Annual Session of The American College of Prosthodontists. San Diego, CA, September 16-19, 1998. Abstracts

Recent clinical trials have indicated that an automated smear apparatus (ThinPrep process) of sample preparation has great diagnostic sensitivity. In this study, conjunctival brush cytology prepared using the ThinPrep method was applied in ocular surface disorders especially for dry eye status. To assess its diagnostic value in cellular samples, 35 patients with keratoconjunctivitis sicca (KCS) and 12 normal volunteer patients were examined using this technique. Conjunctival cells from normal controls revealed fine chromatin and polyhedral cytoplasm without keratinized cytoplasm. However, cellular samples from KCS revealed increased keratinized cells with pyknotic nuclei. They also contained extremely elongated cells. In KCS patients, the mean numbers of keratinized cells were significantly higher (32.3 cells/300 cells) than those of the normal control group (0.2 cells/300 cells). In patients with KCS, inflammatory cell counts were also higher than those of normal controls. Conjunctival cytology by the ThinPrep method obviously deserves additional trials as an adjunct to cytological evaluation of dry eye status, especially for quantitative ocular evaluation of various ocular lesions.     

The "dry eye" phenomenon and ovarian function. Study of 700 women pre- and postmenopausal

One kind of extragenital effects of estrogens are those on the eye-a topic that should interest gynecologists and ophthalmologists alike. The frequency of ovarian function being relevant to the complaint "dry eye" was the subject of a study among more than 700 women. 1.4 out of 11 particular symptoms related to the "dry eye" showed a lower incidence among postmenopausal women receiving oral estrogen-therapy than among those postmenopausal patients without estrogen substitution. Examples for this are epiphora in 16% respectively 32% and visual disturbance in 27% respectively 3% of patients. 2. The more time had passed since the entrance to menopause the more some symptoms increased without estrogen substitution respectively decreased under estrogen-therapy, e.g. visual flicker more than 10 years after menopause: 35% versus 10%. 3. The symptoms of the "dry eye" are most often medicable by estrogen substitution below the age of 60 years. 4. Postmenopausal women aged under 60 years and not receiving estrogen substitution complained of "severe eye problems" in 32% those with estrogen-therapy in only 11% of cases. 5. During child-bearing period the symptoms of the "dry eye" are also relevant to gynaecological practice. Seven of the 11 particular symptoms showed higher incidence among patients taking ovulation inhibitors than among those having spontaneous menstrual cycles. Visual flicker in 42% respectively 24% of patients may serve as an example. This study demonstrates that functional disorders of tear film with symptoms of keratoconjunctivitis sicca are "relatively often" related to ovarian steroids- and therefore to gynecological practice.     

Influence of axial length on visual field defects in primary open-angle glaucoma

With the high frequency of myopia in Taiwan, potential complications or associated conditions, such as glaucoma, are of great concern. To investigate the role of axial length in glaucoma, we enrolled 307 primary open-angle glaucoma (POAG) patients from 1986 through 1996. For the control group, 124 persons were recruited from a survey of a non-glaucoma population and the Ophthalmology Out-patient Department of the National Taiwan University Hospital. Routine eye examination, stereophotography of the optic disc, automated visual field tests, and A-scan ultrasonography were performed on each patient. The Glaucoma Hemifield test was used for analysis of visual field results. The mean axial length was longer in the POAG group than in the control group, especially in the younger age groups (40-59 yr). The POAG group was divided into a short-axial-length (SAL, axial length < 26 mm) group and a long-axial-length (LAL, axial length > or = 26 mm) group. Both subgroups had the deepest visual field defects in the upper and lower nasal areas. The LAL group had deeper visual field defects and the defects were more frequently involved in all sectors analyzed than the SAL group defects. The upper visual field had deteriorated more in the SAL group, whereas the depth of scotoma was similar in the upper and lower hemifields in the LAL group. Our results support the idea that glaucoma patients have a longer axial length than people without glaucoma, and that visual field defects are more pronounced in patients with LAL than in those with SAL.     

Influence of glaucomatous visual field loss on health-related quality of life

We examined the influence of glaucomatous visual field defects on vision-targeted and generic health-related quality of life. Vision-targeted and generic health status were assessed across 5 glaucoma treatment categories and a normal reference group from 5 tertiary care ophthalmology practices during regularly scheduled eye care visits. The sample consisted of 147 patients who were members of specific glaucoma treatment categories and 44 reference group patients. For patients with glaucoma, eligibility included a diagnosis of glaucoma at least 1 year prior to enrollment and no evidence of other eye disease. Participants completed 2 vision-targeted surveys, the National Eye Institute Visual Functioning Questionnaire and the VF-14, and a generic health-related quality of life measure, the Medical Outcomes Study 36-Item Short Form. Data from automated perimetry (Humphrey Field Analyzer 24-2, Humphrey Instruments, San Leandro, Calif) were used to generate Advanced Glaucoma Intervention Study scores for all participants. The Medical Outcomes Study 36-Item Short Form scores from glaucoma and reference group participants collected on a random half of the sample were similar. However, comparisons of the vision-targeted surveys demonstrated significant mean differences on 7 of 11 National Eye Institute Visual Functioning Questionnaire scales, and a trend toward significant differences for the VF-14 (P < .07 by linear regression). Greater visual field defects in the better eye were significantly associated with poorer National Eye Institute Visual Functioning Questionnaire scores (P < .05), as well as with worse VF-14 scores. These findings were most dramatic for patients with the most severe field loss in the better eye. Vision-targeted questionnaires were more sensitive than a generic health-related quality of life measure to differences between glaucoma and normal reference participants. Our findings indicate that self-reports of vision-targeted health-related quality of life are sensitive to visual field loss and may be useful in tandem with the clinical examination to fully understand outcomes of treatment for glaucoma.     

Special indications for the use of soft contact lenses as a drug-release-system (author''s transl)

Research has been performed, both experimentally and clinically, to establish the value of the association of soft contact lenses and some types of eye drops. The use of soft contact lenses with eye drops may be useful in some special cases: a) more prolonged and more sustained effect compared with the usual way of administration of eye drops (especially antiglaucomatous substances, antimetabolites, mydriatics); b) possibility of reducing the concentration to avoid local discomfort or systemic side-effects, without loss of their effectiveness on the eye conditions to be treated. The combined use of soft lenses (12.5-15 mm in diameter) with eye drops may be obtained either by presoaking the lens in the liquid or by regular instillation of eye drops after insertion of the lens; the two techniques may of course be associated. In the present research the advantages of utilizing hydrophylic lenses with osmotically active substances, to obtain a better and more protracted dehydration of the cornea, were first examined, in vitro and in vivo. The following substances were tested: 10% propylenglycol, 10% glycerol, 10% glucose and 5% natrium chloride. The clearing effect of the different types of treatment was evaluated in 45 patients with edematous bullous keratopathy with an instrument which measured the infrared light emitted by an optic fiber and reflected by the cornea. The effects were more marked for the epithelial than for the stromal oedema. Another group of investigations was performed with two polypeptides with high molecular weight: Eledoisin, extracted from a mediterranean octopus, Eledone moschata, and Physalaemin, extracted from the skin of a south american batrachian, Physalaemus fuscomaculatus, both of these stimulate the lacrimal secretion and were previously successfully employed topically by the authors against keratoconjunctivitis sicca. The increase of the amount of fluid was however short-lived. Eledoisin at a concentration of 200 mug/ml, was examined in its effects both in vitro and in vivo, whereas physalaemin, at a concentration of 20 mug/ml, only in vitro, owing to the present shortage of the product. The clinical tests in 23 eyes of 14 patients with keratoconjunctivitis sicca proved satisfactory, since the lacrymal stimulating effect is not only greater, but lasts three times longer by combining the instillation of eledoisin with a presoaked soft lens. Some antiglaucomatous products (propranolol, clonidine, prostigmine) were, finally, used in association with a soft lens to reduce the concentration of the eye drops for a better tolerance locally (propranolol: a beta-adrenergic blocking agent) or generally (clonidine: alpha-adrenergic agent), also with the advantage of protracted release. With propranolol the concentration could be reduced to 0.01-0,10% (instead of 0.125 to 0.25%) and to 1.5% (instead of 3%) with prostigmine, when lenses were presoaked or instillations took place at regular time intervals, after insertion of the lenses.     

Intraoperative mitomycin C in complicated glaucomas

Filtering surgery has been found to be less successful in certain types of glaucoma. These include young patients, those with pigmentary glaucoma, secondary glaucoma, angle recession glaucoma, aphakic or pseudophakic glaucoma, and patients requiring reoperation. This study describes the authors' attempt to evaluate the effectiveness of conventional trabeculectomy with intraoperative application of mitomycin C in such patients. Ten eyes of 8 patients were evaluated in this study. Of these cases 4 eyes (2 bilateral cases) were from the primary juvenile open angle group; 2 eyes each had pseudophakic glaucoma and previous anti-glaucoma surgery which had failed; one eye had aphakic glaucoma and the last suffered from angle recession glaucoma. The intraocular pressure was successfully controlled in all the ten eyes. The preoperative IOP ranged from 28 to 50 mm Hg and the postoperative IOP ranged from 7 to 16 mm Hg. The postoperative complications were minimal.     

Extracapsular cataract extraction with posterior chamber lens implantation in primary angle-closure glaucoma

PURPOSE: To evaluate long-term intraocular pressure (IOP) control after extracapsular cataract extraction (ECCE) with posterior chamber intraocular lens (IOL) implantation in patients with primary angle-closure glaucoma. SETTING: Ophthalmology Department, Groote Schuur Hospital, Cape Town, South Africa. METHODS: This retrospective study comprised 17 patients (19 eyes) with primary angle-closure glaucoma who had ECCE and posterior chamber IOL implantation. Four presented initially with acute glaucoma, 5 with subacute angle-closure glaucoma, and 8 (10 eyes) with chronic angle-closure glaucoma. In all, less than half the circumference of the angle was permanently closed. The drainage angle was evaluated preoperatively and postoperatively to monitor changes in the amount of angle closure. Intraocular pressure was measured in the early and late postoperative periods. RESULTS: On the first postoperative day, mean IOP was 17.2 mm Hg, although 5 patients (26%) had an IOP rise above 21 mm Hg despite the use of perioperative topical pilocarpine gel. After a mean follow-up of 19 months, IOP remained below 22 mm Hg without medication in 13 eyes (68%) and with topical medication in 5 eyes (26%). Mean number of glaucoma medications was reduced from 1.5/eye preoperatively to 0.5/eye postoperatively. CONCLUSION: Cataract extraction with IOL implantation resulted in good long-term IOP control in patients with primary angle-closure glaucoma, suggesting that combined cataract and trabeculectomy surgery may not be necessary to achieve long-term IOP control in these patients.     

Punctal occlusion with n-butyl cyanoacrylate tissue adhesive

N-butyl cyanoacrylate tissue adhesive can be easily placed in the lid puncta to serve as a temporary method for punctal occlusion. Such a procedure is a useful therapeutic trial in borderline cases of keratoconjunctivitis sicca being considered for further permanent punctal occlusion or in patients where a temporary dry eye condition is expected to be resolved in the near future.     

Prophylactic Nd:YAG-laser iridotomy versus surgical iridectomy: a randomized, prospective study

Both surgical iridectomy and YAG-laser iridotomy have been shown to prevent angle-closure glaucoma. However, it remains unknown as to which procedure is superior. We therefore conducted a prospective randomized study, which compared the effect of the two methods on visual acuity, intraocular pressure, endothelial cell density, depth of the anterior chamber, and iris configuration as well as acceptance by the patients. A total of 30 patients, who were treated for acute angle-closure glaucoma in one eye, were subjected to either surgical iridectomy or Nd:YAG-laser iridotomy in the other eye according to a randomized protocol. All patients were followed for 12 months by examination at the 1st, 6th, and 12th month post treatment. No significant difference between the two treatments was found regarding visual acuity or intraocular pressure. The peripheral anterior chamber increased in depth following both methods, whereas the central depth of the anterior chamber was unaffected. A better gonioscopic visibility of the trabecular meshwork resulted from the increased width of the chamber angle. Whereas the number of endothelial cells remained constant in the patients treated with laser iridotomy, a small decrease was observed in the group of patients who underwent iridectomy (-7.2% after 12 months; difference not significant). The subjective acceptance by the patients was better in the group treated with laser iridotomy. We conclude that the two methods are equivalent with regard to intraocular pressure and visual acuity. The constant number of endothelial cells and the better acceptance by the patients suggest Nd:YAG-laser iridotomy to be the preferable method for prophylaxis of acute angle-closure glaucoma.     

Frequency of asymmetric visual field defects in normal-tension and high-tension glaucoma

OBJECTIVE: The purpose of the study was to evaluate the frequency of asymmetric visual field loss at presentation in patients with normal-tension glaucoma (NTG) and high-tension glaucoma (HTG). DESIGN: A retrospective cross-sectional study design was used. PARTICIPANTS: Four hundred and three NTG patients and 337 consecutive HTG patients (consecutive diagnoses between 1986 and 1996). INTERVENTION: Analysis of the frequency of unilateral field loss presentations in NTG and HTG. The visual fields of fellow eyes were compared to determine the side of more severe field loss. For the NTG patients, the relationship between the side with greater field loss and corresponding intraocular pressure (IOP) was investigated. MAIN OUTCOME MEASURES: Humphrey field analyzer mean defect (MD) and mean diurnal IOP. RESULTS: In the NTG group, 101 (25%) patients presented with unilateral field loss. The proportion of cases with unilateral field loss decreased with increasing age of presentation (chi-square test for trend = 26.9; P < 0.0001). Sixty-four percent of the patients had unilateral field loss in the left eye. Sixty-eight percent of the cases with bilateral field loss had a higher MD in the left eye. The diurnal IOP was estimated as 0.23 +/- 0.068 mmHg (mean +/- SE) higher in the left eye (P = 0.001). In the HTG group, 104 (31%) patients presented with unilateral field loss. The proportion of cases with unilateral field loss decreased with increasing age of presentation (chi-square test for trend = 4.6; P = 0.03). Right and left eyes had an equal chance of having field loss in unilateral cases and of being the side of more advanced field damage in bilateral cases. CONCLUSIONS: The frequency of cases with unilateral field loss was similar in HTG and NTG patients. Patients with unilateral field loss at presentation were more likely to be at the younger end of the age range. In the NTG population we studied, the left eye was more frequently the side of onset of field loss and 2.1 times more likely to present with a greater field defect than the right eye. In HTG patients, right and left eyes showed an equal chance of being the side of onset of field damage and the more affected side.     

转移到眼前房的转移性乳腺癌病例报道及讨论

Intraocular metastases are the most common malignancies of the eye. Carcinoma of the breast is the most common malignancy to metastasize to the uvea usually posterior uvea. Anterior chamber metastasis is extremely rare. We describe a patient of breast cancer who presented with pain and impaired vision in right eye 8.5 months after metastasis to bone and other viscera were detected and more than 10 years after her primary disease was diagnosed. Multiple yellowish white deposits were noted scattered in anterior chamber giving rise to symptoms of acute narrow angle glaucoma. Metastatic deposits of duct cell carcinoma cells were found by fine needle aspiration cytology. Patient received local external beam radiotherapy to right eye with moderate improvement in her symptoms. The rare features in this case were clinical presentation of acute glaucoma and anterior chamber as the site of metastasis.     

Moisture aid during sleep for the treatment of dry eye: wet gauze eye mask

While various techniques have been proposed for the treatment of dry eye, there have been no studies published evaluating the efficacy of the following wet gauze eye mask (WGEM) treatment of dry eye. One or two gauze mask(s) (9 x 12 cm) wetted with tap water and wrung were placed over both eyes during sleep. The treatment was performed on 30 patients with dry eye. Of these, 22 performed the treatment actively. In 14 (63.6%) out of the 22 patients, dry-eye symptoms were eliminated by the WGEM all day or until the evening. Of these 14, 7 were freed from eye drop treatment by the WGEM procedure. The WGEM treatment is safe, effective, simple and economical, and can be performed by the patients themselves. Moisture aid by the WGEM and/or a humidifier should be performed before resorting to punctal-plug insertion which may induce canalicular obstruction.     

Unilateral testing of utricular function

PURPOSE: To examine acquired pit of the optic nerve as a risk factor for progression of glaucoma. METHODS: In a retrospective longitudinal study, 25 open-angle glaucoma patients with acquired pit of the optic nerve were compared with a group of 24 open-angle glaucoma patients without acquired pit of the optic nerve. The patients were matched for age, mean intraocular pressure, baseline ratio of neuroretinal rim area to disk area, visual field damage, and duration of follow-up. Serial optic disk photographs and visual fields of both groups were evaluated by three independent observers for glaucomatous progression. RESULTS: Of 46 acquired pits of the optic nerve in 37 eyes of 25 patients, 36 pits were located inferiorly (76%) and 11 superiorly (24%; P < .001). Progression of optic disk damage occurred in 16 patients (64%) in the group with acquired pit and in three patients (12.5%) in the group without acquired pit (P < .001). Progression of visual field loss occurred in 14 patients (56%) in the group with acquired pit and in six (25%) in the group without pit (P=.04). Bilateral acquired pit of the optic nerve was present in 12 patients (48%). Disk hemorrhages were observed more frequently in the group with acquired pit (10 eyes, 40%) compared with the group without pit (two eyes, 8%; P=.02). CONCLUSION: Among patients with glaucoma, patients with acquired pit of the optic nerve represent a subgroup who are at increased risk for progressive optic disk damage and visual field loss.     

Ophthalmic disorders among the homeless and nonhomeless in Los Angeles

BACKGROUND: Few studies have addressed ocular disorders among the homeless and nonhomeless poor. METHODS: To better understand the health problems of the homeless, ophthalmic disorders were analyzed among 512 homeless and 413 nonhomeless poor individuals receiving vision-screening examinations in Los Angeles. RESULTS: Significantly, more 4- to 17-year-old nonhomeless poor were diagnosed with uncorrected visual acuity worse than or equal to 20/50 without correction (p = 0.001), total refractive errors (p < 0.0005), astigmatism (p = 0.001), and myopia (p < 0.0005) than were a control group of 4- to 17-year-old homeless individuals. More homeless individuals had extraocular muscle imbalance (p < 0.040), but fewer had external eye diseases (p2 = 0.016) than the nonhomeless poor, when age adjusted. In addition, higher rates of glaucoma and cataracts were observed in both homeless and poor nonhomeless populations than in the general population. CONCLUSIONS: Health care professionals should provide vision screenings intended to detect these ocular disorders. Screening and correction of myopia and glaucoma, in particular, can greatly improve the quality of life for those treated.     

The role of early trabeculectomy in the control of chronic simple glaucoma

Seventy patients of bilateral chronic simple glaucoma with a mean age of 59.7 years, an intra-ocular pressure over 25 mmg Hg, optic disc cupping, and without visual field loss were selected. The eye with higher intra-ocular pressure or the larger optic disc cup was treated by early trabeculectomy while the other eye of the same patient was subjected to medical therapy with topical beta blockers for 3 years (without any surgical treatment). Both the eyes of 70 patients were compared after 3 years. Eyes which had undergone trabeculectomy had a mean intra-ocular pressure of 11.7 mm Hg against 18 mm Hg in the medically treated eyes. Surgically treated eyes had decrease in the mean cup : disc ratio (from 0.54 : 1 to 0.48 : 1) whereas medically treated eyes showed an increase from 0.41:1 to 0.51: 1. Visual field loss occurred in 3/70 operated eyes and in 27/70 medically treated eyes. Twenty-one of 70 treated eyes developed cataract and 12 of these required cataract surgery. Only 18/70 medically treated eyes developed cataracts but none of these required cataract surgery. Early trabeculectomy in cases of chronic simple glaucoma resulted in a large reduction of intra-ocular pressure and consequently reduced the size of optic disc cup and the chances of visual field loss.     

Acute postictal cerebral imaging

OBJECTIVE: Changes in the ocular surface of patients with Sj?gren syndrome (SS) often are more severe than those in patients with dry eye without SS. This study was conducted to investigate the possible involvement of meibomian gland dysfunction in SS-related ocular surface abnormalities. DESIGN: A nonrandomized, prospective, clinical study. PARTICIPANTS: Twenty-seven eyes of 27 consecutive patients with SS (SS group) were studied. Twenty-nine eyes of age- and gender-matched non-SS patients with aqueous tear deficiency (non-SS group) were examined as control subjects. INTERVENTION: Changes in the ocular surface, tear function, and meibomian gland were examined. MAIN OUTCOME MEASURES: Tear evaporation rate, meibomian gland expression, and meibography were measured. RESULTS: Fluorescein and rose bengal staining scores were significantly higher in the SS group than in the non-SS group (P = 0.0001). Evaporation of tears was increased significantly in the SS group compared with the non-SS group. There were no significant differences in the rate of tear production between the SS and non-SS groups. Meibography showed that 11 (57.9%) of 19 eyes in the SS group had gland dropout (i.e., histologic destruction of meibomian glands) in more than half of the tarsus. The incidence was significantly higher than that in the non-SS group (5 [18.5%] of 27 eyes; P = 0.005). CONCLUSIONS: The results of this study indicate that destruction of meibomian glands and an increase in tear evaporation often are associated with changes in the ocular surface in patients with SS. Severe ocular surface changes in patients with SS may be attributed, in part, to the meibomian gland dysfunction.     

Increased production of a Th2 cytokine profile by activated whole blood cells from rheumatoid arthritis patients

The results of primary trabeculectomy with and without mitomycin C (MMC) were evaluated in young glaucoma patients. The patients, 15-40 years of age, were divided into two main groups and two subgroups. In group IA, primary Cairns type trabeculectomy was performed in 24 eyes of 24 patients with juvenile glaucoma; in group IB, trabeculectomy + MMC 0.4 mg/ml in 3 min was done in 20 eyes of 20 patients with juvenile glaucoma; in group IIA, primary trabeculectomy was performed in 20 eyes of 20 patients with developmental glaucoma, and in group IIB, trabeculectomy + MMC 0.4 mg/ml in 3 min was performed in 16 eyes of 16 patients with developmental glaucoma. The success rate of the surgery was 75% in group IA, 90% in group IB, 50% in group IIA, and 75% in group IIB. There was no statistically significant difference among the groups in terms of success rates of trabeculectomies (p > 0.05).     

Photodegradation of furosemide solutions

PURPOSE: To evaluate the therapeutic effect of combined argon and Nd: YAG laser peripheral iridectomy. METHODS: 151 cases (200 eyes) of primary angle-closure glaucoma and combined glaucoma were treated by combined procedure. Argon laser was the first used to create partial iridectomy in 2/3-3/4 thickness without penetrating pigmented epithelium, and then Nd: YAG laser was required to complete a patent iridectomy. RESULTS: A successful iridectomy was achieved in all patients independent of any type of irides (100%). Iris penetration rate in one session presented in 95.0%. Complications appeared to be less common in our patients: iris bleeding was only seen in 5.0% cases; the postoperative inflammation was mild; corneal burns, localized lenticular opacities and closure of iridectomies were less frequent. The follow-up ranged from 3m to 6.5 years. The success rate in controlling IOP with/without medications were 99.0% except 2 eye failure. No attack occurred in 129 eyes with prophylactic laser therapy during the periods of follow-up. CONCLUSION: Combined procedure had much more advantage over either the argon or Nd: YAG laser iridectomy. It tended to be more preferable for Asian patients with heavily pigmented and thick irides.     

Risk factors for noncompliance with glaucoma follow-up visits in a residents' eye clinic

OBJECTIVE: This study aimed to identify factors associated with compliance with glaucoma follow-up visits. DESIGN: Computer records of a university residents' eye clinic were reviewed to identify a random sample of all persons who had an examination with International Classification of Disease (ICD) 9 coding (ICD9) for glaucoma suspect or glaucoma during a 2-year period (1991-1993) to undergo telephone interview. PARTICIPANTS: Those who were seen at least every 6 months regardless of earlier return instructions were defined as compliant with follow-up (controls, n = 362). Those who had any lapse between visits of longer than 6 months were defined as noncompliant (cases, n = 362). RESULTS: Interviews were completed for 196 cases and 242 controls. Noncompliant persons were significantly more likely to be suspects for glaucoma rather than to have definite glaucoma and to be dissatisfied with waiting time in the clinic (29.1% vs. 17.8%, P < 0.005) and to state that they did not take their glaucoma medications as prescribed (25.4% vs. 13.4%, P < 0.004). They also were less likely to have been prescribed eyedrop medication. A high percentage of both patients and controls knew that glaucoma can lead to blindness (85.2% and 88.4%, respectively). The most common reasons patients gave for not keeping follow-up visits were the perception that their eye problem was "not serious enough," the cost of examinations, and that the doctor did not tell them to come back. CONCLUSION: Compliance with follow-up visits for glaucoma is associated with markers for early disease. Attempts to improve compliance might focus on improved communication of the seriousness of the disease and improvements in clinic waiting time.     

Antitumor activity of degraded products of lentinan: its correlation with molecular weight

Twelve of 25 patients with mixed connective tissue disease complained of xerostomia and/or ocular symptoms of keratoconjunctivitis sicca. In addition to the clinical features of mixed connective tissue disease, all 12 patients had high titers of antibody to the ribonuclease-sensitive component of the extractable nuclear antigen. Eight patients had both clinical xerostomia and keratoconjunctivitis sicca, one had keratoconjunctivitis sicca and salivary gland enlargement, while there had xerostomia but no ocular complaints. Sj?rgren's syndrome was confirmed in all 12 patients by means of Schirmer's tests, Rose Bengal staining tests, salivary gland scintiscans, radionuclide excretion studies in saliva, parotid sialographies, and lip biopsies. At least three of these tests were abnormal in all patients.