Biomedical subjects
Publications and source records attributed to A P Ferry.
Lichen simplex chronicus is a common dermatosis that rarely affects the eyelids. We report the clinical and pathologic features in the case of a middle-aged man who had lichen simplex chronicus of both lower eyelids. The clinical features suggested the presence of basal cell carcinoma.
PURPOSE: To investigate the activities of the firm that manufactured and sold the Actina, the leading example of ophthalmic quackery in the era of the founding of the American Academy of Ophthalmology. METHODS: Advertisements for the Actina in turn-of-the-century newspapers and magazines were studied, and additional related investigations were undertaken at leading historical societies in the United States and at the headquarters of the American Medical Association. RESULTS: The Actina was widely advertised as a cure for most of life's ills, particularly those of the eye and ear. Its manufacturers claimed that electrical properties were the mechanism of the Actina's alleged therapeutic effects. However, research has shown that the instrument had no electrical properties, its manufacturers had no medical training, and that the Actina was useless as a therapeutic agent. CONCLUSIONS: The firm that manufactured the Actina was located in Kansas City and was at the zenith of its success when the first meeting of the American Academy of Ophthalmology was held there in 1896. Its fraudulent activities sparked a continuing public outcry that contributed to the passage of the Pure Food and Drug Act of 1906. The American Medical Association's Investigative Bureau was a major factor in the firm being put out of business in 1915 by the federal government.
BACKGROUND/PURPOSE: In 1988, a report was published describing the histopathologic examination of corneal buttons of 4 patients who had undergone unilateral keratoplasty because of decreased vision caused by what had been diagnosed clinically as granular dystrophy. But on pathologic examination, lesions characteristic of both granular dystrophy and lattice dystrophy were found in each of the 4 corneal buttons. The patients came from 3 different families, each of which traced its origin to the Italian province of Avellino. We studied the clinical and histopathological features of 4 corneas affected by combined granular-lattice dystrophy, adding thereby to the total of 12 other corneas that have been so-described in the literature. METHODS: Two women underwent bilateral penetrating keratoplasty for what was diagnosed clinically as Reis-Bücklers dystrophy in the first patient, and as granular dystrophy in the second patient. We studied all 4 corneas pathologically, using both conventional hematoxylin and eosin stains as well as special histochemical techniques. RESULTS: All 4 corneas contained lesions characteristic of both granular dystrophy and lattice dystrophy, a circumstance that has given rise to the name "combined granular-lattice dystrophy." The patients are not known to be of Italian ancestry. CONCLUSIONS: Three clinical signs characterize combined granular-lattice dystrophy: (1) anterior stromal discrete, grayish-white deposits; (2) lattice lesions located in mid-stroma to posterior stroma; and (3) anterior stromal haze. Both clinically and histopathologically, the lattice lesions are of greater diameter than are those that occur in lattice dystrophy type I. In the past few years, striking advances have been made in understanding the genetics of combined granular-lattice dystrophy. The most recent of these was published just 2 months before the 1997 meeting of the American Ophthalmological Society, and establishes a common molecular origin for granular dystrophy, lattice dystrophy type I, Avellino dystrophy, and Reis-Bücklers dystrophy.
PURPOSE: Although Nd:YAG laser cyclophotocoagulation has been extensively used for nearly a decade in treatment of severe glaucoma, there have been remarkably few reports (each of them extremely brief) of histopathological examination of glancomatous human eyes that had been so treated. We undertook this study to provide further details regarding the nature of the lesions produced in this type of ciliary ablation. METHODS: We chose three representative cases in which a glaucomatous human eye had been subjected to Nd: YAG cyclophotocoagulation, and was subsequently enucleated. To better understand the temporal evolution of the lesions, we selected eyes that were enucleated 1 day, 20 days, and 3 months, respectively, after they had been treated with noncontact Nd: YAG laser cyclophotocoagulation. RESULTS AND CONCLUSIONS: (1) energy levels ranging from 4.4 Joules to 5.6 Joules were effective in producing appropriate lesions; (2) direction of the laser beam 1 to 1.5 mm behind the limbus caused severe destructive lesions of the pars plicata: (3) toward the periphery of the individual treatment sites, the stroma and ciliary muscle continued to exhibit severe degeneration, as did the epithelium lining the valleys between the crests of the ciliary processes; but in those peripheral zones of individual treatment sites, the epithelium lining the crests of the ciliary processes survived and appears normal; (4) bleb-like separations of the ciliary epithelium from the adjacent stroma, particularly along the posterior aspect of the ciliary body lesions, are a prominent early feature of Nd:YAG cyclophotocoagulation; (5) the pigmented epithelium is more vulnerable to laser energy than is the nonpigmented epithelium of the ciliary body; (6) the destruction of the ciliary epithelium is permanent; (7) deeply pigmented persons have more melanocytes in the ciliary body muscle and stroma than do more lightly pigmented individuals, a circumstance that renders the tissues more vulnerable to laser energy; (8) the ciliary muscle was always severely damaged; (9) no scleral injury was observed other than evanescent, focal areas of edema of the deep sclera; and (10) except in the episclera, inflammatory cells were strikingly few in number, a circumstance providing support for the clinical observation that eyes treated with laser cyclophotocoagulation exhibit less of an inflammatory response than do those treated with cyclocryotherapy.
Conjunctival synthetic fiber ("teddy bear") granulomas result from a granulomatous response to synthetic fabric fibers introduced into the conjunctival sac. There is a striking propensity for these lesions to develop in the pediatric age group, to be unilateral, and to be situated in the inferior conjunctival fornix. It is believed that proximity of the eye to comforting blankets, fabric toys, or forcibly applied pullover sweaters may provide the opportunity for ocular inoculation. Described below is the case of a 6-year-old girl who had a conjunctival synthetic fiber granuloma that exhibited the characteristic clinical and pathologic features of these lesions.
Vanity Fair was the leading Society magazine of Victorian and Edwardian England. A key feature of each weekly issue was the inclusion of a chromolithographed caricature and biographic sketch of a prominent individual. The author undertook a survey of the more than 2000 caricatures published from 1869 to 1914 to determine if any portrayed an ophthalmologist. Seventy-nine of the caricatures depicted physicians and scientists, of whom three were ophthalmologists: Sir Jonathan Hutchinson, Sir Robert Brudenell Carter, and Sir Anderson Critchett. A brief sketch of their ophthalmic accomplishments is presented. Caricatures from Vanity Fair are avidly sought after and are often found in antique shops, sporting venues, and professional offices, especially those of lawyers and judges. It has been said that when seeking the true perspective of the Victorian and Edwardian eras, the most faithful mirror and record of representative men and the spirit of their times can be found in Vanity Fair.
The types of orbital cysts that are most familiar to ophthalmologists are epidermoid and dermoid cysts, both of which are lined by keratinized stratified squamous epithelium. We studied six patients who had orbital cysts lined by nonkeratinized epithelium that resembled normal conjunctiva. Compared with epidermoid and dermoid cysts, these primary nonkeratinized cysts tend to cause symptoms later in life, occur preferentially in the superonasal aspect of the orbit, and are less likely to be associated with underlying bony changes.
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Two children had subepidermal calcified nodules of the upper eyelid. The first patient was a 13-year-old girl who noted painless increase in size of a lesion involving her right upper eyelid over four months. The clinical diagnosis was "warty papilloma." The second patient was a 13-year-old boy who had a slowly growing, keratinized lesion involving his left upper eyelid. The clinical diagnosis was "cutaneous horn." On histopathologic examination, the nodules demonstrated the characteristic changes associated with subepidermal calcified nodules, including the presence of calcified material in the uppermost dermis, occasional foreign body giant cells around the calcific masses, acanthosis of the overlying epithelium, and calcium granules in the epidermis.
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Dr. William O. Coffee was an ophthalmologist who conducted an office and mail-order practice in the Midwest from the 1880s until 1927. His main stock in trade was a self-discovered absorption cure for a variety of ocular diseases, with particular emphasis on the medical cure of cataracts. Dr. Coffee's career was a checkered one, marked by dubious credentials, exuberant self-promotion, unlikely and exaggerated claims of medical successes, plagiarism, and rejection by the medical "establishment." Certain parallels may be drawn between his activities and some currently observed practices in ophthalmology.
Two patients with epibulbar juxtalimbal primary conjunctival melanomas experienced local intralymphatic metastases to the inferior cul-de-sac, and a hematogenous metastasis to the conjunctiva developed in five other patients with cutaneous melanomas. Whether reflective of a local or distant metastasis, all of the lesions histopathologically were located in the substantia propria, and were separated from the overlying epithelium by a thin mantle of collagen. There was no evidence of atypical intraepithelial melanocytic proliferation, as would be expected in association with a primary conjunctival melanoma. Two of the cutaneous metastases exhibited a binodular or multinodular appearance that correlated histopathologically with variably confluent micronodules suggestive of the origin of the clinical lesion from a shower of tumor cell emboli. Patients with local intralymphatic spread from a primary conjunctival melanoma may experience additional lesions in the conjunctival sac or eyelid skin and are at risk for regional or distant metastases. They should be examined closely several times a year. The patients with the distant metastases all had their previously diagnosed primary cutaneous tumors on the truncal skin (a similar tendency emerges from a review of previous ocular cases), typically had myriad other cutaneous lesions, and two of them had a neoplastic iridocyclitis and vitreitis. These patients tended to die of the disseminated tumors within 1 year after conjunctival metastases developed.
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Although toxoplasmosis is the most common infectious cause of posterior intraocular inflammation, it is rarely described in association with scleritis. The authors present five cases of toxoplasmosis with scleritis. Two of the five cases were diagnosed clinically and serologically as having toxoplasmosis. Their retinochoroiditis and scleritis responded well to medical therapy. Retinochroiditis and scleritis that was refractory to treatment developed in the other three patients, two of whom had been receiving immunosuppressive therapy for systemic diseases. Their therapeutic regimens did not include treatment for toxoplasmosis. All three eyes became blind and were enucleated. Results of pathologic examination of all three enucleated eyes showed Toxoplasma gondii in the retina. There was severe inflammation of the retina, choroid, and sclera. Toxoplasmosis should be considered in the clinical differential diagnosis of scleritis associated with retinochoroiditis, particularly in immunosuppressed patients.
We report two cases of nocardial endophthalmitis. Case 1 is a 66-year-old man whose left eye was enucleated about one month after onset of decreased vision. Ophthalmoscopic examination disclosed multiple choroidal masses. Six weeks before the onset of ocular manifestations he had undergone a prolonged carotid endarterectomy with intraoperative complications. The source of the ocular infection was probably exogenous. Case 2 is a 49-year-old woman who had systemic sclerosis (scleroderma) with severe pulmonary insufficiency. She had received moderate doses of corticosteroids. Seventeen months after initiation of therapy she developed ocular manifestations leading to enucleation of the eye one month later. Histopathologically, the enucleated eyes in both cases showed numerous branching, Gram-positive, filamentous organisms involving mainly the plane of Bruch's membrane and the subretinal space. The nosological and microbiological aspects of nocardiosis are reviewed.
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Charles A. Tyrrell was a masseur who obtained his MD degree at age 57 in 1900. In addition to his private practice he was editor of several pseudomedical magazines. He also owned two proprietary ventures that he conducted on a mail order basis. One of these involved production and sale of the The Ideal Sight Restorer, a U-shaped device consisting of a rubber bulb at the base, from which on both sides arose an arm of rubber tubing capped by an ivory eye piece. The eye cups were applied to the closed eyelids and the intermittent suction produced by squeezing the rubber bulb was claimed to provide a form of ocular massage capable of curing serious eye diseases (eg. cataract and glaucoma), as well as doing away with the need for spectacles. Although his fraudulent activities and deceptive advertising practices were described on several occasions in the Journal of the American Medical Association, Dr. Tyrrell persisted in his enterprises until he died in 1918.
Filamentary keratitis is characterized by the presence of fine filaments of epithelium and mucus that are attached to the cornea. The exact pathogenesis of this entity has remained unclear. One reason has been the lack of pathologic specimens of corneas from patients with filamentary keratitis. We examined the corneas of a patient who had died while suffering from filamentary keratitis. Scattered groups of inflammatory cells and fibroblasts were present just below the basal epithelium. It seemed that these cells had disrupted the epithelial basement membrane and Bowman's layer. To our knowledge, this is the first postmortem analysis of a cornea in a patient with acute filamentary keratitis. These findings support the theory that filamentary keratitis results from damage to the basal epithelial cells, epithelial basement membrane, or both.