Efficacy and safety of infrared warming of the eyelids

PURPOSE

To evaluate our newly developed infrared heater (IRH) and compare it to a broad-spectrum heater (BSH) for warming the eyelids.

MATERIALS AND METHODS

Ten normal subjects were enrolled in this study. All measurements were recorded in a room with temperature 23 degrees C, 40% humidity, and no wind. The IRH is composed of two hard eye patches that have light-emitting diodes (LEDs) emitting near-infrared radiation. We first compared the temperature rises in the cornea, lacrimal gland, and eyelids after warming through closed eyelids with the IRH for 5 and 10 min. Next, we compared warming with the IRH or BSH for 30 min. We then used the IRH for 5 min with the eyes open to confirm its safety. Finally, we determined subjective feeling after warming the eyes.

RESULTS

Direct comparison of 5 versus 10 min of warming with the IRH showed no significant differences in temperature rises in the upper eyelid (p = 0.09). The IRH caused significantly more heating (p < 0.05) than did the BSH everywhere except the cornea. The temperatures never rose above 37.7 degrees C for either heater during 30 min or with the IRH with the eyes open for 5 min. The subjects' comfort level rose significantly (p < 0.05) after treatment with the IRH.

CONCLUSIONS

Our study showed the efficacy and safety of warming the eyelids with a newly developed IRH. Only 5 min is necessary to increase ocular temperature and enhance comfort.

Multivariate analysis of occult lymph node metastasis as a prognostic indicator for patients with squamous cell carcinoma of the oral cavity

BACKGROUND

The biologic aggressiveness of squamous cell carcinoma of the oral cavity is reflected in its ability to metastasize to regional cervical lymph nodes. Patients with clinically negative cervical lymph nodes are believed to have a good prognosis; however, the prognosis of patients with lymph node metastasis occurring after excision or radiotherapy of the primary tumor is poor.

METHODS

Univariate and multivariate analyses for occult lymph node metastasis (ONM) in 172 patients with clinically negative cervical lymph nodes were performed by the authors to elucidate the clinical and histologic tumor risk factors to enhance their ability to predict ONM. A multivariate Cox proportional hazards model and Hayashi's quantification theory type II were used to analyze prognostic factors and to determine the probability of ONM.

RESULTS

Using Cox's proportional regression model, the factors linked to cancer specific survival were selected: tumor differentiation (P = 0.0330), mode of carcinoma invasion (P = 0.0175), and ONM (P = 0.0433). Pathologically identified metastatic lymph nodes were found in 21.5% of the cases studied (37 of 172 cases). The 5-year cancer specific survival was 94.0% for patients without lymph node metastasis, and 51.0% for patients with ONM (P < 0.0001, log rank test). The most significant predictors for ONM of each of the clinical and histologic factors, in descending order, were: mode of carcinoma invasion, intensity of lymphocytic infiltration, degree of differentiation, number of mitotic figures, and type of growth by means of Hayashi's quantification theory type II. The presence or absence of ONM in 147 of 172 patients (85.5%) was correctly predicted by the score at the point of intersection of the two curves, which was -0.03. Further investigation revealed that 28 of 32 new cases were differentiated accurately by means of this diagnostic system.

CONCLUSIONS

The results of the current study suggest that this method of analysis can establish a reliable predictor of ONM, thereby facilitating correct choices for surgical procedures to enhance the survival rates of patients with clinically negative cervical lymph nodes.

Blinking is controlled primarily by ocular surface conditions

PURPOSE

To investigate the relation between blinking and ocular surface conditions and to introduce and examine a new index, the maximum blink interval.

METHODS

In a prospective study, the blink rate of subjects under relaxed conditions was determined from a video recording taken by a hidden observer. The maximum blink interval was defined as the longest time subjects can avoid blinking without feeling uncomfortable.

RESULTS

Significant changes in the blink rate and maximum blink interval were induced by factors that directly or indirectly affect the ocular surface: topical anesthesia, changing exposed ocular surface area, and wind. Moreover, the blink rate and maximum blink interval were significantly different in dry eye patients compared with healthy volunteers, with the values of the former approaching the values of the latter after use of artificial tears. The maximum blink interval was decreased by the same factors that increased the blink rate, and there was a significant inverse correlation between blink rate and maximum blink interval. Use of video display terminals was associated with decreased maximum blink interval and, hence, the development of dry eye symptoms.

CONCLUSIONS

There was an important association among blink rate, maximum blink interval, and ocular surface conditions. The blink rate and our newly introduced measurement, the maximum blink interval, should prove useful in assessing factors that cause dry eye. This prospective study should contribute to the understanding and treatment of dry eyes.

Quantitative videographic analysis of blinking in normal subjects and patients with dry eye

OBJECTIVE

To study patterns of eye blinking in normal subjects and patients with dry eye.

METHODS

We developed an automated, noninvasive blink monitor that permits quantitative analysis of 6 parameters of blinking. We used this method under normal conditions and then examined the effects on the patterns of blinking in patients with dry eye; several steps in this method were designed to exacerbate or ameliorate ocular surface desiccation.

RESULTS

The mean (+/-SD), maximum, and coefficient of variation of the interblinking time in normal subjects and patients with dry eye were 4.0 +/- 2.0 and 1.5 +/- 0.9 seconds, 8.9 +/- 4.0 and 4.2 +/- 2.4 seconds, and 55% +/- 21% and 65% +/- 24%, respectively. Those values for the blinking time were 0.20 +/- 0.04 and 0.27 +/- 0.16 seconds, 0.35 +/- 0.12 and 0.99 +/- 1.30 seconds, and 23% +/- 9% and 46% +/- 34%, respectively. The use of artificial tears or spectacles with moist panels and moist inserts tended to normalize the patterns of blinking in the patients with dry eye, whereas exposure to wind made them more abnormal.

CONCLUSIONS

Our technique permitted a rigorous analysis of blinking that was previously unavailable. We have shown that local ocular surface conditions alone can significantly affect patterns of blinking. This method should be applicable to studying psychologic and any other factors that may influence blinking.

The reactivity of taurine with hypochlorous acid and its application for eye drops

The ability of taurine to protect biomembranes attacked by HOCl was examined using canine erythrocytes which had been pre-treated with HOCl. Of the amino acids tested, taurine was the most effective in inhibiting attack by HOCl, followed by glycine, alpha-alanine and beta-alanine. During the incubation of HOCl-treated erythrocytes with taurine, an appreciable amount of monochlorotaurine (TauNHCl) was detected in the supernatant. This suggests that taurine may remove the oxidized chlorine from HOCl-treated erythrocytes, resulting in the production of TauNHCl. The effect of taurine on the removal of Cl+ moiety was examined using Sepharose gel with amino groups. Taurine removed Cl+ from HOCl-treated Sepharose gel. The yield of TauNHCl depended on the concentration of taurine. The effectiveness of taurine in preventing ocular surface damage caused by HOCl was investigated in albino rabbits. The activity of lactate dehydrogenase (LDH) released from ocular tissues into tears during eye irritation was used as an index of ocular surface damage. Taurine effectively protected ocular surface tissues from damage induced by HOCl, and arrested the progression of tissue damage that had already been initiated by HOCl. These finding suggest that taurine may be clinically useful in the treatment of ocular surface damage caused by oxidants such as HOCl.

Spindle cell hemangioendothelioma: an immunohistochemical and flow cytometric study of six cases

Six cases of spindle cell hemangioendothelioma (SCH) are presented with immunohistochemical and flow cytometric analyses. One case was associated with Maffucci's syndrome. All lesions were solitary or multifocal in the extremities, and prepresentation duration ranged from years to decades. One case recurred but none had metastases. Histologically, in four of the six cases the main lesions appeared to arise within vessels, predominantly muscular vessels. All lesions consisted of cavernous hemangioma-like areas and solid cellular areas resembling Kaposi's sarcoma. Cellular atypia was minimal. At the periphery of the lesions, a cluster of large thick or thin walled, and probably malformed, vessels were observed. Immunohistochemically, factor-VIII related antigen, CD34, vimentin, and lectin binding Ulex europaeus agglutinin 1 stained endothelial cells lining vascular channels, and vacuolated, or epithelioid cells. Spindle cells in the solid areas were negative for these endothelial markers except for vimentin, but showed divergent positive immunoreactions of HHF35, alpha-smooth muscle actin, desmin, and collagen type IV. Five cases were diploid and one was aneuploid. There was no significant correlation among DNA ploidy, S-phase fraction, and local recurrence in SCH although the number of cases examined was small. These results suggest SCH may be a benign lesion, probably a reactive process, rather than a low-grade angiosarcoma.

Effects of ocular surface area and blink rate on tear dynamics

OBJECTIVE

To study the effects of exposed ocular surface area and blink rate on tear dynamics by the measurement of tear evaporation under a range of conditions.

METHODS

Tear evaporation was measured in three gaze positions in 15 normal volunteers, and the ocular surface area was determined as a function of the width of the palpebral fissure. In 17 normal volunteers, the effect of blink rate on tear evaporation was assessed.

RESULTS

The ocular surface area was 1.2 +/- 0.27, 2.2 +/- 0.39, and 3.0 +/- 0.33 cm2 with patients looking down, ahead, and up, respectively. The corresponding tear evaporation rates per eye were 7.0 +/- 3.5, 17.6 +/- 6.6, and 23.7 +/- 6.3 x 10(-7) g/s, respectively. The tear evaporation per square meter also increased proportionally with the ocular surface area. When the blink rate was changed from 10 to 60 per minute, the tear evaporation did not change in those individuals with evaporation rates more than 7.8 x 10(-7) g/s per square centimeter, whereas it did increase with the blink rate in those whose evaporation rates were lower.

CONCLUSIONS

Ocular surface area and blink rate affect tear dynamics. Moderate palpebral fissure width and blink rate are necessary for the prevention of desiccation of the ocular surface.

Study on the detection of implantation site in rabbits

In this study, an alkaline treatment was applied to the observation of implantation site in rabbits. Embryos in pregnant rabbits were stabbed to death on days 7, 8, 9, 10 and 18 of gestation. These animals were sacrificed on day 29. The uteri were removed, immersed in 2% sodium hydroxide and fixed with 10% buffered formalin. After the alkaline treatment, all of the implantation sites were clearly recognizable as white tissue since the other parts became fairly transparent. Even after the formalin fixation, all the implantation sites were similarly detectable. The mean area of implantation sites visibly increased after day 10. From all the results, the simple and accurate procedure including alkaline treatment was concluded to be useful for estimating implantation and pregnancy conditions in rabbits.

Stable positively charged liposome during long-term storage

The effect of taurine, as an isotonic solute, and of benzalkonium chloride (BZC), as a positive membrane component, on the long-term stability of liposomal suspensions was investigated by measuring surface potential. The surface potential, which introduced electrostatic repulsion to liposomes against aggregation, increased dose-dependently with the addition of BZC, which gave a positive charge. However, a further addition of BZC caused unexpected aggregation during storage, so the optimum addition of BZC was defined. On the other hand, taurine, which forms a zwitter ion in an aqueous solution, did not reduce the surface potential, suggesting that taurine is of possible utility as an isotonic solute. As the result of stability testing, the liposomal system using taurine and BZC was stable against aggregation during 6 months at 40 degrees C. We were successful in developing a stable, positively charged liposomal system during long-term storage, and our liposomal system is believed to be of wide utility as a drug carrier for therapeutic drugs applied topically to negatively charged mucosal tissues. We applied the Derjaguin-Landau-Verwey-Overbeek (DLVO) theory to estimate the colloidal stability of liposomes. As a result of stability testing, positively charged liposomes had a good correlation between maximum total repulsive energy (VT(max)/kT) between two liposome particles and colloidal stability, suggesting that the VT(max)/kT value is useful for estimating stability and for designing liposomal preparations containing some ionic substances.

Simultaneous determination of NK611, a novel water-soluble derivative of etoposide, and its metabolite (DeNK611) in dog plasma by column-switching high performance liquid chromatography

A simple, selective, reversed phase liquid chromatographic method using a column-switching technique has been developed for the simultaneous determination of a novel derivative of etoposide (NK611) and its O-demethyl metabolite in dog plasma. A good linear response was obtained for both drugs in the range 0.1-12.0 micrograms/mL. The mean recoveries were within 100 +/- 5%. The within- and between-day precisions were within 3.5% and 4.6%, respectively. This method was used in a pharmacokinetic study following intravenous and oral administration of NK611 to beagle dogs.

Quantitative evaluation of the effectiveness of taurine in protecting the ocular surface against oxidant

Quantitative evaluation of the effectiveness of taurine against ocular surface damage caused by hypochlorous acid (HOCl) was investigated using albino rabbits. The activity of lactate dehydrogenase (LDH) released from ocular tissues into meniscus tears at eye irritation was used as an index of ocular surface damage. Instead of collecting meniscus tears directly with a glass micropipette, a new sampling method, where 150 microliters of saline was instilled into the cul-de-sac of rabbit eyes and collected all of the diluted tears within 10 s, was developed. The LDH activity after serial instillations of HOCl increased dose-dependently with increasing HOCl concentration. After serial instillation of taurine, HOCl was instilled in the same way. Pre-application of taurine effectively suppressed (p < 0.01, n = 11) the HOCl-induced LDH release as compared to saline, suggesting that the residual taurine in ocular surface tissues was still effective in protecting the tissues against HOCl by scavenging HOCl. LDH activity at 30 in after post-application of taurine was significantly lower (p < 0.01, n = 10) than that in the case of saline. This result indicates that taurine is effective in protecting the ocular surface after it has been attacked by HOCl. LDH activity in meniscus tears became a good index of quantitatively estimating ocular surface damage due to HOCl by devising the new sampling method. By using this method, we were able to prove objectively and quantitatively that taurine is effective in protecting the ocular surface against HOCl. It was suggested that taurine is clinically useful in the treatment of ocular surface damage caused by oxidants, such as HOCl.

A flow cytometric DNA analysis of giant cell tumors of bone including two cases with malignant transformation

BACKGROUND AND METHODS

Flow cytometric DNA analysis was performed on 30 cases of giant cell tumor (GCT) of bone with the use of paraffin-embedded sections.

RESULTS

According to the criteria of Huvos, they were classified histologically into three groups: Grade 1, 26 cases; Grade 2, 4 cases; and Grade 3, no cases. Among the Grade 1 cases, 21 were diploid and 5 were aneuploid. Of the four Grade 2 cases, three were diploid and one was aneuploid. Nine patients had local relapses. Among four patients with complications by lung metastases, two have remained well at 18 and 157 months with the metastases. The other two patients, who had Grade 1 DNA diploid GCT of the 11th thoracic spine, had malignant transformation (osteosarcoma) resulting from radiation therapy. In one patient, the primary lesion exposed to radiation and the lung lesions were diploid, but in the other patient both were found to be aneuploid at autopsy. No significant differences of S-phase fraction were observed between two different grade groups. There was no significant correlation among DNA ploidy, histologic grade, and the presence or absence of lung metastases.

CONCLUSIONS

Based on this study, the DNA analysis has a limitation in predicting the biologic behavior of GCT.

Primitive neuroectodermal tumors of bone and soft tissue. With reference to histologic differentiation in primary or metastatic foci

Primitive neuroectodermal tumors (PNET) of the bone and soft tissue were reviewed by immunohistochemistry and partly by morphometry, focusing particularly on histologic changes in recurrent or metastatic foci, in order to elucidate their probable histogenetic relationship with Ewing's sarcoma (ES) and its extraskeletal counterpart (EES). Eleven cases of bone tumor (average patient age; 15.1 yr) and 12 cases of soft tissue tumor (average patient age; 22.1 yr) which disclosed unequivocal Homer-Wright rosettes and/or at least foci of ganglion cell differentiation either in a given primary tumor or metastatic (or recurrent) foci were selected from small round cell tumors primarily categorized as ES or EES. Most of the cases for which follow-up biopsy samples were available disclosed prominent Homer-Wright rosettes in the metastases, whereas the primary tumors showed features of ES and lacked rosettes. In only one case, Homer-Wright rosettes were absent in the metastatic tumor. Most cases had been treated by combined intensive chemotherapy and radiotherapy, which might have influenced cell differentiation. Neural markers (neuron-specific enolase, neurofilament protein and others) were positive in most cases. Three cases with otherwise typical histologic features of ES or EES showed minute foci of ganglion cell differentiation, as confirmed by morphometry and neural markers. These results suggest that ES (or EES) and PNET are histogenetically related, but represent different stages of cell differentiation.

High performance liquid chromatographic determination of 1,5-anhydroglucitol in human plasma for diagnosis of diabetes mellitus

This paper describes a high performance liquid chromatographic (HPLC) method for determining 1,5-anhydroglucitol in plasma, in which anion exchange chromatography and pulsed amperometric detection are used. Plasma samples deproteinized with trichloroacetic acid are passed through a three-layer column packed with (1) strongly basic anion (BO3(3-) form, the upper layer), (2) strongly basic anion (OH- form, the middle layer) and (3) strongly acidic cation (H+ form, the lower layer) exchange resins. 1,5-Anhydroglucitol is efficiently recovered in the flow-through fraction and interfering substances are completely removed by the column treatment. The analytical response of the method is linear with concentration to 40 mg/L, and it is possible to detect as little as 0.1 mg 1,5-anhydroglucitol per litre of plasma. Analytical recovery is between 96 and 103%, and there is good agreement between the results measured by our method and by a gas/liquid chromatographic method (r = 0.998). The method has been successfully used for the determination of very low 1,5-anhydroglucitol concentrations (less than 1 mg/L) in the plasma of diabetic patients.