The clinical significance of class III (suspicious) urine cytology.

BACKGROUND: Urine cytology, combined with cystoscopy, is the mainstay of the diagnosis and surveillance of urothelial carcinoma (UC). While classes I and II urine cytology are considered benign and classes IV and V are considered malignant the clinical significance of class III urine cytology is unclear. We evaluated the positive predictive value of class III urine cytology for concurrent and subsequent UC. METHODS: The records of all class III urine cytology cases during a 3-year period were retrospectively reviewed for the presence of concurrent and subsequent UC, determined by cystoscopy and histological confirmation. RESULTS: Of 111 cases, 54 (48.7%) were associated with concurrent UC and 14 (12.6%) with subsequent UC after an initial evaluation negative for malignancy, with a mean time to diagnosis of 10.8 months. Of 27 cases of class III urine cytology with no prior history of UC, 13 (48.1%) had concomitant UC and none had subsequent UC. Of 84 cases of class III urine cytology with a prior history of UC, 41 (48.8%) had a concomitant diagnosis of UC and 14 (16.7%) developed UC during their follow-up, leading to a total of 55 (65.5%) cases of UC. CONCLUSIONS: Patients with class III urine cytology and a prior history of UC should undergo a full initial evaluation of their urinary tract, and should be followed vigorously if this evaluation is negative for malignancy. Patients without a prior diagnosis of UC and class III urine cytology should also undergo a full initial evaluation, while further larger studies are needed to elucidate the need for further follow-up in such patients.

Retinal tears with total vitreous hemorrhage.

In ten cases of nontraumatic retinal tears with initial vitreous hemorrhages so dense that all retinal detail was obscured, medical management included hospitalization, sedation, and binocular patching. It took an average of 4.3 days for the vitreous to clear so that the tears could be examined. All the tears were on or anterior to the equator, and all were in the superior quadrants. Surgery was performed promptly once the tears were visible even though much of the retina was still covered with hemorrhage. After total clearing of the vitreous, no additional retinal tears were found in any of the ten cases. Postoperative complications included hemorrhages in three cases, macular pucker in one case, and a paramacular star in one case.

A controlled eye irrigation system.

Irrigation of the eye and adnexa is a way of removing damaging material and treating different diseases by applying medicants in the irrigant in humans and in laboratory animals. A system for controlled eye irrigation in animals is presented, suggesting possible use in human patients as well.

Recurrent, isolated, post-febrile abducens nerve palsy.

A case presenting with three episodes of recurrent benign abducens palsy is reported. The patient experienced her first episode at age of 3 years, her second when she was 13 years old, and the last at the age of 25 during pregnancy. Full recovery was attained within approximately three months after each episode.

Legal aspects of work-related eye injuries.

As court-appointed medical advisors in the speciality of ophthalmology for the Israeli Labour Courts, we are called upon to assist in making decisions on work-related eye injuries or illnesses. In this report we present seven cases of eye injuries which workers claimed were caused by work accidents. Each case helps to illustrate the various guidelines we use in making a medical judgement as to whether or not a specific ocular problem was, indeed, the result of a work accident.

Ethmoidal sinus osteoma--a primary cause of nasolacrimal obstruction and dacryocystorhinostomy failure.

An osteoma is a slow growing, bony tumor which forms in the sinuses of the skull. Presenting complaints include headaches, cerebral symptoms, or visual disturbances, depending upon the location of the tumor. This paper describes an unusual case of ethmoid sinus osteoma, with epiphora as the primary symptom; it also caused the failure of a previous dacryocystorhinostomy. This case illustrates the need for thorough evaluation of epiphora, including sinus x-rays.

A new sling material for ptosis patients.

Patients with poor or total absence of levator function require correction of their ptosis by a sling procedure. The aim of the procedure is to utilize the action of the frontalis muscle, innervated by the seventh nerve, to mechanically raise the droopy eyelid. The most common materials used for the sling are autogenous or preserved fascia lata and synthetic products such as nylon or dacron sutures. We introduce a new material for the sling procedure--preserved placental umbilical vein modified for the use as a sling. Two cases are presented in which this material was used with excellent results.

Late onset of total eversion of the upper eyelids.

A case of total eversion of both upper eyelids of late onset is reported. There were no associated ocular or general anomalies. No apparent cause was found. The treatment was directed toward diminishing the swelling of the lids and preventing corneal involvement, secondary infections, and epidermalization of the conjunctiva. Within the first week, the eyelids returned to their normal position. In a three-month follow-up period, no complication or other anomalies were found.

Werner's syndrome as a cause of chronic leg ulcers.

Werner's syndrome is believed to be an autosomal-recessive inherited disorder. Among other manifestations of premature aging, patients with Werner's syndrome frequently develop chronic leg ulcers that heal poorly. We present a patient who suffered from this rare syndrome and developed typical leg ulcers. We wish to alert physicians to this syndrome so that its attendant problems can be considered when treatments are being planned for patients with chronic leg ulcers.

Trichoepithelioma.

Trichoepithelioma histologically resembles basal cell epithelioma, but only rarely do the two lesions coexist. The case reported here documents a patient with hereditary trichoepithelioma who presented with a basal cell epithelioma of the medial canthus invading the lower eyelid. The clinical and histologic features of both entities will be discussed, as well as the possibility of malignant transformation of a trichoepithelioma to a basal cell epithelioma.

Orbital varices: a surgical approach.

Five cases of orbital varices are presented, demonstrating a surgical approach with the use of vascular clips. Three of four cases were clipped at the apex of the orbit, with no recurrence. A fourth case was clipped two-thirds of the way back in the orbit, with no progression of the varix and significant improvement of the patient's symptoms. A fifth case failed because of extensive hemorrhaging. Follow-up ranged from 2 to 9 years.

Human fibroblast interferon in treatment of viral diseases of the skin and mucous membranes.

The therapeutic effect of human fibroblast interferon (HFIF) was studied in 33 patients. Seven had ophthalmic lesions (three due to adenovirus Type 8, four to herpes simplex virus, and one to herpes zoster) and were treated with HFIF. In the four patients with herpes simplex keratitis, HFIF was given in addition to standard therapy or together with other antiviral agents. Ten other patients, 8 with herpes simplex or herpes zoster skin or mucous membrane lesions, were treated with HFIF. HFIF was incorporated into an ointment as well as into a solution for subconjunctival infections. Although the number of cases was small, our results showed that HFIF was effective in shortening the course of the disease.

A method for repositioning or extraction of lacrimal system silicone tubes.

A method of repositioning extruding silicone tubes is described by reintubation with a second Crawford intubation set. The method and indications are described.

Argon laser treatment of a pupillary membrane in pseudophakia.

A method of opening an opacified, retrolental, intrapupillary membrane in a pseudophakic eye, using the argon laser, is presented. The procedure was safe, and the membrane remained retracted one year after treatment.

Globular-like deformities of the cornea in a patient with dwarfism.

A family affected with pituitary dwarfism transmitted probably as an X-linked recessive or autosomal recessive condition, is described. The propositus had globular-like changes in his cornea, this latter as a sequela of endocrine disturbances, is suggested and discussed.

The use of artificial skin in the prevention of early wound healing.

We present our experience in using artificial skin (Omniderm) in the prevention of early healing of a raw lid margin. The material is inert and acts properly for this procedure.