SHORT PAPER - extensive spinal meningioma in a young dog.

The meningioma is one of the most common intradural spinal neoplasms in dogs. Such tumours are usually solitary, well-defined masses that tend to occur in mature and aged dogs. Several variants have been described in the medical and veterinary literature. This paper records a case of a spinal meningioma that extended from the cervical to the lumbosacral spine, with concurrent hydrocephalus, in a 5-month-old male Rhodesian Ridgeback. The tumour appeared to be a meningothelial meningioma with focal mineralization.

Which patients are treated for glaucoma? An observational analysis.

PURPOSE: More than one million patients in the United States are treated for glaucoma, although little is known about the typical clinical characteristics of this group of patients and the type of therapy they receive. This study was conducted to describe the demographic and diagnostic characteristics of patients beginning long-term drug therapy for glaucoma. METHODS: This cross-sectional study included 544 patients beginning topical glaucoma medication regimens who received care at a group model health-maintenance organization (HMO) located in central Massachusetts. The primary medical records of 544 patients beginning topical glaucoma medication between 1987 and 1990 were reviewed to ascertain the presence of three clinical findings: intraocular pressure (IOP) > or = 22 mmHg; optic disc changes including cup-to-disc ratio > or = 0.8, cup-to-disc asymmetry > or = 0.2, or morphologic disc changes consistent with glaucomatous optic neuropathy; and visual field defect consistent with glaucoma. RESULTS: A majority of the 544 patients (86%) were diagnosed as having primary open-angle glaucoma (POAG) by their physicians. Almost half (44.7%) of these patients had only an elevation in IOP without other clinical findings, and 9% met none of the above criteria for glaucoma according to information in the medical record. CONCLUSION: In this setting, most patients who were prescribed drug therapy for POAG were treated for an elevation in IOP alone in the absence of other ophthalmologic characteristics of glaucoma.

Patient noncompliance in the managed care setting. The case of medical therapy for glaucoma.

OBJECTIVES: The authors identify demographic and clinical characteristics associated with noncompliance in patients beginning medical therapy for the treatment of glaucoma in a managed care setting. METHODS: The authors describe a retrospective cohort study in a group-model health maintenance organization in Massachusetts. Patients were members of the health maintenance organization who were newly initiated on topical drug therapy to treat open-angle glaucoma during the period January 1, 1987 through December 31, 1990, who met eligibility requirements, and who had evidence of health services utilization for a 12-month follow-up period. For all study subjects, we determined the number of days without available therapy for glaucoma during the 12-month period. Study subjects who did not fill prescriptions adequate to provide medication to cover at least 80% of days during the study period were considered noncompliant. Logistic regression analysis was used to assess demographic and clinical factors independently associated with noncompliance among patients initiated on medical therapy for the treatment of glaucoma. RESULTS: Of 616 subjects who met inclusion criteria, 152 (24.7%; 95% confidence interval, 21.3%-28.1%) met the study definition for noncompliance. These patients had an average number of days without therapy during the 12-month study period of 103.9 +/- 70.0 days compared with 6.8 +/- 19.5 days for those categorized as compliant. Of a variety of selected demographic and clinical characteristics, having fewer visits with an ophthalmologist during the study period (< 2) was most strongly related to noncompliance (odds ratio 2.99; 95% confidence interval 2.03, 4.40). There were no differences in average intraocular pressure between the compliant and noncompliant groups during the study period. CONCLUSIONS: Noncompliance with prescribed medical therapy for glaucoma was found to be common in a managed care setting characterized by essentially unrestricted access to health care and medications. It remains difficult to identify noncompliant patients based on demographic and clinical characteristics. The use of automated prescription data to identify noncompliant patients is feasible in large managed health care insurance programs where such data are collected routinely for administrative purposes.

Ocular inflammatory pseudotumor associated with propranolol therapy.

A 60-year-old man presented with a unilateral mass involving the iris and ciliary body associated with iridocyclitis, which was refractive to both topical and systemic corticosteroid therapy. After a systemic work-up was negative, anterior chamber paracentesis and transcorneal biopsy were performed to rule out malignant melanoma and other tumors. The lesion proved to be an inflammatory lymphoid process, which resolved when systemic propranolol administration was withdrawn. Evidence for the possible role of propranolol in the induction of an intraocular inflammatory pseudotumor is presented.