Orbital solitary fibrous tumor: A clinicopathologic correlation and review of literature

Orbital solitary fibrous tumor (SFT) is a rare tumor originating from the mesenchyme. Initially described in the pleura and subsequently in other mesenchymal structures, orbit continues to be one of the uncommon extrapleural sites. The diagnosis of orbital SFT cannot be made with certainty on clinical or radiological evaluation and requires histologic studies with immunohistochemical confirmation for which CD 34 is the most specific diagnostic test. We describe clinical presentations, radiological and operative findings, and pathological features of a patient with orbital SFT along with a review of literature.     

Management of canalicular lacerations: epidemiological aspects and experience with Mini-Monoka monocanalicular stent

PURPOSE: To report the epidemiological data, clinical profile, and surgical outcome of canalicular lacerations in an Indian population. DESIGN: Retrospective interventional case series. METHODS: All patients who underwent canalicular laceration repair from July 1, 2002 to June 30, 2005 at a tertiary eye care center were retrospectively reviewed. Demographics, cause of eyelid injury, associated ocular injury, surgical management with Mini-Monoka monocanalicular stent, and its outcome were analyzed. RESULTS: Sixty-six patients underwent eyelid laceration repair, of which 24 (36%) had involvement of the canalicular system. The mean age at presentation was 16 years (range, 10 months to 52 years); 20 (83.3%) patients were males. Mode of injury included the blouse-hook fastener in five (20.8%) breast-feeding infants, bicycle handle injury in four (16.7%) children, and metal rod injury in five (20.8%) adults. Lower canaliculus was involved in 13 (54.1%), upper in eight (33.3%), and both in three (12.5%) patients. Simultaneous globe injury was noted in six (25%) patients, five (83.3%) of which had upper canalicular involvement. Twenty-seven canalicular lacerations (24 patients) underwent stenting with the Mini-Monoka monocanalicular stent. Three (11.1%) stents extruded within one month. At the final follow-up (mean, 18.5 months), canalicular block was noted in two (10%) out of 20 patients; none had epiphora. CONCLUSION: Canalicular involvement occurs in 36% of eyelid injuries. Injury by the "blouse-hook fastener" is unique to infants in the Indian context. Simultaneous globe injury is present in 25% of cases, especially when the upper canaliculus is involved. Mini-Monoka stent extrusions occur within one month. With an 11.1% extrusion rate, Mini-Monoka stents achieved good anatomical (90%) and functional (100%) success in the management of canalicular injury.     

Bicanalicular laceration managed with two Mini-Monoka monocanalicular stents

Bicanalicular lacerations have been traditionally managed using bicanalicular nasal intubation or annular stents. The Mini Monoka monocanalicular stent has been described for the management of monocanalicular lacerations. A bicanalicular laceration can also be successfully managed using two Mini Monoka monocanalicular stents, and this technique has several advantages. We report this simple and minimally invasive alternative in the management of bicanalicular laceration.     

Rationale and Design of PEMVITASTART—An Open-label Randomized Trial Comparing Simultaneous Versus Standard Initiation of Vitamin B12 and Folate Supplementation in Nonsquamous,Non–Small-cell Lung Cancer Patients Undergoing First-line Pemetrexed-based Chemotherapy

Pemetrexed is the preferred chemotherapeutic drug for nonsquamous, non–small-cell lung cancer patients whenever the predictive molecular biomarkers for targeted therapy have either not been assessed or are absent. As per manufacturers' instructions, supplementation with folic acid (FA; folate) at a dose of 350 to 1000 μg daily should be started seven days before the first dose of pemetrexed-based chemotherapy and continued during therapy and for 21 days after therapy cessation. Vitamin B₁₂ injections (1000 μg intramuscularly) should also be started one week before the first dose of chemotherapy. However, the evidence for delaying chemotherapy by one week for the purpose of providing vitamin B₁₂ and FA supplementation is not robust. Observational and prospective single-arm studies have not shown any increased toxicity if pemetrexed was started earlier than the recommended duration of supplementation. In a resource-constrained setting, the standard (conventional) approach would lead to one additional visit and a 1-week chemotherapy delay, both of which could be inconvenient for patients. Hence, an open-label, randomized trial (PEMVITASTART [Vitamin Supplementation in NSCLC Patients on Pemetrexed Based Chemotherapy]; ClinicalTrials.gov identifier, NCT02679443) is being undertaken to evaluate whether any differences exist in pemetrexed-related hematologic toxicity among patients who receive delayed initiation of chemotherapy (after 5-7 days of vitamin B₁₂ and FA supplementation [delayed arm]) compared with those for whom vitamin B₁₂ and FA supplementation is started simultaneously (within 24 hours) of chemotherapy initiation (immediate arm). The present report describes the rationale and detailed design of the PEMVITASART trial.     

Pulmonary arteriovenous malformations

Pulmonary arteriovenous malformations rarely present in childhood. Two cases are presented in this report. Both the cases presented clinically with cyanosis and clubbing without a cardiac murmur. The second case had cerebral abscess in addition. Both the cases underwent a contrast-enhanced echocardiography which suggested the presence of pulmonary arteriovenous malformations. The first case also underwent^99mTc radionuclide scan and pulmonary angiography. The cases are being reported for their characteristic clinical features and for emphasizing the role of non-invasive modalities like contrast-enhanced echocardiography and radionuclide scan in reaching the diagnosis.