Biomedical subjects
Publications and source records attributed to D de Wolff-Rouendaal.
After excision of conjunctival melanomas the rate of recidivation is high. This may partly be due to local seeding of tumour cells in the excision wound, as we observed in one patient. We now use a sodiumhypochlorite solution (Dakin's solution) as tumour cell killing agent. Instead of diagnostic biopsy exfoliative cytology is performed; at surgery the tumour is not touched except for cauterisation with formaldehyde.
Two chemical agents, sodium hypochlorite 0.5% (Dakin's solution) and mercury chloride 0.1%, capable of killing seeded tumour cells, were used for washing the cornea and conjunctiva of rabbits. Both agents produced considerable superficial lesions in the cornea and conjunctiva after irrigation for 3 and 5 min, but these were restored to normal after 2 weeks.
A report is given of the fundus changes in a 17-year-old boy suffering from SSPE, which clinically first manifested itself by visual disturbances. At first the right eye showed extensive yellowish-white oedema at the posterior pole, surrounded by smaller round, yellow, partly confluent lesions, passing into a scarring stage in about ten days. Fluorescein angiography of the right eye was performed, both in the acute stage, which suggested a Harada syndrome, and in the scarring stage, which resembled a disseminated chorioretinitis. Three weeks later, during the development of the general neurological symptoms, the left eye developed the same fundus picture and course as the right eye. The condition of the patient rapidly deteriorated, leading to death five weeks after the onset of his visual complaints.
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In a series of 193 choroidal melanomas we collected the histological data of 25 small and 31 medium-sized tumours enucleated on the basis of the results of the 32P-test. Thirty four (34%) percent showed epitheloid cells and 70% showed scleral involvement, both percentages being higher than in most reports. We do not advocate observation and delay of treatment in case of small melanomas until growth is established clinically.
We treated a 69-year-old man for metastatic endophthalmitis associated with Staphyloccus aureus septicaemia after abdominal surgery. General and local antibiotics did not prevent deterioration. Post-mortem examination of the eyes revealed intraocular Staphylococcus retinitis and endophthalmitis and bilateral central retinal vein occlusion.
Intraneural and perineural spread of a squamous cell carcinoma of the frontal region via the orbit to the cranial cavity is a rare cause of a superior orbital fissure syndrome. This mode of tumor spread, for which a previously excised invasive malignant tumor is responsible, is rarely reported. The absence of an intraorbital mass and the fact that computed tomography (CT) and magnetic resonance imaging (MRI) are normal make the diagnosis extremely difficult. We describe a 76-year-old patient in whom both intraneural and perineural tumor growth deep into the orbit caused acute oculer motility disturbances, visual impairment, and ocular dysfunction with subsequent cerebral and vascular dysfunction. Surgery, radiotherapy, and orbital exenteration did not prevent spread of the tumor toward vital intracranial and intracerebral structures. Even the advanced diagnostic modalities of CT and MRI failed to reveal the cause of the pathologic process in our patient. In such a case, one should look carefully for both intraneural and perineural tumor invasion on previous histologic material and, if positive, treat the patient with radical surgery on purely clinical grounds as early as possible.