Intercellular adhesion molecule-1 in proliferative vitreoretinopathy.

PURPOSE: To measure vitreous levels of the soluble intercellular adhesion molecule (sICAM-1) in eyes with rhegmatogenous retinal detachment (RRD) complicated or uncomplicated by proliferative vitreoretinopathy (PVR) to investigate whether levels of this molecule related to history of previous retinal surgery or to the duration and severity of PVR. METHODS: The authors measured vitreous sICAM-1 by enzyme-linked immunosorbent assay in 28 eyes with PVR and 35 eyes with uncomplicated RRD. Vitreous from 10 eyes with macular holes and from 12 cadaveric eye donors were used as control specimens. RESULTS: Vitreous sICAM-1 levels were higher in the group with RRD complicated by PVR as a whole than in the group with RRD alone or in the control groups. In patients with no previous retinal surgery, there was no difference in vitreous sICAM-1 levels between the groups with RRD alone and RRD complicated by PVR. However, in patients who had undergone previous external surgery, those with PVR showed higher levels of vitreous sICAM-1 than those with RRD alone. In PVR, raised levels of sICAM-1 were associated preferentially with a history of previous vitrectomy as well as with a longer duration of the condition, although these levels were not related to the grade of PVR. In eyes with RRD alone, the levels of sICAM-1 were not enhanced with the duration of the detachment. Despite showing high vitreous levels of sICAM-1, patients with PVR did not exhibit increased serum levels of this adhesion molecule. CONCLUSIONS: The current observations suggest that those persons in whom PVR develops may have an impairment of the mechanisms that control the inflammatory response to retinal trauma. Persistently raised vitreous levels of sICAM-1 point to the continued operation of cytokine-mediated vascular reactions at the blood-retinal barrier.

Mucosal-associated lymphoid tissue lymphoma of the conjunctiva.

The recognition of mucosal-associated lymphoid tissue as a distinct entity has lead to the separate classification of tumors arising in this tissue, ie, the mucosal-associated lymphoid tissue lymphoma. Five patients with mucosal-associated lymphoid tissue lymphoma of the conjunctiva are described herein; four of the five patients had bilateral tumors. Laboratory analysis was done using microscopy, immunophenotyping, gene rearrangement analysis using both Southern blot and polymerase chain reaction techniques, and oncogene (bcl-1, bcl-2, and c-myc) rearrangement studies. Typical mucosal-associated lymphoid tissue lymphoma features were seen in all patients; three of four patients who underwent testing with immunphenotyping had light-chain restriction, four of five patients had a clone detected using Southern blot analysis, and all five patients showed clones on polymerase chain reaction analysis. No patient demonstrated oncogene rearrangement. In all patients, complete physical examinations and laboratory tests did not detect any evidence of systemic spread. After treatment, no evidence of local recurrence or dissemination was found during follow-up ranging from 2 to 3 years.

Late onset Leber's optic neuropathy: a case confused with ischaemic optic neuropathy.

A case is reported of a 63-year-old man with progressive central visual loss in one eye followed 11 months later by involvement of the fellow eye. A diagnosis of chronic ischaemic optic neuropathy was considered. However, despite a negative family history, the absence of electrocardiographic abnormalities, and minimal fundus changes a diagnosis of Leber's optic neuropathy was made on the basis of magnetic resonance imaging findings and the mitochondrial DNA mutation at base pair 11778.

Congenital radio-ulnar synostosis: surgical treatment.

The results of an operative approach to the problem of radio-ulnar synostosis were assessed in thirteen patients, ten to twenty-five and one-half years after the procedure was performed. We concluded that in a patient with bilateral synostosis one hand, the one not used in writing, should be shifted to a position of 20 to 35 degrees of supination. With one hand in this position, the other may be left in considerable pronation. Often after such a shift it is not necessary to rotate the second arm. However, if the pronation is marked in the second forearm, and if function is impaired unduly by this position, surgical correction is indicated. The arm should be placed in a position of 30 to 45 degrees of pronation. In unilateral radio-unlar synostosis, the ordinarily ideal position of the radius is between 10 and 20 degrees of supination. In an adult, the patient's occupation should be considered in deciding on the rotatory positions of the forearms. We usually prefer a method of transverse osteotomy through the conjoined mass of the radius and ulna. Careful observation of the effect on the vascular status of the limb during and immediately after surgery is important.

Primary vitrectomy for rhegmatogenous retinal detachment: an analysis of failure.

PURPOSE: To find the cause of failure in primary vitrectomy for rhegmatogenous retinal detachment. METHODS: Retrospective review of 171 consecutive cases of RRD treated by primary pars plana vitrectomy (PPV) from a tertiary referral centre to identify the 25 cases in which surgery had failed. Detachments with giant or macula breaks at initial presentation, with proliferative diabetic retinopathy or with PVR greater than grade B were excluded. RESULTS: The failure rate after the first operation was 14.6% and the commonest cause of failure was missed retinal breaks, accounting for 64.3% of failures. CONCLUSION: Missed retinal breaks are the commonest cause of failure of primary PPV for RRD although proliferative vitreoretinopathy may contribute to surgical failure. This re-emphasises the importance of assiduous peroperative retinal examination.

Orthopedic overview of juvenile rheumatoid arthritis.

Juvenile rheumatoid arthritis can be classified into three forms by the extent of early involvement: (1) pauciarticular, (2) polyarticular, and (3) systemic. When this disease, in which remission is common, is properly diagnosed and appropriately treated by physical therapy, occupational therapy, drug therapy, and surgical treatment, a good clinical result can usually be expected. Only 16 of 124 children had severe persistent impairment because of the disease in one recent study;18 this number may be high, since mild cases may be unrecognized or not be referred to the study clinic. However, efforts should be directed to reducing this number of severely impaired children -- in the short run by better techniques of reconstructive surgery and in the long run by a better understanding, through research into the etiology and pathogenesis of the disease adequate to prevent or significantly alter its course. The disease may be caused by a treatable occult infective agent and may respond to an approach similar to that for rheumatic fever, which no longer fills the wards of our children's hospitals as it once did.

Painful bipartite patellae. A report of three cases.

This is a report of three children with tender painful patellae, bipartite at the superior, lateral pole. Non-operative treatment failed to relieve these symptoms, but excision of the accessory ossification center resulted in a painless knee. Gross and microscopic pathological examination was consistent with the hypothesis that this syndrome was caused by fracture through the interposed cartilage which failed to heal satisfactorily.

Articular cartilage repair. Behavior of rabbit chondrocytes during tissue culture and subsequent allografting.

Chondrocytes from rabbit articular cartilage were freed from their matrix by enzymatic digestion. Under appropriate conditions of culture, these cells proliferated through many generations while maintaining their chondrocytic differentiation. They produced a cartilage-like matrix which was studied by histologic, electron microscopic, and chemical techniques. Chondroid tissue from subculture on decalcified bone, allografted into the rabbit knee, repaired a large articular defect in 10 days.

Corneal complications of cataract surgery.

Developments in cataract surgery have stimulated a greater interest in minimizing unwanted effects of cataract surgery on the cornea. The two main areas of concern are protection of the corneal endothelium and minimizing distortion of the anterior corneal surface. Endothelial cell loss is of particular importance where there is a preexisting significantly low cell count due to ocular trauma, surgery, or dystrophy, and in situations where cataract extraction is combined with other procedures that may be prolonged or require extensive manipulation. Recent availability of heavier molecular-weight viscoelastic substances are expected to help in minimizing endothelial cell trauma in these situations. In terms of postoperative corneal astigmatism the emphasis has changed for those who are regularly performing phacoemulsification from minimizing surgically induced astigmatism to planning the procedure so that it incorporates a correction of preexisting astigmatism. This emphasis may be more significant in cases of previous anterior segment surgery or trauma.

Histochemical and electron microscopic comparison of tissue produced by rabbit articular chondrocytes in vivo and in vitro.

Rabbit articular chondrocytes produce a chondroid matrix in subculture. This tissue was compared to articular cartilage by histochemical and electron microscopic techniques. Although both tissues were similar, the cytology of chondrocytes and the matrix structure of chondroid tissue appeared less mature.

Experimental production of cartilage necrosis by cold injury: failure to cause degenerative joint disease.

A cryoprobe (-20 to -80 C) was applied for 10-60 seconds to cause necrosis of metatarsal head cartilages of 11 rabbits. Segmental loss of nuclear staining was noted at 1 week and depletion of chondroitin sulfate (toluidine blue metachromasia and staining with safranin 0) a few days later. No degenerative joint disease was evident up to 6 months later. The latter finding suggests that, in addition to chondrocyte death, externally imposed stresses are necessary to disrupt the collagenous "skeleton" and initiate the changes of degenerative joint disease.

Freeze-dried fascia lata allografts: a review of 47 cases.

Fascia lata used to connect bony structures can provide stability while maintaining mobility. Experience with reconstituted freeze-dried allogeneic fascia used in 56 patients was reviewed, including ankle, hip, and shoulder suspensions, plus ligament and tendon repairs. Follow-up was available in 47 patients with 51 fascial grafts whose ages ranged from 2 to 58 years (mean, 19.2 years). Follow-up ranged from 6 months to 16 years with a mean of 7.2 years. Results were good in 72%, fair in 20%, and poor in 8%. Allograft fascia did not stretch out with time in these cases. Preserved fascia can provide satisfactory clinical results, thus eliminating the need for collecting autogenous fascia.