Intra-arterial chemotherapy as a treatment for intraocular retinoblastoma: alternatives to direct ophthalmic artery catheterization.

BACKGROUND AND PURPOSE: Intra-arterial chemotherapy is a very effective treatment option for intraocular retinoblastoma. However, direct catheterization of the OA is not always possible. The purpose of this work was to report our initial results with intra-arterial chemotherapy for intraocular retinoblastoma when delivery of the drug was not via direct catheterization of the OA. MATERIALS AND METHODS: Retrospective review of 110 eyes (89 patients) undergoing a total of 351 intra-arterial treatments at our institution between 2006 and 2010 identified 18 eyes (14 patients) that received at least 1 infusion via a vascular route other than direct OA catheterization. Alternatives included catheterization of the orbital branch of the MMA and temporary balloon occlusion of the ICA. RESULTS: Tumor control was observed in 17 of 18 eyes at a mean follow-up of 18.9 months (median, 17.5 months; range, 8-36 months). The mean number of intra-arterial infusions was 3.7 per eye (median, 3; range, 2-9). Treatment routes included the following: MMA only, 3 eyes; MMA + OA, 4 eyes; MMA + balloon, 2 eyes; balloon only, 1 eye; balloon + OA, 7 eyes; balloon + OA + MMA, 1 eye. Intra-arterial chemotherapies included melphalan, topotecan, and carboplatin. Complications were all transient. ERG readings were the following: stable, 10 eyes; improved, 3 eyes; reduced, 5 eyes. One patient died from a second malignancy (pinealoblastoma). CONCLUSIONS: This initial experience shows that when direct OA catheterization is not possible, using alternative routes of intra-arterial chemotherapy saves eyes and preserves vision with acceptable side effects.

Subconjunctival versus peribulbar anesthesia in trabeculectomy: a prospective, randomized study.

BACKGROUND AND OBJECTIVE: To compare the use of subconjunctival and peribulbar anesthesia for trabeculectomy. PATIENTS AND METHODS: Sixty patients undergoing trabeculectomy were prospectively randomized to receive either peribulbar or subconjunctival anesthesia. Peribulbar anesthesia consisted of a 3-ml inferior and a 1-ml superior injection of a 1:1 mixture of 2% mepivacaine, 0.75% bupivacaine, and hyaluronidase. Subconjunctival anesthesia consisted of a 1- to 2-ml injection of the same mixture without hyaluronidase in the superotemporal quadrant. Intraoperative pain, presence of eye movements, and complications during surgery were evaluated. RESULTS: The frequency and intensity of pain was statistically similar between the two groups. All episodes of pain (20% in the subconjunctival group and 6.6% in the peribulbar group) were rated as mild. Eye movement was more common in the subconjunctival group than in the peribulbar group, but it was controlled by verbal command and did not interfere with the procedure. No clinically significant complications occurred during surgery. CONCLUSION: Subconjunctival anesthesia is an effective alternative to peribulbar anesthesia for trabeculectomy.

Experimental evaluation of a new device for percutaneous transrenal ureteral occlusion.

PURPOSE: To develop a device for percutaneous transrenal ureteral occlusion. MATERIALS AND METHODS: The device was a double-body Gianturco-Rösch biliary stent constrained at the junction of the two stents to create an hourglass shape. One stent was coated with silicone. One device was percutaneously placed in each of nine pigs through a 9-F Teflon sheath. Urographic and hematologic follow-up was performed for up to 12 weeks. RESULTS: Seven pigs showed immediate, complete ureteral occlusion, and two pigs exhibited persistent incomplete high-grade obstruction. All animals exhibited varying degrees of hydronephrosis and hydroureter. No device migration was noted. Minor complications were encountered during device placement in three pigs. Mucosal folds and villus-like projections that arose from the lamina propria protruded into the lumen of the ureter at the cranial end of the covered stent and around the wire of the caudal stent. Varying degrees of mural inflammation and edema were noted. CONCLUSION: Transrenal ureteral occlusion with the described device appears to be a viable method for treating urinary fistulas.

Leuprolide acetate elevates prolactin during ovarian stimulation with gonadotropins.

OBJECTIVE: The purpose of this study was to determine whether gonadotropin-releasing hormone agonist further increases the prolactin rise accompanying ovarian stimulation. DESIGN: Serum prolactin concentrations were compared between cycles with and cycles without the use of leuprolide acetate (LA) matched for estradiol levels. Relationships of prolactin levels to cycle outcomes were examined. SETTING: The study took place at a private fertility center. PATIENTS: Patients were women receiving stimulation for oocyte retrieval using human menopausal gonadotropins. INTERVENTIONS: No interventions were used. MAIN OUTCOME MEASURES: Serum prolactin level, fertilization rate, embryo quality, and pregnancy were the main outcome measures. RESULTS: Higher serum prolactin was associated with both higher estradiol levels and use of LA but did not have any effects on fertilization rate, embryo quality, or occurrence of pregnancy. CONCLUSION: LA stimulates prolactin release during ovarian stimulation but without apparent consequence.

Coronary risk factors in a rural community which includes aborigines: Inverell Heart Disease Prevention Programme.

A coronary risk factor screening and referral service was established in Inverell, New South Wales, in July 1978. In non-Aboriginal subjects, there was an increasing prevalence of coronary risk factors with age (hyperlipidaemia, hypertension and obesity), except for cigarette smoking which showed a reverse trend. Allowing for minor differences in sampling, the average level of plasma cholesterol, blood pressure and cigarette smoking in rural inverell closely resembled that in Sydney. However, Inverell subjects of both sexes were consistently more overweight at all ages. Aboriginal subjects of both sexes showed an increased prevalence of hypertriglyceridaemia and cigarette smoking compared with non-Aboriginal subjects, whilst hypertension and obesity were also more prevalent in the Aboriginal females. High Coronary risk Inverell subjects sustained significant improvements in serum cholesterol, cigarette smoking and body weight levels over one year of follow-up. Community-wide control of hypertension was initially unsatisfactory and this remained so.