Implantation of Kelman-style, open-loop anterior chamber lenses during keratoplasty for aphakic and pseudophakic bullous keratopathy. A comparison with iris-sutured posterior chamber lenses.

The clinical and specular microscopic results of 40 cases (39 patients) of penetrating keratoplasty during which a Kelman-style anterior chamber intraocular lens was implanted were reviewed retrospectively. Thirty-one pseudophakic eyes received an intraocular lens exchange and nine aphakic eyes received a secondary intraocular lens. Postoperative follow-up averaged 24.

An orbital observation chart.

Retrobulbar haemorrhage is a rare complication of trauma or surgery involving the orbit or periorbital region. Permanent blindness may result if early diagnosis is not made and treatment carried out. A simple scheme of orbital observations to aid early diagnosis of this complication and other sequelae of orbital trauma and surgery has been used at St Lawrence Hospital since 1983.

Pneumocystis carinii pneumonia complicating somatostatin therapy of Cushing's syndrome in a patient with metastatic pancreatic islet cell carcinoma and Zollinger-Ellison syndrome.

Described is the case of a 73-yr-old woman with metastatic pancreatic islet carcinoma that manifested initially as Zollinger-Ellison syndrome followed by onset of endogenous Cushing's syndrome, who developed Pneumocystis carinii pneumonia while on therapy with a long-acting somatostatin analog. Although P. carinii pneumonia has been observed in patients with Cushing's syndrome associated with other conditions, this is the first reported case in a patient with Zollinger-Ellison syndrome.

Macrophage- and oxidant-mediated inhibition of the ability of live Blastomyces dermatitidis conidia to transform to the pathogenic yeast phase: implications for the pathogenesis of dimorphic fungal infections.

Conidia, produced by the mycelial phase of dimorphic fungi, are thought to represent the infectious form of the organism but must complete a transition to the tissue-invasive, yeast-like phase for infection to ensue. Preventing such transition should effectively eliminate pathogenicity. Using Blastomyces dermatitidis as a target, murine bronchoalveolar macrophages preferentially blocked phase transition after 4 h of incubation with conidia, relatively sparing the ability of conidia to produce hyphae.

Fungal meningitis.

Fungal meningitis tends to be a subacute or chronic process; however, it may be just as lethal as bacterial meningitis if untreated. There are many similarities between the pathogenic fungi. Most of the fungi are aerosolized and inhaled, and initiate a primary pulmonary infection which is usually self-limited.

Late management of cleft lip and palate problems: a joint orthodontic/surgical approach.

Three patients are presented from a larger case series of adolescent cleft lip and palate patients to illustrate a combined approach to the treatment of severe facial and dentoalveolar discrepancy. The following treatment regime was employed: orthopaedic expansion of the maxillary dentoalveolus; tertiary bone grafting of the alveolar cleft; upper and lower dental arch alignment and decompensation; and orthognathic surgery to correct the skeletal defect by means of a maxillary single unit advancement. The advantages of tertiary grafting (when secondary grafting has not been carried out) in the orthodontic and surgical management of these patients is discussed.

Successful treatment of Candida osteomyelitis with fluconazole. A noncomparative study of two patients.

We describe two patients with osteomyelitis due to Candida spp. treated with fluconazole, a new triazole antifungal. One patient had extensive involvement of ribs and costochondral regions of the anterior chest, and the other had vertebral infection.

Empiric treatment of fungal infections in the neutropenic host. Review of the literature and guidelines for use.

Persistent fever that is refractory to broad-spectrum antibacterials is common in neutropenic patients undergoing induction chemotherapy of acute leukemia. Clinical experience suggests that many of these patients are infected with fungi. Until recently, data supporting the role of empiric antifungal therapy in this setting were limited to small groups of patients or postmortem reports.

Adie's pupil following Le Fort I maxillary osteotomy. A complication or coincidence?

A case is reported of right-sided tonic pupil in isolation (Adie's pupil) following Le Fort I maxillary osteotomy. It is difficult to identify whether this rare finding immediately postoperatively is either a pure coincidence or a genuine complication of surgery.

Endothelial rejection following penetrating keratoplasty using Healon or BSS.

In order to evaluate the effect of a commonly used sodium hyaluronate preparation (Healon, Pharmacia AB, Uppsala, Sweden) on the incidence of endothelial rejection, endothelial cell loss, intraocular pressure, and corneal thickness after penetrating keratoplasty, we conducted a randomized clinical trial. Patients were allocated to receive Healon (n = 41) or BSS (Alcon Laboratories, Inc., Fort Worth, TX, U.

Surgical ciliated (postoperative maxillary) cysts following mid-face osteotomies.

Surgical ciliated (postoperative maxillary) cysts have been reported extensively as occurring 6 months to 50 years after radical surgery for maxillary sinusitis. Three cases are presented in which these aggressive cysts occurred 3 to 4 years after Le Fort I, II and III mid-face osteotomies. The presentation, treatment and possible aetiology are discussed and some attempt made to clarify the descriptive terms used in the literature.

Radiological assessment of hemifacial microsomia by three-dimensional computed tomography.

Hemifacial microsomia (HFM) is the commonest asymmetrical craniofacial deformity leading to underdevelopment of the craniofacial skeleton and soft tissues on the affected side. Timing of reconstructive surgery is based on a comprehensive analysis and classification of the deformity. Lateral cephalometric radiographs are of limited value because of superimposition of normal and abnormal bony structures.

Incidence of HIV antibody-positive eye/cornea donors in hospital versus medical examiner cases.

We retrospectively examined Michigan Eye-Bank and Transplantation Center data on all eye/cornea donors in Michigan and Illinois for whom human immunodeficiency virus (HIV) antibody screening results were available. This was done to compare the HIV-antibody positive serology rate in hospital versus medical examiner donors. This population consisted of 3,783 donor records for the period January 1, 1986 through June 30, 1988--a 30-month period.

Production of high quality ground sections of bone containing metal implants to demonstrate osseo-integration: a simplified method.

A simple method is described for examining bone-titanium implant relationship using a modified embedding technique. The method involves complete dehydration with acetone prior to infiltrating and embedding in methyl methacrylate supplemented with dibutylphthalate. Slow polymerisation is initiated with benzoyl peroxide, allowed to progress at room temperature and completed at 56 degrees C.

Treatment of murine pulmonary blastomycosis with SCH 39304, a new triazole antifungal agent.

SCH 39304, a broad-spectrum azole derivative, was evaluated in an experimental mouse model of blastomycosis pneumonia. Five days after being inoculated with Blastomyces dermatitidis, infected mice were treated with either oral SCH 39304, fluconazole, or intraperitoneal amphotericin B. A dose response protective effect was observed with SCH 39304 at 5 to 100 mg/kg of body weight per day, with 5 mg of SCH 39304 per kg per day providing activity similar to that of 100 mg of fluconazole per kg per day.

P&T Committee review of fluconazole: an effective alternative to antifungal therapy.

Fluconazole is a new antifungal agent available in both oral and parenteral formulations. According to the experts in this roundtable discussion, fluconazole represents a major clinical advance in the treatment of candidiasis and cryptococcosis in cancer patients, patients with AIDS, organ transplant recipients, and other patients at risk for opportunistic mycoses. The pharmacokinetic profile for fluconazole permits infrequent dosing and also makes it ideal for tissue site infections.

Overview: treatment of cryptococcal meningitis.

Infections caused by Cryptococcus neoformans cause significant morbidity and high mortality, particularly among immunocompromised patients. Cryptococcal meningitis is an important cause of central nervous system disease and death in patients with AIDS. Although the introduction of amphotericin B has greatly improved the prognosis of patients with cryptococcal meningitis, 30 years of experience have revealed important clinical limitations, including modest efficacy, nephrotoxicity, other clinically significant toxicities, and the inconvenience of intravenous dosing.

Attachment of Blastomyces dermatitidis conidia to murine bronchoalveolar macrophages: characterization of binding and elicitation of respiratory burst.

We studied the mechanisms of adherence of Blastomyces dermatitidis conidia to murine bronchoalveolar macrophages and the ability of the conidia to elicit an increase in macrophage O2- production, using an avirulent fungal strain. The number of cell associated conidia was counted by visual inspection of 2 hour macrophage monolayers incubated with conidia and O2- was measured by reduction of ferricytochrome c. Adherence of conidia to bronchoalveolar macrophages was time dependent and reached a plateau after 30 min (36 +/- 5%, 51 +/- 22%, and 36 +/- 17% macrophages with adherent conidia after 15, 30, and 60 min, respectively).

Treatment of fungal infections in patients infected with the human immunodeficiency virus.

Mycoses due to a variety of organisms have been implicated as opportunistic pathogens in patients infected with HIV. These infections are a cause of significant morbidity and mortality, and most often require life-long antifungal medication to suppress reactivation of the fungal process. With the advent of newer antifungal drugs, such as fluconazole and itraconazole, options are available so that appropriate nontoxic, long-term therapy can be administered.

Neurilemmoma of the mandible. Report of a case.

A case of neurilemmoma is described recurring 15 years after a previous excision.

Effect of cilofungin (LY121019), a fungal cell wall synthesis inhibitor, on interactions of Candida albicans with human neutrophils.

The effects of cilofungin, a lipopeptide antifungal agent active against several species of Candida, on human neutrophil candidacidal activity were investigated. While no increase or decrease in neutrophil killing of blastospores was observed when cilofungin was simultaneously incubated with neutrophils and yeasts, preincubation of yeasts with serum containing cilofungin resulted in approximately 90% decrease in killing of five of six strains. Attachment/phagocytosis of these strains was unchanged from controls.

Fungal infections in the immunocompromised host.

With the increased number of immunocompromised patients there has been a concomitant increase in patient morbidity and mortality due to fungi. The etiologic microorganisms vary depending upon the type of immune dysfunction. Patients with malignancies and chemotherapy-induced neutropenia commonly are infected with Candida and Aspergillus.