Isolated inferior rectus muscle palsy from a solitary metastasis to the oculomotor nucleus.

A 55-year-old man with squamous cell carcinoma of the esophagus had vertical diplopia secondary to metastasis to the brain stem. The lesion was detected by magnetic resonance scanning but not by computed tomography. Clinically, the disturbance in ocular motility localized to the right inferior rectus muscle. At autopsy, a single metastasis was present in the brain stem, contiguous with the right oculomotor nucleus and involving a small portion of the nucleus. The findings in this case support the concept that, in humans, the oculomotor nucleus is organized into functional subnuclei.

Zygomaticofrontal suture defect associated with orbital dermoid cyst.

The zygomaticofrontal suture is a strong joint needed for protection of the orbit. During infancy its development can be altered by local mechanical factors which prevent its complete union. The following case report of a man with a slowly growing lesion of the left orbit was found to have a large dermoid cyst communicating with the temporal fossa. Presumably, the presence of choristomatous tissue at the junction of the zygomatic and frontal bones prevented normal closure of the joint during infancy. The computed tomographic findings in this condition are pathognomonic of dermoid cyst.

Induction of sister chromatid exchanges in mouse fetuses resulting from maternal alcohol consumption during pregnancy.

Mice were force-fed ethyl alcohol at different doses, administration rates, and durations during pregnancy. A tablet of 5-bromodeoxyuridine (BrdU) was implanted subcutaneously in the animals between the 16th and 18th day of gestation. Twenty-one hours later, the animals were killed, the fetuses removed, and the fetal liver cells treated to exhibit sister chromatid exchanges (SCE's). The following conclusions were drawn: (1) Ingestion of alcohol by pregnant mice induced SCE's in the liver cells of their fetuses. (2) The number of exchanges in the fetal cells was directly proportional to the amount of alcohol consumed by the dam in the period when BrdU was present in her blood. (3) The induction of exchanges above control level was due entirely to alcohol ingestion and was independent of exposure to BrdU, any other drug, or any dietary deficiency.

Corneal manifestations of scleromyxedema.

Bilateral superficial corneal deposits and scleromyxedema, an uncommon dermatosis caused by the accumulation of acid mucopolysaccharide in the skin often associated with a benign monoclonal gammopathy developed in a 71-year-old man. A biopsy specimen of the cornea showed that the deposits stained strongly positive for IgG and lambda chains. Ultrastructurally, the deposits consisted of amorphous granular material. Scleromyxedema should be considered in the differential diagnosis of noninflammatory superficial keratopathies associated with benign gammopathies.

Lipid crystals in malignant melanoma of the choroid.

The crystallization of extracellular lipid (other than cholesterol) in histologic preparation is a rarely observed phenomenon. The following case report describes lipid crystals within a necrotic uveal melanoma. Ultrastructural findings suggest that lipids released from necrotic lipidized melanoma cells were the source of the extracellular deposits. No unique lipids were identified from extracts of the tumor using thin layer chromatography. Energy dispersion microanalysis revealed elemental concentrations within the crystals comparable to intracellular organelles.

Cavernous sinus syndrome as the initial manifestation of multiple myeloma.

A 76-year-old man developed a cavernous sinus syndrome as the initial manifestation of multiple myeloma. Although clinically the patient had stage IA disease, which is typically associated with a favorable response to therapy, his disease was rapidly fatal. This case emphasizes a weakness of the traditional staging system because it does not take into account certain clinical and histopathologic aspects of myeloma relevant to extramedullary plasmacytomas. Since disorders of ocular motility are more likely to be associated with extramedullary myeloma than myeloma confined to the marrow, clinicians need to be aware of the limitations in the clinical staging system and the potential problems associated with anaplastic plasmacytomas.

The impact of variable tint optics (Transitions Gray) on vision-related quality of life in normal volunteers: a randomized clinical comparison in a warm climate.

PURPOSE: A randomized crossover comparison of Transitions Gray variable tint optics (VTO) vs clear and fixed-tint lenses was undertaken to evaluate the impact of VTO on vision-related quality of life (VRQOL) in a warm climate. METHODS: Fifty-nine patients were randomized to one of four lens crossover groups: Transitions-->clear; clear-->Transitions; Transitions-->fixed-tint; fixed-tint-->Transitions. Each lens was worn for 30 days. VRQOL was measured using a newly developed and validated questionnaire instrument-the Transitions VRQOL. Changes in visual acuity were assessed by functional exam. RESULTS: Overall, Transitions was associated with the greatest improvement in VRQOL relative to clear and fixed-tint lenses without compromise in acuity. Transitions proved statistically superior to clear lenses, most notably in vision comfort both indoors and outdoors. Seventy percent of all patients selected Transitions as their primary lens at the end of the study. CONCLUSIONS: Transitions brand VTO offer patients significant and clinically meaningful improvements in VRQOL superior to clear lenses. VRQOL assessments provide clinicians with valuable information above and beyond visual acuity to help optimize lens product selection and enhance patient satisfaction.

Threshold retinopathy of prematurity. Transition from cryopexy to laser treatment.

PURPOSE: The authors studied the effectiveness of laserpexy versus cryopexy for treatment of acute retinopathy of prematurity. METHODS: Seventy-six eyes in 41 patients were treated for acute retinopathy of prematurity from January 1991 to April 1994. RESULTS: Fifty-six eyes in 30 patients had zone 2 disease. Of these 30 patients, 11 received laser treatment and 20 received cryopexy treatment; there was at least one anatomically successful eye in each patient. Twenty eyes in ten patients had zone 1 disease. Seven patients had bilateral laser treatment. Three patients had bilateral cryopexy. In seven eyes with zone 1 disease, five were treated successfully with laser. None of the three eyes with zone 1 disease treated with cryopexy were successful. CONCLUSION: Laserpexy and cryopexy are of equal efficacy in treating zone 2 disease. There is a tendency that suggests that laserpexy is more effective than cryopexy in treating zone 1 disease. Diode and argon lasers are of equal efficacy in treating zone 1 disease.