Successful treatment of all-trans retinoic acid resistant and chemotherapy naïve acute promyelocytic patients with arsenic trioxide--two case reports

Arsenic trioxide(As2O3) has proved highly effective in treating both refractory or primary cases of acute promyelocytic leukemia (APL). The role of arsenic trioxide in APL treatment has been confirmed by study groups in China and in the USA. However, what is the role of As2O3 in treating APL? Should it be used as first line therapy, or should it be used as a second line drug. This still remains to be defined. Here, we report two cases of APL, who were treated successfully with As2O3 when they relapsed. Initially, both received all-trans retinoic acid (ATRA) for primary remission induction therapy, and obtained a complete remission. For ethical or personal reasons, they did not receive chemotherapy as consolidation therapy and when they relapsed at 23 months and 12 months later respectively, they both received As2O3 therapy after being resistant to ATRA treatment. Two courses of As2O3 were given and both reached complete remission. There were very few adverse reactions to the drug, only mild abdominal cramps, mild fluid retention, and transient elevation of transaminases. They both had rather good quality of life throughout the treatment and both remain in remission for 32 months and 10 months since therapy, respectively.

Reversible axial myopia following infectious scleral ulceration--a case report

Adult-onset axial myopia is uncommon in comparison with the lenticular myopia. When we dealt with a case of the infectious scleral ulceration, the progressive myopic shift was not only due to the dense nuclear sclerosis but also due to the longer axial length. The elongating axis became shortened after 3-months follow up. Then the patient underwent uneventful cataract surgery. However, the reversal process persisted even after the operation. Although the pathogenesis is not well known, we concluded that the cataract surgery in dealt with the complicated cataract should be delayed in the cases with any inflammation or the axial changes.

Treatment of tooth fracture by medium energy CO2 laser and DP-bioactive glass paste: thermal behavior and phase transformation of human tooth enamel and dentin after irradiation by CO2 laser

Acute trauma or trauma associated with occlusal disharmony can produce tooth crack or fracture. Although several methods are proposed to treat the defect, however, the prognosis is generally poor. If the fusion of a tooth fracture by laser is possible it will offer an alternative to extraction or at least serve as an adjunctive treatment in the reconstruction. The responses of soft tissues to lasers of different wavelengths are fairly well known, but the reactions of hard tissues are still to be understood. The purpose of this research was to study the feasibility of using a medium energy continuous-wave CO(2) laser and a low melting-point bioactive glass to fuse or bridge tooth fractures. The present report is focused on the first part of the research, the analysis of changes in laser-irradiated human tooth enamel/dentin by means of X-ray diffractometer (XRD), Fourier-transforming infrared spectroscopy (FTIR), differential thermal analysis/thermogravimetric analysis (DTA/TGA), and scanning electron microscopy (SEM). After CO(2) laser irradiation, there were no marked changes in the X-ray diffraction pattern of the enamel when compared to that before laser treatment. However, a small peak belonging to alpha-TCP appeared at the position of 2theta=30.78 degrees C. After being treated with CO(2) laser, the dentin showed much sharper peaks on the diffraction patterns because of grain growth and better crystallinity. alpha-TCP and beta-TCP were identified after laser treatment. In the FTIR analysis, an HPO(4)(-2) absorption band was noted before laser treatment disappeared after the irradiation. No significant change in the absorption band of HPO(4)(-2) was found on the FTIR curves of enamel after laser treatment. The results of DTA/TGA indicated that loss of water and organic materials occurred in both enamel and dentin after laser treatment. Under SEM, melting and resolidification occurred in both enamel and dentin by medium energy of CO(2) laser. This implies that using a continuous-wave CO(2) laser of medium energy density to fuse a low melting-point bioactive glass to the enamel/dentin is possible. We believe these phase changes and thermal data can make a useful guide for future studies on the thermal interaction and bridging mechanism between the bioactive glass and enamel/dentin under CO(2) laser irradiation.

Gastrointestinal metastasis in hepatocellular carcinoma: radiological and endoscopic studies of 11 cases

BACKGROUND

From October 1990 to January 1999, 11 of 2237 hepatoma patients at our hospital had gastrointestinal tract metastasis. We describe the radiological and endoscopic features, clinical course and prognoses of those patients.

METHODS

All patients were male. Six patients were hepatitis B carriers, and cirrhosis was noted in eight patients on admission. We reviewed all available radiological, endoscopic and pathological features.

RESULTS

The commonest clinical presentation was frank gastrointestinal bleeding. Histological proof of gastrointestinal involvement was seen in six patients. Endoscopic features included ulcerative tumours mimicking advanced gastric carcinoma (43%) and submucosal tumours (29%). The sites of organ involvement were stomach (five), duodenum (two), colon (three) and duodenum and colon (one). Direct invasion by a contiguous neoplasm was the major route of gastrointestinal tract metastasis. Portal vein thrombosis may be the key point of haematogenous spread to other sites.

CONCLUSIONS

The prognosis in these patients was extremely poor. Almost all patients died within 5 months if no further aggressive management was performed. Surgical intervention may be the optimal choice for palliative treatment of HCC with gastrointestinal tract involvement.

Recurrent gastrointestinal bleeding and high output cardiac failure caused by hereditary hemorrhagic telangiectasia

Hereditary hemorrhagic telangiectasia, commonly known as Osler-Weber-Rendu disease, is a systemic autosomal dominant inherited disorder, that occurs in Caucasian populations. We report the case of a 56-year-old housewife who was admitted to the gastrointestinal and cardiovascular ward because she had suffered from recurrent gastrointestinal bleeding and heart failure from 1994 to 1997. Panendoscopy showed vascular ectasia scattered over the tongue, larynx, esophagus, and posterior wall of the gastric body. Colonoscopy showed clusters of telangiectasia over the cecum and ascending colon. Arteriovenous malformations (AVMs) were found in the liver and lungs on computerized tomography. Recurrent gastrointestinal bleeding was controlled by estrogen treatment during the follow-up period. In July 1997, the patient was readmitted to our cardiovascular section due to aggravated dyspnea, orthopnea and bilateral lower leg edema. Cardiac catheterization showed a large fistula from the left pulmonary artery to the left atrium and left ventricle, pulmonary arterial pressure of 37/13 mmHg and cardiac output of 9.61/minute. Other studies excluded the possibility of sepsis, and high-output cardiac failure was suspected. The patient was discharged in a stable condition and scheduled for AVM embolization management. Unfortunately, she died of a suspected heart attack at home two weeks following discharge.

Effect of fortified antibiotic solutions on corneal epithelial wound healing

PURPOSE

To evaluate the influence of fortified antibiotic eyedrops on corneal epithelial wound healing.

METHODS

We developed an in vitro epithelial wound-healing model to evaluate the toxicity of antibiotics. An excimer laser was used to create an epithelial defect 1.5 mm in diameter, 70 microm in depth on the central area of porcine cornea. The intact animal globes were maintained in the incubator by a perfusion system. Fortified antibiotics: 10% piperacillin, 5% cefazolin, 0.5% chloramphenicol, 5% vancomycin, 1% amikacin, 2% gentamicin, and 0.1% amphotericin B were applied to the wound in three applications. The wounds were evaluated 24 h after setup with fluorescein stain and a scoring system.

RESULTS

The 0.1% amphotericin B and 2% gentamicin disturbed the corneal epithelial healing rate significantly. The remaining antibiotics did not interfere with the epithelial healing rate in our study design.

CONCLUSION

Fortified antibiotic eyedrops demonstrated varied degrees of influence on corneal epithelial wound healing. When antibiotic eyedrops are used, both the efficacy and toxicity of the antibiotics should be the major concern. If efficacy is equivalent, less-toxic agents should be given preference.

Combined use of an amniotic membrane and tissue adhesive in treating corneal perforation: a case report

We report a new method combining the use of an amniotic membrane and cyanocrylate tissue adhesive to seal a corneal perforation. A 47-year-old male suffered from an alkali injury complicated with corneal melting and perforation in the left eye. We placed an amniotic membrane of optimal size in the anterior chamber directly under the corneal perforation lesion. The cyanocrylate tissue adhesive was then applied over the perforation site and sealed successfully. Three weeks later, the tissue adhesive had dislodged. The amniotic membrane had sealed the perforated lesion and was well adhered to the surrounding corneal tissue with complete epithelial covering. Vision was 20/25 six months after the operation. The combined use of an amniotic membrane and tissue adhesive is a promising method in the treatment of corneal perforation.

Treatment of tooth fracture by medium energy CO2 laser and DP-bioactive glass paste: compositional, structural, and phase changes of DP-bioglass paste after irradiation by CO2 laser

Nowadays, fractured teeth are difficult to treat effectively. Currently, root fractures are usually treated by root amputation, hemisection or tooth extraction. If the fusion of tooth fracture by laser were possible, it would offer a different therapy to repair fracture teeth. We tried to use a developed DP-bioactive glass paste to fuse or bridge the tooth crack line by a medium energy continuous-wave CO2 laser. The study is divided into three parts: (1) The compositional and structure changes in tooth enamel and dentin after laser treatment; (2) The phase transformation and recrystallization of DP-bioactive paste during exposure to the CO2 laser; (3) The thermal interactions and bridge mechanism between DP-bioactive glass paste and enamel/dentin when they are subjected to CO2 laser. The present report will focus on the second part that will examine the changes of laser-exposed DP-bioactive glass paste by means of X-ray diffractometer (XRD), Fourier transforming infrared spectroscopy (FTIR), differential thermal analysis/thermogravimetric analysis (DTA/TGA), and scanning electron microscopy (SEM). From the study, we could find that the temperature increase due to laser irradiation is greater than 900 degrees C and that the DP-bioactive glass paste could be melted in a short period of time after irradiation. In the study, we successfully developed a DP-bioactive glass paste which could form a melting glass within seconds after exposure to a medium energy density continuous-wave CO2 laser. The paste will be used in the near future to bridge the enamel or dentin surface crack by the continuous-wave CO2 laser.

Corneal subepithelial opacities associated with inappropriate contact lens care

PURPOSE

To report two cases of corneal subepithelial opacities, which may be related to improper lens care by the patients.

METHODS

Slit-lamp examination and monitoring of contact lens care procedures.

RESULTS

Two female patients experienced similar symptoms of soreness, blurring, and red eyes after wearing soft contact lenses. Slit-lamp examinations demonstrated numerous subepithelial opacities in the central cornea. Both patients used the same kind of cleaner (MiraFlow) inappropriately, which resulted in the possibility of residual cleaner remaining in the lenses. The symptoms and signs gradually subsided after discontinued use of soft contact lens and application of topical steroid.

CONCLUSIONS

Residual MiraFlow in soft contact lenses may result in corneal subepithelial opacities.

Recombinant protein composed of Pseudomonas exotoxin A, outer membrane proteins I and F as vaccine against P. aeruginosa infection

We have constructed a chimeric protein composed of the receptor binding and membrane translocation domains of Pseudomonas exotoxin A (PE) with the outer membrane proteins I and F, together designated as PEIF. The potential of PEIF as a vaccine against Pseudomonas infection was evaluated in BALB/c mice and New Zealand white rabbits. We examined titers of anti-PE and anti-OprF antibodies, and the ability both to neutralize PE cytotoxicity and to increase opsonophagocytic uptake of Pseudomonas aeruginosa strain PAO1, serogroups 2 and 6. The results showed that PEIF can induce antibodies not only to neutralize the PE cytotoxicity but also to promote the uptake of various strains of P. aeruginosa by murine peritoneal macrophages. In a burned mouse model, PEIF afforded significant protection against infection by the homologous P. aeruginosa strain PAO1, heterologous serogroup 2, and the PE hyperproducing strain PA103. These observations thus indicate that PEIF may be used as a novel vaccine against P. aeruginosa infection.

Root deformation during root-end preparation

Ultrasonic root-end preparation techniques have recently been introduced and revolutionized the field of endodontic surgery. However, several reports claimed that there was an increasing incidence of crack formation after ultrasonic root-end preparation. As yet, little work has focused on the root deformation during root-end preparation. Thus, the purpose of this investigation was to measure the amount of root deformation during root-end preparation with the use of microhandpiece and ultrasonic systems by using strain gauge methods, and simultaneously to detect any cracks with the aid of the stereomicroscope, stain, and an image processing system. The results demonstrated the ultrasonic instrumentation produced significantly greater strain on average than that generated with the microhandpiece system. From the viewpoint of fracture, any technique that could diminish the strain on the root would decrease the likelihood of fracture; however, no crack was observed on any resected surface of roots in this study.

Toxic effects of mitomycin-C on cultured corneal keratocytes and endothelial cells

Improper use of mitomycin-C in ocular medication may result in damage to corneal cells. In this study, the toxic effects of mitomycin-C on cultured porcine keratocytes and endothelial cells were estimated by MTT, 3H-thymidine uptake and cellular counting assay methods. It was found that mitomycin-C caused a dose-dependent toxic effect to keratocytes and endothelial cells. Both cells were treated with mitomycin-C at the concentration ranging from 100, 10, 1, 0.1 to 0.01 microg/ml for 3 min, 5 min or 100 min. The 50% inhibitory dose (ID50) of mitomycin-C to keratocytes and endothelial cells as measured by MTT assay was 0.40, 0.18, 0.16 mg/ml and 0.27, 0.15, 0.14 mg/ml, respectively, after 3, 5 and 100 minutes drug treatment. The ID50 for keratocytes and endothelial cells as measured by 3H-thymidine uptake immediately, 1 day and 7 days after 100 minutes mitomycin-C treatment was 0.3, 0.0002, 143.2 microg/ml and 45.1, 101.1, 450.2 microg/ml, respectively. The ID50 for keratocytes and endothelial cells as measured by cellular counting 1 day and 7 days after mitomycin-C treatment was 232.5, 109.7 microg/ml and 239.9, 367.5 microg/ml, respectively. It is concluded that mitomycin-C is more toxic to cellular proliferation in cultured corneal keratocytes than in endothelial cells.

Precise, controlled laser delivery with evanescent optical waves

Precise laser surgery is possible with laser pulses at wavelengths that are strongly absorbed at the surface of tissue. However, pulses at these wavelengths (far UV, far infrared) are not compatible with fiber-optic transmission, making endoscopic surgical procedures inside the body difficult. We use evanescent optical waves to demonstrate an alternative for confining energy near the tissue surface. Precise, superficial tissue ablation is achieved with evanescent waves generated at a sapphire-tissue interface by a free-electron laser, where the ablation depth may be varied. A new class of precise, controlled laser surgical tools may be achieved in this novel approach for use in endoscopic procedures. Electromagnetic theory governing evanescent-wave tissue ablation is presented.

A nontoxic Pseudomonas exotoxin A induces active immunity and passive protective antibody against Pseudomonas exotoxin A intoxication

Pseudomonas exotoxin A (PE) is one of the most potent cytotoxic agents produced by Pseudomonas aeruginosa. In this study, we examined the possibility of using PE with a deletion of 38 carboxyl-terminal amino acid residues, designated PE(Delta576-613), for active immunization against PE-mediated disease. We first examined the toxic effects of PE and PE(Delta576-613) on 5- and 9-week-old ICR mice. The results show that the subcutaneous administration of PE(Delta576-613) at a dose of 250 microg was still nontoxic to 5- and 9-week-old ICR mice, while native PE was lethal at a dose of 0.5 and 1 microg, respectively. PE(Delta576-613) was then used to immunize ICR mice. The minimum dose of PE(Delta576-613) that could effectively induce anti-PE antibodies in 5- and 9-week-old ICR mice was found to be 250 ng. However, immunization with 250 ng PE(Delta576-613) failed to protect the immunized mice from a lethal dose of PE. The effective immunization dose of PE(Delta576-613) that could protect mice against a 2 microg PE challenge was found to be 15 microg. In addition, sera obtained from PE(Delta576-613)-immunized ICR mice were able to neutralize PE intoxication and effectively protect mice from PE. Thus, PE(Delta576-613) may be used as an alternative route to new PE vaccine development.

The combined occluding effect of sodium fluoride varnish and Nd:YAG laser irradiation on human dentinal tubules

Various methods and materials used in the treatment of dentin hypersensitivity are thought to achieve a therapeutic benefit by tubule occlusion. The aim of the present study was to evaluate the combined occluding effect of sodium fluoride varnish and Nd:YAG laser irradiation on human dentinal tubules. Thirty-six dentin specimens with exposed dentinal tubule orifices were used in this study. The samples were randomly divided into four groups. Groups A, B, and C were varnished by sodium fluoride, whereas group D served as a control. Then, group C was lased by 30 mJ of Nd:YAG laser, 10 pulses/s for 2 min by light painting. Three hours later, groups B and C were brushed by an electrical toothbrush for 30 min. Under SEM observation, the control group showed numerous exposed dentinal tubule orifices, and the sodium fluoride varnished specimens showed closure of exposed dentinal tubule orifices. After electrical toothbrushing, most of the sodium fluoride varnish was brushed away, except in the specimens that were irradiated by Nd:YAG laser. Over 90% of the dentinal tubule orifices were occluded by sodium fluoride varnish combined with Nd:YAG laser irradiation.

Fungal corneal ulcers of onion harvesters in southern Taiwan

Fungal corneal ulcers related to agriculture has been reported throughout the world, especially in tropical areas. Most of them were sporadic and had histories of ocular trauma or use of topical corticosteroids and topical antibiotics. Five onion harvesters had fungal corneal ulcers during the same harvest period in Southern Taiwan. The authors think that this is the first report of a group occurrence relating to agricultural workers. Although all of the patients improved after medical and surgical management, their vision was greatly decreased. It is suggested that the tropical climate, the harvest procedure, the characteristic monsoon, and lack of eye protection were involved. Therefore, the importance of the eye protection, hygiene education, and improving medical care to reduce the occurrence of fungal corneal ulcer in agriculture workers must be emphasised.

Effect of reaction conditions on preparations of rhenium-188 hydroxyethylidene diphosphonate complexes

Rhenium-186 (Re-186) hydroxyethylidene diphosphonate (HEDP) has been shown to localize in metastatic foci within bone in a manner similar to Tc-99m bone-seeking agents. Usually, in the preparation of diagnostic Tc-99m radiopharmaceuticals, the concentration of Tc is at trace level (10(-8) M). However, large amounts of carrier are included in the preparation of Re-186 radiopharmaceuticals (10(-4) M), which may significantly affect the preparation of Re-HEDP. In this study, Re-188 was used as an Re tracer. The effects of pH and concentrations of Re carrier on the preparation of Re-HEDP were investigated. Re-188-Sn-HEDP was prepared by reconstitution of a kit of lyophilized HEDP mixture, and tin chloride with a radioactive solution of perrhenate in saline. The total concentration of Re present in this work ranged from 10(-8) to 10(-3) M. The results showed that high labeling efficiency was obtained for each preparation. Although the chemical behaviors of the Re-188 HEDP complexes, with and without carrier, were similar, the biodistribution patterns of carrier free Re-188 HEDP in rats were found to differ from the biodistribution patterns of carrier-added Re-188 HEDP.

Vertical root fracture in endodontically versus nonendodontically treated teeth: a survey of 315 cases in Chinese patients

OBJECTIVE

The purpose of this study was to compare endodontically versus nonendodontically treated teeth with respect to clinical features, including patient age and gender and tooth types of vertical root fractures.

STUDY DESIGN

A total of 315 consecutive cases of vertical root fracture occurring in 274 Chinese patients during a 1 3-year period were reviewed. Age and gender, as well as tooth type and root distribution of vertical root fractures, were presented and compared in endodontically versus nonendodontically treated teeth.

RESULTS

Most patients (87%) had 1 fractured tooth; the others had 2 or 3 fractured teeth. Of all vertical root fractures, 40% occurred in nonendodontically treated teeth. In comparison with those in endodontically treated teeth, vertical root fractures in nonendodontically treated teeth tended to occur in patients with a higher mean age (55 years vs. 51 years) and were more frequent in male patients (78% vs. 58%). Vertical root fractures occurred in nonendodontically treated teeth more often in molars (84% vs. 53%), less often in premolars (16% vs. 33%), and seldom in anteriors (1 tooth vs. 27 teeth).

CONCLUSIONS

Vertical root fractures in nonendodontically treated teeth are not uncommon and comprise a large proportion of such fractures in Chinese patients. Differences between endodontically and nonendodontically treated teeth in patient age and gender, as well as in tooth types of vertical root fractures, were demonstrated.

Ultrastructural changes of the tooth root surface by Nd:YAG laser irradiation followed by citric acid and tetracycline

The neodymium:yttrium-aluminum-garnet (Nd:YAG) laser has been used for treatment of dentinal hypersensitivity, eradicating periodontal pathogens, and facilitating calculus removal. However, Nd:YAG laser irradiation exerts potentially harmful effects on the tooth root surface. The purpose of this study was to examine the ultrastructural changes of the tooth root surface caused by Nd:YAG laser irradiation, and to determine whether chemical and mechanical preparations can correct these ultrastructural changes. Eighteen tooth specimens (3 x 3 x 0.5 mm) with healthy root surfaces were prepared and irradiated with an Nd:YAG laser at various power densities. Root surfaces were irradiated at 100 mJ at 20 pulses per second (pps) for 2 seconds followed by the application of citric acid (pH 1.2) or tetracycline solution (100 mg/mL) for 3 and 5 minutes, respectively, or ultrasonic scaling for 5 strokes of 3 seconds per stroke. As observed with low-vacuum scanning electron microscopy, (Wet-SEM), Nd:YAG laser irradiation at 70 to 100 mJ, 20 pps for 2 seconds caused surface cratering, areas of porosity, pitting, fissures, and lava-like structures in an area 140 to 280 microns in diameter. Irradiation of 50 mJ, 20 pps for 2 seconds, led to only mild surface charring. No evidence of morphologic changes was found when root surfaces were irradiated with the Nd:YAG laser at 20 mJ, 20 pps for 2 seconds or at 50 mJ, 10 pps for 8 seconds. The laser-induced lava-like structures were partially detached by citric acid (pH 1.2) etching and ultrasonic scaling, but not by tetracycline (100 mg/mL). These results indicate that chemical and mechanical preparations can be used effectively in conjunction with Nd:YAG laser irradiation for root surface preparation during both nonsurgical and surgical periodontal treatments.

Intraocular use of fluconazole in the management of ocular fungal infection

In this study, we investigate the efficacy and safety of intraocular use of fluconazole in the treatment of ocular fungal infection. Ten patients with intraocular fungal infections were examined. Among these patients, eight were infected with keratomycosis with intraocular spreading, one had postoperative fungal endophthalmitis after cataract operation with an intraocular lens implant, and another suffered from endogenous fungal endophthalmitis. In addition to the conventional local application with or without systemic administration of antifungal drugs, all ten patients were treated with intraocular administration of 5-10 micrograms/ml of fluconazole. The ocular fungal infections resolved in nine patients without obvious side effect. One failed in the antifungal treatment with loss of vision. In our experience, the results revealed that fluconazole is a safe and effective antifungal agent that can be administered intraocularly. We suggest that intraocular administration of this drug could be considered as an alternative or additional choice for the treatment of severe ocular fungal infections.

Thrombin activates the growth, cell-cycle kinetics, and clustering of human dental pulp cells

Thrombin is activated during vascular injury and inflammation of the dental pulp. In the present study, we found that thrombin can stimulate the proliferation of pulp cells in a dose-dependent manner as analyzed by modified MTT assay. The cell number increased by 1.6, 1.77, and 2.14-fold over that of control after exposure to 5, 10, and 20 units/ml of thrombin for 5 days. Flow cytometry studies also found that thrombin (10 units/ml) can induce the cell cycle progression of pulp cells after 24 h of incubation, as revealed by increasing the proportion of cells in the S phase and the G2/M phase from 29 to 72%. Moreover, exposure to thrombin (> 5 units/ml) for 3 days led to marked clustering of pulp cells. We concluded that thrombin can regulate the growth, cell cycle progression, and functional reorganization of the pulp tissue during pulp healing and inflammatory processes.

Progressive outer retinal necrosis syndrome as an early manifestation of human immunodeficiency virus infection

Progressive outer retinal necrosis syndrome is a recently recognized variant of necrotizing herpetic retinopathy, developing in patients with acquired immune deficiency syndrome (AIDS) or other conditions causing immune compromise. We report a case in which the diagnosis of retinal necrosis syndrome was made before the diagnosis of AIDS was confirmed. A 41-year-old man presented with a 1-month history of blurred vision in his left eye. Ophthalmologic examination revealed extensive retinal necrosis with total retinal detachment in his left eye and multifocal deep retinal lesions scattered in the posterior fundus as well as in the peripheral retina in his right eye. The serologic test for human immunodeficiency virus (HIV) was positive. Despite intravenous acyclovir treatment for 1 week, the lesions in the right eye showed rapid progression. High doses of intravitreal ganciclovir were then given in addition to intravenous acyclovir. After combined treatment for 1 month, the lesions became quiescent and the visual acuity improved to 20/30. Although the patient soon developed full-blown AIDS, the vision in his right eye remained undisturbed. Physicians should suspect progressive outer retinal necrosis syndrome in any patient with rapidly progressive necrotizing retinopathy and test the patient for HIV infection. Aggressive combined antiviral agent therapy should be considered to save vision.

Stability of self-prepared fortified antibiotic eyedrops

Self-prepared fortified antibiotic eye drops are essential for the severe ocular infection. The relation of potency decay and storage conditions including temperature, concentration and duration were studied by the changes of MIC. 1% and 10% amikin, 10% and 50% pipril, and 5% and 25% vancomycin were diluted from the prarenteral antibiotics with the 5% glucose and storage at 4, -18 and -80 degrees C for 3, 7, 14 and 28 days. MICs of amikin against Pseudomonas aeruginosa, pipril and vancomycin against Staphylococcus aureus were determined by the agar diffusion method. Fluctuations of the MIC were noted during the observation period. Most of the significant changes of MIC were found during the first 7 days. When the potencies between time of zero and 28 days are compared, only 10% pipril and 25% vancomycin stored at -80 degrees C had significant change. Our conclusion is that all of the fortified antibiotic eye drops in this study can be stored in the house refrigerator or freezer for up to 28 days. High concentration may show a negative result of the preservation. Temperature does not influence the preservative effect within four weeks' observation.

Influences of methylcellulose on corneal epithelial wound healing

We performed a study to evaluate the influence of methylcellulose (MC) on the corneal epithelial wound healing. A precise epithelial wound 2.0 mm in diameter and 70 microm in depth was created by an excimer laser on the cornea of a pig's eyeball. After treatment, the eyeballs were cultured in the incubator and perfused with TC-199 medium into the vitreous cavity. Topical MC with eight different combinations of concentrations and viscosities for experimental groups and BSS for the control group were applied on the epithelial defects three times. Wounds were evaluated 24 hours later with fluorescein stain and recorded with a scoring system. All of the experimental groups except one showed a more statistically significant superior wound-healing rate than the control group. MC possesses the effect to accelerate corneal epithelial wound healing.