RESUMEN
AIM: To define the clinical and histopathological characteristics of primary lacrimal sac lymphoma in a predominantly white population. METHODS: Specimens of lacrimal sac lymphoma and follow up data were solicited from members of the Ophthalmic Oncology Task Force of the European Organization for Research and Treatment of Cancer (EORTC) and the European Ophthalmic Pathology Society (EOPS). Specimens were stained with haematoxylin and eosin and an immunohistochemical panel against leucocyte antigens was applied. Diagnosis was reached by consensus of five experienced pathologists according to the World Health Organization classification system. The histopathological findings were correlated with the clinical data. RESULTS: Of 15 primary lacrimal sac lymphomas, five (33%) were diffuse large B cell lymphoma (DLBCL), five (33%) were extranodal marginal zone B cell lymphoma of mucosa associated lymphoid tissue (MALT lymphoma), three were classified as "transitional MALT lymphoma," being in transition from MALT lymphoma to DLBCL, and two were unclassified B cell lymphomas. Nine of the patients were female, and the median age at the time of diagnosis was 71 years (range 45-95 years). The most frequent presenting symptoms were epiphora (85%), swelling in the region of the lacrimal sac (79%), and dacryocystitis (21%). All but one patient presented in stage I. Systemic spread occurred in three of nine patients (33%). The 5 year overall survival was 65%. CONCLUSIONS: DLBCL and MALT lymphoma are equally common in the lacrimal sac in contrast with the remaining periorbital and/or orbital region where MALT lymphoma predominates.
Asunto(s)
Enfermedades del Aparato Lagrimal/diagnóstico , Linfoma de Células B/diagnóstico , Anciano , Anciano de 80 o más Años , Antígenos CD/metabolismo , Antígenos de Neoplasias/metabolismo , Femenino , Humanos , Enfermedades del Aparato Lagrimal/patología , Enfermedades del Aparato Lagrimal/terapia , Linfoma de Células B/patología , Linfoma de Células B/terapia , Linfoma de Células B de la Zona Marginal/diagnóstico , Linfoma de Células B de la Zona Marginal/patología , Linfoma de Células B de la Zona Marginal/terapia , Linfoma de Células B Grandes Difuso/diagnóstico , Linfoma de Células B Grandes Difuso/patología , Linfoma de Células B Grandes Difuso/terapia , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
AIM: Chronic critical limb ischemia (CLI) often requires venous bypass grafting to distal arterial segments. However, graft patency is influenced by the length and quality of the graft and occasionally patients may have limited suitable veins. We investigated short distal bypass grafting from the superficial femoral or popliteal artery to the infrapopliteal, ankle or foot arteries, despite angiographic alterations of inflow vessels, providing that invasive pressure measurement at the site of the planned proximal anastomosis revealed an inflow-brachial pressure difference of Asunto(s)
Implantación de Prótesis Vascular/métodos
, Arteria Femoral/cirugía
, Isquemia/cirugía
, Pierna/irrigación sanguínea
, Vena Safena/trasplante
, Anciano
, Anciano de 80 o más Años
, Angiografía de Substracción Digital
, Femenino
, Arteria Femoral/diagnóstico por imagen
, Humanos
, Incidencia
, Isquemia/diagnóstico por imagen
, Masculino
, Persona de Mediana Edad
, Complicaciones Posoperatorias/epidemiología
, Estudios Retrospectivos
, Índice de Severidad de la Enfermedad
, Tasa de Supervivencia
, Trasplante Autólogo
, Resultado del Tratamiento
, Ultrasonografía Doppler Dúplex
RESUMEN
Drug addicts very often present with vascular complications. A great number of these lesions require medical care. Vascular problems are diverse and multiple affecting both veins and arteries, the latter being often the most dramatic. This article attempt to describe the most frequent lesions observed in drug addicts considering two different mechanisms; traumatic versus drug induced complications.
Asunto(s)
Abuso de Sustancias por Vía Intravenosa/complicaciones , Enfermedades Vasculares/etiología , HumanosRESUMEN
Deep vein thrombosis in children and adolescents is a quite rare event. Risk factors most often associated with DVT in this particular population are: central vein catheters, neoplasia, vascular malformations and oral contraception. Diagnosis and management of DVT in adolescents does not differ greatly from that of adults. Compression ultrasound is the initial exam of choice. Hospitalization is often not necessary and treatment can be started by using low molecular weight heparin followed by oral anti-vitamin K antagonists. Thrombophilia screening is not routinely recommended and should be reserved for those patients for whom results would change therapeutical management.
Asunto(s)
Tromboembolia/etiología , Tromboembolia/terapia , Adolescente , Humanos , Factores de Riesgo , Tromboembolia/diagnóstico , Tromboembolia/epidemiologíaRESUMEN
PURPOSE: To identify the genetic defect for the Coppock-like cataract (CCL) affecting a Swiss family, which defect was unlinked to the chromosome 2q33-35 CCL locus. METHODS: A large family was characterized for linkage analysis by slit lamp examination or by the review of drawings made before cataract extraction. The affection status was attributed before genotyping, and the genotyping was masked to the affection status. Two-point and multipoint linkage analyses were performed using the MLINK and the LINKMAP components of the LINKAGE program package (ver. 5.1), respectively. Mutational analysis of candidate genes was performed by a combination of direct cycle sequencing and an amplification refractory mutation system assay. RESULTS: Ten individuals were affected with the CCL phenotype. The disease was autosomal dominant and appeared to be fully penetrant. A new CCL locus was identified on chromosome 22q11.2 within a 11.67-cM interval (maximum lod score [Zmax] = 4.14; theta = 0). Mutational analysis of the CRYBB2 candidate gene identified a disease-causing mutation in exon 6. This sequence change was identical with that previously described to be associated with the cerulean cataract, a clinically distinct entity. CONCLUSIONS: The CCL phenotype is genetically heterogeneous with a second gene on chromosome 22q11.2, CRYBB2. The CCL and the cerulean cataract are two distinct clinical entities associated with the same genetic defect. This work provides evidence for a modifier factor that influences cataract formation and that remains to be identified.
Asunto(s)
Catarata/genética , Mapeo Cromosómico , Cromosomas Humanos Par 22/genética , Cristalinas/genética , Heterogeneidad Genética , Mutación , Cadena B de beta-Cristalina/análogos & derivados , Adolescente , Adulto , Catarata/patología , Niño , Preescolar , Análisis Mutacional de ADN , Exones/genética , Femenino , Ligamiento Genético , Genotipo , Humanos , Lactante , Masculino , LinajeRESUMEN
The Equator-Plus camera can photograph a 148-degree view of the fundus, measured from the nodal point of the eye. We tested this instrument clinically more than 800 times on over 700 eyes. The large field, which is three to four times that of any conventional fundus camera, is achieved by using a special contact lens as the front element in the camera optics. Photographs taken with the Equator-Plus camera can resolve a lesion as small as one-eighth of a disk diameter, if the contrast is good. Protruding tumors, choroidal or retinal detachment, and extensive disease of the choroid and fundus show up well with this technique. We obtained good pictures in 87% of the clinical tests. We have not observed complications of any kind after photography with the Equator-Plus camera.
Asunto(s)
Oftalmopatías/diagnóstico , Fondo de Ojo , Fotograbar , Adolescente , Adulto , Anciano , Niño , Lentes de Contacto , Estudios de Evaluación como Asunto , Femenino , Humanos , Masculino , Métodos , Persona de Mediana Edad , Oftalmología/instrumentación , Fotograbar/instrumentación , Pupila , Transiluminación/métodosRESUMEN
PURPOSE: The RHO C110Y mutation has been recently reported to cause a phenotypically unspecified form of autosomal dominant retinitis pigmentosa (adRP). The study of a family affected with this mutation allowed us to hereby describe the genotype/phenotype correlation associated with the RHO C110Y mutation. METHODS: A six-generation pedigree cosegregating adRP and RHO C110Y in ten accessible individuals was ophthalmologically investigated. All family members affected with RP went through complete eye examination and ERG testing. RESULTS: The disease first manifested with nyctalopia during adulthood and slowly progressed over the next decades towards tubular visual field defects and relatively preserved central vision. Ophthalmoscopically, the fundus remained almost unaltered until the end of the third decade of life, and then slowly progressed towards typical RP changes with minimal macular involvement by the eighth decade. Color vision remained unaltered. Earliest ERG alteration was limited to the rod system followed by a rod-cone pattern. Scotopic and photopic ERG were recordable until the fourth and sixth decades, respectively. DISCUSSION: RHO C110Y-associated adRP is characterized by a late onset and a mild progression compatible with type 2 or regional RP with little intrafamilial phenotypic variability and complete penetrance. Characterization of genotype-phenotype correlations plays a role in the improvement of genetic and prognostic counselling.
Asunto(s)
Genes Dominantes , Mutación/fisiología , Retinitis Pigmentosa/genética , Rodopsina/genética , Adulto , Anciano , Sustitución de Aminoácidos/genética , Progresión de la Enfermedad , Electrorretinografía , Femenino , Angiografía con Fluoresceína , Fondo de Ojo , Genes Dominantes/fisiología , Humanos , Masculino , Persona de Mediana Edad , Mutación/genética , Linaje , Retinitis Pigmentosa/patología , Retinitis Pigmentosa/fisiopatología , Visión Ocular/fisiologíaRESUMEN
Giant cell tumors of the skull are very rare and usually occur in the sphenoid bone. The authors report the case of a 10-year-old boy with such a tumor involving exclusively the roof of the left orbit. He presented essentially with edema of the left superior eyelid and diplopia. Computed tomographic examination and magnetic resonance imaging delineated the lesion, which was radically removed via a left fronto-orbital craniotomy. Some aspects of this rare neoplasm are reviewed.
Asunto(s)
Tumores de Células Gigantes/cirugía , Neoplasias Orbitales/cirugía , Angiografía Cerebral , Niño , Craneotomía , Diagnóstico Diferencial , Tumores de Células Gigantes/diagnóstico , Tumores de Células Gigantes/patología , Humanos , Masculino , Órbita/patología , Neoplasias Orbitales/diagnóstico , Neoplasias Orbitales/patología , Tomografía Computarizada por Rayos XRESUMEN
Twenty insulin-dependent diabetic patients with signs of background retinopathy were given Buflomedil 600 mg/day orally or placebo in a randomized double-blind trial for a 6-month period. A larger number of patients had their retinal condition deteriorating in the placebo group and this finding is an indication for pursuing investigations on a larger scale in this direction.
Asunto(s)
Retinopatía Diabética/tratamiento farmacológico , Pirrolidinas/uso terapéutico , Vasodilatadores/uso terapéutico , Retinopatía Diabética/patología , Método Doble Ciego , Evaluación de Medicamentos , Angiografía con Fluoresceína , Humanos , Persona de Mediana Edad , Distribución AleatoriaRESUMEN
INTRODUCTION: Nontraumatic orbital diseases only exceptionally require emergency treatment. In this paper an emergency is considered when the diagnosis and/or treatment must be done within a maximal period of 1 week. MATERIALS AND METHODS: All patients with nontraumatic orbital diseases from the Department of Ophthalmology of the University of Lausanne and from the office of one of the authors (N.D.) over the last 35 years were studied, in view of their degree of emergency. Data from 77 patients (28 females and 49 males), aged from birth to 85 years, were collected. RESULTS: Idiopathic inflammations of the orbit (pseudotumors) were the most frequent diagnoses seen as an emergency, followed by rhinological diseases with orbital consequences (exteriorized sinusitis or mucoceles), dysthyroid orbital pathologies, bleeding in lymphangiomas and varices, rhabdomyosarcoma, and acute dacryoadenitis. Fast progressive proptosis, oculomotor disorders, and pain are the most frequent alarm signals. After the diagnostic procedure, a surgical or medical treatment is frequently proposed. CONCLUSION: Although rare, emergencies in orbital diseases are a challenge for the general ophthalmologist. The morbidity and sometimes the mortality due to these diseases are often reduced by proper management. Patients generally have to be referred to a specialized unit.
Asunto(s)
Enfermedades Orbitales , Enfermedad Aguda , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Blefaroptosis/etiología , Niño , Preescolar , Diagnóstico Diferencial , Urgencias Médicas , Exoftalmia/etiología , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Enfermedades Orbitales/diagnóstico , Enfermedades Orbitales/tratamiento farmacológico , Enfermedades Orbitales/etiología , Enfermedades Orbitales/cirugía , Seudotumor Orbitario/diagnóstico , Seudotumor Orbitario/terapia , Dolor/etiología , Factores Sexuales , Factores de TiempoRESUMEN
PURPOSE: Describe our series of patients with non-traumatic orbital diseases. PATIENTS AND METHODS: A series of patients with non-traumatic orbital diseases seen in Lausanne from 1965 to 1996. RESULTS: Inflammatory conditions and infections were the most frequently observed diseases. Pseudotumors were the most representative. Orbital involvement in systemic diseases (for example Graves' disease), vascular tumors and malformations, as well as orbital involvement in rhinological diseases were also often observed. Orbital cysts, particularly dermoid and epidermoid cysts, and orbital diseases of nervous origin were exceptional. Finally, diseases of the lacrimal gland, metastases, secondary tumors from adjacent structures and diseases of mesenchymal origin were more rare. DISCUSSION: This study also reports the proportion of male and female patients and the percentage of proptosis.
Asunto(s)
Enfermedades Orbitales/epidemiología , Enfermedades Orbitales/etiología , Adolescente , Adulto , Distribución por Edad , Anciano , Niño , Preescolar , Femenino , Humanos , Incidencia , Lactante , Masculino , Persona de Mediana Edad , Enfermedades Orbitales/clasificación , Enfermedades Orbitales/diagnóstico , Distribución por Sexo , Suiza/epidemiología , Salud UrbanaRESUMEN
INTRODUCTION: Rhabdomyosarcoma is the most frequent primitive orbital malignant tumor in children. If the treatment is started as soon as possible after discovery of the disease, the vital prognosis is considerably better than otherwise. The goal of this paper is to present the new therapeutic protocol and to report our experience in this field. MATERIAL AND METHOD: During the past 35 years, 102 cases of orbital tumors were collected in children under 15 years of age: 5 cases of rhabdomyosarcoma were cared for in our department. At the time of tumor diagnosis, the age of our patients ranged from 3 weeks to 13 years. After a biopsy or excision biopsy, all our cases were treated by chemotherapy with or without radiotherapy. Medication was mostly vincristine, ifosfamide and actinomycine D. When the result of the treatment was not satisfactory, carboplatine and epirubicine, vincristine as well as ifosfamide were given. Radiotherapy was performed only in particular cases or in recurrences. CONCLUSION: Rhabdomyosarcoma is a highly malignant tumor. Although rare, it is the most frequent of malignant tumors in children. It is important to keep it in mind in order to perform a biopsy enabling quick diagnosis and treatment following the modern protocol giving the highest chances of survival to these patients: about 98% in 3 years.
Asunto(s)
Neoplasias Orbitales/terapia , Rabdomiosarcoma/terapia , Adolescente , Factores de Edad , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Biopsia , Niño , Preescolar , Terapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Lactante , Recién Nacido , Imagen por Resonancia Magnética , Masculino , Órbita/patología , Neoplasias Orbitales/diagnóstico , Neoplasias Orbitales/tratamiento farmacológico , Neoplasias Orbitales/patología , Neoplasias Orbitales/radioterapia , Dosificación Radioterapéutica , Rabdomiosarcoma/diagnóstico , Rabdomiosarcoma/tratamiento farmacológico , Rabdomiosarcoma/patología , Rabdomiosarcoma/radioterapia , Factores de TiempoRESUMEN
Plexiform neurofibromas of the orbit, sometimes extending to the temporal region and the face, are considered to be a rare but devastating and disfiguring complication of neurofibromatosis type 1. The first symptoms appear in infancy and the involvement of the orbit and the face is present in nearly all children after the age of 5. The disease is unilateral in most cases but can exceptionally involve both sides of the face. Progressive deformation of the orbital frame due to the expanding plexiform neurofibroma and buphthalmos occurs in a large proportion of cases. The associated sphenoidal dysplasia, which is thought to be, according to the most recent hypothesis, genetically determined, will inescapably increase the burden to the orbital content, cause pulsating proptosis and will endanger noble structures, finally resulting in loss of vision. Using the Jackson classification, the authors report their personal series of 22 cases (19 operated). Until now, there has been no effective medical treatment for plexiform neurofibroma and surgery remains the standard care for these patients. Controversies remain about the timing of the first operation and today most multidisciplinary teams involving plastic, maxillofacial, ophthalmologic, and neurosurgeons favor early intervention to try to minimize the secondary deformation of the orbital and facial skeleton. A number of cases of plexiform neurofibromas are illustrated within the three Jackson groups and treatment results of the rare elephantiasis neuromatosa cases are presented. Special techniques such as preoperative embolization of heavily vascularized plexiform neurofibroma are also discussed.
Asunto(s)
Cara/patología , Neurofibromatosis 1/patología , Transformación Celular Neoplásica/patología , Preescolar , Femenino , Lateralidad Funcional , Humanos , Incidencia , Masculino , Mutación , Neurofibroma/patología , Neurofibroma/cirugía , Neurofibromatosis 1/epidemiología , Neurofibromatosis 1/genética , Neurofibromatosis 1/cirugía , Órbita/patología , Hueso Esfenoides/patología , Seno Esfenoidal/patologíaAsunto(s)
Endoftalmitis/inducido químicamente , Endoftalmitis/etiología , Cuerpos Extraños en el Ojo/complicaciones , Intoxicación por Mercurio/complicaciones , Automutilación , Adulto , Endoftalmitis/patología , Cuerpos Extraños en el Ojo/diagnóstico por imagen , Cuerpos Extraños en el Ojo/cirugía , Femenino , Humanos , Inyecciones , RadiografíaRESUMEN
BACKGROUND: The superficial femoral vein (SFV) is a well-established alternative conduit for infra-inguinal reconstructivenous hypertension after SFV harvest may however result in significant morbidity. This study reports the efficiency of SFV as conduit for infra-inguinal reconstructions and characterize the anatomic and physiologic changes in harvest limbs and their relationship to the development of venous complications. METHODS: From May 1999 through November 2003, 23 SFV were harvested from 21 patients undergoing infra-inguinal reconstructions. Bypasses were controlled by regular duplex-ultrasound. The venous morbidity was assessed by measurements of leg circumferences, strain-gauge plethysmography and quality of life, investigated by the VEINES-QOL scale. RESULTS: At a mean follow-up of 10.4 months (range 1-56), primary, secondary patency and limb salvage rates of infra-inguinal bypasses using SFV are 71.4%, 76.2% and 85.7% respectively. No patient had major venous claudication. Oedema was significantly present in nine patients. Strain-gauge plethysmography showed outflow obstruction in all patients. The VEINES-QOL assessment showed no limitation in social and domestic activity, moderate complain about leg heaviness despite presence of oedema. CONCLUSION: The SFV harvest is a reliable conduit for infra-inguinal reconstructions and results in moderate venous morbidity in terms of functional consequences and quality of life.
Asunto(s)
Vena Femoral , Pierna/irrigación sanguínea , Recuperación del Miembro , Recolección de Tejidos y Órganos , Procedimientos Quirúrgicos Vasculares , Anciano , Anciano de 80 o más Años , Prótesis Vascular , Implantación de Prótesis Vascular , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Pletismografía de Impedancia , Estudios Prospectivos , Calidad de Vida , Factores de Riesgo , Encuestas y Cuestionarios , Análisis de Supervivencia , Factores de Tiempo , Ultrasonografía Doppler Dúplex , Grado de Desobstrucción VascularRESUMEN
Following a brief survey of the subjects covered in this paper the author discusses the problem of lacrimal gland tumefactions. These can be divided into five groups: malignant lymphoma and leukemias, proliferative reactions of the lymphatic tissues, dacryoadenitis, secondary and metastatic tumors, and finally miscellaneous conditions; the main nosological characteristics are described.
Asunto(s)
Dacriocistitis/diagnóstico , Enfermedades del Aparato Lagrimal/diagnóstico , Leucemia/diagnóstico , Linfoma/diagnóstico , Diagnóstico Diferencial , HumanosRESUMEN
Since the publication of randomized studies essentially performed in England and the United States, indications to photocoagulation in most cases of diabetic retinopathy have become precise and accepted by all physicians who take care of diabetics. These indications are reviewed following these randomized studies and the programme of blindness prevention recommended by the World Health Organization and the International Diabetes Federation. Presentation of the techniques used in Lausanne.