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Multimodal management of diffuse neonatal hemangiomatosis.

Diffuse neonatal hemangiomatosis is a rare, frequently fatal disorder. We describe the case of a neonate with numerous cutaneous and ocular hemangiomas. Hepatic hemangiomas were noted at 4 weeks of age, associated with congestive heart failure resulting from hepatic arteriovenous shunting. This condition was controlled by treatment with prednisone, interferon alfa-2b and hepatic embolization. Treatment of cutaneous hemangiomas with the tunable dye laser prevented hemorrhage, facilitated routine skin care, and allowed uninhibited intravenous access during hospitalization.

Antineoplastic Agents↗

[Retinoblastoma and pseudoretinoblastoma: diagnostic study].

Between 1963 and 1987 admitted Lausanne University Eye Hospital 140 infants with suspected retinoblastoma. Of these, 98 (70%) were subsequently confirmed cases, while 42 (30%) were found to be suffering from a benign disorder. Among these pseudoretinoblastomas, Coats' disease was found to be the most prevalent (21%) in this study. The examination procedure is discussed and the importance of genetic research is emphasized.

Child↗

Antisense therapy in clinical oncology: preclinical and clinical experiences.

Nucleic acid molecules have emerged as versatile tools with promising utility as therapeutics for human diseases. The specificity of hybridization of an antisense oligonucleotide (AS ODN) to the target mRNA makes the AS strategy attractive to selectively modulate the expression of genes involved in the pathogenesis of malignant or non-malignant diseases. One AS drug has been approved for local therapy of cytomegalovirus retinitis, and a number of AS ODN are currently tested in clinical trials including ODN that target bcl-2, survivin, and DNA methyltransferase. The clinical studies indicate that AS ODN are well tolerated and may have therapeutic activity. In this overview, we summarize therapeutic concepts, clinical studies, and new promising molecular targets to treat human cancer with AS ODN.

Clinical Trials as Topic↗

DNA and RNA aptamers as modulators of protein function.

The SELEX technique (systematic evolution of ligands by exponential enrichment) is a combinatorial library approach in which DNA or RNA molecules are selected by their ability to bind their protein targets with high affinity and specificity. The isolated molecules are referred to as aptamers (from aptus = Latin "to fit"). First, RNA and DNA aptamers were identified that bind to proteins naturally interacting with nucleic acids, or to small organic molecules such as ATP. In the following years, the use of the SELEX technique was extended to isolate oligonucleotide ligands for a wide range of proteins of importance for therapy, and diagnostics. Since these RNA and DNA molecules bind their targets with similar affinities as antibodies, and are able to distinguish between isotypes of an enzyme, aptamers have been also called synthetic antibodies. Recently, the use of in vitro selection methods to isolate protein inhibitors has been extended to complex targets, such as receptors that are only functional in their membrane-bound form, cells, and trypanosomes. RNA aptamers have been expressed in living cells where they inhibit a protein implicated in intracellular signal transduction. The utility of aptamers for in vivo experiments, and diagnostic and therapeutic purposes, is considerably enhanced by introducing chemical modifications into the oligonucleotides to provide resistance against enzymatic degradation in body fluids. Recently, such inhibitors have been evolved for a great variety of targets, including receptors, growth factors, and adhesion molecules implicated in disease. Furthermore, some results were already obtained in animal models and clinical trials.

Animals↗

Lesions simulating retinoblastoma.

Of 500 consecutive patients referred to the Ocular Oncology Service at Wills Eye Hospital with the diagnosis of possible retinoblastoma, 288 (58%) were found on clinical evaluation to have retinoblastoma and 212 (42%) had lesions that simulated retinoblastoma. A total of 23 different conditions accounted for the 212 pseudoretinoblastomas. Three most common pseudoretinoblastomas were: persistent hyperplastic primary vitreous (28%), Coats' disease (16%), and presumed ocular toxocariasis (16%). Congenital cataract and retinopathy of prematurity accounted for a much lower percent of pseudoretinoblastomas in this series as compared to a previously reported series. The pertinent clinical features that serve to differentiate these simulating lesions from retinoblastoma are reviewed.

Diagnosis, Differential↗

Ocular embolism.

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Adolescent↗

Chorioretinal folds associated with a meningioma.

Chorioretinal folds are a rare presentation of a meningioma. We report a case of a meningioma with chorioretinal folds as its initial presentation. A 39-year-old female patient complained of progressive blurring of the right eye. A fundus examination of the right eye revealed chorioretinal folds. Magnetic resonance imaging found a tumor mass involving the right orbit and right anterior middle cranial fossa. An echo-guided biopsy confirmed the meningioma. She received surgical excision of the meningioma, and her visual acuity was stationary at 12/20 after 15 months of follow-up. We review the etiologies of chorioretinal folds and elucidate the strategies for dealing with them. Certain underling diseases associated with chorioretinal folds are lethal and require prompt management. Ophthalmologists should evaluate these patients carefully in a stepwise manner.

Adult↗