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Biomedical subjects

J Rootman

Publications and source records attributed to J Rootman.

At least 73 records · Page 4Linked to original sources
PubMed1990

Combined frontotemporal-orbitozygomatic approach for tumors of the sphenoid wing and orbit.

An extension of a combined frontotemporal and orbitozygomatic exposure was developed to remove 8 hyperostosing invasive sphenoid wing meningiomas (Group 1) and 11 complicated intraorbital tumors with and without intracranial extension (Group 2). Two separate bone flaps were created: a free frontotemporal-sphenoidal (pterional) bone flap and en bloc removal of the superior and lateral orbital margins with attached zygomatic arch. Cranio-orbital reconstruction was performed using the inner table of the pterional bone flap. Complete tumor removal was achieved in 14 patients and near total removal in 5. There was no mortality and in those patients who did not require orbital exenteration excellent to good cosmetic results were achieved in all but one case. This approach affords a wide exposure of the orbit and anterior and middle skull base, so that large tumors of the orbit and tumors involving the orbital apex, sphenoid wing, and infratemporal and pterygopalatine fossae can be removed.

Adolescent↗
PubMed1990

Infestation of extraocular muscle by Cysticercus cellulosae.

Reports of orbital cysticercosis are uncommon despite the high incidence of brain and ocular involvement. Infestation of extraocular muscle is exceedingly rare. Two cases of cysticercosis of the extraocular muscles are reported here. Surgical removal of the encysted parasites successfully resolved the infestation in both cases.

Adult↗
PubMed1990

Uveal malignant melanoma and optic nerve glioma in von Recklinghausen's neurofibromatosis.

A case of uveal malignant melanoma and contralateral optic nerve glioma is described in a 53-year-old Caucasian male with multiple uveal melanocytic hamartomas and neurofibromatosis. The eye was enucleated, and histologically the melanoma was found to consist of 70% epithelioid cells, with many bizarre, multinucleated forms. CT scan demonstrated a non-enhancing, fusiform enlargement of the contralateral optic nerve with enlargement of the optic canal and intracranial extension. This combination of tumours has not previously been reported in a patient with neurofibromatosis and serves to emphasise the common neuroectodermal origin of tumours in this autosomal dominant condition.

Cranial Nerve Neoplasms↗
PubMed1990

Orbital lymphangiomas: clinical, radiologic, and pathologic characteristics.

To assess the value of computed tomography (CT) in evaluation of orbital lymphangioma, the CT findings in 11 patients were retrospectively analyzed and correlated with the clinical, hemodynamic, surgical, and pathologic findings. The lesions were classified by location in three categories: superficial (n = 1), deep (n = 6), or combined (n = 6); the latter were evident earlier in life. The CT findings correlated well with the surgical and histologic findings. Orbital lymphangiomas were poorly defined lesions that crossed anatomic boundaries such as the conal fascia and orbital septum. Some degree of enhancement was the rule, ranging from scattered patchy areas to enhancement of the majority of the lesion. Areas of hemorrhage caused cystlike masses with rim enhancement. Preoperative identification of the vascular enhancing component at CT examination enables the surgeon to resect this area to prevent postoperative hemorrhage. High-resolution CT is of great value in the diagnosis and preoperative treatment planning of orbital lymphangioma.

Adolescent↗
PubMed1990

Graves orbitopathy: correlation of CT and clinical findings.

The clinical and high-resolution computed tomographic (CT) findings in 71 patients (142 orbits) with Graves orbitopathy and 20 healthy patients (40 orbits) were retrospectively reviewed. The orbits with orbitopathy were subgrouped at clinical examination into those with (n = 18) and those without (n = 124) optic neuropathy. Mean extraocular muscle diameters and the calculated muscle diameter index were significantly increased in all orbits with ophthalmopathy, particularly in those with optic neuropathy. Graves orbitopathy affected the superior muscle group (63.4%) more than the medial (61.3%) or inferior (57%) recti. The most common pattern of muscle involvement involved all five measured extraocular muscles. Solitary muscle involvement most frequently involved the superior muscle group (6.3%). Significant enlargements of the retrobulbar optic nerve sheath and superior ophthalmic vein were noted only in orbits with optic neuropathy. Anterior displacement of the lacrimal gland at CT correlated with clinical palpability and occurred more frequently in patients with optic neuropathy. Severe apical crowding was the most sensitive indication of optic neuropathy at CT.

Female↗
PubMed1990

Changing indications for penetrating keratoplasty in Vancouver, 1978-87.

Indications for penetrating keratoplasty (PK) were assessed by clinicopathological review of 659 corneal buttons submitted from 1978 to 1987 to the Ophthalmic Pathology Service in Vancouver. Leading indications for PK were bullous keratopathy (22.2%), keratoconus (17.1%), scarring with or without chronic inflammation (13.5%), graft failure (12.1%), scarring or active keratitis secondary to virus (9.0%) and Fuchs' dystrophy (8.3%). The principal factors responsible for graft failure were also judged by clinicopathological correlation. The authors compare their findings with those in other series.

Adolescent↗
PubMed1990

Pharmacological modulation of human subconjunctival fibroblast behavior in vitro.

The response of human subconjunctival fibroblasts to a variety of pharmacological agents was evaluated utilizing a novel in vitro wound assay and a separate proliferation assay. Both colchicine and cytochalasin B dramatically arrested wound closure at concentrations greater than or equal to 0.01 micrograms/ml and 2 micrograms/ml, respectively (p less than 0.05). At lower doses these drugs altered fibroblast morphology and inhibited directed cell migration. Dexamethasone and 6-MP delayed wound closure at concentrations greater than or equal to 100 micrograms/ml and 1000 micrograms/ml, respectively (p less than 0.05). Effective antiproliferative agents, in order of decreasing potency (based on unit weight), were Cytarabine (cytosine arabinoside), doxorubicin (Adriamycin), colchicine, 5-fluorouracil, cytochalasin B, cyclosporin (Sandimmune), 6-mercaptopurine, and dexamethasone. The antiprotease agents and methotrexate were ineffective as determined by both assays. We conclude that the wound assay is well suited for rapid screening of drugs for their effect on fibroblast morphology, motility, and proliferation, and that colchicine and cytochalasin B, in doses well below those documented to produce ocular toxicity, are effective in inhibiting directed migration and proliferation of subconjunctival fibroblasts in vitro. Differences in mechanism, onset of action, therapeutic range, and cytotoxicity of drugs could be exploited in controlling ocular fibroblast behavior in vivo.

Antineoplastic Agents↗
PubMed1989

Malignant rhabdoid tumor of the orbit.

Malignant rhabdoid tumor (MRT), originally described as a sarcomatous variant of Wilms' tumor, is now recognized as a distinct, highly malignant entity. The authors describe, for the first time, a primary tumor of the orbit with histologic, immunohistochemical, and ultrastructural features of MRT. Their findings suggest both epithelial and mesenchymal differentiation of this unique tumor.

Biopsy↗
PubMed1989

Primary liposarcoma of the orbit. Problems in the diagnosis and management of five cases.

The clinicopathologic features and the results of diagnostic studies were reviewed in five patients with primary orbital liposarcoma. The major clinical complaints were diplopia and proptosis; visual function was typically well maintained. In three cases, computed tomographic (CT) scans displayed lesions with a central fat density rimmed by a variably radiodense pseudocapsule, leading to the erroneous clinical impression that the lesions were cystic in character. Ultrasonography ruled out a truly cystic tumor by demonstrating internal acoustic interfaces. Magnetic resonance imaging (MRI) in one case showed hyperintense signals in T-1-weighted images, suggesting the presence of fat within the lesional tissue. In the other two cases, CT scans showed reticulated densities accentuating the septa of the orbital fat in the absence of clear-cut circumscription. A potentially useful feature pointing to a neoplasm was bowing of an involved extraocular muscle, which is usually straightened and splinted in either Graves' disease or inflammatory pseudotumor. Histopathologically, two lesions were well-differentiated liposarcomas and three were myxoid liposarcomas, all featuring univacuolar signet ring lipoblasts. Scattered bizarre hyperchromatic mesenchymal cells without prominent lipidization were present in the lesions. None of the patients has experienced regional or distant metastases with follow-ups from onset of 1 to 7 years (mean, 5.2 years); three required orbital exenteration after local recurrence; and two who refused exenteration received only orbital radiotherapy.

Adult↗
PubMed1989

Effect of subconjunctivally administered antineoplastics on experimentally induced intraocular malignant tumour.

Twice-weekly subconjunctival injections of 5-fluorouracil (5-FU), 6-mercaptopurine (6-MP), cytarabine (ARA-C) and methotrexate (12.5 mg, 20 mg, 75 mg and 12.5 mg per dose respectively) were used to treat Greene melanoma implanted in the anterior chamber of the eyes of three groups of New Zealand rabbits: group 1 (14 animals), the control group, received saline, group 2 (16 animals) received treatment beginning immediately after tumour implantation and group 3 (15 animals) received treatment starting 1 week after implantation. Both 5-FU and 6-MP were effective in delaying iris tumour growth, as judged by daily clinical examination, histopathological study and reduction in tumour weight compared with control eyes after 17 days (group 2: p less than 0.001, p less than 0.05; group 3: p less than 0.025, p less than 0.05). The delay was correlated with earlier onset of treatment (group 2 v. 3: 5-FU, p less than 0.025; 6-MP, p less than 0.05). ARA-C and methotrexate were ineffective at the dosages used. Our results suggest that subconjunctivally administered 5-FU and 6-MP significantly delay tumour growth in this experimental model of iris melanoma and that efficacy is correlated with earlier initiation of treatment.

Animals↗
PubMed1989

Extramedullary plasmacytoma (amyloid tumour) of the caruncle.

An 81-year-old man presented with a globoid caruncular mass of recent onset involving the left medial canthus. Pathological examination of the mass after its complete excision showed a roughly spherical subepithelial tissue deposit of amyloid, surrounded and sparsely infiltrated by plasma cells. The amyloid showed permanganate-resistant congophilia consistent with immunamyloid, and since most of the plasma cells stained positive for lambda light chains on immunohistochemical cytoplasmic staining, with no demonstrable heavy chains, the lesion was regarded as an extramedullary amyloid-producing plasmacytoma. Its solitary appearance in our patient, who has remained disease free, probably predicts the favourable prognosis generally associated with such lesions.

Aged↗
PubMed1989

Uveitis and arthritis induced by adjuvant: clinical, immunologic and histologic characteristics.

The intradermal administration of complete Freund's adjuvant (CFA) containing Mycobacterium butyricum to Sprague-Dawley (SD) and Lewis strain rats results in polyarthritis and uveitis. Over 90% of the eyes examined from the SD rats given CFA had histologic evidence of anterior uveitis, clinically evident in only 20 to 28%. Many rats developed arthritis without clinical uveitis, but uveitis was rare in the absence of arthritis. Histologically, the ocular inflammation was characterized by a polymorphonuclear, and later, a lymphocytic infiltration of the iris and ciliary body with cells and fibrinous exudate in the anterior chamber and cells in the vitreous. Antibodies and cellular immunity to ocular (S antigen, alpha crystallin), articular (type II collagen, proteoglycan) and bacterial components (MDP), were demonstrated in some rats, but positive tests did not correlate with either articular or ocular disease. Ten percent of rats given type II collagen in incomplete Freund's adjuvant developed uveitis. Thus, the pathogenesis of the arthritis and uveitis in the adjuvant model may be mediated by lymphocytes which exhibit crossreactivity with antigens in these structures, although the specificity of such antigens has not been identified in our studies.

Animals↗
PubMed1988

Dysthyroid optic neuropathy. The crowded orbital apex syndrome.

The authors have reviewed the clinical presentation, visual fields, color vision testing, visual-evoked potentials, and computed tomographic (CT) findings of 58 patients (95 eyes) with dysthyroid optic neuropathy. The authors compared these findings to a control group of 60 patients (119 eyes) with thyroid eye disease who underwent CT scanning and did not exhibit evidence of optic neuropathy. Clinically, dysthyroid optic neuropathy is an insidious disease; when compared with the usual Graves' orbitopathy patient, the optic neuropathy group presented at a later age and with a later onset of thyroid eye disease. The patients in this group were more likely to be male and/or diabetic, and often presented with desaturation of color vision. Asymmetrical extraocular muscle restriction and vertical tropias were more frequent in the optic neuropathy group. The most sensitive indicators of optic nerve dysfunction appeared to be visual-evoked potentials and color vision. Computed tomographic studies confirmed that apical orbital crowding was a characteristic feature of optic neuropathy. These findings should alert the clinician to a more aggressive approach to these patients.

Adult↗
PubMed1988

Symptoms and time to presentation and treatment in ocular melanoma: the Western Canada Melanoma Study.

Reports on all ocular melanomas newly diagnosed between Apr. 1, 1979, and Mar. 31, 1981, were obtained from the cancer registries of British Columbia, Alberta, Saskatchewan and Manitoba. Of the 90 cases, 87 were in patients aged 20 to 79 years, 64 of whom were interviewed about their initial symptoms. Three symptoms--loss of part of the visual field (in 33% of patients), photopsia (in 20%) and blurred vision (in 20%)--emerged as the main indicators of disease. In 17% of cases the tumour was discovered as an incidental finding on ocular examination. The length of delay before consulting a physician was generally short in symptomatic patients, with 85% reporting that they saw a physician within 3 months of onset of the first symptom. Of the 30 patients who received definitive treatment 4 months or more after initial presentation, 13 were seen by general practitioners who delayed before referring the patient to an ophthalmologist. Continuing medical education is needed to ensure earlier referral to ophthalmologists by general practitioners of patients with ocular melanoma.

Adult↗