RESUMEN
PURPOSE: To describe the rapid time course of visual and electroretinographic recovery from vitamin A deficiency in a patient with a history of multiple resected abdominal tumors, including ileal carcinoid and pancreatic adenocarcinoma. METHODS: A 61-year-old white man with a history of resected malignant ileal carcinoid and Stage III pancreatic adenocarcinoma referred with complaints of 6 weeks of difficulty with night vision. RESULTS: Initial testing showed significantly reduced scotopic rod responses in both eyes and decreased vitamin A levels and a normal cancer-associated retinopathy laboratory panel. He had complete recovery of both his symptoms and full-field electroretinography within 5 days of starting intramuscular vitamin A. CONCLUSION: Vitamin A deficiency-related retinopathy after abdominal surgery may be an underreported complication. This case provides a unique clinical perspective in our patient with a history of ileal carcinoid and Stage III pancreatic adenocarcinoma and confirms that rapid symptomatic and electroretinographic recovery is possible with appropriate treatment.
Asunto(s)
Adenocarcinoma/complicaciones , Tumor Carcinoide/complicaciones , Neoplasias del Íleon/complicaciones , Ceguera Nocturna/etiología , Neoplasias Pancreáticas/complicaciones , Síndromes Paraneoplásicos Oculares/tratamiento farmacológico , Deficiencia de Vitamina A/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Vitamina A/uso terapéutico , Vitaminas/uso terapéuticoRESUMEN
Federal initiatives since 1996 have intensified the efforts of states to achieve adoption for children in foster care. For many waiting children, the path to adoption is long. The authors offer an economic analysis of adoption from foster care, with an emphasis on the reasons why achieving the goal of adoption for all waiting children may be so difficult. The authors then estimate the determinants of adoptions from foster care across the states using data for fiscal years 1996 and 1997. Adoption assistance subsidy rates stand out as the most important determinant of adoptions from foster care, followed by use of alternatives (e.g., intercountry adoption). Adoptive matching on the basis of race does not appear to prevent adoptions from foster care in the aggregate, leaving flaws in the matching process, such as a lack of information and difficulty using the Interstate Compact on the Placement of Children (ICPC), as a primary reason why children wait.
