Subarachnoid hemorrhage-negative Terson syndrome after intracranial artery treatment with a flow diverter device.

PURPOSE: To report a case of subarachnoid hemorrhage-negative Terson syndrome following intracranial artery treatment with flow diverter stents. OBSERVATIONS: A 40-year-old Asian woman presented with floaters in her right eye after treatment of an intracranial aneurysm with flow diverter stents. Vitreous hemorrhage and sub-inner limiting membrane (sub-ILM) hemorrhage were present in her right eye. On fluorescein angiography, contrast perfusion and vascular occlusion were not noted. Magnetic resonance imaging (MRI) did not show any evidence of subarachnoid hemorrhage (SAH). We hypothesize that the bleeding was due to Terson syndrome associated with intracranial treatment with the flow diverter stents. During follow-up, the vitreous hemorrhage and sub-ILM hemorrhage disappeared, and the floaters in her vision improved. CONCLUSIONS AND IMPORTANCE: This is the first reported case of vitreous hemorrhage and sub-ILM hemorrhage that should be considered to be Terson syndrome, after flow diverter stents treatment in the absence of SAH.

Measurements of the parapapillary atrophy zones in en face optical coherence tomography images.

OBJECTIVE: To measure the parapapillary atrophy (PPA) area in en face images obtained with swept-source optical coherence tomography (SS-OCT), and to evaluate its relationship to glaucoma, myopia, and age in non-highly myopic subjects. DESIGN: Retrospective, cross-sectional study. PARTICIPANTS: Fifty eyes of 30 subjects with open-angle glaucoma (G group) and forty-three eyes of 26 healthy control subjects (C group). Eyes with high myopia (spherical equivalent refractive error ≤ -8 diopters or axial length ≥ 26.5 mm) were excluded. METHODS: Mean age ± standard deviation was 59.9 ± 12.4 years. The beta zone and the gamma zone PPA areas were measured in en face images reconstructed from three-dimensional SS-OCT images. Relationship between the PPA areas and patient characteristics such as glaucoma, axial length, and age was statistically evaluated using multivariate mixed-effects models. MAIN OUTCOME MEASURES: Areas of the beta zone and the gamma zone PPA measured on en face OCT images. RESULTS: Average ± standard deviation area of the beta and the gamma zone was 0.64 ± 0.79 and 0.16 ± 0.30 mm2, respectively. In multivariate models, the gamma zone significantly correlated with axial length (P = 0.001) but not with glaucoma (P = 0.944). In contrast, the beta zone significantly correlated with age (P = 0.0249) and glaucoma (P = 0.014). CONCLUSIONS: En face images reconstructed from 3D SS-OCT data facilitated measurements of the beta and the gamma PPA zones even in eyes with optic disc distortion. The OCT-defined beta zone is associated with glaucoma and age, whereas the gamma zone correlated with myopia but not with glaucoma. This study confirmed the clinical usefulness of OCT-based classification of the PPA zones in distinguishing glaucomatous damage of the optic nerve from myopic damage in non-highly myopic eyes.

[A case of locally advanced breast cancer for which local control was obtained by combination therapy].

The patient was a 40-year-old woman who was experiencing right-axillary lymph node(LN) swelling. She was diagnosed with suspected malignant lymphoma, but the final diagnosis was advanced breast cancer. Luminal A type breast cancer was determined from the biopsy, and docetaxel therapy and cyclophosphamide+doxorubicin+5-fluorouracil (CAF) enabled a clinical complete response to be obtained. The surgery performed was a mastectomy with pectoral muscle merger. The primary tumor obtained a histological complete response. However, radiotherapy was given to the chest wall and regional lymph nodes because of metastasis to lymph nodes. She is currently alive without recurrence.

[A case of male breast cancer in which oncotype DX was used to determine the therapeutic strategy].

Male breast cancer is rare, and reportedly to accounts for less than 1% of all breast cancers. Postoperative therapy of male breast cancer is similar to that for female cancer. We experienced a male patient and used oncotype DX to determine the therapeutic strategy. A 60-year-old man was diagnosed with breast cancer Stage I. He underwent sentinel lymph node biopsy and mastectomy, but lymph node dissection was omitted. However, micro-metastases were found in the permanent specimen. Later, axillary node dissection was performed. The patient was finally diagnosed with Stage IIA (T1c, N1mi, M0) and luminal A type breast cancer. From using oncotype DX to determine the therapeutic strategy, the recurrence score was 8 and within the low recurrence score group. Currently, we are only administering endocrine therapy.

Cellular distribution of telomerase reverse transcriptase in human hepatocellular carcinoma.

BACKGROUND AND AIM: Telomerase is the enzyme that synthesizes telomeric DNA, and the activation of telomerase is closely related to cellular immortality. Telomerase activity has been reported in many human cancer tissues and is regulated by the expression of human telomerase reverse transcriptase (hTERT). The aim of the present study was to identify hTERT-expressing cells in human liver tissues and evaluate the feasibility of the hTERT promoter for gene therapy of hepatocellular carcinoma (HCC). METHODS: The authors examined the cellular distribution of hTERT transcripts in surgically resected HCC by in situ hybridization. RESULTS: Among 20 samples, hTERT expression was observed in 15 HCC. Transcripts of hTERT were homogenously distributed in the cytoplasm of HCC cells in nine of 15 cases; six of 15 cases displayed a heterogeneous staining pattern. All poorly differentiated HCC that expressed hTERT showed a homogenous pattern of staining. None of the non-cancerous hepatocytes were positive for the transcripts, but infiltrating lymphocytes were faintly stained. The homogenous expression of hTERT was also observed in the vascular invasion of HCC. CONCLUSIONS: The results indicate that most HCC cells express hTERT RNA and that the promoter is a good candidate as a target for gene therapy. However, careful consideration must be taken concerning the potential effects on lymphocytes.

The association of HLA with young-onset keratoconus in Japan.

PURPOSE: To report the association of HLA antigens with keratoconus in Japanese patients. DESIGN: Observational consecutive case series. METHODS: In 90 consecutive Japanese keratoconus patients, HLA class I (HLA-A, -B, -C) and class II (HLA-DR, -DQ) were analyzed. RESULTS: Compared with control frequencies, based on mean gene frequencies for the Japanese population, higher frequencies of HLA-A26, B40, and DR9 antigens were found in patients whose conditions were diagnosed before 20 years of age (chi(2) = 6.45, P =.01; chi(2) = 6.78, P =.01; chi(2) =3.99, P =.05, respectively), but were not found in patients whose conditions were diagnosed later in life. Men were significantly younger at diagnosis than were women. No obvious relation was found between HLA antigens and other clinical data. CONCLUSION: HLA-A26, B40, and DR9, which were found relatively frequently in the ancient Japanese population, seem to be associated with keratoconus in younger individuals.