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1.
Med Phys ; 48(3): 1315-1326, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33336379

RESUMO

PURPOSE: To develop a high-resolution three-dimensional (3D) magnetic resonance imaging (MRI)-based treatment planning approach for uveal melanomas (UM) in proton therapy. MATERIALS/METHODS: For eight patients with UM, a segmentation of the gross tumor volume (GTV) and organs-at-risk (OARs) was performed on T1- and T2-weighted 7 Tesla MRI image data to reconstruct the patient MR-eye. An extended contour was defined with a 2.5-mm isotropic margin derived from the GTV. A broad beam algorithm, which we have called πDose, was implemented to calculate relative proton absorbed doses to the ipsilateral OARs. Clinically favorable gazing angles of the treated eye were assessed by calculating a global weighted-sum objective function, which set penalties for OARs and extreme gazing angles. An optimizer, which we have named OPT'im-Eye-Tool, was developed to tune the parameters of the functions for sparing critical-OARs. RESULTS: In total, 441 gazing angles were simulated for every patient. Target coverage including margins was achieved in all the cases (V95%  > 95%). Over the whole gazing angles solutions space, maximum dose (Dmax ) to the optic nerve and the macula, and mean doses (Dmean ) to the lens, the ciliary body and the sclera were calculated. A forward optimization was applied by OPT'im-Eye-Tool in three different prioritizations: iso-weighted, optic nerve prioritized, and macula prioritized. In each, the function values were depicted in a selection tool to select the optimal gazing angle(s). For example, patient 4 had a T2 equatorial tumor. The optimization applied for the straight gazing angle resulted in objective function values of 0.46 (iso-weighted situation), 0.90 (optic nerve prioritization) and 0.08 (macula prioritization) demonstrating the impact of that angle in different clinical approaches. CONCLUSIONS: The feasibility and suitability of a 3D MRI-based treatment planning approach have been successfully tested on a cohort of eight patients diagnosed with UM. Moreover, a gaze-angle trade-off dose optimization with respect to OARs sparing has been developed. Further validation of the whole treatment process is the next step in the goal to achieve both a non-invasive and a personalized proton therapy treatment.


Assuntos
Terapia com Prótons , Neoplasias Uveais , Humanos , Imageamento por Ressonância Magnética , Órgãos em Risco , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador , Neoplasias Uveais/diagnóstico por imagem , Neoplasias Uveais/radioterapia
2.
BMC Ophthalmol ; 19(1): 193, 2019 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-31455325

RESUMO

BACKGROUND: In the recently published article entitled "Ocular ultrasound versus MRI in the detection of extrascleral extension in a patient with choroidal melanoma" Jacobsen et al. describe a case in which a hyper-intense extra-ocular lesion on MRI was erroneously diagnosed as an extrascleral extension of the tumor. Based upon this the authors conclude "the superiority of ocular ultrasound in the diagnostic management of extra scleral extension in choroidal melanoma". In our view, there are numerous flaws in the investigation that cast doubt on this message. MAIN: First of all, this is quite a bold statement when only one patient has been evaluated. Secondly, the manuscript only presents a post-contrast T1-weighted image, whereas multiple MRI-sequences need to be included to determine if a hyperintense region is an extrascleral invasion. Moreover, no modern MRI-techniques such Dynamic Contrast Enhanced (DCE) or Diffusion Weighted Imaging (DWI) have been included in the evaluation of this patient, making it hard to use this single case to compare the efficacy of MRI and Ultrasound. The presented data do, however, give clear clues that the hyperintense lesion is likely to be inflammatory. CONCLUSION: Although the study falls short in providing a comprehensive comparison between current MRI techniques and ultrasound, it does show that the evaluation of ocular MR-images should be made in a multi-disciplinary setting involving both ophthalmologist and radiologists, since the field of ocular MRI is continuously progressing.


Assuntos
Neoplasias da Coroide/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Melanoma/diagnóstico por imagem , Doenças da Esclera/diagnóstico por imagem , Neoplasias da Coroide/patologia , Humanos , Melanoma/patologia , Invasividade Neoplásica , Doenças da Esclera/patologia , Ultrassonografia/métodos
3.
Neuroradiology ; 60(12): 1253-1266, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30310941

RESUMO

PURPOSE: Orbital inflammation can be idiopathic or in the context of a specific disease and it can involve different anatomical orbital structures. On imaging, inflammatory disease is frequently mistaken for infection and malignant tumors, and its underlying cause is often not determined. Through this article we aim to improve orbital inflammation diagnosis and underlying inflammatory diseases recognition. METHODS: The imaging protocols and characteristics of orbital inflammation were reviewed. RESULTS: A decision tree for the evaluation of these patients is provided. First, a combination of clinical and radiological clues is used to recognize inflammation, in particular to differentiate it both from orbital infection and tumor. Subsequently, different radiological patterns are recognized, often allowing the differentiation of the several orbital inflammatory diseases. CONCLUSION: The use of adequate imaging protocols and subsequent evaluation allow the recognition of an orbital lesion as inflammatory and the diagnosis of the underlying inflammatory disease. All in all, a proper treatment can be established, and at times, a biopsy can be avoided.


Assuntos
Inflamação/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Doenças Orbitárias/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Árvores de Decisões , Diagnóstico Diferencial , Humanos
4.
Ned Tijdschr Geneeskd ; 160: D197, 2016.
Artigo em Holandês | MEDLINE | ID: mdl-27334084

RESUMO

A 20-year-old woman with congenital iris heterochromia presented with loss of vision of her right eye. We made de diagnosis of a large 'uvea melanoma' and enucleated the eye. Pathological examination showed an underlying oculodermal melanocytosis (ODM). The life-time risk of uveal melanoma in the general population is 0.7:100,000, but 1:400 in patients with ODM. Therefore, annual fundoscopy is recommended in these patients.


Assuntos
Anormalidades do Olho/diagnóstico , Neoplasias da Íris/diagnóstico , Iris/patologia , Melanoma/diagnóstico , Neoplasias Uveais/diagnóstico , Feminino , Humanos , Neoplasias da Íris/complicações , Melanoma/complicações , Neoplasias Uveais/complicações , Adulto Jovem
5.
Biomaterials ; 81: 36-45, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26717247

RESUMO

PURPOSE: To determine whether a fish scale-derived collagen matrix (FSCM) meets the basic criteria to serve as an artificial cornea, as determined with in vitro and in vivo tests. METHODS: Primary corneal epithelial and stromal cells were obtained from human donor corneas and used to examine the (in)direct cytotoxicity effects of the scaffold. Cytotoxicity was assessed by an MTT assay, while cellular proliferation, corneal cell phenotype and adhesion markers were assessed using an EdU-assay and immunofluorescence. For in vivo-testing, FSCMs were implanted subcutaneously in rats. Ologen(®) Collagen Matrices were used as controls. A second implant was implanted as an immunological challenge. The FSCM was implanted in a corneal pocket of seven New Zealand White rabbits, and compared to sham surgery. RESULTS: The FSCM was used as a scaffold to grow corneal epithelial and stromal cells, and displayed no cytotoxicity to these cells. Corneal epithelial cells displayed their normal phenotypical markers (CK3/12 and E-cadherin), as well as cell-matrix adhesion molecules: integrin-α6 and ß4, laminin 332, and hemi-desmosomes. Corneal stromal cells similarly expressed adhesion molecules (integrin-α6 and ß1). A subcutaneous implant of the FSCM in rats did not induce inflammation or sensitization; the response was comparable to the response against the Ologen(®) Collagen Matrix. Implantation of the FSCM in a corneal stromal pocket in rabbits led to a transparent cornea, healthy epithelium, and, on histology, hardly any infiltrating immune cells. CONCLUSION: The FSCM allows excellent cell growth, is not immunogenic and is well-tolerated in the cornea, and thus meets the basic criteria to serve as a scaffold to reconstitute the cornea.


Assuntos
Estruturas Animais/química , Materiais Biocompatíveis/farmacologia , Córnea/efeitos dos fármacos , Córnea/imunologia , Animais , Adesão Celular/efeitos dos fármacos , Morte Celular/efeitos dos fármacos , Permeabilidade da Membrana Celular/efeitos dos fármacos , Proliferação de Células/efeitos dos fármacos , Sobrevivência Celular/efeitos dos fármacos , Colágeno/farmacologia , Substância Própria/citologia , Células Epiteliais/citologia , Células Epiteliais/efeitos dos fármacos , Epitélio Corneano/citologia , Feminino , Peixes , Glucose/metabolismo , Humanos , Fenótipo , Coelhos , Ratos Endogâmicos F344 , Resistência à Tração/efeitos dos fármacos
6.
J Fr Ophtalmol ; 38(6): 516-21, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25976137

RESUMO

Uveal melanoma (UM) is the most common intraocular malignancy in adults with an incidence of about 1/100,000 new cases per year in the Western world. Risk factors are having a light skin, blond hair and blue eyes. As some UM patients have a young age at diagnosis or an affected family history for UM or other malignancies, there may be an underlying genetic basis. This review discusses known or suspected risk factors for UM, the cancer risk in UM patients and their family members, and the genes that have been reported to predispose to UM (germline mutations) and tumor development (somatic mutations).


Assuntos
Predisposição Genética para Doença/genética , Melanoma/diagnóstico , Melanoma/genética , Neoplasias Uveais/diagnóstico , Neoplasias Uveais/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Proteína BRCA1/genética , Transformação Celular Neoplásica/genética , Análise Mutacional de DNA , Progressão da Doença , Feminino , Mutação em Linhagem Germinativa/genética , Humanos , Masculino , Melanoma/epidemiologia , Melanoma/mortalidade , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco , Análise de Sobrevida , Neoplasias Uveais/epidemiologia , Neoplasias Uveais/mortalidade
7.
NMR Biomed ; 26(12): 1864-9, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24123279

RESUMO

High-field MRI is a promising technique for the characterisation of ocular tumours, both in vivo and after enucleation. For in vivo imaging at 7 T, a dedicated three-element microcoil array was constructed as a high-sensitivity receive-only device. Using a dedicated blink/fixation protocol, high-resolution in vivo images could be acquired within 3 min in volunteers and patients with no requirement for post-acquisition image registration. Quantitative measures of axial length, aqueous depth and lens thickness in a healthy volunteer were found to agree well with standard ocular biometric techniques. In a patient with uveal melanoma, in vivo MRI gave excellent tumour/aqueous body contrast. Ex vivo imaging of the enucleated eye showed significant heterogeneity within the tumour.


Assuntos
Imageamento por Ressonância Magnética/instrumentação , Melanoma/patologia , Neoplasias Uveais/patologia , Artefatos , Estudos de Casos e Controles , Humanos , Melanoma/diagnóstico por imagem , Movimento (Física) , Ultrassonografia , Neoplasias Uveais/diagnóstico por imagem
9.
Ophthalmologe ; 107(8): 728-32, 2010 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-20393728

RESUMO

BACKGROUND: We reviewed the radiologic features of 15 patients with orbital metastases originating from breast cancer. METHODS: This was a retrospective consecutive case series. Fifteen consecutive patients with orbital metastases originating from breast carcinoma were identified between March 1997 and September 2008. A retrospective chart review was carried out, and the radiologic findings were reviewed. RESULTS: The metastases were preseptal in 53%, intraconal in 60%, and both intraconal and extraconal in 33%. Lacrimal gland enlargement was noted in 33%, episcleral space involvement in 33%, bone involvement in 13%, and globe dystopia in 53%. The extraocular muscles were involved in 87%; in 60%, two or more muscles were involved. The medial and lateral rectus muscles were affected in 53% and 47%, respectively, and the inferior and superior rectus muscles in 33%. In 47% one or more radiologic features had not been noted by the radiologist, and in 20% the findings were misinterpreted as an"orbital pseudotumor." CONCLUSION: Orbital metastases originating from breast cancer may present heterogeneously. Orbital imaging most commonly shows unilateral and multifocal involvement of multiple extraocular muscles and intraconal and preseptal areas by an irregular lesion.


Assuntos
Neoplasias da Mama/diagnóstico , Imageamento por Ressonância Magnética , Neoplasias Orbitárias/diagnóstico , Neoplasias Orbitárias/secundário , Tomografia Computadorizada por Raios X , Adenocarcinoma/diagnóstico , Adenocarcinoma/patologia , Adenocarcinoma/secundário , Adenocarcinoma Esquirroso/diagnóstico , Adenocarcinoma Esquirroso/diagnóstico por imagem , Adenocarcinoma Esquirroso/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Neoplasias da Mama/patologia , Diagnóstico Diferencial , Oftalmopatias/diagnóstico , Oftalmopatias/patologia , Feminino , Humanos , Metástase Linfática , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Órbita/patologia , Neoplasias Orbitárias/patologia , Estudos Retrospectivos , Transtornos da Visão/diagnóstico , Transtornos da Visão/patologia
10.
Br J Cancer ; 101(2): 312-9, 2009 Jul 21.
Artigo em Inglês | MEDLINE | ID: mdl-19568237

RESUMO

BACKGROUND: The RAS/RAF/MEK/ERK pathway is involved in the balance between melanocyte proliferation and differentiation. The same pathway is constitutively activated in cutaneous and uveal melanoma (UM) and related to tumour growth and survival. Whereas mutant BRAF and NRAS are responsible for the activation of the RAS/RAF/MEK/ERK pathway in most cutaneous melanoma, mutations in these genes are usually absent in UM. METHODS: We set out to explore the RAS/RAF/MEK/ERK pathway and used mitogen-activated protein kinase profiling and tyrosine kinase arrays. RESULTS: We identified Src as a kinase that is associated with ERK1/2 activation in UM. However, low Src levels and reduced ERK1/2 activation in metastatic cell lines suggest that proliferation in metastases can become independent of Src and RAS/RAF/MEK/ERK signalling. Inhibition of Src led to the growth reduction of primary UM cultures and cell lines, whereas metastatic cell line growth was only slightly reduced. CONCLUSION: We identified Src as an important kinase and a potential target for treatment in primary UM. Metastasis cell lines seemed largely resistant to Src inhibition and indicate that in metastases treatment, a different approach may be required.


Assuntos
Melanoma/enzimologia , Neoplasias Uveais/enzimologia , Quinases da Família src/metabolismo , Processos de Crescimento Celular/fisiologia , Linhagem Celular Tumoral , Ativação Enzimática , Humanos , Melanoma/patologia , Proteína Quinase 1 Ativada por Mitógeno/metabolismo , Proteína Quinase 3 Ativada por Mitógeno/metabolismo , Metástase Neoplásica , Neoplasias Uveais/patologia
12.
Clin Genet ; 72(2): 122-9, 2007 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-17661816

RESUMO

The current clinical diagnosis of Von Hippel-Lindau (VHL) disease demands at least one specific [corrected] VHL manifestation in a patient with familial VHL disease, or, in a [corrected] sporadic patient, at least two or more hemangioblastomas or a single hemangioblastoma in combination with a typical visceral lesion. To evaluate this definition, we studied the frequency of germline VHL mutation in three patients groups: (i) multi-organ involvement (classic VHL), (ii) limited VHL manifestations meeting criteria (non-classic VHL) and (iii) patients with VHL-associated tumors not meeting current diagnostic VHL criteria. In addition, we validated multiplex ligation-dependent probe amplification (MLPA) as a rapid and reliable quantitative method for the identification of germline VHL deletions. The frequency of germline VHL mutations was very high in classic VHL cases with multi-organ involvement (95%), lower in non-classic cases that meet current diagnostic criteria but have limited VHL manifestations or single-organ involvement (24%) and low (3.3%), but tangible in cases not meeting current diagnostic VHL criteria. The detection of germline VHL mutations in patients or families with limited VHL manifestations, or single-organ involvement is relevant for follow-up of probands and early identification of at-risk relatives.


Assuntos
Frequência do Gene , Mutação em Linhagem Germinativa , Doença de von Hippel-Lindau/diagnóstico , Doença de von Hippel-Lindau/genética , Southern Blotting , Análise Mutacional de DNA , Humanos , Técnicas de Amplificação de Ácido Nucleico , Linhagem , Prevalência , Análise de Sequência de DNA
13.
Cancer Chemother Pharmacol ; 55(1): 91-9, 2005 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-15565444

RESUMO

BACKGROUND: Resistance to chemotherapy can partly be explained by the activity of membrane bound P-glycoprotein. Competitive inhibition of P-glycoprotein, by multidrug resistance (MDR) converters, may overcome this MDR. Previously studied MDR converters either have serious intrinsic side effects or considerably influence the pharmacokinetics of cytotoxic agents at concentrations theoretically required to convert MDR. GF120918 is a third-generation MDR converter with high affinity for P-glycoprotein and can be given orally. We performed a phase 1 study with escalating doses of GF120918 in combination with doxorubicin. PATIENTS AND METHODS: The study group comprised 46 patients with advanced solid tumors. Doxorubicin was administered on day 1 (cycle 1), GF120918 on days 22-24 (cycle 2), and on days 29-33 with doxorubicin administered on day 31 (cycle 3). Pharmacokinetics of both GF120918 and doxorubicin were studied. The starting daily dose of GF120918 was 50 mg and was to be increased in subsequent cohorts until a steady state plasma level of 100 ng/ml was reached. The starting dose of doxorubicin was 50 mg/m2 and was to be increased after reaching the target dose level of GF120918. RESULTS: In 37 of the 46 patients, full pharmacokinetic data from the three scheduled cycles were obtained. Pharmacokinetics of GF120918 showed a less than linear increase in Cmax with increasing doses, with considerable interpatient variation. The target steady-state plasma level for GF120918 was exceeded in 12 out of 19 patients who received 400 mg GF120918 alone twice daily and in 12 of 17 patients who received 400 mg GF120918 twice daily in combination with doxorubicin. GF120918 pharmacokinetics were not influenced by coadministration of doxorubicin. The doxorubicin AUC was only marginally influenced by GF120918 and only at the highest dose levels. In these patients there was a significant increase in the AUC of doxorubicinol in cycle 3 as compared to cycle 1. Hematologic toxicity mainly consisted of neutropenia and was more severe in cycle 3 than in cycle 1 (13 vs 5 patients with grade 4 neutropenia, P=0.003). Neutropenic fever was the dose-limiting toxicity at a doxorubicin dose of 75 mg/m2 with 400 mg GF120918 twice daily. The toxicity of GF120918 was limited to somnolence in eight patients and occasional gastrointestinal complaints. CONCLUSION: GF120918 is an MDR converter with only minimal side effects at a dose level yielding concentrations able to convert the action of P-glycoprotein in vitro. A doxorubicin dose of 60 mg/m2 on day 3 in combination with 400 mg GF120918 twice daily on days 1-5 is an acceptable regimen for further clinical trials.


Assuntos
Acridinas/farmacologia , Acridinas/farmacocinética , Antibióticos Antineoplásicos/farmacocinética , Doxorrubicina/farmacocinética , Resistência a Múltiplos Medicamentos , Tetra-Hidroisoquinolinas/farmacologia , Tetra-Hidroisoquinolinas/farmacocinética , Membro 1 da Subfamília B de Cassetes de Ligação de ATP/metabolismo , Acridinas/administração & dosagem , Administração Oral , Adulto , Idoso , Antibióticos Antineoplásicos/administração & dosagem , Antibióticos Antineoplásicos/efeitos adversos , Relação Dose-Resposta a Droga , Doxorrubicina/administração & dosagem , Doxorrubicina/efeitos adversos , Esquema de Medicação , Interações Medicamentosas , Quimioterapia Combinada , Feminino , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Neoplasias/tratamento farmacológico , Tetra-Hidroisoquinolinas/administração & dosagem
14.
J Clin Oncol ; 19(4): 1167-75, 2001 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-11181683

RESUMO

PURPOSE: A single-agent dose-escalating phase I and pharmacokinetic study on the farnesyl transferase inhibitor SCH 66336 was performed to determine the safety profile, maximum-tolerated dose, and recommended dose for phase II studies. Plasma and urine pharmacokinetics were determined. PATIENTS AND METHODS: SCH 66336 was given orally bid without interruption to patients with histologically or cytologically confirmed solid tumors. Routine antiemetics were not prescribed. RESULTS: Twenty-four patients were enrolled onto the study. Dose levels studied were 25, 50, 100, 200, 400, and 300 mg bid. Pharmacokinetic sampling was performed on days 1 and 15. At 400 mg bid, the dose-limiting toxicity (DLT) consisted of grade 4 vomiting, grade 4 neutropenia and thrombocytopenia, and the combination of grade 3 anorexia and diarrhea with reversible grade 3 plasma creatinine elevation. After dose reduction, at 300 mg bid, the DLTs consisted of grade 4 neutropenia, grade 3 neurocortical toxicity, and the combination of grade 3 fatigue with grade 2 nausea and diarrhea. The recommended dose for phase II studies is 200 mg bid, which was found feasible for prolonged periods of time. Pharmacokinetic analysis showed a greater than dose-proportional increase in drug exposure and peak plasma concentrations, with increased parameters at day 15 compared with day 1, indicating some accumulation on multiple dosing. Plasma half-life ranged from 4 to 11 hours and seemed to increase with increasing doses. Steady-state plasma concentrations were attained at days 7 through 14. A large volume of distribution at steady-state indicated extensive distribution outside the plasma compartment. CONCLUSION: SCH 66336 can be administered safely using a continuous oral bid dosing regimen. The recommended dose for phase II studies using this regimen is 200 mg bid.


Assuntos
Antineoplásicos/uso terapêutico , Piperidinas/uso terapêutico , Piridinas/uso terapêutico , Administração Oral , Adulto , Idoso , Alquil e Aril Transferases/antagonistas & inibidores , Antineoplásicos/administração & dosagem , Antineoplásicos/farmacocinética , Inibidores Enzimáticos/administração & dosagem , Inibidores Enzimáticos/farmacocinética , Inibidores Enzimáticos/uso terapêutico , Farnesiltranstransferase , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Piperidinas/farmacocinética , Piridinas/farmacocinética
15.
Genes Chromosomes Cancer ; 30(3): 267-73, 2001 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-11170284

RESUMO

Several nonrandom recurrent chromosomal changes are observed in uveal melanoma. Some of these abnormalities, e.g., loss of chromosome 3, gain of the q arm of chromosome 8, and chromosome 6 abnormalities, are of prognostic value. Cytogenetic analysis and/or fluorescence in situ hybridization (FISH) are used to detect these changes. In some cases, however, detailed cytogenetic analysis is not possible due to the presence of complex abnormalities. To define more accurately these cytogenetic changes, we have applied comparative genomic hybridization (CGH) and/or spectral karyotyping (SKY) to two uveal melanoma cell lines and five primary uveal melanomas, with partially defined and/or complex abnormalities. SKY provided additional information on 34/39 partially defined aberrant chromosomes and revealed a new abnormality, a der(17)t(7;17)(?;q?), that had not been recognized by conventional cytogenetics. Additionally, using SKY, abnormalities involving chromosome 6 or 8 were found to be twice as common as observed with cytogenetic analysis. CGH was especially useful in assigning the abnormalities identified by SKY to specific chromosomal regions and, in addition, resulted in the detection of a small deletion of chromosome region 3q13 approximately 21. We conclude that SKY and CGH, as methods complementary to cytogenetic and FISH analysis, provide more complete information on the chromosomal abnormalities occurring in uveal melanoma.


Assuntos
Aberrações Cromossômicas/genética , Hibridização in Situ Fluorescente , Cariotipagem , Melanoma/genética , Neoplasias Uveais/genética , Adulto , Idoso , Transtornos Cromossômicos , Cromossomos Humanos Par 6/genética , Cromossomos Humanos Par 8/genética , Feminino , Humanos , Cariotipagem/métodos , Masculino , Pessoa de Meia-Idade , Hibridização de Ácido Nucleico , Células Tumorais Cultivadas
16.
J Refract Surg ; 17(6): 634-40, 2001.
Artigo em Inglês | MEDLINE | ID: mdl-11758980

RESUMO

PURPOSE: To evaluate the efficacy, safety, predictability, and stability of implanting a polymethylmethacrylate (PMMA) phakic intraocular lens (PIOL) (the Artisan myopia lens) to correct high myopia. METHODS: An Artisan myopia lens was implanted in 78 consecutive eyes of 49 patients with preoperative myopia that ranged from -6.25 to -28.00 D. Mean patient age was 42.4 years. Mean follow-up was 10.7 months and all patients were followed for at least 6 months; 45 eyes had follow-up of 12 months, and 10 eyes had 24 months. The desired outcome was emmetropia in all eyes except for those eyes with preoperative myopia greater then -23.00 D. RESULTS: Fifty-three eyes (67.9%) had a postoperative refraction at the last follow-up examination within +/-1.00 D of emmetropia, and 39 eyes (50.0%) had a postoperative refraction +/- within 0.50 D of emmetropia. The postoperative refraction remained stable during the entire follow-up period. Mean spectacle-corrected visual acuity improved from 20/32 preoperatively to 20/25 postoperatively. Mean postoperative uncorrected visual acuity was 20/32. There was no significant change in endothelial cell density from baseline. We did not encounter major complications. CONCLUSION: Implantation of the Artisan myopia lens to correct high myopia resulted in a stable and fairly predictable refractive outcome. A significant endothelial cell change was not detected.


Assuntos
Iris/cirurgia , Implante de Lente Intraocular , Cristalino/fisiologia , Miopia/cirurgia , Adulto , Feminino , Seguimentos , Humanos , Lentes Intraoculares , Masculino , Pessoa de Meia-Idade , Miopia/fisiopatologia , Polimetil Metacrilato , Refração Ocular , Segurança , Resultado do Tratamento , Acuidade Visual
17.
J Cataract Refract Surg ; 26(8): 1163-71, 2000 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-11008043

RESUMO

PURPOSE: To assess the Artisan intraocular lens to correct myopia in phakic eyes. SETTING: European multicenter study sponsored by Ophtec BV, Groningen, The Netherlands. METHODS: In this prospective multicenter clinical study, the Artisan lens was implanted in 518 eyes between September 1991 and October 1999. The power of the lenses ranged from -5.0 to -20.0 diopters (D). Follow-up examinations were performed at 6 months and 1, 2, and 3 years. Follow-up ranged from 6 months (n = 454) to 3 years (n = 249). The preoperative uncorrected visual acuity (UCVA) was not recorded but was estimated to be worse than 0.1. The preoperative mean best spectacle-corrected visual acuity (BSCVA) was 0.67 +/- 0.26 (SD). Endothelial cell counts were done at 6 months and 1, 2, and 3 years in a subgroup of 129 eyes. RESULTS: A UCVA of 20/40 or better was observed in 76.8% of eyes regardless of the postoperative goal. A BSCVA of 20/40 or better was observed in 93.9% of eyes and remained stable throughout the follow-up. Of the eyes with extremely high myopia (>-15.0 D), 63.3% gained 2 or more lines of BSCVA; of those with moderate myopia (-5.0 to -10.0 D), 23.5% gained 2 or more lines. The mean endothelial cell density change was 4.8% at 6 months, 2.4% at 1 year, 1.7% at 2 years, and 0.7% at 3 years. The incidence of persistent adverse events at 3 years was relatively low. Secondary surgical interventions included repositioning of the lens because of poor initial placement and lens exchange because of preoperative power calculation errors. Glare and halo effects during night driving were noted and were related to large pupils in young patients. CONCLUSION: The Artisan lens is a safe, stable, efficacious, and predictable method to correct -5.0 to -20.0 D of myopia. This study suggests that the corneal endothelial cell loss is stabilized to the physiologically normal level after 3 years.


Assuntos
Lentes Intraoculares , Miopia/cirurgia , Adolescente , Adulto , Idoso , Contagem de Células , Endotélio Corneano/patologia , Europa (Continente) , Feminino , Humanos , Implante de Lente Intraocular , Masculino , Pessoa de Meia-Idade , Prognóstico , Desenho de Prótese , Refração Ocular , Segurança , Acuidade Visual
19.
Strahlenther Onkol ; 175(1): 21-7, 1999 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-9951514

RESUMO

CASE REPORT: A case history of unanticipated radiation-induced bilateral optic neuropathy, 18 months after induction chemotherapy and radiation therapy for a locally advanced nasopharyngeal carcinoma, is presented. Retrospective reanalysis of the radiation therapy technique, with emphasis on the doses received by the optic pathway structures, was performed. These re-calculations revealed unexpectedly high doses in the range 79 to 82 Gy (cumulative external and brachytherapy dose) at the level of the optic nerves, which explained the observed radiation injury. CONCLUSION: Routine implementation of computed tomography for 3D dose planning purposes is therefore advocated. Review of the current literature confirms the importance of 3D dose planning in avoiding this complication and high-lights the role of MRI in establishing the diagnosis of radiation-induced optic neuropathy.


Assuntos
Carcinoma de Células Escamosas/radioterapia , Neoplasias Nasofaríngeas/radioterapia , Nervo Óptico/efeitos da radiação , Neuropatia Óptica Isquêmica/etiologia , Radioterapia/efeitos adversos , Adulto , Antineoplásicos/uso terapêutico , Cegueira/etiologia , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/tratamento farmacológico , Terapia Combinada , Relação Dose-Resposta à Radiação , Angiofluoresceinografia , Seguimentos , Humanos , Imageamento por Ressonância Magnética , Masculino , Neoplasias Nasofaríngeas/diagnóstico , Neoplasias Nasofaríngeas/tratamento farmacológico , Quiasma Óptico/efeitos da radiação , Neuropatia Óptica Isquêmica/diagnóstico , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador , Radioterapia de Alta Energia , Estudos Retrospectivos , Fatores de Tempo , Tomografia Computadorizada por Raios X
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