Orbital metastasis of invasive lobular carcinoma of the breast.

We herein report a case of orbital metastasis from the breast cancer in a 58-year-old woman presenting with visual disturbance and bilateral periorbital swelling. She had undergone radical mastectomy for right breast cancer 9 years previously and been receiving hormone therapy for bone metastasis of breast cancer for the past 4 years. Computed tomography and magnetic resonance imaging revealed an ill-defined mass in the bilateral orbits, whereas an excisional biopsy confirmed metastasis of invasive lobular carcinoma (ILC) of the breast. The appearance of eye symptoms in patients who have a history of breast cancer, especially ILC should be investigated, with a consideration of orbital metastasis.

A Comparison of the Corrected Intraocular Pressure Obtained by the Corvis ST and Reichert 7CR Tonometers in Glaucoma Patients.

The purpose of the study was to investigate the accuracy of two corrected intraocular pressure (IOP) measurements by Corvis Scheimpflug Technology (CST)-IOPpachy and by corneal-compensated IOP (IOPcc) using the Reichert 7CR (7CR) tonometers. We also investigated the effects of corneal anatomical and structural parameters on the IOP measurements. The participants included 90 primary open-angle glaucoma patients. We assessed the IOP measurements, obtained by the CST, 7CR, and Goldmann applanation tonometer (GAT), using a paired t-test with Bonferroni correction, Bland-Altman plots, and multiple regression analyses. The 7CR-IOPcc gave the highest value (15.5 ± 2.7 mmHg), followed by the 7CR-IOPg (13.7 ± 3.1 mmHg), GAT-IOP (13.6 ± 2.2 mmHg), CST-IOP (10.3 ± 2.6 mmHg), and CST-IOPpachy (9.7 ± 2.5 mmHg). The values of CST-IOPpachy were significantly lower than those obtained by the other IOP measurement methods (all, p < 0.01). The values of 7CR-IOPcc were significantly higher than those obtained by the other IOP measurement methods (all, p < 0.01). Bland-Altman plots showed a mean difference between the GAT-IOP and the other IOP measurements (CST-IOP, CST-IOPpachy, 7CR-IOPg, and 7CR-IOPcc), which were -3.20, -3.82, 0.14, and 2.00 mmHg, respectively. The widths of the 95% limits of agreement between all pairs of IOP measurements were greater than 3 mmHg. With the exception of the 7CR-IOPcc, all of the IOP variations were explained by regression coefficients involving gender, average corneal curvature, and central corneal thickness. The IOP values obtained by the GAT, CST, and 7CR were not interchangeable. Each new IOP measurement device that was corrected for ocular structure had its own limitations.

hCAS/CSE1L regulates RAD51 distribution and focus formation for homologous recombinational repair.

Homologous recombinational repair (HR) is one of the major repair systems for DNA double-strand breaks. RAD51 is a key molecule in HR, and the RAD51 concentration in the cell nucleus increases after DNA damage induction. However, the mechanism that regulates the intracellular distribution of RAD51 is still unclear. Here, we show that hCAS/CSE1L associates with RAD51 in human cells. We found that hCAS/CSE1L negatively regulates the nuclear protein level of RAD51 under normal conditions. hCAS/CSE1L is also required to repress the DNA damage-induced focus formation of RAD51. Moreover, we show that hCAS/CSE1L plays roles in the regulation of the HR activity and in chromosome stability. These findings suggest that hCAS/CSE1L is responsible for controlling the HR activity by directly interacting with RAD51.

Morphological features and important parameters of large optic discs for diagnosing glaucoma.

PURPOSE: To compare the optic disc parameters of glaucomatous eyes to those of non-glaucomatous eyes with large discs. METHODS: We studied 225 consecutive eyes with large optic discs (>2.82 mm2): 91 eyes with glaucoma and 134 eyes without glaucoma. An eye was diagnosed with glaucoma when visual field defects were detected by the Humphrey Field Analyzer. All of the Heidelberg Retina Tomograph II (HRT II) parameters were compared between the non-glaucomatous and glaucomatous eyes. A logistic regression analysis of the HRT II parameters was used to establish a new formula for diagnosing glaucoma, and the sensitivity and specificity of the Moorfields Regression Analysis (MRA) was compared to the findings made by our analyses. RESULTS: The mean disc area was 3.44±0.50 mm2 in the non-glaucomatous group and 3.40±0.52 mm2 in the glaucoma group. The cup area, cup volume, cup-to-disc area ratio, linear cup/disc ratio, mean cup depth, and the maximum cup depth were significantly larger in glaucomatous eyes than in the non-glaucomatous eyes. The rim area, rim volume, cup shape measurement, mean retinal nerve fiber layer (RNFL) thickness, and RFNL cross-sectional area were significantly smaller in glaucomatous eyes than in non-glaucomatous eyes. The cup-to-disc area ratio, the height variation contour (HVC), and the RNFL cross-sectional area were important parameters for diagnosing the early stage glaucoma, and the cup-to-disc area ratio and cup volume were useful for diagnosing advanced stage glaucoma in eyes with a large optic disc. The new formula had higher sensitivity and specificity for diagnosing glaucoma than MRA. CONCLUSIONS: The cup-to-disc area ratio, HVC, RNFL cross-sectional area, and cup volume were important parameters for diagnosing glaucoma in eyes with a large optic disc. The important disc parameters to diagnose glaucoma depend on the stage of glaucoma in patients with large discs.

Clinical manifestations and treatment of retinoblastoma in Kobe children's hospital for 16 years.

PURPOSE: To report the clinical manifestations and therapeutic outcomes of retinoblastoma during 16 years. METHODS: Forty-three eyes of 34 patients with retinoblastoma from 1996 to 2011 were retrospectively examined for eye preservation rates based on the disease stage, and the treatment outcomes between monocular and binocular cases were compared. In addition, the relationship between age at initial examination and disease stage and the difference of age at enucleation with or without preservation therapy were examined. RESULTS: Twenty-five patients had monocular retinoblastoma and 9 patients had binocular retinoblastoma. Three patients had a family history of retinoblastoma. The mean observation period was 106.6 ± 53.0 months. Median age at initial examination was 13.5 months. There was no correlation between age at initial examination and disease stage. Preservation therapy was performed for 24 eyes. Nineteen eyes were enucleated without performing preservation therapy. There was a significant difference in age at enucleation between the preservation therapy group (finally enucleated 13 eyes, median = 30.0 months) and the non-preservation therapy group (19 eyes, median = 13.0 months). Eye preservation rates according to the International Classification of Retinoblastoma (ICRB) were as follows: 100% for group B, 100% for group C, 33% for group D, and 0% for group E. In eyes with ICRB group D, the ratio of induction with preservation therapy was 50% of monocular cases and 75% of binocular cases. CONCLUSIONS: Preservation therapy was able to significantly delay enucleation. Eye preservation therapy was performed for a higher proportion of advanced cases among binocular cases than among monocular cases.

Using the early postoperative intraocular pressure to predict pressure control after a trabeculectomy.

PURPOSE: The goal of this study was to identify the early postoperative intraocular pressure (IOP) that predicts low pressure control after a trabeculectomy with mitomycin C. MATERIALS AND METHODS: This study retrospectively analyzed the medical records of the initial trabeculectomy with mitomycin C in patients with primary open-angle glaucoma. We established 2 target postoperative IOPs, ≤11 and ≤15 mm Hg. The preoperative and early postoperative factors contributing to the success and failure of postoperative IOP control were studied by multiple regression analyses. These factors included the sex and age of patients, record of cataract surgery, number of preoperative medications, preoperative IOP, IOP recorded 2 weeks after surgery, laser suture lysis after surgery, and the presence of a shallow anterior chamber and choroidal detachment during the first month after surgery. The optimal IOP levels 2 weeks after surgery for long-term IOP control were examined using the Kaplan-Meier survival analyses. RESULTS: Sixty-six patients (66 eyes) with open-angle glaucoma participated in the study. The age and IOP 2 weeks after surgery were selected as the confounding factors affecting the probability of successfully satisfying both target IOPs;≤11 and≤15 mmHg postoperatively. An IOP under 8 mm Hg at 2 weeks after surgery was found to be associated with maintaining the postoperative IOP at either ≤11 and ≤15 mm Hg for an extended period. CONCLUSIONS: An IOP of 8 mm Hg was associated with successful outcomes in patients undergoing trabeculectomy. Also, younger age was found to be a risk factor for surgical failure.

Magnetic resonance imaging-determined subretinal fluid volume in an uveitic patient.

PURPOSE: To describe the usefulness of the magnetic resonance imaging-determined subretinal fluid volume to evaluate the therapeutic effect on the retinal detachment caused by uveitis with the clouded media. METHODS: We obtained the images by half-Fourier single-shot rapid acquisition with relaxation enhancement magnetic resonance imaging using a microscopy coil. We measured the area of subretinal fluid on each image and calculated the volume of subretinal fluid by multiplying the total area by the slice thickness. RESULTS: A 56-year-old male who had lost his central visual field developed bullous retinal detachment in both eyes associated with uveitis. We treated him with steroid pulse therapy. We could not accurately evaluate the improvement of retinal detachment by ophthalmoscopy and ultrasonography as a result of the clouded media. We measured the volume of the subretinal fluid using magnetic resonance imagings. The volume of the subretinal fluid was observed to gradually decrease. These methods enable us to obtain clear magnetic resonance images within 2 seconds per slice. The reproducibility of the volumetry obtained by magnetic resonance imaging was excellent. CONCLUSION: The adaptation of half-Fourier single-shot relaxation enhancement imaging performed with a surface coil makes it possible to evaluate the volumetry of a targeted space while also being useful for evaluating the effect of the treatment.

Association of viral isolates from stool samples with intussusception in children.

BACKGROUND: Intussusception is the most common cause of intestinal obstruction in young children. The pathogenesis of intussusception is still not well understood. In this study the pathogens from stool specimens were investigated in children with intussusception. METHODS: Patients diagnosed with primary idiopathic intussusception were enrolled. Pathogenic bacteria and viruses were detected in the stool samples by routine culture, cell culture, polymerase chain reaction, reverse transcriptase-polymerase chain reaction, enzyme immunoassay, and electron microscopy examinations. RESULTS: A total of 71 samples were analyzed during the 2-year study period. The patients ranged in age from 4 to 47 months. Viruses were detected in 56 of the 71 stool samples (78.9%). Adenovirus was found in 19 of 35 cases aged <2 years, whereas it was found in 17 of 21 cases aged ≥2 years. The majority of adenovirus isolates were non-enteric organisms generally associated with respiratory tract symptoms. CONCLUSIONS: These results suggest a casual association of viral infections in children with intussusception. Adenovirus infection, especially with the primary non-enteric types, is a significant risk factor for developing intussusception in children, particularly those aged over 2 years.