Usefulness of ulceration and hyperkeratosis as clinical predictors of Merkel cell polyomavirus-negative and combined Merkel cell carcinoma: A retrospective study.

Merkel cell carcinoma is a rare neuroendocrine carcinoma of the skin that is associated with Merkel cell polyomavirus (MCPyV). The clinical appearance and demographic characteristics of this tumor have been described using the mnemonic AEIOU: asymptomatic, expanding rapidly, immune suppression, older than 50 years, and ultraviolet-exposed fair skin. In addition, MCC can be categorized based on morphology as pure MCC or combined MCC that exhibits neuroendocrine and other phenotypic elements. There is limited information regarding the clinical characteristics and prognosis of combined MCC. This retrospective study aimed to identify factors, such as ulceration or hyperkeratosis, that could predict MCPyV status and morphological variants. Twenty patients with MCC were divided into groups based on MCPyV status and morphology: MCPyV-positive or MCPyV-negative MCC and pure or combined MCC. The patients' MCPyV status was immunohistochemically determined using the CM2B4 antibody to the MCPyV large T-antigen. The patients' clinicopathological characteristics were evaluated to identify predictors of MCPyV-negative MCC and combined MCC. The presence of ulceration/hyperkeratosis predicted the presence of MCPyV-negative MCC (80% of cases) and combined MCC (50% of cases). None of the 10 patients with MCPyV-positive MCC had ulceration/hyperkeratosis. The clinical presence of ulceration/hyperkeratosis may help guide the diagnosis of MCPyV-negative MCC and combined MCC.

Comparison of wavefront-guided aspheric laser in situ keratomileusis for myopia: coaxially sighted corneal-light-reflex versus line-of-sight centration.

PURPOSE: To compare refractive outcomes, higher-order aberrations (HOAs), and contrast sensitivity of myopic wavefront-guided aspheric laser in situ keratomileusis centered on the coaxially sighted corneal light reflex or on the line of sight. SETTING: Okamoto Eye Clinic, Ehime, Japan. DESIGN: Comparative case series. METHODS: Data at 3 months were compared based on the distance between the coaxially sighted corneal light reflex and the line of sight (P-distance) as follows: distance greater than 0.25 mm (high-distance group), distance greater than 0.15 mm and less than 0.25 mm (intermediate-distance group), and distance less than 0.15 mm (low distance group). RESULTS: The chart review included 317 eyes in the corneal-light-reflex group and 269 eyes in the line-of-sight group. The mean postoperative manifest refraction spherical equivalent was +0.123 diopter (D) ± 0.378 (SD) and +0.187 ± 0.480 D, respectively (P = .07). The safety and efficacy indices were significantly higher in the corneal-light-reflex group, including the high-distance subgroup and eyes with a P-distance less than 0.25 mm (P<.05, all cases). The HOAs (P<.001) and coma (P = .001) were significantly higher in the line-of-sight group (P<.001 and P = .001, respectively). The line-of-sight group had a significantly greater change in contrast sensitivity (P = .026). CONCLUSIONS: Centration on the coaxially sighted corneal light reflex resulted in better safety, effectiveness, and contrast sensitivity than line-of-sight centration. Centration on the coaxially sighted corneal light reflex was safer for myopic eyes with P-distances greater than 0.25 mm. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned. Additional disclosures are found in the footnotes.

Comparison of myopic LASIK centered on the coaxially sighted corneal light reflex or line of sight.

PURPOSE: To compare refractive outcomes of myopic LASIK with centration on the coaxially sighted corneal light reflex (CSCLR) to centration on the center of the pupil (line of sight [LOS]). METHODS: The NIDEK CXIII excimer laser was used to treat 268 eyes with centration on the CSCLR (CSCLR group) and 288 eyes with centration on the LOS (LOS group). For the CSCLR group, the laser ablation was delivered 80% closer to the visual axis. One-month postoperative outcomes were compared. RESULTS: Preoperative manifest refraction spherical equivalent (MRSE) was -4.88+/-1.55 diopters (D) (range: -8.50 to -1.25 D) in the CSCLR group and -5.05+/-1.63 D (range: -9.75 to -1.50 D) in the LOS group. The postoperative MRSE was 0.17+/-0.39 D (range: -1.38 to -1.25 D) in the CSCLR group and 0.19+/-0.48 D (range: -1.63 to +1.88 D) in the LOS group. Safety (1.18) and efficacy (1.047) indices were statistically significantly higher in the CSCLR group compared to the LOS group (1.138 and 0.997, respectively) (P<.05). This trend was accentuated in a subgroup analysis of patients with >0.25-mm difference between the CSCLR and LOS, favoring the CSCLR group. A statistically significantly greater induction of higher order aberrations (P=.04) and coma (P<.01) was noted in the LOS group postoperatively. CONCLUSIONS: Myopic LASIK centered on the CSCLR was significantly safer and more effective than LASIK centered on the pupil (LOS), with significantly lower induction of coma and total higher order aberrations.

Angiographic demarcation of an occlusive lesion may predict recanalization after intra-arterial thrombolysis in patients with acute middle cerebral artery occlusion.

BACKGROUND AND PURPOSE: The aim of this study is to investigate whether angiographic demarcation of an occlusive lesion may predict successful or failed result of intra-arterial thrombolysis in acute middle cerebral artery (MCA) occlusion. METHODS: We reviewed retrospectively the angiography and clinical data of acute MCA occlusion patients who underwent intra-arterial thrombolysis from 1994 to 2004. Pretreatment angiographic findings at the occlusive lesions were classified as either blurred or sharp, depending on whether the proximal portion of the occlusive lesions had poorly or well demarcated margins. Using uni- or multivariate analysis, recanalization was correlated with our angiographic classification or other clinical variables. RESULTS: Forty-six patients with MCA occlusions underwent intra-arterial thrombolysis during the 10-year period. Forty-four of the angiograms could be classified into one of the two categories: Blurred-type in 20 patients and Sharp-type in 24 patients. Univariate analysis showed a significant association of the classification with recanalization. (Recanalization rate: 95% in Blurred-type and 38% in Sharp-type, P < .0001) Logistic regression analysis showed that the association was independent from other factors (P= .004). CONCLUSION: In acute MCA occlusion, our classification may indicate the difficulty of the recanalization procedure, and may assist in patient triage for different intra-arterial treatment strategies.

Rhythmic movement disorder: polysomnographic study and summary of reported cases.

Rhythmic movement disorder (RMD) is classified as a sleep-wake transition disorder. However, some RMD patients show rhythmic movements during rapid-eye-movement (REM) sleep, during which muscle activity is completely absent. In order to determine the sleep stages in which episodes of RMD occur, we investigated two children with RMD by means of polysomnography, and also summarized the polysomnographic reports on patients with RMD. We also quantified the REM sleep atonia in our patients using the tonic and phasic inhibition indices (TII and PII). In addition, to examine the involvement of the basal ganglia in RMD patients, we studied the frequency of gross movements (GMs) during sleep in each sleep stage. Both patients showed rhythmic movements in all sleep stages, i.e. including REM sleep. Few rhythmic movements occurred during sleep-wake transition periods. Both patients showed normal TII and PII scores as well as a normal pattern for the sleep stage-dependent modulation of GMs during sleep. Eighteen of the 33 reported RMD patients, including ours, experienced episodes during REM sleep, while the other 15 patients had no episodes during REM sleep. Among the 18 patients who had episodes during REM sleep, eight experienced the episodes exclusively during REM sleep. It is unlikely that the neuronal mechanisms that underlie RMD episodes were the same in the 15 patients who had no RMD episodes during REM sleep and the eight who had them only during REM sleep. We propose that RMD can be divided into several subgroups according to the differences in the underlying neuronal mechanisms.

Eye movements in REM sleep could be controlled by the same conjugate system while awake.

We describe the impairment of eye movements during REM sleep in a patient with internuclear ophthalmoplegia. A 75-year-old woman, complaining of acute unsteady gait and diplopia, was diagnosed to have right medial longitudinal fasciculus (MLF) syndrome with limited adduction of the right eye. Overnight polysomnography revealed the same impairment of right adductive ocular movement during REM sleep. Our findings suggest that the MLF mediates lateral conjugation of eye movements during REM sleep as well as voluntary lateral conjugate eye movements during wakefulness.