Ocular malignant tumors. Review of the tumor registry at a tertiary eye hospital in central Saudi Arabia

To present the epidemiologic profile and magnitude of ocular malignant tumors [MT] representative of the Saudi population from the Tumor Registry [TR] at King Khaled Eye Specialist Hospital [KKESH]. This study evaluated the demographic information, clinical features including tumor laterality, ocular tissue of origin, and diagnosis of patients from the TR registry between 1983 and 2012 at KKESH, Riyadh, Kingdom of Saudi Arabia. The incidence of MT among Saudi adults [>/= 15 years old], and children [<15 years old] was estimated. The TR recorded 4,146 neoplasms [2,509 [60.5%] benign tumors, and 1,637 [39.5%] MT]. The incidence of MT in children was 3.6 per million/year [M/Y], and 2.4/M/Y for adults. Retinoblastoma [Rb] [n=763, 91%] was the most common ocular malignancy in children. In adults, the most common MT was squamous cell carcinoma [SCC] [n=363, 45.8%], basal cell carcinoma [BCC] [n=186, 23%], uvealmelanoma [n=94, 11.9%], sebaceous gland carcinoma [n=54, 6.8%], lymphomas [orbital, adnexal] [n=46, 5.8%], and others [n=53, 6.8%]. The Rb [7.7/M/Y in <5 years old Saudi children] was less frequent than that reported in some Gulf countries, but higher than that reported from the West. The SCC was less frequent in countries with comparable sun exposure than in other continents, but the incidence remained unchanged over 3 decades. There was a significant increase in BCC between 1983-1992 and 2003-2012. The rates of all cancers remained stable over 3 decades except BCC, which showed a significant rise

Unilateral optic neuritis, scleritis and exudative retinal detachment due to recurrent orbital pseudotumor

Idiopathic orbital inflammation, also known as orbital pseudotumor, describes a spectrum of idiopathic, non-neoplastic, non-infectious, space-occupying orbital lesions without identifiable local or systemic cause. The condition occurs mainly in young adults who may present with acute pain, proptosis, chemosis and limitations of extraocular movements. Decreased vision due to optic nerve infiltration and macular edema as a result of scleritis is less common sequel of orbital pseudotumor. Herein, we present a case of unilateral orbital pseudotumor in a young male who presented with chief complaints of painful decreased vision which was attributed to optic neuritis and macular edema as a result of scleritis. Imaging studies were helpful in the establishment of the correct diagnosis and patient's complaints improved with administration of systemic corticosteroids

hot orbit: orbital cellulitis

Orbital cellulitis is an uncommon condition previously associated with severe complications. If untreated, orbital cellulitis can be potentially sight and life threatening. It can affect both adults and children but has a greater tendency to occur in the pediatric age group. The infection most commonly originates from sinuses, eyelids or face, retained foreign bodies, or distant soources by hematogenous spread. It is characterized by eyelid edema, erythema, chemosis, proptosis, blurred vision, fever, headache, and double vision. A history of upper respiratory tract infection prior to the onset is very common especially in children. In the era prior to antibiotics, vision loss from orbital cellulitis was a dreaded complication. Currently, imaging studies for detection of orbital abcess, the use of antibiotics and early drainage have mitigated visual morbidity significantly. The purpose of this review is to describe current investigative strategies and management options in the treatment of orbital cellulitis, establish their effectiveness and possible complications due to late intervention

Orbital alveolar soft part sarcoma: histopathologic report of two cases

Alveolar soft part sarcoma is considered as a distinct histopathological entity with rare cases reported from the orbit area. Two cases of alveolar soft part sarcomas occurring in the orbit of two patients along with their histopathologic findings are reported herewith. In both cases, the patients presented with eyelid swelling and proptosis. The diagnosis was made by incisional biopsies and histopathology. The literature is reviewed regarding occurrence of this tumor, its diagnosis and management

Eradicating blinding trachoma: what is working?

Trachoma remains the leading cause of preventable corneal blindness in developing countries. The disease is contracted in early childhood by repeated infection of the ocular surface by C. traehomatis. Initial clinical manifestation is a follicular conjunctivitis which if not treated on timely basis, may lead to conjunctival and eyelid scarring that may eventually result in corneal scarring and loss of vision. Over the past two decades, a remarkable reduction in the prevalence of active trachoma has occurred due to the World Health Organization's [WHOs] program GET 2020 for the elimination of trachoma with adoption of the SAFE strategy incorporating Surgery, Antibiotic treatment, Facial cleanliness and Environmental hygiene. However, patients who already had infection at young age may present with adnexal-related complications of trachomatous scarring that may cause corneal scarring and visual loss. These patients may present with evidence of trichiasis/entropion as well as eyelid retraction. Lacrimal complications may include nasolacrimal-duct obstruction, dacryocystitis and canaliculitis requiring intervention. In addition to the increased risk for corneal scarring, trichiasis/entropion may further increase the risks for microbial keratitis in patients who may have unrecognized dacryocystitis and canaliculitis. Female patients may have more trachomtous-related complications and may present at an early age. Available evidence indicates that SAFE strategy may be effective and on the right track towards achieving GET 2020 goal for the eradication of trachoma

Modified fasanella-servat for acquired ptosis: case report and review of the literature

A 28-year-old man who had acquired ptosis of his left upper eyelid after a traffic accident did not benefit from standard levator advancement surgery. Patient had significant ptosis with moderate levator function. A modified Fasanella-Servat procedure under local anesthesia resulted in the desired correction of his left upper eyelid ptosis. A review of the Fasanella-Servat procedure for ptosis surgery is presented, as well as its modifications, along with its limitations

Supraclavicular artery flap "its weightage in reconstructing burn neck contracture"

Flexion contractures of neck are a common sequel of deep burns. Severity varies from discrete linear bands to severe labiomentosternal contractures leading to functional and cosmetic impairment. Use of local flaps can produce best restoration of form and function. This study was meant to analyze clinical utility, advantages and any complications specific to islanded supraclavicular artery flap. This was a descriptive study carried out at department of plastic and reconstructive surgery Mayo hospital Lahore between January 2005 and November 2006. Ten patients presenting with neck contractures with out evidence of trauma in supraclavicular fossae, shoulder and deltoid region were included in the study. History and physical examination details including extent of contracture and cosmetic impairment were endorsed. Essential preoperative workup was done accordingly including assessment by anesthetist. Ten patients with varying severity of neck contractures were included in the study. Age range was 15-35 years. Average hospital stay was 10 days. Five patients had severe labiomentosternal contractures. Eight patients reported neck wound appearing excellent at 6 months postoperatively. In contrast donor area appearance was reported satisfactory by 7 and poor by 3 patients at 6 months. Functional consequences were most with 6 patients having full range of motion [ROM] and 4 patients having limited but satisfactory ROM. There is no reported recurrence so far. Supraclavicular artery based islanded fasciocutaneous flap is a reliable reconstructive tool ideally suited to cover defects in the region of neck to restore form and function

Evaluation and management of periocular capillary hemangioma: a Review

To review the salient features of periocular capillary hemangioma, provide the ophthalmologist with clinical, diagnostic and histological features characteristic of the tumor and discuss various methods of management. Literature review of periocular capillary hemangioma, diagnostic evaluation with emphasis on treatment through the presentation of illustrative clinical cases. Capillary hemangioma is the most common benign vascular tumour found on the head and neck area including eyelids and orbit. The lesion typically manifests within the first few weeks of life, grows rapidly in the first year during the proliferative phase, then invariably and slowly regresses over the next 4 to 5 years during the patients, however, the functional defects in the form of amblyopia, squint, facial disfigurement and rarely optic atrophy may persist long after complete resolution of the tumor. the diagnosis of capillary hemangioma requires a combination of clinical and imaging studies such as ultrasonography, computerized tomography, magnetic resonance imaging, and angiography in selected cases. With the advent of less invasive diagnostic techniques, the need for biopsy in capillary hemangiomas has decreased. Nevertheless, it should be differentiated from other periocular tumour such as rhabdomyosarcoma, lymphangioma, chloroma, neuroblastoma, orbital cyst, and orbital cellulitis. Treatment is indicated to prevent amblyopia or cosmetic disfigurement. If indicated, intra-lesional corticosteroids may be used to enhance resolution of the tumor. Other forms of treatment tried with variable success include systemic and topical corticosteroids, radiation, surgical excision and intravenous embolization of the tumor. In recent years, laser ablation of the tumor has been found to be effective in some cases. Interferon-u' has been utilized effectively in cases of capillary hemangiomas that are refractory to other forms of therapy. Early treatment of amblyopia is essential to restore good vision in the affected eye. Eyelid and orbital capillary hemangiomas are treatable vascular lesions. Ophthalmologists should be aware of the ocular complicationns of this tumor. Early recognition and timely diagnosis and treatment may prevent amblyopia and cosmetic disfigurement

Retinal pigment epithelial cell culture and cooperation of L-carnitine in reducing stress induced cellular damage

To show that L-carnitine [LC] is capable of reducing non-oxidative stress in the retinal pigment epithelial cells [RPE] of the human eye. The RPE cells were cultured from donor eyes, obtained immediately after post-mortem. The interaction between bovine serum albumin [BSA] and non-oxidative [sodium hydroxide and methyl methane sulphonate] stressinducers was observed by recording the change in the absorption profiles of the interacting molecules after incubation in light for 5 hours and after treatment with LC. The isolated and cultured RPE cells from human eyes were treated with sodium hydroxide or methyl methane sulphonate and/or LC for 5 hours under light, and the qualitative effect on cell morphology after treatment was analyzed by staining the cells with Giemsa and visualization by light microscopy. The cell morphology was also qualitatively analyzed by scanning electron microscopy [SEM]. L-carnitine and stress-inducers interact with BSA and bring about changes in the spectral profile of the interacted molecules. Light microscopy as well as SEM show that the changes in the cellular morphology, induced by 100 micro M concentrations of non-oxidative stress-inducers, are considerably reduced in the presence of 100 micro M LC. However, L-carnitine alone does not cause any qualitative damage to the cell morphology during incubation under similar conditions. The results give a preliminary indication that LC has the ability to reduce the changes brought about by the non-oxidative stress-inducers in the RPE cells in culture

Evaluation of anti tuberculous antibodies in healthy contact and non contacts persons

This study was conducted to see the presence of the antimycobacterial antibodies in healthy household contacts of tuberculous patients and healthy normal subjects who have never been in contact with tuberculous patients. A total of 200 subjects, 120 with history of household contact and 80 without such history were included in the study. Routine Haematological investigations were performed and all the sera of 200 subjects were tested for IgM, IgG and IgA anti tuberculous antibodies using ELISA technique. There was no difference in the average age of the household contacts and non-contacts. The complaints of pyrexia, night sweats and loss of weight was more in house hold contacts as compared to non-contacts. The awareness about BCG vaccination was equal among the household contacts and non-contacts. The combined serological positivity of the household contacts was 65.8% and the combined serological positivity for non-contacts was 34.1%. There was no statistically significant difference in the presence of I gM among household contacts as compared to non-contacts. However both IgG and IgA were present in significantly higher number of household contacts as compared to non-contacts. This study concludes that the persons living in the house with a patient suffering from active pulmonary tuberculosis [household contact] have more chances of being infected with Mycobacterium tuberculosis as compared to the healthy non-contacts

AgNOR stain in normal, cirrhotic and carcinomatous liver

In this era of tumor marker AgNOR stain has still retained the diagnostic yield in tumor pathology. This study was conducted to evaluate the role of AgNOR number and morphological features in cirrhotic and carcinomatous liver. A total of one hundred liver biopsy specimens were included, twenty cases were of hepatocellular carcinoma, sixty were those of cirrh0sis of the liver and twenty cases with normal histology as control. The mean AgNOR count, size and distribution were significantly of higher grade in hepatocellular carcinoma as compared to cirrhosis of liver

Pattern of primary pulmonary malignancies in central Punjab

Three hundred patients of primary malignancies of the lung from Gulab Devi Chest Hospital and other hospitals of Lahore were studied. The history of the patients and their clinical findings were recorded. The sections of the tissues were stained with haematoxylin and eosin whereas all large cell carcinomas were stained with Alcian Blue-Periodic Acid-Schiff [AB-PAS] stain. There were 255 males and 45 females with a male to female ration of 5.7:1. The age ranged from 10-90 years with a mean age of 54.17 +/- 3.46 years. Different tumours were significantly more [p<0.001] in males than in females. The mean age in squamous cell carcinoma cases was significantly high [P<0.001] as compared to adenocarcinoma. Small cell carcinoma cases had significantly low [P<0.02] mean age as compared to squamous cell carcinoma. The difference of mean age in cases of adenocarcinoma approached significant level [0.1> P>0.05] as compared with small cell carcinoma

Intra-cranial space occupying lesions a morphological analysis

The purpose of this study was to provide preliminary data on morphological patterns of intracranial space occupying lesions [ICSOL] in central Punjab province. This is a cross-sectional prospective study on 100 consecutive cases of intra-cranial space occupying lesions admitted to both the neurosurgery units of Lahore General Hospital, Lahore, Pakistan. The biopsy materials were examined histologically using paraffin sections. Eighty nine [89] patients had neoplasms, while eleven [11] had non-neoplastic lesions. Neuroepithelial tumours comprised 41% of all the neoplasms, followed by meningiomas being 23%, schwannomas 11% and metastatic tumours 6%. Males were affected slightly more than females [1.17:1]. Tuberculomas constituted 3% of the lesions. It was concluded that age and sex distribution were generally comparable to the other published literature. Similarly neuroepithehal tumours formed majority of the lesions. However meningiomas had a higher frequency as compared to the western literature; moreover tuberculomas should also be considered in the differential diagnosis of such lesions in this part of the world

Bone mineral density measurement in a medical camp to identify osteopenic and osteoporotic subjects

To identify osteopenic and osteoporotic subjects through bone mineral density measurement. Design: An observational, cross sectional study, carried out in a relatively affluent community, both below and above 40 years of age, in both sexes. Settings: In a medical camp held under the supervision of the medical specialists. Main outcome measures: Bone Mineral Density [BMD] was assessed on all the subjects by SAHARA ultrasound bone densitometer on right calcaneus. Sixty subjects were studied, out of these 35[58.3%] were females and 25[41.7%] were males. The age range was 16 - 80 years with the mean of 46.95 +/- 18.61. Out of sixty subjects 17 were below 40 years and 43 were above the age of 40. Daily milk intake was in the range of 25-750 ml/day with the mean of 166.82 +/- 137.10. Symptoms of difficulty in getting up from floor, bone pains, cramps, body aches and pains were more prominent amongst subjects above the age of 40 years. BMD, in males below 40 years was in the Range of -3.20 +/- 2.80 with the mean of 0.125 +/- 1.66 and in females was in the Range of -2.80 +/- 2.00, with the mean of 0.266 +/- 1.34. In subjects above 40 years, amongst males it was in the Range of -3.00 +/- 3.00, and mean of -0.1720 +/- 1.532 and females in the Range of -3.50 +/- 1.70 with the mean -0.8057 +/- 1.364. In subjects understudy 30/60 [50%] had normal BMD, 20/ 60 [33.4%] were osteopenic and 10/60 [16.6%] were osteoporotic. In patients over 40 years of age 29/43[67.44%] were either osteopenic or osteoporotic. BMD is a simple noninvasive but expensive tool which can help in identifying osteopenic and osteoporotic subjects in both genders. It is expected that the problem is much more in the poor and malnourished community. Early detection of potential and at risk individuals and their timely and appropriate treatment can reduce the stresses of mental, physical and financial nature. Strategies need to be developed to encourage modifications of all risk factors for osteoporosis early in life