Retinoblastoma in a pediatric oncology reference center in Southern Brazil.

BACKGROUND: Retinoblastoma (Rb) is the most common intraocular tumor diagnosed in children in Brazil. However, detailed information is lacking regarding patient clinical demographics. This study aimed to determine the clinical profile of patients with Rb who were treated in a public university hospital in southern Brazil from 1983 to 2012. METHODS: Patients' medical records were reviewed to retrospectively identify patients with a principal diagnosis of Rb. Rb was classified as hereditary or non-hereditary. Clinical staging was reviewed by an ophthalmologist. Statistical analysis was performed using SPSS. RESULTS: Of 165 patients with a diagnosis of Rb during this period, 140 were included in the study. Disease was unilateral in 65.0 % of patients, bilateral in 32.9 %, and trilateral in 2.1 %. The mean age at onset of the first sign/symptom was 18.1 month, and 35.7 % of patients were diagnosed during the first year of life. The most common presenting signs were leukocoria (73.6 %) and strabismus (20.7 %). The mean age at diagnosis was 23.5 months, and time to diagnosis was 5.4 months. In patients with clinical features of hereditary Rb, both onset of the first sign/symptom and diagnosis were at an earlier age than in patients without these features (12.3 vs 21.6 months [P = 0.001] and 15.9 vs 28.0 months [P < 0.001], respectively). However, there was no significant difference in overall survival between the two groups. Ocular stage at diagnosis was advanced in 76.5 % (Reese V) and 78.1 % (International Classification D or E). Of patients with unilateral and bilateral disease, 35.2 % and 34.8 %, respectively, had extraocular disease at diagnosis; 10.7 % had metastatic disease at diagnosis. Enucleation was observed in 88.1 % and exenteration in 11.9 % of patients; 93.6 % patients were followed until 2012, and 22.9 % relapsed. Overall survival was 86.4 %. CONCLUSIONS: Most Rb diagnoses are still diagnosed in advanced stages of the disease, considerably reducing overall survival time and the rate of eye and vision preservation.

Are Retinal Vessels Calibers Influenced by Blood Pressure Measured at the Time of Retinography Acquisition?

BACKGROUND: Retinal arterial narrowing is associated with higher office blood pressure (BP) and ambulatory blood pressure monitoring, and increased incidence of cardiovascular disease, but it is still unknown if the vessel caliber is associated with BP measured at the time of retinography acquisition. METHODS: Retinal arteriolar and venular calibers were measured by the microdensitometric method in 448 patients with hypertension. Participants underwent 24-hours ambulatory blood pressure (24-h ABP) monitoring simultaneously with the retinography acquisition. Association between arteriolar and venular calibers with increase of 10 mmHg in the mean 24-hours, daily, and nightly BP, and with BP measured at the time of retinography, was evaluated by ANOVA and multivariate analyses. RESULTS: Mean 24-hours, daytime and nighttime systolic and diastolic BP were inversely associated with the arteriolar caliber, but not with the venular caliber. Arteriolar caliber decreased -0.8 (95% CI -1.4 to -0.2) µm per 10-mmHg increase in 24-hours mean systolic BP, adjusted for age, gender, fellow vessel, and duration of hypertension (P = 0.01). The corresponding decreasing in arteriolar caliber by 10 mmHg of increasing in mean diastolic BP was -1.1 µm (-2.0 to -0.2, P = 0.02). The decrease of arteriolar caliber by the same increasing of BP measured at the time of retinography was lower and not statistically significant, particularly for mean diastolic BP and outer arterioles calibers: -1.0 (-1.8 to -0.2) µm in the daytime BP average versus -0.3 (-0.9 to 0.3) at the moment of retinography acquisition. CONCLUSIONS: These findings suggest that the caliber of arteriolar retinal vessels in patients with uncontrolled hypertension are not significantly influenced by blood pressure measured at the time of retinography acquisition.

Association between plasma adiponectin and arteriolar vessel caliber among elderly hypertensive subjects.

Circulating adiponectin has been related to vascular diseases, but few studies examined the relationship between plasma adiponectin and microvascular abnormalities among hypertensive individuals. We tested the association between plasma adiponectin level and retinal vessel calibers in patients with hypertension.This study included 172 patients with confirmed hypertension, aged 18-80 years. Subjects with recent cardiovascular events, advanced heart failure and end-stage renal disease were excluded. Arteriolar and venular calibers were measured in retinographies using a microdensitometric image-processing method. Blood pressure was measured using a validated oscillometric device. We observed a statistically significant inverse association between plasma adiponectin and arteriolar caliber among participants aged 60 years or older after controlling for confounders (Adjusted ß = -0.42; P = .001). In the final model, HbA1C and low-density lipoprotein also remained independently associated with arteriolar caliber. There was no association of adiponectin with venular caliber and retinal vessel calibers in participants <60 years old.Adiponectin is inversely associated with retinal arteriolar caliber in elderly hypertensive participants, suggesting that plasma adiponectin may be a marker of microvascular damage and of higher cardiovascular risk in this age stratum.

[Medical assessments and measurements in ELSA-Brasil]. / Aferições e exames clínicos realizados nos participantes do ELSA-Brasil.

The article describes assessments and measurements performed in the Brazilian Longitudinal Study for Adult Health (ELSA-Brasil). Some assessments including anthropometric assessment, casual blood pressure measurement, and ankle-brachial index have an established clinical application while others including pulse wave velocity, heart rate variability, and carotid intima-media thickness have no established application and do not have reference values for healthy Brazilian population but may be important predictors of cardiovascular outcomes. Blood pressure measurement following postural change maneuver was included in the ELSA-Brasil because it has not been much tested in epidemiological studies. Innovative approaches were developed for assessing the ankle-brachial index using an automatic device instead of the mercury column to measure blood pressure and for assessing the anterior-posterior diameter of the right lobe of the liver by ultrasound for quantitative assessment of nonalcoholic fatty liver disease. All ELSA-Brasil subjects were younger (35 years or more) than those included in other cohorts studying subclinical atherosclerosis. The inclusion of younger individuals and a variety of assessments make the ELSA-Brasil a relevant epidemiology study nationwide and worldwide.

Afericoes e exames clinicos realizados nos participantes do ELSA-Brasil / Medical assessments and measurements in ELSA-Brasil

Este artigo descreve os exames clínicos realizados no Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil). Alguns deles (antropometria, pressão arterial e índice tornozelo-braquial) já têm uso clínico consolidado. Outros, como a velocidade de onda de pulso, variabilidade da frequência cardíaca e medida da espessura médio-intimal de carótidas, carecem de valor de referência na população brasileira não doente e podem constituir preditores importantes de desfechos cardiovasculares. A medida da pressão arterial após manobra postural foi incluída no ELSA-Brasil porque foi pouco testada em estudos epidemiológicos. O ELSA-Brasil inovou na realização do índice tornozelo-braquial, ao usar um aparelho automático em substituição à coluna de mercúrio na medida da pressão arterial, e também na medida do diâmetro ântero-posterior do lobo direito do fígado pela ultrassonografia, proposta para avaliação quantitativa da doença hepática gordurosa não-alcoólica. Os participantes são indivíduos mais jovens (a partir dos 35 anos) do que em outras coortes focadas no estudo da aterosclerose subclínica. A inclusão de indivíduos mais jovens e a diversidade dos exames realizados tornam o ELSA-Brasil um estudo relevante no contexto da epidemiologia brasileira e internacional.

The article describes assessments and measurements performed in the Brazilian Longitudinal Study for Adult Health (ELSA-Brasil). Some assessments including anthropometric assessment, casual blood pressure measurement, and ankle-brachial index have an established clinical application while others including pulse wave velocity, heart rate variability, and carotid intima-media thickness have no established application and do not have reference values for healthy Brazilian population but may be important predictors of cardiovascular outcomes. Blood pressure measurement following postural change maneuver was included in the ELSA-Brasil because it has not been much tested in epidemiological studies. Innovative approaches were developed for assessing the ankle-brachial index using an automatic device instead of the mercury column to measure blood pressure and for assessing the anterior-posterior diameter of the right lobe of the liver by ultrasound for quantitative assessment of nonalcoholic fatty liver disease. All ELSA-Brasil subjects were younger (35 years or more) than those included in other cohorts studying subclinical atherosclerosis. The inclusion of younger individuals and a variety of assessments make the ELSA-Brasil a relevant epidemiology study nationwide and worldwide.

Association between carotid intima-media thickness and retinal arteriolar and venular diameter in patients with hypertension: a cross-sectional study.

OBJECTIVE: Abnormalities in retinal vessels are frequent, but its association with findings in other vascular sites has been scarcely investigated. This study aimed to examine the association between ultrasound-measured carotid intima-media thickness (IMT) and retinal arteriolar and venular diameters, in hypertensive patients. METHODS: In this cross-section study, 173 hypertensive patients had both retinography taken and digitized to determine vessel diameters by an edge-detecting computerized method and carotid ultrasound for semi-automated carotid IMT measurement. The association between the mean common carotid IMT and retinal arterioles and venules diameters was assessed by using multiple linear regression models. RESULTS: The mean (±SD) arteriolar and venular diameters were 102. 8 (±11.6) µm and 128.9 (±15.5) µm, respectively, and common carotid IMT was 0.87 (±0.19) mm. A significant and independent association was demonstrated for carotid IMT and retinal arteriolar caliber (adjusted ß -0.245, p = 0.001) and for carotid IMT and retinal venular caliber (adjusted ß 0.191, p = 0.009) after controlling for age, gender, systolic blood pressure, total cholesterol and HDL (high-density lipoprotein) cholesterol, prior cardiovascular disease, carotid plaque and the retinal fellow vessel. CONCLUSION: In patients with hypertension, carotid intima-media thickness, a marker of macrovascular damage, is significantly and independently associated with microvascular damage, determined by retinal arteriolar and venular calibers.

Computer-assisted methods to evaluate retinal vascular caliber: what are they measuring?

PURPOSE: Computer-assisted methods to measure retinal vessel diameters have been incorporated into research, but it is not clear which component of the vessels they are measuring. This study was conducted to compare measurements of retinal vessel diameter by using imaging-processing software on color fundus photographs (FPs) and fluorescein angiographs (FAs). METHODS: FP and FA images were taken simultaneously in 52 eyes of 31 patients referred for angiography for diagnosis of retinal disease. Arteriolar and venular calibers were measured in two concentric zones around the optic disc center. Pearson correlation coefficients and Bland-Altman plots were used to evaluate the agreement between the measurements made by FP and FA. RESULTS: The differences between the diameters measured by the microdensitometric method from FP and FA were 2.59 ± 8.67 µm in the inner arteriola, 4.93 ± 7.47 µm in the outer arteriola, -1,58 ± 8.49 µm in the inner venula, and -1.80 ± 7.28 µm in the outer venula. The differences plotted by the Bland-Altman method were slight. The Pearson correlation coefficients of measurements by FP and FA were 0.84 for inner zone and 0.87 for outer zone arterioles and 0.93 and 0.94 for the inner and outer zone venules, respectively. CONCLUSIONS: The very slight differences between measurements of retinal vessel diameter by the two methods demonstrate that the microdensitometric method mostly measures the vessel lumen. Differences in vessel diameters measured by the microdensitometric method observed in clinical conditions may therefore be ascribed to variation in wall thickness or vasoconstriction.

Measuring arteriolar-to-venous ratio in retinal photography of patients with hypertension: development and application of a new semi-automated method.

BACKGROUND: The extent of arteriolar narrowing has been recognized as a major sign of end-organ damage in patients with hypertension, but most methods used for its evaluation are highly dependent on the observer. We describe a new semi-automated method to measuring arteriolar-to-venous (A/V) ratio in retinal photography and present its application in the evaluation of patients with hypertension. METHODS: In a cross-sectional study, 58 patients with hypertension had retinographies taken and digitized to determine the vessel diameter by direct measurement (micrometric method) or by the new microdensitometric method. Sub-pixel resolution was obtained via cubic spline fitting of the edge of vessel walls. For each pair of adjacent pixels, 10 intermediate points were generated in the perpendicular direction of the wall. Vessel widths were automatically extracted from this synthetic curve, with cut-points defined where the exterior wall position equals the double of mean noise along the slice. RESULTS: The intra- and interobserver kappa statistics for the diagnosis of abnormal A/V ratio by the microdensitometric measurements were 0.93 (P < .0001) and 0.85 (P = .0005), respectively. Systolic blood pressure was inversely and significantly associated with the A/V ratio measured by the microdensitometric method. CONCLUSIONS: The microdensitometric method is reliable, is easy to operate, and captures the expected association between blood pressure and retinal vessels narrowing. Its performance in clinical practice and in the prediction of cardiovascular events should be confirmed in larger databases with retinographies.

Oftalmomiíase sub-retiniana presumida / Presumed subretinal ophthalmomyiasis

Os autores apresentam um caso de infestaçäo presumida do globo ocular humano por larva de mosca. Foi caracterizado pela migraçäo da larva através do espaço sub-retiniano, produzindo alteraçöes oftalmoscópicas e angiofluoresceínicas que se acredita serem secundárias à oftalmoniíase intra-ocular sub-retiniana