PubMed Health⌕ Search

Biomedical subjects

C L Shields

Publications and source records attributed to C L Shields.

At least 19 recordsLinked to original sources
PubMed1992

Hydroxyapatite orbital implant after enucleation. Experience with initial 100 consecutive cases.

The hydroxyapatite orbital implant is designed to provide the enucleated patient with improved motility of the prosthesis. We report the results of our first 100 consecutive cases of hydroxyapatite implantation in eyes enucleated primarily for intraocular neoplasms. During a median of 11 months' follow-up, there have been no cases of orbital infection, implant extrusion, or implant migration. Minor postoperative problems have included transient orbital pain in six patients, Tenon's fascia edema and buried peg from tissue overgrowth in two patients each, wound erosion and peg extrusion in one patient each, and audible click of the peg in three patients. Movement of the socket and fornices was excellent in 99% of patients. Motility was cosmetically satisfactory with 10 degrees to 15 degrees rapid darting prosthesis movement present in 96% of patients regardless of whether the peg had been placed. Large-degree prosthesis motility (greater than 15 degrees) was present in 24% of all patients and was most impressive in those adults who had the peg in place and in children. The hydroxyapatite implant appears to be well tolerated and provides prosthesis motility with few problems.

Adolescent↗
PubMed1992

Progressive enlargement of a circumscribed choroidal hemangioma. A clinicopathologic correlation.

A man with a circumscribed choroidal hemangioma was followed up for almost 10 years as the tumor showed gradual, progressive enlargement in both diameter and thickness. In spite of photocoagulation therapy, a total retinal detachment and blindness ensued. Enucleation was performed because the possibility of amelanotic choroidal melanoma could not be absolutely excluded. Although the tumor thickness measured by ultrasonography before enucleation was 4.5 mm, the lesion measured only 2.0 mm in thickness in the pathology laboratory. Circumscribed choroidal hemangioma rarely demonstrates clinical evidence of growth. It appears that the tumor enlargement noted in this case was due to venous congestion in the tumor and not to cell multiplication.

Adult↗
PubMed1992

Unusual MRI findings in metastatic carcinoma to the choroid and optic nerve: a case report.

A 51 year old man with biopsy proven pulmonary sarcoidosis and skin test positive for tuberculosis presented with features of an amelanotic flat choroidal mass suggestive of choroiditis. The mass enlarged despite corticosteroids and anti-tuberculous medications. A thorough systemic evaluation for possible primary tumor metastatic to the choroid was negative. Further clinical evaluation and magnetic resonance imaging suggested a diffuse primary choroidal malignant melanoma with optic nerve invasion. The eye was enucleated and the mass proved histopathologically to be a mucin secreting adenocarcinoma of unknown origin despite a repeat systemic work-up. The patient died three months after the onset of symptoms and three weeks after enucleation with diffuse metastases from an unknown primary cancer. Magnetic resonance imaging (MRI) is usually helpful in the differentiation of uveal melanoma from uveal metastasis. In this case, however, it suggested the diagnosis of a diffuse choroidal melanoma. The reason for the atypical MRI findings will be discussed.

Adenocarcinoma↗
PubMed1992

Pigmented adenoma of the optic nerve head simulating a melanocytoma.

PURPOSE: The purpose of this report is to describe a clinicopathologic correlation of an unusual pigmented tumor of the optic nerve head, to point out that such a lesion can simulate clinically a melanocytoma of the optic disc, and to discuss the differential diagnosis of pigmented epipapillary lesions. FINDINGS: Histopathologic studies of the affected eye showed a peculiar pigmented tumor of the optic disc that was compatible with an adenoma arising from the juxtapapillary retinal pigment epithelium. CONCLUSIONS: Adenoma of the retinal pigment epithelium can closely simulate a melanocytoma of the optic disc. There are some clinical features that may serve to differentiate the two lesions.

Adenoma↗
PubMed1992

Lack of association among typical congenital hypertrophy of the retinal pigment epithelium, adenomatous polyposis, and Gardner syndrome.

BACKGROUND: It has been recently documented that multiple bilateral pigmented lesions at the level of the retinal pigment epithelium may be an indicator of patients with familial adenomatous polyposis who are prone to develop intestinal cancer, particularly if there is a positive family history of these intestinal disorders. Although atypical, such lesions have been called congenital hypertrophy of the retinal pigment epithelium (CHRPE). This study was undertaken to determine whether the typical lesions of CHRPE, seen frequently by ophthalmologists, also were indicators of familial adenomatous polyposis. METHODS: Review of charts and follow-up studies were performed on all patients diagnosed and coded as having solitary CHRPE or its multifocal variant (congenital grouped pigmentation; bear tracks). Patients and their physicians were contacted by telephone to complete a detailed questionnaire designed to detect signs or symptoms of familial adenomatous polyposis or Gardner syndrome among these patients with CHRPE and their relatives. RESULTS: Of the 132 patients with previously diagnosed CHRPE, there were none with familial adenomatous polyposis, Gardner syndrome, or intestinal cancer, and only one patient had a history of intestinal polyps. Among more than 2000 of their blood relatives, only 20 had intestinal polyposis or colonic cancer (1%). This is much lower than would be expected from a survey of patients with the typical fundus lesions seen with familial adenomatous polyposis. CONCLUSIONS: It appears that solitary CHRPE and congenital grouped pigmentation differ clinically from the multiple pigmented lesions seen with familial adenomatous polyposis and that patients with these conditions, as well as their relatives, are not at a greater risk of developing intestinal cancer.

Adenomatous Polyposis Coli↗
PubMed1992

Role of magnetic resonance imaging in the evaluation of the hydroxyapatite orbital implant.

The role of magnetic resonance imaging (MRI) in the assessment of fibrovascular ingrowth in the integrated hydroxyapatite orbital implant is evaluated. Fifteen patients who underwent enucleation and placement of a hydroxyapatite orbital implant were evaluated for degree of implant vascularity with gadolinium-DPTA-enhanced MRI with surface coil before drilling the implant. On T1-weighted images, the hydroxyapatite sphere appeared with intermediate signal. After gadolinium-DPTA administration, all patients showed an enhancement in the implant consistent with the presence of fibrovascular ingrowth. The enhancement was most notable in the peripheral portions of the sphere and was seen as early as 5 months after implantation. Comparison of gadolinium-DPTA-enhanced MRI with contrast-enhanced computed tomography, ultrasonography, and color Doppler imaging suggests that these latter techniques are not as helpful in the detection of the fibrovascular tissue in the orbital implant. Bone scan, a technique used by many surgeons, demonstrates fibrovascular ingrowth, but it is limited by its one-dimensional low-resolution image. Because of its three-dimensional capability and its highest resolution, contrast-enhanced MRI with surface coil appears to be the best imaging method for evaluating the hydroxyapatite orbital implant and its fibrovascular ingrowth.

Adolescent↗
PubMed1992

Clinicopathologic correlation of choroidal folds: secondary to massive cranioorbital hemangiopericytoma.

A 55-year-old woman developed marked choroidal folds in the right eye secondary to a massive tumor in the right orbit. The patient underwent a modified exenteration with debulking of the tumor, thus providing the opportunity to do a clinicopathologic correlation on the choroidal folds. Histopathologically, the orbital tumor proved to be an unusually aggressive malignant hemangiopericytoma. Microscopic examination of the globe showed that the apices of some of the folds were directed toward the retina, whereas the apices of other folds were directed toward the choroid. In contrast to popular concepts, the retinal pigment epithelium was intact at the crests of the folds toward the retinal side, while the retinal pigment epithelium was atrophic in the valleys toward the choroid.

Brain Neoplasms↗
PubMed1992

Pyogenic granuloma of the cornea after penetrating keratoplasty.

An 81-year-old man with metastatic prostate carcinoma underwent a penetrating keratoplasty for phlyctenular keratitis. Two years later he developed a fleshy, vascular mass in the superotemporal corneal graft wound, at the site of prior graft sutures. An excisional biopsy of the mass was performed to rule out metastatic carcinoma. Histopathological findings were consistent with pyogenic granuloma. To our knowledge there have been no prior case reports illustrating pyogenic granuloma as a late complication of penetrating keratoplasty.

Aged↗
PubMed1992

Orbital cyst in a patient with Stevens-Johnson syndrome.

A 10-year-old girl with ocular complications of Stevens-Johnson syndrome developed a large superior orbital cyst above the right eye. When the cyst recurred after needle aspiration, it was removed surgically and the superior conjunctival fornix was replaced with a buccal mucous membrane graft. Histopathologically the lesion proved to be a clear cyst lined by nonkeratinizing epithelium compatible with conjunctival epithelium with rare goblet cells. The patient did well postoperatively. An orbital cyst is a rare ocular complication of the Stevens-Johnson syndrome.

Child↗
PubMed1992

Unusual retinal and renal vascular lesions in the Klippel-Trenaunay-Weber syndrome.

Ocular fundus abnormalities associated with the Klippel-Trenaunay-Weber syndrome are uncommon and include retinal vascular tortuosity and diffuse choroidal hemangioma. A case involving a young girl with Klippel-Trenaunay-Weber syndrome who had unusual bilateral, exudative, outer retinal vascular masses involving the peripheral fundus in one eye and the foveal area in the other eye is reported. Kidney biopsy for renal insufficiency disclosed abnormal excess mesangial tissue. The fundus lesions appear to represent vascular tumors of the retina that differ clinically from previously reported retinal vascular tumors and Coats disease. The simultaneous retinal and renal involvement suggest that Klippel-Trenaunay-Weber syndrome may be associated with more widespread vascular malformations than previously realized.

Biopsy↗
PubMed1992

Nocardia choroidal abscess.

Nocardia is a Gram positive, aerobic, filamentous branching micro-organism that rarely causes human infection. When infection does occur it usually takes the form of a subcutaneous abscess or a pneumonia-like illness. We describe a case of a patient with chronic lymphocytic leukaemia who developed painless loss of vision in the right eye secondary to a choroidal abscess after a prolonged course of treatment on several immunosuppressive agents. The patient also complained of right shoulder pain that was unresponsive to conventional therapy, and had been admitted and treated for several episodes of 'pneumonia'. A diagnostic transvitreal fine-needle aspiration biopsy of the ocular lesion was performed which demonstrated Nocardia asteroides. This allowed for appropriate antibiotic therapy to be instituted early in the course of the infection and prompted the systemic work-up which also demonstrated central nervous system and arthropic nocardial infection.

Abscess↗
PubMed1992

The CT and MRI features of an unusual case of isolated orbital neurofibroma.

A 35-year-old woman developed painful proptosis of the left eye over a period of 3 weeks. Orbital computed tomography and magnetic resonance imaging revealed a well-circumscribed superior orbital tumor with variable density. The mass was removed entirely by way of a superior orbitotomy. Histopathologically, it was found to be a neurofibroma. The patient had no clinical findings of neurofibromatosis. The presence of extensive myxomatous degeneration and the dense collection of collagen bundles in the tumor are correlated with the unusual computed tomography and magnetic resonance imaging features.

Adult↗
PubMed1991

Retinoblastoma manifesting as orbital cellulitis.

Five children with previously undiagnosed retinoblastoma had signs of unilateral orbital cellulitis and were treated with systemic antibiotics, corticosteroids, or both. When retinoblastoma was finally diagnosed clinically, radiologists believed in every case that, on the basis of the soft-tissue swelling seen with computed tomography, there was orbital extension of the tumor. However, intraoperative and histopathologic observations disclosed no demonstrable orbital tumor involvement. The affected eyes all had neovascular glaucoma, and all harbored highly necrotic tumors that were contained within the eye. We concluded that orbital inflammation can occur with retinoblastoma confined to the eye and that signs of orbital cellulitis do not necessarily imply orbital extension of the tumor.

Cellulitis↗