Refractive surgery in systemic and autoimmune disease

Patients with underlying systemic disease represent challenging treatment dilemma to the refractive surgeon. The refractive error in this patient population is accompanied by a systemic disease that may have an ocular or even a corneal component. The literature is rather sparse about the use of laser refractive surgery [LRS] and such procedure is not approved by the United States Food and Drug Administration [FDA] in this patient population. Patients with collagen vascular disease, diabetes mellitus [DM], allergic and atopic disease, or human immunodeficiency virus [HIV] are never ideal for LRS. Patients with uncontrolled systemic disease or ocular involvement of the disease should not undergo LRS. However, a patient with well-controlled and mild disease, no ocular involvement, and not on multidrug regimen may be a suitable candidate if they meet stringent criteria. There is a need for a large, multicenter, controlled trial to address the safety and efficacy of LRS in patients with systemic disease before such technology can be widely adopted by the refractive surgery community

What is central toxic keratopathy syndrome if it is not diffuse lamellar keratitis grade IV?

The Central Toxic Keratopathy [CTK] syndrome describes a rare, acute, self-limited, non-inflammatory process that yields central corneal opacification and significant hyperopic shift after refractive surgery. Despite being exceedingly rare, certain clinical features of CTK give the condition a striking resemblance to other more serious inflammatory conditions, including diffuse lamellar keratitis [DLK]. As the authors demonstrate in this article, despite the overlapping clinical features, CTK is a disease process that is distinct from DLK and, therefore, in need of distinct management interventions

Feasibility of quality of life assessment in routine clinical oncology practice: a Tunisian study

Limited research has been devoted to quality of life [QOL] of cancer patients in developing countries. To assess the feasibility of QOL assessment in a cohort of Tunisian cancer patients, the EORTC QLQ-C30 questionnaire was administered to 23 women treated with adjuvant chemotherapy for early breast cancer on an outpatient basis at baseline and during the 3rd cycle of chemotherapy. We observed a significant deterioration in physical functioning, cognitive functioning and social functioning during chemotherapy. However, a wide range of methodological and practical obstacles to routine QOL evaluation were identified through this study. Further improvement of cancer care infrastructure and public education is still needed before reliable QOL studies can be performed

Primtive neuroetodermal tumors in childhood Abour four cases

Peripheral primitive neuroectodermal tumors are malignant small round cell tumors which occur rarely in children we retrospectively reviwed the clinical data and radiological studies of four such cases. the youngest child had a pelvic tumor and each of two children had a chest wall tumor. the fourth patient had a bone swelling tumors were all diagnosed by histological and immunhistochimical examinations most patients had combined treatment with chemotherapy surgery and radiation therapy. Best results were obtained in two cases and another died. in this report the clinical aspects of PNET in children are described reviewing the presentation of the disease in four patients and detailing the treatment strategies

Erysipele apres traitement du cancer du sein

study of the epidemiological, clinical and evolutive characteristics of the erysipelas of patients treated for breast cancer. Between February 93 and December 9920 patients among 700 [2.85%] treated for breast cancer in the radiotherapy department of sfax have presented an erysipelas. All of these patients had undergone a chirurgical treatment containing an axillary lymph node dissection with radiotherapy in 95% and adjuvant chemotherapy in 80% of cases. the medium delay between the appearance of the erysipelas and the end of treatment was 23 months. The preferential localization was the homolateral upper limb to the treated breast [95%]. The immediate evolution was favourable in 85% after antibiotherapy. Recurrence of erysipelas was seen in 20% in cases. Erysipelas after treatment of breast cancer is known but rarely reported. The secondary lymphedema of the upper limb is the major favouring factor. Appearance of erysipelas among women treated for brest cancer is frequent, his recurrent character must always lead to antibiotic prophylaxis