Quality assurance in a cooperative group.

Quality control in a large cooperative group involves a number of different levels of checking which can be divided into three main sections: quality control in data management, quality control in special areas, and the verification that events on paper reflect real events in the clinic. Quality control in special areas is the province of those using various techniques and disciplines and it will not be discussed in this overview, since others will cover the monitoring of radiation therapy, standardization of biochemical tests, and pathology review.

Proteinaceous film without macrophages covering lens implant in acute panophthalmitis.

A very well-preserved capsule-like proteinaceous film continuously covering a Copeland lens implant in a late stage of alpha streptococcus panophthalmitis exhibits neutrophils and fibrin as well as massive pus on its outer surface. But no macrophages, fibroblast-like cells, or giant cells are found. The proteinaceous film has resisted the proteolytic actions of the massive pus present on and around the implant.

Acellular proteinaceous film on lens implants: a typical reactive situation in complicated cases.

The more or less complete absence of fibroblast-like cells from reactive membranes on the optics of lens implants is demonstrated in four clinically complicated cases of pseudophakia. This is associated with preservation of the film-like proteinaceous part of these membranes. In these cases the lack of cells is believed to be secondary in nature and a sign of significant adaptation difficulties.

White thrombi in massive subchoroidal haemorrhage: indicators of the site of its origin and of the mechanism of its control.

Sharply circumscribed white thrombi with well developed Zahn's lines resembling the free-floating ball thrombi occurring in the auricles of the heart are demonstrated histologically at the end of ruptured ciliary arteries, causing massive subchoroidal haemorrhages in two degenerated human eyes. Not only do white thrombi in subchoroidal haemorrhages, in principle, serve as indicators for the exact location of the bleeding vessel, but their formation also allows for an understanding of the natural control of arterial bleeding in the eye.

Primary hormonal therapy of advanced breast cancer with megestrol acetate: predictive value of estrogen receptor and progesterone receptor levels.

Estrogen (ER) and progesterone receptor (PR) levels in human breast cancer have been shown to have value in predicting response to a variety of hormonal therapies. However, the relationships between steroid receptor levels and tumor response and survival in patients treated with progestational agents for primary hormonal therapy have not been clearly defined. Forty-three advanced breast cancer patients, whose tumors had been assayed for ER and PR were treated with megestrol acetate as initial hormonal therapy.

Megestrol acetate used as primary hormonal therapy in stage D prostatic cancer.

The majority of patients with advanced prostatic cancer respond either to castration or estrogen therapy. In an attempt to identify an alternative hormonal therapy, 25 symptomatic stage D prostate cancer patients were treated with megestrol acetate as initial hormonal therapy. Thirty-three patients were evaluable for response as defined by the National Prostatic Cancer Project criteria.

Sessile macrophages forming clear endotheliumlike membrane on the inside of successful keratoprosthesis.

Clinical observation and cytological study of a successful "through and through" type of Cordona keratoprosthesis, which was removed along with a corneal button about 20 years after its implantation in an aphakic eye, revealed an acellular epitheliumlike film on its outer surface, firm anchoring of its supporting skirt by stable fibrous connections to the stroma, and a continuous separating membrane composed of a homogeneous proteinaceous film with fibroblastlike cells of macrophage origin on its inner surface. The significance of the successful adaptation of the plastic materials of the prosthesis to the tissues of the cornea and the fluid of the inner eye for the future of tissue engineering is discussed.

Reactive cellular membrane on a glass fragment after two years in the anterior chamber.

An optically clear membrane composed of a continuous proteinaceous film and sessile cells of macrophage origin was present on the surface of a glass fragment removed from the anterior chamber of the eye of a nine-year-old boy almost two years after a perforating corneal injury. This finding indirectly contributes to the understanding of membranes formed by the inner eye during adaptation to an intraocular lens implant.

Cytopathology of intraocular lens implantation.

The cytopathology of intraocular lens (IOL) following implantation is reviewed. A newly placed implant attracts macrophages and these settle on its surfaces to form optically clear membranes composed of so-called fibroblast-like cells and a film of proteinaceous material. The membranes apparently become tougher and more firmly adherent with time.

Lens implant cyto-pathology in postoperative Proteus panophthalmitis.

The reactive membrane on a posterior chamber lens implant removed from an eye with postoperative proteus mirabilis panophthalmitis was found to be based on a continuous proteinaceous capsule exhibiting only very few fibroblast-like cells. Diffusely arranged neutrophils exhibiting evidence of phagocytosis were attached to a delicate fiber network continuous with the processes of fibroblast-like cells. There was also pus and acellular debris loosely covering the outer surface of this capsule.

Healon effect on the reactions of macrophages to a clear plastic surface.

Growth of peritoneal mouse macrophages in tissue culture on the bottom of clear plastic dishes is used as an experimental model to study the influence of Healon on the reactions of these cells. It is found that a layer of Healon on the plastic surface does not interfere with the adherence of the macrophages to the plastic, and allows for the formation of a continuous and well-developed separating membrane with phagocytizing epithelioid cells, fibroblast-like cells, and small giant cells.

Absence of reactive membrane associated with failure of lens implantation.

Cytological study of an iris-supported intraocular lens implant removed three years after its insertion because of clinical failure revealed the first instance of complete absence of a reactive membrane on its optic portion. The significance of this observation is discussed, and it is concluded that a continuous and optically clear monolayer of cells with a proteinaceous film in the interspaces on the surface of lens is a cytological indicator of good adaptation and clinical success. Absence of a separating reactive membrane is not desirable.

Bilateral attachment of corneal endothelium to lens implants in corneal collapse at death: a pseudophakic eye with a Fuchs' epithelioma.

The pathological situation of bilateral attachment of corneal endothelium to iris plane lens implants, due to collapse of the anterior chambers, is recorded in a patient who died of heart failure. The additional observation of a Fuchs' epithelioma on the ciliary body adjacent to the implant in one of the eyes is used to start a discussion about possible interactions between lens implants and unsuspected intraocular tumors.

Sessile macrophages forming clear endothelium-like membrane on inside of successful keratoprosthesis.

Clinical observation and cytological study of a reasonably successful keratoprosthesis removed along with a corneal button about 20 years after its implantation in an aphakic eye revealed an acellular epithelium-like film on its outer surface, firm anchoring of its supporting skirt by stable fibrous connections to the corneal stroma, and a continuous separating membrane composed of a homogeneous proteinaceous film and fibroblast-like cells of macrophage origin on its inner surface. The significance of the successful adaptation of the plastic materials of the prosthesis to the tissues of the cornea and the fluids of the inner eye for the future of tissue engineering in the region of the eye is discussed.

Cellular membranes on glass lens implants--formed in tissue culture by mouse macrophages.

Intraocular lens implants made of glass were exposed to a suspension of mouse macrophages in tissue culture for 48 and 96 hours. After 48 hours the macrophages had formed a dense cellular membrane on the glass surface and some of them had changed into fibroblast-like cells, epithelioid cells, and early stages of giant cells. After 96 hours a firm and continuous proteinaceous capsule had formed on the glass in the interspaces between the cells.

Formation of proteinaceous capsules on plastic lens implants--by mouse macrophages under tissue culture conditions.

Formation of continuous proteinaceous capsule-like layers is demonstrated in tissue culture on plastic lens implants as part of cellular membranes created by mouse macrophages after 48, 56, and 96 hours of incubation. The capsules resemble similar formations seen on lens implants removed from human eyes and their existence is considered part of a clinically beneficial adaptation of man-made materials to the inner eye.

Adherence of mouse macrophages to plastic lens implants--resulting in the formation of a cellular membrane.

An experiment for the study of the adherence of mouse macrophages to lens implants under tissue culture conditions has been developed. Formation of a continuous monolayer of cells on the surface of a plastic implant after 18 hours of incubation is demonstrated when this is exposed to a fluid with a high concentration of macrophages. Fewer macrophages in a thin fluid layer on the surface of a tissue culture dish made of clear plastic under the same conditions also showed adherence in a noncontinuous pattern.

Fibroblast-like cells on intraocular lens implants: phagocytosing erythrocytes.

An intraocular lens implant had to be removed 4 years after its implantation from the eye of a patient on warfarin (Coumadin) medication because of repeated intraocular haemorrhages. Implant cytology staining revealed a continuous membrane on the removed implant that contained relatively few large foreign body giant cells and great numbers of small fibroblast-like cells. An impressive clean-up function of the fibroblast-like cells with phagocytosis of whole erythrocytes was observed.

Foreign body giant cells selectively covering haptics of intraocular lens implants: indicators of poor toleration?

A Sputnik lens implant removed after five years because of bullous keratopathy exhibits a dense covering of its Supramid anterior staves with large foreign body giant cells, while its Prolene loops and Polymethylmethacrylate optics have attracted only few of these cell units. The glass-membrane-like component of the reactive membrane also shows significant differences on the different parts of this implant. The use of observation of the components of reactive membranes on lens implants as indicators of toleration in the eye is suggested.