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Biomedical subjects

I Rennie

Publications and source records attributed to I Rennie.

At least 19 recordsLinked to original sources

Management of symptomatic choroidal naevi with photodynamic therapy.

BACKGROUND/AIMS: To describe the use of photodynamic therapy (PDT) in the management of symptomatic serous retinal detachment associated with choroidal naevi. METHODS: Interventional case series. The records of seven patients with choroidal naevus and associated serous retinal detachment, treated with PDT were reviewed retrospectively. Main outcome measures were Snellen visual acuity, clinical appearance, and ocular tomographic findings. RESULTS: All seven patients showed a reduction in the degree of serous detachment and symptomatic improvement. Five patients showed a corresponding improvement in visual acuity that persisted over a mean period of 9 months. CONCLUSION: PDT appears to be effective in the management of serous retinal detachment associated with choroidal naevus.

Adult↗

Proton beam therapy for iris melanoma: a review of 15 cases.

AIM: To report results of proton beam therapy for iris melanoma. METHODS: A retrospective case series of 15 patients with nonresectable iris melanomas treated with proton beam therapy between August 1998 and August 2004. The main outcome measures were (1) local tumour control, (2) complications, and (3) eye retention. RESULTS: Of the 15 cases, 11 patients showed documented growth (including two cases of local recurrence following iridocyclectomy) while a further three cases were biopsy-proven melanoma. One patient presented with a newly acquired vascular nodule of the iris associated with angle seeding and glaucoma. Tumour control at mean follow-up of 34 months was 93% (14 of 15 eyes). Common complications included glaucoma in 53% (five patients had glaucoma prior to irradiation), dry eye (27%) and cataract in three patients (20%). Eye retention was possible in 80% (12 cases). CONCLUSION: Proton beam therapy is an effective treatment for cases of nonresectable iris melanoma. The major complications are cataract and glaucoma.

Adolescent↗

Quality improvement report: Effect of a formal education programme on safety of transfusions.

PROBLEM: Failure of correct identification and insufficient monitoring of patients receiving transfusions continue to be appreciable and avoidable causes of morbidity and mortality. DESIGN: A study by a regional transfusion service and a transfusion nurse specialist of the effects of an education programme based on the current national guidelines on identification and monitoring of patients receiving transfusions. SETTING: A large United Kingdom teaching hospital which houses the headquarters of the regional transfusion service. KEY MEASURES FOR IMPROVEMENT: Improvement in compliance with published national guidelines on the prescription and administration of blood transfusions. STRATEGY FOR CHANGE: An audit of current compliance followed by dissemination by a transfusion nurse specialist of a clinical skills package (based on the best practice for transfusion) to all staff involved in giving transfusions. This was supported by trained instructors and the display of standard operating procedures for transfusion in all clinical areas. EFFECT OF CHANGE: An improvement in compliance with the national guidelines to over 95% in six out of seven of the recommendations on best practice was seen 18 months after the initial intervention. LESSONS LEARNT: The study shows that education of those who prescribe and administer transfusions, as recommended by bodies concerned with the hazards of transfusion, can improve the safety of transfusions.

Blood Transfusion↗

An audit of the investigation and use of anti-D immunoglobulin prophylaxis in Tayside.

OBJECTIVES: To audit the implementation of national guidelines on the investigation and management of RhD disease in Tayside. SETTING: Tayside region. DESIGN: An eight month retrospective audit. RESULTS: Two hundred and eighty eight completed pregnancies in RhD negative women were observed from a total of 1879 deliveries. Of these, 120 RhD negative and 169 RhD positive babies were delivered from women who had not previously been sensitised. At delivery, anti-D was used appropriately in all cases. Of those assessed to require anti-D (n = 168), 91% received it within 24 hours of delivery. In 59 RhD negative subjects, 75 potential sensitising events occurred antenatally. In 45 of these, the event occurred after 20 weeks gestation and 44 received appropriate anti-D. In 11 (23.7%) of these, no foetomaternal haemorrhage assessment was carried out. CONCLUSION: Despite a significant increase in awareness of antenatal prophylaxis since a previous audit in the region, there is still a significant failure to request FMH assessments following potential antenatal sensitising episodes and after delivery. During the audit period, an EDTA plasma gell-based antibody detection system was commissioned in the region. This has allowed the introduction of internal laboratory referral for FMH assessment. This has allowed accurate knowledge on the possible occurrence of FMH at delivery, but has not had a significant impact on antenatal events.

Female↗

Dead or alive: immunogenicity of human melanoma cells when presented by dendritic cells.

Uveal melanoma is an aggressive malignancy with a poor prognosis despite current therapeutic intervention. These tumors have been shown to be antigenic because they express a number of melanoma-associated antigens and are therefore attractive targets for immunotherapy. Here, we investigated the immunogenicity of uveal melanoma cells that have undergone apoptosis and compared this with their necrotic or live counter-parts. The fate of the tumor antigens in these cells largely depends on their ability to be processed and phagocytosed by dendritic cells (DCs). Flow cytometric analysis shows that human DCs form conjugates more efficiently with dead uveal melanoma cells, and consequently these are effective stimuli of lymphocyte proliferation. However, only DCs pulsed with apoptotic cells were able to induce proliferation of CD8+ cytotoxic T cells and stimulate antigen-specific T cells. This study demonstrates for the first time that DCs derived from melanoma patients process and present antigens derived from both HLA-matched or HLA-mismatched human apoptotic tumor cells stimulating both CD4+ and CD8+ T cells. This approach may be important to the development of DC-based immunotherapies for melanoma.

Antigen Presentation↗

The use of single fraction Leksell stereotactic radiosurgery in the treatment of uveal melanoma.

Fourteen patients with posterior uveal melanomas were treated using single fraction stereotactic radiosurgery. In each case a dose of 70 Gy was administered to the periphery of the tumour. Regression of the tumour has been observed in 13 patients, whilst the lesion has remained unchanged in one patient. The visual acuity has deteriorated in all 14 patients. Significant radiation induced adverse reactions were noted in 13 patients and include; retinopathy, optic neuropathy, rubeosis iridis, and secondary glaucoma. Two patients have required enucleation because of intractable rubeotic glaucoma. One patient has died from proven metastases. Although stereotactic radiosurgery appears to be a practical and effective method of treating uveal melanomas, its usefulness is limited by a high incidence of radiation induced adverse reactions. Further work is required to refine the current treatment protocol and establish an optimal prescription dose.

Adult↗

The effect of topical beta-blocker medications on the proliferation and viability of human Tenon's capsule fibroblasts in tissue culture.

Several recent publications have suggested that the long-term use of topical antiglaucoma medications may be detrimental to the outcome of trabeculectomy. In this study we investigated the effect of topical beta-blocker medications on the proliferation and viability of human Tenon's capsule fibroblasts in tissue culture to see if there was a direct mechanism of enhanced proliferation. None of the tested medications stimulated the proliferation of fibroblasts. They were shown to have an inhibitory effect on proliferation and were toxic to cells at higher concentrations. The relevance of these findings to wound healing following trabeculectomy is discussed.

Adrenergic beta-Antagonists↗

Retained intraocular foreign body simulating choroidal melanoma. A report of two cases.

Many different lesions can be difficult to distinguish from malignant melanomas of the choroid. With the use of modern diagnostic facilities the misdiagnosis rate has been greatly reduced. In a recent report from the Collaborative Ocular Melanoma Study Group the incidence of misdiagnosis was only 0.48%. The presence of a retained intraocular foreign body presenting as a raised pigmented choroidal mass similar to a uveal melanoma is rare. We report two cases in which retained intraocular foreign bodies presented clinically as raised pigmented intraocular lesions. Retained intraocular foreign bodies should be considered in the differential diagnosis of ocular tumours, especially if there are any atypical features.

Aged↗