Localized conjunctival argyrosis: a late sequela of strabismus surgery.

We describe a case of focal argyrosis of the conjunctiva clinically simulating a melanoma. An 82-year-old woman was referred for an asymptomatic pigmented conjunctival lesion. Her only significant past ocular history was strabismus surgery 76 years earlier. Biopsy of the conjunctiva and lateral rectus muscle revealed the discoloration was pigment granules. Energy-dispersive x-ray microanalysis revealed the pigmentation to be silver deposits. The patient had strabismus surgery probably using a silver clip. Argyrosis should be considered in the differential diagnosis of focal pigmented conjunctival lesions.

Patient tolerance and ocular surface staining characteristics of lissamine green versus rose bengal.

PURPOSE: To determine patient tolerance and ocular surface staining characteristics of 1% lissamine green versus 1% rose bengal solutions in patients with dry eye and in those with normal ocular surfaces by comparison of subjective sensation and objective staining scores. METHODS: Twelve patients with keratoconjunctivitis sicca and eight subjects with no ocular surface disease recorded their symptoms on a graded scale (0-5) and the duration of symptoms after instillation of one drop of 1% lissamine green and 1% rose bengal on two different occasions in different order. Lissamine green and rose bengal staining patterns were recorded on a graded scale (0-4) by one of the authors. RESULTS: For patients with keratoconjunctivitis sicca mean sensation score with lissamine green (2.42) was significantly lower (P = 0.00006) than with rose bengal (4.58). The duration of symptoms was significantly longer (P = 0.0007) after rose bengal instillation as well. For subjects with no ocular surface disease, mean sensation score with lissamine green (1.375) was significantly lower (P = 0.01) than with rose bengal (2.5). In this group, duration of symptoms also was significantly longer (P = 0.001) after rose bengal instillation. In both groups, there was no difference in objective staining scores. CONCLUSION: Lissamine green is better tolerated than rose bengal by patients and is equally as effective as rose bengal in evaluating the ocular surface in keratoconjunctivitis sicca.

Cytomegalovirus keratitis after penetrating keratoplasty.

We report the development of cytomegalovirus (CMV) keratitis in the penetrating keratoplasty of a 59-year-old human immunodeficiency virus-negative woman after uncomplicated corneal transplantation. Immunosuppression with topical cyclosporine A 2% in corn oil and topical prednisolone acetate 1% suspension was used postoperatively. The 15-month postoperative course was complicated by multiple episodes of endothelial rejection, medically controlled elevated intraocular pressure, polymicrobial bacterial (coagulase-negative staphlococcus and alpha-hemolytic streptococcus) keratitis, and endothelial plaque formation with associated hypopyon and epithelial defect. The graft failed and penetrating keratoplasty was repeated. Cytomegalovirus infection of superficial keratocytes in a region of scarring was identified in histological sections stained with hematoxylin and eosin and confirmed using mouse monoclonal anti-cytomegalovirus antibodies. Excision of the diseased corneal button with no additional treatment appears to have been curative. Low-grade keratitis was the only manifestation of the CMV infection, and it has not recurred 6 months postoperatively.

Electroretinograms in microcephaly with chorioretinal degeneration.

We recorded full-field electroretinograms from a family with two daughters with microcephaly and chorioretinal degeneration and a third daughter and mother with microcephaly without chorioretinal degeneration. The two siblings with inferior chorioretinal degeneration showed electroretinographic responses to 0.5-Hz white light that were reduced 60% to 70% below normal, suggesting that the loss of photoreceptor function exceeded the areas of visible atrophy. The mother and third daughter had normal electroretinograms. The two siblings, ages 12 and 21 years, had virtually the same electroretinographic amplitudes. In a second family, a man with microcephaly and inferior chorioretinal degeneration, examined at ages 9 and 23 years, also showed 60% to 70% reduction in electroretinographic responses to 0.5-Hz white light and showed no change in amplitudes over the 14-year interval. These findings suggest that the chorioretinal degeneration sometimes associated with microcephaly is stable in young adult life, although the long-term prognosis remains to be defined.

Drug "overdoses" among U.S. soldiers in Europe, 1978-1979. II. autopsies following deaths and near-deaths.

On-site investigations involving interviews with spouses, friends, coworkers, supervisors, and commanders were conducted following 37 deaths or near-deaths by drug overdose among U.S. soldiers stationed in Europe. Subjects were all active-duty soldiers put on the seriously ill list at any Army hospital with an initial diagnosis which included suspected drug overdose. Victims were typically single Black males, less than 22, high school graduates in excellent health. They had been in Germany 7-24 months, liked their jobs, and were judged better than average workers by both peers and supervisors. Fifty percent played on a unit sports team, 6 of 10 had German girlfriends, and one-third had prior disciplinary problems. Although nearly half had been previously identified as having a drug or alcohol problem, only two or three could be called addicts in even the broadest sense. Six cases were suicide gestures, and only these six cases did not involve heroin and/or alcohol. The modal case followed a party, with substantial drinking. In only 25% of the cases did the victim collapse upon injection. More often he went to bed, vomited during the night, and choked on or inhaled vomitus. The data suggest reexamination of two common myths: that heroin users comprise a very unique, albeit undesirable, sample of the general population; and that "overdose" deaths are the result of ignorance, incompetence, or indifference.

Drug "overdoses" among U.S. soldiers in Europe, 1978-1979. I. Demographics and toxicology.

The files of the Casualty Branch of the Military Personnel Center, Europe, Seventh Medical Command, and of the U.S. Army's Tenth Medical Lab were used to examine the epidemiology of "overdose" deaths of U.S. Army soldiers in Europe during the calendar years 1978 and 1979. A total of 91 cases were so identified; i.e., death was the direct result of injection, inhalation, or ingestion of an intoxicant, legal or illegal. Not included were deaths caused by trauma or drowning while intoxicated, deaths from disease secondary to chronic drug or alcohol abuse, and deaths due to chemicals not widely viewed as intoxicants. The monthly distribution of cases showed a spring peak similar to that reported by several studies of U.S. civilian drug deaths. No such similarity was apparent in terms of victim characteristics and circumstances, with soldier victims being nearly always male, equally often White as Black, 20-24 years old, very rarely suicides, and nearly always using heroin and/or alcohol. "Control" data from circumscribed subgroups of nonvictim European soldiers, however, show that victims did not differ markedly from the junior enlisted population from which they came, as least on the variables generally available in personnel and medical records.

Dorsolateral prefrontal cortex lesions and discrimination of movement-produced cues by rhesus monkeys.

Rhesus monkeys were trained on a conditional discrimination in which sequences of either 32 or 64 lever presses served as discriminative stimuli. For half the subjects, reinforcement was contingent upon choice of a red response key following a sequence of 32 presses (FR 32), and a white key after FR 64, with the position of the two key colors randomized across trials. The remaining subjects were reinforced for left key presses after FR 64, and right key presses after FR 32, with key color again randomized across trials. Ablation of dorsolateral prefrontal cortex resulted in postoperative deficits in all subjects, although 6 of 8 eventually remastered the task. This recovery was investigated in a second experiment, in which psychophysical functions were generated by varying the length of the shorter FR. Although dorsolateral lesions again produced a severe disruption in performance, the post-operative functions eventually obtained were identical to the preoperative functions. This pattern of marked impairment in retention of fixed ratio discriminations, but no change in asymptotic capacity, suggests participation of dorsolateral prefrontal cortex in processing kinesthetic information, possibly analogous to the role of inferior temporal cortex in processing visual information.

Non-spatial memory after selective prefrontal lesions in monkeys.

Separate groups of monkeys were trained on delayed object alternation, delayed object matching, and delayed color matching, after which half the animals in each group received lesions of the cortex in the principal sulcus, and the other half, lesions of the inferior frontal convexity. The inferior convexity lesions produced severe and lasting impairments on all three tasks, perhaps as a result of the perseverative disorder that has been associated with damage to this region. By contrast, the principal sulcus lesions, which yield such severe deficits on spatial memory tasks, led to only small, transient disruptions on each of the three non-spatial tasks. According to these results, the non-spatial memory deficits that have been found after unrestricted lateral prefrontal lesions are due mainly to damage below the principal sulcus in the inferior prefrontal cortex. The function of the tissue in the principal sulcus itself, on the other hand, appears so far to be limited largely to the spatial modality.

Enduring effects of morphine pellets revealed by conditioned taste aversion.

Morphine pellets (75 mg) were implanted subcutaneously in albino rats. Three days later, following 24 h without water, these rats (Group MSN) were given access to a saccharin solution for 30 min, then injected with naloxone hydrochloride. The classical abstinence signs, including "wet dog shakes"and weight loss, were noted in these subjects, but not in controls given placebo pellets and /or saline injections. In addition, when given an opportunity to drink either saccharine solution or water 24 h later, Group MSN rats drank significantly less saccharin than any of the control groups. Similar drinking patterns were found even when naloxone injection was delayed as long as 3 weeks after pellet implantation, when none of the classical abstinence signs were seen and serum levels of morphine and its metabolites were 100 times lower according to radioimmunoassay. This simple and objective technique is thus more sensitive as a measure of prior morphine exposure than any of the commonly used indices. The continued utility of a dependent-nondependent dichotomy is also examined in light of these and other findings.

Role of experience in acquisition and loss of tolerance to the effect of delta-9-THC on spaced responding.

Albino rats were given extensive training in spaced responding, using a DRL 30 sec schedule of food reinforcement (only lever presses more than 30 sec apart were reinforced). All rats then went 12 days without behavioral testing. During this period half the rats received daily intragastric doses of delta-9-tetrahydrocannabinol (THC) and the rest equal volumes of the THC vehicle. On day 13, some rats received THC 3 hr before behavioral testing while others received only vehicle. The former showed a sharp increase in lever press rate over baseline levels, but the vehicle control rats were unaffected. The rats with 12 prior THC doses were no less affected than those with no previous drug history. Continued testing resulted in recovery of baseline performance within 5 sessions, again with no effect of previous drug history. Similar results were obtained with doses of 4 mg/kg and 16 mg/kg, though the drug's effects were more pronounced at the higher dose. These results demonstrate that performance in the drug state can be a far more important determinant of tolerance than mere exposure to THC. Drug administration was then suspended for 1 week. Rats that had become tolerant to 4 mg/kg THC were then redivided into 3 new groups. One group received daily doses of vehicle and DRL sessions, a second received DRL sessions without vehicle, and 1 group received neither vehicle nor DRL sessions for this week. Subsequent DRL testing after THC administration showed that only the groups receiving DRL sessions in the intervening week lost their previously acquired tolerance. Experience thus appears to play an important role in loss of tolerance to THC as well as in acquisition of tolerance.