was detected. The clinical and histological findings were compatible with cutaneous plasmacytosis and treatment with topical PUVA gradually reduced the size and number of the lesions.     

Congenital short bowel syndrome associated with appendiceal agenesis and functional intestinal obstruction

Congenital short bowel with functional intestinal obstruction and absence of appendix vermiformis is a very rare condition with poor prognosis. Seventeen cases of congenital short bowel have been reported previously in the literature. The etiology is unknown. In this report, a case of congenital short bowel, combined with functional intestinal obstruction, mal-rotation, and absence of the appendix vermiformis, is presented and the pathogenesis discussed.     

Nasal obstruction improvement induced by topical furosemide in subjects affected by perennial nonallergic rhinitis

Osteocalcin is mainly secreted by osteoblasts, and then diffuses into blood which can be detected by several experimental methods. This study determined the osteocalcin level by solid phase fluorescent immunosorbent assay (Pharmacia CAP; Sweden), a well-established and accurate laboratory method for determining the minor concentration of substances in blood. A total of 332 healthy children were enrolled in the study, including 176 boys and 156 girls ranging in age from one to fifteen years. It was concluded that (1) quantitative osteocalcin (OCs) value varies between 30.2 to 41.0 ng/ml; (2) there is an incremental tendency in both sexes until puberty; (3) girls generally have a higher osteocalcin level than boys before mid-puberty (2-12 years old). The differences are statistically significant.     

Management and prognosis of advanced ovarian cancer associated with bowel metastasis and obstruction

OBJECTIVE: To investigate the high risk factors and prognostic factors of bowel metastasis and obstruction in the patients with late stage ovarian cancer by analyzing the clinical characteristics and to find out appropriate methods to solve this difficult problem. METHODS: 151 cases with ovarian cancer in stages I and IV who received the treatment from January 1, 1988 to December 31, 1992 were analyzed retrospectively. RESULTS: Operative residues, diffuse bowel metastasis, small intestinal involvement and papillary serous cystadenocarcinoma were found to be high risk factors for bowel obstruction. Age, duration between operation and obstruction, level of CA125 at occurrence of obstruction, numbers of operation and the histologic grade were disclosed as prognostic factors. The prognosis was much worse if the score is more than 6. CONCLUSION: Due attention paid to the high risk factors and the prognostic factors should be emphasized to improve the quality of life and the survival rate.     

Hot spots on liver scans associated with superior or inferior vena caval obstruction

Although hot spots on hepatic scintigrams have been reported in association with superior and inferior vena caval obstruction, these studies were not clinically correlated, and are hampered by the poor resolution of earlier scintillation cameras. In this report, a modern scintillation camera was used to study the formation of hot spots associated with superior and inferior vena caval obstruction. Moreover, radionuclide cavography was performed in 70 patients with superior vena caval (SVC) obstruction and in 95 patients with inferior vena caval (IVC) obstruction. As a result, 13 cases of hot spots in the liver were observed. In cases of SVC obstruction, hot spots were seen in the quadrate lobe, the medial segment, and the bare area of the liver. In IVC obstruction, a hot spot was seen in the quadrate lobe in all cases. In rare instances, in cases of both SVC and IVC obstruction, a hot spot was seen in the wide area. For these hot spots to develop, it appears necessary to have systemic-portal venous blood flow through the internal thoracic vein and the paraumbilical vein.     

Suppression of ongoing ocular inflammatory disease by topical administration of plasmid DNA encoding IL-10

Ocular infection with herpes simplex virus leads to an inflammatory lesion in the cornea orchestrated by CD4+ Th1 lymphocytes. This immunopathologic disease, called herpetic stromal keratitis, is an important cause of impaired vision. In this study, we set out to determine whether established lesions of herpetic stromal keratitis could be controlled by topically administering naked plasmid DNA encoding cytokines to the corneal surface. A single topical administration of DNA encoding IL-10 was beneficial to the majority (75%) of treated animals, and 50% (vs 10% in controls) resolved their lesions completely over a 23-day observation period. Topical ocular application of DNA encoding foreign proteins was also shown to be an effective means of inducing systemic and mucosal immune responses. The direct application of DNA encoding cytokines may represent an additional therapeutic option for the management of immunoinflammatory disease.