Some aspects of photocoagulation treatment of intra-ocular vascular tumors and malignant melanoma of the choroid.
Explore the source record for details and available documents.
SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Explore the source record for details and available documents.
BACKGROUND: In radiotherapy of intraocular tumors, e. g., in the case of malign choroid melanomas, episcleral brachytherapy with (106)Ru ophthalmic plaques has proven to be successful. In a study, the authors reported on the discovery of the following shortcomings in industrial quality assurance, which are relevant to therapy, during the course of an internal clinical acceptance test of (106)Ru ophthalmic plaques, manufactured by the company Bebig from Berlin, Germany. This consisted of inconsistent dose rate specifications in the manufacturer's certificate, covering a range of 111% and with the risk of leakage of the plaques. Bebig was called upon to adapt state-of-the-art production methods with regard to (106)Ru ophthalmic plaques. MATERIAL AND METHODS: In the meantime, Bebig has modernized production of (106)Ru ophthalmic plaques and adopted all the quality assurance procedures proposed by the authors. Moreover, the requested traceability of the calibration of activity and dose rate of the (106)Ru ophthalmic plaques to standards of the federal authorities in charge of measurement procedures has been implemented. RESULTS: In the year 2002, Bebig updated, among other things, the ASMW (GDR) calibration of the dose rate of the (106)Ru ophthalmic plaques from the years 1987-1989 by a calibration of the NIST (USA). The current NIST calibration, together with the new equipment for the measurement of the depth dose curves, led to the consequence that the new NIST 2001 dose rate values show, in the mean, a deviation of 0.75 times (plaque type CCC) up to 2.06 times (plaque types CCX, CCY, and CCZ) compared to the dose rate values that had been indicated so far in Bebig's certificate, based on the ASMW 1987 calibration. For the 95% confidence interval, Bebig estimated the measurement uncertainty to be +/- 25%. If one takes into consideration the minimal and maximal values in such 95% confidence intervals, it follows that the new NIST 2001 dose rate values deviate between 0.56 times (plaque type CCC) and 2.58 times (plaque types CCX, CCY, and CCZ) from the Bebig certificate (ASMW calibration 1987). As regards leakage, no objections arose in the case of the (106)Ru ophthalmic plaques produced according to the new quality standards. CONCLUSION: Legislation has to make sure that the use of radioactive material on humans be, among other things, permitted as a matter of principle only, if the dose rate calibration can be traced to standards of a federal authority of measurement procedures. Furthermore, special leakage tests for radiation sources which come into direct contact with body fluids should be established. A historical retrospect reveals that the greatest changes have taken place in the indication of the dose rates of (125)I sources. Since the beginning of the use of (125)I sources in brachytherapy in the late 1960s, the dose rate indications, so far, have had to be reduced in small steps over a period of about 35 years by nearly a factor of 2. As regards the (106)Ru ophthalmic plaques, the NIST 2001 calibration has resulted in a comparable reduction of the dose rate indications of up to a factor of 2 within the period of about several months. Thus, in the previous history of radiotherapy this case must be regarded as unique, because for the first time ever, an urgently needed recalibration has been protracted for such an unduly long period of time.
We performed T1-, T2-, proton density-weighted, and T1-weighted gadolinium-enhanced MRI on 24 patients with retinoblastoma, using a 1.5 T superconducting unit and head and orbital surface coil imaging. All patients underwent a complete ophthalmologic examination, including B-scan ultrasonography. CT was performed on 10 of 24 patients. Pathologic correlation was obtained in 18 patients who required enucleation. Contrast-enhanced T1-weighted MRI with fat suppression was the sequence most sensitive to optic nerve extension and provided the greatest differentiation between tumor and uninvolved extrascleral tissue. Retinoblastoma demonstrated contrast enhancement.
PURPOSE: Primary intraocular lymphoma (PIOL) is an uncommon non-Hodgkin lymphoma and is usually of B-cell type. Intraocular T-cell or T/NK-cell lymphomas are extremely rare and mostly represent a secondary manifestation of either a cutaneous or a systemic lymphoma. The aim of the current paper is to report the clinical, histopathological and molecular biological findings of a PIOL of T-cell type. METHODS: Conventional cytological and immunocytological examination of vitrectomy specimens. Conventional histology, immunohistochemistry and polymerase chain reaction (PCR) for the detection of immunoglobulin heavy chain (IgH) and T-cell-receptor gamma (TCR-gamma) gene rearrangement, GeneScan analysis, and DNA sequencing were performed on the chorioretinal biopsy. RESULTS: Cytology of the right vitreous aspirate revealed a moderate cellular infiltrate consisting of medium-sized T-cells with pleomorphic nuclei. Similar atypical lymphocytes were seen in the partially necrotic chorioretinal biopsy. These lymphocytes expressed CD3, CD4, betaF1 and CD30, with a growth fraction of 90%. TCR-gamma-PCR, GeneScan analysis and DNA sequencing demonstrated a monoclonal amplification product within the expected range. In contrast, IgH-PCR revealed oligoclonal amplificates. The patient was treated with low-dose radiotherapy (total 45 Gy), and was in complete remission at final follow-up. CONCLUSION: A rare PIOL of T-cell type was diagnosed on the basis of vitreous aspiration and chorioretinal biopsy. In addition to conventional cytology and immunocytology, the utilisation of gene rearrangement studies on vitreous or chorioretinal biopsies increases the chances of diagnosing or excluding a PIOL of either B-cell or T-cell type. Despite its rarity, ophthalmic pathologists should always consider the diagnosis of T-PIOL when reviewing vitreous samples.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
In four of eight cases of reticulum cell sarcoma with ocular involvement diagnosis was made by craniotomy when the signs of a brain tumor developed. A fifth case had an isolated intraocular tumor. Of the other three, two were diagnosed by vitreous aspiration and one by cerebrospinal fluid cytology. Ocular reticulum cell sarcoma frequently accompanies or precedes brain involvement. In this form of the disease the ocular lesion is usually a tumor cell infiltrate of the retina. The associated retinochoroiditis leads to marked vitreous clouding and eventual retinal detachment and glaucoma may occur. On the other hand, when intraocular reticulum cell sarcoma occurs in association with the systemic lymph node visceral form of the disease, choroidal involvement is the rule. Vitreous aspiration may confirm the diagnosis at an early stage when clinical and laboratory evaluation reveal no disease outside the globe. The retinal tumor foci are radiosensitive and local radiation, although not curative, may restore visual acuity. Immunosuppressive therapy given in low doses for anti-inflammatory effect may exacerbate the disease.
Explore the source record for details and available documents.
We conducted a long-term follow-study of 20 patients whose exposed or extruded orbital implants had been replaced or salvaged with scleral grafts. We judged 11 cases to be successes and six failures. Three patients were lost to follow-up. Among the failures were three orbits that had received radiation therapy for retinoblastoma. They could not retain an orbital implant despite several scleral grafts.
Explore the source record for details and available documents.
We treated a 3-year-old boy with neurofibromatosis who had an optic glioma, intraocular extension with seeding, and iris tumors. On the basis of results of ultrasonography, computed tomography, magnetic resonance imaging, and fine needle aspiration, other intraocular and orbital tumors were excluded. Because of the malignant intraocular aspect, the optic nerve glioma was extirpated. Histologic examination confirmed the diagnosis of an optic nerve glioma with intraocular extension, seeding, and iris nodules. In this juvenile pilocytic astrocytoma with secondary perineural fibrous hyperplasia, several mitoses were found in the orbital and intraocular parts. In the optic canal, three small islands were found that were compatible with the diagnosis of malignant astrocytoma, grade 3. The iris nevi appeared as iris pits and not like the Lisch nodules typical of neurofibromatosis. Café au lait spots were present on the skin. The family history was positive for neurofibromatosis. The results of this study demonstrate that optic gliomas are true astrocytomas and not hamartomas, and have a continuous scale from benign to malignant differentiation.
The cellular localization of alpha-, beta- and gamma-subunits of enolase isoenzyme was studied immunohistochemically in various human brain tumors, retinoblastomas and pituitary adenomas (total, 91 cases). The alpha-subunit was found in almost all brain tumors except in medulloblastoma cases. A case of medullomyoblastoma contained beta-subunit-positive myoblastic cells, which was also positive for human myoglobin. The gamma-subunit was frequently observed in medulloblastomas, retinoblastomas and pituitary adenomas. However, gamma-subunit was also present in some non-neuronal brain tumors such as astrocytomas and oligodendrogliomas. Enzyme immunoassay technique also confirmed the presence of gamma-subunit in a medulloblastoma and two retinoblastomas.
Hydroxyindole-O-methyltransferase (HIOMT, EC 2.1.1.4) was studied in extracts of human pineal gland, retina and Y79 retinoblastoma cells. HIOMT enzyme activity and immunoreactive protein (approximately 42 kDa) were undetectable in the human retina; very low levels of HIOMT mRNA were detected using a highly sensitive RT-PCR/Southern blot method, as has been reported. Analysis of extracts of Y79 cells indicated that HIOMT enzyme activity, immunoreactivity (approximately 42 kDa) and mRNA (approximately 1.3 kb) were detectable at approximately 1/5-1/40 the levels found in the pineal gland. This unambiguously establishes that the HIOMT gene is expressed in Y79 cells. Kinetic analysis of Y79- and pineal-derived HIOMT indicates that the enzyme is generally similar in both tissues; one difference, however, is that substrate inhibition by N-acetylserotonin is greater with the Y79-derived enzyme. These studies show that Y79 cells represent a valid model to study the regulation of human HIOMT protein and mRNA; the differences detected may reflect the existence of tissue-specific regulatory mechanisms or differential patterns of expression of HIOMT isoforms.
Reconstructive procedures were used on 14 patients who had undergone orbital exenteration and radiotherapy for malignant tumours. All patients were tumour free after a follow-up of between 5 and 18 years. Reconstruction was carried out in 3 stages. In the first operation the orbit was filled, in the second the orbital rims and eyelids were shaped, and in the third a cavity for a static eye prosthesis was created. Critical assessment of results showed that the first stage alone produced a marked improvement in appearance and occluded existing fistulae. The subsequent procedures improved aesthetic results further. Difficulties were encountered from retraction of the tissues and insufficient tissue mobility.
When noninvasive techniques fail to confirm or rule out the suspicion of a malignant lesion, fine needle aspiration biopsy may provide an efficient, economical and relatively safe method of obtaining material for cytological study. The technique may also be valuable for intraoperative morphological evaluation. Traumatic complications produced by fine (21-25 gauge) needles are infrequent and almost never serious, and concerns about tumor seeding through the procedure have been largely dispelled by recent studies. Reliable results require a high level of skill in performing the aspiration procedure and in cytologically examining the small amount of material obtained. The authors review the history, applications, techniques and complications of fine needle aspiration biopsy, presenting guidelines for and illustrations of its use in specific ophthalmic situations.