Intravitreal ranibizumab for choroidal neovascularization secondary to pathologic myopia: 12-month results.

AIMS: To determine the efficacy and safety of intravitreal ranibizumab in the treatment of choroidal neovascularization (CNV) secondary to pathologic myopia (PM). METHODS: Prospective, consecutive, non-randomized, interventional case series of 23 eyes of 23 patients with CNV secondary to PM treated with intravitreal ranibizumab as needed, after the first injection (PRN: Pro Re Nata). Patients were followed-up monthly with best-corrected visual acuity (BCVA), biomicroscopy, fluorescein angiography, and optical coherence tomography. RESULTS: There were 23 eyes of 23 patients, and the mean age was 51.08 (SD=17.40) years. One patient was lost during the follow-up. At the 12-month follow-up, the mean VA improved by 9.53 letters (P<0.05). In all, 69% of patients increased at least one line, and 34.7% increased three or more lines. There were no cases of moderate vision loss (>3 lines) or severe vision loss (>6 lines). Favourable outcomes were obtained in all subgroups. Patients received an average of 1.52 injections. No serious ocular complications were noted. CONCLUSIONS: The 12-month results of this consecutive series of 23 patients suggests that a small number of injections of intravitreal ranibizumab may be safe and effective for both preventing and restoring visual loss in patients with CNV secondary to PM. Further studies to evaluate the safety and efficacy are justified.

[Hematuria during pregnancy caused by bladder tumour. Report of 2 cases]. / Hematuria durante la gestación debida a tumor vesical. Presentación de 2 casos.

Tumours of the urinary bladder are rare in pregnancy. We report two such cases presenting with gross hematuria, but one of them was initially mistaken as vaginal bleeding. Patients age was 41 and 27 years old, at 26 and 18 weeks of gestation respectively. Diagnoses were made with cystoscopy and sonography. Tocolytics agents were employed. Both of the tumours were managed succesfully by transurethral electroresection. Raquianesthesia was employed in both. There were no adverse effects on the pregnacies. Transurethral resection is a safe procedure during pregnancy. The pathology diagnoses were inverted papilloma in the first case and papillary urothelial neoplasm of low malignant potential in the other one. The literature is reviewed.

Digital indocyanine-green angiography in chorioretinal disorders.

The authors performed digital indocyanine-green angiography in 37 patients with chorioretinal disorders. Eighteen patients had choroidal neovascularization, 7 patients had atrophic age-related maculopathy, and 12 patients had uncommon choroidal and retinal disorders. A Topcon indocyanine-green camera was integrated with a digital (1024-line resolution) angiography system. Compared with conventional video or photographic indocyanine-green angiography, this technique offers enhanced image resolution, the possibility of direct qualitative comparison with fluorescein angiography, image archiving, hard-copy generation, and tracing capabilities to plan laser treatment strategies and monitor the adequacy of laser therapy after surgery.

Cavitation and other atypical manifestations of Pneumocystis carinii pneumonia.

In the 1980s, under the impact of the acquired immune deficiency syndrome, Pneumocystis carinii Pneumonia (PCP) has become the prime infectious manifestation of this condition. In addition to the well-recognized "classic" features of this disease, several unusual manifestations are being recognized with increasing frequency. We presently review and illustrate the following "atypical" manifestations of PCP: (1) interstitial lung responses that include diffuse alveolar damage, bronchiolitis obliterans, interstitial fibrosis, and lymphoplasmacytic infiltrates; (2) striking localized processes frequently exhibiting granulomatous features; (3) extensive necrosis and cavitation; and (4) extrapulmonary dissemination of the disease. Close clinico-pathologic correlation and attention to roentgenographic detail are invaluable aids in arriving at the correct diagnosis.

The pathology of treated Pneumocystis carinii pneumonia.

Post-mortem examinations were conducted in 28 patients with the acquired immune deficiency syndrome (AIDS) and biopsy-proven Pneumocystis carinii pneumonia (PCP) who had been treated with trimethoprim-sulfamethoxazole (Bactrim, intravenous infusion [Roche]) and/or pentamidine isethionate. According to the evolution of the pulmonary process, the cases were classified into three groups. Group I ("fulminant" PCP) was composed of eight patients who died during the first week of the disease. Although treatment had eradicated most of the organisms, one third of the alveolar space volume, on the average, was filled by foamy exudates characteristic of PCP. This accounted for the respiratory insufficiency and death of these patients. Group II ("nonresolving" PCP) was comprised of nine patients who died within eight days and 2 months of diagnosis. PCP was less severe than in group I, but fatal respiratory insufficiency was the result of fibroblastic organization of the intraalveolar exudates (fibrosing alveolitis). In seven of the nine patients (78%), the latter resulted from oxygen toxicity; in the remaining two patients (22%) PCP, per se, was the original stimulus for the fibrosis. Patients in group II also had a high incidence of thromboembolic pulmonary lesions. Group III ("cured" PCP) was composed of 11 patients who responded dramatically well to therapy but died months or years later of other manifestations of AIDS. In group III patients, the roentgenographic picture at diagnosis was consistently less severe than in groups I and II.

HIV-associated lymphocytic interstitial pneumonia: radiologic manifestations and pathologic correlation.

The authors reviewed chest radiographs of 16 patients with biopsy-proved lymphocytic interstitial pneumonia (LIP) who also had acquired immunodeficiency syndrome (AIDS) or AIDS-related complex (ARC). Radiographs revealed fine reticular or reticulonodular infiltrates in the pulmonary interstitium in five patients, coarse reticulonodular infiltrates in two, and reticular or reticulonodular opacities with superimposed patchy alveolar infiltrates in nine. Pathologic examination of biopsy specimens revealed lymphocytes, plasma cells, and reticulum cells aggregated about the small arteries and compressing the distal airways. Throughout the course of AIDS or ARC, the radiographic findings of LIP remained stable in 12 of 16 patients. AIDS/ARC-related LIP appears to be a benign reaction of bronchial-associated lymphatic tissue to the human immunodeficiency virus (HIV). However, this indolent process cannot be correctly diagnosed based on radiographic findings alone; the use of lung biopsy is required to differentiate LIP from other infections. The authors suggest that patients with these radiographic findings, HIV seropositivity, but no other signs of opportunistic infection or neoplasia should be classified as having AIDS.

Intestinal metaplasia of the gallbladder: a morphologic and immunocytochemical study.

The morphologic spectrum of intestinal metaplasia was studied in 49 gallbladders that had been excised because of cholelithiasis. Based on the absence or presence of endocrine cells, the cases of intestinal metaplasia were arbitrarily divided into two groups. The gallbladders from the first group (26 cases) contained isolated or small clusters of mature goblet cells, while those from the second group (23 cases), in addition to the goblet cells, contained argyrophil and argentaffin cells and, less frequently, Paneth cells and gland-like structures similar to colonic crypts. Pseudopyloric glands and superficial gastric-type epithelium were present in both groups. Argyrophil cells outnumbered argentaffin cells by a ratio of 4 to 1. By immunocytochemical methods serotonin-containing cells were found to be the most common endocrine cells. Other endocrine cells showed immunoreactivity for somatostatin, cholecystokinin, gastrin, and pancreatic polypeptide. The presence of gut endocrine cells and Paneth cells in the pseudopyloric glands suggests that these glands are also an integral component of intestinal metaplasia of the gallbladder. The findings support the hypothesis that cholelithiasis induces the appearance of a stem endodermal cell that, in turn, may differentiate into cells with mature intestinal or gastric phenotypes.

Diagnosis of Pneumocystis carinii pneumonia. Roentgenographic-pathologic correlates based on fiberoptic bronchoscopy specimens from patients with the acquired immunodeficiency syndrome.

We analyzed the diagnosis of Pneumocystis carinii pneumonia by fiberoptic bronchoscopy in a large series of patients with the acquired immunodeficiency syndrome (AIDS). Transbronchial biopsy fragments, as opposed to endobronchial specimens, were found to have high diagnostic value. Their optimal number for diagnosis was determined by a simple statistical principle. It varied from a minimum of two in cases of severe pneumonia to a maximum of four when roentgenographic manifestations were altogether absent. The diagnostic yield of the transbronchial biopsy alone was 97 percent and that of "touch" preparations of the biopsies 88 percent; when both techniques were combined, the accuracy rose to 98 percent. By comparison, bronchial "washings" and "brushings" had a much lower yield, 59 percent and 57 percent, respectively. Because their diagnostic contribution was negligible, we conclude that the latter two procedures represent an unnecessary expense and waste of technical and professional effort.

Bilateral and synchronous squamous cell carcinoma of the cervix in a patient with uterus didelphys.

Reported herein is the case of a 30-year-old white woman who had a congenitally double uterus with two cervixes (uterus didelphys). Each cervix was diffusely involved by squamous cell carcinoma in situ that had progressed to a microinvasive stage of the same depth (0.8 mm) on each side. This coincidence was the more remarkable because it had taken place synchronously. A transmissible coital factor of a viral nature, ie, human papillomavirus infection, was suggested by the presence of koilocytotic atypia in both uterine cervixes.