Search PubMed⌕ Search

Biomedical subjects

J A Shields

Publications and source records attributed to J A Shields.

At least 253 records · Page 14Linked to original sources
PubMed1994

Uveal metastasis from carcinoid tumor. Clinical observations in nine cases.

BACKGROUND: Carcinoid tumor is a low-grade malignancy that usually arises in the gastrointestinal tract or bronchus and rarely metastasizes to the eye. Metastasis of carcinoid tumor to the uvea can be confused clinically with other primary and metastatic uveal tumors. METHODS: The authors reviewed the records of 410 consecutive patients with uveal metastases referred to the Ocular Oncology Service at Wills Eye Hospital to identify those in whom carcinoid tumor was the primary neoplasm. The authors evaluated the clinical features of these metastases. RESULTS: Of 410 consecutive patients with uveal metastases, the primary neoplasm was a carcinoid tumor in 9 (2.2%). There were four men and five women. The mean age at ocular diagnosis was 50 years. In five patients (56%), the primary tumor was undiagnosed at ocular presentation. In the other four patients, the mean time interval from diagnosis of the primary carcinoid tumor to uveal metastasis was 89 months (range, 55-180 months). The site of the primary carcinoid tumor was the bronchus in seven patients, the esophagus in one, and the thymus in one. The site of intraocular metastasis was the choroid in six patients, the ciliary body in two, and the iris in one. All choroidal tumors had a characteristic orange color. Initial ocular treatment included external beam radiotherapy in five patients, plaque radiotherapy in two, argon laser photocoagulation in one, and local resection in one. Ocular tumor control was achieved in each patient. After a mean follow-up of 34 months, four patients (44%) are still alive. Five patients have died, with a mean survival of 34 months (range, 2-104 months) after the diagnosis of uveal metastasis. CONCLUSIONS: Uveal metastasis from carcinoid tumor is rare and tends to arise from the bronchus. Clinically, it has a distinctive orange color and may be associated with a longer systemic survival, compared with uveal metastasis from other primary sites.

Adult↗
PubMed1994

The expanding role of laser photocoagulation for intraocular tumors. The 1993 H. Christian Zweng Memorial Lecture.

BACKGROUND: Methods of management for intraocular tumors include observation, radiotherapy, surgery, and laser therapy. Indications for and techniques of laser photocoagulation in the management of intraocular tumors have never been clearly defined in one report, however. METHODS: A review of selected cases of choroidal and retinal tumors treated with laser therapy between 1974 and 1993 was conducted, as was the literature on laser treatment of intraocular tumors. Based on these observations, indications for, techniques of, and results of laser treatment of selected intraocular tumors are discussed. RESULTS: The results suggest that the preferred technique of laser treatment varies with the type of tumor. Small melanomas are treated by two or three sessions of laser around the tumor and subsequent heavy treatment directly to the tumor. Choroidal nevus with serous detachment of the fovea is treated by either delimiting laser or direct treatment of focal leaks, depending on the distance of the lesion from the foveola. Choroidal hemangiomas are treated by light to medium photocoagulation over the tumor surface to create chorioretinal adhesion and reattachment of the retina. A small retinoblastoma is best treated by surrounding the tumor with heavy laser to destroy its blood supply without treating the lesion directly. Retinal capillary hemangioma can be treated by heavy direct laser application to the tumor, or by obliterating first the feeding artery and later the draining vein. CONCLUSION: Laser photocoagulation is an acceptable therapeutic option for selected benign and malignant intraocular tumors, and its role in the overall management of patients with intraocular tumors is expanding.

Choroid Neoplasms↗
PubMed1994

Clinical management of retinoblastoma.

There have been many recent advances in the diagnosis and management of children with retinoblastoma. Regarding diagnosis, the judicial use of ancillary studies, particularly B-scan ultrasonography, has been instrumental in supplementing the diagnosis when opaque media preclude a clear view of the underlying neoplasm. Computed tomography and magnetic resonance imaging are important in the early detection of associated pinealoblastoma, which occurs as part of the recently described syndrome of "trilateral retinoblastoma." With regard to management, the technique of enucleation continues to improve and the scleralized hydroxyapatite implant is now available to provide a better cosmetic appearance and better motility of the artificial eye. Methods have been described for harvesting fresh tumor tissue immediately after enucleation for special DNA studies. Recent reports have documented a decreasing frequency of enucleation and an increasing tendency to use eye-preserving methods of management. Plaque radiotherapy, which provides more localized irradiation to the specific tumor, is gradually supplanting external beam irradiation for localized retinoblastoma that does not exhibit extensive vitreous seeding. The indications and contraindications for cryotherapy and photocoagulation have been more clearly delineated. The role of chemotherapy is being evaluated in the treatment of primary retinoblastoma and for metastatic disease. New breakthroughs in genetic research are being applied to clinical genetic counseling. The prognosis for life and for preservation of vision has improved greatly in recent years.

Combined Modality Therapy↗
PubMed1994

Impact of enucleation versus plaque radiotherapy in the management of juxtapapillary choroidal melanoma on patient survival.

The records of 265 consecutive patients with juxtapapillary choroidal melanoma were reviewed and a statistical non-randomised retrospective study was performed to evaluate the risk for metastasis and compare the survival rate of patients treated with plaque radiotherapy or enucleation. To obtain sufficient overlap between the enucleation and plaque radiotherapy, the statistical analysis was limited to an adjusted subgroup of 127 patients who met eligibility criteria for plaque radiotherapy and who had a minimum of 3 years of follow up after treatment. In the adjusted subgroup of 127 patients, 92 patients (72%) were initially treated with enucleation and 35 (28%) with plaque radiotherapy. In both univariate and multivariate logistic analysis models, the age of the patient (> 50 years), tumour thickness (> 3 mm), and treatment by age interaction were found to be significant factors for development of distant metastasis. In patients younger than 50 years, the method of treatment (enucleation versus plaque radiotherapy) did not significantly affect the risk of metastasis. For those older than 50 years, there was a non-significant trend for patients in the enucleation group to be at a higher risk for metastasis than those in the plaque group. In the enucleation group, patients older than 50 years had a significantly higher incidence of distant metastasis than those younger than 50 years. In the plaque radiotherapy group, there was no significant higher incidence of metastasis in patients younger than 50 years than in those older than 50 years. When a Cox proportional hazards model was used to evaluate the survival rate, there was the same statistically significant effect of treatment by age interaction as was found in the multivariate logistic model on survival time. Moreover, there was a significant effect of treatment by tumour thickness interaction on survival time. Patients in the enucleation group had a better survival rate when the thickness of the tumour was less than 3 mm compared with a tumour of more than 3 mm. There were no apparent effects of tumour thickness on survival for patients treated with plaque radiotherapy. From these results, the authors currently recommend plaque radiotherapy as a viable option to enucleation in patients with juxtapapillary choroidal melanoma.

Adolescent↗
PubMed1994

Problems with the hydroxyapatite orbital implant: experience with 250 consecutive cases.

The coral derived hydroxyapatite sphere is a popular, integrated orbital implant designed to provide improved motility of the ocular prosthesis following enucleation. Although the implant has rapidly become widely used by ophthalmologists, little information is available regarding the problems of this technique in a large series of cases. Experience with 250 consecutive cases of hydroxyapatite orbital implant use was reviewed and the problems of the implants and their management investigated specifically. The reasons for enucleation included uveal melanoma (157 cases), retinoblastoma (70 cases), blind painful eye (22 cases), and intraocular medulloepithelioma (one case). Earlier treatment to the eye was performed before enucleation in 47 cases and included repair of ruptured globe (17 cases), plaque radiotherapy (18 cases), external beam radiotherapy (six cases), and others (six cases). During a mean of 23 months' follow up (range 6-40 months), there have been no recognisable cases of orbital haemorrhage related to the implant, and no cases of implant extrusion or implant migration. There was one case of presumed orbital infection (culture negative) that resolved with intravenous antibiotics and the implant was retained within the orbit. Other problems included conjunctival thinning in eight cases managed by observation and prosthesis adjustment, and conjunctival erosion in four cases managed by combinations of scleral patch graft, conjunctival flap, and prosthesis adjustment. The conjunctival erosion was caused by a poorly fitting prosthesis in three cases and wound dehiscence in one case. The problem rate in eyes receiving prior radiotherapy or surgery was not increased. The hydroxyapatite integrated orbital implant is a well tolerated motility implant without the high rate of extrusion and infection seen with other motility implants. The prosthesis fit may contribute to the tolerance of the implant.

Child↗
PubMed1994

[Iris neovascularization, increased intraocular pressure and vitreous hemorrhage as risk factors for invasion of the optic nerve and choroid in children with retinoblastoma].

A review of 289 eyes enculeated for retinoblastoma to evaluate prognostic factors for involvement of the choroid or optic nerve revealed choroidal invasion in 67 eyes (22%) and optic nerve invasion in 84 eyes (27%) due to retinoblastoma. Intraocular pressure (IOP) > or = 22 mmHg was found in 85 eyes prior to enucleation. A total of 118 eyes (38% showed histopathologic evidence of the development of glaucoma: 90 of them with iris neovascularisation and 28 with angle closure configuration. Patients with elevated IOP, iris neovascularisation and angle closure configuration had a significantly higher risk of optic nerve (P < 0.005) and choroidal (P < 0.002) involvement. On the other hand, optic nerve invasion due to retinoblastoma was significantly more frequent in eyes with elevated IOP (P < 0.02) and iris neovascularisation or angle closure configuration (P < 0.01). Risk factors for choroidal invasion of retinoblastoma were raised IOP (P < 0.04) and iris neovascularisations or angle closure configuration (P < 0.01) (univariant analysis). Raised IOP, iris neovascularisations and vitreous haemorrhage remained significant in the multivariant analysis. This study emphases the importance of IOP, iris neovascularisation and angle closure configuration as risk factors for outspreading invasion due to retinoblastoma.

Adolescent↗
PubMed1994

Hepatocellular carcinoma metastatic to the orbit in an African patient.

Primary hepatocellular carcinoma rarely metastasizes to the orbit. We report a 19-year-old black man from Zimbabwe who had hepatomegaly and an orbital mass. An orbital biopsy suggested a diagnosis of hepatocellular carcinoma. Immunohistochemical stains supported the diagnosis. To our knowledge, this is only the second reported case of hepatocellular carcinoma metastasizing to the orbit and the first such reported case from Africa.

Adult↗
PubMed1994

Peripheral giant-cell granuloma: a review.

In the past, the terms describing giant-cell granulomas of the oral tissues have been confusing. A peripheral soft tissue lesion and a central bony lesion are now well recognised. Trauma would not appear to be an important factor in the development of these lesions. The cells from which these lesions develop are likely to arise from periosteum a lamina propria, rather than periodontal ligament, as previously believed. This paper discusses, with case reports, the importance of correct diagnosis and management of the peripheral giant-cell granuloma.

Adolescent↗
PubMed1993

Uveal metastasis from prostate carcinoma.

BACKGROUND: Although breast and lung cancers account for most metastatic tumors to the uvea, prostate carcinoma metastatic to the uvea is relatively rare. METHODS: The authors reviewed 379 consecutive patients with uveal metastasis referred to the Ocular Oncology Service at the Wills Eye Hospital to determine the frequency of prostate carcinoma as the primary neoplasm. RESULTS: Of 379 consecutive patients with uveal metastasis, the primary tumor was prostate carcinoma in 7 (2% of all patients, 5% of male patients). The mean age at ocular diagnosis was 66 years. In six patients (85%) a prior history of prostate carcinoma was known and the prior history of prostate carcinoma was known and the mean time interval between the diagnosis of the primary tumor and the uveal metastasis was 28 months. All seven patients were found to have active or regressed metastases elsewhere. The choroid was involved in six patients (85%) and the iris in one (15%). Ocular treatment included external-beam radiation therapy in five patients (70%) and episcleral radioactive plaque in two (30%). After a total mean follow-up of 84 months (range, 44-140 months) from the diagnosis of prostate carcinoma, two patients were still alive and five patients have died (mean, 6 months after diagnosis of uveal metastasis). CONCLUSIONS: Prostate carcinoma can metastasize to the uvea and the presence of uveal metastasis is associated with a shorter survival time compared with metastasis to other sites.

Aged↗
PubMed1993

Regression of retinoblastoma after plaque radiotherapy.

A review of 400 consecutive patients with retinoblastoma disclosed that 103 tumors in 103 eyes were treated with solitary plaque radiotherapy. The tumors were from 1 to 16 mm (mean, 7 mm) in basal diameter and from 1 to 8 mm (mean, 4 mm) in thickness. Thirty-one tumors were treated with plaque radiotherapy as initial treatment, whereas 72 tumors were treated with plaque radiotherapy as secondary treatment after failure of other methods. Of the 102 tumors on which adequate follow-up data were available, all responded initially to plaque radiotherapy with tumor regression. Over the mean follow-up of 38 months (range, six to 192 months), 89 tumors (87%) showed persistent regression and 13 (13%) showed tumor recurrence. The recurrence occurred at a mean interval of five months (range, one to 11 months) after plaque radiotherapy. A statistical analysis of tumor size, tumor location, tumor proximity to the optic disk and foveola, presence of vitreous seeds, radioactive plaque diameter, plaque shape, radioisotope, and primary or secondary treatment disclosed no important predictors of tumor recurrence. Carefully selected retinoblastoma, even juxtapapillary and macular tumors and those with localized vitreous seeds, can be successfully treated with plaque radiotherapy.

Brachytherapy↗
PubMed1993

Hydroxyapatite orbital implant after enucleation--experience with 200 cases.

The recently introduced hydroxyapatite orbital implant was designed to provide improved motility of the prosthesis in patients who have undergone enucleation. To date, little has been written about the use of the hydroxyapatite orbital implant in eyes that harbored malignant neoplasms. We have performed hydroxyapatite orbital implantation in approximately 200 patients, including children as young as 1 month of age, who underwent enucleation primarily for malignant intraocular tumors. During a median follow-up of 24 months, no cases of orbital hemorrhage, orbital infection, implant extrusion, or implant migration have occurred. Three patients have had conjunctival erosion, which was successfully repaired. Motility of the socket and fornices has been excellent, and all patients have cosmetically satisfactory motility of the prosthesis. Use of the hydroxyapatite implant has had no adverse effect on the clinical course of the intraocular neoplasms, and it has not hindered postoperative evaluation for recurrent orbital tumor. Overall, the hydroxyapatite orbital implant seems to be well tolerated, provides improved motility of the prosthesis, and is associated with few complications.

Adult↗