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Show LlTEl~ATLI/\E ABSTRACTS 15-yl'<1r time period at Wilmer Ophthalmologic Institutt' were reviewed. Deletion of patients whose biopsies were simply J"l'viewed ,1Ild clinical history unavailable leit 250 biopsil's from 237 patienls which wert' sludil'd in det'lil. Each biopsy was reviewed by four p,llhologic "obsl'rvl'rs." Consensus diagnoses were active arteritis in 32 biopsies, healed arteritis in 10, arteriosclewsis in 185, normal in 16, and "other" in seven. Inll'robserVt'r variation (i.e., the number of times any observer disagreed with the majority opinion) was greatest in the "healed arteritis" category. Intraobserver variation (i.e., the number of times one observer reviewed a previously studied slide and had a different opinion) was between 4.4'lr and 25.6(1r, (!). Of the 237 patients biopsied, 46 were felt to have temporal arteritis "by the clinician(s) based on clinical presentation, biopsy results, and post-biopsy course." Only 31 patients had a biopsy positive for temporal arteritis; thus, 15 patients were treated presumably on clinical grounds only. Correlation between specific symptoms, like jaw claudication, and the positivity of biopsy is presented in a number of tables. As one expects, the more symptoms and signs of temporal arteritis present, the more likely the biopsy would be positive. The authors conclude that "active arteritis" is easier to diagnose than "healed arteritis" and advocate biopsy within several weeks of the onset of steroid therapy. Moreover, they conclude that "the clinical diagnosis of temporal arteritis can be based on the clinical signs and symptoms and responses to therapeutic trials of steroids," and imply that temporal artery biopsy may not be necessary. This conclusion may seem warranted to some, but does not seem to be a logical extrapolation from the study performed. This presentation addresses some fundamental issues in the diagnosis and treatment of temporal arteritis and would have benefited from invited critical discussion, as is given to many of Oplit/mllllOlogy's more controversial or thoughtful articles. LYII A. Sedwick. M.D. Progressive Visual Loss With Normal Examination. A Conundrum. Slamovits TL, Burde RM. Comments by NR Miller, JW Gittinger Jr, and JL Keltner. SIIYV OphthalmoI1986;30:251-7 (Jan-Feb). [Reprints are not available.) A 68-year-old lady had complete visual loss in both eyes over 7 weeks. She was seen by an oph- 10111 N'·'ITlH'phthalmt>/. V"I. b. Nt>. .3. 1986 thalmologist and neurologist 2-3 weeks into her difficulty; computerized tomography and visualevoked responses were reported as normal. Elevated sedimentation rate (57) led to temporal artery biopsy (negative) and steroid therapy (no help). The correct diagnosis was reached only after evaluation at 7 weeks, which found no light perception in both eyes, with pupils unreactive to light but reactive to convergence. Computerized tomography was repeated and showed a biopsyproven anaplastic astrocytoma involving anterior visual pathways bilaterally. As usual, the discussion by Drs. Miller, Gittinger, and Keltner is excellent and centers on (a) the lack of visual field testing, (b) the lack of pupil testing by the first two physicians caring for the patient, and (c) the "red herring" of the normal visual-evoked response. LVII A. Sedwick, M.D. Central Trochlear Palsy. Mansour AM, Reinecke RD. Sun' Ophthalmol 1986;30:279-97 (Mar-Apr). [Reprint requests to Robert D. Reinecke, M.D., Wills Eye Hospital, Ninth and Walnut Sts., Philadelphia, PA 19107.) This review would more accurateh' be titled "Isolated Trochlear Nerve Palsv" as th~se authors present their own 82 patients \~'ith this problem as well as review 893 cases from the literature. Their own series has an unusuall~' high percentage (52(7() of congenital trochlear pals~', which they acknowledge is secondary to a large number of children in the series. Trauma heads the list of causes in almost all other series. There are several helpful examination techniques discussed but few surprises in this review article. LYII A. Sedwick, M.D. Seeing But Not Recognizing. Trobe JR, Bauer RM. Sun' OpilthtlIl1/lll 1986;30:328-36 (Mar-Apr). [Repnnt requests to Jonathan D. Trobe, M.D., W. K. Kellogg Eye Center, 100 Wall St., Ann Arbor, MI 48105.) Three patients who can see but not use their vision effectively are presented in this interesting paper. Specific entities discussed are alexia without agraphia, prosopagnosia, and simultanagnosia. Given the rarity of these disorders, |