Adverse periocular reaction after blood transfusion

PURPOSE: To describe a patient with an acute conjunctival and periocular reaction after blood transfusion. METHODS: Case report and literature review. RESULTS: A 67-year-old woman sustained a self-limited periocular reaction characterized by bilateral turgescence and redness of the conjunctiva and eyelids after blood transfusion. More than 100 similar reactions of this type have been reported by the Centers for Disease Control and Prevention. CONCLUSIONS: The cause of this periocular transfusion reaction is unclear, but this type of reaction is being investigated by the Centers for Disease Control and Prevention. This case suggests that mild transfusion complications, even if unusual, may be under-reported.     

Borderline melanocytic tumor of the conjunctiva: diagnostic and therapeutic considerations

A clinically benign appearing nevus was surgically excised from the conjunctiva of a 13-year-old girl because of complaints that it had recently enlarged. Histologically, the melanocytic lesion displayed considerable cytologic atypia and showed signs that were consistent with malignant transformation. Because of the rarity of conjunctival melanomas in children, the case was reviewed by several experienced pathologists and dermatopathologists whose diagnoses ranged from benign nevus with atypia to malignant melanoma. When the biologic potential of certain melanocytic lesions cannot be accurately predicted histologically, treatment and follow up must be individualized. Physicians must weigh the perceived risks and disadvantages of treating a histologically indeterminate tumor against the consequences of "under" treatment if the lesion is, in fact, biologically malignant.     

Role of n-3 fatty acids in prevention of disease complications in patients with HIV.

Hypertriglyceridemia and insulin resistance have been seen in patients with HIV. Beneficial effects of the n-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) have been reported for these conditions. One study of n-3 fatty acid supplementation in patients with HIV reported a decrease in serum triglyceride levels. These marine fatty acids appear to be working at a number of sites to achieve an improvement in lipid metabolism and insulin sensitivity. There is disagreement about the amount of n-3 fatty acids needed to achieve different effects and about the optimal ratio of dietary n-6 and n-3 fatty acids.     

Predictors of positive sentinel lymph node in thin melanoma

Background

The treatment of thin melanoma (Breslow thickness <1.0 mm) may include sentinel lymph node (SLN) biopsy (SLNB). The validity of SLNB for thin melanoma remains widely debated. The purpose of this study was to elucidate pathologic factors that are predictive of SLN positivity.

Methods

A retrospective analysis of a prospective database revealed 1,199 patients diagnosed with primary cutaneous melanoma. Multiple logistic regression was used to determine an association between pathologic factors and SLN positivity.

Results

Thin melanomas were identified in 469 patients (39%). Of these, 147 patients (31%) underwent SLNB. Positive SLNs were found in 16 patients (11%). Multiple logistic regression demonstrated that both ulceration (odds ratio, 5.27; P = .047) and thickness (odds ratio, 46.69; P = .022) were associated with SLN positivity.

Conclusions

Patients with thin melanomas >.75 mm and/or ulceration should be considered for SLNB.     

Is there a role for staging laparoscopy in patients with locally advanced,unresectable pancreatic adenocarcinoma?

The study objective was to determine the incidence of laparoscopically detected metastasis in patients with radiographically staged locally advanced adenocarcinoma of the pancreas. Patients with locally advanced pancreatic cancer are considered candidates for novel treatment protocols. Stratification of patients into locally advanced disease versus metastatic disease is imperative to accurately evaluate treatment outcome. Between 1994 and 2000, 100 consecutive patients undergoing staging laparoscopy with radiologic evidence of unresectable locally advanced pancreatic cancer were identified from a prospective database. All patients had preoperative contrast-enhanced, thin-cut computed tomography scanning or magnetic resonance imaging and had no evidence of detectable metastatic disease. There were 53 men and 47 women, with a median age of 64 years. The disease site was the pancreatic head in 69 cases and the body or tail in 31. Radiographic assessment of nonresectability was due to encasement of the celiac or hepatic artery in 37 patients, of the portal vein and superior mesenteric vessels in 56, and extrapancreatic extension in 7. Laparoscopy identified metastatic disease in 37% of patients, not seen on preoperative imaging. Peritoneal disease was noted in 12 cases and liver metastasis in 18 cases, and 7 patients had both. Neither the primary tumor size nor location influenced the incidence of metastatic disease. Standard imaging modalities failed to detect metastatic disease in 37% of patients who were considered to have locally advanced pancreatic cancer. Patients considered for treatment protocols for locally unresectable pancreatic cancer should be staged laparoscopically before initiation of therapy. Presented at the Forty-Third Annual Meeting of The Society for Surgery of the Alimentary Tract, San Francisco, California, May 19–22, 2002.