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C W Spraul

Publications and source records attributed to C W Spraul.

At least 91 records · Page 5Linked to original sources
PubMed1996

[Primary extradural meningioma of the orbits: a report of a patient and review of the literature].

BACKGROUND: Over 98% of all meningiomas originate in the central nervous system including the optic fascicle. Spread outside this area occurs in 20% of cases. Ectopic (extradural) meningiomas that do not originate from either the optic fascicle or the intracranial meninges are exceedingly rare. We treated a patient with an ectopic meningioma of the orbit and reviewed the literature concerning ectopic orbital meningiomas. HISTORY AND SIGNS: A 30-year-old man presented with a painless tumor in the left medial canthal area. This tumor had developed over a period of two years. The patient complained of intermittent epiphora. Ophthalmologic examination revealed a slight lateral displacement of the left eye. There was a palpable medial orbital mass with an otherwise normal ophthalmological examination. Computed tomography and magnetic resonance imaging showed a homogeneous, well-marginated soft tissue mass. THERAPY AND OUTCOME: The lesion which had neither a contact to the dura of the anterior cranial fossa nor to the optic fascicle was excised and histologic examination showed a fibroblastic meningioma. There was no recurrent tumor after a follow-up of 18 months. CONCLUSION: Less than 50 ectopic (extradural) meningiomas of the orbit have been described in the literature. The most common histologic type is the meningotheliomatous (syncytial or transitional) meningioma. The mean age at diagnosis of these tumors is 31 years. After complete resection the prognosis is good.

Adult↗
PubMed1996

Retinoblastoma recurrence after iodine 125 plaque application.

PURPOSE: The authors report the clinicopathologic features of a recurrent retinoblastoma after radioactive iodine 125 (125l) plaque therapy. METHODS: The clinical and histopathologic findings of a 1-year-old boy with a recurrent retinoblastoma after 125l radioactive plaque application were reviewed. The patient's enucleated right eye was processed for routine histologic evaluation. Immunostains for glial fibrillary acid protein and S-100 protein were performed. RESULTS: Examination of the enucleated eye revealed a retinal tumor composed of two populations of cells. One population consisted of poorly differentiated cells, and the second population at the base of the tumor contained well-differentiated cells with numerous fleurettes. Immunohistochemical stains were positive for glial fibrillary acid protein and S-100 protein in the well-differentiated portion of the tumor. CONCLUSION: This case illustrates a recurrent retinoblastoma that may have arisen from radioresistant well-differentiated cells after 125l plaque therapy.

Brachytherapy↗
PubMed1996

Cytology of metastatic cutaneous melanoma to the vitreous and retina.

PURPOSE: The authors report one patient with definitive and one patient with presumed metastatic cutaneous malignant melanoma to the vitreous and retina diagnosed by cytologic evaluation of the vitreous and subretinal fluid. METHODS: A diagnostic vitrectomy was performed on two patients with atypical vitreous and retinal infiltrates. Additionally, subretinal fluid was obtained from the second patient. The specimens were processed for cytologic examination. The cytology specimens were compared with previously excised cutaneous melanomas from the patients. RESULTS: Examination results showed cells in the vitreous with high nuclear-to-cytoplasm ratios, coarse chromatin, and intracytoplasmic melanin pigment granules. The cytologic features were compared with the cutaneous malignant melanoma, and a diagnosis of metastatic melanoma was made. One patient eventually required enucleation, and the metastatic tumor in the other patient was controlled by local irradiation. CONCLUSIONS: Cytologic evaluation of the vitreous and subretinal fluid is helpful in establishing a diagnosis in patients with metastatic cutaneous melanoma to the vitreous and retina.

Aged↗
PubMed1996

Tumors of the cornea and conjunctiva.

This article reviews literature regarding tumors and tumor-like lesions of the conjunctiva and cornea as published in 1995. Causative and prognostic factors, as well as treatment options, are discussed. Ocular surface squamous neoplasia has been suggested as an "umbrella" term for dysplastic and carcinomatous lesions of the cornea and conjunctiva. Squamous cell carcinoma shows a higher incidence in patients with AIDS. A high prevalence (36%) of primary acquired melanosis is reported in one article, and the need for biopsy of all these lesions is questioned. Reviews of conjunctival myxoma, corneal pyogenic granuloma, and limbal juvenile xanthogranuloma are also included. The pathogenesis and newer treatment options for pterygia are discussed. Simple excision or resection of the pterygium followed by conjunctival autografting or intraoperative or postoperative mitomycin C application seems to be equally effective in reducing the rate of recurrence.

Combined Modality Therapy↗
PubMed1996

[Risk factors and clinical fluorescein angiography findings in anterior ischemic optic neuropathy].

BACKGROUND: Nonarteritic anterior ischemic optic neuropathy (AION) is the most common cause of visual loss in older patients with optic disc swelling. METHOD: In our study all patients with acute AION examined clinically and by fluorescein angiography between 1986 and 1994 were retrospectively reviewed. The prevalence of associated systemic diseases and the results of Doppler sonographic examinations of extracranial vessels were investigated. RESULTS: The records of 86 patients (60 male, 26 female) with AION were available. The mean age at the time of onset of AION was 61 years (range 41 to 85 years, SD = 11.9 years). In 50 patients the right and in 36 the left eye was involved. In 36% of the patients optic atrophy of the other eye because of AION was found. The median visual acuity was 0.25 (range, light perception to 1.25). Fluorescein angiography showed diffuse edema of the optic disc in 23% (20/86) of patients and localized segmental edema in 77% (66/86). Statistical analysis revealed a predominant involvement of the temporal quadrants. Ninety-three percent of patients with AION showed underlying systemic diseases. In 15% of these patients the systemic diseases were unknown at the time of onset of the AION; 58% (50/86) of the patients had hypertension, 28% (24/86) had diabetes mellitus, and 37% (32/86) had disorders of lipid metabolism. Seven percent (6/86) of patients showed no risk factors. Doppler sonographic examinations of extracranial vessels revealed hemodynamic relevant stenosis in 11% (6/56), and non stenotic plaques in 28% of patients (16/56). CONCLUSION: Because of the high percentage of associated systemic diseases in patients with AION a general examination and adequate treatment are necessary.

Acute Disease↗
PubMed1996

Morphometric analysis of the choroid, Bruch's membrane, and retinal pigment epithelium in eyes with age-related macular degeneration.

PURPOSE: To quantify morphologic changes in the choroid, including choriocapillaris and larger choroidal vessels, Bruch's membrane, and retinal pigment epithelium in eyes with age-related macular degeneration (AMD) and late ARM (age-related maculopathy). METHODS: The authors analyzed 40 eye bank eyes with late ARM (21 with the neovascular AMD and 19 with nonneovascular AMD) and compared them with 40 age-matched eyes without signs of late ARM (AMD). The eyes were processed for light microscopy, and seven variables were measured in the macular and peripheral regions with a digital filar micrometer. RESULTS: There were no statistically significant differences observed between eyes with neovascular versus nonneovalcular AMD. The single most important difference between eyes with and without AMD was the amount of basal laminar deposit (P < 0.001). Eyes with AMD displayed fewer large choroidal vessels in the submacular choroid than eyes without AMD (3.5 +/- 1.5 mm-1 and 5.7 +/- 1.6 mm-1; P < 0.001). The submacular choriocapillaris density was higher in eyes with AMD (0.62 +/- 0.06) than in eyes without AMD (0.51 +/- 0.08; P < 0.001). The diameter of the large choroidal vessels in the peripheral choroid was increased in eyes with AMD (30 +/- 8 microns) compared to eyes without AMD (21.4 +/- 6.2 microns; P < 0.001). The peripheral choriocapillaris density displayed the same pattern as in the macular region in eyes with and without AMD. CONCLUSIONS: The amount of basal laminar deposit strongly correlates with the histologic presence of AMD. Eyes with AMD show differences of the density and diameter of choroidal blood vessels compared to eyes without AMD.

Aged↗
PubMed1995

Metastatic adenocarcinoma to the retina in a patient with Muir-Torre syndrome.

PURPOSE/METHODS: A 74-year-old woman had multiple tumors including a retinal mass. Her medical history included cutaneous sebaceous adenomas, adenocarcinoma of the breast, and colonic adenocarcinoma. Her involved eye became painful and was enucleated. RESULTS/CONCLUSIONS: Examination of the enucleated eye disclosed metastatic adenocarcinoma to the retina with retinal detachment. The patient described has a retinal metastasis of an unknown primary tumor site with Muir-Torre syndrome, characterized by an association of a sebaceous gland tumor with an internal malignancy.

Adenocarcinoma↗
PubMed1995

[Juvenile xanthogranuloma of the corneoscleral limbus: report of a patient and review of the literature].

BACKGROUND: Juvenile xanthogranuloma is an uncommon benign skin disease primarily affecting infants and young children. Ocular involvement is rare and most often affecting the iris. Isolated xanthogranulomas of the corneoscleral limbus are reported in the literature in only a few patients. HISTORY AND FINDINGS: A 10-year-old boy presented in October 1993 with a yellow solid tumor at the limbus of his left eye. The other ocular and extraocular structures were normal. Furthermore, he showed a preauricular nodular skin lesion. THERAPY AND OUTCOME: We suspected a dermoid of the corneoscleral limbus and performed an excision of the tumor. Histological examination revealed a juvenile xanthogranuloma. The tumor had regrown to its original size 2 months after excision. Treatment with topical corticosteroids resulted in an acceptable but incomplete regression of the tumor. CONCLUSION: Juvenile Xanthogranulomas of the corneoscleral limbus are rare tumors. The majority of previously reported cases showed a recurrence of the tumor at the original site after simple excision. In the case of unsuccessful therapy with topical corticosteroids a lamellar graft is recommended.

Child↗
PubMed1995

Allergic and atopic diseases of the lid, conjunctiva, and cornea.

Ocular allergies are commonly encountered in clinical practice. The familiarity with the typical constellation of signs and symptoms, as well as the pathophysiology of these syndromes, is of utmost importance in diagnosing and treating these diseases. Several new therapeutic options have been tested in clinical settings in recent time. Lodoxamine tromethamine is a mast cell stabilizer at least as effective as cromolyn sodium, which is currently not available in the United States. Nedocromil sodium in addition to its mast cell stabilizing effect, has anti-inflammatory properties. Levocabastine hydrochloride is a very selective and potent H1 antihistamine. Ketorolac tromethamine is a topical nonsteroidal anti-inflammatory agent.

Animals↗
PubMed1995

[Results of perifoveal argon laser coagulation of subfoveal choroid neovascularization in age related macular degeneration].

BACKGROUND: The treatment of patients with subfoveal choroidal neovascular membrane in age-related macular degeneration is unsatisfactory because only a limited number of patients are eligible. The aim of this study was to prospectively evaluate a new perifoveal treatment technique in patients with subfoveal choroidal neovascular membrane. METHODS: Between April 1992 and January 1994, 385 patients underwent clinical examination and fluorescein angiography. Eligibility criteria were met by 21 (5.5%) patients (22 eyes): well or poorly defined subfoveal choroidal neovascular membrane (< or = 3.5 disc diameters), without fibrosis, with visual acuity < or = 0.25. Visual acuity, morphological findings and complications were studied. The follow-up period was 12-32 months. RESULTS: The visual acuity before laser treatment ranged from counting fingers up to 0.25 (median 0.06). At the end of the follow-up (median 18 months) 28% (6/21) of patients showed a better visual acuity, whereas 44% (9/21) were unchanged and 28% (6/21) had deteriorated compared to visual acuity before treatment. In 71% (15/21) of eyes, resolution of the choroidal neovascular membrane was achieved with development of an atrophic laser scar. CONCLUSION: The visual outcome and the morphological findings after perifoveal laser treatment of subfoveal choroidal neovascular membrane in age-related macular degeneration show it to be an alternative method of treatment with favourable results. Due to inclusion criteria it is suitable only for a limited number of patients.

Aged↗
PubMed1994

[Corneal ulcer in chronic graft-versus-host disease: treatment with collagen shields].

BACKGROUND: After bone marrow transplantation various ocular diseases have been described. Ocular involvement is very common in patients with chronic Graft-versus-Host Disease (GvHD). These patients show clinical and histological evidence of a dry-eye condition in 60-100 per cent. A severe complication is the development of a corneal ulcer with possible corneal perforation. Two patients with a severe dry-eye condition and development of corneal stroma ulceration are described. The corneal ulcers healed after treatment with collagen-shield. HISTORY AND SIGNS: In a 13-year-old boy an allogeneic bone marrow transplantation was performed in April 1989 because of Fanconi's anemia. In November 1989 a severe dry-eye condition occurred due to GvHD with skin, liver, and gastrointestinal tract manifestation. In April 1991 he presented with corneal stroma ulceration of the right eye. In a 24-year-old patient an allogeneic bone marrow transplantation was performed because of chronic myeloid leukemia in August 1989. In December 1989 he developed dry-eye condition due to GvHD with skin, mucosa and liver involvement. In December 1991 a corneal ulcer of the left eye occurred. THERAPY AND OUTCOME: Repeated conjunctival and corneal smears were negative. Local antibiotic and antiviral treatment showed no effect. Corneal ulcers deteriorated progressively with corneal thinning. Both patients were therefore treated with daily collagen-shields and hourly polyvinyl-pyrrolidon eye-drops resulting in healing of the corneal ulcer within 3 and 2 weeks respectively. CONCLUSION: Treatment of corneal stromal ulceration in dry eye condition caused by chronic GvHD is difficult. In noninfectious ulcers daily application of collagen-shields and hourly artificial tears may prevent severe ocular complications like corneal perforation.

Adolescent↗
PubMedDate not supplied

Vitreous Hemorrhage.

The incidence of spontaneous vitreous hemorrhage is approximately 7 cases per 100,000 population. Proliferative diabetic retinopathy (32%), retinal tear (30%), proliferative retinopathy after retinal vein occlusion (11%) and posterior vitreous detachment without retinal tear (8%) are the most common causes of spontaneous vitreous hemorrhage. Vitreous hemorrhage can be caused by the pathologic mechanisms of disruption of normal retinal vessels, bleeding from diseased retinal vessels or abnormal new vessels, and extension of hemorrhage through the retina from other sources. Hemorrhage into the vitreous gel results in rapid clot formation and is followed by slow clearance of approximately 1% per day. The cellular response to vitreous hemorrhage is unusual with regard to hemorrhage in any tissue outside the vitreous cavity and has been compared to a "low-turnover" granuloma. Unique clinicopathologic features of long-standing vitreous hemorrhage include cholesterolosis bulbi (synchysis scintillans), hemoglobin spherulosis, and vitreous cylinders. Complications of nonclearing vitreous hemorrhage are hemosiderosis bulbi and glaucoma. Ghost cell glaucoma, hemolytic glaucoma, and hemosiderotic glaucoma may result from vitreous hemorrhage. The established treatment option for nonclearing vitreous hemorrhage is pars plana vitrectomy. Experimental nonsurgical treatment options involve improvement of physiologic clearance mechanisms in order to accelerate fibrinolysis, liquefaction, hemolysis and phagocytosis.

Animals↗
PubMedDate not supplied

Kimura disease of the orbit and ocular adnexa.

Kimura disease (KD) is a distinct clinicopathologic entity that has been the subject of considerable confusion and debate. Although common in Asia, KD rarely occurs in non-Asian patients. Kimura disease shares both clinical and histopathologic features with angiolymphoid hyperplasia with eosinophilia (ALHE). Because of this overlap and the rarity of KD in Europe and the United States, KD and ALHE have been used synonymously in the Western medical literature, as they were thought to represent variations of the same disease. Some pathologic reports have called for distinguishing KD and ALHE as two separate entities, based on their histologic features. Kimura disease occurs most commonly in the head and neck region and has been described in the orbit, eyelids, and lacrimal gland more frequently than ALHE. Because both diseases can cause proptosis, lid swelling, ocular dysmotility, or a palpable mass, they should be considered in the differential diagnosis of orbital lesions occurring in adults. We report two cases of KD involving the orbit and ocular adnexa, and review additional cases reported in the literature. The ophthalmic literature does not clearly reflect the current understanding that KD and ALHE are best considered two separate clinicopathologic entities.

Adult↗
PubMedDate not supplied

Analysis of 24,444 surgical specimens accessioned over 55 years in an ophthalmic pathology laboratory.

PURPOSE: To summarize the pathologic diagnoses of a large number of surgically-obtained specimens over an extended time period in a single ophthalmic pathology laboratory. METHODS: We analyzed the records of 24,444 surgically obtained specimens accessioned in the L.F. Montgomery Ophthalmic Pathology Laboratory, Emory University, Atlanta, GA between May 1941 and December 1995. Age, sex, topography, clinical procedure, and histologic diagnosis were entered into a database using the modified SNOMED coding system. The diagnosis of the surgically enucleated eyes were analyzed with respect to years of enucleation. RESULTS: The most common topographic area associated with a histologic diagnosis was the cornea (39.3%), followed by lens (16.0%), vitreous (12.0%), uvea (9.8%), eyelids (8.0%), conjunctiva (7.7%), retina (7.7%), and orbit (2.1%). The relative proportion of vitreous specimens has continuously increased and became the most common surgical specimen in 1995. The most common underlying disease of surgically enucleated eyes is trauma (40.9%), followed by ocular neoplasia (24.2%), 'surgical' diseases of the cornea, lens and retina including glaucoma (17.3%), vascular diseases (6.7%), and inflammatory conditions (6.7%). The relative frequency of trauma and ocular inflammation as a cause of enucleation decreased significantly (p < 0.05) over the time of the study period while the relative proportion of ocular neoplastic processes increased (p < 0.0001). CONCLUSIONS: The availability of new surgical techniques has caused a change in the relative frequencies of different ocular specimens submitted for histologic examination.

Adolescent↗
PubMedDate not supplied

[Orbital myopathy in metastatic malignant paraganglioma: a paraneoplastic syndrome?].

BACKGROUND: Several disease entities of the orbit are known which display an autoimmunological pathogenesis. Among these disease entities the thyroid-related immune orbitopathy and the idiopathic orbital inflammatory syndrome (orbital pseudotumor). The pathogenesis of these diseases is not well understood; however, an autoimmune inflammatory reaction histologically characterized by a chronic inflammatory cell infiltrate has been suggested. One care of orbital pseudotumor presumably of paraneoplastic origin occurring in a patient with a non-Hodgkin's lymphoma has been reported. We report a patient with a metastatic paraganglioma and a proptosis secondary to enlargement of all extraocular muscles. CASE REPORT: A 52-year-old woman presented with a recent decline in visual clarity of her left eye and diplopia. Two years ago, the diagnosis of a hormonally inactive paraganglioma has been made. Ophthalmologic examination displayed a lagophthalmos caused by a right-sided facial paralysis secondary to a cerebral metastasis and a bilateral enlargement of all extraocular muscles. Curative therapy for the paraganglioma was not available. Palliative therapy as well as a high-dose corticosteroid therapy for the orbitopathy was refused by the patient. The patient died 18 months later. DISCUSSION: Our patient developed orbital changes similar to thyroid-related immune orbitopathy; however, there was no dysfunction of the thyroid. We believe that the orbital changes were a paraneoplastic immune reaction caused by the metastatic paraganglioma. We recommend that in patients who do not conform to the prototypical profile of well-known orbital disease entities should undergo further testing to exclude a remote neoplasm.

Autoimmune Diseases↗
PubMedDate not supplied

[Oncocytoma of the conjunctiva].

A 72-year-old woman presented with a lesion in her right eye, which had developed over 2 years. The cherry red lesion was located in the bulbar conjunctiva in the area of the plica semilunaris. Ophthalmologic examination was otherwise normal. Differential diagnosis included a pyogenic granuloma and a hemangioma. Excision of the tumor was performed. Histological examination revealed solid nests and cords of polyhedral cells exhibiting abundant, finely granular acidophilic cytoplasm and round to oval paracentral nuclei usually containing a single prominent nucleolus. The diagnosis of oncocytoma was established. Ocular oncocytomas are rare neoplasms and are mostly found in the caruncle. A location in the bulbar conjunctiva is extremely rare and only two reports are found in the literature with both of these located in the plica semilunaris.

Adenoma, Oxyphilic↗
PubMedDate not supplied

Value of positron emission tomography in the diagnosis of malignant ocular tumors.

PURPOSE: To address the question whether positron emission tomography (PET) can identify malignant ocular tumors. METHODS: In patients with ocular tumors, PET was performed using the incorporation of the glucose analogue (18)F-2-fluoro-2-deoxy-D-glucose. The diagnosis of the ocular lesions was based on conventional diagnostic procedures including histologic examination. RESULTS: Nineteen patients with a mean age of 62.8 +/- 14.2 years were included in this study. Nine patients with a mean age of 62.9 +/- 13.1 years displayed the presence of a malignant tumor including metastatic lesions (4), malignant melanomas (4) and squamous cell carcinoma (1). Additionally, 10 patients with a mean age of 62.8 +/- 15.9 years with benign lesions were studied. There was a statistically significant difference (p = 0.012) in tumor height and tumor volume, but not in tumor diameter between benign and malignant lesions. The smallest PET positive lesion measured 7 x 3 mm. PET was positive in 7 out of 9 malignant lesions and negative in all 10 benign lesions, i.e. there was no false-positive and two false-negative results. The two false-negative tumors represented malignant melanomas of the choroid. Additionally, results of the PET examination were independent of tumor size. CONCLUSION: PET seems to be of limited value for the diagnosis of malignant melanoma of the choroid, i.e. a negative result does not exclude a malignant process.

Adult↗