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Biomedical subjects

R Folberg

Publications and source records attributed to R Folberg.

At least 91 records · Page 5Linked to original sources
PubMed1989

Animal model of conjunctival primary acquired melanosis.

A condition clinically identical to human conjunctival primary acquired melanosis (PAM) was induced in 16 of 20 Dutch (pigmented) rabbits after weekly topical 60-microliters applications of a 1% solution of 7,12-dimethylbenz[a]anthracene (DMBA) in acetone. Pigment stippling appeared in the conjunctiva as early as 5 weeks after the initial carcinogen application. Confluent patches of flat pigmentation appeared over the palpebral conjunctiva 18 weeks after the onset of treatment and showed progressive lateral enlargement and darkening. Histologically, a spectrum of changes from increased melanin production and melanocytic hyperplasia without atypia (resembling the human condition of PAM without atypia) through atypical melanocytic hyperplasia (resembling human PAM with atypia) was identified. The development of this model permits further investigations to explore and explain the clinically observed phenomenon of waxing and waning of PAM and its promotion to conjunctival malignant melanoma.

9,10-Dimethyl-1,2-benzanthracene↗
PubMed1989

The treatment of serous macular detachment secondary to choroidal melanomas and nevi.

The authors successfully treated with laser photocoagulation five patients who had a serous macular detachment secondary to leakage from a pigmented choroidal tumor. Three patients had dye leakage on fluorescein angiography from a choroidal neovascular membrane. The subretinal fluid resolved in all three patients after the neovascular membrane was obliterated by either krypton red (2 patients) or argon green (1 patient) laser photocoagulation. The other two patients had prominent leakage from a localized choroidal neovascular membrane as well as mild diffuse leakage over the entire tumor. Focal argon laser treatment to the neovascular membrane alone did not cause permanent resolution of the subretinal fluid. The fluid did resolve, however, after the entire area of diffuse leakage was retreated with photocoagulation. In one of the patients who received both focal and confluent laser treatment, the choroidal tumor grew in a collar-button fashion through Bruch's membrane at the original site of focal treatment. This eye was enucleated, and results of histopathologic examination showed a choroidal melanoma.

Aged↗
PubMed1989

Benign conjunctival melanocytic lesions. Clinicopathologic features.

The common acquired conjunctival nevus usually undergoes progressive maturation and only exceptionally gives rise to conjunctival melanoma. Pure junctional nevi are rare except in childhood. Histologically, however, a junctional nevus may be indistinguishable from primary acquired melanosis (PAM) with atypia, a condition of middle-aged and elderly individuals that has a tendency to evolve into melanoma. Nevi in adolescents may attract a vigorous lymphocytic response and may cause clinical and histologic confusion with other entities, particularly a regressing nodule of melanoma that occurs predominantly in adults. Rarely, congenital conjunctival nevi are identified, sometimes in patients with adjacent congenital nevi of the eyelid. A variety of unusual nevi, including balloon-cell nevi, Spitz nevi, epithelioid cell nevi, dysplastic nevi, recurrent nevi, episcleral melanosis and the nevus of Ota, blue and cellular blue nevi, melanocytoma, and composite or mixed nevi all may be identified in the conjunctiva. Concepts of histogenesis as well as the clinical, light microscopic, and ultrastructural features of these and other benign pigmentary conditions of the conjunctiva are described.

Adolescent↗
PubMed1989

Clinicopathologic characteristics of premalignant and malignant melanocytic lesions of the conjunctiva.

Primary acquired melanosis (PAM), a disease that affects mostly middle-aged white patients, is predominantly a proliferative condition of the melanocytes that normally populate the conjunctival epithelium. Primary acquired melanosis without atypia (low risk for the development of melanoma) is typically created by increased numbers of melanocytes restricted to the basilar region of the epithelium without nuclear hyperchromasia or prominence of the nucleoli. Primary acquired melanosis with atypia, a formal precursor of melanoma, is characterized by the proliferation of small polyhedral cells, spindle cells, large dendritiform melanocytes, or epithelioid cells that may: remain restricted to the basilar region (basilar nests); form nests at all levels of the epithelium; spread individually to all levels of the epithelium (pagetoid extension); or proliferate in a sheet-like fashion approximating a melanoma in situ. Lesions composed of epithelioid cells or exhibiting intraepithelial pagetoid extension have, respectively, a 75 or 90% chance of eventuating in invasive melanoma. Primary acquired melanosis in an adult should not be confused with "a junctional nevus," which is almost always restricted to childhood. Invasive melanomas measuring less than 0.8 mm in thickness tend not to be associated with metastases; the tumor cells may be small polyhedral (in which case confusion with a compound nevus often arises), epithelioid, spindled, or ballooned. Nodules composed of spindle cells in part or in toto tend to have less metastatic potential at a given thickness measurement than comparable nodules composed of epithelioid or polyhedral cells. The clinical features, electron microscopic findings, and biologic principles underwriting clinical management are also presented.

Conjunctival Neoplasms↗
PubMed1988

Postkeratoplasty crystalline deposits mimicking bacterial infectious crystalline keratopathy.

Three corneal transplant patients developed white, crystalline, anterior stromal lesions in their grafts while receiving long-term topical corticosteroid therapy. A presumed diagnosis of infectious crystalline keratopathy was made in each case. However, histologic examination of the lesions failed to show gram-positive cocci. A fungal infiltrate was present in the first two patients, and calcium deposits produced the lesion in the third patient.

Aged↗
PubMed1988

Simple dacryops.

Explore the source record for details and available documents.

Cysts↗
PubMed1988

Elevated corneal epithelial lines in Acanthamoeba keratitis.

Elevated corneal epithelial lines are another clinical sign in Acanthamoeba corneal infection. In this report, one patient wore extended wear soft contact lenses, and another wore daily wear soft contact lenses. Both patients used distilled water and salt tablets in their lens care. Histopathologic examination of these lines revealed trophozoites and cysts. In one of the patients following penetrating keratoplasty, Acanthamoeba castellani and Acanthamoeba polyphaga were cultured by impression cytology of an epithelial line, as well as from the bulbar and tarsal conjunctiva. In the other patient who did not undergo penetrating keratoplasty, these lines appeared in the cornea one month after initial symptoms.

Acanthamoeba↗
PubMed1988

Melanocytic nevi of the palpebral conjunctiva. An extremely rare location usually signifying melanoma.

Nevi of the conjunctiva generally develop during the first 2 decades of life, and are almost entirely restricted to the epibulbar surface, the plica, the caruncle, and the lid margin. Therefore, any elevated pigmented lesion of the forniceal or tarsal conjunctiva acquired later in life must be regarded with suspicion as a melanoma or melanoma precursor, and a biopsy should be done routinely. This report is, to the best of the authors' knowledge, the first histopathologic documentation of nevi located in the palpebral conjunctiva. One nevus was acquired and the other was probably congenital.

Biopsy↗
PubMed1988

Complications after proton beam therapy for uveal malignant melanoma. A clinical and histopathologic study of five cases.

Proton beam therapy for uveal malignant melanoma has been advocated as effective therapy because of documented reduction in tumor size and few clinical complications. However, some eyes have been removed because of adverse effects. The authors report the clinical courses and pathologic findings of five eyes enucleated after proton beam irradiation. Neovascular glaucoma had developed in three eyes, two eyes had vitreous hemorrhage, and two had extraocular extension. The tumors in the radiation treatment field showed continued postirradiation growth clinically in four of the five eyes, and mitotic activity histologically in all five cases. Two and one half years after irradiation, and nearly 2 years after subsequent enucleation, one of those two patients had biopsy-proven liver metastases, and later died. Despite the considerable success rate of proton beam irradiation, the potential for clinical complications and subsequent tumor growth remains.

Adult↗
PubMed1988

Clinically atypical granular corneal dystrophy with pathologic features of lattice-like amyloid deposits. A study of these families.

Four patients from families in Pennsylvania, Massachusetts, and Argentina were diagnosed clinically as having granular dystrophy. Results of pathologic examination of the corneal buttons from each patient after penetrating keratoplasty confirmed granular deposits in the anterior third of the stroma. Amyloid was demonstrated within some of these granular deposits by Congo red staining with birefringence and dichroism and by electron microscopy. In addition to the morphologically granular deposits, numerous fusiform deposits identified as amyloid by histochemistry and electron microscopy and morphologically identical to those seen in lattice corneal dystrophy were detected deep to the granular deposits. It was further shown that the histochemical pattern of staining of the granular material by a series of lectins was similar to that present in corneas with lattice dystrophy. Although a relationship between these patients cannot be definitively proven, each family traces its origins to the Italian province of Avellino.

Adult↗
PubMed1988

Xanthoma disseminatum. An unusual histiocytosis syndrome.

The histiocytoses are a diverse group of illnesses that present a variety of diagnostic and therapeutic dilemmas. In this article, we describe the case of an 8-year-old boy with xanthoma disseminatum, a histiocytic disorder involving the skin, eyes, and brain. In our discussion, we have emphasized the clinical, pathologic, and radiographic features that distinguish this entity from clinically similar juvenile xanthogranuloma and Langerhans' cell histiocytoses (histiocytosis X) such as the Hand-Schuller-Christian syndrome. The importance of differentiating the various histiocytoses, in view of their varying natural histories and therapeutic responsiveness, is reviewed in relation to the new classification system for these disorders proposed by the Histiocyte Society.

Brain Diseases↗
PubMed1988

Technique for incisional biopsy of a lacrimal gland mass when the diagnosis of benign mixed tumor cannot be excluded clinically.

In most cases of a lacrimal gland mass, the management course can be defined clearly based on an accurate history supported by characteristic radiographic features. There are, however, certain cases that do not fit cleanly into management algorithms and, on occasion, it may be necessary to obtain an incisional biopsy into a lacrimal gland mass when the diagnosis of benign mixed tumor cannot be excluded conclusively. We report a technique for incisional lacrimal gland biopsy under these circumstances. To prevent tumor spillage in the event of benign mixed tumor, the incision site into the gland is covered with several drops of butyl-2-cyanoacrylate. The biopsy specimen is submitted for frozen section examination. If the frozen section reveals benign mixed tumor, the entire gland may be removed, with the cyanoacrylate bond protecting the lacrimal gland contents from contaminating the orbit. The technique and its indications are described in detail.

Aged↗
PubMed1987

Recurrent and residual sebaceous carcinoma after Mohs' excision of the primary lesion.

We reviewed the histories of three patients with sebaceous carcinoma (two of the eyelid and one of the caruncle) who had had their tumors excised by surgeons experienced in the Mohs' technique. In each patient the tumor was considered totally excised. In one patient, residual intraepithelial pagetoid sebaceous carcinoma of the eyelid was detected incidentally when a reparative flap was placed. In the other two patients, invasive sebaceous carcinoma recurred, necessitating orbital exenteration; one patient has regional lymph node metastases. Because of the difficulty in detecting pagetoid spread on frozen sections and the multicentric nature of sebaceous carcinoma, we advocate managing these tumors by wide local excision, checking margins with high-quality permanent sections.

Adenocarcinoma↗
PubMed1987

Lumbosacral chordoma metastatic to the eyelid.

The authors report a patient treated with radiation therapy for a lumbosacral chordoma. The first and only evidence of metastatic disease was an eyelid cyst. This case is unusual for several reasons. First, eyelid metastases are rare; they are much more uncommon than metastases to the uvea or orbit. Second, metastatic tumors to the eyelid are usually manifestations of widespread disease and seldom occur as a solitary focus of dissemination. Third, the clinical presentation of our patient's lesion as an eyelid cyst is uncommon for a metastasis to the eyelid. Finally, to the best of our knowledge, all previously reported tumors metastatic to the eyelid have been carcinomas; this is the first report of a metastatic soft-tissue tumor to the eyelid.

Aged↗
PubMed1987

The treatment of aqueous-deficient dry eye with removable punctal plugs. A clinical and impression-cytologic study.

Punctal plugs were placed in 18 dry eye patients of the aqueous-deficiency type who were on maximally tolerable medical therapy and who had Schirmer testing with topical anesthetic measuring less than 6 mm. Pretreatment and posttreatment evaluations included rose Bengal and fluorescein staining, Schirmer testing, and conjunctival impression cytology. Six weeks after plug placement, 11 of 18 patients had subjective improvement and were able to decrease dependency on tear supplements; all of these patients have successfully worn plugs for at least 8 months. Although these 11 patients improved clinically, impression cytologic abnormalities persisted 6 weeks after plug placement. Three patients did not improve clinically after punctal plug therapy, and four patients improved subjectively but extruded plugs within 2 weeks of placement. Three of the patients who extruded plugs had marked lid laxity and dilated puncta before placement. Reversible punctal occlusion by plugs may significantly decrease dependency on tear supplements in selected patients.

Adult↗
PubMed1987

Multipurpose closed-circuit television teaching cart.

We developed a mobile closed-circuit television cart for resident and staff presentations at rounds, and fluorescein angiography and pathology conferences. The system, operated without special training, permits presentation of x-rays, CT scans, visual fields, echographic and electrophysiologic tracings, fluorescein angiograms, color photographs, 35 mm slides, and printed text on standard closed-circuit television monitors. For pathology conferences, gross dissections, slides of whole eyes and standard high power microscopic fields may be shown. The cart can be assembled using readily available components for the same cost as a stand-alone glass slide projector. Mounted on wheels, the entire unit may be moved to any location equipped with closed circuit television monitors. Because the cart can be used to teach nearly every medical discipline, the cost of construction can be shared by a number of departments.

Audiovisual Aids↗