RESUMO
PURPOSE: To analyze the anatomical characteristics of lamellar macular holes using cross-sectional and en face spectral domain optical coherence tomography. METHODS: Forty-two lamellar macular holes were retrospectively identified for analysis. The location, cross-sectional length, and area of lamellar holes were measured using B-scans and en face imaging. The presence of photoreceptor inner segment/outer segment disruption and the presence or absence of epiretinal membrane formation were recorded. RESULTS: Forty-two lamellar macular holes were identified. Intraretinal splitting occurred within the outer plexiform layer in 97.6% of eyes. The area of intraretinal splitting in lamellar holes did not correlate with visual acuity. Eyes with inner segment/outer segment disruption had significantly worse mean logMAR visual acuity (0.363 ± 0.169; Snellen = 20/46) than in eyes without inner segment/outer segment disruption (0.203 ± 0.124; Snellen = 20/32) (analysis of variance, P = 0.004). Epiretinal membrane was present in 34 of 42 eyes (81.0%). CONCLUSION: En face imaging allowed for consistent detection and quantification of intraretinal splitting within the outer plexiform layer in patients with lamellar macular holes, supporting the notion that an area of anatomical weakness exists within Henle's fiber layer, presumably at the synaptic connection of these fibers within the outer plexiform layer. However, the en face area of intraretinal splitting did not correlate with visual acuity, disruption of the inner segment/outer segment junction was associated with significantly worse visual acuity in patients with lamellar macular holes.
Assuntos
Retina/patologia , Perfurações Retinianas/diagnóstico , Tomografia de Coerência Óptica , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Retina/fisiopatologia , Perfurações Retinianas/fisiopatologia , Estudos Retrospectivos , Acuidade Visual/fisiologiaRESUMO
PURPOSE: To describe a case of Purtscher-like retinopathy after uncomplicated radical prostatectomy. METHODS: Observational case report. RESULTS: Purtscher retinopathy is named after the Austrian ophthalmologist Othmar Purtscher (1852-1927) who first fully described the syndrome of "traumatic retinal angiopathy" in 1912 as patches of retinal whitening, retinal hemorrhages, and disk edema after compression injury to the head. Since that time, similar findings, often called Purtscher-like retinopathy, have been described in association with a number of conditions, including, among others, acute pancreatitis, chest compression injury, childbirth, and fat embolism syndrome, after long-bone fracture or surgery. CONCLUSION: The occurrence of Purtscher-like changes after nonorthopedic surgery seems, however, to be rare. The authors describe a single case of Purtscher-like retinopathy after uncomplicated radical prostatectomy.
Assuntos
Prostatectomia/efeitos adversos , Doenças Retinianas/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias da Próstata/cirurgia , Remissão Espontânea , Hemorragia Retiniana/etiologiaRESUMO
The DecisionDx-UM gene expression profiling test is an accurate, popular, and technically simple method for obtaining prognostic information from uveal melanoma tissue. However, this test does not provide diagnostic information and may errantly provide prognostication results for lesions other than uveal melanoma. A 73-year-old woman presented with a uveal metastasis from lung adenocarcinoma, which was misdiagnosed as uveal melanoma. DecisionDx-UM gene expression profiling was performed on tissue obtained from a needle biopsy. A test result was provided regarding the lesion's metastatic potential even though it was not a uveal melanoma.
Assuntos
Adenocarcinoma/secundário , Regulação Neoplásica da Expressão Gênica , Genes Neoplásicos , Neoplasias Pulmonares/secundário , Melanoma/genética , Neoplasias Uveais/genética , Adenocarcinoma/genética , Adenocarcinoma/metabolismo , Adenocarcinoma de Pulmão , Idoso , Diagnóstico Diferencial , Erros de Diagnóstico , Feminino , Técnicas Genéticas , Humanos , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/metabolismo , Melanoma/metabolismo , Metástase Neoplásica , Neoplasias Uveais/diagnóstico , Neoplasias Uveais/metabolismo , Neoplasias Uveais/secundárioRESUMO
BACKGROUND: There has been increasing attention over the last decade on the issue of indigenous youth suicide. A number of studies have documented the high prevalence of suicide behavior and mortality in Australia and internationally. However, no studies have focused on documenting the correlates of suicide behavior for indigenous youth in Australia. AIMS: To examine the prevalence of suicide ideation and attempt and the associated factors for a community1 cohort of Koori2 (Aboriginal) youth. METHOD: Data were obtained from the Victorian Aboriginal Health Service (VAHS) Young People's Project (YPP), a community initiated cross-sectional data set. In 1997/1998, self-reported data were collected for 172 Koori youth aged 12-26 years living in Melbourne, Australia. The data were analyzed to assess the prevalence of current suicide ideation and lifetime suicide attempt. Principal components analysis (PCA) was used to identify closely associated social, emotional, behavioral, and cultural variables at baseline and Cox regression modeling was then used to identify associations between PCA components and suicide ideation and attempt. RESULTS: Ideation and attempt were reported at 23.3% and 24.4%, respectively. PCA yielded five components: (1) emotional distress, (2) social distress A, (3) social distress B, (4) cultural connection, (5) behavioral. All were positively and independently associated with suicide ideation and attempt, while cultural connection showed a negative association. CONCLUSIONS: Suicide ideation and attempt were common in this cross-section of indigenous youth with an unfavorable profile for the emotional, social, cultural, and behavioral factors.
Assuntos
Havaiano Nativo ou Outro Ilhéu do Pacífico/psicologia , Estresse Psicológico/psicologia , Ideação Suicida , Tentativa de Suicídio/psicologia , Adolescente , Adulto , Austrália/epidemiologia , Criança , Estudos de Coortes , Estudos Transversais , Análise Fatorial , Feminino , Humanos , Masculino , Havaiano Nativo ou Outro Ilhéu do Pacífico/estatística & dados numéricos , Modelos de Riscos Proporcionais , Fatores de Risco , Meio Social , Estresse Psicológico/epidemiologia , Tentativa de Suicídio/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Adulto JovemRESUMO
A 3-year-old girl with a history of bilateral retinoblastoma presented with a new right lower periorbital mass that showed calcifications on ultrasound. She had previously undergone systemic and intra-arterial chemotherapy for retinoblastoma but had no evidence of active disease for at least 6 months previously. Her family and oncologists feared that this mass was an extraocular metastasis of her retinoblastoma. On excision, it was diagnosed as a pilomatrixoma, an uncommon benign neoplasm that originates from the matrix of the hair root. This is the first reported case of pilomatrixoma in a patient with retinoblastoma.
Assuntos
Doenças do Cabelo/complicações , Pilomatrixoma/complicações , Neoplasias da Retina/complicações , Retinoblastoma/induzido quimicamente , Neoplasias Cutâneas/complicações , Antineoplásicos Alquilantes/uso terapêutico , Pré-Escolar , Pálpebras , Feminino , Doenças do Cabelo/diagnóstico por imagem , Doenças do Cabelo/cirurgia , Humanos , Melfalan/uso terapêutico , Pilomatrixoma/diagnóstico por imagem , Pilomatrixoma/cirurgia , Neoplasias da Retina/tratamento farmacológico , Retinoblastoma/tratamento farmacológico , Neoplasias Cutâneas/diagnóstico por imagem , Neoplasias Cutâneas/cirurgia , UltrassonografiaRESUMO
BACKGROUND: Intra-arterial administration of melphalan chemotherapy has shown promise in the treatment of retinoblastoma. This report describes our results using superselective intra-arterial melphalan in patients with newly diagnosed retinoblastoma and those who were treated for progression after systemic chemotherapy. METHODS: This is a retrospective review of all retinoblastoma patients treated with intra-arterial melphalan at the University of California, San Francisco from March 2010 to August 2012. Twenty eyes (16 patients) underwent 40 intra-arterial melphalan infusions, and dose was determined by age. Patients were treated at monthly intervals and received a range of 1-5 treatments. Response to therapy, toxicity, and procedural radiation exposure was assessed. RESULTS: All patients are alive without metastatic disease at a median follow-up of 14.5 (1-29) months. Treatment with enucleation or external beam radiation was avoided in 11/20 eyes (55%) overall [6/12 (50%) in newly diagnosed eyes and 5/8 (63%) in refractory/relapsed eyes]. Response rates (per the International Classification of Retinoblastoma) were as follows: 6/7 (86%) in groups A-C and 5/13 (38%) in groups D and E. Nonhematologic and hematologic toxicities were minimal and comparable with those in previous reports. The mean procedural radiation dose was 20.2 ± 11.9 mGy per eye per procedure. CONCLUSION: Superselective intra-arterial melphalan therapy is effective for less advanced eyes but further modifications to therapy are required to improve results in eyes with advanced retinoblastoma.