- Email: [email protected]
Mikulicz Disease Treated by X-Ray
MIKULICZ DISEASE T R E A T E D BY X-RAY. MAJOR R . E . W R I G H T , L M . S .
MADRAS, INDIA. This is the report of a case, with mention of another, in which exposure to X-ray was followed by recovery. The cornea ulcerated from exposure making necessary removal of tissue and tarsorrhaphy. The untreated salivary glands remained enlarged. Reported from the Government Ophthalmic Hospital, Madras.
C , Hindu, male, aged 60, came to hospital on 16-5-1924 complaining of swelling of the lids. He stated that the condition started 9 months before in the right eye. subsequently the left
illary glands were the only other glands enlarged. The blood picture showed no evidence of white cell dis turbance. There was no evidence of syphilis.
Fig. 1.—Right lid inverted showing enlarged lacrimal gland. Left lid swollen but less so. For stereoscopic effect see directions for plate 9.
became swollen. On examination the right eye was markedly proptosed and the cornea ulcerated from exposure. The globe was pushed forwards and inwards by a mass which occupied the superior, outer and inferior aspects of the orbit. The bulging was most prominent under the upper lid in the superior temporal region. Edematous folds of conjunctiva presented in the palpebral aperture (see stereoscopic photograph). The condition was ob viously due to a solid enlargement of the lacrimal gland. On the left side there was a similar condition very much less extensive. The submax903
A similar case in the previous year had greatly improved subsequent to X-ray treatment. But it could hardly be regarded as uncomplicated, inas much as the patient had syphilis and was treated for that disease at the same time as the X-ray exposures were given. Syphilis was excluded in the present case, and it was determined to try the effect of X-rays alone. The cornea was carefully attended to and exposures were started on 23-5-1924. Details are given below. At first the corneal ulcer improved, but after a time it extended, and it was considered advisable to close the lids
904
R. Β. W R I G H T
by a partial tarsorrhaphy; the opera tion was performed on 7-6-1924. T o ensure union of the lid margins it was necessary first to do an external canthotomy and remove a portion of the enlarged gland, sufficient to allow the lids to come together without tension. A piece was shelled out about the size of a filbert, the lids stitched together in their outer two-thirds and the can-
other specimen of the growth which was fixed and hardened (specimen B ) . A median tarsorrhaphy was now per formed, as it was considered safer foi the patient to have the cornea pro tected for a time. On 14-7-1924 the patient was discharged; the cornea by this time had healed and the swelling of the lacrimal glands practically gone (see photograph). The submaxillary
Fig. 2.—Appearance after two months x-ray treatment of both eyes and removal of tissue from upper Ud of right.
thotomy wound closed. The tissue re moved was fixed and hardened (speci men A ) . Exposures were then con tinued and apparently with good eflfect. Even if diminution of the growth on the right was masked by the partial removal, the enlargement on the left side steadily diminished. The cornea too was healing rapidly. A s there was much redundant tissue in the upper lid it was decided to re move a wedge of the thickened con junctiva. On 28-6-1924 the lids were , separated and a wedge of tissue re moved from the deep surface where the conjunctiva was very massive and folded transversely'on itself. The op portunity was taken of obtaining an-
glands had not altered since his admis sion. W h e n specimen " A " was examined it showed a lymphoblastomatous type of growth. There was no apparent arrangement of the round cells which were of a lymphoid type and the stroma was very scanty. Blood ves sels were capillary in type. There was delicate capsule of connective tis sue, no evidence of lacrimal gland structure and no amyloid change. Specimen "B" was very similar ex cept that the capsule was thicker and fibrous trabeculae with larger vessels had made their appearance. Homo geneous degeneration had appeared in the deeper layers of the capsule, along
MIKULICZ D I S E A S E T R E A T E D B Y X - R A Y
the trabeculae and around the vessels, which in the latter situation gave char acteristic amyloid staining. DETAILS OF X-RAY TREATMENT.
23-5-1924. Right eye B. dose 1 mm. filter at normal distance. 23-5-1924. Left eye Yi B. dose 1 mm. filter at normal distance. 30-5-1924. Right eye 1 B. dose 2 mm. filter at normal distance. 30-5-1924. Left eye J4 B. dose 2 mm. filter at normal distance.
thru thru thru thru
906
28-6-1924. Right eye 1 B. dose thru 2 mm. filter at normal distance. · 1-7-1924. Right eye 1 B. dose thru 2 mm. filter at normal distance. 5-7-1924. Right eye V/^ B. dose thru 1 mm. filter at normal distance. 12-7-1924. Right eye ^ B. dose thru 1 mm. filter at normal distance. For this statement of treatment I am indebted to Capt. T . W . Barnard, radiologist, Government X-ray Insti tute, Madras, where the exposures were given.
MADRAS, INDIA. This is the report of a case, with mention of another, in which exposure to X-ray was followed by recovery. The cornea ulcerated from exposure making necessary removal of tissue and tarsorrhaphy. The untreated salivary glands remained enlarged. Reported from the Government Ophthalmic Hospital, Madras.
C , Hindu, male, aged 60, came to hospital on 16-5-1924 complaining of swelling of the lids. He stated that the condition started 9 months before in the right eye. subsequently the left
illary glands were the only other glands enlarged. The blood picture showed no evidence of white cell dis turbance. There was no evidence of syphilis.
Fig. 1.—Right lid inverted showing enlarged lacrimal gland. Left lid swollen but less so. For stereoscopic effect see directions for plate 9.
became swollen. On examination the right eye was markedly proptosed and the cornea ulcerated from exposure. The globe was pushed forwards and inwards by a mass which occupied the superior, outer and inferior aspects of the orbit. The bulging was most prominent under the upper lid in the superior temporal region. Edematous folds of conjunctiva presented in the palpebral aperture (see stereoscopic photograph). The condition was ob viously due to a solid enlargement of the lacrimal gland. On the left side there was a similar condition very much less extensive. The submax903
A similar case in the previous year had greatly improved subsequent to X-ray treatment. But it could hardly be regarded as uncomplicated, inas much as the patient had syphilis and was treated for that disease at the same time as the X-ray exposures were given. Syphilis was excluded in the present case, and it was determined to try the effect of X-rays alone. The cornea was carefully attended to and exposures were started on 23-5-1924. Details are given below. At first the corneal ulcer improved, but after a time it extended, and it was considered advisable to close the lids
904
R. Β. W R I G H T
by a partial tarsorrhaphy; the opera tion was performed on 7-6-1924. T o ensure union of the lid margins it was necessary first to do an external canthotomy and remove a portion of the enlarged gland, sufficient to allow the lids to come together without tension. A piece was shelled out about the size of a filbert, the lids stitched together in their outer two-thirds and the can-
other specimen of the growth which was fixed and hardened (specimen B ) . A median tarsorrhaphy was now per formed, as it was considered safer foi the patient to have the cornea pro tected for a time. On 14-7-1924 the patient was discharged; the cornea by this time had healed and the swelling of the lacrimal glands practically gone (see photograph). The submaxillary
Fig. 2.—Appearance after two months x-ray treatment of both eyes and removal of tissue from upper Ud of right.
thotomy wound closed. The tissue re moved was fixed and hardened (speci men A ) . Exposures were then con tinued and apparently with good eflfect. Even if diminution of the growth on the right was masked by the partial removal, the enlargement on the left side steadily diminished. The cornea too was healing rapidly. A s there was much redundant tissue in the upper lid it was decided to re move a wedge of the thickened con junctiva. On 28-6-1924 the lids were , separated and a wedge of tissue re moved from the deep surface where the conjunctiva was very massive and folded transversely'on itself. The op portunity was taken of obtaining an-
glands had not altered since his admis sion. W h e n specimen " A " was examined it showed a lymphoblastomatous type of growth. There was no apparent arrangement of the round cells which were of a lymphoid type and the stroma was very scanty. Blood ves sels were capillary in type. There was delicate capsule of connective tis sue, no evidence of lacrimal gland structure and no amyloid change. Specimen "B" was very similar ex cept that the capsule was thicker and fibrous trabeculae with larger vessels had made their appearance. Homo geneous degeneration had appeared in the deeper layers of the capsule, along
MIKULICZ D I S E A S E T R E A T E D B Y X - R A Y
the trabeculae and around the vessels, which in the latter situation gave char acteristic amyloid staining. DETAILS OF X-RAY TREATMENT.
23-5-1924. Right eye B. dose 1 mm. filter at normal distance. 23-5-1924. Left eye Yi B. dose 1 mm. filter at normal distance. 30-5-1924. Right eye 1 B. dose 2 mm. filter at normal distance. 30-5-1924. Left eye J4 B. dose 2 mm. filter at normal distance.
thru thru thru thru
906
28-6-1924. Right eye 1 B. dose thru 2 mm. filter at normal distance. · 1-7-1924. Right eye 1 B. dose thru 2 mm. filter at normal distance. 5-7-1924. Right eye V/^ B. dose thru 1 mm. filter at normal distance. 12-7-1924. Right eye ^ B. dose thru 1 mm. filter at normal distance. For this statement of treatment I am indebted to Capt. T . W . Barnard, radiologist, Government X-ray Insti tute, Madras, where the exposures were given.