Management of severe proliferative vitreo-retinopathy with perfluorocarbon liquids and silicone oil.

12 patients of retinal detachment with advanced proliferative vitreoretinopathy were managed with intraoperative perfluoro-N-octane and postoperative silicone oil injection from March 1994 to June 1996 in Kaohsiung Medical University Hospital. The combined intraoprative procedures included posterior vitrectomy (12 eyes), membrane peeling (12 eyes), lower peripheral iridectomy (8 eyes), endo-photocoagulation (8 eyes), retinotomy (8 eyes), and retinal fixation with tack (1 eye). After a minimum of 10 months of follow up, the retina was successfully reattached in 10 (84%) of the 12 eyes, 5 of these eyes had stable tractional detachments on the anterior part of the scleral buckle. Seven patients (58.3%) regained vision of 5/200 or better. The rate of improvement by listing best corrected visual acuity after operation was 75%. We think that the ability to readily remove additional pre-retinal fibrous tissue after the retina was flattened with perfluorocarbon liquids allowed the surgeon to perform a further complete membrane dissection. It can therefore improve the success rate of surgery and hence decrease the rate of complications that was previously thought to be caused by sillicone oil.

Keratomycosis with an unusual clinical manifestation--a case report.

We report a case of keratomycosis which had recurrent, deep stromal infiltration and an endothelial plaque for half a year after the original corneal foreign body injury. The subject had an unusual clinical picture of deep corneal infiltration and later hair-like material growing from the endothelial plaque into the anterior chamber. Repeated corneal scrapings for smears and cultures all showed negative during the initial treatment. We tried anterior chamber paracentesis and endothelial aspiration and got a positive finding of Cladosporium infection. This case is presented because of the difficulty of diagnosis and management of fungal keratomycosis.

Use of dynamic capillaroscopy for studying cutaneous microcirculation in patients with diabetes mellitus.

To investigate the relationship between cutaneous microcirculation and retinopathy in diabetes mellitus, we studied by dynamic capillaroscopy 35 diabetes mellitus patients, including 10 patients without retinopathy, 10 patients with background retinopathy, and 15 patients with proliferative retinopathy. We found that (1) cutaneous and retinal microcirculation in diabetes mellitus in long-term diabetes mellitus, regressional rather than proliferational changes occurred in skin vasculature as compared to that in retina; (2) functional impairments of cutaneous microcirculation, that is, decreased resting capillary blood cell velocity, peak blood cell velocity, and prolonged time to peak capillary blood cell velocity by dynamic capillaroscopy, could be detected in diabetes mellitus patients without retinopathy; (3) the degree of tortouosity of capillaries, impairment in peak capillary blood cell velocity, and time to peak capillary blood cell velocity of cutaneous microcirculation were significantly correlated with the gravity of retinopathy in diabetes mellitus patients; (4) abnormal leakage of fluorescence in cutaneous microcirculation appeared in diabetes mellitus patients with or without abnormal fluorescein angiography in retina. In conclusion, dynamic capillaroscopy used in concert with ophthalmoscopy and fluorescein angiography can facilitate a comprehensive examination of vasculopathy in diabetes mellitus.

Antibodies to Epstein-Barr virus-specific DNase in patients with nasopharyngeal carcinoma and control groups.

Serum samples from 154 patients with nasopharyngeal carcinoma (NPC), 374 with other cancers, 1,000 normal controls from Government Employees' Clinic Center (GECC), and 3,642 individuals of various ethnic-dialect groups living in high-risk areas for NPC were collected and the concentration of antibodies to Epstein-Barr virus (EBV)-specific DNase activity was determined. Taking a serum sample where 1 ml will neutralize two or more units of the DNase activity as positive, 2-4 units as low level, 4-6 units as medium level, and more than 6 units as a high level of antibody, 90.3% of the NPC patients contained significant amounts of antibodies to EBV-specific DNase activity and most of those had high levels of the antibody. In contrast, only 11% of sera from patients with cancers other than NPC contained antibodies to EBV-specific DNase activity, and high levels were very rare (2.1%). The difference in positive rates between these two groups is highly significant according to the chi 2 test (P less than 0.001). The positive rate of this antibody in the control group (GECC) was 5.3% with 0.0%, 0.8%, and 4.5% having high, medium, and low levels of antibodies, respectively. Again, the difference in positive rates between the GECC group and the NPC group is statistically significant (P less than 0.001). Taken separately, the positive rates of anti-EBV DNase activity in the three high-risk groups were 11.7%, 13.0%, and 13.1%. No significant difference in age distribution for the levels of this antibody was observed in the control GECC group or the three high-risk groups. However, the positive rates of the three high-risk groups are more than twice those of the GECC group (11.7% approximately 13.1% vs 5.3%). This ratio coincides with the ratio of the probability of developing NPC in high-risk groups compared to that of the GECC group (also more than two times). The significance of this coincidence is discussed.

Antibody to Epstein-Barr virus-specific DNase as a marker for the early detection of nasopharyngeal carcinoma.

We have previously shown that high levels of antibody to Epstein-Barr virus (EBV)-specific DNase may be a useful marker for the early diagnosis of nasopharyngeal carcinoma (NPC). Sera from 3,368 males in an area with a high risk for the development of NPC were examined for the presence of antibody to EBV-specific DNase activity. Significant levels of the antibody were found in 430 of these sera. As a result, 32 individuals have attended the out-patient department of otolaryngology for clinical examination. Among them, one individual was found to have a stage II nasopharyngeal carcinoma. This result supports the value of determination of antibody to EBV-specific DNase as a marker for the early detection of NPC.

The granulomatous response of leprosy patients to lepromin and killed BCG.

The volunteers studied included 6 tuberculoid and 11 lepromatous leprosy patients (Ridley and Jopling). Each received intradermally 0.1 ml of lepromin (Wade method) and 0.1 ml of autoclaved BCG (grown on Dubos medium) at 2 separate sites on the left upper arm. Observations were made at weekly intervals, and biopsy specimens were taken at the fourth wk. Within 3 to 4 wk all 6 tuberculoid patients responded to lepromin with typical granulomas (5 of which measured 5 mm or more in diameter) composed of epithelioid cells, lymphocytes and giant cells. In contrast, 8 of the 11 lepromatous patients remained negative; the other 3 developed tiny papules less than 3 mm in diameter which disappeared after 2 wk. Biopsy specimens taken from injection sities at the fourth wk showed essentially normal histology. All 1 patients developed typical granulomas to heat-killed BCG (non were less than 5 mm in diameter and most were larger) consisting of epithelioid cells, many lymphocytes and a few giant cells. The reaction in tuberculoid leprosy was stronger than that in lepromatous leprosy and the reaction to BCG in tuberculoid leprosy was stronger than that to lepromin, but the differences were not very remarkable.

Ability of the leprous macrophage to accept cytophilic antibodies.

The ability of leprous macrophages to accept cytophilic antibodies was not damaged. Blood macrophages derived from both types of leprosy formed rosettes with cytophilic antibody sensitized goat red cells. The rosette forming rates of tuberculoid (65.0%) and lepromatous macrophages (66.4%) were essentially the same as that of normal blood macrophages (68.8%).