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Biomedical subjects

Jerry A Shields

Publications and source records attributed to Jerry A Shields.

At least 163 records · Page 9Linked to original sources
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Diagnosis and management of retinoblastoma.

BACKGROUND: Retinoblastoma is a highly malignant tumor of the eye that manifests most often in the first 3 years of life. METHODS: Published articles were reviewed to evaluate the clinical features and current methods of diagnosis and to assess the trends in management. RESULTS: This malignancy leads to metastatic disease and death in 50% of children worldwide but in less than 5% of children in the United States and other developed nations with advanced medical care. Over the past decade, there has been a trend away from enucleation and external beam radiotherapy and toward chemoreduction followed by focal therapies. This is largely due to more effective chemotherapeutic regimens, improved focal treatment modalities, and the desire to avoid loss of the globe and/or exposure to radiotherapy. Chemoreduction and focal therapies are most successful for eyes with minimal to moderate retinoblastoma, with enucleation needed in less than 15% of cases. Eyes with very advanced retinoblastoma require enucleation in approximately 50% of cases. CONCLUSIONS: Progress in the clinical recognition and management of retinoblastoma has led to high survival rates. Improved methods of treatment using chemoreduction and focal treatments without the need for external beam radiotherapy allow preservation of the eye in some cases, often with visual function.

Antineoplastic Agents↗
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Retinoblastoma.

Explore the source record for details and available documents.

Humans↗
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Outcome of eyes with unilateral sporadic retinoblastoma based on the initial external findings by the family and the pediatrician.

PURPOSE: To evaluate the enucleation rate for children with unilateral sporadic retinoblastoma based on initial external findings detected by the family and the pediatrician. PATIENTS AND METHODS: A retrospective, nonrandomized review was performed on 257 consecutive patients with unilateral sporadic retinoblastoma treated at a major ocular oncology center. Data were gathered regarding the initial external clinical finding noted by the family members, pediatrician, and ocular oncologist and then correlated with the final resulted in enucleation in 77%. Specifically, enucleation was necessary in 75% of patients with pediatrician-detected leukocoria, 46% of those with pediatrician-detected strabismus, and 86% of those with pediatrician-detected red eye, heterochromia, decreased visual acuity, or an unspecified eye problem. Enucleation was necessary in 81% of those patients in whom an ocular oncologist detected any external finding such as leukocoria, strabismus, red eye, heterochromia, or buphthalmos and in only 33% of those without external findings. CONCLUSIONS: Children with retinoblastoma who present with obvious external findings of leukocoria, strabismus, or red eye detectable by their family or pediatrician most often require enucleation. Children who manifest no obvious external findings can often avoid enucleation.

Child, Preschool↗
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Optical coherence tomography in children: analysis of 44 eyes with intraocular tumors and simulating conditions.

PURPOSE: To investigate the role of optical coherence tomography (OCT) in the evaluation of fundus tumors and simulating lesions in children. PATIENTS AND METHODS: We report the results of a retrospective single-center case series of 44 eyes of 44 children younger than age 18 with fundus lesions who were evaluated with OCT. In comparison, 12 eyes of 12 children with a normal macula were evaluated with OCT. Main outcome measures were cooperation of children while undergoing OCT and correlation of OCT findings with clinical and ultrasonographic findings RESULTS: The OCT was performed without difficulty in all 56 children. Mean patient age was 12 years (median, 12 years; range, 4 to 17 years). The mean horizontal foveal thickness in the 12 normal eyes was 137 microm (median, 132 microm; range, 109 to 185 microm). Clinical diagnoses included retinoblastoma in 10 (23%) eyes, Coats' disease in 4 (9%) eyes, retinal capillary hemangioma in 3 (7%) eyes, astrocytic hamartoma of the retina in 3 (7%) eyes, toxocara granuloma in 2 (5%) eyes, and others. OCT was more sensitive than clinical examination in detection of macular pathology including shallow posterior vitreous detachment, surface wrinkling maculopathy, cystoid and noncystoid macular edema, subfoveal fluid, and retinal thinning. In comparison to ultrasonography, OCT was more sensitive in detection of surface wrinkling maculopathy, macular edema, and subfoveal fluid. Ultrasonography was more sensitive in detection of posterior vitreous detachment. CONCLUSIONS: OCT is a useful and well-tolerated diagnostic modality for macular evaluation in children. It is more sensitive than clinical examination and ultrasonography in the detection of surface wrinkling maculopathy, macular edema, and subfoveal fluid.

Adolescent↗
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Retinoblastoma in an eye with features of Coats' disease.

A 44-month-old girl developed retinal detachment with extensive telangiectasia and "light bulb" aneurysms suggestive of Coats' disease. However, underlying and within the retina was diffuse retinoblastoma. Diffuse infiltrative retinoblastoma can manifest features of Coats' disease and could lead to diagnostic confusion.

Child, Preschool↗
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Uveal metastases from breast carcinoma in three male patients.

The authors present a case series of three male patients with uveal metastases originating from breast carcinoma. The mean age at discovery of uveal metastases and the mean interval from diagnosis of primary breast carcinoma were 49.7 and 2.3 years, respectively. The analogous data in women are 56 and 5.4 years, respectively. In this series, all three patients were affected bilaterally and four of six eyes (67%) had multifocal tumors. In women, metastases are bilateral in 38% and multifocal in 48%. Compared with women, metastases in men may occur sooner and with a higher incidence of bilateral and multifocal tumors.

Adult↗
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Simultaneous choroidal and brain metastasis as initial manifestations of lung cancer.

A previously healthy 75-year-old woman developed blurred vision in her left eye and was found to have an amelanotic choroidal metastasis. Cranial magnetic resonance imaging disclosed 2 brain lesions compatible with metastasis. Subsequent evaluation revealed a primary cancer in the lung. Simultaneous metastasis to the choroid and the brain from an occult primary lung cancer is rare. This case underscores the need for a detailed systemic evaluation in a patient with an amelanotic choroidal mass in which a metastasis is a diagnostic consideration.

Aged↗
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Orbital melanoma metastatic from contralateral choroid: management by complete surgical resection.

We discuss a clinicopathologic correlation of orbital metastasis from a contralateral choroidal melanoma wherein the orbital tumor was removed completely by surgical resection. In October 1982, a 29-year-old woman was treated with cobalt-60 plaque radiotherapy for a choroidal melanoma in her right eye. The tumor responded well but recurred after 9 years, necessitating enucleation. In August 1999, 17 years after initial presentation, metastatic melanoma to liver, lung, and brain were found and the patient had a favorable response to chemotherapy and brain irradiation. Five months later, in November 2000, an enlarging orbital mass was documented to be compressing the left optic nerve. Complete surgical removal of the tumor was achieved by a superotemporal orbitotomy. Histopathologically, the tumor was a malignant melanoma with features similar to the choroidal tumor. The contralateral orbit can be the site of late metastasis from choroidal melanoma. In rare instances, an orbital metastasis can be completely removed surgically without subjecting the patient to orbital irradiation.

Adult↗