Enucleation versus plaque irradiation for choroidal melanoma.

The Collaborative Ocular Melanoma Study (COMS) is an international, multicenter-controlled study. The organization includes an Executive Committee, Steering Committee, 6 Central Units, 32 Clinical Centers, and a Data and Safety Monitoring Committee. Scientifically, the COMS consists of (1) a randomized trial of patients with medium choroidal melanoma treated with enucleation versus iodine-125 plaque irradiation, (2) a randomized trial of patients with large choroidal melanoma treated with enucleation versus preenucleation external beam irradiation and enucleation, and (3) a prospective observational study of patients with small choroidal melanoma to determine whether a randomized trial of treatment is appropriate.

Linkage studies of Best's macular dystrophy.

Genetic linkage studies are presented for nine kindreds with Best's vitelliform macular dystrophy (BVMD). This condition is an autosomal dominant macular dystrophy with reduced penetrance and highly variable expressivity. Asymptomatic carriers were identified with electro-oculography, fundus photographs and fluorescein angiography.

Disposition of cyclophosphamide on two consecutive cycles of treatment in patients with ovarian carcinoma.

The disposition of cyclophosphamide was determined in 12 women with ovarian carcinoma receiving cyclophosphamide 500 mg/m2, doxorubicin (adriamycin) 50 mg/m2 and cisplatin 50 mg/m2 during their first and second courses of therapy. Plasma samples were obtained over 24 h following the completion of the cyclophosphamide infusion and assayed for cyclophosphamide by high performance liquid chromatography. The mean disposition of cyclophosphamide conformed to a 2-compartment model with a mean terminal half-life of 7.

Age-related macular degeneration.

Age-related macular degeneration (AMD) is the leading cause of irreversible severe visual loss in the United States in people over 50 years of age. The nonexudative stage includes hard drusen (associated with localized dysfunction of the retinal pigment epithelium [RPE]), soft drusen (associated with diffuse dysfunction of the RPE), and geographic (areolar) atrophy. These fundus changes may predispose the eye to develop the neovascular/exudative stages of AMD.

An interdisciplinary psychoeducation program for schizophrenic patients and their families in an acute care setting.

A psychoeducation program in an acute care inpatient psychiatric setting involves schizophrenic patients and their families in a range of educational interventions that are responsive to their particular strengths and vulnerabilities. Patients receive one-on-one instruction about their illness from a psychiatrist and the nursing staff and learn community living skills in classes and tutorials conducted by occupational therapists. Families discuss ways of coping with the patients' illness in a series of meetings with a social worker, and they attend workshops led by a team of clinicians and an administrator, who advise them of current perspectives on the illness and its management and about how to negotiate the mental health system.

A randomized trial of fluorouracil and folinic acid in patients with metastatic colorectal carcinoma.

We determined the therapeutic effect of fluorouracil (5-FU) in combination with folinic acid (FA) in patients with measurable recurrent or metastatic carcinoma of the colon or rectum by comparing it to standard 5-FU therapy in a prospective randomized controlled trial. Patients were randomized to receive either FA, 200 mg/m2/d for five consecutive days, or nothing. All patients received 5-FU, 370 mg/m2/d for five days on the first course, with subsequent dose modifications to maintain equal toxicity in the two arms.

Laser treatment for choroidal neovascularization outside randomized clinical trials.

This study was undertaken to determine whether the treatment benefit reported in randomized trials for patients with extrafoveal choroidal neovascular membranes (NVMs) secondary to age-related macular degeneration (AMD) or the ocular histoplasmosis syndrome (OHS) can be duplicated in other clinical settings. The visual results and recurrence rates in treated extrafoveal NVMs of 70 patients with AMD and 21 patients with OHS were similar to those reported by the Macular Photocoagulation Study Group, in which all treated patients received argon blue-green laser photocoagulation after the administration of retrobulbar anesthesia. In this study, 78% (71/90) of the patients were treated with krypton laser and only 35% (32/90) had retrobulbar anesthesia.

Choroidopathy in systemic lupus erythematosus.

Choroidopathy in association with systemic lupus erythematosus (SLE) is a clinically unusual manifestation, previously described in only six patients, to our knowledge. We have followed up six patients with SLE and choroidopathy manifested by multifocal, serous elevations of the retinal pigment epithelium and sensory retina. In four patients, macular involvement was present, and they suffered visual loss.

Contrast sensitivity in age-related macular degeneration.

Low-contrast charts were used to investigate the possibility that patients with drusen have visual deficits not detected by standard Snellen charts. We compared performance on Regan letter charts between 52 eyes with drusen and Snellen acuity of 20/20 and 27 control eyes. The drusen group read fewer letters than the control group on all of the charts tested.

Subfoveal neovascularization in the ocular histoplasmosis syndrome. A natural history study.

The visual outcome of 74 eyes with the ocular histoplasmosis syndrome and active subfoveal subretinal neovascular membranes was studied retrospectively. Follow-up time ranged from 12 to 109 months (median, 36.5 months).

Anterior segment ischaemia following laser photocoagulation in a patient with systemic lupus erythematosus.

The authors report the occurrence of occlusive retinal arterial disease and retinal neovascularisation in a 44-year-old woman with systemic lupus erythematosus (SLE). Two days after uncomplicated panretinal photocoagulation the patient developed an acute anterior segment ischaemic syndrome. To our knowledge this complication has not been reported in any other patient following laser photocoagulation or in association with SLE.

Ten years after the Diabetic Retinopathy Study.

The Diabetic Retinopathy Study (DRS) demonstrated that prompt argon laser photocoagulation, in comparison to indefinite delay in treatment, could reduce by more than 50% the risk of severe visual loss from proliferative diabetic retinopathy. The DRS also enlightened two generations of ophthalmologists about the value of the randomized controlled clinical trial as a way of assessing new and existing treatments for unsolved therapeutic problems. After the example of the DRS, laser treatment was shown to be effective in reducing vision loss in selected patients with branch retinal vein occlusion, age-related macular degeneration, ocular histoplasmosis, and diabetic macular edema.

Two Japanese families: a cultural perspective.

Some of the difficulties in treating second and third generation Japanese immigrant families are reviewed. An authoritarian, rather concrete approach to symptom relief is expected by, and is effective in, some families. The emphasis placed on academic achievement may lead to particular problems and misunderstandings.

Developing a Role Activity Performance Scale.

This article describes the Role Activity Performance Scale (RAPS) and presents data from a study of its reliability and validity. The RAPS evaluates an individual's functional level, using 12 subscales that represent a range of life roles. It was developed as an instrument for evaluating the impact of occupational therapy and other treatment modalities on the functioning of psychiatric patients.

Hepatic arterial infusion of mitoxantrone in the treatment of primary hepatocellular carcinoma.

Twenty-three patients (16 male, seven female) with hepatocellular carcinoma (HCC) were treated by hepatic arterial infusion (HAI) of mitoxantrone every 4 weeks. At each treatment, a catheter was inserted percutaneously into the main hepatic artery via the femoral artery under image intensification. Treatment consisted of a 24-hour continuous HAI of mitoxantrone, 6 mg/m2/d X 3 (eight patients) or 10 mg/m2/d X 3 (14 patients) without heparin.

Mitomycin C pharmacokinetics in patients with recurrent or metastatic colorectal carcinoma.

The pharmacokinetics of mitomycin C as a single agent have been determined in 25 treatment courses given to 18 patients with recurrent or metastatic colorectal carcinoma using a high performance liquid chromatography (HPLC) assay to analyze plasma and urine samples. The plasma pharmacokinetics conformed to a two-compartment linear model in 21 of 25 courses monitored with a mean t1/2 lambda 1 of 9.8 +/- 1.

Computed tomography in advanced ovarian cancer: an evaluation of diagnostic accuracy.

The authors have investigated the diagnostic accuracy of computed tomography (CT) of the abdomen and pelvis in the assessment of patients prior to second-look laparotomy for advanced ovarian cancer. CT studies (read independently by three radiologists) and laparotomy findings were analyzed in 50 patients. Sensitivity varied from 0.