Hypertensive Gas Technique for Enucleation of Choroidal Melanomas: A Preliminary Report

1992 ◽  
Vol 2 (1) ◽  
pp. 30-32
Author(s):  
I. Kreissig ◽  
B. Jost
Keyword(s):  
Choroidal Melanoma ◽  
Inclusion Criteria ◽  
Epithelioid Cells ◽  
Base Diameter ◽  
Simple Alternative ◽  
Choroidal Melanomas ◽  
Melanoma Patients ◽  
A Prospective Study ◽  
Previous Irradiation

The hypertensive gas technique induces avascularity within the eye during enucleation of a melanoma. Before touching the eye for enucleation, pressure is raised to maximum by an intravitreal injection of approximately 1.4 ml of gas (perfluorocarbon, air) resulting in a rock-hard eye. Avascularity persists for the duration of enucleation. From 9/1987 to 6/1989, 15 patients with choroidal melanomas were enrolled in a prospective study with the hypertensive gas technique instead of prior radiotherapy (the death rate in that series was five out of 26 melanoma patients at three years). Inclusion criteria for the hypertensive gas technique study were the same as for our previous irradiation series: (1) absence of detectable metastases and (2) a choroidal melanoma too large for a radioactive plaque. The average base diameter of melanomas measured 13.2 mm, height 8.4 mm. The cytology was: 11x spindle, 3x mixed, 1x epithelioid cells. At re-examination in 7/1991 (average follow-up 33 months) two diabetics had died with no detectable metastases prior to death, and one of the 15 melanoma patients had died with metastases 24 months after enucleation. So far the hypertensive gas technique for enucleation of a melanoma eye seems to have no adverse effect on survival. It seems to be a simple alternative to the precautions taken otherwise and it facilitates enucleation with pratically no bleeding from the globe.

Long-Term Follow-Up of Iodine-125 Brachytherapy for Choroidal Melanomas. Part I: Anatomical Results and Life Expectancy

1993 ◽  
Vol 3 (3) ◽  
pp. 121-126 ◽  
Author(s):  
I. Kreissig ◽  
D. Rose ◽  
B. Jost
Keyword(s):  
Base Diameter ◽  
Long Term Follow Up ◽  
Choroidal Melanomas ◽  
The Mean ◽  
Tumor Regrowth ◽  
Iodine 125 ◽  
A Prospective Study ◽  
Severe Deterioration

We report a prospective study of 19 choroidal melanomas treated with iodine-125 plaque from 1984 to 1989. The mean tumor height was 5.8 mm, base diameter 11.6 mm, and tumor volume 80 to 510 mm3. The mean radiation dose to tumor apex was 70 Gy and scleral contact dose 355 Gy; tumor base was surrounded by contiguous laser or cryopexy lesions. Follow-up was 27 to 84 months (mean 60 months). All tumors regressed at least 50% in volume with no tumor regrowth within 27 months to 60 months. Late tumor regrowth, localized in the center, occurred in one eye after 65 and another after 69 months. One tumor was successfully replaqued; the other was not re-treated because the patient had had a recent heart attack. In 17 eyes radiation retinopathy developed after 1½ years, the earliest in a diabetic eye. Despite primary recovery of preoperative vision, there was severe deterioration of visual acuity after 4½ years in all the eyes. During follow-up, two patients died due to metastases after 28 and 71 months; one patient is alive with metastases after 17 months. None of the eyes had to be enucleated. There was no incidence of madaurosis, Symblepharon, or dry eye.

scholarly journals Pediatric wrist buckle fractures: Should we just splint and go?

CJEM ◽  
2004 ◽  
Vol 6 (06) ◽  
pp. 397-401 ◽  
Author(s):  
Amy C. Plint ◽  
Jeffrey J. Perry ◽  
Jennifer L.Y. Tsang
Keyword(s):  
Tertiary Care ◽  
Study Cohort ◽  
Inclusion Criteria ◽  
Distal Ulna ◽  
Radiology Reports ◽  
Both Bones ◽  
A Prospective Study ◽  
Record Review ◽  
Retrospective Medical Record Review

ABSTRACT: Objectives: The objective of this study was to evaluate the utility of circumferential casting in the emergency department (ED), orthopedic follow-up visits, and radiographic follow-up in the management of children with wrist buckle fractures. Methods: We performed a retrospective medical record review of all children < 18 years of age who presented to our tertiary care children’s hospital between July 1, 2000, and June 30, 2001, and were diagnosed with a fracture of the wrist, radius or ulna. Based on the radiology reports, we identified buckle fractures of the distal radius, the distal ulna, or both bones. We excluded children who had other types of fractures. Results: We identified 840 children with fractures of the wrist, radius, or ulna. Of these, 309 met our inclusion criteria. The median age of our study cohort was 9.2 years. Emergency physicians immobilized 269 of these fractures in circumferential casts; of these, 30 (11%) had cast complications. Of the 276 subjects who had orthopedic follow-up visits and radiographs, 184 (67%) had multiple visits and 127 (46%) had multiple radiographs performed. No subjects had fracture displacement identified on follow-up. Conclusions: Orthopedic follow-up visits and radiographic follow-up may have minimal utility in the treatment of pediatric wrist buckle fractures. ED casting may pose more risk than benefit for these children. Splinting in the ED with primary care follow-up appears to be a reasonable management strategy for these fractures. A prospective study comparing ED splinting and casting for pediatric wrist buckle fractures is needed.

scholarly journals Effectiveness of transperforation myringoplasty in bilateral chronic otitis media patients undergoing contralateral tympanoplasty

2016 ◽  
Vol 131 (1) ◽  
pp. 64-68 ◽  
Author(s):  
A T Ihsan ◽  
K Ranjana
Keyword(s):  
Otitis Media ◽  
Chronic Otitis Media ◽  
Contralateral Side ◽  
Tympanic Membrane Perforation ◽  
Inclusion Criteria ◽  
Hearing Improvement ◽  
Membrane Perforation ◽  
Bilateral Surgery ◽  
A Prospective Study

AbstractObjectives:Bilateral tympanic membrane perforation closure is usually performed by otosurgeons in two sittings. However, in this study, transperforation myringoplasty was performed alongside contralateral tympanoplasty in a single sitting. The effectiveness of transperforation myringoplasty procedure and the benefits of single sitting bilateral surgery were evaluated.Methods:A prospective study of 50 selected patients with mucosal-type bilateral chronic otitis media was conducted. All patients underwent transperforation myringoplasty on the side that met the inclusion criteria and tympanoplasty on the contralateral side. Graft uptake and hearing improvement were evaluated after 6 months.Results:At the 6-month follow up, the graft uptake rate was 82 per cent, the hearing gain was 11.5 dB and the air–bone gap gain was 11.6 dB.Conclusion:This procedure offers perforation closure in a single sitting to patients with bilateral chronic otitis media who meet the inclusion criteria.

scholarly journals P.073 Improving access to urgent neurology care for pediatric patients

2019 ◽  
Vol 46 (s1) ◽  
pp. S34
Author(s):  
A Yaworski ◽  
J Yager ◽  
J Mailo ◽  
L Richer ◽  
T Rajapakse ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Wait Time ◽  
Wait Times ◽  
Referral Process ◽  
Inclusion Criteria ◽  
University Of Alberta ◽  
Future Evaluation ◽  
A Prospective Study ◽  
The University

Background: Pediatric neurology referral wait times are increasing, often leading to emergency department (ED) utilization. On average 5% of ED patients present with neurological symptoms and 35% of ED neurological diagnoses are revised after specialist review. A Stollery Rapid Access Neurology (RAN) clinic was created to decrease wait time, and initiate an efficient referral process. Methods: The RAN clinic ran weekly from March 2018 until February 2019. This was a prospective study approved by the University of Alberta ethics board. Inclusion criteria were met. Information was collected for diagnosis, along with confidential patient satisfaction surveys. Results: Seventy-five patients were referred, 49% from the ED. Wait time averaged 6 weeks. The most frequent referral reason was seizures, with 60% of referring diagnosis being correct. Prior to RAN appointment, 61% of patients presented to the ED, whereas only 0.1% returned in the following 3 months. Neurology follow up was required in 81% of patients. Overall satisfaction was ranked 9.6/10. Conclusions: The RAN clinic created an effective urgent triage method. Neurologist review revised 40% of diagnoses. This ongoing study reveals that a RAN clinic can reduce visits to the ED following appointment and initiate appropriate follow up. Future evaluation in cost effectiveness and telehealth appointments are required.

Primary photodynamic therapy for small amelanotic choroidal melanomas: consecutive case series of 69 patients with at least 24-month follow-up

2020 ◽  
pp. bjophthalmol-2020-316616
Author(s):  
Hibba Quhill ◽  
Daniel Gosling ◽  
Katharine Sears ◽  
Paul Rundle
Keyword(s):  
Photodynamic Therapy ◽  
Choroidal Melanoma ◽  
Case Series ◽  
Retrospective Case ◽  
Recurrence Rates ◽  
Basal Diameter ◽  
Visual Outcomes ◽  
Choroidal Melanomas ◽  
The Mean

AimsTo investigate the success and recurrence rates and visual outcomes in a large case series of amelanotic posterior choroidal melanomas treated by means of primary photodynamic therapy (PDT) with verteporfin.MethodsRetrospective case series from a single specialist ocular oncology centre. All patients had a clinical diagnosis of choroidal melanoma and were selected for PDT based on tumour characteristics. Included patients had at least 24 months of follow-up from initiation of treatment and all but one had not received treatment prior to PDT.Results69 patients were included. Mean tumour thickness was 1.9 mm (range 0.5–4.4), while the mean basal diameter was 6.9 mm (range 2.4–11.0). Included lesions were stage cT1a (n=66) or cT2a (n=3). The mean duration of follow-up from treatment initiation was 57 months (range 24–116 months). Seven lesions (10%) failed to respond to PDT. 10 patients (16%) experienced recurrence during follow-up. Overall success rate in this series was 75% (n=52). 83% of successfully treated patients (n=43) maintained or gained vision by final follow-up. Visual outcomes were significantly better in those patients who received PDT therapy alone in comparison to those who needed other treatments for their melanoma (Fisher’s exact test, p=0.004). Unfortunately, one patient (1.4%) in the series developed systemic metastases and died.ConclusionSelected amelanotic posterior uveal melanomas may be successfully treated with PDT with retention of good vision in the majority of cases, maintained with a mean of 57 months (minimum of 24 months) of follow-up.

scholarly journals Fundus Autofluorescence Change as an Early Indicator of Treatment Effect of Brachytherapy for Choroidal Melanomas

2019 ◽  
Vol 5 (6) ◽  
pp. 445-453 ◽  
Author(s):  
Jesintha Navaratnam ◽  
Thomas P. Bærland ◽  
Nils A. Eide ◽  
Rowan T. Faber ◽  
Bernt L. Rekstad ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Retinal Pigment Epithelium ◽  
Pigment Epithelium ◽  
Fundus Autofluorescence ◽  
Retinal Pigment ◽  
Choroidal Melanoma ◽  
Choroidal Melanomas ◽  
Rpe Atrophy ◽  
Time Point

Background: Early confirmation of the effect of brachytherapy for choroidal melanoma showing that tumour coverage is valuable. The irradiated retinal pigment epithelium (RPE) commonly develops atrophy. This study compares the fundus autofluorescence (AF) changes to the development of RPE atrophy following brachytherapy. Methods: Retrospective study of 19 patients treated with 106Ru and 2 with 125I plaques with either a 3- or 6-month follow-up period. Ultra-widefield (UW) composite colour and AF images were obtained with Optomap 200Tx and interpreted as complete, partial, or no RPE changes and complete or partial hyperautofluorescence, hypoautofluorescence, or isoautofluorescence. Results: At the 3-month follow-up, 9 of 13 patients (69%) (95% confidence interval [CI], 0.389–0.896) treated with 106Ru plaques developed complete homogenous hyperautofluorescence surrounding the tumour, but only 1 of 13 (8%) (95% CI, 0.004–0.379) developed complete RPE atrophy at the same time point. Six patients in the 106Ru plaque group had their first follow-up with UW imaging at 6 months. Four of them developed homogenous hyperautofluorescence and none developed complete RPE atrophy around the tumour. The 2 patients treated with 125I did not demonstrate any clear RPE or AF changes. Conclusion: The effect of 106Ru plaque treatment on fundus UW imaging is detected as homogenous and well-demarcated hyperautofluorescence before visible RPE atrophy.

scholarly journals A diagnostic assessment of angioarchitectonics of choroidal melanoma

2021 ◽  
Vol 14 (3) ◽  
pp. 40-45
Author(s):  
I. E. Panova ◽  
E. V. Samkovich ◽  
P. A. Nechiporenko ◽  
N. N. Grigoryeva
Keyword(s):  
Indocyanine Green ◽  
Choroidal Melanoma ◽  
Diagnostic Value ◽  
Diagnostic Assessment ◽  
Oct Angiography ◽  
Contrast Angiography ◽  
Choroidal Melanomas ◽  
Melanoma Patients

Purpose: to study angioarchitectonics of choroidal melanoma with varied biometric characteristics by comparing the results of indocyanine green angiography (IAG) and OCT angiography (OCTA).Material and methods. Angiography with indocyanine green and OCT angiography was performed in 45 choroidal melanoma patients (45 eyes, 20 men, 25 women, mean age 57.36 ± 15.11 years) to see the features of angioarchitectonics for various tumor elevations: up to 3 mm (small choroidal melanomas) and within the 3.1– 5.0 mm range (medium choroidal melanomas) and assess the informative value of the techniques.Results. We established a high diagnostic value of angiography with indocyanine green and OCT angiography in the diagnosis of vasculature of choroidal melanoma (89% and 71 %, respectively), an acceptable significance in small choroidal melanomas, and a higher informative value of angiography with indocyanine green in medium choroidal melanomas. The vasculature of small choroidal melanomas is characterized by type 1 angioarchitectonics predominance (59 %), while that of medium-sized melanomas corresponds to type 2 angioarchitectonics (81 %). The pattern match in angiography with indocyanine green and OCT angiography took place in 93.8 % of patients. The average depth of vessel identification during OCT angiography was determined to stay within the range of 186 μm for choroidal melanomas of up to 1.9 mm high, 220 μm for melanomas between 2 and 3 mm high, and 255 μm for melanomas higher than 3 mm.Conclusions. The use of contrast and non-contrast angiography in assessing the vasculature of choroidal melanoma is highly informative and useful for the assessment of the type of angioarchitectonics. The use of OCT angiography is more informative for tumors with an elevation of up to 3 mm. In order to increase the accuracy and effectiveness of OCTA, the identification of newly formed vessels should be carried out with regard to the parameters established.

scholarly journals Incidence of a First Thrombo-Embolic Event in Patients With Systemic Lupus Erythematosus and Anti-phosphatidylserine/prothrombin Antibodies: A Prospective Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Savino Sciascia ◽  
Massimo Radin ◽  
Irene Cecchi ◽  
Elena Rubini ◽  
Silvia Grazietta Foddai ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Inclusion Criteria ◽  
Systemic Lupus ◽  
Prospective Data ◽  
Glycoprotein I ◽  
Cerebrovascular Events ◽  
Increased Risk ◽  
A Prospective Study

Objective: This study aimed to prospectively investigate the incidence of first thromboembolic events (TEs) in a cohort of systemic lupus erythematosus (SLE) patients. The patients were positive for anti-phosphatidylserine/prothrombin (aPS/PT) antibodies and tested negative for anticardiolipin (aCL) and anti-β2–glycoprotein I (aβ2GPI) antibodies [regardless of their Lupus Anticoagulant (LA) status].Methods: Inclusion criteria included: (a) SLE with no previous TEs; (b) no concomitant anti-thrombotic therapy; (c) isolated confirmed positive test for aPS/PT.Results: From the total of 52 SLE patients (42, 80.8% women), 18 patients (34.6%) were found to be positive for aPS/PT (IgG/IgM). During a mean follow-up (3.9 ± 1.1 years), 3 TEs occurred (1.3%/year). The overall cumulative incidence of TEs was 5.8% after 2 years, and up to 16.7% when focusing on aPS/PT positive patients. All the TEs events (two cerebrovascular events and one thrombotic kidney microangiopathy) occurred in the aPS/PT positive group. When focusing on IgG aPS/PT, we found that patients who tested positive were at a significantly higher risk for TEs (crude HR 19.6, 95%; CI 1.1 to 357.6; p < 0.05) compared to patients with negative aPS/PT.Conclusion: This study observed a rate of TEs of 1.3%/year, in aPS/PT positive only patients. Our prospective data suggest that aPS/PT might confer an increased risk for the development of TEs in SLE patients.

scholarly journals Сombined Treatment of Juxtaand Parapapillary Choroidal Melanoma

2020 ◽  
Vol 17 (2) ◽  
pp. 195-201
Author(s):  
V. V. Neroev ◽  
S. V. Saakyan ◽  
А. G. Amiryan ◽  
V. V. Valskiy ◽  
А. Iu. Tsygankov
Keyword(s):  
Optic Disc ◽  
Combined Treatment ◽  
Local Treatment ◽  
Flow Analysis ◽  
Choroidal Melanoma ◽  
Laser Coagulation ◽  
Basal Diameter ◽  
Tumor Focus ◽  
Choroidal Melanomas

Purpose. Estimation the local efficacy of the combined treatment — brachytherapy (BT) with laser coagulation (LC) in choroidal melanomas of juxta and parapapillary localization in the long-term follow-up. Patients and Methods. In 2009–2013, 50 patients with choroidal melanoma of juxta and parapapillary localization were examined and treated, 32 women and 18 men aged from 32 to 76 years old (average — 53.8 ± 9.6 years). The averaged tumor height was 3.8 ± 1.3 mm, basal diameter — 11.2 ± 2.4 mm. The combined organ-preserving treatment included a LC from the optic disc with subsequent BT was performed. The indications for this method were choroidal melanomas of juxta and parapapillary localization (the distance between the optic disc and the central border of the tumor was no more than 1.5 pd), with the absence of subretinal exudate and retinal detachment in this zone. The follow-up period after the combined treatment ranged from 18 to 102 months (Me = 60 months). Results. Complete tumor resorption was achieved in the majority — 38 (76.0 %) of cases, partial — in 11 (22.0 %) patients, stabilization of the process — only in one (2.0 %) patient, continued growth was not observed in any patient. The initial size of melanoma in patients with complete and partial tumor resorption showed similar averaged values, amounting to 3.8 ± 1.3 mm and 3.6 ± 1.1 mm (p > 0.05), respectively, basal diameter — 11.1 ± 2.4 mm and 11.4 ± 2.4 mm (p > 0.05), respectively. According to the duplex scanning, an increase in the distribution density of bloodflow in the projection of the tumor focus was noted compared with the initial data. In the spectral Doppler flow analysis study, an increase in the linear characteristics of the blood flow in the tumor’s own vessels after LC was recorded. Complications included optic neuropathy (88 %), hemorrhage (36 %) and secondary glaucoma (6 %). Conclusions. The combined treatment allowed to achieve high therapeutic results — 76.0 % of the total resorption of choroidal melanomas, which have unfavorable localization for BT. Given the main focus of local treatment of the choroidal melanoma on its destruction, this technique can be used to increase the effectiveness of the BT of choroidal melanomas of juxta and parapapillary localization.

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