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Biomedical subjects

C L Shields

Publications and source records attributed to C L Shields.

At least 415 records · Page 23Linked to original sources
PubMedDate not supplied

The effect of intraarticular injection of morphine and bupivacaine on postarthroscopic pain control.

This study sought to compare the effects of morphine, bupivacaine, and saline injected into the knee after arthroscopic surgery. In a double-blind, randomized trial, 124 patients received either bupivacaine, morphine, bupivacaine and morphine, or saline at the completion of surgery. Postoperative pain was assessed with a 100-mm visual analog pain scale. Analgesic requirements were calculated, and weightbearing status was recorded. We found that morphine alone injected intraarticularly at the completion of arthroscopic knee surgery had no significant effect on postoperative pain, need for supplemental analgesia, or weightbearing status. Patients receiving morphine in combination with bupivacaine did not demonstrate any statistically significant improvement over those receiving bupivacaine alone. Therefore, our results failed to show any beneficial effect of morphine used for postoperative analgesia, either alone or in combination with bupivacaine. The overall pattern in all patients demonstrated decreased pain scores, decreased analgesic use, and increased weightbearing status as the observation period progressed. Finally, preoperative pain was correlated with pain at discharge, indicating that the most significant predictor of postoperative pain was preoperative level of discomfort.

Adolescent↗
PubMedDate not supplied

Acute tears of the medial head of the gastrocnemius.

Twenty-five patients with acute tears of the medial head of the gastrocnemius were evaluated in follow-up from 1 to 3 years after injury. The patients were treated with a heel lift, calf sleeve, and physical therapy. The majority of the patients were men who injured their dominant lower extremity in one explosive episode. Cybex II testing revealed no significant difference in the plantarflexion strength of the noninjured and injured extremity after healing. All patients returned to their previous level of athletic activity.

Adult↗
PubMedDate not supplied

Involution of retinochoroidal shunt vessel after radiotherapy for optic nerve sheath meningioma.

PURPOSE: To illustrate the development and involution of retinochoroidal shunt vessel of the optic disc in a patient with primary optic nerve sheath meningioma. CASE REPORT: A 38-year-old woman presented with gradual onset of blurred vision in her right eye. Examination revealed a right relative afferent pupillary defect and mild edema of the right optic disc. Computed tomography (CT) showed changes consistent with a primary optic nerve sheath meningioma affecting the orbital portion of the right optic nerve. Patient was observed without treatment and subsequently developed a retinochoroidal shunt vessel on her right optic disc. With progression of the meningioma towards the optic chiasm, treatment with stereotactic radiosurgery was done. Following treatment, the optic disc gradually became pale and the retinochoroidal shunt vessel decreased in caliber with complete involution three years after radiotherapy.

Adult↗
PubMedDate not supplied

Bilateral primary choroidal melanoma treated with bilateral plaque radiotherapy: a report of three cases.

PURPOSE: To report three cases of bilateral primary choroidal melanoma treated with bilateral plaque radiotherapy. METHODS: Retrospective, single-center case series. RESULTS: Case 1: In 1981, a 50-year-old man was diagnosed with a 5-mm-thick choroidal melanoma in the right eye (OD) and treated with plaque radiotherapy. In 1994, a 6.8-mm-thick choroidal melanoma in the left eye (OS) was treated with plaque radiotherapy. Final visual acuity was light perception OD and 20/20 OS at 24 years follow-up. Case 2: In 1983, a 53-year-old woman was diagnosed with a 3.5-mm-thick choroidal melanoma OS and treated with plaque radiotherapy. In 2001, an enlarging 2.5-mm-thick choroidal melanoma OD was treated with plaque radiotherapy. Final visual acuity was 20/30 OD and 20/20 OS at 22 years follow-up. Case 3: In 2001, a 92-year-old man was diagnosed with a 7.9-mm-thick choroidal melanoma OD treated with plaque radiotherapy. In 2003, an enlarging 2.8-mm-thick juxtapapillary choroidal melanoma was treated with plaque radiotherapy. Final visual acuity was 20/70 OD and 20/60 OS at 2.5 years follow-up. No patient showed ocular melanocytosis. Stable tumor regression was achieved in all six eyes. Metastatic disease did not develop in any case over 16 years of follow-up. CONCLUSIONS: Monitoring of both eyes of patients with uveal melanoma is important for the remote possibility of melanoma in the second eye. In these three patients, plaque radiotherapy allowed for preservation of the globes and some vision.

Aged, 80 and over↗
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Iris melanoma in a ten-year-old boy with familial atypical mole-melanoma (FAM-M) syndrome.

A ten-year-old boy was referred with an enlarging amelanotic iris tumor and secondary glaucoma in the left eye. After excisional biopsy it proved histopathologically to be an iris melanoma. The patient also had multiple nevi on his trunk, scalp, and buttocks suggestive of familial atypical mole melanoma (FAM-M) syndrome and confirmed histopathologically. To the authors' knowledge, this is the first report of iris melanoma in association with FAM-M syndrome. The young age at tumor onset is suggestive of a predisposing condition such as FAM-M syndrome. The association of uveal melanoma with FAM-M syndrome is discussed.

Child↗
PubMedDate not supplied

Lesions simulating retinoblastoma.

Of 500 consecutive patients referred to the Ocular Oncology Service at Wills Eye Hospital with the diagnosis of possible retinoblastoma, 288 (58%) were found on clinical evaluation to have retinoblastoma and 212 (42%) had lesions that simulated retinoblastoma. A total of 23 different conditions accounted for the 212 pseudoretinoblastomas. Three most common pseudoretinoblastomas were: persistent hyperplastic primary vitreous (28%), Coats' disease (16%), and presumed ocular toxocariasis (16%). Congenital cataract and retinopathy of prematurity accounted for a much lower percent of pseudoretinoblastomas in this series as compared to a previously reported series. The pertinent clinical features that serve to differentiate these simulating lesions from retinoblastoma are reviewed.

Diagnosis, Differential↗
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Enucleation technique for children with retinoblastoma.

Based on personal experience with approximately 350 enucleations for retinoblastoma, the authors describe their current surgical technique for removal of the eye, opening the globe to harvest fresh tissue for research including DNA analysis, and placement of the new hydroxyapatite orbital implant. Enucleation should be performed as gently as possible. A hemostat is placed on the stump of the severed medial rectus muscle for traction purposes, and long, minimally curved scissors are used to cut the optic nerve near the orbital apex. Clamps and snares are not advised and cautery of the orbital tissue is avoided. A piece of optic nerve is first submitted separately for histopathologic study and the globe is opened with a specific technique to harvest fresh tumor tissue. A hydroxyapatite implant covered by sterilized sclera is placed in the anophthalmic socket to provide orbital volume and improved motility of the prosthesis.

Child, Preschool↗
PubMedDate not supplied

Clinical variations of trilateral retinoblastoma: a report of 13 cases.

Of 440 consecutive children with retinoblastoma whom we treated between April 1972 and April 1992, 13 (3%) developed a midline intracranial neoplasm. Four of these 13 patients had bilateral familial retinoblastoma, 7 had bilateral sporadic retinoblastoma, and 1 patient had unilateral familial retinoblastoma. The twin brother of the latter patient developed pinealoblastoma without retinoblastoma. In this series, the incidence of trilateral retinoblastoma was 8% of all bilateral familial retinoblastoma and 5% of all bilateral sporadic retinoblastoma. The retinoblastoma was diagnosed at a mean age of 4.5 months and the midline intracranial tumor was diagnosed at a mean age of 23 months. The mean time interval between the diagnosis of retinoblastoma and the intracranial tumor was 22 months (range, 0 to 48 months). Seven patients (55%) were asymptomatic and their intracranial neoplasm was found on routine brain-imaging studies. The primary intracranial neoplasm had a pineal location in 10 cases and parasellar location in three cases. Despite aggressive combined treatment, 12 patients (92%) have died at a mean interval of 11 months after the diagnosis of intracranial malignancy. The mean survival of patients with midline intracranial neoplasm who were asymptomatic was significantly longer than that of symptomatic patients (P = .05).(ABSTRACT TRUNCATED AT 250 WORDS)

Brain Neoplasms↗
PubMedDate not supplied

Plaque radiotherapy for residual or recurrent retinoblastoma in 91 cases.

Plaque radiotherapy has been used successfully as primary treatment for selected solitary retinoblastomas. However, there is relatively little information on its role as a secondary treatment after other methods have failed to control the tumor. We have used solitary plaque radiotherapy to treat 91 children with residual or recurrent retinoblastoma after failure of one or more treatment modalities, which included external beam radiotherapy in 63 children, plaque radiotherapy in 9, cryotherapy in 26, and photocoagulation in 18, for a total of 116 treatments in the 91 children. Despite the fact that enucleation was considered to be the only remaining option in many of these children, tumor regression was achieved in 81 cases (89%) and recurrence developed in only 10 cases (11%) during a mean follow up lf 52 months. Treatment of the recurrence following plaque radiotherapy in these 10 cases included repeat plaque radiotherapy in 6 cases, enucleation in 3 cases, and external beam radiotherapy in 1 case. In view of the fact that enucleation was being considered as the only remaining option in many of these children, control of the tumor with plaque radiotherapy in 89% of the cases is very encouraging. Plaque radiotherapy should be considered as an important option for recurrent retinoblastoma after failure of other methods to achieve tumor control.

Brachytherapy↗
PubMedDate not supplied

Treatment of retinoblastoma with indirect ophthalmoscope laser photocoagulation.

INTRODUCTION: The indirect ophthalmoscope laser photocoagulation delivery system is relatively new and is potentially applicable for treating selected small retinoblastomas. There has been very little reported on the results achieved with this laser delivery system in the treatment of retinoblastoma. METHODS: We reviewed all patients with retinoblastoma managed by indirect ophthalmoscope laser photocoagulation on the Ocular Oncology Service between July 1, 1991 and July 1, 1994. The individual tumor size, location, and proximity to the optic disc and foveola, as well as the laser power, duration, and number of sessions ,were recorded. We assessed the tumor response to treatment and the visual outcome of the patients. RESULTS: There were 30 retinoblastomas in 20 eyes of 18 patients managed with indirect ophthalmoscope laser photocoagulation over the 3-year period. The mean tumor base was 2.1 mm (range: 1 mm to 8 mm); the mean tumor thickness, 1.2 mm (range: 0 mm to 3 mm). The tumor margin was a mean of 6.5 mm (range: 0 mm to 19 mm) from the foveola, and 7.7 mm (range: 0 mm to 22 mm) to the optic disc. In general, it required a power of approximately 350 mW and a continuous duration lasting 1 to 4 seconds to obtain satisfactory obliteration of feeding blood vessels. The tumor responded in one to three sessions (mean: 1.9 sessions per tumor). Complete regression occurred in 21 tumors (70%) and local recurrence in nine (30%). The recurrent tumors were successfully treated with plaque radiotherapy in seven cases and cryotherapy in two cases. The central vision was minimally distorted due to foveal traction from the laser treatment in three cases. CONCLUSION: Indirect ophthalmoscope laser photocoagulation is an effective conservative method to manage selected small retinoblastomas. Tumors treated by this technique should be followed closely due to the moderate risk for local recurrence.

Child, Preschool↗
PubMedDate not supplied

The effect of chemoreduction on retinoblastoma-induced retinal detachment.

BACKGROUND: Retinoblastoma with total retinal detachment traditionally has been managed with enucleation. We employed a chemoreduction protocol in an effort to reduce the tumor size to allow for focal treatment and salvage of the eye. METHODS: A prospective study was performed to assess the effects of a 2-month chemoreduction regimen of vincristine, etoposide, and carboplatin on massive retinoblastoma with total retinal detachment. RESULTS: We treated 17 eyes with total retinal detachment from retinoblastoma in 13 patients over a 14-month period. At the initial examination, the mean tumor base was 15 mm and mean thickness was 10 mm. The eyes were classified as Reese-Ellsworth group V in 16 cases (94%) and group III in one case (6%). The retina was totally detached with serous subretinal fluid in all cases. After 2 months of chemoreduction, all tumors showed a response, and the tumors decreased to a mean base of 10 mm and thickness of 5 mm. Overall, a mean of 33% decrease in base and 47% decrease in thickness was noted. The subretinal fluid had resolved completely in seven eyes (41%), leaving flat retina. In three eyes (18%), partial resolution was achieved; in seven eyes (41%), minimal resolution of the subretinal fluid at the 2-month period was noted. By last follow up, at a mean of 10 months after initiation of chemoreduction, complete resolution of the subretinal fluid occurred in 13 eyes (76%) and partial resolution of subretinal fluid occurred in four eyes (24%). CONCLUSION: Preliminary observations suggest that chemoreduction may be an important tool in the initial management of retinoblastoma, even for large tumors with total retinal detachment. Tumor shrinkage may be dramatic and subretinal fluid resolution may be complete.

Antineoplastic Combined Chemotherapy Protocols↗