Human Dirofilaria repens infection in Serbia.

Human infection by Dirofilaria repens in Serbia has been increasing steadily. The first case was reported in 1971, presented in the form of a single subcutaneous nodule on the back of a young boy. As established by a literature search, eight additional cases were reported until mid-2001. The most frequent site of infection was subcutaneous tissue, with the exception of two cases, in which parasites were found in subconjunctiva and epididymis. Our study, conducted from 2001 to 2008, encompasses 19 new cases. Most of them (63.1%) presented as ocular or periocular infections, in which the parasite was typically found under the conjunctiva. In other cases a parasitic nodule was localized in the temporal region of the head, epididymis, testicle, abdomen, breast or arm. The diagnosis was made by morphological and histological analysis of the extracted intact worms and parasite sections from the tissue. Morphology of the filarial worms was well preserved in more than half of the cases (12/19) and there was never more than one parasite found inside the lesions. Adult worms and immature nematodes were observed in nine and seven cases, respectively. Furthermore, in two cases microfilariae were discovered inside the pseudocoelom, sections of the female reproductive tubes filled with clearly visible larval stages. Dirofilaria repens infection was diagnosed by its morphological features (17/19) or by performing polymerase chain reactions (PCR) using paraffin-embedded tissues (2/19) in the cases where the morphology was insufficient for identification and the parasites had been determined initially as Dirofilaria spp. The amplified 246 bp PCR product showed that the worms were D. repens.

[Amputation of the lower eyelid in the therapy of eyelid tumors].

In carefully selected cases of tumors of the lower eyelid (tumors which destroy more than 40% of the eyelid margin and are not higher then 3 mm, in old patients in bad general condition and in the cases of multiple microrecurrences of a tumor) authors suggest simple excision of a tumor without reconstruction of a eyelid. It is an effective method of treatment of the tumor with good functional effects and acceptable cosmetic results.

Diagnosis and follow up of primary ocular melanoma by radioimmunoscintigraphy.

PURPOSE: To determine the usefulness of immunoscintigraphy with Tc-99m labeled anti-melanoma antibodies in the diagnosis of primary ocular melanoma. Furthermore, to try to determine whether the treatment of ocular melanoma by contact radiotherapy had an influence on the immunoscintigraphic disease detection. PATIENTS AND METHODS: Immunoscintigraphy was performed on 17 patients: 9 patients with newly diagnosed choroidal melanoma (group A), 6 patients with choroidal melanoma treated by ruthenium contact radiotherapy (group B) and 2 patients with melanoma conjunctivae (group C). F(ab')2 fragments of 225.28S monoclonal antibody directed against a high molecular weight melanoma- associated antigen (HMW-MAA) were used. Planar scintigtaphy was done 4 hours after intravenous (i.v.) injection of 300-445 MBq of labeled antibodies, in anterior Waters projection, with 95 degrees of cranial tilt of the gamma-camera head. 500,000 counts static images were acquired in 256x256 resolution matrix. RESULTS: All group A patients showed positive immunoscintigraphy. The maximum diameter of these tumors, measured by ultrasound, was between 9 and 18 mm, with maximal prominence between 5 and 10.5 mm. Both patients of group C showed negative immunoscintigraphy, due to the small dimensions of the tumors (less than 2.7 mm). In all 6 patients of group B immunoscintigraphy was negative although the dimensions of the tumors were sufficient enough to be visualized by immunoscintigraphy (diameter between 8.3 and 17 mm and prominence between 5 and 10.3 mm). CONCLUSION: According to our preliminary results, we concluded that immunoscintigraphy was useful diagnostic modality in the detection of small intraocular tumors. The negative immunoscintigraphy in patients with tumors treated by contact radiotherapy could be explained by the biological regression of the tumor that precedes regression of its volume. This finding indicates that immunoscintigraphy could be useful in the follow-up of conservatively or surgically treated patients with choroidal melanoma.

Isolated choroidal metastasis from primary adenocarcinoma of the distal esophagus: a case report.

We present a case of a 41-year-old male patient who, 1 year after transhiatal esophagectomy and transmediastinal gastroplasty for an adenocarcinoma of the distal esophagus, presented with an isolated metastasis in the choroids of the left eye. Because of pains caused by secondary glaucoma, enucleation of the left eyeball had to be performed as the treatment of choice. At 1 year after surgery of the eye, the secondaries in both adrenal glands were revealed. Despite the applied chemotherapy, the patient died with signs of generalized disease 3 years after the initial surgery.

[Should keratoacanthoma be treated surgically?]. / Treba li keratoakantom leciti hirurski?

Keratoacanthoma is a rapidly growing cutaneous neoplasia of adult persons that may regress spontaneously. It is believed to arise from the hair follicles. It is sometimes difficult to distinguish keratoacantoma from squamous cell carcinoma either clinically or histologically. During ten years period (1992-2001) we were treating 18 patients with keratoacanthoma of the skin. We discuss here our experience with this tumor, and we conclude that early, complete excision is the treatment of choice for it.

[Pilomatrixoma as a problem in ophthalmic surgery]. / Pilomatrikom kao oftalmohirurski problem.

Pilomatricoma, relatively rare benign tumour of the hair matrix cells, is usually misdiagnosed preoperatively. This result in unnecessary extensive surgery. In order to improve diagnosis and treatment of pilomatricoma, authors discuss their ten years experience (28 cases) with this tumour.

[Surgical treatment of lesions of the lacrimal caruncle]. / Hirursko lecenje lezija karunkule lakrimalis.

Each lesion which produces a prolong change of the volume of the caruncle necessitates surgical treatment, removal of the caruncle. Caruncular lesions are uncommon. During 15 years on the Institute for eye diseases in Belgrade authors have treated 121 caruncular lesions. Here they present their way of surgical treatment of the caruncle and point out some problems connect with this procedure.

[Semi-exenteration of the orbit in therapy of malignant conjunctival tumors]. / Semiegzenteracija orbite u terapiji malignih tumora konjunktive.

Authors present their experience in treatment of the conjunctival maliganncies by semiexenteration of the orbit. They discuss the advantages and the disadvantages of this procedure. They suggest the use of semiexenteration in stead of exenteration whenever it is possible.

Predictors of survival in malignant melanoma of the conjunctiva: a clinico-pathological and follow-up study.

The study comprised 61 patients with histologically diagnosed malignant melanoma of the conjunctiva (MMC) who were treated and followed up in the Department of Ophthalmology, Clinical Center of Serbia, Belgrade, over a period of 24 years (1970-1993). Data on 15 clinical and 10 histopathological characteristics of MMC were related to the outcome of the disease. Tumour thickness on the histological section was the most important single predictor of survival in MMC. Other predictors of survival in MMC were the number of mitoses, the histologically assessed degree of tumour pigmentation and the intensity of inflammation at the tumour site. The variables entered into the model comprised as much as 85.3% of all predictors of survival in MMC.

An epidemiological investigation of the first outbreak of rhinosporidiosis in Europe.

Until January 1992 rhinosporidiosis was unknown in the Balkans. The outbreak which took place at that time in northern Serbia (Yugoslavia) affected 17 people over a period of less than two years. The number of patients in this epidemic exceeded the total number of autochthonous cases of rhinosporidiosis ever recorded in Europe. The male-to-female ratio was 10:7 and, except for a middle-aged man, all patients were in the age range 6-16 years. Preponderance of ocular (12) over nasal (5) localization of the disease in this epidemic indicates that the real number of cases may be much higher. The only experience all patients had in common was that they spent their holiday preceding the onset of symptoms bathing in the same accumulation of stagnant water (the Silver Lake). A case-control study showed that the odds of being exposed to that particular environment by chance were extremely remote.

Surgical treatment of large corneal dermoid.

Corneal and limbal dermoids are uncommon choristomatous corneal tumors. They clinically present as round or oval, whitish or yellowish cones protruding on the anterior surface of the eyeball. They are composed of ectodermal (keratinized epithelium, hairs, sebaceous and sudoriferous glands, nerves, smooth muscles and, less frequently, teeth) and mesodermal elements (fibrous tissue, fat, blood vessels and cartilage) combined in different proportion. If fat dominates in histology of the tumor, it is called a lipodermoid. A case of a two-year old boy with a large corneal dermoid on the right eye is presented. Dermoid covered almost the whole cornea and was associated with adherence of the atrophic iris to the posterior corneal surface and partial congenital cataract. Surgical therapy included excision of dermoid together with the superficial lamellae of the corneal stroma and penetrating keratoplasty. Satisfactory tectonic and esthetic outcome was achieved and has been maintained for four postoperative years now.

[Orbital lymphomas]. / Limfomi orbite.

Lymphomas are relatively rare in the orbit: only about 8-11% of all orbital tumours. The most common histological type is diffuse well-differentiated lymphocytic lymphoma (DWDLL--Rappaport's classification)--70%. Orbital lesions are always curable by radiotherapy, but in some 40% of these patients local recurrence or dissemination occur. The authors present two patients with diffuse well-differentiated lymphocytic lymphoma, and one patient with FCC lymphoma of centrocytic type (Kiel classification) localized in the orbit. Two of them were irradiated after an unsuccessful treatment by chemotherapy. In the third patient local radiotherapy is still in the course.

Marfan syndrome with aortic dissection and triple-barrel aorta.

A case of Marfan syndrome with spontaneously and subsequently developed dissections of the aorta, one in the form of triple-barrel aorta, three times corrected by grafts is described. The autopsy revealed "healed" and acute dissections in almost the entire aorta outside the grafts. "Healed" thoracoabdominal dissection had true lumen (with entry and re-entry intimal tears), and old false lumen and in addition in its distal portion of a triple-barrel aorta was formed (dissection of healed aortic dissection). Lethal adventitial rupture occurred in the portion with an old false lumen. Dissection of the left subclavian artery, the right common carotid artery, resulting in saccular aneurysm, and avulsion of the right renal artery were also found.

[Tumours as cause of eyeball loss in adults]. / Tumori ocne jabucice kod odraslih kao uzrok za njen gubutak.

Causes of eyeball loss in patients over 15 years of age are analyzed, over the period from the beginning of 1966 to the end of 1987. Data from the files of the Ophtalmopathologic Laboratory, Department of Eye Diseases, UCC, Belgrade, were used. In the period of 22 years 2067 eyeballs were enucleated, the procedure being necessitated by tumurs, injuries and other disease in 834, 722 and 511 cases, respectively. The analysis focuses on tumours as the cause of eyeball enucleation. Malignant melanoma of the choroid was noted in 700 cases, skin or conjunctival carcinoma in 117 cases, metastatic tumours of the choroid in 9 cases, and other types of tumours in the remaining 8 cases. At the beginning of the period (1966-1987) tumours were the third most common cause of enucleation, just after diseases and injuries. However, in the last ten years there is a continuous increase in the number of enucleations performed for ocular tumours. Thus tumours have become the most common cause of enucleation. The results show that the number of enucleations is related to the age of the patients. Male to female ratio was uniform in all age groups.

Malignant teratoid medulloepithelioma in an adult.

A 50-year-old man presented with a reddish, well-vascularized mass in the region of a nasal iridodialysis of his left eye, pushing the whole iris in this sector forwards; the mass had a pinkish, partly cystic appearance in the pupil. The tumour was transparent on diaphanoscopy. A-scan sonography revealed a solid tumour of the ciliary body with partial retinal detachment suggesting a malignant melanoma. Fluorescein biomicroscopy did not confirm this suspicion. The enucleated eye demonstrated a malignant teratoid medulloepithelioma of the whole nasal and lower ciliary body, infiltrating the deep iris stroma, the anterior choroid, the neighbouring vitreous body and spreading along the inner retinal surface back to the equator of the eye. The occurrence of medulloepithelioma in adult and senior persons is rather exceptional and this is the reason for this publication.