Treatment of craniopharyngiomas—the stereotactic approach in a ten to twenty-three years' perspective

Summary Fourty-two consecutive patients with craniopharyngioma were treated by stereotactic approach, i.e. preferentially stereotactic puncture and installation of colloid isotope into cystic tumours and external stereotactic single dose irradiation to solid tumour parts. In a minority of cases, such treatment was less suitable, and surgical removal and/or radiotherapy was used. There was no peroperative mortality. A long-term follow up (observation time 10–23 years) of the 31 patients alive indicated that they were socially well adapted with a high rate of fulltime work and a low rate of intercurrent disease. In spite of substitution therapy for pituitary insufficiency in most cases, the patients were subjectively seldom disturbed by their disease.Our results support a change in the choice of therapy for craniopharyngioma patients, from open neurosurgery to the less invasive stereotactic techniques.     

The effect of lithium on amphetamine-induced locomotor stimulation

Rats were treated chronically with -methyl-p-tyrosine methyl-ester HCl (-MT) twice daily for 0–14 days. At 1 h after the (last) -MT injection, d-amphetamine sulphate was given and motor activity was measured in an ANIMEX activity meter for 4 h. Amphetamine-induced excitatory and stereotyped behaviour was scored according to a rating scale in a separate experiment. A single dose of -MT markedly reduced the activity response after amphetamine. After 1–3 days of -MT treatment, tolerance to its amphetamine-antagonistic affect started to develop, reaching a maximal degree after 7–14 days. The pattern of the amphetamine response, monophasic in control rats, became biphasic in the -MT tolerant rats with an early (at 0–1 h) and a late (2–4 h) peak of motor activity. The late peak appeared within 3 days, while the early peak appeared after 7 days of -MT treatment. The results on amphetamine-induced excitatory and stereotyped behaviour in essence agreed with the motor-activity data. It is concluded that tolerance to the amphetamine-antagonistic action of -MT is not complete. Its rate of development varies in a complex pattern, indicating the presence of more than one mechanism of tolerance.     

Significance of orbital fatty tissue for exophthalmos in thyroid-associated ophthalmopathy

PURPOSE: To correlate exophthalmos with the volume of extraocular muscle and orbital fatty tissue in thyroid-associated ophthalmopathy (TAO), using MRI that enables the orbital soft tissues to be well defined. METHODS: Thirty-three orbits, 20 from 10 patients with TAO and 13 from 13 controls, were employed. T1-weighted orbital MR slices 2 or 3 mm thick were obtained in axial, coronal and sagittal planes. Tracing the outlines of each structure, we measured the total sectional areas. Volumes of the extraocular muscle, of the fatty tissue and of the bony orbital cavity were calculated by multiplying the slice thickness. Exophthalmos was also measured using axial MRI. RESULTS: In TAO the volume increment of orbital fatty tissue (6.19 cm(3)) was much greater than that of extraocular muscle (1.16 cm(3)). Increase of exophthalmos by 1 mm needed a total orbital volume increment of 0.92 cm(3). The total orbital fatty tissue volume (correlation coefficient 0.70, P=0.06%) and the anterior orbital fatty tissue volume (0.64, P=0.23%) were more closely correlated with the degree of exophthalmos than was extraocular muscle volume (0.58, P=0.8%). Moreover, the volume increment of extraocular muscle and orbital fatty tissue was not always proportional. CONCLUSION: The results show that the orbital fatty tissue involvement is closely related to the degree of exophthalmos. For studying exophthalmos in TAO, the volumetric change, not only in ocular muscles, but also in orbital fatty tissue, should be taken into consideration.     

The Bostr?m-Kugelberg pseudo-isochromatic plates. How efficient is the third edition?

The third edition of the Bostr?m-Kugelberg pseudo-isochromatic plates was printed to the best possible visual match with the second edition. Slight colour differences between the 2 editions initiated this study where 72 colour defectives and 57 normal trichromats were tested with the plates and classified with the aid of Nagel's anomaloscope. Of the defectives, the plate test disclosed all but two anomalous trichromats. One normal subject was falsely classified as defective. The plates had to be shown twice according to the instructions since otherwise 13 of the 53 normals were misclassified. Three plates were shown to have low sensitivity; one is best used as a demonstration plate, and the other two can be deleted without lost efficiency. Forty-eight of the colour defectives were also studied with Farnsworth's lantern. The correlation between the numbers of plate and signal errors was weak. All subjects who failed the lantern test made several plate errors, but 15 subjects who passed the lantern test, made two or more errors on the plate test. The outcome of the plate test does not give evidence of the subject's lantern test performance.     

Treatment of craniopharyngiomas — the stereotactic approach in a ten to twenty-three years' perspective

Summary A multi-modality treatment programme, where stereotactic methods were used preferentially, gave results in a consecutive series of craniopharyngiomas, not inferior to those reported after microsurgical removal. Fourty-two patients with a follow-up range of 10–23 years are reported.     

Therapy-refractory secondary open-angle glaucoma caused by epithelialization of the anterior chamber following cataract extraction

Histologic findings are presented which relate to a case of primary diffuse epithelial downgrowth into the anterior segment after surgery, with subsequent secondary open-angle glaucoma which resisted all attempts at therapy. Possible types of early therapy are discussed.     

Saccadic eye movement velocity measured with the infrared reflection and search coil eye-tracking systems in patients with thyroid-associated ophthalmopathy

BACKGROUND: Assessment of changes in saccade velocity may be useful in the early detection of thyroid-associated ophthalmopathy (TAO). Two eye-tracking systems were used to measure the velocity of saccadic eye movements in patients with TAO. METHOD: Fourteen patients with active TAO and 14 healthy controls were enrolled for recordings with two eye-tracking systems: the magnetic scleral search coil (MSC; Skalar Medical) and the infrared reflection systems (IR; Orbit XY-1000). The MSC is generally considered the "gold standard" method for tracking of rapid eye movements. The IR system uses novel computer technology and is based on sampling of reflected infrared light from the surface of the eyes. Main sequence plots constructed from the recorded saccadic peak velocity and amplitude were analyzed for differences between patients and healthy controls. RESULTS: There were no significant differences between patients with TAO and healthy controls in the constructed main sequence plots of maximum velocity (V(MAX)) and the slope constant (C). CONCLUSIONS: Main sequence analysis of saccadic eye movements was not useful for detecting TAO in this experimental setting with either of the two eye-tracking methods. This is hypothesized to be due to compensation for the early orbital changes in TAO by neural adaptation of the saccades in the brain stem. The contradictory results between this and previous studies cannot be easily explained. We assume that there is a large heterogeneity in the saccadic eye movement performance in both the normal population and the TAO-population. Also, differences in the study design may cause dissimilar outcomes and hence incoherent conclusions. A non-invasive recording system that is able to generate a minimum amount of intra- and inter-individual variability and a study design where normal variability can be reduced to a minimum may be useful for future identification of early eye muscle changes in TAO.     

MRI measurements of orbital tissues in dysthyroid ophthalmopathy

BACKGROUND: Muscle volume investigation by different imaging techniques has proven useful in the diagnosis and follow up of treatment in dysthyroid ophthalmopathy. However, no study on muscle volume measurement by magnetic resonance imaging (MRI) has been done in this disease. METHODS: Six patients with monocular or asymmetric binocular dysthyroid ophthalmopathy and eight controls were examined with orbital MRI using a surface coil. In the muscle volume study, 2 mm coronal slices were used for measuring the six extraocular muscles (EOM), i.e., medial rectus (MR), lateral rectus (LR) superior rectus (SR), inferior rectus (IR), superior oblique (SO), and inferior oblique (IO) muscles, as well as the orbital fatty tissue (OFT). In the muscle thickness study, 3 mm transverse and sagittal images were used for measuring the four rectus muscles during fixation in different gaze positions in horizontal and vertical planes. RESULTS: In dysthyroid ophthalmopathy, the muscle volume of the six external eye muscles was significantly larger than in controls, except for the IO. The IR and MR showed the largest increase in muscle volume. The correlation between muscle thickness and different degrees of eye deflections was linear for all four rectus muscles both in patients and controls, and no significant differences in the slopes of the regression lines were found. The volume of OFT was significantly larger in patients than in controls, and the change in volume was larger than that of muscle volume. CONCLUSIONS: MRI technique makes it possible to observe and evaluate quantitatively the volume of all six extraocular muscles and the orbital fatty tissue in dysthyroid ophthalmopathy. It also makes it possible to evaluate changes in morphology during eye muscle contraction.     

Duration of treatment for candidemia and risk for late-onset ocular candidiasis

Purpose

Few reports have been published on the optimal duration of treatment of ocular candidiasis. We have investigated the incidence of late-onset Candida chorioretinitis and endophthalmitis in patients with candidemia who did not initially receive an ophthalmologic examination. The aim was to determine the duration of initial antifungal treatment that may be sufficient to avoid this complication.

Methods

This was a long-term follow-up study of 144 patients with candidemia who survived for at least 60 days after the onset of candidemia. The frequency of early- and late-onset ocular complications due to candida infection and factors associated with ocular candidiasis were investigated.

Results

Fundoscopy was performed on 60 patients, revealing 12 cases of ocular candida infection (20 %). Risk factors were infection with Candida albicans compared to other Candida species (p = 0.021) and surgery due to solid tumor (p = 0.004). Only one case of late-onset ocular candidiasis occurred among the 84 candidemic patients who did not receive an initial ophthalmologic examination. For unknown reasons, this patient had received only 2 days of systemic antifungal treatment initially.

Conclusions

No case of late-onset ocular candidiasis was detected in unexamined patients who received at least 14 days of antifungal treatment. Based on our results, it would appear that the recommended 2 weeks of treatment after the first negative blood culture are sufficient to avoid late-onset complications due to undiscovered Candida chorioretinitis in patients surviving for more than 60 days after the onset of candidemia.