Field collection of rectal samples for sexually transmitted infection diagnostics among men who have sex with men.

Rectal sexually transmitted infections (STIs) are common in men at risk for urethral infections with these pathogens, particularly men who have sex with men (MSM). However, for those individuals not regularly seen by a clinician, screening for rectal STI is not currently a widespread option. Qualitative data and samples (i.e. self-obtained rectal specimens) were collected from 75 MSM in a variety of venues. Upon completion of the rectal self-sampling, each participant completed a brief interview regarding their overall experience with the process. Participants reported an overall high level of acceptability and comfort-level involved with self-sampling for rectal STI. Of the majority of men who agreed to provide a rectal self-sample, all reported that they would provide a sample again in the future. However, many men also appreciated the interaction with a health-care provider that a clinical setting offered. In conclusion, self-sampling is a feasible and acceptable option when offered to MSM in a range of community-based venues. Further research is needed to determine which combinations of STI testing and treatment methods (including self-sampling) are most appropriate for diverse groups of men.

Oval corneal opacities in beagles. III. Histochemical demonstration of stromal lipids without hyperlipidemia.

We found oral stromal avascular corneal opacities in 128 eyes of 75 beagles from 497 studied. There were three morphologic types that progressed in severity with time; nebular, racetrack, and white arc. Histochemical study of the earliest morphologic type (nebular) revealed neutral fats, cholesterol, phospholipids, and sometimes fatty acids both intracellularly and extracellularly. We found no elevation of serum cholesterol or triglycerides except in dogs with the most advanced morphologic type (white arc) and no alteration in thyrometabolic function. We think that oval stromal opacities in beagle corneas are a primary disorder of corneal lipid metabolism closely resembling the central crystalline dystrophy of Schnyder and may be an animal model for this human disease.

The cancer-associated retinopathy antigen is a recoverin-like protein.

Cancer-associated retinopathy (CAR) is a rare form of retinal degeneration that occurs in association with certain forms of cancer. CAR patients typically possess high titers of autoantibodies against a specific photoreceptor protein--the 23 kD retinal CAR antigen. The mechanisms involved in the vision loss experienced by CAR patients are not understood, but serologic studies indicate the process could include a series of autoimmune reactions directed at specific components of the retina. Because the retinal CAR antigen is the principal ocular autoantigen involved in the antibody response of CAR patients, characterizing it would contribute to the understanding of putative autoimmune involvement. Serum antibodies from CAR patients have been used to isolate the gene encoding the CAR antigen from a cDNA library of human retina. Nucleotide sequence analysis suggests that the CAR antigen shows approximately 90% homology to the published amino acid sequence of bovine recoverin.

The ultimate diagnoses of patients undergoing temporal artery biopsies.

Patients with signs and symptoms of giant cell arteritis may have normal temporal artery biopsy specimens. To study the relationships between signs and symptoms of this disease and the ultimate clinical diagnosis, we reviewed 51 patients who had undergone temporal artery biopsy. The mean age of the patients with abnormal biopsy specimens was higher than that of patients with normal biopsy specimens. We found headache, fever, and jaw claudication were useful symptoms in predicting abnormal biopsy specimens. The ultimate diagnoses of patients with normal biopsy specimens and no response to treatment showed high incidence of malignant neoplasms and diabetes mellitus.

Cancer-associated retinopathy.

Antiretina antibodies have been found in the serum samples of four patients with cancer experiencing concomitant loss of vision (cancer-associated retinopathy [CAR] syndrome). These immunoglobulins bound an antigen from normal pooled retina having a molecular weight of 23,000 daltons, which we describe as the CAR antigen. No corresponding antibodies could be found in serum samples obtained from patients with cancer not experiencing vision loss, from patients having retinitis pigmentosa, or from normally sighted individuals who did not have cancer. The early detection of rising antibody titers against the CAR antigen could prove important in the identification of patients likely to suffer from CARs.

Photoreceptor degeneration. Possible autoimmune disorder.

A 61-year-old woman with progressive blindness, initially responsive to steroid therapy, was found to have an undifferentiated neoplasm in the cervix uteri. Visual fields demonstrated ring scotomas and the electroretinographic pattern eventually became flat. The interval from onset of visual symptoms to blindness was 19 months. Eye pathologic findings included loss of retinal photoreceptors, a macular hole, and normal optic nerves. Antibodies were demonstrated in the patient's serum to normal fresh human retinal photoreceptors. An autoimmune mechanism may have been responsible for the retinal degeneration in this patient, and such a hypothesis raises questions about (1) autoimmune mechanisms in patients with retinitis pigmentosa and other retinal degenerative diseases and (2) autoimmune mechanisms in other cases of remote effects of carcinoma.

Conjunctival transplantation. Autologous and homologous grafts.

Autologous conjunctival transplants have been used successfully for restoration of damaged ocular surfaces. Homologous (allogeneic) conjunctival grafts have been explored less systematically. We developed a nonhuman primate model for comparison of autologous and homologous conjunctival transplantation in order to assess the clinical viability and immunopathologic characteristics of these grafts. Autologous or homologous grafts were performed in nine adult rhesus monkeys. Both autologous and homologous grafts were compared for clinical viability and immunopathologic change. Clinical results suggest that, although homologous grafts incited a greater inflammatory and scarring response, there was minimal graft shrinkage and a normal surface epithelium. Immunopathologic studies using laminin, bullous pemphigoid antigen, and fibronectin indicate that, despite the increased inflammatory response seen in homografts, the epithelial surface is normal. With our increasing ability to modulate the immune response, conjunctival homografts may play a role in restoration of the ocular surface.

Acanthamoeba sclerokeratitis. Determining diagnostic criteria.

Acanthamoeba infection of the cornea is an entity now recognized with increasing frequency. We saw two cases of Acanthamoeba sclerokeratitis in contact lens wearers in whom scleritis (anterior and posterior) played a central role in the clinical course of the disease. Scleritis is probably a more common component of Acanthamoeba infection than has generally been acknowledged. Posterior scleritis has not, to our knowledge, been reported previously in this disorder. The clinical diagnosis of Acanthamoeba infection has often been missed due to lack of a definition of the historical and clinical criteria by which this disease is characterized. We reviewed the 26 previously reported cases and suggest a set of criteria that can be used to establish an early diagnosis. Historical criteria include minor corneal trauma, exposure to soil or standing water, or contact lens wear. Clinical characteristics include severe pain, infiltrative (often ring-shaped) stromal keratitis, variable anterior uveitis, epithelial erosion, scleritis, standard bacterial culture negativity, chronicity, and lack of response to antimicrobial agents.

Antibody reactions with retina and cancer-associated antigens in 10 patients with cancer-associated retinopathy.

OBJECTIVE: Our objectives were to determine what clinical characteristics are common to the form of cancer-associated retinopathy (CAR) encountered in patients with small-cell carcinoma of the lung (SCCL). Is the 23-kd retinal CAR antigen/antibody reaction present in other forms of retinopathy? Can an antigen identical or similar to the 23-kd retinal CAR antigen be identified in an established culture of SCCL? METHODS: Ten patients with CAR who had SCCL were identified by their antibody reactivity with the 23-kd retinal CAR antigen. We inquired into common clinical characteristics by means of questionnaires to the referring physicians. We looked for antigen/antibody reactions with the 23-kd retinal CAR antigen in patients with diabetic and age-related macular degenerations and in a continuous, in vitro propagated culture of SCCL (HTB 119) obtained from the American Type Culture Collection. RESULTS: We encountered many similar signs and symptoms in our patient population. These included rapid vision loss, night blindness, color loss, vitreous cells, and either flat or greatly reduced electroretinograms. No corollary to the 23-kd CAR antigen/antibody could be identified in unrelated retinopathies or cultured SCCL. CONCLUSIONS: We conclude that patients with SCCL-related CAR consistently produce antibodies against the 23-kd retinal CAR antigen. This immunologic reaction was not found in patients with unrelated retinopathies and may possibly represent a cancer marker for SCCL.

Intraperitoneal cultivation of small-cell carcinoma induces expression of the retinal cancer-associated retinopathy antigen.

OBJECTIVE: We have inquired into the reason why patients with cancer-associated retinopathy (CAR) produce antibody reactions with the 23-kd retinal CAR antigen. Possible reasons include the expression of this antigen in the related carcinoma. Previous studies have failed to identify any antigenic counterpart expressed by in vitro cultivated small-cell carcinoma of the lung. We, therefore, inquired into the effects of in vivo cultivation of the cancer cells and its influence on protein expression, with specific reference to the appearance of the 23-kd retinal CAR antigen. DESIGN: A complementary DNA library was prepared from small-cell carcinoma of the lung cells propagated intraperitoneally in Lewis rats and probed with antibodies reactive with the 23-kd retinal CAR antigen. RESULTS: We found evidence of the expression of a cancer-associated gene in ascites-propagated small-cell carcinoma of the lung that encodes for a protein antigenically similar to the 23-kd retinal CAR antigen. A complementary DNA encoding this protein revealed complete DNA sequence homology with the retinal CAR antigen showing the cancer cells are expressing this photoreceptor protein. CONCLUSIONS: We hypothesize that the carcinoma-retina immunologic cross-reaction is responsible for the induction of the unique antibody response encountered in patients with CAR with vision loss developing as a cancer-evoked autoimmune retinopathy.

Management and monitoring of cancer-associated retinopathy.

Cancer-associated retinopathy is a rare paraneoplastic event that can involve allergic reactions and result in retinal degradation. A patient, who had a 35-year smoking history, complained of visual loss and was found to have serum antibodies that reacted with an extract of retina, including the previously described retinal cancer-associated retinopathy antigen. Prednisone treatment appeared to reduce the patient's antibody titers to normal levels. Visual fields stabilized, and the patient was able to maintain useful vision throughout the course of treatment until his death 1 year following initial diagnosis. To our knowledge, this is the first reported case in which monitoring of antibody responses to retinal antigens appeared to be useful in the decision whether to initiate prednisone therapy. Rising antibody titers to the cancer-associated retinopathy antigen probably occurs before progressive visual field loss and may be considered an indication for prompt steroid therapy.

Malignant change in melanocytomas of the uveal tract.

Melanocytomas are pigmented tumors of the uvea and optic nerve head composed of plump polyhedral melanocytes which have been regarded as nevus cells. There are few reports of malignant change in these usually benign lesions. This study documents 16 cases of malignant melanoma of the uvea, eight of which were characterized by the presence of plump polyhedral melanocytes in and around the tumor. The melanocytoma cells were aggregated throughout the tumors and/or at the margins of the lesions; these cells did not appear between the melanoma and the sclera, as has been reported with spindle-type nevus cells. Electron micrographs of these plump melanocytes had the characteristics of common uveal melanocytes, while the tumor cells had features of malignant melanoma cells. The clinician should recognize the potential of melanocytomas for undergoing malignant change and should follow patients who have this lesion with this in mind. Article is followed by comments of Dr. L. E. Zimmerman.

Solitary keratoacanthoma of the conjunctiva.

Two ranch workers had rapidly-growing crateriform conjunctival nodules excised without recurrence. Histopathologically, these lesions consisted of acanthotic epithelium characterized by prominent keratin formation both within cells and in horn pearls. Although both clinically and histologically they resemble squamous cell carcinoma, keratoacanthomas are benign tumors commonly thought to arise in hair follicles. The presence of these lesions on conjunctiva and other epithelia without hair in the two cases described was evidence against this hypothesis.

Histoplasma capsulatum in the presumed ocular histoplasmosis syndrome.

I demonstrated Histoplasma capsulatum organisms in disciform macular lesions, as well as a peripapillary lesion and peripheral atrophic scars in both eyes and in the lung of a patient with no history of active histoplasmosis. Autopsy findings were compatible with those of the presumed ocular histoplasmosis syndrome.

Intraosseous hemangioma of the orbital roof.

A 63-year-old woman had an osseous hemangioma of the orbital rim. Diagnosis of this primary bone tumor was made by its distinctive radiographic appearance and confirmed by pathologic, examination. Although this is a benign lesion, it is expansile and can cause ocular signs. Surgical resection is the recommended treatment.

Optic cupping caused by an intracranial aneurysm.

A 51-year-old woman had optic disk cupping from optic nerve compression by an intracranial aneurysm. Slit-lamp stereoscopic examination of the living eye immediately post mortem revealed an optic cup vertically oral, elongated superiorly, and indistinguishable from disk changes seen early in glaucoma. The histopathological changes differed from those in glaucoma by showing no glial atrophy. Instead, the cupping was caused by loss of axons in the prelaminar region of the nerve head and collapse of glial columns.

Ocular findings associated with encephalomyelitis caused by Herpesvirus simiae.

A 29-year-old monkey handler developed acute encephalomyelitis with serological evidence of Herpesvirus simiae infection. He had sudden unilateral loss of vision on the 32nd day of illness caused by vitreous hemorrhage. This cleared gradually, revealing chorioretinal scarring and a gliovascular vitreous band which eventually caused local tractional retinal detachment.

Clinical and pathologic description of 17 cases of corneal intraepithelial neoplasia.

In 17 patients with corneal intraepithelial neoplasia (dysplasia), the epithelium formed a gray plaque at the corneal limbus adjacent to a conjunctival papilloma in seven cases, leukoplakia in six cases, a pterygium in one case, and a pinguecula in one case. The lesion was an extension of a similar neoplastic process of the conjunctiva in 15 cases, was associated with chronic conjunctivitis in one case, and was isolated to the cornea in one case. Fine white dots mottled the opalescent, ground-glass sheet, whose fimbriated leading edge consisted of sharply demarcated gray fingers that extended to the visual axis in some cases. The disorder can wax and wane spontaneously, shown in one case observed for 16 years. Histopathologically, the thick, hypercellular corneal epithelium abutted sharply against adjacent normal epithelium and demonstrated both cellular pleomorphism and poor intercellular adhesion in the deeper layers. The adjacent conjunctival neoplastic lesions ranged from mild dysplasia to invasive squamous cell carcinoma. Ultrastructurally, the corneal epithelium showed a marked decrease in desmosomal attachments, an abundance of intracytoplasmic filaments characteristic of keratin, and a loss of epithelial basement membrane and hemidesmosomes. The lesion did not extend into Bowman's zone. We classify this dysplastic process as a mild form of corneal intraepithelial dysplasia, a term used to designate the spectrum of epithelial changes ranging from dysplasia to carcinoma in situ. The virulence of the corneal lesion itself is low.

Lepromatous iridocyclitis diagnosed by anterior chamber paracentesis.

A 34-year-old man with a three-month history of intraocular inflammation after ocular trauma with a fir branch, had an acute unilateral fulminant iridocyclitis. The iris had a thick, gray, cheesy membrane composed of nodular lepromata. The patient denied a history of Hansen's disease, despite the dermatologic and facial features that suggested the diagnosis. Anterior chamber paracentesis and scleral nodule biopsy demonstrated Mycobacterium lepra. The iridocyclitis resolved after treatment with dapsone, corticosteroids, and rifampin.

Clinicopathologic correlation of microphthalmos with cyst.

Three patients had microphthalmos with cyst in one orbit and contralateral congenital cystic eye, microphthalmos alone, or microphthalmos with cyst. Four eyes were examined histopathologically. The microphthalmic eye demonstrated a spectrum of anterior segment abnormalities, retinal disorganization and gliosis, and a choroidal and scleral colomboma. The cyst connected to the colobona consisted of an outer fibrovascular layer and inner gliotic neuroectodermal layer. The cyst probably originated from proliferation of neuroectodermal tissue at the edge of a persistently open embryonic fissure. Treatment consisted of multiple aspirations of the cyst, excision of the cyst alone, and excision of both the microphthalmic eye and cyst.