ABSTRACT
A 35-year-old man had a primary neuroblastoma of the left orbit. Histopathologically, the tumor was composed of uniform small round cells containing argyrophilic granules arranged in nests and cords with pseudorosettes, Homer-Wright rosettes, and a fine fibrillary background matrix. Immunohistochemical staining for chromogranin was positive. Electron microscopy showed small (108- to 173-nm) dense core granules. Eight years after surgery and radiation therapy the patient was free of local recurrence and metastases. To our knowledge, primary orbital neuroblastoma has been reported only once previously. Neuroblastoma, which occurs most frequently in children and has an incidence in the United States of 500 cases annually, is a distinctly unusual tumor in adults.
Subject(s)
Neuroblastoma , Orbital Neoplasms , Adult , Cytoplasmic Granules/ultrastructure , Humans , Male , Neuroblastoma/pathology , Neuroblastoma/ultrastructure , Orbital Neoplasms/pathology , Orbital Neoplasms/ultrastructureABSTRACT
There are many reviews of pediatric orbital tumors in the literature. Most of the series originated from the tumor registries of large pathology referral centers, whereas others are from large medical institutions and pediatric hospitals. The distribution of types of tumors reported in each series are unavoidably biased by the nature of the evaluating facility. The findings were also affected by the geographic location of the clinical facility. We present an analysis of 141 orbital tumors in children and review 9 other series (totaling 1,229 cases) for an aggregate total of 1,370 cases. Our clinically based series had an incidence of malignant lesions of 10.6%, much lower than the 24% incidence among the combined referral center/pediatric hospital studies. Cystic orbital and vasculogenic tumors were the most common, comprising 58% of our cases and 40% of orbital tumors in children among the combined series.
Subject(s)
Orbital Neoplasms/epidemiology , Adolescent , Child , Humans , Incidence , Ohio/epidemiology , Orbital Diseases/epidemiology , Orbital Neoplasms/classificationABSTRACT
Esthesioneuroblastoma, a tumor that arises from the olfactory sensory epithelium, often manifests with ocular and orbital signs and symptoms. A review of 38 cases of esthesioneuroblastoma at the Mayo Clinic revealed that ophthalmic signs or symptoms occurred in 28. Twenty patients had ophthalmic signs or symptoms at the time of presentation, and five of these had ocular symptoms as the primary complaint. Five patients presented to an ophthalmologist, but a nasal or paranasal sinus tumor was not suspected. Periorbital pain and excessive tearing were the most commonly reported symptoms. The most common ophthalmic sign was eyelid edema followed by proptosis, globe injection, and ptosis. Recognition of the signs and symptoms of neoplasms of the nose and paranasal sinuses and consideration of esthesioneuroblastoma in the differential diagnosis by clinicians and pathologists allow for prompt management of this tumor.
Subject(s)
Eye Manifestations/pathology , Neuroectodermal Tumors, Primitive, Peripheral/pathology , Orbital Neoplasms/pathology , Aged , Female , Humans , Male , Middle AgedABSTRACT
The medical records of 126 patients requiring 129 temporary pacemakers were viewed retrospectively. The pacemakers were inserted by general internists using venous access from subclavian and internal jugular veins under ECG guidances. Fluoroscopy was not used. There was 14% incidence of pacemaker electrode malfunction and a 4% risk of complication with no pacemaker-related mortality. These results compare favorably with reports from university cardiology services. Temporary pacemakers can be safely inserted by general internists without fluoroscopy.
Subject(s)
Cardiac Pacing, Artificial/methods , Internal Medicine , Aged , Arrhythmias, Cardiac/therapy , Cardiac Catheterization , Cardiac Pacing, Artificial/adverse effects , Electrocardiography , Equipment Failure , Female , Humans , Male , Middle Aged , Pacemaker, Artificial , Retrospective StudiesSubject(s)
Intraocular Pressure/drug effects , Psychotropic Drugs/pharmacology , Adult , Humans , Middle Aged , RiskABSTRACT
A high incidence of abnormal EEGs and response to anticonvulsant medication has been noted among binge eaters. We report the case of a young women with binge eating episodes and an abnormal EEG who responded to diphenylhydantoin therapy.
Subject(s)
Feeding and Eating Disorders/drug therapy , Hyperphagia/drug therapy , Phenytoin/therapeutic use , Adult , Electroencephalography , Epilepsy/physiopathology , Female , Humans , Hyperphagia/physiopathologyABSTRACT
Loss of vision is a social and psychologic handicap as well as a physical one. The patient's initial reactions to blindness may include self-pity, feelings of hopelessness and recrimination, and even suicidal ideation. The ophthalmologist should encourage expression of these feelings. Severe or lasting emotional problems are often associated with previous psychologic problems, previous eye disease, coexisting physical handicaps, middle age, low income, poor education, humility and shyness. Acceptance of one's visual loss is crucial to good adjustment. The ophthalmologist should be understanding and supportive but should help the patient avoid false hope. Every ophthalmologist should be able to provide blind patients with information about local agencies that offer social support and rehabilitation services.
