ABSTRACT
This article describes several melanocytic lesions of the eye. Benign and malignant lesions will be discussed as well as a review of the dysplastic nevus syndrome and its proposed association with ocular melanoma. Ocular melanomas arise from the same embryologically derived melanocytes as their cutaneous counterparts. However, ocular and cutaneous melanomas differ in many respects. The diagnosis and management of these ocular tumors rely heavily on the ophthalmologist. However, knowledge of melanocytic lesions will aid the dermatologist in detection and in proper referral of these patients.
Subject(s)
Eye Diseases/diagnosis , Eye Neoplasms/diagnosis , Melanoma/diagnosis , Pigmentation Disorders/diagnosis , Conjunctival Neoplasms/diagnosis , Conjunctival Neoplasms/pathology , Dermatology , Dysplastic Nevus Syndrome/diagnosis , Dysplastic Nevus Syndrome/pathology , Eye/anatomy & histology , Eye Diseases/pathology , Eye Neoplasms/pathology , Humans , Melanocytes/pathology , Melanoma/pathology , Melanosis/diagnosis , Melanosis/pathology , Nevus/diagnosis , Nevus/pathology , Nevus of Ota/diagnosis , Nevus of Ota/pathology , Ophthalmology , Pigmentation Disorders/pathology , Referral and Consultation , Scleral Diseases/diagnosis , Scleral Diseases/pathology , Skin Neoplasms/pathology , Uveal Neoplasms/diagnosis , Uveal Neoplasms/pathologyABSTRACT
During the last decade, ambulatory blood pressure monitoring (ABPM) made a transition from a method reserved for clinical investigators to a technique considered useful by practicing physicians in assessing certain problems in hypertension. Recent recommendations of the National High Blood Pressure Education Program (NHBPEP) Working Group on Ambulatory Blood Pressure Monitoring suggested using ABPM for a number of clinical problems, including borderline hypertension without target organ damage, evaluation of drug resistance, and white-coat hypertension. We evaluated the clinical indications for ordering ABPM by Connecticut physicians both in hospital and community-based practices. Through specific questionnaires, the clinical indications used by referring physicians to order ABPM and their inclinations for future use of the methodology were assessed. Forty-seven of 70 physicians (65%) responded to the questionnaire, basing their answers on 237 patients. The majority of physicians were internists (57%) or cardiologists (25%). Leading indications for patient referral for ABPM included borderline hypertension (27%), assessment of drug therapy/BP control (25%), and possible white-coat hypertension (22%). Far fewer referrals were observed for severe hypertension or as a routine test for the diagnosis of hypertension. These data suggest that practicing physicians have become aware of the usefulness of ambulatory blood pressure recordings and are following the NHBPEP guidelines on referral for the study.
Subject(s)
Blood Pressure Monitors , Hypertension/diagnosis , Ambulatory Care , Humans , Hypertension/physiopathologyABSTRACT
OBJECTIVE: To study the test-ordering behavior of practicing physicians regarding ambulatory monitoring of blood pressure and to assess changes in patient management after this study. DESIGN: Cross-sectional assessment of physicians' practice habits regarding the ordering of ambulatory blood pressure monitoring and a longitudinal study of patient management after monitoring. SETTING: Physicians' offices in central Connecticut. PARTICIPANTS: Two hundred thirty-seven consecutive patients referred by 65 community- and hospital-based physicians. MEASUREMENTS: Indications for ambulatory blood pressure monitoring, changes in diagnosis and therapy, and office blood pressures before and after the ambulatory blood pressure study. RESULTS: The main indications for ordering the test included borderline hypertension (27% of studies ordered), assessment of blood pressure control during drug therapy (25%), evaluation for "white coat" or "office" hypertension (22%), and drug-resistant hypertension (16%). After the ambulatory blood pressure study, only 13% of the patients had further testing (for example, echocardiography); the diagnosis was changed in 41% of the patients, and antihypertensive therapy was changed in 46%. In 122 patients for whom data were complete, office blood pressure measured by the referring physician decreased from 161/96 +/- 22/12 mm Hg before the ambulatory blood pressure study to 151/86 +/- 27/12 mm Hg 3 months after the study (P = 0.004 for systolic blood pressure and P < 0.001 for diastolic blood pressure). One to 2 years after the study, office blood pressure was 149/86 +/- 24/12 mm Hg (P > 0.2 compared with 3 months after the study). Seventy-two percent of the patients had a lower office blood pressure within 3 months of the ambulatory blood pressure study. CONCLUSIONS: Practicing physicians use ambulatory blood pressure recordings for appropriate indications, and data from the monitoring studies affected the management of patients with hypertension.
