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Biomedical subjects

R M Ellsworth

Publications and source records attributed to R M Ellsworth.

At least 73 records · Page 4Linked to original sources
PubMed1980

Lactate dehydrogenase in tears.

Lactate dehydrogenase levels in tears were measured in normal subjects and in patients with retinoblastoma. When specimens were collected without trauma in normal subjects, there were usually no detectable levels of lactate dehydrogenase. When the eyelids were rubbed (probably liberating epithelial cells) lactate dehydrogenase levels were detectable and were five to ten times those of normal aqueous humor. When lactate dehydrogenase isoenzymes in such specimens were analyzed, the level of lactate dehydrogenase 5 was always higher than that of lactate dehydrogenase 1 (similar to normal aqueous humor). While occasional patients with retinoblastoma do have elevated levels of lactate dehydrogenase in tears, it is uncertain if this is due to epithelial destruction or retinoblastoma itself. Lactate dehydrogenase in tears does not appear to be a useful test for the diagnosis of retinoblastoma given present techniques for collection and analysis.

Child↗
PubMed1980

The surgical management of retinoblastoma.

Retinoblastoma is the most common intraocular malignancy of childhood. Present survival rate is 92%. The role of surgery in the management of retinoblastoma is limited to therapy of retinoblastoma as the diagnosis is usually without histopathological confirmation. There has been a trend in recent years to surgical techniques which have enabled the treatment of the intraocular tumor without the destruction of the function of the eye. The following surgical techniques, indications and complications are discussed: exenteration, enucleation, diathermy, Xenon arc photocoagulation, cryopexy and the use of local cobalt 60 plaques.

Eye Neoplasms↗
PubMed1979

Lactate dehydrogenase levels and isozyme patterns. Measurements in the aqueous humor and serum of retinoblastoma patients.

Lactate dehydrogenase (LDH) activity was determined in 24 cases of histologically proved retinoblastoma. The mean level was 1,825 IU/L, with a range of 10 to 15,920 IU/L. Twenty-two patients had elevated aqueous humor LDH levels. In two, the aqueous humor level was within the normal range. Student's t testing showed a highly significant difference between cataract and retinoblastoma aqueous humor. The retinoblastoma aqueous humor to blood ratio ranged from 0.045 to 58,529--not a good index of retinoblastoma. Isozyme patterns of retinoblastoma aqueous humor were statistically similar to those of normal cataract aqueous humor. The serum LDH level of cataract patients was not statistically different from that of retinoblastoma patients. The LDH 5/LDH 1 ratio of retinoblastoma aqueous humor ranged from 0.042 to 27.05--not a good index of retinoblastoma, as 28 of 34 aqueous samples of cataract patients had LDH 5 greater than LDH 1. Ten of 13 retinoblastoma patients had aqueous humor LDH 5 greater than LDH 1. The best index of the presence or absence of retinoblastoma is the total aqueous humor LDH level.

Aqueous Humor↗
PubMed1979

Second tumors in nonirradiated bilateral retinoblastoma.

We reviewed the records of 1,323 patients with retinoblastoma treated here between 1922 and 1978. Twenty-eight patients underwent bilateral enucleation alone and received no additional treatment for their advanced tumors. Of the 28 patients, 22 (92%) survived. Four patients were lost to follow-up, and two died of metastatic retinoblastoma. Of 22 survivors of bilateral retinoblastoma treated with enucleation alone, three developed second tumors at a mean of 15.3 years after bilateral enucleation. One patient developed a rhabdomyosarcoma in the left temple region, the second patient developed an osteogenic sarcoma of the right femur, and the third developed a malignant melanoma of the left thigh. All three patients died of their disease. The incidence of second tumors in patients who survived bilateral retinoblastoma treated without radiation was 14% (three patients), which is comparable to a series previously reported in which patients were treated with enucleation and irradiation.

Adolescent↗
PubMed1979

The treatment of orbital rhabdomyosarcoma with irradiation and chemotherapy.

Fifty-eight patients with orbital rhabdomyosarcoma were treated with irradiation alone (25) or irradiation and chemotherapy (33) with follow-ups of 6 months to 14 years (mean 5.2 yr). At present, 74% are alive and 26% have died. Local control of the tumor was accomplished in 91% of cases. When local sinuses were invaded the survival rate was 55%. Chemotherapy appears to be of greatest value when disease is limited to the orbit. Irradiation or irradiation and chemotherapy should now be the treatment of choice for orbital rhabdomyosarcoma.

Adolescent↗
PubMed1979

Capillary hemangioma of the lids and orbit: an analysis of the clinical features and therapeutic results in 101 cases.

The clinical records of 101 patients (biopsies done on 48) with capillary hemangiomas of the orbit, orbit and lids, and lids were analyzed. Lesions predominated in females and typically appeared at birth or within the first two months of life. The superior orbit and lids were definite sites of predilection. Telltale periocular cutaneous involvement occurred in one third of the cases. Pure proptosis caused by a deep orbital tumor without an anterior component was found in seven cases. Proptosis in general was mild, but in two cases was severe enough to cause corneal exposure. Findings suprortive of a diagnosis of an orbital or periorbital hemangioma include (1) change in tumor size on crying (46%); (2) a dark vascular coloration to the subcutaneous tissue (80%); and (3) the existence of nonperiocular strawberry marks (25). Diagnostic tests of most value were plain radiography, ultrasonography, computed axial tomography, and arteriography. The complication rate in the 50 patients followed up over five years was 80% (60% with amblyopia). Present treatment modalities do not appear to be achieving the desired goals of a good cosmetic and functional outcome. Radiotherapy and corticosteroids are both effective in individual cases, but many lesions are resistant to all forms of present treatment. Amblyopia therapy is difficult and often unsuccessful in these patients.

Age Factors↗
PubMed1979

The occurrence of new retinoblastomas after treatment.

New separate tumors have developed in 11% of eyes containing retinoblastoma treated primarily with external beam radiation. The tumors were primarily found in the inferior retinal periphery and averaged 1.5 disc diameters in size. All of the tumors were controlled, with photocoagulation and cryopexy being the most frequently used treatments.

Child, Preschool↗
PubMed1978

Aqueous humor lactate dehydrogenase in retinoblastoma patients. Clinicopathologic correlations.

Aqueous humor lactate dehydrogenase (LDH) levels were assayed for 23 patients with histologically proved retinoblastoma. The mean aqueous level was 1,886 IU/liter. Twenty-one of these patients had an aqueous humor LDH level above the normal mean. Clinicopathological parameters were determined and evaluated using standard statistical formulas. Only the presence of tumor in the anterior chamber correlated significantly with the aqueous humor LDH level. The following clinical features did not correlate with aqueous humor LDH levels: sex, family history, bilaterality, prior treatment, presentation age, enucleation age, and metastasis. The following pathological features did not correlate with aqueous humor LDH levels: calcification, necrosis, rosettes, inflammation, choroidal or optic nerve invasion, or neovascularization.

Aqueous Humor↗
PubMed1978

Orbital extension of retinoblastoma: a clinicopathological study.

We have studied all cases of orbital extension of retinoblastomas at the Edward S. Harkness Eye Institute in New York since 1925. Only 9.4% of the patients lived more than 2 years after diagnosis. Orbital retinoblastoma is frequently associated with systemic metastases. We emphasize the significance of massive choroidal involvement and periemissarial extension. Careful handling of the enucleation specimen at the time of surgery and during histologic preparation is important to avoid cell spillage and artifacts. Treatment should be early, multidisciplinary and include adjuvant chemotherapy.

Child↗
PubMed1977

Lactate dehydrogenase levels and isoenzyme patterns in the serum and aqueous humor of adult cataract patients.

Serum and aqueous humor lactate dehydrogenase (LDH) levels were assayed in 46 patients with senile cataracts at the time of cataract extraction. The mean aqueous level was 37 IU/liter and the mean serum level 152 IU/liter. In each case, the serum LDH level was higher than the corresponding aqueous LDH. The LDH isoenzyme levels were also determined; LDH 4 and LDH 5 were elevated in cataract aqueous samples, while the serum isoenzymes were normal. The LDH studies of normal and diseased globes must be rigorously standardized to avoid artificially high or low levels.

Adult↗
PubMed1977

Retinoblastoma.

Newer concepts in the diagnosis and treatment of retinoblastoma are briefly discussed. The role of ultrasonography, EMI scanning and LDH assays in the anterior chamber are evaluated. The greatest problems in differential diagnosis in recent years have been larval granulomatosis caused by Toxicara canis, Coat's disease and unclassifiable retinal dysplasias. The Ellsworth-Reese classification is discussed. The "cure rate" has been widely misinterpreted as survival and has led to many misapprehensions in the treatment of unilateral disease. The cases in group IV now do better for a variety of reasons and the results in orbital cases have been more extensively studied. The genetics of retinoblastoma have been intensively studied in our laboratory along with Dr. Kitchin and some newer concepts are briefly discussed. The relative roles of orthovoltage, external beam 60Co, linear accelerators and betatron are presented. Dosage level is distinctly related to radiation complications, especially retinal vascular necrosis and fatal radiation-induced neoplasms. The relationship of the latter to the pattern of inheritance is to be stressed. Chemotherapy has been used both as an adjuvant to radiation and for the destruction of micrometastases and a new protocol is described. The results of treatment are presented to update the 1966 report at the Gonin Club Meeting in Munich.

Aqueous Humor↗
PubMed1977

Histocompatibility typing in spontaneous regression of retinoblastoma.

Human Leukocyte Antigen (HLA) Typing of Caucasian patients with retinoblastoma fails to show any difference in antigen frequency compared to a control population. In family studies where several members are affected with retinoblastoma the tumor does not segregate with the HLA type. There is also no significant difference in antigen frequency between spontaneous regression of retinoblastoma, unregressed retinoblastoma, and normal controls. In several families with one member showing spontaneous regression of retinoblastoma, other generations inheriting the same haplotypes have tumors which have failed to regress.

Eye Neoplasms↗
PubMed1976

Invasion of the optic nerve by retinoblastoma: a clinicopathological study.

We have studied all cases of optic nerve invasion in retinoblastoma seen at the Edward S. Harkness Eye Institute in New York since 1925. Since 1959 optic nerve invasion has been less extensive--suggesting earlier diagnosis and management. Since 1959 there has also been an increase in the number surviving. Survival correlates with the extent of spread to optic nerve, choroid and extrabulbar tissues. Current and future therapy are discussed. The importance of subpial extension of retinoblastoma is noted and its relationship to the mode of therapy is emphasized.

Child↗
PubMed1975

Electron microscopic diagnosis of medulloepithelioma.

A 20-month-old boy with a ciliary body tumor presented with two white flocculi floating in the anterior chamber of his left eye. This material was examined by electron microscopy. Both the clinical appearance of the tumor and the ultrastructural findings suggested the diagnosis of medulloepithelioma. The flocculi contained tumor cells forming lumina and displaying neuronal-type cilia, neurotubules, and a complex band of apical desmonosomal junctions. Since the last finding is not present in retinoblastoma rosettes in the absence of fleurette differentiation, it distinguishes medulloepithelioma from retinoblastoma. The electron microscopic diagnosis has permitted a trial period of conservative cryotherapy directed at the tumor and the associated glaucoma. The electron microscopic characteristics of the tumor favor the neuroepitheliomatous and neuroblastic differentiation of medulloepithelioma rather than ependymal differentiation.

Anterior Chamber↗