Prognosis of uveal melanoma based on race in 8100 patients: The 2015 Doyne Lecture.

A retrospective, nonrandomized, interventional case series of 8100 patients with uveal melanoma were evaluated for melanoma-related metastasis based on patient race. The patient race was Caucasian (n=7918, 98%), Hispanic (n=105, 1%), Asian (n=44, <1%), or African American (n=33, <1%). On the basis of race (Caucasian, Hispanic, Asian, and African American), significant differences were noted in mean age at presentation (58, 48, 44, and 52 years; P<0.001), distance of posterior tumor margin to foveola (5, 5, 6, and 4 mm; P<0.001), distance of posterior tumor margin to optic disc (5, 5, 6, and 4 mm) (P<0.001), tumor base (11, 12, 12, and 13 mm; P<0.001), tumor thickness (5.4, 7.1, 6.5, and 7.5 mm; P<0.001), intraocular hemorrhage (10, 14, 11, and 24%; P=0.02), and rupture of Bruch's membrane (20, 27, 39, and 36%; P=0.001). On the basis of multivariate analysis, the rate of metastasis increased with increasing age (P<0.001), ciliary body location (P<0.001), increasing tumor base (P<0.001), increasing tumor thickness (P<0.001), pigmented tumor (P=0.001), subretinal fluid (P=0.001), intraocular hemorrhage (P=0.045), and extraocular extension (P=0.036). Kaplan-Meier estimates of metastasis at 3, 5, and 10 were 8, 15, and 25% in Caucasians; 13, 13, and 13% in Hispanics; 4, 4, and 36% in Asians; and 8, 8, and 8% in African Americans. Compared with Caucasians, despite relative risk for metastasis of 0.31 for African Americans, 0.73 for Hispanics, and 1.42 for Asians, there was no statistical difference in metastasis, or death from uveal melanoma based on race. In summary, uveal melanoma showed similar prognosis for all races.

Mandibular distraction osteogenesis: effects on articulation and velopharyngeal function.

Mandibular distraction osteogenesis has gained popularity for the treatment of mandibular hypoplasia and asymmetry. With this technique, significant skeletal and soft tissue changes in the lower face can be produced in a relatively short time period without the need for extensive surgery. Despite general acceptance, the long-term sequelae of the procedure have not been well documented. In this report, we describe two patients who experienced changes in their articulation and velopharyngeal function after unilateral mandibular distraction. The first patient underwent 35 mm and the second patient 45 mm of mandibular lengthening. In both cases, articulation skills declined, and there was velopharyngeal inadequacy immediately after distraction. However, in both cases, the velopharyngeal inadequacy was transient; one patient recovered near-normal velopharyngeal function within 1 month after distraction and the second patient recovered function within 8 months. The relations among mandibular distraction, articulation, and velopharyngeal function are discussed.

Open transnasal approach to the midline skull base.

Surgical access to the anterior skull base for resection of midline tumors is commonly performed through a transfacial approach. We describe a new, open transnasal approach to the midline skull base and adjacent pituitary region. This technique, devised through our experience with open septorhinoplasty, was initially studied on fresh cadaver heads. It has subsequently been used in 28 consecutive patients for the resection of a variety of midline skull base tumors. We believe that this approach is superior to the traditional rhinal and sublabial transfacial techniques because of the wider exposure and true midline orientation that it offers. In addition, no mucosal membrane is violated, therefore providing a greater seal of the dissection postoperatively. A detailed description of the technique and the results of its clinical use are presented.

Prognostic factors in acute pulmonary edema.

Over a six-month period, 106 admissions of 94 patients for acute pulmonary edema were identified and their charts were reviewed. Precipitating factors for acute pulmonary edema included progressively worsening congestive heart failure in 25.5% of cases, coronary insufficiency in 20.8%, subendocardial myocardial infarction in 16.0%, acute transmural myocardial infarction in 10.4%, arrhythmia in 8.5%, medical noncompliance in 6.6%, and other causes in 12.6%. In-hospital mortality was 17.0% (16 patients). Of those patients discharged from the hospital, an additional 27 (39.7%) were dead at one year, giving an overall one-year mortality of 51.2%. We found that patients with progressively worsening congestive heart failure have a better prognosis than patients with other precipitants. Also, patients with an initial systolic blood pressure in the emergency room of 160 mm Hg or higher had an improved survival over patients with an initial systolic blood pressure under 160 mm Hg. No other in-hospital or long-term prognostic factors were identified.

Benign cysts of the parotid gland.

Benign cysts of the parotid gland are rare. They present with equal distribution between males and females as unilateral painless swelling in the area of the parotid gland without fixation to the overlying skin or involvement of the facial nerve. These cysts can be congenital, acquired, or occasionally may arise from surrounding structures. The preoperative diagnosis is very difficult and the treatment of choice consists of superficial parotidectomy. Our 10-year experience with benign cyst of the parotid gland at Roswell Park Memorial Institute is presented in this paper.

Comparative effects of abrupt withdrawal of propranolol and verapamil in angina pectoris.

The potential hazards of abrupt withdrawal of propranolol have been described in patients with angina pectoris; however, the effects of abrupt withdrawal from long-term therapy with verapamil have not previously been investigated. The comparative effects of withdrawal from long-term treatment with propranolol and verapamil were assessed in a placebo-controlled double-blind randomized crossover study of 20 patients received placebo for 2 weeks, then increasing doses of propranolol (60 to 320 mg/day) or verapamil (240 to 480 mg/day) for 3 weeks. Patients were then abruptly withdrawn from drug onto placebo for 1 week, followed by crossover to the other drug treatment and a second withdrawal period. All 20 patients were withdrawn from verapamil without evidence of a rebound increase in frequency of anginal attacks, blood pressure, heart rate, or rate-pressure product and without a rebound deterioration in exercise tolerance. In contrast, with propranolol withdrawal, 2 patients (with the highest baseline angina attack rate) had a severe exacerbation of their anginal syndrome and could not undergo formal exercise testing; the other 18 patients were withdrawn from propranolol without incident. Plasma catecholamines were increased during exercise compared with rest during all treatments; however, the levels of catecholamines during exercise were significantly higher with propranolol than with verapamil and placebo (p less than 0.05). Levels of exercise catecholamines returned to placebo baseline values after withdrawal of propranolol.

Effect of methylphenidate hydrochloride on stature of hyperactive children.

Twenty-six hyperactive children receiving methylphenidate hydrochloride, eight hyperactive non-medicated children and 25 normal children participated in a study of the effect of such medication on stature of hyperactive children. All the children were below 13 years of age and all but two were male. Predicted adult stature before methylphenidate treatment and predicted adult stature after one year, two years and three years of treatment were calculated by means of the Roche-Weiner-Thissen Adult Stature Prediction Formula. Total milligrams per day dosage, milligrams per kilogram per day dosage and duration of treatment per year were analysed in the medicated hyperactive children and their growth was compared with the other two groups. No significant differences were found for any of the above variables. This study indicates that stature suppression does not occur in male children below 13 years of age when methylphenidate is used up to 0.8mg/kg/day for one or two years and up to 0.6mg/kg/day for three years.

Echocardiographic findings in cardiogenic shock due to right ventricular myocardial infarction.

The echocardiographic findings in a patient with cardiogenic shock secondary to acute right ventricular myocardial infarction based on typical clinical, electrocardiographic, and hemodynamic features are described. The echocardiogram demonstrated a large RV/LV minor axis ratio caused by a volume overload of the right ventricle and an underfilled left ventricle. The interventricular septum showed abnormal movement, presumably due to right ventricular overload or severe disease of the left anterior descending coronary artery. Diminished septal systolic thickening, as seen in our patient, may be explained by extension of the infarct from the right ventricle to the adjacent part of the septum. Predominant right ventricular involvement can be a cause for a correctable hypotension in patients with acute myocardial infarction and should therefore be recognized early. The echocardiographic picture demonstrated in our patient, when considered in conjunction with the clinical status, can be useful for early diagnosis.

Conners' Teacher Rating Scale for use in drug studies with children--an empirical study.

Their classroom teachers rated 291 schoolchildren, grades kindergarten through 6, on Conners' Teacher Rating Scale, developed for and used widely in drug studies in children. Scores were found to be significantly lower than those reported for a similar group of 92 New York children and considerably less than those of a group of 64 children receiving medication for deviant behavior. Boys generally had higher scores for acting-out-type behavior while girls scored higher on neuroticism. The factor structure in this sample showed some differences from that in Conners' original analysis but they are insufficient for any change in the widely accepted scoring system, except perhaps to add a fifth factor of sociability.