[Multiple bile duct hamartomas of the liver -- a rare differential diagnosis to liver metastasis]. / Biliäre Mikrohamartome der Leber -- eine seltene Differentialdiagnose zur Lebermetastasierung.

Multiple bile duct hamartomas of the liver (von Meyenburg complex) are mostly incidental findings at autopsy. The 79-year-old female patient was presented to us with a superinfected Paget lesion of the right nipple. Ultrasound examination of the liver revealed multiple scattered hyperechoic lesions as well as some anechoic lesions, suspicious of metastatic disease. Computed tomography showed multiple focal lesions. The ultrasound-guided needle biopsy of the liver revealed multiple benign bile duct hamartamas. Magnetic resonance imaging ruled out diffuse malignant infiltration of the liver.

[Evaluation of renal artery stenosis: comparison of angiography and invasive blood pressure measurement and Doppler ultrasound]. / Evaluation von Nierenarterienstenosen: Vergleich von Angiographie mit invasiver Blutdruckmessung und Doppler-Sonographie.

PURPOSE: In the procedure of renal artery angioplasty, the angiographically measured degree of stenosis should be compared with the intraarterial transstenotic blood pressure gradient and pre-interventional Doppler findings. METHODS: In a total of 46 renal arteries in 35 patients with renovascular hypertension, the angiographic-morphological parameters: "linear", "geometric" and "densitometric" degree of stenosis are compared with the invasive transstenotic blood pressure gradient and the pre-interventional Doppler ultrasound. RESULTS: All angiographically determined degrees of stenosis ("linear", "geometric" and "densitometric") correlate--moderately--with the transstenotic blood pressure gradient (correlation coefficients: 0.67 ("linear"), 0.65 ("geometric") and 0.49 ("densitometric"), each versus systolic pressure gradient, respectively). Stenoses that are angiographically classified as "low grade" (< 50%) nevertheless have a high number of high transstenotic pressure gradients: 21 of 22 show systolic values > or = 10 mmHg, 13 of 22 even > or = 30 mmHg. All stenoses Doppler sonographically classified as "high or very high grade" (Vmax,syst > or = 3 m/s) are confirmed by angiography and/or pressure measurement. CONCLUSIONS: Angiography has the tendency to underestimate the degree of renal artery stenosis, especially in "low grade" stenoses (< 50%). However, in those > or = 50% a high transstenotic blood pressure gradient can be taken for granted. If the angiographic degree of stenosis seems uncertain, we recommend measurement of blood pressure gradient.

Evaluation of diclofenac sodium 0.1% ophthalmic solution in the treatment of ocular symptoms after bilateral radial keratotomy.

PURPOSE: Patients frequently have ocular pain, photophobia, foreign-body sensation, and burning/stinging after radial keratotomy. This study was a prospective, randomized, double-masked, multicenter, fellow-eye comparison of diclofenac sodium (Voltaren Ophthalmic, 0.1% solution) and placebo for controlling these ocular symptoms after bilateral radial keratotomy. METHODS: Patients who were pain free in both eyes before surgery were randomly assigned to treatment with diclofenac sodium in one eye and placebo in the other. One drop of each masked trial medication was administered 30-60 min before surgery, 5 min and 6 h after surgery, at bedtime on the day of surgery, and four times daily for 2 additional days. Patients evaluated ocular symptoms in each eye 0.5, 1, 2, 4, 6, 24, and 48 h after surgery and provided a global evaluation 6, 24, and 48 h after surgery. For each assessment, the difference in scores between eyes was analyzed by using a paired t test. RESULTS: Diclofenac sodium was significantly (p < 0.001) superior to placebo in controlling each ocular symptom at each interval after surgery and for patient global assessments 6, 24, and 48 h after surgery. CONCLUSION: Diclofenac sodium 0.1% ophthalmic solution is clinically effective in controlling adverse ocular symptoms occurring after bilateral radial keratotomy.

Students attend nurses association convention for college credit.

The author describes a college course that facilitates student attendance at the Iowa Nurses' Association (INA) convention and promotes observation of nurse leaders as they consider nursing and political issues. Using the guidelines in this article, nursing faculty can develop a similar course in their institutions and generate student interest in the activities of the state professional associations.

Conjunctival autograft transplantation for advanced and recurrent pterygium.

The technique and results of conjunctival autograft transplantation for advanced and recurrent pterygium are presented for 57 eyes of 54 patients. The pterygia were primary in 16 eyes and recurrent in 41; among the latter group, 14 patients had diplopia resulting from cicatricial involvement of the medial rectus muscle. In all cases, free conjunctival grafts from the superotemporal bulbar conjunctiva of the same eye were used to resurface exposed sclera and extraocular muscle. There were no intraoperative complications. Postoperative follow-up ranges from 1 to 67 months, with a mean of 24 months. Only three pterygia have recurred (5.3%); two were successfully remedied by a second conjunctival autograft, whereas the third did not require an additional procedure. In all 14 patients with diplopia, extraocular movement was restored. We recommend this surgical approach as a safe and effective means of treating pterygia complicated by conjunctival scarring with extraocular muscle involvement and requiring concurrent fornix reconstruction.

Endothelial and epithelial-like cell formations in a case of posterior polymorphous dystrophy.

Histology of the endothelial and epithelial-like cells, vesicles, and membranes seen on the posterior corneal surface in posterior polymorphous dystrophy were examined by light microscopy and scanning and transmission electron microscopy in a 3-month-old female infant. The entire posterior surface of both corneas was covered by a geographic pattern of endothelial and epithelial-like cells, sometimes creating vesicles and sometimes creating partially detached sheets of cells. The thickness of Descemet's membrane varied widely, showing a tendency to be most complete under the remaining endothelial cells and thinner or absent under the epithelial-like cells. Details of this histology have important implications for our understanding of congenital diseases of corneal endothelium.

Congenital cysts of the iris stroma.

We studed the clinical and histopathologic findings in two congenital iris cysts, one in a 19-month-old girl and one in a 7-year-old boy. Our second case showed the resilience of these lesions, with the cyst returning to its original size after needle aspiration, argon iridotomy, marsupialization, and excisional iridotomy. Cryogenic therapy was needed to eliminate the cyst. In both cases, histologic studies showed squamous epithelium with few (Case 1) or no (Case 2) goblet cells.

Effects of physostigmine on septo-hippocampal averaged evoked field potentials.

Field potentials were elicited in the CA3 field of freely-moving animals by paired-pulse stimulation of the ventral portion of the medial septum before and after exposure to physotigmine. Physostigmine had no effect on response components elicited by a single stimulus or by the first stimulus of a pulse pair. However, the amplitude of a late positive component elicited by the second stimulus of a pair was increased significantly following physostigmine. These results suggest that activity in a cholinergic portion of the septo-hippocampal pathway may serve to modulate the responsiveness of neurons in the CA3 field to subsequent stimulation.

Intranigral muscimol suppresses ethanol withdrawal seizures.

Intranigral administration of muscimol produced a dose-related suppression of audiogenic motor convulsions which accompanied withdrawal from chronic ethanol administration. Similar administration of saline did not alter withdrawal seizures. These results are interpreted as supporting the hypothesis that GABA-receptive neurons in the vicinity of the substantia nigra are important in the mediation of seizures induced by ethanol withdrawal.

Development of oral HSV-1 infection model in mice. Evaluation of efficacy of 5'-amino-5-iodo-2',5'-dideoxyuridine.

We developed a new model of oral HSV-1 infection in mice. After oral inoculation, 100 percent of mice developed the clinical lesions at the inoculated area and latent HVS infection in their trigeminal ganglia without mortality. The antiherpetic efficacy of AIdUrd, an agent specifically activated by herpesvirus-encoded enzyme, has been evaluated in this animal model. Early topical or systemic treatment of AIdUrd notably reduced the development of clinical lesions and the virus content in the inoculated lips. However, the establishment of latent HSV infection in the sensory ganglia was not influenced by AIdUrd treatment.

Acyclovir and vidarabine in the treatment of ulcerative herpes simplex keratitis.

In a masked controlled study, we treated 41 patients who had active herpes simplex corneal ulcers with either 3% acyclovir of 3% vidarabine ointment five times daily for 14 days. There was no statistically significant difference between the two drugs with reference to mean healing time, efficacy of healing, development of stromal keratitis or iritis, post-treatment visual acuity, or adverse reaction.

Ac2IDU, BVDU, and thymine arabinoside therapy in experimental herpes keratitis.

The therapeutic efficacy of three new antiviral agents-5-iodo-3',5'-diacetyl-2'-deoxyuridine (diacetylidoxuridine, 1% Ac2IDU), E-5-(2-bromovinyl)-2'-deoxyuridine (0.25% BVDU), and 3% thymine arabinoside-is compared with available antivirals in an experimental model of herpes simplex virus type 1 (HSV-1) keratitis in New Zealand white rabbits. Compared with placebo, Ac2IDU significantly reduced ulcerative keratitis on days 4 through 8 after inoculation with virus and iritis on day 8 after inoculation. Compared with placebo, thymine arabinoside reduced ulcerative keratitis but not significantly. Thymine arabinoside caused significant iritis in all eyes. The epithelial disease in BVDU-treated eyes was significantly less than that in placebo-treated eyes on days 5 through 8 after inoculation. The results indicate that 1% Ac2IDU and 0.25% BVDU were effective in our ocular model of HSV-1 keratitis, whereas thymine arabinoside was not.

Ganglionic herpes simplex and systemic acyclovir.

The therapeutic and systemic effects of acyclovir on ganglionic herpes simplex virus (HSV) in mice were studied by varying the duration of treatment and the time of removal of ganglia for co-cultivation after treatment had ended. When treatment was started three hours after infection, it had a significant therapeutic effect even when the ganglionic culture was delayed 17 days after the end of acyclovir therapy. When treatment was started 24 hours after infection, it had no significant effect under the same circumstances. The treatment of established latent ganglionic HSV for 15 days with acyclovir had a significant therapeutic effect compared with control mice when ganglia were cultured two days after treatment had ended, but this effect was lost by ten and 21 days after the end of therapy. This indicates that acyclovir has a transient suppressive effect on part of the viral ganglionic reservoir, but it also indicates that these titers quickly reestablish themselves with the removal of drug therapy.

Topical therapeutic efficacy of 9-(2-hydroxyethoxymethyl)guanine and 5-iodo-5'-amino-2',5'-dideoxyuridine on oral infection with herpes simplex virus in mice.

The therapeutic efficacy of two new antiviral agents, 5-iodo-5'-amino-2', 5'-dideoxyuridine (AIdUrd) and 9-(2-hydroxyethoxymethyl)guanine (ACV), in the model of mouse lip inoculated with herpes simplex virus type 2 is reported. The effects on development of clinical lesions, viral replication in the inoculated lips, and establishment of latent viral infection in the trigeminal ganglia were observed. The earlier the treatment with AIdUrd and ACV was initiated after inoculation, the better was the chemotherapeutic effect. AIdUrd and ACV treatment, when initiated 48 and 72 hr after inoculation, respectively, showed no chemotherapeutic efficacy. Establishment of viral latent infection in sensory ganglia was significantly prevented only when ACV treatment was initiated very early (1 or 3 hr) after inoculation. The results indicate that both drugs have significant antiviral activity, in part dependent on the time of initiation of therapy, and that ACV is superior to AIdUrd as a topical agent for therapy of herpes simplex virus type 2 infections.