Search PubMed⌕ Search

Biomedical subjects

J A Shields

Publications and source records attributed to J A Shields.

At least 361 records · Page 20Linked to original sources
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

Colour Doppler imaging in the demonstration of an orbital varix.

Colour Doppler imaging (CDI) is a recent development in ultrasonography. It allows simultaneous two-dimensional structural imaging and Doppler evaluation of blood flow. Quantitative information on flow velocity is obtained by pulsed Doppler spectral analysis, the colour information being used to choose the vessel of interest. Using this technique the authors examined a patient with an orbital varix previously diagnosed by clinical findings and computed tomography. Dynamic evaluation with real-time direct imaging of flow facilitated the diagnosis of this orbital disorder without the need for any contrast material. This technique may prove to be a useful adjunct to computed tomography for the evaluation of suspected vascular lesions of the orbit.

Adult↗
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↗
PubMed1990

Changing concepts in the management of retinoblastoma.

For many years the most common treatment for retinoblastoma has been enucleation, generally performed on the affected eye in children with unilateral sporadic disease and on the more severely affected eye in children with bilateral disease. With refinements in conservative treatment methods, however, the affected eye now often may be salvaged and useful vision retained. Emphasizing this trend, we present our current approaches to managing retinoblastoma based on our experience with 324 patients, outlining our indications and pointing out a number of misconceptions about the role of enucleation, photocoagulation, cryotherapy, and radiotherapy in treating this condition. We also sketch some recent findings regarding the genetics of retinoblastoma and consider ways in which such research may lead to improved management of the disease.

Brachytherapy↗
PubMed1990

Squamous cell carcinoma of the conjunctiva associated with benign mucous membrane pemphigoid.

A 67-year-old white man with benign mucous membrane pemphigoid OU developed, over a period of two months, a slightly pedunculated fleshy mass in the bulbar conjunctiva OS. The mass was excised and found histopathologically to be squamous cell carcinoma of the conjunctiva. The association of benign mucous membrane pemphigoid and squamous cell carcinoma of the conjunctiva has not been previously reported in the English literature to our knowledge. The significance of the simultaneous occurrence of these two conditions is discussed.

Aged↗
PubMed1990

[Imaging of intraocular and orbital vessels using angiodynography].

Color Doppler imaging (CDI) is a recent advance in ultrasonography. It allows simultaneous two-dimensional structural imaging and evaluation of blood-flow characteristics. The velocity information of the scan is extracted and added to the images as color information. A total of 20 normal eyes and 30 patients with intraocular tumors were examined with this technique. The central retinal artery, the posterior cliliary arteries, the opthalmic artery and the central retinal vein could be located in all patients. In the intraocular tumors blood flow was detected reliably. Spectrum analysis of the displayed vessels allows semiquantitative assessment of blood flow in these vessels. This new technique of color Doppler imaging offers a new modality to study ocular and orbital blood flow.

Blood Flow Velocity↗
PubMed1990

Postsurgical hematic cyst simulating a conjunctival melanoma.

A 75-year-old man had undergone bilateral intracapsular cataract extraction and then a scleral buckling procedure for an aphakic retinal detachment in the right eye. He presented 15 years later with a dark brown mass in the superior fornix of his right eye. On the basis of the clinical findings, the diagnosis of a conjunctival melanoma was considered. The lesion was surgically excised and found to be a chronic hematic cyst that arose adjacent to a episcleral sponge placed at the time of retinal detachment surgery. Hematic cysts should be included in the differential diagnosis of pigmented conjunctival lesions.

Aged↗
PubMed1989

The role of cryotherapy in the management of retinoblastoma.

Between February 1974 and August 1987, we treated 67 retinoblastomas in 47 eyes of 45 patients with cryotherapy (triple freeze-thaw technique). Overall, cryotherapy eradicated 53 (79%) of the tumors, whereas additional treatment with episcleral plaque radiotherapy, external beam radiotherapy, or enucleation was necessary in 14 (21%) of the tumors. Tumor destruction was achieved with one or more cryotherapy treatments in all cases in which the tumor was no greater than 2.5 mm in diameter and 1.0 mm in thickness, and in which the tumor was confined to the sensory retina without seeding into the adjacent vitreous humor. We therefore recommend cryotherapy in such cases. Cryotherapy alone failed in 14 larger tumors, ten of which had clinical evidence of vitreous seeding by tumor cells. Cryotherapy is therefore contraindicated in cases of vitreous seeding or if the tumor exceeds 3.5 mm in diameter and 2.0 mm in thickness. Cryotherapy can be successful for tumors up to 3.5 mm in diameter and 2.0 mm in thickness, but more than one treatment may be necessary.

Combined Modality Therapy↗
PubMed1989

Decreasing frequency of enucleation in patients with retinoblastoma.

We reviewed our 15-year experience with the management of 324 cases of retinoblastoma. There has been a definite trend away from enucleation in both unilateral and bilateral cases during recent years. In cases of unilateral retinoblastoma, the affected eye was salvaged in 4% of cases (two of 49) during the five-year interval from 1974 through 1978, in 14% of cases (seven of 50) from 1979 through 1983, and in 25% of cases (20 of 80) from 1984 through 1988. In cases of bilateral retinoblastoma, both affected eyes were salvaged in 4% of cases (one of 24) from 1974 through 1978, in 18% of cases (nine of 50) from 1979 through 1983, and in 25% of cases (18 of 71) from 1984 through 1988. Earlier diagnosis of retinoblastoma and refinements in conservative methods of management are believed to be the main reasons for this trend away from enucleation.

Child↗