Venous air and gas emboli in operative hysteroscopy.

Air and gas emboli have been reported in almost all areas of clinical and surgical practice. The literature is replete with observations and methods for treating these events. It is possible to mitigate the consequences of this risk, particularly in operative hysteroscopy. Recommendations include monitoring devices such as capnography to facilitate intraoperative diagnosis of these emboli.

Enhanced oxidative mechanisms in immunologically activated versus elicited polymorphonuclear neutrophils: correlations with fungicidal activity.

Peritoneal polymorphonuclear neutrophils (PMN) from mice were tested for their ability to kill the yeast form of Blastomyces dermatitidis (Bd) in vitro and for their fungicidal mechanisms. PMN elicited from immune mice by the intraperitoneal injection of non-viable Bd (referred to as immunologically activated PMN or ActPMN) showed significantly enhanced fungicidal activity in comparison with PMN elicited with thioglycollate medium (ThioPMN) [means = 44.7% (SD 12.8%) and 16.4% (SD 9.2%) killed; n = 14; p less than 0.001]. Production of superoxide anion (O2-) by ActPMN after stimulation with phorbol myristate acetate was enhanced in comparison with production by ThioPMN. Superoxide dismutase, which removes O2-, inhibited ActPMN killing by 75% (p less than 0.001) when added to cultures immediately before challenge with Bd (optimal concentration: 6000 U/ml). Sodium azide, which inhibits myeloperoxidase and scavenges singlet oxygen (1O2), and catalase, which breaks down hydrogen peroxide (H2O2), inhibited ActPMN killing by 64% (p less than 0.001) and 52% (p less than 0.001), with optimal concentrations of 1 mM and 10,000 U/ml, respectively. Two agents that both scavenge 1O2 and antagonise hypochlorous acid (HOCl-), histidine and tryptophan, were also powerful inhibitors of ActPMN killing. Quenchers of hydroxyl radical (.OH), dimethylsulfoxide and sodium benzoate, had less effect, and required higher concentrations. These data suggest that the enhanced killing of Bd by ActPMN involves one or more oxidative mechanisms, and that there is a prominent role for O2-, either directly or as a precursor of other active oxygen species, a probable role for H2O2, and possible roles for 1O2, HOCl-, and .OH.

Activation of murine polymorphonuclear neutrophils for fungicidal activity by recombinant gamma interferon.

Recombinant murine gamma-interferon (IFN) was tested for its ability to enhance murine polymorphonuclear neutrophil (PMN) fungicidal activity in vitro. PMNs, elicited by intraperitoneal injection of thioglycollate 4 hr prior to collection, were treated with 0.00003-300,000 units of IFN per milliliter for 1 hr prior to challenge with yeast form Blastomyces dermatitidis. These PMNs were not fungicidal for Blastomyces in the absence of IFN; significant enhancement of PMN fungicidal activity by IFN treatment occurred in a dose-dependent manner with maximal enhancement observed at 30,000 U/ml (21% killing). Pretreatment of IFN with rabbit anti-IFN antiserum before addition to PMNs eliminated the enhancement of fungicidal activity by effective doses of IFN. PMN fungicidal activity against phagocytizable Candida albicans was significantly (P less than .001) higher (71.3 +/- 17.4%) than against B. dermatitidis. Candidacidal activity was not significantly enhanced by IFN treatment of PMNs. Exogenously added lipopolysaccharide, at levels corresponding to those found in this preparation of IFN, did not activate PMNs for enhanced fungicidal capacity. These data indicate a stimulatory role for IFN in the killing of B. dermatitidis by PMNs, suggesting that IFN is an active component of the communication between T lymphocytes and PMNs with respect to antimicrobial resistance. They suggest a natural role for IFN in host defense against blastomycosis and other fungal infections, and a possible therapeutic use for exogenous IFN in fungal disease.

Posterior chamber intraocular lenses in a series of 75 autopsy eyes. Part II: Postimplantation loop configuration.

We illustrate, from the pathologist's viewpoint, the configuration of posterior chamber lens loops within the eye. The final configuration of these loops is often a "C" shape, particularly following capsular fixation. When one or both loops are placed in the ciliary sulcus, where tissue resistance to loop compressive forces is less than in the capsular sac, an invagination or erosion of the loop into the ciliary body stroma or ciliary muscle frequently occurs. Although a surgeon should first and foremost choose a lens design with which he or she is comfortable in terms of ease of implantation and good clinical results, our pathological observations indicate that a subtle compromise in loop configuration might provide a more physiologically correct configuration in the eye, particularly for those who prefer in-the-bag implantation. Most surgeons prefer a lens design that will provide adequate fixation in the ciliary sulcus if an attempted capsular sac implantation is not successful.

Posterior chamber intraocular lenses in a series of 75 autopsy eyes. Part III: Correlation of positioning holes and optic edges with the pupillary aperture and visual axis.

The possibility that undesirable visual complications such as glare, halo, monocular diplopia, or other visual aberrations can result from the presence of posterior chamber lens optic edges or such lens elements as positioning holes or loop-optic junctions within the pupillary aperture has received little attention. There is recent clinical evidence that these phenomena may be clinically significant. In a series of 75 autopsy eyes with posterior chamber intraocular lenses, we have observed that in 71% of cases an optic edge, or element of the optic such as a positioning hole, was situated either within the pupillary aperture and visual axis (average pupillary diameter 3.45 mm) or within 0.5 mm of the pupillary margin. This finding was most common (92%) in cases with asymmetric placement, less common (50%) in cases with symmetric placement. Many more young patients are now undergoing implantation surgery. These patients generally have wider, more mobile pupils, and they may be more aware of subjective symptoms, particularly at night. Subtle changes in implantation techniques and in lens design and manufacture can minimize complications related to this condition. These changes include symmetric loop placement (both loops in the capsular sac or both in the ciliary sulcus) to decrease optic decentration. Other measures such as making partial-depth positioning holes, increasing the size of the optic, eliminating or reducing the number of positioning holes, and placing positioning holes in tabs on the optic edges may function to increase the effective optical zone.

Posterior chamber intraocular lenses in a series of 75 autopsy eyes. Part I: Loop location.

Over a period of 27 months, November 1983 to February 1986, 75 eyes obtained postmortem with posterior chamber intraocular lenses (IOLs) were examined at the Center for Intraocular Lens Research, University of Utah Health Sciences Center. These IOLs were studied by histopathological techniques to determine the location of the loops. The most common combination, found in 47% of the specimens, was one loop in the lens capsular sac (bag) and one loop in the ciliary sulcus. In 32% of the specimens, both loops were in the capsular sac; in 17%, both loops were in the ciliary sulcus. Compared to results observed in other autopsy studies, in which capsular fixation was documented in less than 3% of cases, these findings reflect a trend toward capsular sac (in-the-bag) implantation of open-looped posterior chamber IOLs.

Histopathologic and scanning electron microscopic study of one type of intraocular lens.

We performed clinicopathologic analyses of 28 explanted anterior chamber intraocular lenses (Stableflex). Two factors strongly indicated that this lens can be difficult to remove: (1) the clinical histories obtained from the explanting surgeons who, with few exceptions, stated that removal was extremely difficult; and (2) our scanning electron microscopic findings, which documented extensive tissue encapsulation around loops as well as multiple sites of loop severance required at the time of lens removal. The general efficacy of this intraocular lens compared with other anterior chamber lenses was not addressed in this study.

Fungal contamination of balanced salt solution.

A fungal organism, identified as Ulocladium, was isolated from an unopened 15 ml bottle of balanced salt solution. The authors note the importance of visually inspecting solutions used in ophthalmic surgery.

Cellular immunity in infectious mononucleosis. II. Specific reactivity to Epstein-Barr Virus antigens and correlation with clinical and hematologic parameters.

Infectious mononucleosis (IM) patients, Epstein-Barr virus (EBV)-seropositive and seronegative healthy donors, and patients with other viral infections were tested for lymphocyte blastogenesis (LB) with phytohemagglutinin and six EBV (virus concentrate, culture supernatant, and soluble [S] antigen) or control antigens. Fluorescent antibodies to EBV viral capsid antigen of IgG, IgM, IgA specificities, to nuclear antigen (EBNA), and heterophile antibodies were also assayed. These were correlated with clinical parameters (fever, pharyngitis, adenopathy, hepatitis, splenomegaly, atypical lymphocytes, and total mononuclear cell counts). EBV viral and S antigen-induced LB was significantly greater in seropositive donors. IM patients had antigenspecific LB below that of seropositive donors initially and low responses for the acute phase of illness when clinical symptoms were present and antibody titers were maximal. Specific LB rose to a peak at 3.5 to 9 weeks when the patients had recovered, most laboratory findings had returned to normal, and antibodies had declined. At peak, specific LB in IM patients exceeded that of seropositive donors, but later declined. These results demonstrate specific cell-mediated immunity (CMI) to EBV, and indicate that this develops slowly in IM and contrasts with the evolution of the clinical events and humoral immunity. This correlation supports the hypothesis that CMI is the mechanism of terminating lymphoproliferation in IM.

Chemotaxigenic activity of extracts from the mycelial and spherule phases of Coccidioides immitis for human polymorphonuclear leukocytes.

In order to further characterize human host defenses against Coccidioides immitis, extracts of this fungus were tested in vitro for their ability to attract polymorphonuclear leukocytes derived from peripheral blood of uninfected subjects. Soluble substances prepared from the mycelial (saprophytic) and spherule (tissue) phases exhibited, in the presence of serum, dose-dependent chemotactic activity. The dose-response correlations were different. The spherule-derived preparation showed decreased activity at the high concentrations, a diminution not observed with equivalent concentrations of the mycelial filtrate. Chemotactic activity was not observed with either substance in the absence of serum or if heat-inactivated serum was substituted. Because the response of human polymorphonuclear leukocytes to these fungal substances appears complement mediated, a selective cellular defect in this function which antedates exposure to C. immitis seems unlikely.

Cellular immunity in infectious mononucleosis: I. Spontaneous and phytohaemagglutinin-induced blast transformation in infectious mononucleosis, with special reference to depressed cellular reactivity and stimulation-blocking serum factors.

Lymphocytes of patients with infectious mononucleosis (IM), EBV sero-positive subjects, patients with viral infections other than EBV, and EBV sero-negative subjects were tested for phytohaemagglutinin (PHA)-induced and spontaneous transformation in vitro. Lymphocytes of EBV sero-positive healthy subjects, tested in autologous serum, have higher spontaneous transformation than those of EBV sero-negative subjects. IM patients, in the acute phase of illness, have depressed spontaneous lymphocyte transformation, independent of serum factors. Serum factors are present in acute IM that depress spontaneous transformation further, and to a lesser extent depress reactivity to PHA. By the time the IM patients had recovered, greater than 9 weeks after onset of illness, the defects observed had disappeared.