A Multi-Modality Treatment Approach in Vision Therapy for a Patient with Form Deprivation Adult Strabismic Amblyopia and Nystagmus: A Case Report

2021 ◽  
pp. 50-59
Keyword(s):  
Treatment Approach ◽  
Early Stage ◽  
Anterior Segment ◽  
Visual Development ◽  
Function Form ◽  
Strabismic Amblyopia ◽  
Normal Limits ◽  
Binocular Field ◽  
Case Summary ◽  
Vision Therapy

Background: Amblyopia is characterised by visual impairment along with compromised binocular visual function. Form deprivation amblyopia is a result of opaque media which results in obstruction of light. This obstruction of light prevents visual development. It is has traditionally been managed at early stage of life through occlusion therapy. Case Summary: A 29-year old male presented to us, diagnosed with form deprivation adult strabismic amblyopia and nystagmus. Anterior segment evaluation showed pseudophakia in both eyes, and posterior segment was within normal limits. Stereopsis was absent. In-office vision therapy and homebased vision therapy was undertaken, which included optometric syntonic phototherapy, biofeedback mechanisms to improve nystagmus along with oculomotor skills, monocular fixation in a binocular field (MFBF) and binocular therapies in-office, and Amb-iNet at home. Conclusion: A multi-modality treatment approach in vision therapy is presented, which resulted in improvement of visual acuity, stereopsis and other components of vision for an adult with form deprivation strabismic amblyopia and nystagmus.

Does obesity influence the preferred treatment approach for early-stage cervical cancer? A cost-effectiveness analysis

2021 ◽  
Vol 162 ◽  
pp. S142
Author(s):  
Jacqueline Bohn ◽  
Miriam Hernandez-Zepeda ◽  
Alyssa Hersh ◽  
Elizabeth Munro ◽  
Jenna Kahn ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cost Effectiveness ◽  
Treatment Approach ◽  
Early Stage ◽  
Cost Effectiveness Analysis ◽  
Effectiveness Analysis ◽  
Early Stage Cervical Cancer

Successful Combination Therapy for Amblyopia Secondary to Micro-Esotropia And Anisometropia

2021 ◽  
pp. 195-200
Keyword(s):  
Visual Acuity ◽  
Combination Therapy ◽  
Refractive Error ◽  
Combination Treatment ◽  
Current Treatment ◽  
Short Term ◽  
Eccentric Fixation ◽  
Case Summary ◽  
Vision Therapy ◽  
Spectacle Correction

Background: Micro-esotropia is a small-angle esodeviation typically less than nine prism diopters. Patients with this ocular condition often develop amblyopia due to the presence of a constant unilateral strabismus and an anisometropic refractive error in the deviated eye. Current treatment methods for strabismic and refractive amblyopia include spectacle correction, patching, and vision therapy (VT). Case Summary: A 9-year-old Asian female presented with a constant left primary micro-esotropia with unsteady eccentric fixation, contributing to mild amblyopia and frequent suppression in the left eye. She also had a hyperopic anisometropic refractive error. Combination treatment of in-office VT with short-term patching therapy (two hours per day) was administered, with the goal of improving her binocularity, fixation, and visual acuity. Conclusions: Amblyopia results from binocular dysfunction, therefore monocular patching therapy alone will not improve the underlying issue. VT is necessary to actively treat binocularity and subsequently improve visual acuity, while short-term patching can be used in combination to effectively target monocular accommodation and fixation.

scholarly journals Detection limits of significant prostate cancer using multiparametric MR and digital rectal examination in men with low serum PSA: Up-date of the Italian Society of Integrated Diagnostic in Urology

2021 ◽  
Vol 93 (1) ◽  
pp. 92-100
Author(s):  
Andrea B. Galosi ◽  
Erika Palagonia ◽  
Simone Scarcella ◽  
Alessia Cimadamore ◽  
Vito Lacetera ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Clinical Practice ◽  
Early Stage ◽  
Specific Antigen ◽  
Digital Rectal Examination ◽  
Point Of View ◽  
Italian Society ◽  
Rectal Examination ◽  
Normal Limits ◽  
Low Serum

Reasons why significant prostate cancer is still missed in early stage were investigated at the 22nd National SIEUN (Italian Society of integrated diagnostic in Urology, Andrology, Nephrology) congress took place from 30th November to 1st December 2020, in virtual modality. Even if multiparametric magnetic resonance (MR) has been introduced in the clinical practice several, limitations are emerging in patient with regular digital rectal examination (DRE) and serum prostate specific antigen (PSA) levels approaching the normal limits. The present paper summarizes highlights observed in those cases where significant prostate cancer may be missed by PSA or imaging and DRE. The issue of multidisciplinary interest had been subdivided and deepened under four main topics: biochemical, clinical, pathological and radiological point of view with a focus on PI-RADS 3 lesions.

Survival outcomes in primary angiosarcoma of the head and neck: A systematic review and meta-analysis.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18039-e18039
Author(s):  
Sondos Zayed ◽  
Cindy Lin ◽  
Gabriel Boldt ◽  
Pencilla Lang ◽  
Nancy Read ◽  
...  
Keyword(s):  
Systematic Review ◽  
Head And Neck ◽  
Treatment Approach ◽  
Early Stage ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Size Analysis ◽  
Survival Outcomes ◽  
Curative Intent ◽  
Significant Difference

e18039 Background: Angiosarcoma of the head and neck (ASHN) is a rare entity and confers substantial morbidity and mortality. Yet, the optimal management of ASHN remains unclear. This study aimed to describe the epidemiology of ASHN and to identify the most favorable treatment approach. Methods: We performed a systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, using the PubMed (Medline), EMBASE, and Cochrane Library databases, queried from 1990 until present. Articles in the English language reporting on survival outcomes of adult primary ASHN treated with curative-intent, were included. All estimates were weighted based on sample size. Analysis of variance (ANOVA) and two-sample t-tests were used as appropriate. This study was registered with PROSPERO, CRD42021220970. Results: A total of 3652 studies were identified, with 14 articles reporting on 2265 ASHN patients, meeting inclusion criteria. Mean ± SD age was 70.6 ± 7.7 years with 1621 (66.6%) men and 812 (33.4%) women. ASHN involved the scalp (n = 176, 57.9%) and the face (n = 128, 42.1%). 249 patients had early stage I-II disease (39.6%) whereas 379 had late stage III-IV disease (60.4%). Most (n = 529, 45.6%) received surgery and radiotherapy (RT), 305 (26.3%) received surgery alone, 210 (18.1%) received definitive RT/chemoradiotherapy (CRT), 75 (6.5%) received surgery and CRT, and 33 (2.8%) received surgery and chemotherapy. Negative margins were achieved in 471 (55.9%) whereas 371 (44.1%) had positive margins. Mean ± SD follow-up was 41.7 ± 15.4 months. Weighted mean, 1-, 5-, and 10-year overall survival (OS) were 26.9 months, 67.3%, 30.6%, and 20.8% respectively. Mean and 5-year disease-specific survival (DSS) were 72.9 months and 50.3% respectively. Mean ± SD local recurrence rate (LRR) was 32.1 ± 11.7%. Median RT dose delivered was 60 Gy (interquartile range: 60-70). Patients who received surgery had a significantly higher mean OS (34.9 vs. 18.7 months, P = 0.04) and 5-year OS (30.1 vs. 14.2%, P = 0.01) compared with those who did not receive surgery. There was no significant difference in mean OS for receiving adjuvant chemotherapy (P = 0.99) or RT (P = 0.51). Conclusions: In the largest ASHN study to date, definitive surgical resection was associated with an improvement in OS. Multimodality treatment did not confer an OS benefit. Randomized trials are needed to establish the optimal treatment approach for ASHN.

Multimodal imaging of pigmented paravenous retinochoroidal atrophy

2020 ◽  
pp. 112067212096548
Author(s):  
Ratnesh Ranjan ◽  
Arvind Jain M ◽  
Shishir Verghese ◽  
George J Manayath ◽  
Venkatapathy Narendran
Keyword(s):  
Multimodal Imaging ◽  
Early Stage ◽  
Anterior Segment ◽  
Fundus Examination ◽  
Swept Source ◽  
Ocular Coherence Tomography ◽  
Corrected Visual Acuity ◽  
Pigmented Paravenous Retinochoroidal Atrophy ◽  
Best Corrected Visual Acuity ◽  
Ocular Coherence Tomography Angiography

Aim: To describe the multimodal imaging findings of pigmented paravenous retinochoroidal atrophy. Methods: A 23-year-old female presented to us for a routine ocular examination. She had a best-corrected visual acuity of 6/6 in both eyes. Anterior segment examination was unremarkable. Fundus examination showed pigmentary changes along the retinal vasculature extending from mid periphery to post-equatorial retina suggesting a diagnosis of pigmented paravenous retinochoroidal atrophy. Swept-source optical coherence tomography of the macula showed choriocapillaris thinning at the mid periphery whereas coherence tomography angiography at the mid periphery showed a relatively normal choriocapillaris vasculature in the early stage of the disease. Conclusion: A relatively normal choriocapillaris structure was seen on ocular coherence tomography angiography which could have been due to a milder form of the disease in a young patient.

Bilateral Germ Cell Tumors Involving the Basal Ganglia and Thalamus

Neurosurgery ◽  
1989 ◽  
Vol 24 (4) ◽  
pp. 579-583 ◽  
Author(s):  
Tatsuya Kobayashi ◽  
Jun Yoshida ◽  
Yoshihisa Kida
Keyword(s):  
Basal Ganglia ◽  
Germ Cell ◽  
Chorionic Gonadotropin ◽  
Human Chorionic Gonadotropin ◽  
Early Stage ◽  
Germ Cell Tumors ◽  
Biological Behavior ◽  
Computed Tomographic ◽  
Normal Limits ◽  
Extrapyramidal Signs

ABSTRACT Two cases of a human chorionic gonadotropin-producing germ cell tumor originating bilaterally in the basal ganglia and thalamus are reported. The biological behavior and clinical characteristics were similar to those of unilateral germinomas involving the basal ganglia and thalamus. Common clinical features were slowly progressive unilateral pyramidal signs and bilateral and/or unilateral extrapyramidal signs which occurred either concomitantly or sequentially. Bilateral symmetrical lesions were demonstrated by computed tomography and/or magnetic resonance imaging at an early stage of illness. Serum and cerebrospinal fluid human chorionic gonadotropin levels were elevated (116 and 141 mIU/ml, respectively) but decreased and remained within normal limits after radiation therapy alone. Radiosensitivity was confirmed by repeated computed tomographic scans and tumor marker measurements. Multiple concomitant germ cell tumors is a rare, but interesting lesion, especially considering its pathogenesis and oncogenesis.

Case series: Paclitaxel (P) and pegfigrastim (PF)-induced hypersensitivity pneumonitis (HSP) in breast cancer patients (pts)

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e11631-e11631
Author(s):  
L. Cream ◽  
A. C. Barochia ◽  
J. Sivik ◽  
R. Kass
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Case Series ◽  
Ground Glass Opacity ◽  
Left Breast ◽  
Nodal Metastasis ◽  
Breast Cancer Patients ◽  
Duct Carcinoma ◽  
Normal Limits ◽  
Long Acting

e11631 Background: P, a chemotherapeutic agent, extensively used in management of solid tumors. Although hypersensitivity reactions from P are common; HSP is rarely reported. We report 3 pts with early stage, high risk breast cancer, who developed HSP while receiving dose dense (DD) P with PF support. Methods: C#1 51 yr old woman (W) was diagnosed (Di) with triple negative (TN), infiltrating duct carcinoma (ca) with nodal metastasis. Neoadjuvant chemo (NC) with DD adriamycin 60 mg/m2 (A) and Cyclophosphamide 600 mg/m2 (C) was started. She completed 4 cycles of AC with PF 6 mg SQ given day 2 of each cycle without complications. Several days after her first dose of P with PF, she experienced dyspnea on exertion (DOE) and a non productive cough (NPC). CT of chest (CC) revealed ground glass opacity more in upper lungs, suggestive of HSP, and echocardiogram (echo) was within normal limits (WNL). She rapidly improved with steroid (S). C#2 46 yr w was Di with hormone positive, her 2 negative, infiltrating duct ca with nodal involvement. NC with DD AC followed by P was started. She completed 4 cycles of AC with minimal toxicity followed by DDP. After the third P infusion, she developed NPC with DOE. CC revealed diffuse interstitial prominence and echo was WNL. She rapidly improved with S. C#3 63 yr W was Di with 2.3 cm, TN, invasive duct carcinoma of left breast. NC with DD AC followed by P was started. After 2nd infusion of P, she developed hypoxia and cough; CC revealed diffuse groundglass opacities throughout lungs bilaterally, suggestive of HSP. She rapidly improved with S. Results: All 3 cases occurred in non-smoking pts without known lung/cardiac disease, treated with PF on day 2 of each cycle. Pts had abnormal CCs, were afebrile and responded quickly to steroids. Published DD experience (Citron et al) uses daily filgrastim (F), not the pegylated form which our pts received. We believe that HSP in these pts may be related to long acting growth factor stimulation of white cells and causing reversible HSP. Conclusions: Future prospective studies on taxanes using DD regimens should include a randomized design where pts given PF are compared to pts who receive F. No significant financial relationships to disclose.

scholarly journals In VivoConfocal Microscopy and Anterior Segment Optic Coherence Tomography Findings in Ocular Ochronosis

2015 ◽  
Vol 2015 ◽  
pp. 1-6
Author(s):  
Elif Demirkilinc Biler ◽  
Suzan Guven Yilmaz ◽  
Melis Palamar ◽  
Pedram Hamrah ◽  
Afsun Sahin
Keyword(s):  
Confocal Microscopy ◽  
Anterior Segment ◽  
Microscopic Analysis ◽  
Corneal Topography ◽  
Optic Coherence Tomography ◽  
Medical Systems ◽  
Spectral Domain Oct ◽  
Normal Limits ◽  
Pigmented Lesions

Purpose. To report clinical andin vivoconfocal microscopy (IVCM) findings of two patients with ocular ochronosis secondary due to alkaptonuria.Materials and Methods. Complete ophthalmologic examinations, including IVCM (HRT II/Rostock Cornea Module, Heidelberg, Germany), anterior segment optical coherence tomography (AS-OCT) (Topcon 3D spectral-domain OCT 2000, Topcon Medical Systems, Paramus, NJ, USA), corneal topography (Pentacam, OCULUS Optikgeräte GmbH, Wetzlar, Germany), and anterior segment photography, were performed.Results. Biomicroscopic examination showed bilateral darkly pigmented lesions of the nasal and temporal conjunctiva and episclera in both patients.In vivoconfocal microscopy of the lesions revealed prominent degenerative changes, including vacuoles and fragmentation of collagen fibers in the affected conjunctival lamina propria and episclera. Hyperreflective pigment granules in different shapes were demonstrated in the substantia propria beneath the basement membrane. AS-OCT of Case 1 demonstrated hyporeflective areas. Fundus examination was within normal limits in both patients, except tilted optic discs with peripapillary atrophy in one of the patients. Corneal topography, thickness, and macular OCT were normal bilaterally in both cases.Conclusion. The degenerative and anatomic changes due to ochronotic pigment deposition in alkaptonuria can be demonstrated in detail with IVCM and AS-OCT. Confocal microscopic analysis in ocular ochronosis may serve as a useful adjunct in diagnosis and monitoring of the disease progression.

scholarly journals Prevalence of ocular morbidities of children in higher primary schools in rural areas of Mangalore

2017 ◽  
Vol 4 (8) ◽  
pp. 2859
Author(s):  
Vidya R. ◽  
K.G. Kiran
Keyword(s):  
Quality Of Life ◽  
Rural Areas ◽  
Primary Schools ◽  
Early Stage ◽  
Anterior Segment ◽  
Cross Sectional ◽  
Parental History ◽  
Poor Vision ◽  
Ocular Morbidity

Background: Vision plays an important role in proper growth of a child, as poor vision can lead to reduction in the learning potential of a child. Various causes can bring about poor vision in children and proper evaluation at an early stage can help improve the quality of life. The objective of the study was to assess the prevalence of ocular morbidity in school children. Methods: A cross-sectional study was conducted in 6 schools, which included Government and private schools around the field practice areas of a medical college. Eye examination was done which included testing for visual acuity, external examination and anterior segment examination with a pen torch and posterior segment examination with a direct ophthalmoscope. Statistical analysis: Data was analysed using SPSS. Results: Of the 402 children, 51.5% of the children were males and 48.5% were females. All the children were aged between 10 and 13 years. The most common eye symptom the students presented with was headache on reading for long durations (24.6%). The overall prevalence of ocular morbidity was found to be 20.4%. Refractive errors were the most common cause of ocular morbidity (14.2%). Parental history of wearing spectacles had an association with ptosis in children (p<0.026) and faulty near vision (p<0.022). Conclusions: Ocular morbidity is high in school going children. Since most of the causes of ocular morbidity are preventable or treatable, regular screening and early diagnosis and treatment can help improve the quality of life of children.  

Hepatotoxicity Associated with Cisplatin Chemotherapy

1993 ◽  
Vol 27 (4) ◽  
pp. 438-441 ◽  
Author(s):  
Robert J. Cersosimo
Keyword(s):  
Squamous Cell Carcinoma ◽  
Alkaline Phosphatase ◽  
Lactate Dehydrogenase ◽  
Cell Carcinoma ◽  
Liver Damage ◽  
Aspartate Aminotransferase ◽  
Alanine Aminotransferase ◽  
Case Reports ◽  
Normal Limits ◽  
Case Summary

OBJECTIVE: To report a case of possible cisplatin-associated hepatotoxicity. CASE SUMMARY: A 69-year-old man received three cycles of cisplatin (100 mg/m2) and fluorouracil (1000 mg/m2/d for five days) for management of squamous cell carcinoma of the head and neck. Liver enzyme concentrations were within normal limits prior to each cycle of therapy but the aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and lactate dehydrogenase concentrations increased on the second day of each cycle. The concentrations began to decline on day 3 of each course, despite continued fluorouracil administration, and returned to normal by day 10. The patient's antiemetic therapy included metoclopramide in cycle 1 and ondansetron in cycles 2 and 3, which may have contributed to the enzyme elevations. DISCUSSION: Case reports of cisplatin-associated hepatotoxicity are reviewed. An association between cisplatin administration and hepatotoxicity is proposed in this patient. CONCLUSIONS: This patient may have experienced cisplatin-induced liver damage. Metoclopramide and ondansetron may have contributed to this effect.

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