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Biomedical subjects

D J Coleman

Publications and source records attributed to D J Coleman.

At least 91 records · Page 5Linked to original sources

Ultrasonic hyperthermia and radiation in the management of intraocular malignant melanoma.

Hyperthermia and radiation were used in combination to treat four patients with choroidal malignant melanoma. This technique uses ultrasonically induced hyperthermia synergistically with radiation to destroy tumor cells. The lower levels of radiation used should avoid the late vascular and inflammatory complications seen in conventional radiation therapy. Tumors were scanned by a computerized diagnostic ultrasound system before treatment and assigned an acoustic tissue type on the basis of a statistical comparison of their ultrasound backscatter spectrum with spectra of tumors of known pathologic status. During the follow-up period, the longest of which was 15 months, all tumors demonstrated regression patterns consistent with choroidal tumors of the same acoustic tissue types treated with conventional radiation therapy.

Aged↗

Therapeutic ultrasound.

Currently the most widely applied use of therapeutic ultrasound in ophthalmology is for the treatment of refractory glaucoma. This new technique is described, histologic changes in experimental animals discussed, and mode of action postulated. The intraocular pressure (IOP) results obtained after treatment of 187 patient eyes are presented, with a review of complications and visual acuity changes. This study demonstrates that 70% of patients treated had an IOP reduction to 25 mm Hg or less one year after ultrasound therapy.

Adult↗

Ultrasonic tissue characterization and histopathology in tumor xenografts following ultrasonically induced hyperthermia.

Cells derived from human skin malignant melanoma were implanted subcutaneously in athymic nude mice. Tumors which developed at the implant site were treated with ultrasonically induced hyperthermia at 49 degrees C for 30 min. Tumors were scanned with a computerized diagnostic ultrasound system before and after treatment. Light (LM) and electron (EM) micrographs of tumors were obtained after scanning. Changes in ultrasonic tissue characterization parameters following treatment were well correlated with histopathologic changes observed in tumors. The results are significant in terms of clinical application of ultrasonically induced hyperthermia for treatment of intraocular tumors and the noninvasive monitoring of tumors by use of diagnostic ultrasound.

Animals↗

Treatment of glaucoma with high-intensity focused ultrasound.

This report is a summary of results for 170 eyes of patients with refractory glaucoma treated with high-intensity focused ultrasound. The results are analyzed in terms of the effectiveness of various treatment regimens, complications, and classifications of the patient population according to such factors as age and etiology. The mean pretreatment intraocular pressure (IOP) for the ensemble of patients treated with optimal intensity levels was 38.6 mmHg. Whereas only 10% of these patients had an IOP of 25 mmHg or less prior to treatment, 90% had an IOP of 25 mmHg or less within 3 months of treatment. At 1 year after a single treatment, 65% of patients still maintained intraocular pressures of 25 mmHg or less, and 56% had pressures of 22 mmHg or less. The effectiveness of retreatment of failed or unresponsive cases was also investigated and found to have a degree of success comparable to that of initial treatments.

Choroid↗

Proton beam irradiation and hyperthermia. Effects on experimental choroidal melanoma.

Ultrasonically induced hyperthermia (4.75 MHz) and proton irradiation (160 meV) were evaluated alone and combined to treat experimental choroidal melanoma in 58 rabbit eyes. Threshold tumoricidal doses were established for each modality. Therapy was performed combining subthreshold doses of heat and radiation. Focused ultrasonic energy via an external beam was found to deliver well-localized heat to an intraocular tumor. Ectopic temperature elevations due to soft-tissue-bone interfaces were alleviated by modifying beam alignment. The results indicate that hyperthermia (43 degrees C for one hour) potentiated the tumoricidal effects of radiation, while sparing normal ocular structures. Therefore, we believe that experimental hyperthermia is suitable as an adjuvant treatment modality. This shows that ultrasound hyperthermia has the potential to increase the efficacy of proton irradiation by lowering radiation doses and thus decreasing posttreatment ocular morbidity in human intraocular malignancies.

Animals↗

Magnetic resonance imaging in the evaluation of leukocoria.

Leukocoria is an important clinical sign in ophthalmology. Conditions producing this white pupillary reflex must be differentiated from retinoblastoma to insure appropriate and timely treatment. Auxiliary diagnostic testing has been helpful in securing a clinical diagnosis. A new diagnostic modality, magnetic resonance imaging, provides similar morphologic information with the additional potential for biochemical characterization. A series consisting of 14 patients presenting with leukocoria as a result of retinoblastoma and simulating conditions was examined. The magnetic resonance imaging findings are discussed.

Child↗

Perfluorocarbon gases in vitreous surgery.

Fifty-six patients with complicated retinal detachments were managed with vitreous surgery and one of two perfluorocarbon gases. These gases are capable of greater expansion and greater longevity compared to sulfur hexafluoride. Forty-five patients received perfluoropropane (C3F8), eleven received perfluoroethane (C2F6). The retinas of 31 patients (55.4%) were attached at six months after the disappearance of the gas. In many instances, operations performed with air-sulfur hexafluoride mixtures had failed and the retina was subsequently reattached with the use of the perfluorocarbon gases. The major complications were increased intraocular pressure, which was usually transient, and gas-induced lens opacities.

Fluorocarbons↗

Therapeutic ultrasound in the treatment of glaucoma. II. Clinical applications.

Focused, high-intensity therapeutic ultrasound was used to treat 69 selected patients with uncontrollably elevated intraocular pressure (IOP). This new technique selectively thins scleral collagen, and produces focal damage to the ciliary epithelium. These tissue modifications provide a reduction in IOP pressure to 25 mmHg or less in 83% of patients with a minimum three-month follow-up period.

Ciliary Body↗

Therapeutic ultrasound in the treatment of glaucoma. I. Experimental model.

Controlled ultrasonic energy was used to treat a series of laboratory animals in which glaucoma had been induced experimentally. Insonification successfully reduced elevated intraocular pressure in the majority (86%) of test animals. Histopathologic review of globes examined at varying time intervals following treatment showed localized thinning of the sclera with intact conjunctiva, allowing filtration and focal disruption of ciliary epithelium. This technique of treating elevated intraocular pressure in a noninvasive manner offers potential for clinical application in humans.

Animals↗

Effect of hyperthermia on experimental choroidal melanoma.

Thirty-five rabbit eyes were implanted subchoroidally with Greene's hamster melanoma. When the tumours reached a base diameter of 5 mm, they were treated with ultrasonically induced hyperthermia with a range of temperatures and exposure durations (43-67 degrees C and 75 s to 60 min). Of the 23 treated eyes examined two months after treatment eight showed complete regression of the tumour. Seven showed initial tumour regression, but there was subsequent regrowth of tumour round the margins of the original mass. In eight eyes the tumour continued to grow, though in some cases the rate of growth appeared to be slower than in the controls. In contrast, in all untreated animals the tumour grew to fill the vitreous cavity. These preliminary findings indicate that ultrasonically induced hyperthermia can be an effective local treatment of this intraocular tumour model.

Animals↗

Treatment of experimental lens capsular tears with intense focused ultrasound.

High-intensity focused ultrasound was employed to seal lens capsular tears in a rabbit model. Ultrasound therapy was applied either contiguously, thereby completely covering the tear, or in a discrete exposure pattern around the tear. Both methods prevented the formation of a generalised cataract. This was in contrast to results observed in a group of control (untreated) animals which all developed generalised lens opacities. Each control animal also developed a local lens opacity at the site of the capsular tear, as did half the animals treated with the discrete pattern. No animal treated with contiguous exposures developed any local or generalised traumatic-type cataract other than the small lens opacity immediately produced by the treatment. These treatment cataracts would not constitute a significant impediment to vision so long as they did not fall on the visual axis.

Animals↗

A model for acoustic characterization of intraocular tumors.

Human intraocular tumors and tumors derived from human tumor cell lines grown subcutaneously in the athymic nude mouse were scanned by diagnostic ultrasound. Radiofrequency scan data were converted to digital form and analyzed in the frequency domain. Characteristics of normalized power spectra were found to be significantly different among human spindle cell malignant melanomas, mixed/epithelioid malignant melanomas, metastatic carcinomas, and hemangiomas. Significant differences, as well, were found between implanted primary skin malignant melanomas and adenocarcinomas of the lung, colon, and stomach. Comparison of spectral properties of human intraocular and implanted tumors revealed that human spindle cell malignant melanomas and implanted melanomas exhibit similar characteristics. Human intraocular metastatic tumors from the lung were found to exhibit characteristics similar to those of implanted lung tumors. These results indicate that the implantation of human tumor cell lines in the nude mouse may provide a very useful model for application of diagnostic and therapeutic ultrasound modalities to human intraocular tumors.

Acoustics↗