Treatment of temporal arteritis with ocular involvement.

A 78-year-old white woman had catastrophic visual loss in one eye due to temporal arteritis. Despite treatment with doses of oral corticosteroids high enough to normalize the Westergren erythrocyte sedimentation rate, she experienced progressive retinal ischemia with visual loss in the second eye. The use of 1,000 mg of pulsed intravenous methylprednisolone every 12 hours restored her vision. Brief hospitalization of patients with arteritic ischemic optic neuropathy for treatment with intravenous methylprednisolone may offer a significant chance of visual recovery of the involved eye and provide optimal protection to the uninvolved eye.

Hyaluronidase and retinal function.

Using the incubated isolated rat retina, the effects of hyaluronidase on the electroretinogram (ERG) and metabolic activities were investigated. Initial experiments established the activity of hyaluronidase needed to liquefy, within 15 to 30 minutes, the vitreous of postmortem human eyes; this concentration was 1,000 units/mL. Rat retinas were superfused with a bicarbonate-buffered, oxygenated medium to which hyaluronidase was added in activities ranging from 100 to 5,000 units/mL. These concentrations of hyaluronidase did not significantly alter the amplitudes of the a waves and b waves of the ERG in comparison to their control amplitudes. Measurements were also made of lactic acid production, oxygen consumption, glutathione content, and adenosine triphosphatase activities in control and hyaluronidase-exposed retinas. In the presence of hyaluronidase, their respective values were similar to the controls for all biochemical factors studied. The present experiments demonstrate that addition of hyaluronidase to an "ocular irrigating" solution results in normal ERGs and normal retinal metabolic activity and suggests the possibility that hyaluronidase may be useful in enzyme-assisted vitrectomy.

Optic nerve sheath meningioma. Neuroradiologic findings.

Surgical exploration and biopsy confirmed the clinical diagnosis of bilateral optic nerve sheath meningiomas in a 27-year-old male patient with radiologic findings of calcifications of the intraorbital portions of the optic nerves. Plain orbital x-rays revealed ring calcifications and a CT scan disclosed the true extent of these calcifications, which were found to extend bilaterally along the nerves from the globes to the optic foramina. Coronal CT scan images revealed that the ring of calcification extended almost unbroken for the entire intraorbital length of the optic nerves. These optic nerve sheath calcifications represented calcified meningiomas.

Inflammatory bowel disease and leukemia.

Five patients with inflammatory bowel disease developed leukemia. In the literature, only a single report was found in which five patients developed acute myelogenous leukemia during the course of ulcerative colitis. Four of our patients had myelogenous and one lymphocytic leukemia. Three patients had Crohn's disease involving primarily the small bowel; and the other two cases involved ulcerative colitis.

Determination of circulating DNA levels in patients with benign or malignant gastrointestinal disease.

Previous studies showed that patients with neoplasms of various types and origins have abnormally high concentration of DNA in their serum. The current work compares circulating DNA levels in patients with benign or malignant disease of the gastrointestinal tract and determines the diagnostic value of such measurements. DNA was quantitated by radioimmunoassay capable of detecting 25 ng/ml, and as a simple and noninvasive test, it could be a useful addition to other diagnostic procedures. The GI tract was chosen because it affords a comparison of benign, precancerous, and malignant lesions of the same organ. Of the 386 patients studied prospectively, 48% had benign disease and mean DNA levels (+/- SE) of 118 +/- 14 ng/ml, whereas 52% had malignant disease and 412 +/- 63 ng DNA/ml. The difference was statistically significant (P less than 0.001). The DNA assay showed the highest sensitivity for pancreas carcinoma: 90% of the patients had DNA levels above 100 ng/ml, chosen as the upper normal limit. Simultaneous measurements of both DNA and carcinoembryonic antigen (CEA) resulted in increased sensitivity and specificity, even when either marker alone had low sensitivity (gastric carcinoma). The results indicate that serum DNA concentration is markedly elevated in malignancy, and moderately elevated in benign disease, as compared with normal controls. These findings may have diagnostic and prognostic value.

Computer assisted tomography in experimentally induced orbital pseudotumor.

Induction of an entity that is comparable to pseudotumor of the orbit in humans has been performed successfully in the rabbit. Injection of a retrobulbar antigen in a previously sensitized rabbit produced a profound inflammatory mass. Proptosis, soft tissue swelling, and an orbital mass effect were grossly visible after a short interval. Computer assisted tomography disclosed dense orbital mass and uveoscleral thickening. Exenteration specimens confirmed as inflammatory cell mass similar to the histology associated with pseudotumor of the human orbit.