[Periorbital liposarcoma in pediatric patient: a case report]. / Lipossarcoma periorbital em paciente pediátrico: relato de caso.

The purpose of this study is report a child with periorbital liposarcoma describing the clinical, epidemiological and therapeutic aspects. Six-months-old female baby with increasing tumor in the right fronto-zigomatic region wich was submitted to excision and the patologic and immunohistochemistry analisys observed typical findings of lipoblastoma. After that, there were three tumors relapse with the same diagnosis. One year after the last surgery there was a recurrence of the tumor but at this time the diagnosis was lipossarcoma and the patient was referred for additional treatment wilth radiotherapy and chemotherapy no new injuries so far Due to its rarity, liposarcoma usually does not enter the differencial diagnosis in the patients with orbital masses, however because of its local aggressiveess, it's vital the early identification and treatment to provide better therapeutic results and quality of life.

Lipossarcoma periorbital em paciente pediátrico: relato de caso / Periorbital liposarcoma in pediatric patient: a case report

O objetivo desse estudo é descrever uma criança com lipossarcoma periorbital, caracterizando seus aspectos clínico-epidemiológicos e terapêuticos. Menina de 6 meses de idade com tumoração crescente há dois meses em região fronto-zigomática direita, a qual foi submetida à exérese e cujas análises anatomopatológica (AP) e imuno-histoquímica (IH) observaram achados típicos de lipoblastoma. Após isso, apresentou mais três recidivas tumorais com diagnósticos similares. Um ano depois da última cirurgia, houve nova recorrência, porém, dessa vez, o resultado dos exames análises anatomopatológica e imuno-histoquímica foi de lipossarcoma, sendo, então, encaminhada para complementar o tratamento com radio e quimioterapia, sem novas lesões até o momento. Devido a sua raridade, geralmente o lipossarcoma não entra no diagnóstico diferencial em pacientes com massas orbitais, porém, por ser localmente agressivo, torna-se vital a pronta identificação e tratamento de forma a oferecer melhores resultados terapêuticos e influência sobre a qualidade de vida do paciente.

The purpose of this study is report a child with periorbital liposarcoma describing the clinical, epidemiological and therapeutic aspects. Six-months-old female baby with increasing tumor in the right fronto-zigomatic region wich was submitted to excision and the patologic and immunohistochemistry analisys observed typical findings of lipoblastoma. After that, there were three tumors relapse with the same diagnosis. One year after the last surgery there was a recurrence of the tumor but at this time the diagnosis was lipossarcoma and the patient was referred for additional treatment wilth radiotherapy and chemotherapy no new injuries so far Due to its rarity, liposarcoma usually does not enter the differencial diagnosis in the patients with orbital masses, however because of its local aggressiveess, it's vital the early identification and treatment to provide better therapeutic results and quality of life.

Toxicity of high-dose intravitreal adalimumab (Humira) in the rabbit.

PURPOSE: To evaluate the ocular toxicity of escalating doses of intravitreous adalimumab (Humira®) in the rabbit eye. METHODS: Thirty New Zealand albino rabbits received intravitreous injections of 0.5 mg (6 eyes), 1.0 mg (6 eyes), 2.5 mg (6 eyes), 5 mg (6 eyes), and 10 mg (6 eyes) adalimumab. Slit lamp biomicroscopy and fundoscopy were carried out at baseline, day 7, and day 14 after intravitreous injection, whereas electroretinography (ERG) was carried out at baseline and day 14. Animals were euthanized on day 14, and histopathological examination of the eyes was performed. RESULTS: Slit lamp biomicroscopy and fundoscopy were normal in all eyes receiving doses up to 5 mg. In the 10 mg group, 3 of 6 eyes showed mild anterior chamber inflammatory reaction on day 7. Similarly, scotopic and photopic a- and b-wave ERG amplitudes at baseline and day 14 were similar in all groups up to 5 mg, but there was a significant decrease in the photopic-wave ERG response in the 10 mg group (P=0.046). Finally, histopathology demonstrated no differences among eyes receiving balanced salt solution, 0.5, 1.0, 2.5, 5.0, or 10 mg of adalimumab. CONCLUSIONS: Intravitreous adalimumab exhibited no associated ocular short-term toxicity in rabbit eyes up to the 5 mg dose. In the 10 mg group mild clinical findings and ERG amplitude reduction could reflect early toxicity.

Increased frequency of anti-retina antibodies in asymptomatic patients with chronic t. gondii infection.

PURPOSE: To search for anti-retina antibodies that serve as markers for eye disease in uveitis. MATERIALS AND METHODS: Stored sera from patients with uveitis, ocular toxoplasmosis (n = 30) and non-infectious, immune-mediated uveitis (n = 50) and from asymptomatic individuals who were positive (n = 250) and negative (n = 250) for anti-Toxoplasma antibodies were tested. Serum anti-retina IgG was detected by an optimized ELISA using a solid-phase whole human retina extract, bovine S-antigen or interphotoreceptor retinoid-binding protein. RESULTS: Uveitis patients showed a higher mean reactivity to whole human retina extract, interphotoreceptor retinoid-binding protein and S-antigen in comparison to the asymptomatic population. These findings were independent of the uveitis origin and allowed the determination of the lower anti-retina antibody cut-off for the three antigens. Asymptomatic anti-Toxoplasma serum-positive individuals showed a higher frequency of antihuman whole retina extract antibodies in comparison to asymptomatic anti-Toxoplasma serum-negative patients. The bovine S-antigen and interphotoreceptor retinoid-binding protein ELISAs also showed a higher mean reactivity in the uveitis groups compared to the asymptomatic group, but the observed reactivities were lower and overlapped without discrimination. CONCLUSION: We detected higher levels of anti-retina antibodies in uveitis patients and in a small fraction of asymptomatic patients with chronic toxoplasmosis. The presence of anti-retina antibodies in sera might be a marker of eye disease in asymptomatic patients, especially when whole human retina extract is used in a solid-phase ELISA.

Ten-year follow-up of a case series of primary epithelial neoplasms of the lacrimal gland: clinical features, surgical treatment and histopathological findings.

PURPOSE: To describe and analyze the features of a cases series of patients with primary epithelial neoplasms of the lacrimal gland, its surgical treatment, and histopathological findings. METHODS: Retrospective evaluation of files from patients with primary epithelial neoplasms of the lacrimal gland in the period from 1997 to 2007. All patients with primary epithelial tumors of the lacrimal gland were included in this study. Data on gender, age, clinical features, surgical treatment, histopathological findings and follow-up were collected. The slides with histological sections of the tumors were reviewed by the same pathologist. RESULTS: During the study period, there were 12 patients, 5 (41.7%) with benign tumors, all pleomorphic adenomas (benign mixed tumor) and 7 (58.3%) with malignant neoplasms, thus distributed: four cases of adenoid cystic carcinoma, two of mucoepidermoid carcinoma and one carcinoma expleomorphic adenoma. Globally, patients mean age was 54.1 years-old (ranging from 14 to 70 years-old), with mean age of 52.4 years-old (ranging from 14 to 65 years-old) for benign neoplasms, and 55.3 years-old for malignant neoplasms (ranging from 26 to 70 years-old). Clinical follow-up information, ranging from 2 to 10 years-old, was available for all patients. Three patients developed distant metastasis and died of disease. CONCLUSIONS: The most frequent primary epithelial neoplasms of the lacrimal gland were pleomorphic adenoma and adenoid cystic carcinoma during the study period. Malignant tumors were more frequent than benign tumors. The histopathological diagnosis and the disease initial stage can play a significant role in patient's survival.

Ten-year follow-up of a case series of primary epithelial neoplasms of the lacrimal gland: clinical features, surgical treatment and histopathological findings / Dez anos de acompanhamento de uma série de casos de neoplasias epiteliais primárias da glândula lacrimal: características clínicas, tratamento cirúrgico e achados histopatológicos

PURPOSE: To describe and analyze the features of a cases series of patients with primary epithelial neoplasms of the lacrimal gland, its surgical treatment, and histopathological findings. METHODS: Retrospective evaluation of files from patients with primary epithelial neoplasms of the lacrimal gland in the period from 1997 to 2007. All patients with primary epithelial tumors of the lacrimal gland were included in this study. Data on gender, age, clinical features, surgical treatment, histopathological findings and follow-up were collected. The slides with histological sections of the tumors were reviewed by the same pathologist. RESULTS: During the study period, there were 12 patients, 5 (41.7 percent) with benign tumors, all pleomorphic adenomas (benign mixed tumor) and 7 (58.3 percent) with malignant neoplasms, thus distributed: four cases of adenoid cystic carcinoma, two of mucoepidermoid carcinoma and one carcinoma expleomorphic adenoma. Globally, patients mean age was 54.1 years-old (ranging from 14 to 70 years-old), with mean age of 52.4 years-old (ranging from 14 to 65 years-old) for benign neoplasms, and 55.3years-old for malignant neoplasms (ranging from 26 to 70 years-old). Clinical follow-up information, ranging from 2 to 10 years-old, was available for all patients. Three patients developed distant metastasis and died of disease. CONCLUSIONS: The most frequent primary epithelial neoplasms of the lacrimal gland were pleomorphic adenoma and adenoid cystic carcinoma during the study period. Malignant tumors were more frequent than benign tumors. The histopathological diagnosis and the disease initial stage can play a significant role in patient's survival.

OBJETIVO: Descrever e analisar as características de uma série de casos de portadores de neoplasias epiteliais primárias da glândula lacrimal, o tratamento cirúrgico, assim como os achados histopatológicos. MÉTODOS: Avaliação retrospectiva dos arquivos de pacientes com neoplasias epiteliais primárias da glândula lacrimal, no período de 1997 até 2007. Todos os pacientes com tumores epiteliais primários da glândula lacrimal foram incluídos neste estudo. Foram analisados os dados sobre sexo, idade, características clínicas, tratamento cirúrgico, achados histopatológicos e seguimento dos pacientes. As lâminas com secções histológicas dos tumores foram revisadas pelo mesmo patologista. RESULTADOS: No período do estudo, foram encontrados 12 pacientes, sendo 5 (41,7 por cento) portadores de tumores benignos, todos adenomas pleomórficos (tumor benigno misto), e 7 (58,3 por cento) com neoplasias malignas, assim distribuídos: quatro casos de carcinoma adenóide cístico, dois de carcinoma mucoepidermóide e um de carcinoma ex-adenoma pleomórfico. Analisando-se de modo global, a idade média dos portadores foi de 54,1 anos (variando de 14 a 70 anos); com média de idade de 52,4 anos (variando de 14 a 65 anos) para neoplasias benignas, e 55,3 para neoplasias malignas (variando de 26 a 70 anos). Informações do seguimento, variando de 2 a 10 anos, estavam disponíveis para todos os pacientes. Três pacientes desenvolveram metástases distantes e morreram devido à doença. CONCLUSÕES: A maioria das neoplasias epiteliais primárias da glândula lacrimal foi o adenoma pleomórfico e o carcinoma adenóide cístico no período de estudo. Os tumores malignos foram mais frequentes que os benignos. O diagnóstico histopatológico e o estadiamento inicial da doença podem desempenhar uma papel significante na sobrevida do paciente.

Increased frequency of anti-retina antibodies in asymptomatic patients with chronic t. gondii infection

PURPOSE: To search for anti-retina antibodies that serve as markers for eye disease in uveitis. MATERIALS AND METHODS: Stored sera from patients with uveitis, ocular toxoplasmosis (n = 30) and non-infectious, immune-mediated uveitis (n = 50) and from asymptomatic individuals who were positive (n = 250) and negative (n = 250) for anti-Toxoplasma antibodies were tested. Serum anti-retina IgG was detected by an optimized ELISA using a solid-phase whole human retina extract, bovine S-antigen or interphotoreceptor retinoid-binding protein. RESULTS: Uveitis patients showed a higher mean reactivity to whole human retina extract, interphotoreceptor retinoid-binding protein and S-antigen in comparison to the asymptomatic population. These findings were independent of the uveitis origin and allowed the determination of the lower anti-retina antibody cut-off for the three antigens. Asymptomatic anti-Toxoplasma serum-positive individuals showed a higher frequency of antihuman whole retina extract antibodies in comparison to asymptomatic anti-Toxoplasma serum-negative patients. The bovine S-antigen and interphotoreceptor retinoid-binding protein ELISAs also showed a higher mean reactivity in the uveitis groups compared to the asymptomatic group, but the observed reactivities were lower and overlapped without discrimination. CONCLUSION: We detected higher levels of anti-retina antibodies in uveitis patients and in a small fraction of asymptomatic patients with chronic toxoplasmosis. The presence of anti-retina antibodies in sera might be a marker of eye disease in asymptomatic patients, especially when whole human retina extract is used in a solid-phase ELISA.

[Transscleral infrared laser retinal photocoagulation experimental study under low visibility conditions]. / Estudo experimental da aplicação retiniana do laser infravermelho via transescleral sob condições de baixa visibilidade.

PURPOSE: Retinal photocoagulation under poor visualization condition is often required. Transscleral infrared laser can be used as an alternative to regular transpupillary treatment. Based upon retinographic measurements, we proposed to estimate the reproducibility as well as ocular wall permeability rate for this treatment. Our primary goal was to evaluate whether this technique can deliver adequate photocoagulation at predetermined parameters without direct retinal visualization. METHODS: In New Zealand pigmented rabbits, optimal transscleral infrared diode laser settings were administered to the right eye. With the same parameters, transpupillary photocoagulation was repeated in the left eye. Retinographic and clinical examinations were performed immediately and two months later. RESULTS: Ocular wall permeability rate varied between 58.95 and 63.87%. Average permeability using a power of 300 mW (63.14%) was found to be higher than that encountered before its enhancement up to 500 mW (59.11%), (P<0.05). CONCLUSIONS: Setting parameters showed dose-response effect. No retinal hole or retinal detachment was noticed in any rabbit. Transscleral infrared photocoagulation appeared to be a reproducible and secure method in the experimental model.

Estudo experimental da aplicação retiniana do laser infravermelho via transescleral sob condições de baixa visibilidade / Transscleral infrared laser retinal photocoagulation experimental study under low visibility conditions

OBJETIVOS: Pesquisa experimental, com laser de diodo infravermelho, para estimar a segurança, a reprodutibilidade e a permeabilidade da parede ocular à sua atuação clínica, quando aplicado via transescleral, em condições de baixa visibilidade. MÉTODOS: Submetemos olhos de coelhos pigmentados da raça Nova Zelândia à fotocoagulação retiniana por laser de diodo infravermelho. No olho direito, realizamos fotocoagulação via transescleral sob parâmetros de potência e tempo pré-determinados clinicamente. No olho esquerdo, foram repetidos os mesmos valores da potência e tempo usados no olho direito, desta vez, via transpupilar. Imediatamente e após 2 meses, estudos clínicos baseados na retinografia e histopatológicos foram realizados. RESULTADOS: A permeabilidade da parede ocular, quando da aplicação do laser de diodo infravermelho via transescleral, variou entre 58,95 e 63,87 por cento. A média da permeabilidade da parede ocular a 300 mW (63,14 por cento) mostrou-se significativamente superior àquela da permeabilidade da parede ocular encontrada a 500 mW (59,11 por cento), (P<0,05). CONCLUSÕES: Este estudo sugere a existência da relação dose-resposta em relação aos parâmetros empregados na aplicação do laser de diodo infravermelho via transescleral, com permeabilidade da parede ocular mensurável e reprodutível. Nenhuma rotura, hemorragia ou descolamento da retina ou vítreo foi constatado aos exames subseqüentes às aplicações do laser de diodo infravermelho, o que torna o uso da fotocoagulação via transescleral, no modelo experimental, seguro, mesmo sob condições de baixa visibilidade dos meios.

PURPOSE: Retinal photocoagulation under poor visualization condition is often required. Transscleral infrared laser can be used as an alternative to regular transpupillary treatment. Based upon retinographic measurements, we proposed to estimate the reproducibility as well as ocular wall permeability rate for this treatment. Our primary goal was to evaluate whether this technique can deliver adequate photocoagulation at predetermined parameters without direct retinal visualization. METHODS: In New Zealand pigmented rabbits, optimal transscleral infrared diode laser settings were administered to the right eye. With the same parameters, transpupillary photocoagulation was repeated in the left eye. Retinographic and clinical examinations were performed immediately and two months later. RESULTS: Ocular wall permeability rate varied between 58.95 and 63.87 percent. Average permeability using a power of 300 mW (63.14 percent) was found to be higher than that encountered before its enhancement up to 500 mW (59.11 percent), (P<0.05). CONCLUSIONS: Setting parameters showed dose-response effect. No retinal hole or retinal detachment was noticed in any rabbit. Transscleral infrared photocoagulation appeared to be a reproducible and secure method in the experimental model.

Evidências sorológicas e experimentais da resposta autoimune humoral contra a retina em uveites causada por Toxoplasma gondii / Experimental and serological evidence of humoral autoimmune response against retina in Toxoplasma gondii uveitis

A toxoplasmose ocular é atribuída ao parasita, mas a auto-imunidade pode participar do processo. Soros humanos com IgG positiva para T. gondii mostraram níveis altos de IgG anti-retina para diferentes antígenos, se comparados com soros negativos para T. gondii, uveítes de outras origens também tiveram títulos elevados. Hamsters imunizados e/ou infectados não mostraram estes anticorpos sem mimetismo antigênico. A retinocoroidite por Toxoplasma induz resposta humoral auto-imune contra antígenos da retina, provavelmente piorando o efeito direto do agente. Estes anticorpos podem ser usados como marcadores de doença ocular em pacientes soropositivos para toxoplasmose pela triagem de lesão ocular.

Ocular toxoplasmosis is attributed to the parasite, but autoimmunity could have a role in this process. Human sera, positive of anti-T. gondii IgG, show high levels of anti-retina IgG, measured by several antigens, as compared to T. gondii seronegative samples. Sera from patients with uveitis from other origins also had higher anti-retina abs levels. Challenged and/or immunized hamsters showed low anti-retina abs levels, without antigen mimicry. Toxoplasmic retinochoroiditis presents a humoral anti-retina abs, probably worsening the parasite direct effect. Those antibodies could be used as markers of eye involvement in toxoplasmosis seropositive patients, as a screening for eye examination.