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Biomedical subjects

J B Michelson

Publications and source records attributed to J B Michelson.

34 records · Page 2Linked to original sources

Retinitis secondary to acquired systemic toxoplasmosis with isolation of the parasite.

A 43-year-old woman developed a heterophile-negative infectious mononucleosis syndrome for which no cause was apparent. During her illness she developed subjective changes in the central vision of her right eye and had focal retinal inflammation, which suggested the diagnosis of toxoplasmosis. The clinical course was accompanied by an increased titer to Toxoplasma gondii. Organisms were isolated from lymph node tissue and injected into the peritoneum of mice from which organisms were harvested.

Adult↗

Evaluation of metastatic cancer to the eye. Carcinoembryonic antigen and gamma glutamyl transpeptidase.

Plasma carcinoembryonic antigen (CEA) and gamma glutamyl transpeptidase (GTP) were studied in 24 patients with cancer metastatic to the uveal tract. Eighty-three percent demonstrated elevated CEA levels, while only 36% (49 of 135 patients) with primary uveal melanoma showed elevated levels. While none of the uveal melanoma patients had a CEA value greater than 10 ng/ml, 58% (14) of the patients with metastatic tumors to the uvea had values greater than 10 ng/ml. Forty-six percent (11) of patients with metastatic tumors to the uvea demonstrated elevated GTP levels that correlated with documentation of liver metastases. Ninety-two percent of the patients with metastatic cancer to the uvea had either an elevated CEA or GTP level. When used together, plasma CEA and GTP levels appear to be helpful in differentiating metastatic tumors to the uvea from primary uveal melanomas. These assays also appear to be useful in determining tumor burden and concurrent hepatic involvement in patients with metastatic tumors to the uvea.

Acyltransferases↗

Relationship of iris nevi to malignant melanoma of the uvea.

To test the hypothesis that there is an increased number of iris nevi in eyes with a posterior uveal melanoma, we performed slit-lamp examinations on 50 patients with choroidal or ciliary body melanomas to note the presence and number of iris nevi in both eyes. We compared these patients to 50 age-matched control subjects who had cataracts. No relationship was found between the number of iris nevi and posterior uveal melanoma.

Choroid Neoplasms↗

Carcinoembryonic antigen. Its role in the evaluation of intraocular malignant tumors.

Plasma carcinoembryonic antigen (CEA) was studied in 60 patients with histologically confirmed intraocular neoplasms including 56 malignant melanomas of the uvea and four metastatic tumors to the choroid. While 45% of the patients with primary uveal melanomas, as well as 75% of the patients with metastatic disease demonstrated elevated plasma CEA levels, both patients who exhibited metastatic lesions of entodermal origin demonstrated plasma CEA values that clearly fell into a separate, highly elevated category, consistent with metastatic disease or pancreatic or colorectal carcinoma. Thus, in the patient seen with a nonpigmented choroidal mass that may represent either a choroidal hemangioma, amelanotic melanoma, or metastatic tumor, plasma CEA levels may be useful in the differential diagnosis. If the clinician suspects a metastatic tumor from an occult primary site, highly elevated CEA levels may indicate that the lesion is of entodermal origin.

Adenocarcinoma↗

Fetal antigens in retinoblastoma.

Plasma carcinoembryonic antigen (CEA) and alpha fetoprotein (AFP) levels were studied in five patients with retinoblastoma. CEA and AFP were found elevated in four of five patients prior to therapy. Following enucleation and/or radiation therapy, the elevated values were significantly lowered. This preliminary study suggests that CEA and AFP levels may be of value in the diagnosis of retinoblastoma, and that serial CEA levels may be useful in evaluation of retinoblastoma patients after treatment.

Carcinoembryonic Antigen↗

CEA family syndrome. Abnormal carcinoembryonic antigen (CEA) levels in asymptomatic retinoblastoma family members.

Plasma carcinoembryonic antigen (CEA) levels were studied in all available members of 17 families in which a presumed sporadic retinoblastoma had occurred. In 9 of the 17 families, close relatives of the patient had elevated CEA levels in the absence of demonstrable disease; this we have termed the "CEA family syndrome." In two families (Nos. 8 and 17) one or both parents and all of the siblings had elevated CEA levels. To our knowledge, this is the first report of abnormal CEA levels in unaffected family members of patients with nonadenocarcinoma-type malignancies. As follow-up studies of such families become available, detection of the "CEA family syndrome" may prove to be a useful means of locating individuals with inherited premalignant or malignant conditions and may provide a stimulus for additional clinical examination of asymptomatic individuals considered at risk for developing malignancies.

Adenocarcinoma↗

B-scan ultrasonography in the diagnosis of atypical retinoblastomas.

Contact B- scan ultrasonography (Bronson-Turner unit) was performed on fourteen patients with retinoblastoma. In ten cases, the patient presented with leukocoria, and ultrasonography was helpful in confirming the clinical diagnosis. In four atypical cases contact B-scan ultrasonography was instrumental in making the diagnosis. The ultrasonographic pattern for retinoblastoma is characteristic but not pathognomic. There is a solid intraocular echo corresponding to the tumor and within it are numerous dense focal echoes which persist at lower sensitivities, suggesting calcification. Calcification was demonstrated ultrasonographically and confirmed histologically in all four of these atypical cases, but routine skull x-rays failed to demonstrate calcium in three of the four children. Contact B- scan ultrasonography is a safe and simple procedure which may provide valuable diagnostic information in children with suspected retinoblastoma.

Calcinosis↗

Carcinoembryonic antigen-positive metastatic adenocarcinoma of the choroid. A case report.

Plasma carcinoembryonic antigen (CEA) levels were found to be elevated in a 62-year-old woman who came to us with a diffuse choroidal mass in the left eye. Although a metastatic tumor was suspected clinically, a thorough medical evaluation failed to detect a primary lesion and the eye was enucleated. The histologic diagnosis was metastatic adenocarcinoma. On immunohistologic assay, the choridal metastases stained positively for CEA. We believe this to be the first CEA-positive intraocular tumor to be reported.

Adenocarcinoma↗

Behçet's disease.

Behçet's disease is characterized by three primary components: iridocyclitis (historically with hypopyon), aphthous lesions in the mouth, and ulceration of the genitalia. Erythema nodosum, arthropathy and thrombophlebitis often accompany these manifestations, but the ocular symptoms may be the most important and serious manifestations of the disease. Central nervous system involvement, most often due to necrotizing vasculitis, may be the most protean manifestation of the disease, leading to death. The frequency of ocular manifestations is 70-85% in patients with the disease; the underlying disease mechanism in all organ systems is an occlusive vasculitis. Although the most common ocular symptom is that of anterior uveitis, often with hypopyon as a very late sign, the presence of necrotizing retinal vascular lesions is well known and often obscured by the severity of the anterior reaction. Definitions, incidence, clinical characteristics, differential diagnosis, and management of Behçet's ocular disease are discussed, as are the interrelationships of the different organ manifestations. The ophthalmologist should be familiar with the full spectrum of disease presentation since he or she may be the first physician to encounter the Behçet's patient.

Adolescent↗

Melting corneas with collapsing nose.

A 31-year-old white woman with relapsing polychondritis presented with profound, diffuse episcleritis, marked conjunctival chemosis, and corneal-limbal inflammation and melting, which was refractory to corticosteroid treatment. With the initiation of chlorambucil the inflammation subsided, leaving an almost normal slit-lamp picture. The associated findings of nasal cartilage and pinna cartilage inflammation helped to establish the diagnosis of relapsing polychondritis in this patient.

Adult↗

Nonocular manifestations of parenteral drug abuse.

The nonocular manifestations of parenteral drug abuse are presented to familiarize the ophthalmologist with this ever growing, medical and psychosocial problem. The ophthalmologist, like other primary care physicians, may be the first professional to encounter these patients whose substance abuse may lead to a wider spectrum of physical and psychiatric illness. The variety, history, and manifestations of abused substances are discussed.

Acquired Immunodeficiency Syndrome↗

Iridocyclitis masquerade syndrome.

A 52-year-old man presented with blurred vision and a red, painful eye. There was a marked anterior uveitis associated with a solid white lesion on the iris. The differential diagnosis and appropriate diagnostic workup are discussed. The diagnosis of adenocarcinoma of the lung with metastasis to the iris was made.

Adenocarcinoma↗

Retroviruses and their play-pals.

A 28-year-old man with a previous history of Neissena infection presented with diminished vision, disc swelling, and panuveitis. Serologic tests revealed positive titers for both HIV and syphilis. Current epidemiology and treatment of such cases are discussed.

Acquired Immunodeficiency Syndrome↗