RESUMO
INTRODUCTION: Fertility preservation is essential before cancer treatment. When ejaculated sperm preservation is not possible, testicular tissue can be surgically collected by Onco-TESE technic (Oncological Testicular Sperm Extraction) to isolate sperm. We report on our experience with Onco-TESE in testicular cancer patients at the Rouen University Hospital. MATERIAL AND METHOD: Retrospective study including all pubescent men, treated for testicular cancer, uni- or bilateral, before any carcinological therapy, who have undergone Onco-TESE at the Rouen University Hospital. Fragment weight, detection of sperm or its precursors were analysed. A histological interpretation of the testicular tumor was carried out. For each positive sample, straws were kept at the French Sperm Bank. RESULTS: Twenty-four patients had an Onco-TESE: 58.34% severe sperm alteration (SSA) and 41.36% sperm collection failure (SCF), between 1996 and 2019. The mean age was 26.6 (±5.29) years. The mean procedure and length of stay were 71minutes (±30.7) and 3.75 days (±2.83), respectively. The rate of positive testicular biopsies (TB) was 58.33% overall and 66,67% in the case of TB on tumour testis. One patient had a Clavian-Dindo III complication. The mean number of straws preserved per patient was 14.28 (±15.34) for 7.14% use. CONCLUSION: Our results seem to confirm that Onco-TESE is an effective solution for preserving fertility in men with testicular cancer in cases of SSA or SCF. LEVEL OF EVIDENCE: III.
Assuntos
Preservação da Fertilidade/métodos , Neoplasias Testiculares/cirurgia , Testículo/cirurgia , Coleta de Tecidos e Órgãos , Adulto , Humanos , Masculino , Estudos Retrospectivos , Adulto JovemRESUMO
INTRODUCTION: Childhood ocular trauma is a preventable cause of visual impairment and blindness worldwide. The purpose of our study was to determine demographic, etiologic, and clinical characteristics, visual outcome, and factors affecting visual prognosis in children with open globe injuries (OGI) and to analyze the predictive value of ocular trauma scoring systems for OGI in children. METHODS: We conducted a retrospective study enrolling 120 pediatric patients hospitalized for OGI from January 2010 to March 2017. Age, gender, date of trauma, time between trauma and presentation, place and circumstances of injury, etiology, visual acuity (VA), wound location and type of injury based on the Birmingham Eye Trauma Terminology, and the clinical signs were recorded. We recorded the number of surgical procedures performed, complications and visual outcomes. RESULTS: The mean age was 7.38 years. In all, 62.5% of the patients were male, and 37.5% were female. The gender ratio was observed to decrease with increasing age. The mean time interval between injury and consultation was 22.80±42.68hours. Injuries usually occurred at home (80%) followed by playgrounds and sports venues (8.3%), the street (6.7%) and school (5%). All of the OGI's were accidental, and the main context was play (70%). The most common traumas were penetrating injury (60.8%) and metal (30%) objects. Penetrating trauma accounted for 68.3% of cases, followed by rupture (27.5%) and intraocular foreign body (IOFB) (7.5%). Initial VA was<1/10 in 59.2% of cases, and the point of entry was the cornea in 65.8% of cases. Final VA was<1/10 in 39.69% of all cases. FVA was significantly correlated with BCVA prior to the surgery, mechanism of the trauma, wound location and size, and other associated lesions. The Ocular Trauma Score (OTS) and the Pediatric Ocular Trauma Score (POTS) were significantly correlated with final VA. CONCLUSION: OGI's in children occurs most frequently in school-age boys. Prognosis is determined by presenting visual acuity, trauma score, and wound severity and location.
Assuntos
Ferimentos Oculares Penetrantes/diagnóstico , Ferimentos Oculares Penetrantes/epidemiologia , Adolescente , Cegueira/diagnóstico , Cegueira/epidemiologia , Cegueira/etiologia , Criança , Pré-Escolar , Corpos Estranhos no Olho/diagnóstico , Corpos Estranhos no Olho/epidemiologia , Corpos Estranhos no Olho/etiologia , Ferimentos Oculares Penetrantes/patologia , Feminino , Humanos , Lactente , Masculino , Prognóstico , Estudos Retrospectivos , Ruptura/diagnóstico , Ruptura/epidemiologia , Ruptura/etiologia , Índices de Gravidade do Trauma , Tunísia/epidemiologia , Baixa Visão/diagnóstico , Baixa Visão/epidemiologia , Baixa Visão/etiologia , Acuidade VisualRESUMO
INTRODUCTION: Renal traumas are common, observed in 10% of patients with abdominal trauma. Most renal traumas are blunt, resulting from a direct hit or from an abrupt deceleration. MATERIAL AND METHODS: We realized a synthesis of renal trauma management for nurses. RESULTS: Clinical presentation often encompasses gross hematuria and lumbar pain. The best diagnostic tool is computed tomography (CT) urogram. Based on CT urogram images, renal traumas are classified according to the American Association for the Surgery of Trauma (AAST) classification in five grades of increasing severity. The management is conservative in the vast majority of cases and has been largely simplified over the past few years, being now mostly based on observation. Radiological interventional and endoscopic procedures are used only in very selected cases and surgical exploration has become extremely rare. CONCLUSION: The prognosis has also considerably improved and renal trauma rarely result in death or loss of the kidney nowadays.
Assuntos
Rim/lesões , Traumatismos Abdominais/diagnóstico , Traumatismos Abdominais/terapia , HumanosAssuntos
Câmara Anterior/patologia , Bevacizumab/administração & dosagem , Oftalmopatias/tratamento farmacológico , Xantogranuloma Juvenil/tratamento farmacológico , Inibidores da Angiogênese/administração & dosagem , Movimento Celular , Túnica Conjuntiva , Oftalmopatias/patologia , Feminino , Humanos , Lactente , Injeções Intraoculares , Xantogranuloma Juvenil/patologiaAssuntos
Doenças da Íris/diagnóstico por imagem , Xantogranuloma Juvenil/diagnóstico por imagem , Corticosteroides/uso terapêutico , Idade de Início , Anti-Inflamatórios/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Diagnóstico Diferencial , Feminino , Angiofluoresceinografia , Humanos , Hifema/etiologia , Doenças da Íris/complicações , Doenças da Íris/tratamento farmacológico , Doenças da Íris/patologia , Neoplasias da Íris/diagnóstico , Imageamento por Ressonância Magnética , Microscopia Acústica , Hipertensão Ocular/tratamento farmacológico , Hipertensão Ocular/etiologia , Xantogranuloma Juvenil/complicações , Xantogranuloma Juvenil/tratamento farmacológico , Xantogranuloma Juvenil/patologia , Adulto JovemRESUMO
PURPOSE: To describe the ocular findings and management of Hymenoptera insect stings. METHODS: We treated and followed 8 patients with ocular Hymenoptera stings. All patients were admitted through emergencies and hospitalized at the Hedi Rays eye institute in Tunis. RESULTS: The site of the sting was the cornea in 5 cases, limbus in one case, conjunctiva in one case and upper lid in the last case. Retained stingers were objectified in 4 cases. Immediate surgical extraction carried out in all cases. We also followed one case of post-sting Adie's syndrome and one case of retrobulbar optic neuritis. The sting was conjunctival in one case and palpebral in the other case. Corticosteroids were ineffective in these two cases. CONCLUSION: Ocular Hymenoptera stings are rare environmental accidents. They may cause various severe ocular complications. Early management, adapted to the clinical manifestations, is the key to a good outcome.
Assuntos
Ferimentos Oculares Penetrantes/etiologia , Ferimentos Oculares Penetrantes/terapia , Himenópteros , Mordeduras e Picadas de Insetos/complicações , Mordeduras e Picadas de Insetos/terapia , Corticosteroides/administração & dosagem , Adulto , Animais , Ciclosporina/administração & dosagem , Ferimentos Oculares Penetrantes/patologia , Feminino , Humanos , Mordeduras e Picadas de Insetos/patologia , Masculino , Soluções Oftálmicas , Estudos Retrospectivos , TunísiaRESUMO
INTRODUCTION: Diabetic papillopathy is a rare ocular complication of diabetes. Its pathophysiology is not well known. It is a unilateral or bilateral optic disc edema with variable degrees of visual loss. OBSERVATION: A 66-year-old woman, with a twelve years old type 2 diabetes mellitus, suddenly presented a unilateral decreased vision. Her ocular examination was normal eight months earlier. Ocular examination, radiological investigations and laboratory analysis were conclusive of diabetic papillopathy. Medical history revealed a recent rapid improvement of blood glucose control after intensification of insulin therapy. A visual acuity improvement with spontaneous regression of papillary edema was observed. CONCLUSION: There is a risk of diabetic papillopathy associated with the rapid control of blood glucose levels after intensification of insulin therapy, even in diabetic patients without known retinopathy.
Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Retinopatia Diabética/induzido quimicamente , Insulina/efeitos adversos , Papiledema/induzido quimicamente , Idoso , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/diagnóstico , Retinopatia Diabética/diagnóstico , Relação Dose-Resposta a Droga , Feminino , Angiofluoresceinografia , Humanos , Insulina/administração & dosagem , Papiledema/diagnóstico , Acuidade Visual/efeitos dos fármacosRESUMO
Ligneous conjunctivitis is a rare and poorly understood pathology. Infections and repeated microtraumas are often involved in acute disease flare-ups. This masquerade may lead to misdiagnosis and delayed treatment. We report two cases of ligneous conjunctivitis, describing various presentations of its natural history and focusing on the treatment of this rare disease.
Assuntos
Conjuntivite/diagnóstico , Conjuntivite/etiologia , Conjuntivite/terapia , Plasminogênio/deficiência , Dermatopatias Genéticas/diagnóstico , Dermatopatias Genéticas/etiologia , Dermatopatias Genéticas/terapia , Adulto , Criança , Conjuntivite/patologia , Diagnóstico Diferencial , Erros de Diagnóstico , Feminino , Humanos , Masculino , Dermatopatias Genéticas/patologia , Tempo para o TratamentoAssuntos
Neoplasias da Retina/diagnóstico , Neoplasias da Retina/patologia , Retinoblastoma/diagnóstico , Retinoblastoma/patologia , Adulto , Enucleação Ocular , Angiofluoresceinografia , Fundo de Olho , Humanos , Imageamento por Ressonância Magnética , Masculino , Neoplasias da Retina/terapia , Retinoblastoma/terapiaAssuntos
Capilares/anormalidades , Hemangioma/terapia , Monitorização Fisiológica , Fluxo Sanguíneo Regional/fisiologia , Neoplasias da Retina/terapia , Oclusão da Veia Retiniana , Adolescente , Capilares/patologia , Capilares/fisiopatologia , Fundo de Olho , Hemangioma/complicações , Hemangioma/diagnóstico , Humanos , Masculino , Reperfusão , Neoplasias da Retina/complicações , Neoplasias da Retina/diagnóstico , Oclusão da Veia Retiniana/diagnóstico , Oclusão da Veia Retiniana/etiologia , Oclusão da Veia Retiniana/terapia , Vasos Retinianos/anormalidades , Vasos Retinianos/diagnóstico por imagem , Vasos Retinianos/fisiopatologia , Tomografia de Coerência ÓpticaAssuntos
Carcinoma Mucoepidermoide/diagnóstico , Neoplasias da Túnica Conjuntiva/diagnóstico , Carcinoma Mucoepidermoide/patologia , Carcinoma Mucoepidermoide/cirurgia , Neoplasias da Túnica Conjuntiva/patologia , Neoplasias da Túnica Conjuntiva/cirurgia , Feminino , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-IdadeRESUMO
INTRODUCTION: The usefulness of partial nephrectomy (PN) has been demonstrated for the treatment of renal tumor<7cm and it is now the standard treatment for such lesions. However, few studies are available regarding tumors≥T2. The objective of this study was to assess PN results for the treatment of renal tumors>7cm. MATERIALS AND METHODS: A retrospective two-center study was performed, including 170 patients treated. Thirty-two patients underwent PN and 138 radical nephrectomy (RN) for renal cT2 tumors between 2004 and 2014. The biological and clinical characteristics including perioperative morbidity as well as the survival rate were compared between these 2 groups. RESULTS: The median age was 59.5 years and the median follow-up was 47 months. More cT2b tumors were treated through RN (34.1% vs. 12.5%, P=0.01). The postoperative decrease in creatinine clearance was higher for the RN group (-24.3mL/min vs. -16.8; P=0.04). This difference was no longer significant at last follow-up. Perioperative complications were more frequent in the PN group (50.0% vs. 18.1%; P=0.008), and more severe (Clavien≥3 18.7% vs. 5.1%, P=0.01). No difference was found regarding the overall survival. Surgical margins were more frequent in the PN group (9.1% vs. 0.85%; P=0.01). CONCLUSION: Our results suggested the feasibility of PN for renal tumors>7cm, involving however a higher perioperative complication risk. Cautious patient selection appeared to be required for the indication of PN for large tumors. LEVEL OF EVIDENCE: 4.
Assuntos
Neoplasias Renais/patologia , Neoplasias Renais/cirurgia , Nefrectomia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Carga Tumoral , Adulto JovemRESUMO
PURPOSE: To discuss possible factors that could influence the prognosis of primary malignant conjunctival tumors. PATIENTS AND METHODS: We retrospectively analyzed medical records of 79 patients followed for primary malignant conjunctival tumors between January 1997 and July 2011. RESULTS: The mean age at the time of diagnosis was 61.1 years; male/female ratio was 2.59. The mean tumor size was 13.9 mm. The histological type was invasive squamous cell carcinoma in 43 cases (54.4%), epithelial dysplasia in 11 cases (13.9%), carcinoma in situ in 7 cases, conjunctival malignant melanoma in 5 cases, conjunctival lymphoma in 4 cases and other rare tumors in 9 cases. We performed an excisional biopsy with a safety margin in 89.8% of cases, associated with cryotherapy in 46.6% of cases. Enucleation was performed in two cases and orbital exenteration in 5 cases. We noted tumor recurrence in 33.3% of patients after an average period of 9.5 months. Radiation therapy was indicated in 44 cases (55.7%). The mean follow-up of our patients was 42 months. Tumor recurrences were statistically associated with a history of xeroderma pigmentosum (P=0.012), a diagnostic delay more than 11 months (P=0.001), caruncular location (P=0.004), tumor size greater than 10mm (P=0.044), scleral extension (P=0.011), initial treatment limited to excisional biopsy (P=0.033) and histopathologic involvement of the margin of the tumor resection (P=0.008). CONCLUSION: A better understanding of the prognostic factors of primary malignant conjunctival tumors is essential for management and may improve the prognosis of these tumors.
Assuntos
Neoplasias da Túnica Conjuntiva/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Carcinoma in Situ/diagnóstico , Carcinoma in Situ/patologia , Carcinoma in Situ/terapia , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/terapia , Terapia Combinada , Túnica Conjuntiva/patologia , Neoplasias da Túnica Conjuntiva/terapia , Feminino , Humanos , Linfoma/diagnóstico , Linfoma/patologia , Linfoma/terapia , Masculino , Melanoma/diagnóstico , Melanoma/patologia , Melanoma/terapia , Pessoa de Meia-Idade , Invasividade Neoplásica/patologia , Lesões Pré-Cancerosas/diagnóstico , Lesões Pré-Cancerosas/patologia , Lesões Pré-Cancerosas/terapia , Estudos Retrospectivos , Adulto JovemRESUMO
INTRODUCTION: Despite surgical reattachment of retinal layers, postoperative functional outcomes after rhegmatogenous retinal detachment (RRD) may be limited. This can be explained by microstructural changes in the macula inherent to the pathology itself as well as the surgery. PURPOSE: To evaluate the various changes in the macula by OCT pre- and postoperatively, and correlate them with functional and clinical outcomes in patients with RRD. To establish pre- and postoperative prognostic factors. METHODS: This was a prospective study of 50 eyes of 50 patients operated for RDD. Each patient underwent a complete clinical examination and macular OCT using the Heidelberg Spectralis; preoperatively and then successively at 7 days, 1 month, 3 months and 6 months after RRD surgery. RESULTS: Preoperative tomographic results revealed an average height of submacular fluid of 742 ± 345 µm. Ninety-six percent of patients exhibited thickening of photoreceptor outer segments (PROS), 62% an outer layer undulation, 60% cystic cavities in the outer and/or inner nuclear layers (ONL, INL), 36% disruptions of the external limiting membrane (ELM) and 64% disruption of the IS/OS junction. Postoperatively, 24% of patients had persistent submacular fluid. The average thickness of the central fovea, the ONL, the IS/OS junction and the PROS were 172 ± 51.3 µm, 88.4 ± 30.9 µm, 11.36 ± 5.4 µm and 19.54 ± 13.1 µm respectively. Postoperative disruptions of the ELM, the IS/OS junction and Verhoeff's membrane (VM) were present in 24%, 60% and 82% of patients respectively. The preoperative tomographic risk factors for poor visual outcome were: submacular fluid height > 800 µm (P<0.001), disruptions of the MLE and/or IS/OS junction (P<0.001), as well as cystic cavities in the ENL and/or INL (P=0.002). Postoperative risk factors were: thinning of the fovea (≤ 250 µm), central fovea (≤ 160 µm), ONL (≤ 90 µm), IS/OS junction (≤ 10 µm) and PROS (≤ 18 µm) layers (P<0.001), as well as a discontinuous or absent appearance of the ELM (P<0.001), IS/OS junction (P<0.001) and VM (P=0.006). CONCLUSION: Spectral domain OCT allows detection of specific microscopic, quasi-histologic macular changes in rhegmatogenous retinal detachment. These anomalies could be predictive of final postoperative visual outcome.
Assuntos
Macula Lutea , Complicações Pós-Operatórias/diagnóstico , Descolamento Retiniano/diagnóstico , Descolamento Retiniano/cirurgia , Doenças Retinianas/diagnóstico , Tomografia de Coerência Óptica/métodos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Seguimentos , Fóvea Central/patologia , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Fatores de Risco , Estatística como Assunto , Transtornos da Visão/diagnóstico , Transtornos da Visão/etiologia , Adulto JovemRESUMO
PURPOSE: To report the relative frequency of presenting signs in Tunisian children with retinoblastoma and to evaluate their prognostic impact. METHODS: A retrospective study was undertaken of 200 patients with retinoblastoma examined and treated between January 1993 and June 2009. RESULTS: There were 123 boys and 77 girls. For all cases, mean age at diagnosis was 29.8 months (range, 1 month to 9 years). There were 138 (69%) unilateral cases and 62 (31%) bilateral cases. Nineteen children (9.5%) had a family history of retinoblastoma. The most common signs were leukocoria (80%) and strabismus (28%) followed by proptosis. Orbital inflammation, hyphemia and phthisis are rare presenting findings in retinoblastoma. In our series, 26 children (13%) presented with extraocular retinoblastoma. Leukocoria and proptosis are significantly associated with a worse prognosis. CONCLUSION: The ability to recognize the presenting signs and symptoms of retinoblastoma can lead to earlier diagnosis and better prognosis.
Assuntos
Neoplasias da Retina/diagnóstico , Neoplasias da Retina/mortalidade , Retinoblastoma/diagnóstico , Retinoblastoma/mortalidade , Criança , Pré-Escolar , Diagnóstico Tardio , Exoftalmia/etiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Prognóstico , Distúrbios Pupilares/etiologia , Neoplasias da Retina/genética , Neoplasias da Retina/terapia , Retinoblastoma/genética , Retinoblastoma/terapia , Estudos Retrospectivos , Estrabismo/etiologiaRESUMO
PURPOSE: The purpose of our study is to evaluate the long-term anatomical and functional results of conjunctival-limbal autograft (AGCL) compared to simple excision with intraoperative mitomycin C. PATIENTS AND METHODS: We conducted a prospective comparative study of 60 eyes of 60 patients presenting with primary pterygium. These patients were divided into two groups, matched according to the age and the stage of the pterygium. Thirty eyes of 30 patients were treated with conjunctival limbal autograft (AGCL group), and 30 eyes of the other 30 patients were treated with simple excision with intraoperative mitomycin C (MMC group). Minimum follow-up was 24 months. RESULTS: The mean age of our patients was 50.6 and 51.3 years in the AGCL and MMC groups, respectively. A male predominance with male to female ratio of 1.5 was noted in both groups. We found more pterygium recurrences in the MMC group. Indeed, seven patients (23.3%) in the MMC group experienced a recurrence. In comparison, we found only a single recurrence (3.33%) in the AGCL group with a statistically significant difference (P=0.026). With regard to postoperative complications, we noted three inflammatory granulomas in the AGCL group (10%). In the MMC group, we observed two cases (6.66%) of delayed corneal healing with superficial punctate keratitis and epithelial defect and one case (3.33%) of symblepharon. There was no statistically significant difference in mean visual acuity gain between the two groups (AGCL: 1.76 lines; MMC: 2.82 lines; P=0.133). CONCLUSION: Pterygium surgery by excision with conjunctival limbal autograft is an effective technique offering a low rate of long-term recurrences and few complications.