Fascin over expression is associated with dysplastic changes in sinonasal inverted papillomas: a study of 47 cases.

Sinonasal inverted papilloma (IP) is a primary benign lesion with a tendency for local recurrence. Malignant transformation may develop in up to 15% of cases. Fascin (Fascin 1) is an actin cross-link binding protein required for the formation of actin-based cell-surface protrusions and cell motility. Fascin up-regulation in lung, gastric, breast and hepatobiliary carcinomas correlates with aggressiveness and decreased survival. Here we evaluate immunohistochemical expression of fascin in 47 sinonasal IPs from 34 patients. Fascin over-expression is significantly more common in sinonasal IP with high-grade dysplasia than in those with no dysplastic or low-grade dysplastic epithelium (P = 0.0001). No significant change in fascin expression is seen with recurrence. Over expression of fascin in high-grade dysplastic epithelium in IP may be associated with tumor progression and malignant transformation.

Cytology of metastatic appendiceal goblet cell carcinoid in pleural effusion fluid: a case report.

Goblet cell appendiceal carcinoid (GCAC) is a rare neoplasm. We described the case of a 72-year-old man who presented with symptoms related to ascites. A computed tomography (CT) scan showed a mass involving the base of the appendix, ascites and concomitant pleural effusion. Thoracentesis of the pleural fluid showed metastatic GCAC. The appendiceal mass was biopsied and diagnosed as a GCAC. We describe the cytologic features of the metastatic GCAC to pleural fluid. To our knowledge this is the first such described case.

Imaging of the optic disc and retinal nerve fiber layer in acute optic neuritis.

PURPOSE: To demonstrate whether optical coherence tomography (OCT-3) and scanning laser ophthalmoscopy (HRT-2) can be used to measure changes of the optic disc and peripapillary retinal nerve fiber layer (RNFL) in eyes with acute retrobulbar optic neuritis that have no clinically apparent optic disc swelling. To correlate these findings with presentation magnetic resonance imaging (MRI) of the affected optic nerve. METHODS: Eight consecutive patients with acute retrobulbar optic neuritis, who had no prior optic neuritis in either eye, were prospectively investigated at presentation and at between 1 and 3 months with clinical examination, OCT-3, HRT-2. At presentation, MRI of the optic nerves were performed in 7/8 patients. RESULTS: Compared to unaffected eyes, affected eyes without clinically seen optic disc swelling at baseline, there was a non-significant trend to increased thickness in the total RNFL, superior and nasal measurements. Baseline HRT in affected eyes showed smaller mean cup to disc ratio (p=0.003) and a smaller cup area (p=0.002) compared with the unaffected eye. The MRI-demonstrated optic nerve lesion did not correlate with OCT RNFL thickening or HRT decrease of the physiological cup. Follow-up imaging of the affected eyes showed normalization of HRT cup size parameters and OCT RNFL thickness (p<0.04). At follow-up, the temporal RNFL had thinning in 7/8 affected eyes (46.8 mum, p=0.021) compared with fellow unaffected eyes (57.8 mum), which did not change. CONCLUSION: OCT-3 and HRT demonstrate mild RNFL thickening or optic disc swelling in acute optic neuritis, even when swelling is not seen clinically. OCT-3 appears to reveal measurable RNFL thinning in the temporal quadrant after retrobulbar optic neuritis, even though vision improves. RNFL imaging may be useful in future studies of residual injury after optic neuritis.

Does malaria during pregnancy affect the newborn?

OBJECTIVE: To investigate the effect of malarial infection during pregnancy on the newborn. METHODS: A retrospective cohort study was conducted at The Aga Khan University Hospital (AKUH), Karachi, using in-patient hospital records over an 11-year period from 1988 to 1999. The incidence of preterm delivery, low birth weight (LBW) and intrauterine growth retardation (IUGR) in 29 pregnant women with malaria, was compared with that in 66 selected pregnant women without malaria, who delivered at the AKUH during the same time period. RESULTS: Pregnant women with malaria had a 3.1 times greater risk of preterm labor (p=0.14). They were more likely to be anaemic compared to women without malaria (RR=2.9, 95% CI=1.6-5.4) and had a significantly lower mean haemoglobin level (p=0.0001). Maternal malaria was significantly associated with LBW babies (p=0.001). The mean birth weight of infants born to pregnant women with malaria was 461 g less (p=0.0005). No significant association was, however, found between malarial infection during pregnancy and IUGR (p=0.33). CONCLUSION: Malarial infection during pregnancy is associated with poor maternal and fetal outcome. It is significantly associated with maternal anaemia and LBW infants. Appropriate measures must, therefore, be taken to prevent malaria during pregnancy, especially in endemic areas.

Macular and retinal nerve fiber layer thickness measurement reproducibility using optical coherence tomography (OCT-3).

PURPOSE: To assess the reproducibility of retinal nerve fiber layer thickness and macular thickness measurements using OCT-3. METHODS: Randomly chosen eyes of healthy individuals were scanned following pupillary dilation by two trained operators (RGO, RV) using OCT-3 (software version A1.1, Carl Zeiss Meditec, Inc., Dublin, CA), three times on separate days within a one-month period. Fast and regular macula (128 A-scans), and fast and regular RNFL (256 A-scans) scanning protocols were performed. Intra- and interoperator measurement reproducibility was evaluated. RESULTS: Ten eyes of 10 subjects (6 females, 4 males) were enrolled. Mean age was 32 +/- 11.2 years (range, 21 to 52 years). Intraoperator reproducibility was high for both macular and RNFL thickness measurements. Mean coefficients of variation (CV) for mean total RNFL thickness measurements ranged from 6.9 +/- 6.4% to 8.0 +/- 3.5% for operators 1 and 2 in fast and regular RNFL protocols. Mean CV for mean macular thickness measurements ranged from 4.7 +/- 2.6% to 6.4 +/- 5.5% for operator 1 and 2 in fast and regular macula protocols. There was no difference in mean total RNFL and mean foveal thickness measurements performed on different days (P > 0.05 for all measurements in all protocols, for operators 1 and 2, ANOVA). Interoperator reproducibility was high for both macular and RNFL thickness measurements (P > 0.05 for all measurements in all protocols, paired t test). CONCLUSION: OCT-3 RNFL and macular thickness measurements are reproducible in normal eyes. These results should be validated in ocular hypertensive and glaucomatous eyes.

Scanning protocol choice affects optical coherence tomography (OCT-3) measurements.

PURPOSE: To determine the optimal OCT-3 scanning protocol. METHODS: Normal subjects, ocular hypertensive, and open-angle glaucoma patients were enrolled. The "fast" RNFL scan protocol consists of 3 consecutive circular scans, each containing 256 A-scans obtained in a single 1.92 second session. The "regular" RNFL scan protocol contains 3 separate circular scans, each of which consists of 512 A-scans and is obtained in 1.28 seconds (total 3.84 seconds). A customized 256-point scan was created from the 512-point "regular" RNFL scan by extracting the RNFL measurements from every second point. Mean RNFL thickness measurements and mean coefficients of variation (CV) were calculated for each of the scan types. RESULTS: Thirty-one eyes with visual field defects (31 glaucoma eyes) and 30 eyes with normal fields (10 normal and 20 ocular hypertensive eyes) were enrolled. There was no difference in RNFL thickness or CV between fast, regular, or customized RNFL scans in the eyes with VF defects (P > 0.05 for all comparisons). Although eyes with normal fields showed no difference in CV between fast, regular, and customized RNFL scans (P > 0.05 for all comparisons), there was a thicker RNFL measurement using the fast RNFL scan (P = 0.01). CONCLUSIONS: Optimal sampling density for OCT-3 assessment of parapapillary RNFL thickness is not more than 256 axial determinations. Although both scanning protocols have good reproducibility, the scanning protocol should remain constant during serial OCT-3 evaluation.

Effect of pupillary dilation on retinal nerve fiber layer thickness measurements using optical coherence tomography.

PURPOSE: To evaluate the effect of pupillary dilation on retinal nerve fiber layer thickness (RNFL) measurements using optical coherence tomography (OCT-3). METHODS: Randomly chosen eyes of healthy individuals were scanned before and after pupillary dilation by two trained operators (R.G.O., R.V.) using OCT-3 (Carl Zeiss Meditec, Inc., Dublin, CA). Fast and regular RNFL (256 A-scans) OCT-3 protocols (software version A1.1) were used in each scanning session. RNFL thickness measurements before and after dilation were compared. RESULTS: Ten eyes of 10 subjects (6 females, 4 males) were enrolled. Mean age was 32.0 +/- 11.2 years (range, 21 to 52 years). Mean pupillary diameter before and after dilation was 2.9 +/- 0.6 mm and 7.6 +/- 0.8 mm, respectively (P < 0.0001, paired t-test). There was no significant difference in RNFL thickness measurements before and after dilation using both fast and regular RNFL protocols (P > or = 0.05 for all comparisons, paired t-test). Mean coefficients of variation for mean RNFL thickness measurements were 15.3% before and 13.7% after dilation for operator 1; and 10.8% before and 12.7% after dilation for operator 2 for the fast RNFL protocol and 11.3% versus 10.4% and 12.9 versus 11.1%, respectively, for the regular RNFL protocol. CONCLUSION: Pupillary dilation is not necessary in all subjects to obtain reproducible RNFL thickness measurements using OCT-3.