[The 400-year "eye service" of George Bartisch (1535-1606)].
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Biomedical subjects
Publications and source records attributed to F H Stefani.
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A newly developed choroidal tumor was observed by an ophthalmologist in 1946. Clinically, it was obviously a malignant melanoma and showed signs of growth. The patient, a 57 year-old woman, refused enucleation because her vision was good. She was examined at intervals by her ophthalmologist. Ten years later the tumor had attained a prominence of 18 D and shortly afterwards the patient developed visual disturbances. Another 11 years later vitreous opacities occurred. After a further 5 years the patient presented with glaucoma which led to chronic corneal edema. The eye was finally enucleated in 1977. Now, four years later, the patient is still well and without any sign of metastases. Histopathologic examination revealed a melanoma of spindle-cell type A, measuring 16 X 16 X 16 mm. The tumor had infiltrated the proximal optic fascicle and the overlying retina. As most prognostic data are based on histopathologic findings it seems essential for the future to find out more about the untreated melanomas (growth rate, vascularization, secondary changes such as perifocal inflammatory reactions, lesions of the retinal pigment epithelium barrier, retinal detachment, cyclitis and glaucoma).
The authors report on the clinical and pathological findings in 8 oncocytic lesions of the ocular adnexa. These tumors may involve the caruncle, the conjunctiva, the lacrimal gland and the lacrimal sac. They are often clinically mistaken for haemangiomas, nevi or cysts. In the present authors series the tumor involved the caruncle in 4 cases, the lacrimal gland in 3 and the conjunctiva in one. The clinical and histopathological findings are presented. The occurrence of a malignant oncocytoma (oxyphilic adenocarcinoma) in a 58-year-old man, an oncocytoma (oxyphilic adenoma) in 18-month-old girl and a cystic oncocytoma in a 76-year-old woman are particularly remarkable findings. They are compared, on the basis of a review of the literature, with 50 previously reported oncocytic lesions of the ocular adnexa, of which only 3 involved the lacrimal gland.
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An ultrastructural study was made on the conjunctiva of a 38-year-old man with adult cystinosis. Intracellular cystine crystals were found not only in fibroblasts but also in numerous macrophages. Both fibroblasts and macrophages showed increased pinocytosis. Occasionally there were macrophage degenerations with extracellular cystine crystals present. Whether this increased macrophage reaction indicates a specific difference to childhood cystinosis remains a matter of speculation.
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The authors report on a case of an orbital embryonal rhabdomyosarcoma in a 12-year-old boy. Treatment consisted of radiotherapy, chemotherapy, and local excision of the tumor, the excision, however, without any mutilating surgery. Altogether, seven children have been treated in the same way at the pediatric clinic of the University of Munich. All seven are quite well and none of them show any signs of recidivism. The longest follow-up observation period is now four years.
An adenoma of the non-pigmented ciliary body was removed locally; 15 years later the eye was enucleated. The globe contained a small tumor with similar histological features but invasive growth.
The authors report on a case of an adenoid cystic carcinoma of the lacrimal gland in a 12-year-old girl. This is probably the earliest manifestation of that tumor so far reported. The tumor was locally excised. The eye was left in place. Despite the high mortality rate of this tumor in the literature the child is in good health and without evidence of metastases or local recurrence two years after surgery.
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Gross examination of globes under the dissecting microscope plays an important role in cases where clinical examination was limited, i. e., within the anterior segment of the eye, the back of the iris and the ciliary body. Anomalies, degenerations, tumors, inflammations and traumatic changes occurring in this region are demonstrated macroscopically.