Biomedical subjects
Publications and source records attributed to L M Collum.
A 65-year-old man developed ocular cicatricial pemphigoid. He was treated with topical and systemic immunosuppressive agents. Three months later, he was found to have metastatic oesophageal carcinoma. To our knowledge, the association of ocular cicatricial pemphigoid and oesphageal carcinoma has not previously been described.
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Two techniques are described which enable a rapid diagnosis of herpes simplex keratitis to be made. The tests, antibody/antigen reactions, were shown to be accurate and sensitive in the 119 patients examined. A result is available within four hours with the indirect peroxidase-antiperoxidase method and within one hour with the direct method. The techniques are relatively inexpensive, though labour intensive. Negative reactions were found in treated cases and in those with some delay in the histochemical staining.
A double-blind comparative trial of acyclovir (ACV) and adenine arabinoside (ARA-A) in combination with dilute betamethasone was carried out in 30 patients with herpetic disciform keratitis. Of those receiving ACV and betamethasone, 86.7% healed in a mean time of 22.5 days, while 76.9% of those receiving the Ara-A combination healed in a mean time of 26.7 days. There was no statistical difference between the two treatment groups for efficacy parameters. However, the proportion of patients developing superficial punctate keratopathy (SPK) was significantly greater in the Ara-A treatment group.
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Sixty patients with simple dendritic corneal ulceration were randomly assigned to double blind treatment with either acyclovir tablets (400 mg) or acyclovir ophthalmic ointment administered five times daily. There was no significant difference in the proportions of patients healed in either treatment group (88.9% on oral acyclovir and 96.6% on acyclovir ointment). The median healing time was five days in both groups. No systemic or significant local side effects were noted in either treatment group. Trough levels of acyclovir in the tear fluid of those who received the oral preparation were within or above the range of mean in-vitro ID50 levels for herpes simplex virus type 1. We conclude that oral administration of acyclovir (400 mg, five times daily) may be an effective alternative to topical therapy in selected patients.
The clinical and pathological presentation of Behçet's disease are discussed. Necrotising arteriolitis and phlebitis with thromboses are demonstrated when a rare enucleation specimen became available for examination in this condition. Immunohistochemical studies show mural IgG, IgA, and C3 deposits in episcleral and some choroidal veins. The value of the clinical use of fibrinolytic agents is discussed.
Fifty-one patients were treated in a dual-centre, double-blind comparison of acyclovir and adenine arabinoside in herpetic amoeboid (geographic) corneal ulceration. Twenty-four of the 25 patients receiving acyclovir healed in a mean time of 12.2 days, while 24 of the 26 patients treated with adenine arabinoside healed in a mean time of 11.0 days. There was no statistically significant difference between the two groups in terms of healing. A second analysis, excluding any patients who had received antiviral treatment immediately prior to entry into the study, showed that 18 of the 19 who received acyclovir healed in an average of 11.7 days and 18 of the 19 recipients of adenine arabinoside healed in a mean time of 11.2 days. Again the difference was not statistically significant.
A double blind comparative study of oral acyclovir and acyclovir ophthalmic ointment was carried out on 29 patients with simple herpetic dendritic corneal ulceration. Patients were randomly allocated to the study. Healing was achieved in all fourteen patients treated with acyclovir ointment, and in fourteen out of fifteen patients treated with oral acyclovir. The mean healing time of 5.6 days was identical for both patient groups. There was no significant systemic or local side effects recorded in either group. The level of acyclovir in tear fluid was measured, and in patients receiving oral acyclovir the level was in excess of the ED50 of herpes simplex virus type 1.
An 18-year-old white man presented with a non-painful yellow raised swelling on the inferior limbus of his right eye. Systemic and ocular examination revealed no other abnormalities. The lesion was dealt with by simple excision, but when it recurred fairly soon it was removed in toto and replaced by a lamellar graft, without recurrence. Histological examination revealed a typical xanthogranuloma. The question is, why should a healthy male with no other manifestations develop a lesion like this on his limbus?
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Forty patients with disciform keratitis were randomly assigned to double-blind treatment with 3% acyclovir and 0.01% betamethasone drops or acyclovir and matching placebo. All patients who received the combination healed in a median time of 21 days, while 11 of 19 patients who received acyclovir alone were withdrawn because their condition remained static or worsened (p less than 0.001). The combination therapy produced a faster rate of healing (p = 0.004); other clinical parameters also improved more favourably in the combination treatment group. Three patients had mild transient punctate keratopathy, but no serious adverse effects were seen despite treatment for a median duration of 28 days in the acyclovir group and 38 days in the combined therapy group. A combination of acyclovir and dilute steroid drops is effective in the management of disciform keratitis.
Acyclovir is an effective and relatively non-toxic antiviral agent which has recently been introduced for the treatment of herpes virus infections in man. When combined with dilute steroid, acyclovir heals herpetic disciform keratitis and preliminary results of a double-blind clinical trial suggest that it may be more effective and less toxic than adenine arabinoside in the treatment of this condition.