Biomedical subjects
S J Livesey
Publications and source records attributed to S J Livesey.
Disappearance of ocular malignant melanoma on computerised scan after spontaneous necrosis: clinical, radiological and pathological features.
An 82 year old patient was lost to follow-up having been diagnosed both clinically and on CT scan as having a right choroidal malignant melanoma. Twenty months later she presented with a painful right proptosis, dense cataract and raised intraocular pressure. A second CT scan showed orbital cellulitis with no evidence of the previous mass. Following enucleation histopathological examination revealed that the tumour had undergone total spontaneous necrosis. The implications of the CT scan findings are discussed. Five cases of necrosed choroidal malignant melanoma producing proptosis in the absence of extrascleral tumour extension have now been described.
Review of fluorescein angiograms performed in one year.
In this study 374 consecutive fundus fluorescein angiograms (FFAs) were performed on 330 patients. Of these, 165 (50%) were investigated for age related maculopathy. In only 12% did this investigation lead to an alteration in treatment. The remaining 50% of angiograms were requested for diabetic patients (15%), retinal vein occlusion (5%), tumours (6%), and various other disorders. In the diabetic patients treatment could have proceeded without FFA in 24% of patients who underwent it. Missed diagnoses corrected by angiography and areas where unnecessary angiograms were performed were identified. One interesting subgroup of eight patients with unexplained loss of central vision was identified. Careful clinical examination had failed to reveal any abnormality. FFAs were of no diagnostic value in these patients.
Screening for hydroxychloroquine retinal toxicity: is it necessary?
All the patients (73) in the Rheumatology Department five year study of second line therapy who have taken hydroxychloroquine (Plaquenil) for rheumatoid arthritis for longer than 18 months were reviewed. These patients have their treatment dosage carefully monitored and have been receiving regular ophthalmic examinations. Most patients still taking the drug were assessed with a battery of tests for evidence of retinal toxicity. No retinal toxicity causing visual loss was found. On the basis of these results and a review of the recent literature we no longer routinely screen patients for hydroxychloroquine retinal toxicity in Cardiff.
Ocular complications of bone marrow transplantation.
Thirty-four patients who had undergone bone marrow transplantation (BMT) were examined; 83.3% of those who received single shot and none of those who received fractionated total body irradiation (TBI) developed cataracts. The use of steroids to treat chronic Graft Versus Host Disease (GVHD) produced more severe cataracts in those who had allogeneic transplants after single shot TBI, but follow-up has not been long enough to assess their effect following fractionated TBI. Keratoconjunctivitis sicca (KCS) was seen in 81.8% of patients with chronic GVHD and in 33.3% of patients after autologous BMT.
Autoantibody analysis in chronic graft-versus-host disease.
Chronic graft-versus-host disease (cGVHD) bears clinical similarities to connective tissue diseases which are characterized by a spectrum of autoantibody formation. A wide range of autoantibody analyses in 19 allogeneic and 16 autologous bone marrow transplant (BMT) patients has determined that the most commonly detected antibody is IgM anti-cytoplasmic factor (ACF) occurring in 37% and 20% of allogeneic and autologous group respectively and of a type not normally seen in connective tissue disease. The antigen is as yet unidentified. These results suggest that autoantibody formation post-BMT is unrelated to the graft-versus-host process. Ophthalmic examination revealed evidence of a Sjögren-like syndrome in 20% autologous and 47% allogeneic patients, suggesting that the development of dry eyes post-BMT is not uniquely a feature of cGVHD.
Chick kidney adenylate cyclase: sensitivity to parathyroid hormone and synthetic human and bovine peptides.
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