Enhanced cutaneous lymphatic network in the forearms of women with postmastectomy oedema.

Postmastectomy oedema (PMO) of the arm is a common aftermath of axillary lymphatic damage during treatment for breast cancer. The aim of the present study was to quantify the forearm dermal lymphatic capillaries in order to determine whether they exhibit adaptive responses to PMO. Both forearms were examined by fluorescence microlymphography in 16 patients with oedema following treatment for breast cancer (mean swelling 25 +/- 4%) and 19 patients treated for breast cancer but without oedema. Delineated lymphatic networks were analysed stereologically. The main findings were: (1) lymphatic density at any specified distance from the injection site was greater in the swollen arm than the control arm (p < 0.01, t test); (2) taking into account the increased skin area, the total length of lymphatic capillaries in a 1-cm annulus of skin was 676 +/- 56 cm (swollen), compared with 385 +/- 30 cm (control) (p < 0.001, t test); (3) fluorescent marker was transported over a greater distance before draining deep in the swollen arm (2.74 +/- 0.33 cm) than in the control arm (1.59 +/- 0.24 cm) (p = 0.02); (4) there was no evidence of lymphatic dilatation in the swollen arm, and (5) in breast cancer patients without swelling, the arm on the side of radiotherapy/surgery (otherwise referred to as the unswollen arm) showed none of the above changes, indicating that the changes are linked to the oedema rather than being universal responses to breast cancer or its treatment. It is concluded that microlymphatic changes occur in the swollen arm, namely a local superficial rerouting of lymph drainage and either lymphangiogenesis and/or increased recruitment of dormant lymphatic vessels. Since blood capillary angiogenesis occurs in the swollen arms, and lymphangiogenesis occurs in experimental lymphoedema, there is a precedent for proposing lymphangiogenesis in PMO. An increased number of functional vessels would help to maintain the ratio of local tissue drainage capacity to filtration capacity.

Clinical application of a homogeneous colorimetric assay for tear lysozyme.

PURPOSE: Tear lysozyme and tear lactoferrin are enzymes synthesized by the lacrimal gland. Their concentration in human tears reflects tear gland function. Tear gland dysfunction can lead to ocular surface disease. We developed a colorimetric lysozyme assay. The objective of this study was to determine the diagnostic power and the clinical application of this assay that allows rapid and precise quantification of tear lysozyme. METHODS: Tear specimens of 120 eyes (30 Sjögren's patients and 30 controls) were collected using standardized filter paper discs. Tear lysozyme concentration was determined using p-nitrophenyl penta-N-acetyl-beta-chitopentaoside as substrate in the colorimetric assay. The results were compared to clinical findings and to two commonly used tests, the Micrococcus agar diffusion assay for tear lysozyme and the tear lactoferrin immunodiffusion assay. RESULTS: The colorimetric assay showed a good dose-response relationship. The use of the assay as a method of diagnosing aqueous tear deficiency, using the clinical findings and the medical history as gold standard, demonstrated 85% sensitivity and 92% specificity. The results of the colorimetric assay when compared with the Micrococcus agar diffusion assay showed a linear relationship of r=0.77; when compared with the lactoferrin immunoassay r=0.73. CONCLUSIONS: The colorimetric assay is simple to perform and does not require sophisticated laboratory equipment and personnel. Results can be precisely quantified within one hour after tear collection. The diagnostic power of the test is comparable to previously reported assays for lysozyme and lactoferrin and will be useful in the diagnosis of ocular surface disease.

Interstitial nephritis and uveitis syndrome presenting with bilateral optic disk edema.

PURPOSE: To report a rare presentation of the tubulointerstitial nephritis and uveitis syndrome. METHOD: Case report. A 34-year-old woman underwent extensive clinical and laboratory evaluation of bilateral intermediate uveitis and optic nerve edema. RESULTS: Laboratory evaluation and nephrology consultation led to a diagnosis of tubulointerstitial nephritis. The condition resolved with the use of topical and systemic corticosteroids and the discontinuation of ibuprofen. CONCLUSIONS: Tubulointerstitial nephritis and uveitis syndrome is uncommon. It may present with anterior or intermediate uveitis. Chronic intermediate uveitis can cause optic nerve and macular edema. A thorough medical evaluation of any patient presenting with uveitis and systemic disease is essential to the diagnosis and management of uveitis.

Delusions of ocular parasitosis.

PURPOSE: To describe four cases of delusions of parasitosis in which self-inflicted ocular trauma occurred. Delusions of parasitosis is a somatic delusional disorder in which patients have the irrational belief that their bodies are infested by parasites or other infectious organisms. Self-inflicted trauma can result from attempts to eliminate the supposed infestation. METHODS: We reviewed the case histories of four patients (one male, three females, 35 to 45 years of age) who presented with complaints of ocular infestation but had no evidence of infectious ocular disease. The characteristics of these cases were compared with the features of delusions of parasitosis. RESULTS: All patients maintained their beliefs regarding infestation, despite extensive clinical and laboratory investigations that found no evidence of infectious diseases. Self-inflicted eye injury, associated with attempts to eliminate the infestation, occurred in each case. CONCLUSIONS: The cases presented in this report are consistent with a diagnosis of delusions of parasitosis. The eye can be a principal focus of attention in this disorder, which may lead to vision loss caused by self-inflicted injury.

Fear of intimacy and attachment among rape survivors.

The purpose of the present study was to investigate attachment and fear of intimacy among rape survivors. As previous research has documented that several domains of functioning are affected by the experience of rape, it was hypothesized that the survivors may have difficulties with attachment and intimacy. Subjects were selected from an undergraduate general psychology class on the basis of responses to a questionnaire on sexual experiences. All of the subjects were female and included 44 rape survivors and 57 controls. As predicted, rape survivors reported greater fear surrounding intimacy. Survivors also differed from the controls on all of the attachment dimensions. They reported less confidence in others' dependability, less comfort with closeness, and more fear of abandonment. Trait anxiety was also controlled in the analyses, and except for fear of abandonment, it attenuated the differences between the groups such that they were no longer significantly different.

Sarcoidosis manifesting as uveitis and menometrorrhagia.

PURPOSE: To report a rare systemic manifestation of sarcoidosis identified in a 47-year-old white woman while she was undergoing evaluation for bilateral recurrent uveitis. METHODS: The patient underwent clinical and laboratory evaluation for bilateral recurrent uveitis including serologic and radiologic testing, a gallium scan, and an endometrial biopsy. RESULTS: Although the serologic tests and chest x-ray were normal, the gallium scan was consistent with sarcoidosis, and the endometrial biopsy provided a tissue diagnosis. CONCLUSION: Sarcoidosis involving the female reproductive tract is rare. A thorough review of systems is crucial in the evaluation of any patient with recurrent uveitis.

Socioenvironmental experiences, self-esteem, and emotional/behavioral problems in early adolescence.

Tested the role of self-esteem as a mediator of relationships between socio-environmental experiences and emotional/behavioral problems using a sample of 215 young adolescents (Grades 7-9). Socioenvironmental experiences were assessed using self-report questionnaire measures of social support and major and minor stressful events. Self-esteem was assessed using a self-report questionnaire, an interview, and a parent-report questionnaire. Emotional/behavioral problems were assessed using self-report, parent-report and teacher-report questionnaires. Utilizing structural equation modeling, the data were used to test a model in which self-esteem mediated the relationship between socioenvironmental experiences and emotional/behavioral problems. The hypothesized model provided a reasonably good fit to the data (normed fit index = .90). However, an alternative model which also allowed for direct effects of socioenvironmental experiences on emotional/behavioral problems produced a significant improvement in model fit. In this model, socio-environmental experiences had significant effects on emotional problems via both direct effects and indirect effects that indicated a mediating role for self-esteem. Only direct effects of socioenvironmental experiences were evident for behavioral problems.

Other infections of the choroid and retina. Toxoplasmosis, histoplasmosis, Lyme disease, syphilis, tuberculosis, and ocular toxocariasis.

The major clinical infectious syndromes involving the retina and choroid are discussed. Means for successful diagnosis and treatment are presented, as well as the major complications. This work emphasizes the need to identify the infectious nature of these syndromes in order to avoid the all-too-common pitfall of just treating all cases of uveitis with steroids alone.

Observations on the lobular organization of the human choriocapillaris.

Vascular casts (Batson mixture) of ocular angioarchitecture were prepared from ten human orbits removed at autopsy. The age of donor specimens ranged from seven months to 68 years. The time interval between death and injection of the orbits averaged seven hours with a range of five hours. The resulting vascular casts were examined using light microscopy and scanning electron microscopy (SEM). We present photomicrographs of our vascular casts that demonstrate predictable variations of the human choriocapillaris angioarchitecture according to the region of the choriocapillaris under examination (i.e. posterior pole, equatorial, peripheral, peripapillary, or submacular areas). Our discussion represents an effort to help clarify some persistent controversies concerning the human choroidal angioarchitecture.

Bilateral orbital infiltration as the initial sign of a peripheral T-cell lymphoma presenting in a leukemic phase.

We describe the clinical course of a young woman with a peripheral T-cell lymphoma who presented in a leukemic phase of the disease with an initial complaint of bilateral conjunctival swelling.