Biomedical subjects

T M Bosley

Publications and source records attributed to T M Bosley.

At least 55 records · Page 3Linked to original sources

PubMed1990

The results of radiotherapy for orbital pseudotumor.

Between January 1982 and March 1987, 23 patients (26 orbits) were treated for orbital pseudotumor with radiation therapy at the Department of Radiation Oncology, Hospital of the University of Pennsylvania. The patients were referred for clinical relapse after steroid taper in 70%, no response to steroids in 17%, and no steroid treatment (refused or contraindicated) in 13%. Presenting symptoms/signs included soft tissue swelling in 92% of orbits, pain in 92%, proptosis in 85%, and extraocular muscle dysfunction or ptosis in 69%. Decreased visual acuity was seen in only 19% of orbits. Biopsy was performed in nine patients. Treatment consisted of 2000 cGy in 2 weeks in 10 fractions for all patients. Median follow-up was 41 months, with a mean of 53 months, and a range of 21-92 months. Complete response was documented in 87% of orbits with soft tissue swelling, 82% with proptosis, 78% with extraocular muscle dysfunction, and 75% with pain. Of the five patients with visual acuity defects, three experienced complete recovery. There was no difference in complete response in patients biopsied versus those not biopsied. Overall, 17 orbits have remained in complete orbital response with no further steroid requirement (66%). Three orbits suffered local relapse at some point following radiation therapy and were retreated with steroids. These three orbits had durable local control off steroids at last follow-up (11%). Therefore, 77% of orbits attained durable local control and were steroid independent with radiation therapy alone or radiation therapy followed by steroids for relapse. Only one patient developed systemic lymphoma with follow-up. No pretreatment clinical factor reached statistical significance with respect to prognosis following radiation therapy at the less than or equal to .05 level. There were no significant acute or chronic side effects secondary to treatment. Steroids should continue to be first line treatment for orbital pseudotumor, but radiation therapy has a well-defined role in cases of steroid failure or in patients unable to tolerate steroid therapy.

Adolescent↗

PubMed1990

Results of radiotherapy in the treatment of acromegaly: lack of ophthalmologic complications.

Between 1956 and 1988, 25 patients were treated with radiotherapy for acromegaly. Acromegalic features were present in 24 (96%), visual field deficits in 4 (16%), and suprasellar extension was present in 7 patients (28%). The median growth hormone level was 40.2 ng/ml (range: 13.8-105) in 15 patients. Initial therapy consisted of radiotherapy alone (19 patients) or surgery followed at some interval by radiation (6 patients). The radiation therapy was administered with megavoltage equipment in 23 (92%) patients and orthovoltage equipment in 2 patients. The median total dose was 46 Gy (range: 24-53.44 Gy) with 21 patients receiving at least 45 Gy. With a median follow-up of 53 months (range: 18-205), 2 of the 19 patients treated with radiotherapy alone have required surgery for symptomatic recurrences. Both are alive and in remission at 69 and 158 months following craniotomy. Thus, the success of radiotherapy as a primary modality in this series is 17/19 (89%). None of the six patients treated postoperatively have recurred. At the time of last follow-up the visual fields remained normal and visual acuity stable in the 21 patients with no pre-existing visual deficits. The four patients with prior visual field deficits improved with therapy. There were no cases of radiation optic neuropathy, brain necrosis or second intracranial malignancies. Seven patients (28%) had evidence of hypopituitarism attributed to the radiotherapy. Growth hormone levels after radiotherapy showed a median of 5.4 ng/ml (range: 3.2-40.0) in 15 patients. Eleven of 15 patients (73%) had growth hormone levels less than 10 ng/ml. Radiation use in acromegaly remains a safe and effective modality assuming careful attention is paid to technique, total dose, and fraction size.

Acromegaly↗

PubMed1990

Rapidly progressive acute retinal necrosis secondary to herpes simplex virus, type 1.

A systemically healthy 22-year-old man presented with unilateral acute retinal necrosis (ARN) that featured diffuse retinal whitening throughout the posterior retina, exudative retinal detachment, and a visual acuity of no light perception. Diagnostic vitrectomy revealed necrotic retinal cells containing intranuclear inclusions visible with light microscopy. On electron microscopy, viral particles consistent with a herpes family virus were detected. Culture of the vitrectomy specimen showed herpes simplex, type 1 (HSV 1) and rising convalescent serum ELISA titers to HSV 1 confirmed a recent infection. This case of ARN is unusual for its severity, early macular involvement, and development of exudative retinal detachment. In addition, it represents one of the few reported cases in which HSV 1 has been confirmed by both vitreous culture and serum titers as the etiologic agent. A review of the literature suggests that posterior segment inflammatory conditions secondary to HSV 1 can be associated with exudative retinal detachment, a clinical finding that may help differentiate such conditions from other infectious causes of chorioretinitis.

Adult↗

PubMed1990

Asymmetric proliferative diabetic retinopathy and carotid artery disease.

The authors prospectively evaluated 387 consecutive patients with proliferative diabetic retinopathy (PDR) for asymmetry in posterior segment neovascularization and its relationship to carotid artery disease. For the purpose of this study, asymmetry is defined as the presence of PDR with high-risk characteristics (as per the Diabetic Retinopathy Study) in one eye, with neither proliferative nor preproliferative changes in the opposite eye. Over the 2-year time period of the study, 20 (5.2%) of 387 patients manifested asymmetric PDR by this definition. All 20 patients underwent carotid artery noninvasive testing and 4 (20%) were found to have hemodynamically significant carotid artery disease. Two of the four patients had their proliferative retinopathy ipsilateral to their severe carotid artery stenosis. This finding does not support the hypothesis that a hemodynamically significant carotid artery stenosis protects against the development of PDR.

Adolescent↗

PubMed1990

Reversible visual loss in a patient receiving high-dose ciprofloxacin hydrochloride (Cipro)

Bilateral acute visual loss characterized by cecocentral scotomas and acquired dyschromatopsia developed in a patient receiving large oral doses of ciprofloxacin hydrochloride (Cipro). The visual defects improved after cessation of this antibiotic. To our knowledge, this association has not been described previously. The use of this medication in high doses must be accompanied by careful monitoring of optic nerve function.

Aged↗

PubMed1990

Delayed radiation injury to the retrobulbar optic nerves and chiasm. Clinical syndrome and treatment with hyperbaric oxygen and corticosteroids.

Thirteen patients with delayed radiation injury to the optic nerves and chiasm were treated with hyperbaric oxygen (HBO) and corticosteroids. These patients experienced painless, abrupt loss of vision in one (6 patients) or both (7 patients) eyes between 4 and 35 months after receiving radiation doses of at least 4500 cGy to the region of the chiasm. Diagnostic evaluation including neuro-imaging and lumbar puncture showed no recurrent tumor and no other cause for visual loss. No patient's vision improved during treatment or follow-up lasting between 1 and 4 years. There were no serious complications of treatment.

Adrenal Cortex Hormones↗

PubMed1990

Optic nerve sheath decompression: a clinical review and proposed pathophysiologic mechanism.

Surgical decompression of the intraorbital meningeal sheath of the optic nerve has undergone a recent resurgence of interest. Previously, the procedure had been reserved only for the most desperate cases of severe visual loss associated with chronic papilloedema. However, recent investigations have demonstrated the operation's efficacy not only for chronic papilloedema and pseudotumor cerebri, but also for the optic neuropathy associated with the acute retinal necrosis syndrome, traumatic subdural haematomas of the optic nerve and progressive nonarteritic ischaemic optic neuropathy. In this article, we review the previous literature concerning optic nerve sheath decompression, the indication for the procedure, its techniques and results. Finally, we propose that optic nerve sheath decompression may be effective for what appear to be very different optic neuropathies because the operation may reverse optic nerve ischaemia, a common pathophysiologic feature of all these disorders.

Humans↗

PubMed1990

Inhibition of follicle-stimulating hormone secretion from gonadotroph adenomas by repetitive administration of a gonadotropin-releasing hormone antagonist.

As a preliminary step in searching for a pharmacological treatment for gonadotroph adenomas, we administered the GnRH antagonist analog Nal-Glu GnRH to five patients, four men and a woman, with FSH-secreting gonadotroph adenomas in order to determine its effect on FSH secretion. Administration of a single 10-mg dose of Nal-Glu GnRH to four of the patients produced a significant decrease in the serum FSH concentration in two patients and returned the FSH level to normal in only one. Administration of 5 mg Nal-Glu every 12 h for 7 days, however, produced a significant (P less than 0.001) decrease, and to within the normal range, in four of the five patients (mean +/- SEM, 32.7 +/- 5.6 IU/L during the 3 days before treatment and 9.8 +/- 1.4 IU/L during the last 3 days of treatment). Also, in response to the 7-day treatment, LH fell significantly in all five patients, alpha-subunit fell in three, and testosterone fell in all four men. Administration for 6 weeks of the GnRH agonist analog leuprolide did not decrease the serum FSH concentration of one of the patients whose serum FSH did decrease in response to Nal-Glu GnRH. We conclude that repetitive administration of Nal-Glu GnRH may often inhibit FSH secretion by gonadotroph adenomas and that FSH secretion by gonadotroph adenomas may be dependent on endogenous GnRH secretion.

Adenoma↗

PubMed1990

MR imaging of Tolosa-Hunt syndrome.

The Tolosa-Hunt syndrome consists of painful ophthalmoplegia caused by cavernous sinus inflammation, which is responsive to steroid therapy. The MR features of 11 patients with the clinical diagnosis of Tolosa-Hunt syndrome were studied. Two patients had normal MR studies of the orbit and cavernous sinuses. In nine patients, abnormal signal and/or mass lesions were seen in the cavernous sinuses; in eight cases, the abnormality was hypointense relative to fat and isointense with muscle on short TR/TE images and isointense with fat on long TR/TE scans. Extension into the orbital apex was seen in eight cases. In six of nine cases the affected cavernous sinus was enlarged; in five of nine it had a convex outer margin. One patient had a thrombosed cavernous sinus and superior ophthalmic vein in addition to a cavernous sinus soft-tissue mass. The signal intensity of Tolosa-Hunt syndrome in this limited series was similar to that of orbital pseudotumor and is confined to a limited differential diagnosis, which includes meningioma, lymphoma, and sarcoidosis.

Adolescent↗

PubMed1989

Positron emission tomography to study the effect of eye closure and optic nerve damage on human cerebral glucose metabolism.

We used 18F-2-fluoro-2-deoxyglucose and positron emission tomography to evaluate the effect of visual deprivation on brain glucose metabolism. In experiment 1, we compared local cerebral metabolic rates for glucose in seven normal volunteers studied with eyes closed to 11 age- and sex-matched normal volunteers studied with eyes open. Whole brain metabolism was similar in the two groups, and region/whole brain analysis of metabolic data showed that metabolism in the calcarine posterior cortex was decreased by 14% (P less than .05) with eye closure. Glucose metabolism in other regions was not different between the two groups. In experiment 2, we compared glucose metabolism in six patients with severe bilateral optic neuropathies to 12 age- and sex-matched normal controls. Whole brain glucose metabolism was unchanged in the optic neuropathy group compared to controls. However, statistically significant reductions in glucose metabolism in the optic neuropathy group were found in anterior calcarine cortex (17%), posterior calcarine cortex (27%), peristriate cortex (27%), and lateral occipital cortex (15%). The metabolic effects of damage to the pregeniculate visual system went well beyond those of simple eye closure.

Adolescent↗

PubMed1989

Abnormal ocular pneumoplethysmographic results in unilateral neovascular glaucoma.

Little is known about the predictive value of ocular pneumoplethysmography in patients with ophthalmic disease. We evaluated eight patients with unilateral increased intraocular pressure due to neovascular glaucoma who did not have evidence of severe extracranial carotid stenosis by duplex scanning and continuous-wave Doppler ultrasound. The ophthalmic systolic pressure measured by ocular pneumoplethysmography was decreased in the affected eye of all eight patients, indicating that neovascular glaucoma may be a cause of abnormal ocular pneumoplethysmographic results. Patients with neovascular glaucoma tended to have larger interocular ophthalmic systolic pressure differences than other patients with false-positive ocular pneumoplethysmographic results by noninvasive criteria.

Aged↗

PubMed1989

Ocular pneumoplethysmography can help in the diagnosis of giant-cell arteritis.

We compared the results of ocular pneumoplethysmography in nine patients who had a temporal artery biopsy (TAB) diagnostic of giant-cell arteritis with results of ocular pneumoplethysmography in nine patients with normal TAB results and 112 patients with anterior ischemic optic neuropathy or central retinal artery occlusion assumed to be nonarteritic. The mean +/- SD ocular pulse amplitude with ocular pneumoplethysmography was 3.9 +/- 1.8 mm in the group with abnormal TAB results and 10.6 +/- 4.0 mm in the group with normal TAB results. Every patient with abnormal TAB results had an average calculated ocular blood flow less than 0.60 mL/min, while only one patient with normal TAB results fell in this range. The average calculated ocular blood flow had a sensitivity of 100% and a specificity of 93.4% in the diagnosis of giant-cell arteritis, with a diagnostic accuracy of 93.9%. These results rival the diagnostic accuracy of the erythrocyte sedimentation rate and TAB results.

Aged↗

PubMed1989

Cryptogenic oculomotor nerve palsy. The need for repeated neuroimaging studies.

Five children between ages 3 and 17 years developed slowly progressive oculomotor nerve palsies. No cause was found on initial clinical or neuroradiologic investigations. Subsequent computed tomography or 1.5-T magnetic resonance imaging revealed a mass along the course of the involved oculomotor nerve in three of the five cases. The clinical and radiologic characteristics of these tumors are consistent with the diagnosis of schwannoma or, less likely, meningioma. Children with acquired oculomotor nerve palsies of initially unknown etiology should undergo imaging every two years with the expectation of eventually detecting a small tumor somewhere along the course of the oculomotor nerve.

Adolescent↗

PubMed1989

Acute retinal necrosis neuropathy. Clinical profile and surgical therapy.

Twelve patients (17 eyes) with the acute retinal necrosis syndrome were analyzed with special reference to the development of an acute optic neuropathy. Six patients (9 eyes) without acute optic nerve involvement were treated with intravenous acyclovir sodium and/or vitreoretinal surgery (group 1). Six patients (8 eyes) fulfilling absolute and relative criteria for acute retinal necrosis optic neuropathy were treated with intravenous acyclovir as well as optic nerve sheath decompression, and, in addition, some of these patients also underwent vitreoretinal surgery. Despite more pronounced initial visual loss compared with group 1, six eyes in group 2 regained visual acuity of 20/400 or better. In contrast, only 2 of 9 eyes in group 1 maintained their entry level visual acuity, and the visual acuities of the remaining 7 eyes deteriorated to counting fingers or worse. Therefore, the acute optic neuropathy complicating the acute retinal necrosis syndrome appears to benefit from prompt recognition and surgical decompression of the intraorbital optic nerve meninges in conjunction with intravenous acyclovir.

Acute Disease↗

PubMed1989

Optic nerve decompression may improve the progressive form of nonarteritic ischemic optic neuropathy.

Optic nerve sheath decompression surgery improved visual function for 12 of 14 patients with progressive nonarteritic ischemic optic neuropathy (NAION). Visual recovery was maintained in all patients during a follow-up period of 6 to 18 months (average, 11 months). Seven patients had experienced a previous NAION in the eye that was not operated on that did not improve spontaneously. Surprisingly, 2 of these 7 eyes with long-standing decreased vision demonstrated some visual improvement after surgery on the contralateral, acutely affected eye. Spontaneous visual improvement did not occur in an age- and sex-matched control group of 12 patients with similar entry-level visual acuity and field loss. Only 1 of 3 patients with sudden, nonprogressive visual loss secondary to NAION improved after surgery. In a control group with nonprogressive NAION, 2 of 15 eyes (14 patients) demonstrated spontaneous improvement. Optic nerve sheath decompression improves visual loss due to progressive NAION, a disorder without any previously effective therapy. However, for acute, nonprogressive NAION, surgery for a small number of patients did not improve the natural history of the disease.

Adult↗

PubMed1989

Intermittent obstructive hydrocephalus in the Arnold-Chiari malformation.

A 26-year-old woman with a Chiari-I malformation and intermittent symptoms of intracranial pressure elevation is described. Clinically, papilledema was accompanied by midperipheral retinal hemorrhages. Repeat computed tomographic scans and lumbar puncture showed normal results. Posterior fossa-directed magnetic resonance image scanning revealed the Chiari-I malformation. Intraventricular monitoring was necessary to demonstrate the marked but unsustained elevation of intracranial pressure.

Adult↗

PubMed1989

Divisional oculomotor nerve paresis caused by intrinsic brainstem disease.

Two patients with findings ascribable to superior branch oculomotor nerve paresis and one patient with findings ascribable to an inferior branch paresis are described. In each patient the paresis was caused by an intra-axial midbrain lesion. These patients represent the first described cases of divisional oculomotor nerve paresis caused by intrinsic brainstem disease.

Adult↗

PubMed1989

Results of radiotherapy for thyroid ophthalmopathy.

Between October, 1978 and August, 1986, 35 patients with thyroid ophthalmopathy were treated with radiotherapy. Twenty-eight patients had treatment with corticosteroids prior to radiotherapy and either progressed on steroids or relapsed during tapering. Seven patients with contraindications to steroids were treated primarily with radiotherapy. After radiotherapy, 25 patients (71%) did not require any further steroids or orbital decompression and ten (29%) failed. Patients who required steroids or decompression for active disease after radiotherapy were considered treatment failures. A total of 14 (40%) patients required eye muscle or lid surgery for correction of stable soft tissue defects after radiotherapy, more commonly in patients treated with radiotherapy after steroids or decompression than those irradiated primarily; the median time between radiotherapy and surgery was 8 months (range 1-48). Various factors were examined for prognostic significance in predicting radiotherapy failure. Review of the interval between onset of eye disease and radiotherapy demonstrated that six of ten (60%) failures versus only five of 25 (20%) successful treatments received radiotherapy within 6 months of onset of eye disease. No relation between outcome and sex, age or hyperthyroid versus euthyroid Graves' disease was apparent. Radiotherapy has been used for patients with thyroid ophthalmopathy who failed steroids, decompression, or had steroid contraindications. Morbidity of radiotherapy was minimal and most patients were spared the morbidity of continued steroid therapy.

Adult↗