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Biomedical subjects

J B Crawford

Publications and source records attributed to J B Crawford.

At least 19 recordsLinked to original sources
PubMed1992

Resection of intraocular squamous cell carcinoma.

A patient with recurrent squamous cell carcinoma of the conjunctiva was referred with 20/20 vision in an eye with obvious intraocular extension. A modified iridocyclochoroidectomy was performed and the tumour was removed. Three and a half years later the patient's vision is 20/30 and there is no recurrence. This is the first case in which an eye has been successfully salvaged with documented intraocular squamous cell carcinoma of the conjunctiva.

Carcinoma, Squamous Cell↗
PubMed1991

Cytopathologic diagnosis of benign lesions simulating choroidal melanomas.

In three cases of benign pigmented lesions (one melanocytoma and two pigment epithelial adenomas) there was evidence of tumor growth and the lesions were referred to us as uveal melanomas. The fine needle aspiration biopsy specimens were correctly interpreted in the operating room as being benign tumors. The pigment granules in these benign pigmented lesions are much larger than are observed in uveal melanomas. When they were visible through the heavy pigmentation, the cellular detail appeared benign. In two cases the tumors were successfully resected with cyclochroidectomy techniques and the visual outcome was good. The third eye was studied after it had been removed at another institution. Fine needle aspiration biopsy can often differentiate a benign-simulating pigmented lesion from uveal melanoma.

Adenoma↗
PubMed1991

Cytomorphometry of uveal melanoma. Comparison of fine needle aspiration biopsy samples with histologic sections.

A number of approaches are being investigated to increase the prognostic accuracy for uveal melanoma patients; the standard deviation of nucleolar area measurements and the DNA content appear to correlate better with survival than do classic histologic parameters. The utility of performing cytomorphometric measurements on fine needle aspiration (FNA) biopsy samples was prospectively analyzed for 24 eyes containing uveal melanomas that were examined with both 25-gauge FNA biopsy and standard histologic techniques. "Masked" analysis of the cellular composition of the 24 cases showed the presence or absence of epithelioid cells to be accurately predicted on the FNA samples in all cases. Image analysis cytomorphometric measurements of nucleolar area showed marked variability (with r less than 0.4) when FNA and histologic samples from the same case were compared. The relationship between these measurements was affected by cell type, sampling, specimen processing and investigator experience.

Biopsy, Needle↗
PubMed1991

A new contact neodymium:YAG laser for cyclophotocoagulation.

A newly developed compact (40 kg), self-contained contact Neodymium:YAG laser produces high-peak, high-energy (800 mJ/pulse), short (1.0 millisecond) pulses with 1 to 3 pulses/exposure. Energy is delivered via a 320-microns cleaved quartz fiber optic probe. Cyclophotocoagulation was performed in five eyes of three medium-sized Dutch-pigmented rabbits. The eyes received exposures of 1 to 3 pulses/exposure. Energy delivered ranged from 100 to 800 mJ/pulse. Histopathology revealed ciliary body disruption and hemorrhage with no damage to overlying sclera. When used for transscleral cyclodiathermy in the rabbit, the laser created significant ciliary body disruption with minimal scleral injury.

Animals↗
PubMed1990

Metastatic ciliary body carcinoid tumor.

A 50-year-old man with a history of systemic carcinoid had decreased right eye vision and a darkly pigmented cilio-choroidal mass. Results of ultrasonographic and fluorescein angiographic examinations were consistent with a malignant melanoma. Fine-needle aspiration biopsy of the lesion identified it as a carcinoid metastasis. The patient refused both radiation and enucleation; complete excision with a cyclochoroidectomy was performed. Histopathologic examination showed a carcinoid neoplasm covered by marked hyperplasia of the retinal pigment epithelium that produced the pigmented appearance of the lesion.

Biopsy, Needle↗
PubMed1990

Subconjunctival THC: YAG laser limbal sclerostomy Ab externo in the rabbit.

A chromium-sensitized, and thulium and holmium-doped YAG laser (THC:YAG laser) was used to create bilateral limbal sclerostomies in six Dutch pigmented rabbits. The laser is a long-pulsed (300 microseconds) [corrected], compact, self-contained, solid-state laser operating in the near infrared (2.1 microns). A 1-mm conjunctival stab incision was made 12 mm away from the sclerostomy site to allow entry of a specially designed 26-gauge (480 microns) optic probe that delivers energy at right angles to the long axis of the fiber. Probe insertion minimally disturbed the conjunctiva. Pulse energies of 60 to 150 mJ were used with a repetition rate of 5 pulses/s. Energy levels ranging from 1.35 to 6.6 J produced full-thickness sclerostomies. Histopathology showed a sharply defined perforating limbal wound at all energy levels. The overlying conjunctiva was intact, with swelling of the adjacent cornea. A peripheral iridectomy was intentionally created with the laser through the peripheral limbus, resulting in a sharply defined perforating tract through the iris/ciliary body. This technique may simplify filtering sclerostomy surgery, without anterior chamber instrumentation and with minimal conjunctival trauma.

Animals↗
PubMed1989

Analysis of radiation failure after uveal melanoma brachytherapy.

We analyzed the number of cycling cells in the DNA synthesis phase and in mitosis in two uveal melanomas unsuccessfully treated with iodine 125 brachytherapy. In one patient, the tumor appeared to have been radioresistant, whereas the other patient had a clinically inapparent area of tumor that was not included in the tumoricidal radiation field. In the first patient, there was uniform tumor cell cycling, whereas the second patient had cycling cells predominantly in the area that did not receive optimal radiation. This gradient of cycling tumor cells in the second patient was observed with both standard histologic examination (mitoses per high-powered field) and bromodeoxyuridine staining (DNA synthesis). The bromodeoxyuridine technique was significantly more sensitive than standard histologic examination in the detection of cycling cells.

Aged↗
PubMed1989

Iris melanoma with increased intraocular pressure. Differentiation of focal solitary tumors from diffuse or multiple tumors.

A 70-year-old man presented with an apparent focal iris ciliary body mass and increased intraocular pressure. Fine needle aspiration biopsy 180 degrees from the main lesion demonstrated uveal melanoma cells in the angle. The eye was enucleated, and multiple separate iris and ciliary body melanomas were noted. This case demonstrates the usefulness of fine needle aspiration biopsy for both diagnosis and optimum therapy in selected cases.

Aged↗
PubMed1989

Metastatic melanoma within and to the conjunctiva.

Two patients with epibulbar juxtalimbal primary conjunctival melanomas experienced local intralymphatic metastases to the inferior cul-de-sac, and a hematogenous metastasis to the conjunctiva developed in five other patients with cutaneous melanomas. Whether reflective of a local or distant metastasis, all of the lesions histopathologically were located in the substantia propria, and were separated from the overlying epithelium by a thin mantle of collagen. There was no evidence of atypical intraepithelial melanocytic proliferation, as would be expected in association with a primary conjunctival melanoma. Two of the cutaneous metastases exhibited a binodular or multinodular appearance that correlated histopathologically with variably confluent micronodules suggestive of the origin of the clinical lesion from a shower of tumor cell emboli. Patients with local intralymphatic spread from a primary conjunctival melanoma may experience additional lesions in the conjunctival sac or eyelid skin and are at risk for regional or distant metastases. They should be examined closely several times a year. The patients with the distant metastases all had their previously diagnosed primary cutaneous tumors on the truncal skin (a similar tendency emerges from a review of previous ocular cases), typically had myriad other cutaneous lesions, and two of them had a neoplastic iridocyclitis and vitreitis. These patients tended to die of the disseminated tumors within 1 year after conjunctival metastases developed.

Adult↗
PubMed1989

Bilateral ciliary body melanomas.

We describe a 78-year-old woman with bilateral primary ciliary body melanomas. The tumours presented 6 months apart and were treated with iridocyclectomy. Histopathological examination revealed type B spindle cell melanomas. To our knowledge this is the first reported case of bilateral ciliary body melanomas.

Aged↗
PubMed1988

Failure of preenucleation radiation to decrease uveal melanoma mortality.

We analyzed uveal melanoma metastases in a group of 41 patients who received 20 Gy of preenucleation radiation in a Northern California Oncology Group preliminary phase I/II study, and compared their survival rates with a retrospective control group of 31 patients with characteristics matching the entrance criteria but treated with enucleation alone. Using the Cox proportional hazards model, we found that increased tumor diameter, mixed or epithelioid cell type, and radiation adversely affected survival. In vivo studies of cell cycling indicated that 20 Gy of preenucleation radiation appeared to diminish the reproductive integrity of the tumor cells. It is most likely that the failure of preenucleation irradiation to prolong patient survival was because of micrometastases that occurred before treatment.

Adult↗
PubMed1987

Sympathetic ophthalmia complicating helium ion irradiation of a choroidal melanoma.

Sympathetic ophthalmia was diagnosed 49 months after helium ion irradiation of a left choroidal melanoma. The patient maintained good vision until 18 months after therapy, when she developed neovascular glaucoma. This complication required multiple therapeutic procedures, including topical anti-inflammatory and antiglaucomatous drops, 360 degrees peripheral panretinal cryoblation, and a single 180 degrees application of inferior cyclocryotherapy over a 2 1/2-year period. Four weeks after the cyclocryotherapy, inflammation was noted in both eyes, and, one month later, enucleation of the left sympathogenic eye was performed. Serial histopathologic sections showed a full-thickness, fibrovascular, scleral scar and tantalum marker ring suture without uveal incarceration. Penetrating surgical trauma, a uveal melanoma, and multiple nonpenetrating treatments resulted in the development of sympathetic ophthalmia.

Aged↗
PubMed1987

Histopathology of uveal melanomas treated with charged particle radiation.

The authors have treated 255 uveal melanomas with helium ion radiation. Twenty-three eyes have been enucleated because of complications and five eyes have been obtained at autopsy. We have evaluated 27 of these eyes. Neovascular glaucoma (10 eyes), painful keratitis (6 eyes), continued tumor growth (4 eyes), and vitreous hemorrhage (2 eyes) were the major complications of treatment that led to enucleation. The degree of tumor necrosis correlated with the size, pigmentation, and anterior extent of the tumor. It did not correlate with the interval from irradiation or with the amount of tumor shrinkage. Mitotic figures were extremely rare in treated tumors, suggesting that the tumor cells have lost their ability to cycle.

Adult↗
PubMed1987

Extensive squamous cell carcinoma of the conjunctiva presenting as orbital cellulitis: the hermit syndrome.

The authors present three cases of extensive squamous cell carcinoma of the conjunctiva invading the orbit and masquerading as orbital cellulitis. All cases were in elderly alcoholic men living in relative social isolation. Total exenteration of the orbit was required in all three cases. Only one patient has had long-term follow-up; he was well 5 years after presentation. The other two patients were well 15 and 5 months after surgery.

Aged↗
PubMed1986

Uveal melanoma necrosis after helium ion therapy.

A 71-year-old man underwent enucleation because of intractable pain ten months after receiving helium ion therapy for a uveal melanoma. There was no clinical or ultrasonographic evidence of tumor regression but histologically the tumor appeared almost entirely necrotic.

Aged↗
PubMed1986

Foreign-body giant cell reaction to liquid silicone.

Although intravitreal injections of liquid silicone have long been used in complicated retinal detachments and long-term complications such as keratopathy, glaucoma, and cataract are well-known, the effect of liquid silicone on the retina, iris, and angle structures is not as well defined. Histopathologic study of one human eye that was enucleated 20 months after liquid silicone injection showed an intraocular foreign-body giant cell reaction.

Adult↗