Chronic varicella-zoster virus epithelial keratitis in patients with acquired immunodeficiency syndrome.

OBJECTIVE: To characterize further a chronic epithelial keratitis caused by varicella-zoster virus infection in patients with acquired immunodeficiency syndrome (AIDS). METHODS: Patients with AIDS and chronic epithelial keratitis associated with varicella-zoster virus from 3 institutions were identified. Patient records were reviewed retrospectively for the following data: medical and demographic characteristics, techniques of diagnosis, physical findings, course, response to treatment, and outcome. RESULTS: Sixteen patients were studied. CD4+ T-lymphocyte cell counts were available in 11 patients, with a median of 0.034 x 10(9)/L (range, 0-0.094 x 10(9)/L). Two patients had no history of a zosteriform rash. In the remaining patients, the interval between rash and keratitis ranged from 0 days to 6 years. In all cases, the keratitis was chronic and characterized by gray, elevated, dendriform epithelial lesions that stained variably with fluorescein and rose bengal. The peripheral and midperipheral cornea was most commonly affected, and, in 13 of the 16 patients, the lesions crossed the limbus. Pain was a prominent feature, occurring in 12 of 16 patients. In 9 of 12 patients tested, varicella-zoster virus was identified by culture, direct fluorescent antibody testing, polymerase chain reaction testing, or a combination of these studies, with direct fluorescent antibody testing (6 of 8 positive results) and polymerase chain reaction testing (3 of 3 positive results) appearing to be the most sensitive. Response to antiviral medication was variable. CONCLUSIONS: In patients with AIDS, varicella-zoster virus may cause a chronic infection of the corneal epithelium. The keratitis is characterized by dendriform lesions, prolonged course, and frequently by extreme pain. It can occur without an associated dermatitis.

Taste performance in Sjogren's syndrome.

Sjogren's Syndrome (SS) patients have impaired salivary gland function and an elevated frequency of oral complaints. The taste complaints are thought to be due to sensory deficits that arise in the absence of sufficient saliva to maintain taste receptors. We assessed the subjective complaints, salivary production and taste functioning of SS patients and unaffected individuals. We found the expected decreased salivary gland function and increased frequency of taste complaints. Our taste assessment with weak stimuli confirmed and expanded the previous report of decreased taste threshold sensitivity in SS. However, perception of stronger taste stimuli was not impaired. In contrast with previous reports, patient judgments of intensity were not significantly reduced for any of the four taste qualities. Although the salivary gland function of all patients was markedly impaired relative to that of controls, patients lacking measurable salivary flow were no more likely than patients with residual function to exhibit subjective complaints or taste impairments. Our observations are inconsistent with a simple causal chain running from salivary gland dysfunction to sensory loss to taste complaints.

Taste intensity performance in patients irradiated to the head and neck.

Decrements in taste-detection thresholds during radiotherapy and subsequent recovery in the months after therapy are well documented. However, few studies have explored suprathreshold taste intensity perception in radiation patients. This cross-sectional study compared taste function in 15 men postradiation with a group of 23 healthy, nonirradiated male volunteers. A direct-scaling procedure was used to assess taste intensity perception of the four basic taste qualities. Patients performed nearly as well as control subjects on objective measures of suprathreshold functioning. Postradiation intensity judgments of salty (sodium chloride), sweet (sucrose), and bitter (quinine sulfate) solutions were not significantly reduced. Subtle, age-related taste impairments were identified for sour perception (citric acid) postradiotherapy. Younger patients judged citric acid to be more intense than did age-appropriate control subjects, whereas older patients judged it to be less intense. Moreover, younger patients were likely to be midly dysgeusic, whereas older patients appeared to be hypogeusic for citric acid. This study provides evidence for near normal suprathreshold taste intensity perception in patients who have received head and neck irradiation.

Pseudophakic endophthalmitis. Diagnosis and management.

Eighty-three cases of endophthalmitis occurring in eyes with intraocular lenses are presented. A problem with the cataract section was felt to contribute to development of the endophthalmitis in 22% of patients. Seventy-five percent of eyes were culture positive with a microbiologic spectrum similar to other reported series without lens implants. Staphylococcus epidermidis was the most common organism accounting for 38% of the isolates. Therapeutic vitrectomy was performed in 46 cases (55%), generally in those eyes with the most severe inflammation. Intraocular lenses were removed in 23 cases (28%), usually to facilitate vitrectomy. Only 1 of 57 eyes with bacterial endophthalmitis could not be sterilized while the intraocular lens was retained. Visual acuity of 20/400 or better was achieved in 63% of culture positive cases, in 78% of eyes infected with S. epidermidis, and in 94% of culture negative eyes.

Chronic conjunctivitis associated with 'floppy eyelids'.

The floppy eyelid syndrome represents a chronic conjunctivitis characterized by a triad of (1) a loose upper lid that readily everts on elevating the lid, (2) a soft rubbery tarsus that can be folded on itself, and (3) a diffuse papillary conjunctivitis. Seven cases of this condition are reported, all involving men, and four involving obese patients.

Secondary syphilis with iris papules.

A 30-year-old man developed bilateral iridocyclitis with iris roseolae and papules three months after the rash of secondary syphilis. The inflammation resolved after treatment with penicillin, intramuscularly, topically given corticosteroids, and cycloplegics. The serum immune-complex levels were slightly increased. Iris angiography showed leakage of fluorescein in the region of the papules and roseolae and from the vessels of the pupillary margin. When the eye was clinically uninflamed, a follow-up angiogram showed leakage of fluorescein from the same areas, suggesting that the inflammatory effect on the iris vessels persisted in the region of the roseolae, the papules, and the sphincter vessels.

Posttraumatic phycomycosis of the anterior segment.

Keratomycosis and infection of the anterior chamber with a Rhizopus sp (phycomycosis, mucormycosis) developed in a 24-year-old man following a perforating injury of the cornea with a soil-contaminated screwdriver. The infection was documented by positive cultures of the corneal wound and of the anterior chamber and by histopathologic studies. Phycomycosis of the eye usually occurs in the setting of systemically impaired host resistance. The patient had no underlying disease that wound predispose him to this infection but the treatment with topical 0.1% dexamethasone and triamcinolone acetonide suspension injected into the sub-Tenon's space following the injury may have impaired his local immunologic defenses. Excisional keratoplasty played an important role in the successful management of this case.

Acute systemic effects of cocaine in man: a controlled study by intranasal and intravenous routes.

Nineteen healthy volunteer subjects who regularly administered cocaine to themselves were given placebo and 10 and 25 milligrams of cocaine hydrochloride intravenously and intranasally. A dose of 100 milligrams of cocaine was administered only by the intranasal route. By this route 10 milligrams of cocaine produced no changes different from placebo, and 25 milligrams of cocaine produced physiologic changes only in systolic blood pressure. The 100-milligram dose given intranasally and all of the doses given intravenously produced significant dose-related physiologic and subjective responses.

Evaluation of propranolol in opiate dependence.

Among the increasing number of recent reports of the use of beta-adrenergic blocking drugs for a variety of psychiatric disorders is a series concluding that propranolol hydrochloride is efficacious in the treatment of opiate dependence. These reports were based on clinical observations of outpatient addicts in an uncontrolled situation. In order to validate these findings, we carried out a series of controlled, double-blind studies with hospitalized volunteers. The results of our studies do not confirm the previous reports. Propranolol neither relieved nor precipitated opiate withdrawal in subjects dependent either on dihydromorphinone hydrochloride or on heroin. It did not effectively block heroin-induced euphoria in dependent or nondependent subjects. In addition, there was no effect on the pattern of self-administration in opiate-dependent subjects, whether they were maintained on propranolol or placebo.