Optic disc cupping after circumpapillary Pd-103 slotted plaque radiation therapy.

Objective: To investigate vascular and morphologic optic disc changes after slotted plaque radiation therapy for choroidal melanoma involving the optic disc.

Design: Retrospective cross-sectional study.

Participants: Thirty-nine patients with choroidal melanoma involving the optic nerve.

Pterygium Recurrence Rates in the Hispanic Population in the Northeastern United States.

Purpose: To determine the rate and factors affecting pterygium recurrence in the Hispanic population of the Northeastern United States, based on patient demographic information.

Methods: In this retrospective cross-sectional study, data were collected on ethnically Hispanic patients from 2013 to 2018 who had primary single-headed pterygia excision and conjunctival autograft, with the minimum of 4-month follow-up time. This study was conducted in an academic institution in the Northeastern United States, with all patients being from the surrounding community.

Doppelgänger dilemma: Leiomyoma versus uveal melanoma.

Background: Ciliary body tumors can remain undetected and achieve large dimensions. Pigmented ciliary body tumors include: melanoma, leiomyoma and melanocytoma, however correct diagnosis may require tissue diagnosis with immunohistochemical stains.

Case Presentation: Two men presented with identical ciliochoroidal tumors.

Cutaneous Cell-Mediated Delayed Hypersensitivity to Intravitreal Bevacizumab.

The literature contains few reports describing autoimmune reactions to intravitreal bevacizumab and no Type-IV delayed hypersensitivity reactions. This was unexpected, as administration of intravenous bevacizumab has frequently caused dermatologic side-effects. This difference was likely attributable in part to the minimum 300-times difference between intravitreal versus intravenous dosing.

Hypochlorous acid antiseptic washout improves patient comfort after intravitreal injection: A patient reported outcomes study.

Purpose: Current ocular antiseptic practice for intravitreal injection (IVI) employs 5% povidone-iodine (Betadine) drops which frequently cause ocular discomfort and prolonged irritation. In an effort to improve comfort while maintaining efficacy, we studied a hypochlorous acid (HOCL 0.01%) spray washout prior to injection.

Numerical techniques for design calculations of longitudinal bending in buried steel pipes subjected to lateral Earth movements.

This paper presents simplified finite-element analysis procedures based on geometrical nonlinearity and ductile Mohr-Coulomb-Davis plasticity for analysis of bending behaviour of steel pipes subjected to lateral soil loading. A simple, and easy to implement, user-defined subroutine to represent soil stiffness using the Janbu model is also presented and discussed. The development of a three-dimensional (3D) finite-element model is presented, and its evaluation against experimental measurements is discussed.

Prevalence of comorbid conditions and prescription medication use among patients with gout and hyperuricemia in a managed care setting.

Background: : Comorbid disorders and multiple prescription drug use are common among patients with gout and/or hyperuricemia and may influence the clinical course and outcome of gout.

Objective: : We wanted to document the conditions and associated medications in a large group of patients with gout in a managed care setting.

Methods: : This study was a 2-year, retrospective, administrative claims analysis examining comorbid conditions and medication use among managed care enrollees with gout/hyperuricemia across the United States.

Malignant evolution of Schnitzler's syndrome--chronic urticaria and IgM monoclonal gammopathy: report of a new case and review of the literature.

Schnitzler's syndrome, initially described in 1974 is an uncommon condition defined by chronic urticaria and monoclonal IgM gammopathy. Additional features include fever of unknown origin, elevated ESR, bone pain and frequently a benign clinical course. We conducted a literature search of Medline, EMBASE and Cancerlit and found 56 cases of Schnitzler's syndrome reported to date.

Recent advances in the management of adult myositis.

Standard drug therapy of adult polymyositis, dermatomyositis and inclusion body myositis includes high-dose corticosteroids and cytotoxic drugs (methotrexate, azathioprine (AZA) and cyclophosphamide). Recent data are in favour of the early introduction of a cytotoxic or immunomodulating drug in addition to corticosteroid therapy. In patients with corticosteroid- and cytotoxic-resistant myositis, promising novel approaches to management include: iv.

Difficult gout and new approaches for control of hyperuricemia in the allopurinol-allergic patient.

A major obstacle to the treatment of hyperuricemia in patients allergic to allopurinol is the limited availability of suitable, equally effective, alternative, urate-lowering drugs. Conventional uricosuric drugs, including probenecid and sulfinpyrazone, are recommended for allopurinol- intolerant patients with gout and "underexcretion" hyperuricemia who have normal renal function and no history of nephrolithiasis. Therapeutic options in those in whom traditional uricosuric drugs are contraindicated, ineffective, or poorly tolerated include slow oral desensitization to allopurinol and cautious administration of oxipurinol.

Efficacy and safety of desensitization to allopurinol following cutaneous reactions.

Objective: To evaluate the long-term efficacy and safety of slow oral desensitization in the management of patients with hyperuricemia and allopurinol-induced maculopapular eruptions.

Methods: A retrospective evaluation of an oral desensitization regimen using gradual dosage-escalation of allopurinol in 32 patients (30 with gout and 2 with chronic lymphocytic leukemia) whose therapy was interrupted because of a pruritic cutaneous reaction to the drug.

Results: Twenty-one men and 11 women with a mean age of 63 years (range 17-83 years), a mean serum urate level of 618 micromoles/liter (range 495-750) (or, mean 10.

Paraneoplastic rheumatic syndromes.

Malignant neoplasms are associated with a wide variety of paraneoplastic rheumatological syndromes. Among these, hypertrophic osteoarthropathy, carcinoma polyarthritis, dermatomyositis/polymyositis, and paraneoplastic vasculitis are the most frequently recognized. Other less known associations are based upon a smaller number of reported patients, and include fasciitis, panniculitis, erythema nodosum, Raynaud's syndrome, digital gangrene, erythromelalgia and lupus-like syndromes.

Primary cutaneous B cell lymphoma during methotrexate therapy for rheumatoid arthritis.

A patient with rheumatoid arthritis developed a reversible, primary cutaneous, large B cell lymphoma during prolonged methotrexate (MTX) treatment. Regression of the skin lesions after discontinuation of the drug suggested a close relationship to MTX. Increased clinical awareness, discontinuation of MTX, and close observation are important in the initial management of this rare lymphoproliferative disorder.

What is new about crystals other than monosodium urate?

Recently, attention has focused on the effects of weather conditions and seasonal changes on the incidence of acute microcrystalline events. Acute gout attacks are more frequent during the spring, but seasonal variations in the incidence of acute pseudogout attacks are less clearly defined. Genetic analysis of two unrelated families with calcium pyrophosphate dihydrate (CPPD) crystal deposition disease showed linkage to the short arm of chromosome 5p.

Skeletal muscle infarction in diabetes mellitus.

Objective: To analyze the risk factors, clinical features, and methods of diagnosis of diabetic muscle infarction (DMI).

Methods: Three patients with diabetes mellitus (DM) and skeletal muscle infarction were studied, and 49 additional cases reported in the English literature (Medline database search) were reviewed.

Results: Review of all 52 patients with DMI revealed a number of typical features: equal sex distribution; mean age 41.

Fibroblastic rheumatism: clinical and histologic evolution of cutaneous manifestations.

Correlation of the clinical manifestations of a patient with fibroblastic rheumatism with sequential skin biopsy findings revealed an early inflammatory stage with cutaneous nodules, patchy erythematous skin lesions, polyarthritis, dermal lymphomonocytic infiltrates, and fibroblastic and myofibroblastic proliferation, followed by a chronic stage with sclerodactyly, joint ankylosis, deformities and dense dermal fibrosis. Treatment of this rare disorder in its early active stages may prevent the development of incapacitating joint sequelae.