Adenoid cystic carcinoma of the lacrimal gland: a case report.

A 70-year-old woman was referred to our clinic for evaluation and treatment of a recurring case of adenoid cystic carcinoma of the lacrimal gland. She had been diagnosed with this tumor three years earlier, and a local resection was attempted on two occasions. We encountered this patient on the third recurrence of the tumor, and a thorough work-up revealed extensive local involvement but no metastases. A total exenteration of the right orbit was then performed with aggressive resection of local extension followed by irradiation. Thirteen years later, our patient presented with metastases throughout her scalp. She died shortly thereafter, having survived a total of 16.5 years after the time of her initial treatment and 13 years after exenteration with bony removal of the orbit and irradiation. A review of the literature reveals that this patient had one of the longest reported survival times in the literature from the time of initial treatment. Also noteworthy is the 13 years this patient survived after aggressive surgical resection combined with radiotherapy following two previous incomplete resections.

Quantitative measurement of wound spreading in radial keratotomy.

BACKGROUND: Many studies of radial keratotomy have been performed, however quantitative laboratory evaluation of the biomechanics of this procedure is still incomplete. Furthermore, most measurements of strain in the past have utilized strip testing, thus destroying the normal physiological structure and water balance of the cornea. METHODS: We report on a membrane inflation method of wound spreading in intact human corneas using the Baribeau Micronscope. RESULTS: We measured a secant elastic modulus of 7.58 x 10(6) N/m2 between 25 and 100 mm Hg. The spreading of radial keratotomy incisions as a function of intraocular pressure showed a maximum spreading of approximately 50 mu at 25 mm Hg at a radius of 3.50 mm from the optical center. A slight increase in spreading was observed in proceeding from a single to four radial incisions. CONCLUSIONS: Quantitative measurement of wound spreading is an important parameter of radial keratotomy and can provide important information regarding opposing theories of the biomechanics of this operation.

Cryogenic induced ocular HSV-1 reactivation is enhanced by an inhibitor of the lipoxygenase pathway.

Reactivation of latent herpes simplex virus type 1 (HSV-1) has been shown to occur in response to localized inflammation. Prostaglandins and lipoxygenase products [eg. hydroxyeicosatetraenoic acids, (HETEs)] are associated with inflammation and, therefore, may play a role in HSV-1 infection and reactivation. In the rabbit cornea, alkali injury, cryogenic injury, and acute HSV-1 infection promote the synthesis of HETEs. Recently, a platelet activating factor antagonist, ginkgolide B (BN 52021) has been found to specifically inhibit the corneal synthesis of HETEs after alkali injury. If the induction of HETEs after injury is related to HSV reactivation and severity of infection, BN 52021 may alter HSV reactivation and the severity of infection by reducing the production of HETEs. To study the effect of BN 52021 on HSV-1 reactivation, cryogenic corneal lesions were produced in ten HSV-1 latently infected rabbits. Five rabbits were treated with topical and intravenous BN 52021 while the remaining five rabbits received topical artificial tears and intravenous saline. In the BN 52021 treated group, 90% (9/10) of the eyes and 53% (35/66) of the total ocular cultures were positive for HSV-1. In the control group, 60% (6/10) of the eyes, and 27% (18/66) of the ocular swabs were positive for HSV-1. The total number of positive cultures was significantly greater (p less than .05) in the BN 52021 treated rabbits. By increasing the number of positive HSV ocular cultures, BN 52021 appeared to act similarly to other inhibitors of arachidonic acid metabolism such as steroidal and nonsteroidal anti-inflammatory agents.