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Biomedical subjects

C L Shields

Publications and source records attributed to C L Shields.

At least 325 records · Page 18Linked to original sources
PubMed1990

Comparison of xenon arc and argon laser photocoagulation in the treatment of choroidal melanomas.

We analyzed the follow-up data in 38 consecutive patients with selected choroidal melanomas that were treated by photocoagulation between 1971 and 1980. Indications for treatment included photographic documentation of tumor growth or an unequivocally positive radioactive phosphorus uptake test, or both. Xenon arc photocoagulation was used in 22 patients (58%) and argon laser was used in 16 patients (42%). At the time of data analysis, the length of follow-up was at least 58 months in all patients. Although all treated tumors were initially eradicated according to ophthalmoscopic and fluorescein angiographic criteria, there was subsequent regrowth in three of the 22 patients (14%) treated with xenon photocoagulation and in ten of the 16 patients (64%) treated with argon laser. The recurrences were observed on an average of 71 months after completion of treatment in the xenon-treated group and on an average of 30 months in the argon-treated group. More treatment sessions were required in the argon laser group to achieve tumor control. Complications of vitreous hemorrhage, cystoid macular edema, and retinal detachment were greater in the xenon photocoagulation group.

Adult↗
PubMed1990

Multiple orbital neurofibromas unassociated with von Recklinghausen's disease.

A 58-year-old man with a 10-year history of right periorbital pain treated with multiple analgesics presented with slowly progressive exophthalmos of the right eye. Orbital imaging studies disclosed three separate well-defined tumors, located in the temporal fossa, the intraconal space, and within the floor of the orbit. All three tumors were removed intact and proved on histopathologic evaluation to be localized neurofibromas. The patient had complete relief of the chronic pain following removal of the tumors. We emphasize that the unusual occurrence of multiple circumscribed orbital tumors should suggest the diagnosis of neurofibroma even in the absence of von Recklinghausen's neurofibromatosis.

Humans↗
PubMed1990

The role of photocoagulation in the management of retinoblastoma.

We treated selected patients with retinoblastoma with xenon arc photocoagulation between February 1974 and August 1987. Of 790 individual tumors in 410 affected eyes, 45 were treated by this technique. Overall photocoagulation alone was successful in eradicating 76% of the tumors, while in 24% of the tumors additional treatment with cryotherapy, plaque radiotherapy, external beam radiotherapy, or enucleation was necessary. In cases where the tumor was less than or equal to 3.0 mm in diameter and 2.0 mm in thickness and was confined to the sensory retina, without seeding into the adjacent vitreous, tumor destruction was achieved with photocoagulation. The mean number of photocoagulation sessions needed for complete tumor regression was 2.5. Photocoagulation alone was generally unsuccessful for tumors greater than 4.5 mm in diameter and 2.5 mm in thickness, and supplemental treatment with other modalities was often necessary in such cases. Based on observations in these patients, we point out certain misconceptions regarding photocoagulation of retinoblastomas and define our current indications and contraindications for this treatment modality.

Adolescent↗
PubMed1990

Solitary orbital involvement with juvenile xanthogranuloma.

A newborn girl was noted to have a smooth superonasal orbital and preseptal mass at the time of birth. The mass enlarged slightly over 3 months and a biopsy revealed histiocytes and Touton giant cells, compatible with juvenile xanthogranuloma. The infant had no other manifestations of juvenile xanthogranuloma. The mass subsided after systemic corticosteroid therapy was administered. Solitary orbital involvement with juvenile xanthogranuloma is exceedingly rare and most of these patients are found to lack the typical cutaneous lesions. Observation, oral prednisone, or low-dose radiotherapy are recommended forms of treatment.

Adrenal Cortex Hormones↗
PubMed1990

Enucleation after plaque radiotherapy for posterior uveal melanoma. Histopathologic findings.

A review of 1019 patients with posterior uveal melanomas, who were treated with episcleral plaque radiotherapy between April 1976 and December 1987, showed that 59 (6%) of these patients have thus far required enucleation of the affected eye. The most common clinical reasons for enucleation were tumor regrowth (51%) and neovascular glaucoma (31%). These irradiated melanomas were of mixed cell type in 40 cases (68%), spindle in 10 cases (17%), totally necrotic in 7 cases (12%), and epithelioid in 2 cases (3%). Some degree of tumor necrosis was seen in all cases. Overall, the median number of mitoses per 40 high-power fields in these irradiated tumors was 0. Most (64%) of the tumors had no identifiable mitosis in 40 high-power fields. A three-way simultaneous comparison of the following groups was made: irradiated eyes enucleated for tumor regrowth, irradiated eyes enucleated for neovascular glaucoma, and a matched group of nonirradiated posterior uveal melanomas. This comparison showed that the largest tumor dimension was significantly greater in the irradiated eyes enucleated for tumor regrowth than in the other two groups. Mitotic activity was significantly higher in the irradiated tumor regrowth and nonirradiated groups than in the irradiated neovascular group. There was no significant difference among the three groups in an analysis of height. The results suggested that mitotic activity may exist after plaque radiotherapy, especially when there is clinical evidence of tumor regrowth.

Brachytherapy↗
PubMed1990

Color Doppler imaging in the management of intraocular tumors.

Forty-four intraocular mass lesions were studied using a new, non-invasive ultrasound technique known as color Doppler imaging (CDI). This technique displays color-encoded Doppler flow information throughout a two-dimensional gray scale image thus providing selective analysis of Doppler spectra in small vessels using pulsed Doppler. Abnormal Doppler shifts were demonstrated within 39 neoplastic lesions studied, but Doppler shifts could not be detected in three tumor-simulating lesions. In a group of 12 choroidal melanomas studied after radiation therapy, lower Doppler shifts were seen compared with a group of 28 tumors before therapy. This change in Doppler shift may reflect the decreased vascular supply of the tumor. Color Doppler imaging may be of value as an additional useful tool in the diagnosis and management of intraocular tumors.

Adolescent↗
PubMed1990

Cystic adenoma of the pigmented ciliary epithelium. Clinical, pathologic, and immunohistopathologic findings.

A 51-year-old white man was found to have a deeply pigmented mass in the ciliary body and peripheral choroid of his right eye with an associated vitreous hemorrhage. Although the tumor appeared to be a ciliochoroidal melanoma, a melanocytoma and adenoma of the pigment epithelium also were considered in the differential diagnosis. The tumor was removed by a large partial lamellar sclerocyclochoroidectomy. Results of histopathologic evaluation showed a cystic adenoma of the pigmented ciliary epithelium. To the authors' knowledge, this was the first immunohistopathologic study of this tumor. Results of the study showed marked immunoreactivity for low molecular weight cytokeratins, vimentin, and S-100 protein. These immunohistochemical studies are consistent with the origin of this tumor from pigment epithelial cells.

Antibodies, Monoclonal↗
PubMed1990

Malignant melanoma associated with melanocytoma of the optic disc.

A 61-year-old white man underwent enucleation because of progressive growth of a pigmented epipapillary tumor that was diagnosed 9 years earlier as an optic nerve and juxtapapillary melanocytoma. Histopathologic studies showed the tumor was a malignant melanoma of the optic disc and juxtapapillary retina and choroid. Foci of typical melanocytoma cells were within the tumor. The tumor produced segmental atrophy of the optic nerve. This is a rare example of a malignant melanoma developing in conjunction with a lesion that possessed typical clinical and histopathologic features of a melanocytoma of the optic disc.

Cell Transformation, Neoplastic↗
PubMed1990

Cutis marmorata telangiectatica congenita associated with bilateral congenital retinal detachment.

Cutis marmorata telangiectatica congenita is a rare congenital vascular disorder of the skin, characterized by persistent telangiectasia of the cutaneous blood vessels often associated with cutaneous ulcers. The only previously recognized ophthalmic association with this condition has been rare instances of unilateral congenital open angle glaucoma. The authors report their observations in a child in whom this cutaneous disorder was associated with congenital bilateral total retinal detachments and secondary neovascular glaucoma. The retinal detachments produced bilateral leukocoria simulating retinoblastoma. The cutaneous disorder and the ocular findings were confirmed histopathologically.

Corneal Diseases↗
PubMed1990

Retinal hemangioma-like lesions in eyes with retinitis pigmentosa.

The authors report two patients with bilateral vascular masses of the peripheral retina associated with primary pigmentary dystrophy of the retina (retinitis pigmentosa). Although they are most similar to the retinal capillary hemangiomas of von Hippel, the affected patients had no clinical history or clinical findings suggestive of that syndrome. They differ from the calcified retinal hamartomas that have been associated with retinitis pigmentosa because they do not show the extensive telangiectasia and exudation seen with the exudative retinopathy that has been described with retinitis pigmentosa. They do not show the fluorescein angiographic pattern that characterizes peripheral choroidal neovascularization. Their main complication seems to be vitreous hemorrhage rather than exudative retinopathy. The authors discuss the possible relationship of these acquired retinal vascular masses to the retinitis pigmentosa.

Adrenal Cortex Hormones↗
PubMed1990

Mucinous adenocarcinoma metastatic to the iris, ciliary body, and choroid.

A 67-year-old woman presented with signs of severe intraocular inflammation and secondary glaucoma. The initial diagnosis was uveitis, and an anterior chamber paracentesis with cytological study of the aspirate failed to establish an aetiological diagnosis. After three trabeculectomies had failed to control the intraocular pressure, the blind eye was enucleated. On histopathological examination a mucinous adenocarcinoma was found to cover diffusely the iris surface and to involve the ciliary body and peripheral choroid. The patient subsequently developed evidence of widespread metastatic disease and died shortly thereafter. Although a primary tumour was never found, histochemical and immunohistochemical studies of the enucleated eye suggested that the lesion originated in the gastrointestinal tract. In cases of intractable glaucoma and anterior chamber inflammation, metastatic carcinoma should be included in the differential diagnosis, and efforts should be made to substantiate the diagnosis by a systemic examination or a biopsy.

Adenocarcinoma, Mucinous↗
PubMed1990

Review of lacrimal gland lesions.

A review of 142 lacrimal gland biopsies performed during a 25 year period revealed that 78% of lacrimal gland lesions were of nonepithelial origin and only 22% were primary epithelial neoplasms. The nonepithelial lesions included inflammation (64%) and lymphoid tumors (14%), while the epithelial lesions included dacryops (6%), pleomorphic adenoma (12%), and malignant epithelial tumors (4%). These results contradict the much quoted teaching that 50% of lacrimal gland lesions are primary epithelial tumors and 50% are nonepithelial lesions.

Adolescent↗
PubMed1990

Clinical spectrum of histiocytic tumors of the orbit.

Histiocytic tumors of the orbit comprise an unusual group of lesions characterized by the infiltration of the orbital tissues by xanthomatous cells. Recently, there have been a number of new observations regarding the various histiocytic tumors that can affect the orbit. The condition previously referred to as histiocytosis X is believed to represent a proliferation of Langerhans cells and the term Langerhans cell histiocytosis is often used instead of histiocytosis X. Juvenile xanthogranuloma has been demonstrated to affect the orbit without involving the skin or the iris. The Erdheim-Chester disease is a condition of adults characterized by infiltration of bone, retroperitoneum, heart, lungs and other tissues by xanthoma cells. This condition has recently been recognized to produce a classic ophthalmological picture of bilateral xanthelasmas and bilateral proptosis. The authors review their personal experience with several patients with histiocytic tumors of the orbit and stress the clinical spectrum of these conditions.

Histiocytosis↗
PubMed1990

Current alternatives in the management of posterior uvea melanomas.

The management of malignant melanomas of the posterior uvea recently has become a topic of great controversy. The traditional treatment by enucleation of the tumor-containing eye has recently been challenged by a number of authorities, and clinicians more frequently are using alternative methods of management when possible. Current management can range from periodic observation and fundus photography of selected small lesions that appear dormant, to photocoagulation, radiotherapy, or local resection in the case of growing tumors in eyes with useful or salvageable vision. In cases where the tumor is far advanced and there is no hope of useful vision, enucleation is often inevitable. The choice of therapy is a complex issue and each case must be individualized. In selecting a therapeutic approach certain factors must be carefully weighed. These include the size of the melanoma, its extent and location, its apparent activity, the condition of the opposite eye and the age, general health, and psychological status of the patient. Based on personal experience with approximately 3000 cases, the authors discuss their current indications for the various therapeutic techniques for posterior uvea melanomas.

Brachytherapy↗
PubMed1990

Observations on intraocular leiomyomas.

Intraocular leiomyoma is a rare ophthalmic tumor that is generally believed to be impossible to differentiate clinically from amelanotic uveal malignant melanoma. Based on their personal experience with three cases of intraocular leiomyoma and a review of the literature, the authors describe certain features of leiomyoma that serve to differentiate this tumor from uveal melanoma. The leiomyoma occurs in younger patients and had a distinct predilection for females. It tends to affect the ciliary body and rarely occurs purely in the choroid. The tumor seems to grow in the supraciliary or suprachoroidal space between the uvea and the sclera and it does not seem to arise from the uveal stroma. If the tumor can be recognized clinically the best management seems to be local surgical resection by partial lamellar sclerouvectomy.

Adult↗
PubMed1990

Treatment of retinoblastoma with photocoagulation.

The authors summarize their experience and review the pertinent literature on photocoagulation in the treatment of selected patients with retinoblastoma. Photocoagulation appears to be an appropriate method of management in cases where the tumor is no greater than 3.0 mm in diameter and 2.0 mm in thickness and is confined to the sensory retina, without seeding into the adjacent vitreous. Photocoagulation alone is generally unsuccessful for tumors greater than 4.5 mm in diameter and greater than 2.5 mm in thickness and supplemental treatment with other modalities was often necessary in such cases. Based on personal observations the authors point out certain misconceptions regarding photocoagulation of retinoblastoma and define their current indications and contraindications for this treatment modality.

Eye Neoplasms↗
PubMed1990

Treatment of retinoblastoma with cryotherapy.

The authors report their personal experience and review the pertinent literature on cryotherapy in the treatment of selected patients with retinoblastoma. Tumor destruction with cryotherapy can generally be achieved with one or more treatments if the tumor is no greater than 2.5 mm in diameter and 1.0 mm in thickness and the tumor is confined to the sensory retina without seeding into the adjacent vitreous. Cryotherapy generally fails for larger tumors, particularly if there is clinical evidence of vitreous seeding by tumor cells. The authors define their current indications and contraindications for cryotherapy of retinoblastoma.

Cryosurgery↗