Value of profiling liver function in the elderly.

The value of measuring three routine tests of liver function was assessed prospectively in 523 geriatric patients. Abnormalities were found in 27% of patients and were clinically helpful in half of these cases. Profiling liver function, without clinical indication, revealed abnormal results in 17% of patients and was important in one-third of these (6% of total). The two most important diagnoses were unsuspected osteomalacia and gall stone disease.

Experimental anterior uveitis after subcutaneous injection of feline sarcoma virus.

Feline sarcoma virus (FeSV) is a naturally occurring virus that causes spontaneous tumors in cats. The immunologic and morphologic characteristics of these tumors have been studied extensively. It was recently observed in experiments undertaken to induce systemic malignancy with this virus, that severe uveitis and clinical blindness occurred. An investigation of the ophthalmologic changes was undertaken. A fulminent anterior uveitis was produced in cats by a series of subcutaneous injections of live FeLV-FeSV. This intraocular inflammation occurred in five of six animals using high viral titers, and four of seven with lower titers, resulting from the freeze thaw process. On histopathologic examination, most animals demonstrated dysplastic changes of the ciliary body in addition to the iridocyclitis. The remainder of the eye was unaffected. These animals developed systemic tumors unaccompanied by local inflammation, many of which spontaneously regressed. Notable features of this potential model for uveitis are that (1) direct injection into the eye is unnecessary, and (2) intravenous administration inducing immune tolerance with antigenic overload presented to the spleen is avoided. This inflammatory reaction seems to be specific to the iris and ciliary body. Levels of live virus detected in the aqueous humor exceeded those in the serum. These results suggest that the virus may be actively secreted by the ciliary epithelium, or may preferentially proliferate within the eye.

Astrocytic hamartoma in tuberous sclerosis mimicking necrotizing retinochoroiditis.

A pale, elevated peripapillary lesion discovered in a young child with no family history of phakomatoses, grew larger, caused vitreous hemorrhage and underwent necrosis. Secondary inflammation developed in the eye, finally producing rubeosis irides with elevated intraocular pressure and a blind, painful eye which required enucleation. Clinically, the lesion was variably diagnosed and treated as toxoplasmosis and toxocara canis. These diagnoses were made despite low titres, a negative ELISA test and a normal eosinophil count. On histopathologic examination, a diagnosis of toxocara canis was entertained, although no remnants of the organism could be found in serial sections. Years later, when a family history of tuberous sclerosis became apparent, a diagnosis of astrocytic hamartoma of the retina with secondary hemorrhage and inflammation was made on the basis of re-examination of the pathologic specimen and special stains.

High altitude retinal hemorrhage: a clinical and pathological case report.

Retinal hemorrhages may occur at high altitudes. They occur more commonly in association with acute mountain sickness and particularly with high-altitude cerebral edema. We describe a 27-year-old man who experienced retinal hemorrhages as well as papilledema and coma at 5,330-m altitude and who died four days later, one day after evacuation to 1,300-m altitude. At autopsy, we found papilledema and hemorrhages in the nerve fiber layer. These were sometimes distant from areas where there were arterioles and venules. There was perivascular red cell infiltration. Deeper layers of the retina were intact. We conclude that the hemorrhages were form both retinal capillaries and veins and we speculate that hypoxia, with or without the Valsalva effect, was the cause of the endothelial damage.

Choroidal neovascularization associated with malignant melanoma: a case report.

Subretinal neovascularization observed over an elevated, pigmented choroidal lesion is usually considered evidence in favour of the benign nature of that lesion, a nevus. Histologic verification of malignant melanoma with choroidal neovascularization has never appeared in the literature. In this report, we present a case of subretinal neovascularization documented by fundus photography, fluorescein angiography, and histology in an eye containing a malignant choroidal melanoma.

Sympathetic ophthalmia: a comparison of the histopathological features from a Chinese and American series.

The importance of this comparison between two large series of cases of sympathetic ophthalmia lies in its confirmation of our previous findings, which differ somewhat from the classical pathological description. Sympathetic ophthalmia remains a clinicopathological diagnosis, relying on a history of perforating injury to one eye, followed after a variable incubation period by inflammation in the fellow eye. The inflammatory changes in both eyes consist of a diffuse, granulomatous proliferation throughout the uveal tract, which involves the choriocapillaris and the retina late in its course. The infiltrate is composed predominantly of lymphocytes and plasma cells, with a variable number of epitheloid and giant cells. Corticosteroid therapy may modify this picture. The epithelioid cells contain phagocytosed pigment granules, but there is not sign of necrosis. Eosinophils appear early in the course of the disease and disappear late. The granulomatous inflammation may spread to involve the optic nerve sheath, the nerve itself, the scleral emissaria, and the scleral stroma. Dalén-Fuchs nodules appear early peripherally, and it is over these nodules that retinal granulomas, when present, usually are found. In the Shanghai series, it was found that corticosteroid therapy and prompt enucleation of the exciting eye reduced the number of exacerbations experienced by these patients but did not improve visual prognosis. The MEEI data, while they did show a bimodal distribution to the visual result, seemed to indicate that prompt enucleation of a blind eye combined with aggressive corticosteroid therapy may improve visual prognosis.

Two cases of suspected familial erythrophagocytic lymphohistiocytosis.

We studied two children who died of suspected familial erythrophagic lymphohistiocytosis. The first child, a 7-year-old boy, had fever, diffuse pulmonary infiltrates, bilateral choroidal effusions, diabetes insipidus, and marked meningitis with increased cerebrospinal fluid protein. Ocular histologic studies disclosed diffuse choroidal infiltrates consisting of atypical mononuclear cells with foamy cytoplasm. Similar histologic changes were seen in the lungs, liver, brain, and kidneys. The second child, the 5-year-old male cousin of Patient 1, had fever, hepatosplenomegaly, pulmonary infiltrates, and cerebrospinal fluid pleocytosis. Histologic changes were similar to those in the first case, but viral particles of the herpes simplex virus group were noted in brain tissue as well. The findings of virus particles in this histiocytic proliferative disease suggested a defect in the inflammatory response in these patients.

Oculocutaneous albinism associated with corneal mesodermal dysgenesis.

A 48-year-old woman had tyrosine-negative oculocutaneous albinism and corneal mesodermal dysgenesis of the Axenfeld type. Results of chromosome analysis were normal, and no other family members showed the association of these two conditions. The rarity with which the association has been reported suggests that this combination of findings is probably coincidental.

Vogt-Koyanagi-Harada syndrome with focal neurologic signs.

The Vogt-Koyanagi-Harada syndrome includes inflammation of the uveal tract, retina, and meninges. Integumentary and auditory signs are common. Neurologic involvement has been reported. We studied two patients who manifested many of the varied clinical signs of Vogt-Koyanagi-Harada syndrome, but who also showed focal neurologic involvement, including acute transverse myelitis and ciliary ganglionitis. Both patients responded well to corticosteroid therapy. The findings in these patients and the results of previous studies suggest that Vogt-Koyanagi-Harada syndrome is a cell-mediated autoimmune disorder in which a component of myelin acts as an inciting antigen.

Rhinoscleroma with exophthalmos: a case report.

This is a report of a 20-year-old Nigerian man with a 15-year history of exophthalmos and nasal blockage caused by rhinoscleromatous. The diagnosis was made by histopathological examination of a biopsy specimen taken from the nasal passages. Despite protracted antibiotic therapy the patient experienced recurrent exophthalmos. Computerised axial tomography and sinus films showed the lesion to have invaded through the sinus passage into the orbit. Further histopathological examination of tissue removed at the time of surgical decompression also revealed rhinoscleroma. This appears to be the third report of rhinoscleromatous spread to the orbit.

Hepatoma metastatic to the orbit.

A 69-year-old man with a history of cirrhosis of the liver had unilateral progressive proptosis without jaundice, abdominal pain, or gastrointestinal symptoms. Results of laboratory and radiographic studies were also normal. Orbital biopsy revealed hepatocellular carcinoma. Although hepatocellular carcinoma has often been shown to metastasize to the brain and often to the flat bones of the skull, to the best of our knowledge, this is the first histologically proven case of hepatoma metastatic to the orbit.

Sixty-five years of sympathetic ophthalmia. A clinicopathologic review of 105 cases (1913--1978).

A retrospective clinicopathologic review of 105 cases of sympathetic ophthalmia showed histologic features of prognostic significance and evaluated the role of therapy. Classic descriptions omit retinal changes, but 58.0% of our cases had retinal detachment and 42.2% showed intraretinal inflammation. The optic nerve and/or meninges were inflamed in 51%. Optic atrophy was seen in 54.4%. Plasma cells are said to be characteristically absent, but 65.0% of steroid-treated and 85.7% of cases before the steroid era showed plasma cell infiltration. Severity of inflammation pathologically correlated with final visual outcome, and corticosteroid therapy changed both the character and severity of inflammation. Early enucleation of the exciting eye after onset of symptoms in the fellow eye was found to improve visual prognosis. Electron microscopy performed on fresh tissue and choroidal cell cultures revealed no viral particles, and viral and mycoplasma cultures all proved negative.