Number, frequency and time interval of examinations under anesthesia in bilateral retinoblastoma.

PURPOSE: Current practice in retinoblastoma (Rb) has transformed this malignancy into a curable disease. More attention should therefore be given to quality of life considerations, including measures related to examinations under anesthesia (EUAs). We aimed to investigate EUA measures in bilateral Rb patients and compare the findings to EUAs in unilateral Rb. METHODS: A retrospective analysis of bilateral Rb patients that presented to the London Rb service from 2006 to 2013, were treated and had long-term follow-up. RESULTS: A total of 62 Rb patients, 15 (24.2%) of which had International Intraocular Retinoblastoma Classification (IIRC) group A/B/no Rb at presentation, 26 (41.9%) C/D, and 21 (33.9%) were E in at least one eye. The mean number of EUAs was 35.8 ± 21.5, mean time from first to last EUA was 50.6 ± 19.9 months, and mean EUA frequency was 0.715 ± 0.293 EUAs/month. IIRC group was found not to correlate with any of the EUA measures. Age at presentation inversely correlated with time interval from first to last EUA and to EUA frequency (p ≤ 0.029). Rb family history correlated with the latter measure (p = 0.005) and intraophthalmic artery chemotherapy and brachytherapy correlated with all EUA measures (p ≤ 0.029). Mean follow-up time was 80.1 ± 24.3 months. When compared with a previously reported cohort of unilateral Rb, the present group underwent 3× more EUAs (p < 0.001) over nearly double the time (p < 0.001). CONCLUSIONS: Families should be counselled on anticipated EUA burden associated with bilateral Rb. In this respect, age at presentation and family history were found to have a predictive role, whereas IIRC group did not.

Examinations under anaesthesia as a measure of disease burden in unilateral retinoblastoma: the London experience.

BACKGROUND: Early diagnosis strategies and advances in retinoblastoma (Rb) management have resulted in nearly 100% survival. More attention should, therefore, be given to quality of life considerations. We aimed to quantify the number of examinations under anaesthesia (EUAs) in a cohort of patients with Rb, as a measure of disease burden. METHODS: A retrospective analysis of patients with unilateral Rb that presented to the London Rb service from 2006 to 2013, were treated and had long-term follow-up. Correlations of clinical variables to number of EUAs were investigated. RESULTS: A total of 107 patients with Rb were included that presented at a mean age of 26.51 ± 22.68 months. The International Intraocular Retinoblastoma Classification (IIRC) was group B in 5 (5%), C in 13 (12%), D in 48 (45%) and E in 41 (38%) of the cases. Primary treatment was intravenous chemotherapy in 36 (34%) and enucleation in 71 (66%) of the cases. Mean number of EUAs was 20.67 ± 6.62, 12.52 ± 6.23 and 11.15 ± 6.91 for combined groups B/C, group D and group E patients (p < 0.001), respectively. On analysis, early age atpresentation and conservative treatments were found to significantly correlate with increased number of EUAs (p < 0.001). Mean follow-up time was 74.42 ± 25.16 months and no metastasis or death were reported. CONCLUSION: Families should be counselled regarding the number of EUAs associated with the patient's IIRC group, with B/C eyes undergoing twice the number as compared with D/E eyes. For group D cases, where both enucleation and conservative therapy are valid options, treatment choice has a significant impact on the number of EUAs.

Treatment of Baylisascaris procyonis infections in dogs with milbemycin oxime.

An examination was made as to the ability of Sentinel Flavor Tabs (milbemycin oxime/lufenuron) to treat Baylisascaris procyonis infections in dogs. The study was designed as a critical trial and included five naturally infected dogs and two dogs that were experimentally infected. Another dog from a prior clinical trial that was treated with Sentinel Flavor Tabs as part of the original FDA submission package for intestinal nematode infections was also included with the treated dogs. Of the five naturally infected dogs treated as part of the critical trial, three were cleared of their infections. These five dogs passed a total of 52 worms after treatment; one dog retained 23 worms and the other retained 1 worm at necropsy 7 days after treatment. Two of five experimentally infected Beagle dogs that had been given mice that had been fed 200 infectious eggs, developed patent infections with the parasite. These dogs were treated, and one of the dogs passed one worm and the other passed two worms after treatment with no worms being detected at necropsy 7 days after treatment. The one dog that was treated with milbemycin oxime as part of the FDA submission was clear of worms at necropsy. Overall, the mean efficacy of Sentinel Flavor Tabs was found to be 91.0%. Of the eight dogs that were treated, six were totally cleared of their infections, a cure rate of 75%. The two dogs that did not clear their infections had very large numbers of adult B. procyonis within their intestinal tracts at the time of treatment, one dog had 40 worms (23 remaining) and the other had 26 worms (1 remaining). It is suggested that the treatment of dogs with monthly Sentinel Flavor Tabs could markedly reduce the chance of infected dogs contaminating the environment. Also, additional monthly treatments are highly likely to clear dogs of any worms not killed with the initial treatment.

Efficacy of moxidectin 6-month injectable and milbemycin oxime/lufenuron tablets against naturally acquired toxocara canis infections in dogs.

The efficacy of moxidectin injection (ProHeart 6 Sustained Release Injectable for Dogs, Fort Dodge Animal Health) against naturally acquired infections of Toxocara canis was compared with that of milbemycin oxime/lufenuron tablets (Sentinel Flavor Tabs, Novartis Animal Health). Eighteen dogs with naturally acquired infections of T. canis were ranked by egg counts and randomly assigned to treatment with moxidectin (170 micro g/kg), milbemycin (500 micro g/kg)/lufenuron (10 mg/kg), or to an untreated control group (six dogs per treatment). Dogs were euthanized 7 days after treatment for recovery, identification, and enumeration of parasites by species. There was no apparent efficacy for moxidectin against T. canis. Conversely, milbemycin oxime/lufenuron was 91.5 % effective against naturally occurring infections of this canine parasite.

Efficacy of moxidectin 6-month injectable and milbemycin oxime/lufenuron tablets against naturally acquired trichuris vulpis infections in dogs.

Efficacy of moxidectin injection (ProHeart 6 Sustained Release Injectable for Dogs, Fort Dodge Animal Health) against naturally acquired infections of Trichuris vulpis was compared with that of milbemycin oxime/lufenuron tablets (Sentinel Flavor Tabs, Novartis Animal Health). Eighteen dogs infected with T. vulpis were ranked by egg counts and randomly allocated to treatment with moxidectin (170 micro g/kg), milbemycin (500 micro g/kg)/lufenuron (10 mg/kg), or to an untreated control group (six dogs per treatment). Dogs were euthanized for worm counting 7 days after treatment. Efficacy of milbemycin/lufenuron against T. vulpis was 99.6 %, compared with 67.5 % for moxidectin. The commercial formulation of milbemycin oxime/lufenuron provided excellent control of whipworm infection, whereas moxidectin demonstrated variable efficacy against this parasite.