A simple algorithm for selection of implant size for enucleation and evisceration: a prospective study

PURPOSE: This prospective study tested a simple formula for selecting an implant size for patients undergoing enucleation, evisceration, and secondary implantation. The formula axial length-2 mm=implant diameter (subtract 1 mm from implant diameter for evisceration and for hyperopia) was tested by the outcome measures, superior sulcus deformity, enophthalmos, and volume of the prosthesis. METHODS: Fifty-four patients undergoing primary or secondary implant surgery after enucleation or evisceration received implants based on the above formula. The volume of the eye, volume of the implant, volume of the prosthesis, and the total percent volume replacement were recorded for each patient. Outcome measures considered clinically acceptable were <2 mm enophthalmos and less than grade 1 superior sulcus deformity, which is defined as barely perceptible deepening of the medial superior sulcus. RESULTS: The average volume replacement was 101%; average prosthetic volume was 2.1 mL; average grade of superior sulcus deformity was 0.6; and average enophthalmos was 1.2 mm. CONCLUSIONS: This formula allows 100% replacement of the volume removed, leaves space for a prosthesis 1.5 to 2.5 mL, and eliminates clinically unacceptable superior sulcus deformity and enophthalmos in 85% of patients. Patients with a history of infection, radiation, buphthalmos, or large orbital fractures (15%) had residual superior sulcus deformity greater than grade 1 and enophthalmos > or =2 mm despite 100% volume replacement. Further study will elucidate the histopathologic processes responsible for residual superior sulcus deformity and enophthalmos in the latter subgroup of patients.     

Merkel cell carcinoma in a renal transplant patient

Merkel cell carcinoma (MCC) is an aggressive neuroendocrine skin cancer which seems to be common in transplant recipients. We describe the case of a renal transplant patient who developed a MCC on the right glutaeus eight years after transplantation.     

Disseminated arthritis and osteitis by Candida albicans in a two month old infant receiving parenteral nutrition.

The case of a two-month -old female infant, who after a severe diarrhoea treated with prolonged intravenous infusion in peripheral veins alternated with total parenteral feeding, developed a Candida albicans septicemia (accompanied by disseminated intravascular coagulation syndrome) is reported. The course of her disease was also complicated by multiple foci of osteoarthritis in both knees, in the left hip and in several long-bones. Radiographically the foci of Candida osteitis appeared as fine erosion of the cortex and minute round areas of osteolysis in the spongiosa, surrounded by a rim of perifocal sclerosis. During the acute stage of Candida sepsis a transitory cellular immunodeficiency was present. Treatment of Candida infection by 5-fluorocytosine was followed by complete recovery.     

Feeding disorders in infancy: an empirical study on mother-infant interactions

AIM: The objective of this paper is an empirical analysis of mother-infant feeding interactions through an observational instrument (Feeding Scale), which is applied to the videotape of a feeding session. METHODS: Three samples of mothers and their children have been examined (104 couples with children ranging in age from 2 to 36 months: a first group in which children presented a feeding disorder on organic and functional base (food intolerances and/or gastroesophageal reflux), a second group in which the disorder was not due to a medical condition and a third group of control. The Authors meant to test three hypotheses: 1) the presence of developmental changes in mother-infant interactional patterns during the course of the first three years of life; 2) higher degree of dysfunction of mother-infant interaction in those dyads in which the feeding disorder had not organic causes; 3) dysfunctional interactions in the couples of mothers and children in which the feeding disorder was on an organic base. RESULTS: The results of the statistic analyses have confirmed the hypotheses, providing different elements of reflection. CONCLUSIONS: The Authors underline the importance of a multidimensional, global and integrated approach in the clinical assessment and treatment, which evaluates the possible interconnections among organic, psychogenetic and relational factors in the origin and course of feeding disorders in infancy and early childhood.     

Stem cell transplantation for hemoglobinopathies

Hereditary anemias caused by beta-thalassemia and sickle cell disease are the most common genetic diseases worldwide. Supportive therapies such as chronic lifelong transfusions, iron chelation for thalassemia, and transfusions or hydroxyurea for sickle cell anemia have significantly ameliorated clinical manifestations of these diseases but cannot eliminate disease and treatment-related complications that result in end-organ damage. Allogeneic hematopoietic stem cell transplantation is the only cure for patients with hemoglobinopathies. Results of transplants have steadily improved over the last few decades due to effective control of transplant-related complications and development of new preparative regimens. Our understandings of mixed chimerism in patients with hemoglobinopathies provide a rationale for the use of less intensive conditioning regimens and gene therapy in these disorders. Although the role of stem cell transplantation for thalassemia major is well defined, few transplants have been carried out in sickle cell disease, and, in light of recent advances, the role of stem cell transplantation in this disease should be revised. This review summarizes the current status of stem cell transplantation for hemoglobinopathies.     

Recovery of stromal stem cells in bone sarcoma patients after chemotherapy: implication for cell-based therapy in bone defect reconstruction

Bone sarcomas, such as osteosarcoma (OS) or Ewing sarcoma (ES), frequently arise in the intramedullary region of long bones. Patients affected by bone sarcomas are treated with preoperative aggressive chemotherapy immediately after diagnosis. After chemotherapy, patients undergo surgery that frequently entails the excision of wide bone segments. If a large segment of the bone is lost (defined as a critical defect) the patient undergoes bone reconstruction. Because bone marrow derived stromal stem cells (SSC) offer great promise for cell-based regenerative medicine in bone reconstruction, we investigated whether SSC could be isolated from chemotherapy-treated bone sarcoma patients. We also investigated whether chemotherapy modified SSC differentiation capability. We studied 9 SSC derived from OS and ES patients that had undergone chemotherapy and 5 SSC derived from bone sarcoma patients that had not undergone chemotherapy. SSC could be obtained from all the patients analyzed regardless of whether the patients received chemotherapy or not. Our results also showed that post-chemotherapy SSC can be cultured and expanded ex vivo, these cells retained the ability to differentiate toward the osteogenic lineage in vitro. In conclusion, our results support that SSC cells can be obtained from bone sarcoma patients that undergo chemotherapy and suggest that SSC can be used for cell-based bone reconstruction techniques in bone sarcoma patients treated with preoperative chemotherapy.