Rescue intra-arterial chemotherapy in unilateral multirelapsed peripapillary retinoblastoma: Decision making and the role of MRI

2020 ◽  
pp. 112067212095758
Author(s):  
Sonia De Francesco ◽  
Paolo Galluzzi ◽  
Sandra Bracco ◽  
Alessandro Di Maggio ◽  
Arianna Sgheri ◽  
...  
Keyword(s):  
Decision Making ◽  
Case Report ◽  
Optic Disc ◽  
Posterior Pole ◽  
Type Iv ◽  
Caucasian Girl ◽  
High Resolution Mri ◽  
Single Mass ◽  
Oncology Unit

Introduction: In this case report we report our experience with rescue intra-arterial chemotherapy in a case of multi-relapsed peripapillary Retinoblastoma (RB) and the importance of high resolution MRI in detecting possible optic disc infiltration. Case report: In 2007, a 14 month-old caucasian girl was referred to our ocular oncology unit for leukocoria. Only left eye was interested, with a single mass of the posterior pole. Patient underwent six cycles of systemic chemotherapy and focal laser consolidation. Several relapses occurred during follow-up. Selective intra-arterial chemotherapy (SIAC) with Melphalan was performed and type IV remission was achieved. A new relapse occurred next to the optic disc. MRI was performed and we decided to try to save the globe with a rescue cycle of SIAC. Conclusion: MRI has demonstrated to be useful in decision making in RB, giving us a last chance to save the globe.

scholarly journals The Role of Parental Capacity for Medical Decision-Making in Medical Ethics and the Care of Psychiatrically Ill Youth: Case Report

2020 ◽  
Vol 11 ◽  
Author(s):  
Ewa D. Bieber ◽  
Gail A. Edelsohn ◽  
Maria E. McGee ◽  
Julia Shekunov ◽  
Magdalena Romanowicz ◽  
...  
Keyword(s):  
Decision Making ◽  
Case Report ◽  
Medical Ethics ◽  
Medical Decision Making ◽  
Medical Decision

The role of intraoperative optical coherence tomography in pediatric hyphema: a case report

2018 ◽  
Vol 28 (1) ◽  
pp. 127-130 ◽  
Author(s):  
Michele Coppola ◽  
Maria Vittoria Cicinelli ◽  
Alessandro Rabiolo ◽  
Giuseppe Querques ◽  
Francesco Bandello
Keyword(s):  
Optical Coherence Tomography ◽  
Case Report ◽  
General Anesthesia ◽  
Anterior Chamber ◽  
Vitreoretinal Surgery ◽  
Posterior Pole ◽  
Integrated System ◽  
Optical Coherence ◽  
Intraoperative Optical Coherence Tomography

Purpose: Intraoperative optical coherence tomography (iOCT) is a valuable tool during vitreoretinal surgery, helping the decision-making process. It is particularly useful in pediatric cases to evaluate the macular anatomy intraoperatively, avoiding further potentially dangerous surgery in children. The aim of this report is to describe the role of integrated iOCT in the management of traumatic hyphema in a pediatric patient. Case report: A 5-year-old girl was referred to our department with a history of recent domestic trauma in her right eye. Massive bleeding in the anterior chamber without visualization of the posterior segment was evident. Surgery was planned for the next day under general anesthesia. A 25-G irrigation cannula and 25-G vitrectome were inserted at the limbus into the anterior chamber for removal of the anterior chamber clot. Careful inspection of the posterior pole and retinal periphery to exclude pathologic findings was carried out. A real-time OCT integrated system was used to assess the macular anatomy and the corneal state. The postoperative course was uneventful and full visual recovery was achieved. Conclusions: The objective confirmation of macular integrity by means of iOCT after anterior chamber clearing had great prognostic value, excluding the need for surgical revision with a second general anesthesia in this young patient.

Optic disc and choroidal metastases secondary to breast cancer: A case report

2021 ◽  
pp. 112067212110362
Author(s):  
Rim Bouraoui ◽  
Khaled El Matri ◽  
Yousra Falfoul ◽  
Zied Chelly ◽  
Ahmed Chebil ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Case Report ◽  
Optic Disc ◽  
Infrared Imaging ◽  
Subretinal Fluid ◽  
Posterior Pole ◽  
Wide Field ◽  
Fundus Examination ◽  
Blurred Vision ◽  
Macular Lesion

Aim: To report an uncommon case of optic disc and multiple choroidal metastases secondary to breast cancer, assessed with swept source optical coherence tomography (SS-OCT), fluorescein (FA), and infracyanine (ICGA) angiographies. Methods: Observational case report. Case presentation: A 40-year-old woman with history of left breast carcinoma presented with blurred vision in her right eye (RE). Her visual acuity was 1/20 in the RE and 10/10 in the left eye. Fundus examination of the RE showed a large yellowish elevation of the posterior pole and a particular whitish nodular papillary cluster protruding from the optic disc into the vitreous. Infrared imaging enhanced the papillary nodular infiltrates. Characteristic findings of choroidal metastasis were noted within the macular lesion on SS-OCT and ICGA. SS-OCT showed specific “lumpy bumpy” irregularity of the anterior surface of the choroid and elevated hyperreflective nodular lesions of the optic disc associated to peripapillary subretinal fluid. The papillary lesions appeared as a bunch of hypofluorescent dots on both FA and ICGA, and ultra-wide field FA was helpful clearly delimiting the large macular lesion. Besides, comprehensive imaging and especially ICGA could detect two asymptomatic choroidal metastases in a systematic assessment of the fellow eye. Conclusion: Optic disc metastases are extremely rare. Their diagnosis can be easily done on fundus examination when presenting with characteristic whitish cluster nodular infiltrates of the optic disc. However multimodal imaging remains very useful for the assessment of the local extension of the lesion and for diagnosing associated asymptomatic choroidal lesions gone unnoticed at the fundus examination.

Elaborating the role of reflection and individual differences in the study of folk-economic beliefs

2018 ◽  
Vol 41 ◽  
Author(s):  
Kevin Arceneaux
Keyword(s):  
Decision Making ◽  
Individual Differences ◽  
Cognitive Processes ◽  
Evolutionary History ◽  
Behavioral Responses ◽  
History Of ◽  
Economic Beliefs

AbstractIntuitions guide decision-making, and looking to the evolutionary history of humans illuminates why some behavioral responses are more intuitive than others. Yet a place remains for cognitive processes to second-guess intuitive responses – that is, to be reflective – and individual differences abound in automatic, intuitive processing as well.

The Role of Shared Decision-Making in Audiologic Rehabilitation

2014 ◽  
Vol 21 (1) ◽  
pp. 15-23 ◽  
Author(s):  
Helen Pryce ◽  
Amanda Hall
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Behavior Changes ◽  
Shared Decision ◽  
Patient Centered ◽  
Treatment Information ◽  
Centered Care ◽  
Potential Risks ◽  
Audiologic Rehabilitation

Shared decision-making (SDM), a component of patient-centered care, is the process in which the clinician and patient both participate in decision-making about treatment; information is shared between the parties and both agree with the decision. Shared decision-making is appropriate for health care conditions in which there is more than one evidence-based treatment or management option that have different benefits and risks. The patient's involvement ensures that the decisions regarding treatment are sensitive to the patient's values and preferences. Audiologic rehabilitation requires substantial behavior changes on the part of patients and includes benefits to their communication as well as compromises and potential risks. This article identifies the importance of shared decision-making in audiologic rehabilitation and the changes required to implement it effectively.

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