Preoperative anemia is associated with disease recurrence and progression in patients with non–muscle-invasive bladder cancer

Purpose

To evaluate the effect of preoperative anemia (PA) on oncological outcomes in a multicenter cohort of patients with non–muscle-invasive bladder cancer (NMIBC) treated with transurethral resection of the bladder (TURB) and adjuvant intravesical therapies. We hypothesize that PA represents a marker of disease aggressiveness and could be used to improve the discrimination of prognostic tools for the prediction of disease recurrence and progression.

Choroidal metastasis in disseminated lung cancer: frequency and risk factors

PURPOSE: To determine frequency, risk factors, and benefit of a prospective screening for intraocular metastasis in patients with metastatic lung cancer. DESIGN: Consecutive observational case series. METHODS: An ophthalmologic screening was performed on 84 consecutive patients suffering from metastatic lung cancer. Medical history and disease stage were evaluated in regard to the risk for intraocular metastasis. RESULTS: In six patients (7.1%) choroidal metastasis (CM) was detected. Choroidal metastasis was present only when at least two other organ system were affected by metastasis (P =.03). The choroid was the sixth common site of organ metastasis. Mean remaining life span in patients with CM was 1.9 (0.2-5.9) months. CONCLUSIONS: Choroidal metastasis is common in advanced metastatic lung cancer. However, due to the short survival of affected individuals, a systematic screening of at-risk patients for CM seems to be of limited benefit.     

A randomized phase II trial of gemcitabine plus treosulfan versus treosulfan alone in patients with metastatic uveal melanoma.

BACKGROUND: Several trials demonstrated efficacy of the gemcitabine/treosulfan (GeT) combination in metastatic uveal melamoma. This randomized phase II trial compared the GeT combination versus treosulfan alone (T) in this rare disease. PATIENTS AND METHODS: Chemotherapy-naive patients with proven metastatic uveal melanoma were randomly assigned to receive 1000 mg/m(2) of gemcitabine plus 3500 mg/m(2) of treosulfan (GeT) or 3500 mg/m(2) of T. Chemotherapy was administered on days 1 and 8 in both arms, cycles were repeated on day 29. Primary end point was rate of responses and disease stabilizations. RESULTS: Forty-eight patients were randomized. Seven confirmed stable diseases (SDs) and one partial remission (PR) were observed in 24 patients treated with the GeT regimen, whereas no PR and only three SDs were observed in the T arm (P = 0.08). Median progression-free survival (PFS) was 3 months (95% CI 1.1-4.9) and 2 months (95% CI 1.7-2.3) in the GeT and T arm (P = 0.008, log-rank). Six and 12 months PFS was 34.8% and 17.9% and 16.7% and 0% always favoring the GeT arm. CONCLUSIONS: This first randomized trial in metastatic uveal melanoma showed a superior PFS and a trend for a higher response/stabilization rate of the GeT combination over T.     

Dysfunction of transmission in the inner retina: incidence and clinical causes of negative electroretinogram

Background Only limited data exist on the incidence of negative electroretinograms (ERG) in clinical practice. The purpose of this study is therefore to determine the incidence and clinical causes of a negative ERG in a tertiary care centre focused on inherited and acquired retinal degenerations. Methods All ERGs recorded (in accordance with ISCEV standards) in our electrophysiological laboratory from 1992 to 2004 were retrospectively reviewed. The negative ERGs (criterion: ERG with b:a wave ratio≤1 in the scotopic standard combined response in at least one eye) were analysed in the context of further clinical results. The photopic ON- and OFF-responses were recorded with long duration (200 ms) stimuli. Results A total of 1999 ERGs from 1644 patients were performed during the study period. 47/1644 patients (2.9%) presented with a negative ERG and were included in the study. Clinical diagnoses included inherited retinal dystrophies [X-linked congenital retinoschisis (XRS) (n=17), congenital stationary night blindness (CSNB) (n=6), retinitis pigmentosa (RP) (n=6), cone (-rod) dystrophy (n=5), choroideremia (n=1), Müller cell sheen dystrophy (MCSD) (n=1)] and acquired retinopathies (melanoma-associated retinopathy (MAR) (n=1), vigabatrin retinotoxicity (n=1)). In nine patients a definitive diagnosis could not be established. Unilateral negative ERGs were seen in 10/37 patients where ERG was bilaterally recorded. The fellow eye presented with a b:a wave ratio >1 (8 eyes) or ERG responses were not detectable (2 eyes). Photopic ON- and OFF-responses were recorded in 38 eyes of 29 patients and 32/38 eyes presented with a negative ERG. The ON-response was reduced in 25/32 eyes, whereas the OFF-response was reduced in only 11/32 eyes. Conclusions The incidence of a negative ERG can differ between the laboratories depending on the causes for ERG recording and was in our laboratory 2.9% in a consecutive series of patients with inherited or acquired retinal degenerations. A disorder characteristically associated with negative ERG (e.g. XRS, CSNB, MAR) was diagnosed in 53% of these patients, whereas in 47% the negative ERG indicated an unexpected post-receptoral dysfunction, e.g. in cone (-rod) dystrophy or RP. The ON-bipolar pathway was affected in most cases. Presented in part at the 103rd annual meeting of the German Society of Ophthalmology (DOG), September 2005, Berlin, Germany. Supported in part by the Deutsche Forschungsgemeinschaft, Bonn, Germany (grant no.: Ke442/11-1,2).     

Histopathologic findings in eyes treated with a ruthenium plaque for uveal melanoma

Fifty-six globes that had to be enucleated following ruthenium plaque therapy were examined histopathologically. These eyes account for 10% of all uveal melanomas treated at the University Eye Clinic Essen up until 1985. All but one revealed at least some supposedly viable tumor cells. The most prominent findings within the tumors were tumor cell necrosis, vacuolization and balloon cell degeneration, vascular obstruction and fibrosis of the tumor stroma with accumulation of pigmented macrophages. Tumor necrosis was complete or nearly complete in five cases. Tumor regression correlated with cell type and pigmentary characteristics of the tumor, with epithelioid and heavily pigmented tumor cells being more radiosensitive. Tumor regression was inhomogeneous, possibly due to polyclonality, with tumor cells of varying radiosensitivitiy, or due to patchy areas of vascular obliteration. Among other ocular structures, extensive subretinal gliosis, chorioretinal atrophy and scarring of the sclera within the field of radiation were observed. Scleral necrosis was present in only five cases and was limited to areas in which the tumor had infiltrated the deep scleral layers. The findings described were considered to reflect radiation injury rather than spontaneous tumor regression when compared to 70 control eyes that had been enucleated without prior treatment for uveal melanoma.     

Color electroretinography

Electroretinograms to white and color stimuli were recorded in four normal subjects and nine subjects with different cone dysfunctions, including protanopia, cone dystrophy, cone dystrophy with supernormal b-waves at dark adaptation, cone dystrophy with missing b-waves during light adaptation and rod-cone dystrophy with blue cone hypersensitivity. Color stimuli were obtained with Kodak Wratten filters in blue, blue-green, green, yellow and red. Electroretinograms to all stimuli were recorded during dark and light adaptation with different stimulus intensities and to 30-Hz flicker stimulation. In protanopia, responses to red during light adaptation and flicker stimulation were reduced. All cone dystrophies showed reduced amplitudes and prolonged implicit times to red when dark adapted. The light-adapted responses were equally reduced to all color stimuli in cone dystrophy and cone dystrophy with supernormal b-waves. Contrary to other cone dystrophies, in cone dystrophy with missing b-waves, responses to red were severely reduced and responses to green were preserved, indicating a predominantly red cone dysfunction. Blue cone hypersensitivity was clearly distinct from other dystrophies in having large responses to blue and blue-green and much smaller responses to all other colors in all stimulus conditions. The electroretinogram with color stimuli allowed separation of different cone dysfunctions and identification of new retinal dysfunction syndromes.     

Gleichzeitiges Vorkommen von Diabetes mellitus,Diabetes insipidus,Opticusatrophie und Innenohrschwerhörigkeit

Summary Report of a further case with coexisting diabetes mellitus, diabetes insipidus, optic atrophy und neurogenic deafness. It was not possible to find a cause for these symptoms. The cases reported in the literature are brought together and discussed.

     

Die PAS-AO-Methode,eine Spezialfärbung für Coccidien im Gewebe

Zusammenfassung Es wird eine Färbemethode beschrieben, von den Autoren PAS-AO-Färbung genannt, die vor allem der morphologischen Differenzierung der Sporozoiten von Coccidien dient. Die PAS-AO-Färbung besteht aus der PAS-Reaktion und einer Gegenfärbung mit einem aus Anilinblau und Orange G bestehenden Farbstoffgemisch. Diese Methode verleiht den Sporozoiten im Darmlumen und im Gewebe eine sehr charakteristische Anfärbung, wobei Kern und Plasma, das hyaline Körperchen und andere Strukturen in differenter Weise dargestellt werden. Die hierdurch erzielten Farbkontraste und die auffällige Anfärbung des Glycogens erleichtern die Suche nach einzeln liegenden Sporozoiten beträchtlich und erlauben eine bessere morphologische Differenzierung. Die Färbung von Sporozoiten, Schizonten und Mikro- und Makrogametocyten von E. tenella mit der PAS-AO-Methode sowie die Lokalisation der Sporozoiten und ihre Wanderung im Gewebe werden beschrieben.Mit 36 Textabbildungen, davon 6 farbigen