Andrew P. Ferry

Diagnosis and Management of Rhino-Orbitocerebral Mucormycosis (Phycomycosis): A Report of 16 Personally Observed Cases

Mucormycosis is the most acutely fatal fungus infection of man. The disease causes a characteristic pattern of clinical symptoms and signs, prompt recognition of which will permit immediate institution of antifungal therapy. Personal experience with 16 cases of the rhino-orbitocerebral form of mucormycosis is the basis of this report. The first of these patients was seen in 1959, and the last in 1981. All of the patients had one or more preexisting diseases, as follows: (1) diabetes mellitus, 13; (2) acute leukemia, 3; (3) terminal carcinomatosis, 1; and (4) chronic sinusitis, 1. The most common initial symptoms and signs were sinusitis, pharyngitis, nasal discharge, and orbital/periorbital pain. Proptosis and formation of a black eschar were only seldom among the initially apparent features. Hyphas were demonstrated in tissue sections in 14 of the 16 patients in whom biopsy was done. Rhizopus species were cultured in 11 of the 13 patients from whom material for culture had been obtained clinically. Five of the 16 patients survived. All of them had been treated with surgical debridement and with intravenous amphotericin B.

Metastatic melanoma within and to the conjunctiva.

Two patients with epibulbar juxtalimbal primary conjunctival melanomas experienced local intralymphatic metastases to the inferior cul-de-sac, and a hematogenous metastasis to the conjunctiva developed in five other patients with cutaneous melanomas. Whether reflective of a local or distant metastasis, all of the lesions histopathologically were located in the substantia propria, and were separated from the overlying epithelium by a thin mantle of collagen. There was no evidence of atypical intraepithelial melanocytic proliferation, as would be expected in association with a primary conjunctival melanoma. Two of the cutaneous metastases exhibited a binodular or multinodular appearance that correlated histopathologically with variably confluent micronodules suggestive of the origin of the clinical lesion from a shower of tumor cell emboli. Patients with local intralymphatic spread from a primary conjunctival melanoma may experience additional lesions in the conjunctival sac or eyelid skin and are at risk for regional or distant metastases. They should be examined closely several times a year. The patients with the distant metastases all had their previously diagnosed primary cutaneous tumors on the truncal skin (a similar tendency emerges from a review of previous ocular cases), typically had myriad other cutaneous lesions, and two of them had a neoplastic iridocyclitis and vitreitis. These patients tended to die of the disseminated tumors within 1 year after conjunctival metastases developed.

Recurrence of Lattice corneal LystLophy type 1 in the Corneal Grafts of two Siblings

Amyloid was identified by light and electron microscopy within corneal grafts of two male siblings from a family with lattice corneal dystrophy type 1. These deposits indicate a recurrent disease within the donor tissue, and we believe this reflects an infiltration of the grafts by genetically abnormal host corneal fibroblasts. One of the patients developed bilateral recurrent disease in the grafts eight and 13 years after penetrating keratoplasty. His brother required a regraft 16 years after a penetrating keratoplasty. Although both of these patients required regrafts because of impaired visual acuity, the decrease in visual acuity in one case was not solely the result of reaccumulation of amyloid, but was at least in part caused by a plaque of fibrous tissue behind the cornea.

Ophthalmology and Vanity Fair

Vanity Fair was the leading Society magazine of Victorian and Edwardian England. A key feature of each weekly issue was the inclusion of a chromolithographed caricature and biographic sketch of a prominent individual. The author undertook a survey of the more than 2000 caricatures published from 1869 to 1914 to determine if any portrayed an ophthalmologist. Seventy-nine of the caricatures depicted physicians and scientists, of whom three were ophthalmologists: Sir Jonathan Hutchinson, Sir Robert Brudenell Carter, and Sir Anderson Critchett. A brief sketch of their ophthalmic accomplishments is presented. Caricatures from Vanity Fair are avidly sought after and are often found in antique shops, sporting venues, and professional offices, especially those of lawyers and judges. It has been said that when seeking the true perspective of the Victorian and Edwardian eras, the most faithful mirror and record of representative men and the spirit of their times can be found in Vanity Fair.

Professor Charles Tyrrell and his ideal sight restorer.

Charles A. Tyrrell was a masseur who obtained his MD degree at age 57 in 1900. In addition to his private practice he was editor of several pseudomedical magazines. He also owned two proprietary ventures that he conducted on a mail order basis. One of these involved production and sale of the The Ideal Sight Restorer, a U-shaped device consisting of a rubber bulb at the base, from which on both sides arose an arm of rubber tubing capped by an ivory eye piece. The eye cups were applied to the closed eyelids and the intermittent suction produced by squeezing the rubber bulb was claimed to provide a form of ocular massage capable of curing serious eye diseases (eg. cataract and glaucoma), as well as doing away with the need for spectacles. Although his fraudulent activities and deceptive advertising practices were described on several occasions in the Journal of the American Medical Association, Dr. Tyrrell persisted in his enterprises until he died in 1918.

Professor William C. Wilson and his Actina electric pocket battery for curing ocular disease.

PURPOSE To investigate the activities of the firm that manufactured and sold the Actina, the leading example of ophthalmic quackery in the era of the founding of the American Academy of Ophthalmology. METHODS Advertisements for the Actina in turn-of-the-century newspapers and magazines were studied, and additional related investigations were undertaken at leading historical societies in the United States and at the headquarters of the American Medical Association. RESULTS The Actina was widely advertised as a cure for most of lifes ills, particularly those of the eye and ear. Its manufacturers claimed that electrical properties were the mechanism of the Actinas alleged therapeutic effects. However, research has shown that the instrument had no electrical properties, its manufacturers had no medical training, and that the Actina was useless as a therapeutic agent. CONCLUSIONS The firm that manufactured the Actina was located in Kansas City and was at the zenith of its success when the first meeting of the American Academy of Ophthalmology was held there in 1896. Its fraudulent activities sparked a continuing public outcry that contributed to the passage of the Pure Food and Drug Act of 1906. The American Medical Associations Investigative Bureau was a major factor in the firm being put out of business in 1915 by the federal government.

DISCUSSION OF PRESENTATION BY DR BARRETT G. HAIK, ET AL

HEMANGIOMAS have been classified in a variety of ways. The concepts governing taxonomy of hemangiomas are being reevaluated in the light of present thinking about angiogenesis and recent ultrastructural studies of vascular tumors. The classification of hemangiomas of the eyelids that recently has been developed by Ashton, Zimmerman, and co-workers on behalf of the World Health Organization is given in the Table.