Spontaneous regression of multiple seborrheic keratoses associated with nasal carcinoma.

Seborrheic keratoses are very common epidermal neoplasms. We describe a patient with seborrheic keratoses presenting multifocal spontaneous regression. The patient had a concurrent nasal adenoid cystic carcinoma. The simultaneous regression of seborrheic keratoses ceased after total resection of the nasal carcinoma. Histological examination revealed marked infiltration of mononuclear cells, including CD4+, CD8+, CD68+ and cutaneous lymphocyte-associated antigen-positive cells, with profound accumulation of CD1a+ dendritic cells. Although apoptotic keratinocytes were not found in the lesional epidermis by histology, the majority of keratinocytes in the regressing seborrheic keratosis were positively stained by the TUNEL method. We postulate that the internal malignancy may induce spontaneous regression of seborrheic keratoses.

Interleukin-8-positive neutrophils in psoriasis.

We performed an immunohistochemical study to try to determine the cellular source of interleukin-8 (IL-8) in psoriatic skin lesions. IL-8 was positively stained in the vast majority of neutrophils but not in the mononuclear cells, macrophages, or keratinocytes. IL-8-positive neutrophils were seen both in Munro's microabcesses in cases of psoriasis vulgaris and in a small spongiform pustule and much larger macropustules of Kogoj in cases of pustular psoriasis. Some IL-8-positive neutrophils were observed in the upper dermis of pustular psoriasis. The staining was considered to be specific because it could be completely blocked by preabsorption with recombinant IL-8. In addition, stimulation of human neutrophils with lipopolysaccharide (LPS) or tumor necrosis factor-alpha (TNF-alpha) for 18 h induced IL-8 production in vitro. In our study, IL-8 was expressed in the neutrophils of psoriasis, suggesting that neutrophils are one of the sources of IL-8 in psoriasis. The expression of IL-8 and the influx of neutrophils led us to speculate that the IL-8 autocrine and/or paracrine system functions in the formation of the microabcesses and pustules in proriasis.

[Vitrectomy in Coats' disease].

Four eyes of four patients with Coats' disease underwent vitrectomy because of exudative or tractional detachments involving the macula or premacular fibrosis. All cases had gelatinous vitreous and had no complete posterior vitreous detachment. The exudates decreased and the retina reattached after removing vitreous traction and coagulating abnormal vessels with endodiathermy and not removing subretinal fluid in 3 eyes with retinal detachment. In one eye with tractional detachment, retinal breaks were found beneath the proliferative membrane during the initial vitrectomy procedure. This eye needed multiple operations because of recurrent traction by the remaining peripheral vitreous. Exudation into the vitreous and vitreous traction may cause mutual progression in these eyes, and vitrectomy is an effective treatment, although there are difficulties in removing vitreous traction completely.

[Combined posterior chamber intraocular lens implantation and trabeculectomy--a life-table analysis of postoperative clinical course].

Postoperative courses of 68 eyes of 58 glaucoma patients who underwent posterior chamber intraocular lens implantation combined with trabeculectomy were studied retrospectively. The visual acuity was 0.5 or better in 66% of the eyes at 3 months postoperatively. The average intraocular pressure (IOP) was below 15 mmHg till 16 months postoperatively. An analysis of the postoperative course using the life-table method of Kaplan-Meier revealed that the probability of successful IOP control with medication was 83% at 18 months and 47% without medication. The subjects aged 75 years or older showed significantly higher success probability than those younger than 75 years, while types of glaucoma, the preoperative IOP control, location of conjunctival or sclerocorneal incision, postoperative 5-fluorouracil (5-FU) injections or surgical intervention on the iris had no significant effects on the probability of successful IOP control. The probability of subsistence of functional filtering bleb was 24% at 18-month follow-up, on which postoperative administration of 5-FU of 35 mg or more had a favorable effect.

[Anticoagulant and fibrinolytic therapies for anterior chamber fibrin following cataract surgery in the rabbit eye].

Effects of anticoagulant or fibrinolytic therapy on anterior chamber fibrin following cataract surgery was evaluated. In one series of experiment, various amounts of antithrombin III (ATIII), an anticoagulant, were injected into the anterior chamber of the rabbit eye immediately after phacoemulsification of the lens. In another series, various amounts of tissue plasminogen activator (TPA), a fibrinolytic agent, were injected into the anterior chamber 24 hours after phacoemulsification when it was filled with fibrin. The extent of the fibrin clot was graded using a slit lamp microscope, and the aqueous flare intensity was determined with a laser cell-flare meter for 2 weeks after operation. The eyes treated with TPA was also examined with light and electron microscopy. ATIII showed an inhibitory effect on fibrin formation, but complete inhibition was not obtained even with the highest concentration used. In contrast, the fibrin clot was completely resolved even with the lowest dose of TPA used, while no side effect such as inflammation or bleeding was seen. Histological examinations revealed no pathological changes in eyes treated with TPA. TPA may be a promising agent for fibrin resolution after cataract surgery.

[Intraocular lens implantation after glaucoma filtering surgery--time course of changes in intraocular pressure control and filtering blebs].

Cataract extraction and intraocular lens (IOL) implantation were carried out in 45 glaucomatous eyes that had undergone glaucoma filtering surgery. Of these, 37 eyes had primary glaucoma, 2 eyes capsular glaucoma, and 6 eyes secondary glaucoma. The visual acuity after IOL implantation was 0.5 or more in 29 eyes (64%) but in 10 eyes (22%) acuity was 0.1 or less because of advanced optic nerve head damage. To analyze affects of IOL implantation on intraocular pressure (IOP) control and functioning of the filtration bleb in 39 eyes of primary or capsular glaucoma, a life-table analysis with the Kaplan-Meier method was performed. The probability that IOP control does not worsen at 2 years was 43 +/- 7% (SE) in 21 eyes without pre-operative ocular hypotensive medication, 56 +/- 16% in 18 eyes with pre-operative ocular hypotensive medication, 47 +/- 12% in 26 eyes where functioning filtering bleb existed pre-operatively. The probability that the filtering bleb survives 2 years post-operatively was 44 +/- 11%. The present results imply that intensive management of post-operative inflammation and careful IOP follow up are imperative in eyes in which IOL implantation was indicated after undergoing filtration surgery.