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Biomedical subjects

R M Ellsworth

Publications and source records attributed to R M Ellsworth.

107 records · Page 6Linked to original sources
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Regression of uveal malignant melanomas following cobalt-60 plaque. Correlates between acoustic spectrum analysis and tumor regression.

Parameters derived from computer analysis of digital radio-frequency (rf) ultrasound scan data of untreated uveal malignant melanomas were examined for correlations with tumor regression following cobalt-60 plaque. Parameters included tumor height, normalized power spectrum and acoustic tissue type (ATT). Acoustic tissue type was based upon discriminant analysis of tumor power spectra, with spectra of tumors of known pathology serving as a model. Results showed ATT to be correlated with tumor regression during the first 18 months following treatment. Tumors with ATT associated with spindle cell malignant melanoma showed over twice the percentage reduction in height as those with ATT associated with mixed/epithelioid melanomas. Pre-treatment height was only weakly correlated with regression. Additionally, significant spectral changes were observed following treatment. Ultrasonic spectrum analysis thus provides a noninvasive tool for classification, prediction and monitoring of tumor response to cobalt-60 plaque.

Cobalt Radioisotopes↗
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Catecholamine metabolites in the aqueous of retinoblastoma.

The aqueous humor of five patients with histologically proven retinoblastoma were analyzed for the main catabolic products of norephinephrine and epinephrine. In each case, there were no detectable levels of normethanephrine, metanephrine, vanilmandelic acid (VMA), and 3-methoxy, 4-hydroxy phenoglycol. The techniques are sensitive to 1 microgram/ml but will not detect the presence of homovanillic acid (HVA).

Aqueous Humor↗
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Leukemic ophthalmopathy detected by ultrasound.

Contact A- and B- scan ultrasonography was performed on 40 patients with acute lymphocytic leukemia at initial diagnosis, during therapy, during remission, and in patients with recurrences. This technique simply and consistently reveals tumor in the choroid, despite the fact that leukemic involvement may cause only 1-2 mm of choroidal thickening. Leukemic involvement may be diffuse or localized, detected with or without visual symptoms, and can be monitored repeatedly. Leukemic involvement of the choroid is difficult to see ophthalmoscopically, but easy to detect with contact ultrasound.

Choroid Neoplasms↗
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Retinoblastoma: survival, age at detection and comparison 1914-1958, 1958-1983.

A retrospective analysis of the records of 1531 retinoblastoma patients (809 male, 720 female, sex of two not known) was carried out to ascertain life table survivals. Of patients seen between 1914 and 1983 survival from metastatic retinoblastoma was the same for unilateral and bilateral patients. Metastatic retinoblastoma occurred within four years from diagnosis of the unilaterally affected patients and within nine years from diagnosis of the bilaterally affected patients. Survival thereafter remained at 76%. Because of the development of second non-ocular tumors in survivors of bilateral retinoblastoma there was a dramatic difference between survival of the patient with unilateral and bilateral disease. Within five years after diagnosis of bilateral retinoblastoma more children die from their second tumor than retinoblastoma itself. By 25 years after diagnosis more than 50% of the bilaterally affected children are dead and by 35 years 59% are dead. There was no difference between survival of boys and girls. Although bilateral patients were seen at significantly lower ages at diagnosis, they did not have a lower mortality rate from metastatic retinoblastoma. Despite the fact that bilaterally affected children with a family history were diagnosed at a younger age than those without a family history (11 vs. 15 mos.) mortality from metastatic retinoblastoma was the same. Similarly, even though unilateral patients with a family history were diagnosed younger than those without a family history (5 vs. 25 mos.) mortality from metastatic retinoblastoma was the same. There has been little change in the age at detection for retinoblastoma in the pre- versus post-1958 series and no change in survival rate for bilateral or unilateral patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
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Retinoblastoma: correlation between age at diagnosis and survival.

Life tables analyses were performed from the records of 1147 patients seen between 1958 and 1983 to determine correlation between age at diagnosis and survival from metastatic retinoblastoma. No difference was noted overall in survival from metastatic retinoblastoma for unilateral vs. bilateral, male vs female, or family history vs negative family history. Survival rate of 21 of 40 patients diagnosed after age 7 and receiving no treatment was 96%. Two patients in this group did develop metastasis: one because of late diagnosis and one because treatment was refused. One patient with an "arrested retinoblastoma" showed growth in his third decade, necessitating treatment. Survival was poorest in patients diagnosed between ages two and seven years where mortality was 19% from metastatic retinoblastoma. Patients diagnosed between birth and two years had an intermediate survival of 95%. Because of second nonocular tumors, survival of the patient with unilateral retinoblastoma was significantly better than that of the bilaterally affected child.

Actuarial Analysis↗
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Endophytic vs exophytic unilateral retinoblastoma: is there any real difference?

A retrospective review of 297 cases of enucleated and histologically proven unilateral retinoblastoma with a minimum of 5-year follow-up was analyzed to see if there were any clinical or prognostic differences between endophytic and exophytic type retinoblastoma. Endophytic retinoblastoma (181 cases) was found more often than exophytic (116 cases). The following features were not associated with the clinical appearance of either endophytic or exophytic tumors: sex of patient, right vs left eye, propensity for bilateral development, initial sign or symptom, presence of rubeosis, preoperative metastasis, optic nerve invasion, orbital recurrence, survival of the patient, length of follow-up, or age at diagnosis. Three features were found that correlated with type: a disproportionately higher percentage of patients with endophytic retinoblastoma had a positive family history; a disproportionately high percentage of patients with exophytic retinoblastoma developed glaucoma; and choroidal invasion occurred significantly more often in patients who had exophytic retinoblastoma than in those who had endophytic retinoblastoma.

Eye Enucleation↗
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Radiation regression patterns in treated retinoblastoma: 7 to 21 years later.

A retrospective review of cases on file at the Ophthalmic Oncology Center of The New York Hospital-Cornell Medical Center, New York was performed in order to examine the appearance of radiation regression patterns 7 or more years after successful treatment of retinoblastoma with external beam radiotherapy. Forty-eight patients were found to have 89 tumors in 57 eyes which were treated solely with external beam radiation; they were followed for a minimum of 7 years and had sufficient information available for analysis. All but five of the patients had bilateral retinoblastoma. Seventy-four of the 89 tumors continued to be ophthalmoscopically visible after 7 or more years. Taking into account those that did change between the time of first evaluation (usually at the completion of treatment) and final evaluation (7 or more years after treatment), the number of Type I regressions increased by 10.1%, Type IIs decreased by 19.1%, Type IIIs fell by 7.8%, Type IVs rose by 10.1%, and the number of tumors that disappeared increased by 6.8%. Type II remained the most common regression throughout the follow-up. The regression with the greatest potential for change was the Type II regression. The pretreatment volume of the tumor correlated with long-term radiation regression patterns. The smallest tumors (mean size 1.1 dd [disc diameter] or less in size) completely disappeared, while the largest (mean 9.9 dd) became Type I regressions.

Child↗
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Changing trends in the management of retinoblastoma: 1951-1965 vs 1966-1980.

A retrospective analysis of the records of 1253 retinoblastoma patients (567 females, 665 males, and sex of one unknown) seen in the years 1951-1965 (575 patients, Interval I) and 1966-1980 (678 patients, Interval II) was conducted to determine changes in the manner of presentation of the disease, the treatment modalities employed, and their subsequent outcomes following treatment. There was no significant difference between the two 15-year time intervals in the age at presentation (mean, range), laterality, gender, family history, laterality vs gender distribution, family history vs laterality, employment of chemotherapy in unilateral cases or the use of external beam radiation (EBR) in bilateral cases. Changing trends in the management of retinoblastoma were observed as a result of the introduction of new treatment modalities, such as cryotherapy, light coagulation, and radioactive plaque therapy. Bilateral patients have received chemotherapy less frequently in interval II. The use of photocoagulation, cryotherapy, and brachytherapy for bilaterals, and cryotherapy for unilaterals increased significantly during Interval II. During both time intervals, a significantly higher percentage of unilaterally affected eyes were enucleated compared with bilaterally affected eyes; in addition, there was a decrease in the percentage of enucleations performed on both unilaterally and bilaterally affected eyes. In Interval II, 87% of unilateral patients and 91% of the bilateral patients had an enucleation performed.

Adolescent↗
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Nonocular cancer in retinoblastoma survivors.

From a review of the records of 2,302 patients with retinoblastoma collated from CPMC and AFIP, it was found that retinoblastoma patients who survived their original eye cancer have a high incidence of second nonocular malignancies. The second neoplasms occur almost exclusively (97.5%) in patients who have had bilateral retinoblastoma, although retinoblastoma is much more commonly unilateral. The second neoplasms have appeared between 1 and 42 years after the successful treatment of retinoblastoma and have been fatal in approximately 85% of cases. Seventy-one percent of patients develop tumors in the field of the radiation beam; many of these were following treatment with low doses of radiation and after short latent periods. Nineteen percent of patients develop tumors clearly out of the field of radiation (eg, osteogenic sarcoma of the femur). Retinoblastoma patients appear to be unusually radio-sensitive to low doses of radiation and develop tumors in the field of radiation following treatment of 3,500 rads. They have a high incidence of nonocular tumors clearly distant from the radiation beam develop nonocular malignancies even if no radiation has been given. The incidence of multiple malignancies in patients successfully treated for retinoblastoma appears to be higher than for any other primary malignancy whether they receive radiation or not.

Eye Neoplasms↗
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Metastatic retinoblastoma and L-phenylalanine mustard-dianhydrogalactitol.

Retinoblastomas heterotransplanted to nude mice were shown to be sensitive to a combination of phenylalanine mustard and dianhydrogalactitol. A patient with metastatic retinoblastoma was treated with this combination and had a significant response with complete clinical clearance of her bone marrow and metastatic tumors. However, the patient's response was similar to that observed in nude mice; recurrences of tumors developed after complete clinical remission.

Animals↗