Tova Monos

Overexpression of p53 tumor suppressor gene in pterygia.

Purpose To assess p53 gene expression in pterygia with and without recurrence. The pathogenesis of pterygium has not yet been determined. The most widely recognized etiologic factor is ultraviolet radiation, which leads to degeneration of the conjunctiva. However, pterygium was recently found to have several tumor-like characteristics. The p53 gene is a common marker for neoplasia, and is known to control cell cycle, cell differentiation and apoptosis. In this study we examined the expression of the p53 gene in primary pterygia with and without recurrence, searching for the pathogenesis of this very common lesion and for a prognostic factor for recurrence.Methods Immunohistochemical staining using a monoclonal antibody to human p53 (DO-7) was performed on 13 consecutive patients with primary pterygia, four pterygia without recurrence and nine pterygia which recurred during a 12-month follow-up. As a control we used two specimens of normal conjunctiva.Results Seven of the 13 pterygia specimens (54%) were positive for abnormal p53 expression. There was no difference between the groups with and without recurrence. Two out of four pterygia (50%) without recurrence and five out of nine (55.5%) pterygia with recurrence were positive. No pathological staining was observed in the control specimens.Conclusions In this study, abnormal p53 expression was found in pterygial epithelium, suggesting that pterygium could be a result of uncontrolled cell proliferation, and not as a degenerative lesion. There seems to be no connection between abnormal p53 expression and recurrence.

Retinopathy of prematurity in multiple-gestation, very low birth weight infants.

Ninety-nine infants from multiple gestation births and weighing < or = 1500 g at birth were matched with infants from single births to clarify the relationship of multiple gestation to retinopathy of prematurity (ROP). There was no significant difference in the incidence of ROP between the twins and the singletons (relative risk [RR] = 0.84, 95% confidence intervals [CI] = 0.61, 1.16). Logistic regression analysis confirmed that very low birth weight (VLBW), not single or multiple gestation, was the most significant predictor of ROP occurrence in either group. In 27 pairs of twin siblings from the original twin group, where both weighed < or = 1500 g at birth, we found that the second-born twin seemed at higher risk for developing ROP, but logistic regression showed that the lower birth weight of the second twin, not birth order, was the more significant predictor of ROP. These results indicate that ROP screening in VLBW twins may be conducted according to the same standard protocols as for singletons.

Bilateral consecutive blindness due to sphenoid sinus mucocele with unilateral partial recovery

BACKGROUND We present an interventional case report of a rare occurrence of sphenoid sinus mucocele causing bilateral consecutive blindness with unilateral partial recovery after endoscopic surgery. METHODS A 64-year-old woman with known sphenoid sinus mucocele and right blindness was referred because of an acute drop of vision to hand motion in her only-seeing left eye over 5 days. Imaging revealed a large mucocele enlarging the sphenoid sinus, eroding the base of the skull, protruding into the cranial cavity, and compressing the left optic nerve. RESULTS Urgent endoscopic sphenoidotomy was performed. Several hours after the procedure, visual acuity was partially recovered in the left eye. INTERPRETATION Sphenoid sinus mucoceles can cause bilateral blindness. A high index of suspicion and urgent imaging studies are necessary. Because visual recovery depends on prompt diagnosis and surgical intervention, a close collaboration between otolaryngologists and ophthalmologists is crucial.

CO2-Laser in the Removal of a Plexiform Neurofibroma from the Eyelid

We present a child with neurofibromatosis type I (NF-I) who underwent excision of a large upper lid neurofibroma using a CO2-laser. Plexiform neurofibromas are notorious for their bleeding tendency and the inability to achieve complete surgical excision. The CO2-laser is an adjunct to achieving better hemostasis and delineation of the tissue in the absence of natural tissue planes caused by the tumors diffuse mode of growth. Using the CO2-laser achieves better cosmesis, while reducing operation time and limiting complications.

Acquired Brown's Syndrome Caused by Frontal Sinus Osteoma

A 32-year-old man had a history of acquired Browns syndrome associated with diplopia, proptosis, downward displacement of the globe, and lid edema. A CT scan of the orbit revealed an osteoma arising from the left frontal sinus and extending into the left orbit. After surgical extirpation the proptosis and diplopia disappeared and the globe returned to normal. To our knowledge, such a case has not been reported previously.

Rhabdomyosarcoma: Invading the Orbit in an Adult

Sites in the head and neck region are among the most frequent locations of rhabdomyosarcoma (RMS) in patients younger than 15 years. However, comparable neoplasms in adults are very uncommon. We present a case report of a 27-year-old man who was diagnosed as having RMS. RMS rarely presents in the head and neck of adults, but should be considered in the differential diagnosis of a small cell neoplasm in patients during the third and fourth decades of life.

Removal of giant vernal papillae by CO2 laser

BACKGROUND We report our experience in removing giant papillae in cases with severe vernal keratoconjunctivitis using CO2 laser. METHODS Five cases with conjunctival giant papillae due to severe vernal keratoconjunctivitis were treated with CO2 laser. All cases were resistant to conventional treatment. In 4 eyes, there was also an associated corneal shield ulcer. RESULTS In all 5 cases the procedure was uneventful. Retreatment was performed in only 2 cases because of recurrence of the papillae. No intra- or postoperative complications were observed. INTERPRETATION CO2 laser seems to be a safe method for removing conjunctival giant papillae in cases with severe vernal keratoconjunctivitis. It is also a repeatable method that enables a rapid conjunctival and corneal recovery.

Intrasinus wood foreign body causing orbital cellulitis in congenital insensitivity to pain with anhidrosis syndrome.

A 2-year-old boy with congenital insensitivity to pain with anhidrosis (CIPA) was referred with a 2-day history of left periorbital swelling and mucoid conjunctival discharge. Marked worsening was noted despite intramuscular ceftriaxone treatment for 3 days, with marked proptosis, conjunctival chemosis, and a frozen eye. Orbital cellulitis was suspected. Ceftriaxone was intravenously administered. Orbital computed tomography (CT) disclosed an inflammatory process in the medial aspect of the left orbit with ethmoiditis. Improvement was not noted after external ethmoidectomy and drainage of the intraconal abscess. Repeat CT showed a recurrent intraconal abscess. A revision external ethmoidectomy was performed, and a bent wooden match was removed from the posterior aspect of the ethmoidal sinus, after which significant clinical improvement was noted. In patients with CIPA, accidental or self-penetrated foreign bodies must be kept in mind when treating all types of wounds.

Blast injury caused by a booby-trapped cellular phone

Terrorists are recently using cellular phones to remotely detonate bombs. A patient was injured while assembling a bomb connected to a cellular phone. The patient sustained combined injury to the head and to the dominant hand which held the phone. Amputation of the hand was required, the facial injuries were reconstructed. The characteristics of this unusual type of injury are described and compared to injuries caused by other bombs and explosive devices.

Sclerosing pseudotumor of the orbit

Idiopathic sclerosing pseudotumor of the orbit is a unique clinico-pathologic entity, similar to retroperitoneal fibrosis, that is characterized by primary, chronic and immunologically mediated fibrosis, poor response to corticosteroid treatment or radiotherapy and frequent visual disability. The clinical and pathologic findings of our case are reviewed.