Several types of benign and malignant tumors
|
|
- Ella Hawkins
- 6 years ago
- Views:
Transcription
1 Retinl Hemngioms: Understnding Clinicl Fetures, Imging, nd Therpies Severl different vsculr tumors cn occur in the retin, ech with its own fetures nd findings. Y CROL L. SHIELDS, MD; LEXZNDR DOUGLSS, S; TIMOTHY HIGGINS, S; WSIM. SMR, MD; nd JERRY. SHIELDS, MD Severl types of benign nd mlignnt tumors cn rise in the retin, originting from neurl (retinoblstom), vsculr (hemngiom/hemngioblstom), nd glil (strocytic hmrtom nd cquired strocytom) elements. The vrious retinl vsculr tumors re benign, nd ech hs distinct funduscopic nd imging fetures. Relted systemic findings nd tumor mngement depend on the specific type of hemngiom. Some of these retinl vsculr tumors cn be ssocited with the oculoneurocutneous syndromes (phkomtoses). This rticle reviews four such tumors nd describes their clinicl findings nd imging fetures on fluorescein ngiogrphy (F), ultrsonogrphy, opticl coherence tomogrphy (OCT), nd other studies. RETINL HEMNGIOLSTOM The retinl hemngioblstom, previously termed retinl cpillry hemngiom, is vsculr hmrtom tht generlly hs clinicl onset in the first 2 decdes of life. ilterl or multiple retinl hemngioblstoms re ssocited with von Hippel-Lindu (VHL) syndrome, nd ptients should be evluted for this condition using brin nd renl imging s well s genetic testing (Tble 1). Solitry retinl hemngioblstoms my lso be ssocited with VHL syndrome. Clinicl Fetures Retinl hemngioblstom ppers ophthlmoscopiclly s reddish-ornge mss, nd it cn be locted in the peripherl retin or ner the mculr region or optic disc. 1-5 This tumor displys dilted retinl vessels feeding nd drining the tumor. Erly on, the tumor my not be cliniclly visible nd my be seen only on F (Figure 1). s it enlrges, the vessels become more dilted nd tortuous (Figure 1). This tumor cn produce subretinl fluid, subretinl nd intrretinl exudtion, nd vitreoretinl fibrosis. The exudtion hs tendency to ccumulte selectively in the mculr re s mculr str. In some instnces, the tumors remin pinpoint nd re detected only by observtion of dilted vessels, confirmed lter by hyperfluorescence on F. When retinl hemngioblstom is locted t the optic disc, the mss cn msquerde t Glnce There re numerous types of retinl vsculr tumors, nd ech hs distinct clinicl fetures, imging findings, genetic ltertions, nd mngement strtegies. Retinl hemngioblstom ppers s reddishornge mss nd cn be locted in the peripherl retin or ner the mculr region or optic disc. Cvernous hemngiom does not hve feeding rtery like retinl hemngioblstom nd is usully locted long the course of retinl vein. cquired vsoprolifertive tumor cn produce findings of intrretinl nd subretinl exudtion, subretinl fluid, remote epiretinl membrne, cystoid mculr edem, retinl hemorrhge, nd vitreous hemorrhge. JULY/UGUST 2015 RETIN TODY 61
2 TLE 1. CRITERI FOR THE DIGNOSIS OF VON HIPPEL-LINDU SYNDROME If fmily history is: Positive Negtive Feture for ny one of the following: retinl hemngioblstom brin hemngioblstom viscerl lesion for ny one of the following: two or more retinl hemngioblstoms two or more brin hemngioblstoms single retinl or brin hemngioblstom with viscerl lesion Viscerl lesions include renl cysts, renl crcinom, pheochromocytom, pncretic cysts, islet cell tumors, epididyml cystdenom, nd endolymphtic sc tumor. s ppillitis, nd the feeder vessels re often not visible. Regrdless of tumor loction, ccumultion of subretinl fluid with exudtion cn led to profound visul loss. C E D F Genetics nd Pthogenesis In VHL syndrome, the stroml cells hve muttion on chromosome 3p25-26, which leds to dysfunctionl VHL protein. 6,7 These cells cnnot degrde hypoxi-inducible fctor 1 (HIF-1), so this fctor ccumultes nd cuses production of VEGF, pltelet-derived growth fctor (PDGF), erythropoietin, nd trnsforming growth fctor-lph, ll of which led to prolifertion nd vsculriztion of the tumor. 7 There re three types of muttion in the VHL gene: type 1, with deletion or nonsense muttion nd mnifesting minly hemngioblstoms only; type 2, with missense muttion t risk for hemngioblstoms nd pheochromocytoms (type 2), dditionl renl cell crcinom (type 2), or only pheochromocytom (type 2C); nd type 3, with risk for polycythemi. 8 The best test for the detection nd confirmtion of retinl hemngioblstom is F becuse it shows rpid filling of the feeding rtery, then the tumor, followed by rpid exit through the drining vein. Subclinicl pinpoint tumors cn be detected on ngiogrphy before they become symptomtic (Figure 1). Smll to lrge tumors cn disply fluorescein dye lekge from the mss into the djcent retin nd vitreous cvity, feture tht cn led to remote mculr edem nd epiretinl membrne (ERM). Ultrsonogrphy depicts the introculr mss s Figure 1. Young child with fmily history of von Hippel-Lindu syndrome, t risk for retinl hemngioblstoms. No tumors were visible in the right () or left () eyes, but retinl hemngioblstoms were clerly seen on F in the right eye (C) temporl to the mcul nd in the left eye (D) s pinpoint dots superior to the mcul (two sites). lrge retinl hemngioblstom (E) with prominent dilted, tortuous feeder vessels (F) tht required plque rdiotherpy cn be seen. cousticlly solid with surrounding subretinl fluid. OCT cn show the intrretinl, opticlly dense tumor occupying full-thickness retin with relted subretinl fluid, intrretinl/ subretinl dense exudtion, intrretinl edem, nd ERM. 9 OCT is lso importnt in judging tretment response. 2,9 Mgnetic resonnce imging (MRI) nd computed tomogrphy (CT) cn expose n enhncing retinl mss in eyes with extensive retinl detchment. These scns re lso essentil for detecting ssocited centrl nervous system nd bdominl neoplsms in VHL syndrome (Tble 2). Severl protocols re used for the evlution of VHL systemic fetures, with vritions depending on whether the geneticlly positive ptient or t-risk reltive is being exmined (Tble 3). Keep in mind tht retinl hemngioblstom could be the first finding of VHL syndrome, nd it generlly presents between the ges 12 nd 25 yers (Tble 2). Other VHL-relted tumors, 62 RETIN TODY JULY/UGUST 2015
3 Tumor TLE 2. TUMORS IN VON HIPPEL-LINDU SYNDROME Hed nd Neck Most Common ge t Frequency of Tumor Retinl Hemngioblstom yers 25-60% Cerebellr Hemngioblstom rinstem Hemngioblstom Spinl cord Hemngioblstom yers 44-72% yers 10-25% yers 13-50% Endolymphtic Sc Tumor yers 11-16% Trunk Renl Cell Crcinom/Cyst yers 25-60% Pheochromocytom yers 10-20% Pncretic Tumor/Cyst yers 35-70% Epididyml Cystdenom yers 25-60% mles rod Ligment Cystdenom yers 10% femles Dt compiled from survey of literture from , including dt from the VHL Fmily llince nd dpted from the VHL Fmily llince Hndbook. VHL Fmily llince: such s pheochromocytom, epididyml cystdenom, nd endolymphtic sc tumor, tend to occur t similr young ge. Others, such s brin hemngioblstom nd renl cell crcinom, occur lter (Tble 2). Mngement nd Course Mngement of retinl hemngioblstom should include both systemic nd oculr evlution. The systemic evlution should be performed by qulified tem of specilists including clinicins nd rdiology experts looking for relted VHL tumors such s cerebellr hemngioblstom, pheochromocytom, renl cell crcinom, nd other ssocited neoplsms nd cysts (Tble 2). rin nd bdominl MRI or CT should be performed periodiclly in ffected ptients. The eye evlution should include complete dilted funduscopic exmintion nd F, s per the Cmbridge protocol (Tble 3). This is importnt for the detection of subclinicl retinl tumors tht might Test TLE 3. THE CMRIDGE PROTOCOL FOR SCREENING PTIENTS WITH VON HIPPEL- LINDU SYNDROME OR T-RISK RELTIVES Frequency ffected symptomtic Ptient Physicl exmintion Retinl exmintion b F Renl ultrsound rin MRI/CT bdomen MRI/CT 24 hour urine for VM Every 3 yers until ge 50 yers, then every 5 yers Every 3 yers t-risk Reltives: Sme Protocol s bove but With ge Limits Retinl exmintion b F rin MRI/CT bdomen MRI/CT, beginning t ge 5 yers, from ge yers Every 3 yers from ge yers, then every 5 yers until ge 60 yers Every 3 yers from ge yers Symptomtic ptients should be investigted urgently nd mnged ccording to their findings. b We believe tht retinl exmintion should be performed t lest twice yerly in symptomtic ptients nd t-risk reltives. bbrevitions: F, fluorescein ngiogrphy; MRI, mgnetic resonnce imging; CT, computed tomogrphy; VM, vnillylmndelic cid be seen only on F (Figure 1). We perform F under nesthesi nnully in VHL-documented ptients 5 yers of ge nd younger, erlier thn suggested by the Cmbridge protocol, to detect pinpoint tumors nd llow prompt tretment. The tretment of retinl hemngioblstom vries with the clinicl sitution. 4,10-13 Tumors ssocited with VHL syndrome tend to be more ggressive; therefore, nerly ll retinl hemngioblstoms must be considered for tretment. If lesions re smll (<3 mm) in size, lser photocogultion or photodynmic therpy (PDT) cn be used; if medium (3-6 mm), PDT or cryotherpy cn be used; nd if lrge (>6 mm), PDT, plque rdiotherpy, or internl resection by prs pln vitrectomy route cn be employed. Tumors not ssocited with VHL syndrome tht re smll nd hve symptomtic lesions without JULY/UGUST 2015 RETIN TODY 63
4 subretinl fluid cn be cutiously observed, prticulrly if they re in the mculr, perimculr, or juxtppillry region, where tretment could be detrimentl to vision. Tretment is wrrnted if lekge ensues. Criteri for tretment re similr to those listed bove. Lser photocogultion nd PDT re useful for smll- to medium-sized tumors locted posterior to the equtor nd cryotherpy for those nterior to the equtor. Plque rdiotherpy is reserved for lrger tumors, nd surgicl repir of secondry ERM or trction retinl detchment is occsionlly necessry. In the cse of n ggressive juxtppillry tumor tht does not respond to conventionl tretment, externl bem rdiotherpy or plque rdiotherpy cn be considered. Some necdotl cses hve reportedly responded to orl proprnolol, orl cetzolmide, nd orl prednisone, but lrge studies hve not been conducted. Orl nd intrvitrel nti-vegf gents hve not been successful in effecting tumor regression, but intrvitrel nti-vegf cn be useful for reducing mculr edem nd occsionlly subretinl fluid. Wong nd Chew reviewed the role of nti-vegf gents nd emerging therpies for retinl hemngioblstom. 4 Histopthology Histopthologiclly, retinl hemngioblstom consists of prolifertion of retinl cpillries tht usully replces the full thickness of the neurosensory retin. On light microscopy, there is benign prolifertion of endothelil cells, pericytes, nd stroml cells. In the end stge, totl retinl detchment with mssive retinl gliosis, ctrct, nd phthisis bulbi cn occur. RETINL CVERNOUS HEMNGIOM Retinl cvernous hemngiom is often ssocited with similr skin nd centrl nervous system lesions nd therefore should be clssified with the oculoneurocutneous syndromes, or phkomtoses. Clinicl Fetures Ophthlmoscopiclly, retinl cvernous hemngiom usully ppers s cluster of drk intrretinl venous neurysms, sometimes described s bunch of concord grpes (Figure 2). 1,2,14-20 This tumor is usully without symptoms but cn be ssocited with visul impirment from vitreous hemorrhge, secondry retinl trction, or mculr scrring. Unlike retinl hemngioblstom, the cvernous hemngiom does not hve feeding rtery nd is typiclly locted long the course of retinl vein. Occsionlly, this lesion is on the optic disc. Rrely is there exudtion, but commonly there is overlying, white, fibroglil tissue on the tumor surfce, suggesting previous vitreous or preretinl C Figure 2. Mculr retinl cvernous hemngiom () with lte onset prtil fluorescence () nd n OCT scn showing multiloculted cvernous spces (C) within the retin. hemorrhge. Retinl cvernous hemngioms re usully nonprogressive but cn show miniml enlrgement over time. Vitreous hemorrhge is the most commonly reported compliction. Genetics Retinl cvernous hemngiom cn occur with cerebrl cvernous mlformtion (CCM) s spordic or fmilil utosoml dominnt disorder with incomplete penetrnce. Three genes cuse CCM: CCM1/KRIT1, CCM2/ MGC4607, nd CCM3/PDCD CCM3 is relted to higher risk for cerebrl hemorrhge in childhood. In most instnces, retinl cvernous hemngiom hs typicl ophthlmoscopic ppernce. F is the most helpful dignostic ncillry test becuse it produces nerly pthognomonic findings of rteril phse hypofluorescence with slow fluorescein ppernce within the venous neurysms. Within the neurysml spce, the red blood cells deposit in the inferior portion nd plsm deposits in the superior region, without lekge of dye. This is clled the fluorescein-erythrocyte interfce, chrcteristic feture of cvernous hemngiom. Vitreous hemorrhge cn occur with lrge retinl cvernous hemngioms, obscuring the tumor nd cusing it to be detectble only by ultrsonogrphy. On -scn ultrsonogrphy, there is high initil spike nd high internl reflectivity; on b-scn, the lesion shows n irregulr but well-defined surfce, coustic solidity, nd no choroidl excvtion. OCT demonstrtes mrkedly irregulr retinl surfce, with numerous cvernous spces within the retin. In generl, the retinl ntomy is disorgnized from tumor compression. 64 RETIN TODY JULY/UGUST 2015
5 Figure 3. dvnced rcemose hemngiom () in the perippillry region showing prominence on F (). Mngement nd Course Most cses of retinl cvernous hemngiom require no tretment becuse these tumors rrely progress or produce visul symptoms. Vitreous hemorrhge cn occur nd cn be mnged with observtion or vitrectomy. For repetitive hemorrhge, the tumor cn be sclerosed with plque rdiotherpy, PDT, or cryotherpy. It is importnt to perform brin MRI to evlute for relted cerebrl cvernoms, nd genetic testing for the CCM genes is dvised, especilly if there is fmily history of cvernoms or the ptient shows multiple cvernoms. Histopthology Histopthologiclly, retinl cvernous hemngiom ppers s mss of lrge-cliber vsculr spces in the inner retin nd ll lyers of the retin. This tumor is lined by endothelium interconnected by nrrow chnnels. 20 There cn be extensive cystic nd fibrous degenertion of the retin. RETINL RCEMOSE HEMNGIOM Retinl rcemose hemngiom is not true neoplsm but rther simple or complex rteriovenous communiction. It cn occur s solitry unilterl lesion, or it cn be prt of Wyburn-Mson syndrome (WMS; lso clled onnet-dechume-lnc syndrome), which is ntomiclly termed retinoencephlofcil ngiomtosis. This rteriovenous mlformtion cn ffect the retin, visul pthwys, midbrin, nd fcil bones, including the mndible nd mxill. There is no hereditry tendency. Clinicl Fetures Cliniclly, the retinl rcemose hemngiom mnifests s lrge, dilted, tortuous retinl rtery tht psses from the optic disc for some distnce into the fundus, communicting directly with dilted retinl vein nd then bck to the optic disc (Figure 3). In some cses, the vsculr nomly displys complex rry of blood TLE 4. RCHER CLSSIFICTION FOR WYURN-MSON SYNDROME Group Feture Comments I II III bnorml cpillry plexus between the mjor vessels of the rteriovenous mlformtions. rteriovenous mlformtions lck ny intervening cpillry bed between the rtery nd vein. Extensive rteriovenous mlformtions with dilted nd tortuous vessels nd no distinction between rtery nd vein. Such lesions tend to be smll, ptients symptomtic, nd intrcrnil involvement uncommon. Risk of retinl decompenstion resulting in retinl edem, hemorrhge, nd vision loss. Low risk for intrcrnil rteriovenous mlformtions. High risk for visul loss due to retinl decompenstion or retinl compression of nerve fiber lyer, optic nerve, or other vessels. High risk for intrcrnil rteriovenous mlformtions. dpted from rcher DM, Deutmn, Ernest JT, Krill E. rteriovenous communictions of the retin. m J Ophthlmol. 1973;75(2): vessels. This retinl mlformtion does not usully produce exudtion or hemorrhge. rcher clssifiction is used to ctegorize the ffected eye ccording to size nd loction of the vsculr mlformtion (Tble 4) Genetics There is evidence tht genetic or developmentl fctors tht occur erly in gesttion led to dysgenesis of the embryologic vsculr plexus. 26 The time of insult determines the loction nd extent of mnifesttions. The tumor is estblished with ophthlmoscopy nd confirmed with F, which shows rpid filling of the ffected dilted rtery nd vein, usully with no intervening cpillry chnnels nd typiclly without lekge into surrounding tissues. Mngement nd Course The mngement of ptient with this vsculr tumor consists of systemic nd ophthlmic monitoring. Furthermore, the ptient should be evluted for WMS with imging studies for similr vsculr bnormlities in the brin nd fcil bones. The retinl lesion usully remins stble, nd tretment is rrely needed. JULY/UGUST 2015 RETIN TODY 65
6 TLE 5. OCULR CONDITIONS SSOCITED WITH SECONDRY VSOPROLIFERTIVE TUMOR ssocited Oculr Condition Retinitis pigmentos 10 (18) Prs plnitis 11 (20) Cots disese 11 (20) Previous retinl detchment repir 8 (14) Idiopthic peripherl retinl vsculitis 3 (5) Fmilil exudtive vitreoretinopthy 3 (5) Toxoplsmosis 3 (5) niridi 1 (2) Congenitl hypertrophy of retinl pigment epithelium Secondry VPT n = 56 ptients n (%) 2 (4) Idiopthic choroiditis 1 (2) Retinopthy of premturity 2 (4) Histoplsmosis 1 (2) Totl 56 Dt dpted from Shields CL, Kliki S, l-dmsh S, et l. Retinl vsoprolifertive tumors. Comprtive clinicl fetures of primry versus secondry tumors in 334 cses. JM Ophthlmol. 2013;131(3): bbrevitions: VPT, vsoprolifertive retinl tumor Histopthology Little histopthologic informtion hs been published on retinl rcemose hemngiom. The lrge, dilted retinl vessels pper to hve n cellulr dventitil covering, nd the retin is thin nd cn show extensive degenertion. CQUIRED VSOPROLIFERTIVE TUMOR cquired vsoprolifertive tumor of the oculr fundus is vsculr mss tht cn occur s primry or secondry condition from predisposing intermedite uveitis, retinitis pigmentos, Cots disese, or chronic retinl detchment (Tble 5) Clinicl Fetures Ophthlmoscopiclly, cquired vsoprolifertive tumor ppers s n elevted sessile or dome-shped mss tht is typiclly locted in the equtoril inferotemporl region (Figure 4). The mss cn be circumscribed or quite ill-defined. Minimlly dilted retinl feeding rtery nd drining vein cn be found, but not s mrkedly dilted or tortuous s seen with retinl C Figure 4. Subtle, ill-defined peripherl retinl vsoprolifertive tumor () documented with telngiectsi, nonperfusion, nd lekge on F (), nd showing remote epiretinl membrne in the fove on OCT (C). hemngioblstom. The tumor cn produce findings of intrretinl nd subretinl exudtion, subretinl fluid, remote ERM, cystoid mculr edem, retinl hemorrhge, nd vitreous hemorrhge. The retinl exudtion generlly begins t the tumor mrgin nd grdully mrches posteriorly into the mcul, with ensuing visul loss. Genetics No genetic bnormlities hve been ssocited with this condition, but ptients with secondry tumors should be evluted for underlying retinl conditions. Rrely, this lesion is ssocited with neurofibromtosis type F demonstrtes filling of the mss through slightly dilted nd minimlly tortuous retinl rtery nd drining vein. There is frequently lekge from the vsoprolifertive tumor into the surrounding retin nd vitreous cvity. Remote mculr edem or ERM cn be seen on F nd confirmed on OCT; OCT cn lso demonstrte relted remote ERM. Mngement nd Course Smll, peripherl tumors cn be cutiously observed if there is no lekge, but it is importnt to relize tht they cn progress slowly nd potentilly led to profound visul loss. This progression might be nticipted nd hlted with erly tretment. Tumors with ctive lekge require therpy, which cn include lser photocogultion, thermotherpy, indocynine green-enhnced thermobltion, PDT, cryotherpy, or plque rdiotherpy Cryotherpy often leds to tumor control nd hs been reported to induce relese of the ERM in 63% of cses. 32 Intrvitrel injection of n nti-vegf gent cn ssist in 66 RETIN TODY JULY/UGUST 2015
7 reducing remote mculr edem, nd sub Tenon fsci injection of trimcinolone cn minimize inflmmtory response t tretment. Histopthology Histopthology of cquired vsoprolifertive tumor in the erly phses when the tumor is mostly vsculr hs not been clerly estblished. It is believed to represent prolifertion of blood vessels, glil tissue, nd retinl pigment epithelium, often in response to previous insult from intermedite uveitis, retinitis pigmentos, Cots disese, or other conditions. Lter, s the tumor becomes cliniclly fibrotic, more rective strocytic ppernce cn be documented. 34,35 CONCLUSION There re number of vsculr tumors of the retin, nd ech hs distinct clinicl fetures, imging findings, genetic ltertions, nd mngement strtegies. It is importnt to remember tht severl of these tumors could potentilly crry genetic muttions tht imply systemic disese nd relted brin lesions, so genetic testing nd MRI cn be instrumentl in mngement. We hve found n informtive website ( for oculr genetic testing tht is helpful in directing clinicins towrd relevnt lbortories tht cn provide genetic evlution. s of pril 2015, this website hd logged tests on 4176 disorders with 4747 genes from 649 lbortories. n lexzndr Douglss, S, is postbcclurete resercher t the Oculr Oncology Service, Wills Eye Hospitl, Thoms Jefferson University, in Phildelphi, Pennsylvni. Timothy Higgins, S, is postbcclurete resercher t the Oculr Oncology Service, Wills Eye Hospitl, Thoms Jefferson University, in Phildelphi, Pennsylvni. Wsim. Smr, MD, is postdoctorl resercher t the Oculr Oncology Service, Wills Eye Hospitl, Thoms Jefferson University, in Phildelphi, Pennsylvni. Jerry. Shields, MD, is director of the Oculr Oncology Service t the Oculr Oncology Service, Wills Eye Hospitl, Thoms Jefferson University, in Phildelphi, Pennsylvni. Crol L. Shields, MD, is the co-director of the Oculr Oncology Service, Wills Eye Hospitl, Thoms Jefferson University, in Phildelphi, Pennsylvni. She is member of the Retin Tody Editoril ord. Dr. Shields my be reched t crolshields@gmil.com. Support provided by the Eye Tumor Reserch Foundtion, Phildelphi, Pennsylvni (CLS), nd Lucille Weidmn Fund for Peditric Eye Cncer, Phildelphi, Pennsylvni (JS, CLS). 1. Shields J, Shields CL. Vsculr tumors of the retin nd the optic disc. In: Shields J, Shields CL, eds. Introculr Tumors. n tls nd Textbook. Phildelphi: W Sunders; 2016: Shields CL, Mnlc J, Ds C, Sktnste J, Shields J. Review of spectrl domin enhnced depth imging opticl coherence tomogrphy (EDI-OCT) of tumors of the retin nd retinl pigment epithelium in children nd dults. Ind J Ophthlmol. 2015;63(2): Singh D, Shields CL, Shields J. Von Hippel-Lindu disese. Surv Ophthlmol. 2001;46(2): Wong WT, Chew EY. Oculr von Hippel-Lindu disese: clinicl updte nd emerging tretments. Curr Opin Ophthlmol. 2008;19(3): Mher ER, Neumnn HP, Richrd S. Von Hippel-Lindu disese: clinicl nd scientific review. Eur J Hum Genet. 2011;19(6): Chn CC, Vortmeyer O, Chew EY, et l. VHL gene deletion nd enhnced VEGF gene expression detected in the stroml cells of retinl ngiom. rch Ophthlmol. 1999;117(5): Kelin WG. Von Hippel-Lindu ssocited mlignncies: Mechnisms nd therpeutic opportunities. Drug Discovery Tody: Disese Mechnisms. 2005;2(2): Clzd MJ. Von Hippel-Lindu syndrome: moleculr mechnisms of the disese. Clin Trnsl Oncol. 2010;12(3): Shields CL, Pellegrini M, Ferenczy SR, Shields J. Enhnced depth imging opticl coherence tomogrphy (EDI-OCT) of introculr tumors. From plcid to sesick to rock nd rolling topogrphy. The 2013 Frncesco Orzlesi Lecture. Retin. 2014;34(8): Singh D, Nouri M, Shields CL, et l. Tretment of retinl cpillry hemngiom. Ophthlmology. 2002;109(10); Kreusel KM, ornfeld N, Lommtzsch, et l. Ruthenium-106 brchytherpy for peripherl retinl cpillry hemngiom. Ophthlmology. 1998;105(8): Rj D, enz MS, Murry TG, et l. Slvge externl bem rdiotherpy of retinl cpillry hemngioms secondry to von Hippel-Lindu disese: visul nd ntomic outcomes. Ophthlmology. 2004;111(1): ch T, Thiemeyer D, Hoeh E, et l. Intrvitrel bevcizumb for retinl cpillry hemngiom: longterm results. ct Ophthlmol. 2010;88(4):e137-e Gss JDM. Cvernous hemngiom of the retin. neuro-oculocutneous syndrome. m J Ophthlmol. 1971;71(4): Goldberg RE, Phesnt TR, Shields J. Cvernous hemngiom of the retin. four-genertion pedigree with neuro-oculocutneous involvement nd n exmple of bilterl retinl involvement. rch Ophthlmol. 1979;97(12): Srrf D, Pyne M, Kitchen ND, et l. Fmilil cvernous hemngiom: n expnding oculr spectrum. rch Ophthlmol. 2000;118(7): Messmer E, Lqu H, Wessing, et l. Nine cses of cvernous hemngiom of the retin. m J Ophthlmol. 1983;95(3): Lbuge P, Denier C, ergmetti F, Tournier-Lsserve E. Genetics of cvernous ngioms. Lncet Neurol. 2007;6(3): Couteulx SL, rezin P, Fontine, et l. novel KRIT1/CCM1 truncting muttion in ptient with cerebrl nd retinl cvernous ngioms. rch Ophthlmol. 2002;120(2): Reddy S, Gorin M, McCnnel T, et l. Novel KRIT/CCM1 muttion in ptient with retinl cvernous hemngiom nd cerebrl cvernous mlformtion. Grefes rch Clin Exp Ophthlmol. 2010;248(9): Shields J, Egle RC, Ewing M, et l. Retinl cvernous hemngiom. Fifty-two yers clinicl follow up with clinicopthologic correltion. Retin. 2014;34(6): rcher D, Deutmn, Ernest JT, Krill E. rteriovenous communictions of the retin. m J Ophthlmol. 1973;75(2): ernth-petersen P. Rcemose hemngiom of the retin. Report of three cses with long term follow-up. ct Ophthlmol (Copenh). 1979;57(4): Shh GK, Shields J, Lnning R. rnch retinl vein obstruction secondry to retinl rteriovenous communiction. m J Ophthlmol. 1998;126(3): Mterin M, Shields CL, Mrr P, et l. Retinl rcemose hemngiom. Retin. 2005;25(7): Ppgeorgiou KI, Ghzi-Nouri SM, ndreou PS. Vitreous nd subretinl hemorrhge: n unusul compliction of retinl rcemose hemngiom. Clin Experiment Ophthlmol. 2006;34(2): Ponce F, Hn PP, Spetzler RF, et l. ssocited rteriovenous mlformtion of the orbit nd brin: cse of Wyburn-Mson syndrome without retinl involvement. Cse report. J Neurosurg. 2001;95(2): Shields J, Decker WL, Snborn GE, et l. Presumed cquired retinl hemngioms. Ophthlmology. 1983;90(11): Shields CL, Shields J, rrett J, De Potter P. Vsoprolifertive tumors of the oculr fundus. Clssifiction nd clinicl mnifesttions in 103 ptients. rch Ophthlmol. 1995;113(5): Shields CL, Kliki S, l-dhmsh S, et l. Retinl vsoprolifertive tumors. Comprtive clinicl fetures of primry versus secondry tumors in 334 cses. JM Ophthlmol. 2013;131(3): Shields J, Pellegrini M, Kliki S, Shields CL. Retinl vsoprolifertive tumors in 6 ptients with neurofibromtosis type 1. JM Ophthlmol. 2014;132(2): Cohen V, Shields CL, Demirci H, Shields J. Iodine plque brchytherpy for vsoprolifertive tumor of the retin in 30 eyes. rch Ophthlmol. 2008;126(9): Mnjndvid FP, Shields CL, Kliki S, Shields J. Cryotherpy-induced relese of epiretinl membrne ssocited with retinl vsoprolifertive tumor: nlysis of 16 cses. Retin. 2014;34(8): Heimnn H, ornfeld N, Vij O, et l. Vsoprolifertive tumours of the retin. r J Ophthlmol. 2000;84(10): Shields J, Reichstein D, Mshyekhi, Shields CL. Retinl vsoprolifertive tumors in oculr conditions of childhood. The 2011 Leonrd pt Lecture. J POS. 2012;16(1): Poole Perry LJ, Jkobiec F, Zkk FR, et l. Rective retinl strocytic tumors (so-clled vsoprolifertive tumors): histopthologic, immunohistochemicl, nd genetic studies of four cses. m J Ophthlmol. 2013;155(3): JULY/UGUST 2015 RETIN TODY 67
Concomitant Intraocular Retinoblastoma and Choroidal Hemangioma in a 1-Year-Old Boy
Cse Report doi: 10.5146/tjpth.2017.01411 Concomitnt Introculr Retinoblstom nd Choroidl Hemngiom in 1-Yer-Old oy Ycoub A. Yousef 1, Mys Al-Hussini 2, Freed H. rkt 2, Al Sleh 3, Mon Mohmmd 1, Rsh Deebjh
More informationGeneral Microscopic Changes
Generl Microscopic Chnges 2 This chpter covers collection of microscopic chnges tht lck dignostic specificity ut occur in different specific diseses, s will ecome pprent in susequent chpters. Almost ll
More informationFibromuscular dysplasia (FMD) is an uncommon
Top 8 Lessons Lerned From the US Registry for FMD Understnding the impct of registry dt on clinicl prctice. By Srh O Connor; Jeffrey W. Olin, DO; nd Hether L. Gornik, MD Fibromusculr dysplsi (FMD) is n
More informationIntravitreal Triamcinolone Acetonide in Macular Edema due to Retinal Vein Occlusions: A Comparative Study of 1 mg and 4 mg Doses
Originl Article DOI: 10.17354/ijss/2015/548 Intrvitrel Trimcinolone Acetonide in Mculr Edem due to Retinl Vein Occlusions: A Comprtive Study of 1 mg nd 4 mg Doses Siknder A K Lodhi 1, Sntosh Devulplly
More informationCase Report Acute Zonal Occult Outer Retinopathy with Atypical Findings
Cse Reports in Medicine Volume 24, Article ID 29696, 7 pges http://dx.doi.org/.55/24/29696 Cse Report Acute Zonl Occult Outer Retinopthy with Atypicl Findings Dimitrios Krginnis, Georgios A. Kontdkis,
More informationBENIGN ulceration along the greater curvature of the pars media of the
BENIGN ULCERS OF THE GREATER CURVATURE OF THE STOMACH Report of Two Cses CHARLES H. BROWN, M.D. Deprtment of Gstroenterology nd ANTHONY D. INTRIERE, M.D.* BENIGN ulcertion long the greter curvture of the
More informationBright Futures Medical Screening Reference Table 2 to 5 Day (First Week) Visit
Bright Futures Medicl Reference Tle 2 to 5 Dy (First Week) Visit Universl Action Metolic nd Verify documenttion of neworn metolic screening results, pproprite rescreening, nd needed follow-up. Document
More informationOuter retinal tubulation in diabetic macular edema following anti-vegf treatment
Al-Hlfi Eye nd Vision (2015) 2:9 DOI 10.1186/s40662-015-0018-2 RESEARCH Open Access Outer retinl tuultion in dietic mculr edem following nti-vegf tretment Ali M Al-Hlfi Astrct Bckground: To ddress the
More informationA Rare Manifestation of Solitary Primary Bone Lymphoma of the Finger: a Case Report
pissn 2384-1095 eissn 2384-1109 imri 2018;22:240-244 A Rre Mnifesttion of Solitry Primry Bone Lymphom of the Finger: Cse Report Jeong A Yeom 2, You Seon Song 1 *, In Sook Lee 1, Kyung Un Choi 3, Jeung
More informationEfficacy of Pembrolizumab in Patients With Advanced Melanoma With Stable Brain Metastases at Baseline: A Pooled Retrospective Analysis
Efficcy of Pembrolizumb in Ptients With Advnced Melnom With Stble Brin Metstses t Bseline: A Pooled Retrospective Anlysis Abstrct 1248PD Hmid O, Ribs A, Dud A, Butler MO, Crlino MS, Hwu WJ, Long GV, Ancell
More informationVisual and Anatomic Outcomes of Vitrectomy With Temporary Keratoprosthesis or Endoscopy in Ocular Trauma With Opaque Cornea
CLINICAL SCIENCE Visul nd Antomic Outcomes of Vitrectomy With Temporry Kertoprosthesis or Endoscopy in Oculr Trum With Opque Corne Dl W. Chun, MD; Mrcus H. Colyer, MD; Keith J. Wroblewski, MD BACKGROUND
More informationFundamentals of Spine MRI and Essential Protocols
Fundmentls of Spine MRI nd Essentil Protocols A. C. Dougls-Akinwnde, MD Octoer 13, 2009 Fundmentls of Spine MRI Lerning Ojectives: 1. List the essentil sequences for Spine MRI exmintion 2. Discuss the
More informationAnus,Rectum and Colon
JOURNAL OF THE Anus,Rectum nd Colon http://journl-rc.jp CASE REPORT Anl Cnl Dupliction Associted with Prescrl Cyst in n Adult Tkyuki Toyong 1), Hiromitsu Mtsud 1), Ryuichi Miu 1), Yohei Toming 1), Keiji
More informationArthroscopic Anatomy of Shoulder
Arthroscopic Antomy of Shoulder Murt Bozkurt, Mehmet Emin Simsek, nd Hlil İrhim Açr 2 2.1 Introduction In the lst 30 yers, shoulder rthroscopy hs ecome of greter importnce in the dignosis nd tretment of
More informationimri 2015;19:
pissn 2384-1095 eissn 2384-1109 imri 2015;19:241-247 http://dx.doi.org/10.13104/imri.2015.19.4.241 Pncretic Arteriovenous Mlformtion s n Unusul Cuse of Chronic Gstrointestinl Bleeding in Ptient with Erly
More informationTales of the Unexpected: Incidental Findings in Ophthalmic Imaging
62 The Journl of Ophthlmic Photogrphy Volume 35, Numer 2 Fll 2013 ORIGINAL ARTICLE Angel J Chppell B.App.Sci, CRA, OCT-C Jmie E Crig MBBS(hons), D.Phil., FRANZCO Ophthlmology Deprtment Flinders Medicl
More informationThe potential future of targeted radionuclide therapy: implications for occupational exposure? P. Covens
The potentil future of trgeted rdionuclide therpy: implictions for occuptionl exposure? Introduction: Trgeted Rdionuclide Therpy (TRT) Systemic tretment Molecule lbelled with rdionuclide delivers toxic
More informationSubthreshold Micropulse Laser (577 nm) Treatment in Chronic Central Serous Chorioretinopathy
Originl Pper Received: Mrch 24, 2015 Accepted fter revision: August 17, 2015 Published online: September 26, 2015 Subthreshold Micropulse Lser (577 nm) Tretment in Chronic Centrl Serous Chorioretinopthy
More informationNational audit of the
(2002) 16, 771 777 2002 Nture Publishing Group All rights reserved 0950-222X/02 $25.00 www.nture.com/eye JA Thompson 1, MP Sned 2, BM Billington 3, Ntionl udit of the T Brrie 4, JR Thompson 5 nd JM Sprrow
More informationElectroretinogram b/a wave ratio improvement in central retinal vein obstruction
BritishJournl ofophthlmology 1994; 78: 191-198 Schepens Eye Reserch Institute, 20 Stniford Street, Boston, USA Y Mtsui O Ktsumi T Hirose Retin Assocites, 100 Chrles River Plz, Boston, USA O Ktsumi T Hirose
More informationUniversity of Cape Town
.. I i I II I I The copyright of this thesis vests in the uthor. No quottion from it or informtion derived from it is to be published without full cknowledgement of the source. The thesis is to be used
More informationThallium-201 chloride scintigraphy in soft tissue tumors
136 ORIGINAL Thllium-201 chloride scintigrphy in soft tissue tumors Hideki Otsuk, Kori Terzw, Nomi Morit, Yoichi Otomi, Shoichiro Tko, Seiji Iwmoto, Kyosuke Oski, Msfumi Hrd, nd Hiromu Nishitni Deprtment
More informationStart ORKAMBI today. INDICATIONS AND USAGE IMPORTANT SAFETY INFORMATION. Sydney Age 4
F O R H E A L T H C A R E P R O F E S S I O N A L S For ptients ge 2 yers nd older who re homozygous for the F508del muttion 1,2 Modify the course. Strt tody. Sydney Age 4 F508del/F508del INDICATIONS AND
More informationEndovascular Management of Sigmoid Sinus Diverticulum
Published online: My 12, 2016 1664 9737/16/0052 0076$39.50/0 Originl Pper Endovsculr Mngement of Sigmoid Sinus Diverticulum Srinivsn Prmsivm Sunil Furtdo Tomoyoshi Shigmtsu Eric Smouh b Center for Cerebrovsculr
More informationSeeding Metastasis of Chromophobe Renal Cell Carcinoma after Robot-Assisted Laparoscopic Partial Nephrectomy
pissn 2384-1095 eissn 2384-1109 imri 2017;21:119-124 https://doi.org/10.13104/imri.2017.21.2.119 Seeding Metstsis of Chromophoe Renl Cell Crcinom fter Root-Assisted Lproscopic Prtil Nephrectomy Knghun
More informationXII. HIV/AIDS. Knowledge about HIV Transmission and Misconceptions about HIV
XII. HIV/AIDS Knowledge bout HIV Trnsmission nd Misconceptions bout HIV One of the most importnt prerequisites for reducing the rte of HIV infection is ccurte knowledge of how HIV is trnsmitted nd strtegies
More informationCase Report INTRODUCTION CASE REPORT. pissn eissn X
pissn 2287-2728 eissn 2287-285X Cse Report Clinicl nd Moleculr Heptology 2018;24:424-429 Complete cure of dvnced heptocellulr crcinom with right drenl glnd metstsis nd portl vein thrombosis by multiple
More informationAmerican Joint Committee on Cancer Staging and Clinicopathological High-Risk Predictors of Ocular Surface Squamous Neoplasia
Americn Joint Committee on Cncer Stging nd Clinicopthologicl High-Risk Predictors of Oculr Surfce Squmous Neoplsi A Study From Tertiry Eye Center in Indi Sheetl Chuhn, MSc; Seem Sen, MD; Anjn Shrm, PhD;
More informationUnilateral Eye Findings: A Rare Herald of Acute Leukemia
Cse Series nd Brief Reports Received: Septemer 10, 2015 Accepted fter revision: Novemer 20, 2015 Pulished online: Jnury 13, 2016 Unilterl Eye Findings: A Rre Herld of Acute Leukemi Avni V. Ptel John B.
More informationThe Dynamics of Varicella-Zoster Virus Epithelial Keratitis in Herpes Zoster Ophthalmicus
Chpter 2 The Dynmics of Vricell-Zoster Virus Epithelil Kertitis in Herpes Zoster Ophthlmicus The morphology of n individul VZV lesion reflects sequence of events triggered y the virus impct on cornel epithelil
More informationC reactive protein: an aid to assessment and
C rective protein: n id to ssessment nd monitoring of cute pncretitis J Clin Pthol 1984;37:27-211 AD MAYR,* MJ McMAHON,* MARGART BOWN,t H COOPRt From the *University Deprtment ofsurgery, Generl Infrmry,
More informationSuccessful Diagnosis of a Thymoma by Endobronchial Ultrasound-guided Transbronchial Needle Aspiration: A Report of Two Cases
CASE REPORT Successful Dignosis of Thymom y Endoronchil Ultrsound-guided Trnsronchil Needle Aspirtion: A Report of Two Cses Ysushi Yoshid 1, Msto Singyoji 1, Hironori Ashinum 1, Meiji Itkur 1, Toshihiko
More informationSymptomatic Remote Cyst after BCNU Wafer Implantation for Malignant Glioma
Cse Report doi: 10.2176/nmc.cr.2017-0218 Neurol Med Chir (Tokyo) 58, 270 276, 2018 Symptomtic Remote Cyst fter BCNU Wfer Implnttion for Mlignnt Gliom Online My 21, 2018 Hideki MATSUMURA, 1 Eiichi ISHIKAWA,
More informationCheckMate 153: Randomized Results of Continuous vs 1-Year Fixed-Duration Nivolumab in Patients With Advanced Non-Small Cell Lung Cancer
CheckMte 53: Rndomized Results of Continuous vs -Yer Fixed-Durtion Nivolumb in Ptients With Advnced Non-Smll Cell Lung Cncer Abstrct 297O Spigel DR, McCleod M, Hussein MA, Wterhouse DM, Einhorn L, Horn
More informationORIGINAL ARTICLE. Diagnostic Signs of Accommodative Insufficiency. PILAR CACHO, OD, ÁNGEL GARCÍA, OD, FRANCISCO LARA, OD, and M A MAR SEGUÍ, OD
1040-5488/02/7909-0614/0 VOL. 79, NO. 9, PP. 614 620 OPTOMETRY AND VISION SCIENCE Copyright 2002 Americn Acdemy of Optometry ORIGINAL ARTICLE Dignostic Signs of Accommodtive Insufficiency PILAR CACHO,
More informationImprovement in Vision Parameters for Participants Treated With Alternative Therapies in a 3-day Program
This rticle is protected by copyright. To shre or copy this rticle, plese visit copyright.com. Use ISSN#178-6791. To subscribe, visit lterntive-therpies.com ORIGINAL RESEARCH Improvement in Vision Prmeters
More informationInfluence of lateral cephalometric radiography in orthodontic diagnosis and treatment planning
Originl Article Influence of lterl cephlometric rdiogrphy in orthodontic dignosis nd tretment plnning An Reis Durão ; Ali Alqerbn b ; Afonso Pinhão Ferreir c ; Reinhilde Jcobs d ABSTRACT Objective: To
More informationSurgical Neurology International
Surgicl Neurology Interntionl SNI: Peditric Neurosurgery, supplement to Surgicl Neurology Interntionl OPEN ACCESS For entire Editoril Bord visit : http://www.surgiclneurologyint.com How I Do It: Mngement
More informationClinical manifestations in patients with alpha-fetoprotein producing gastric cancer
Curr Oncol, Vol. 21, pp. e394-399; doi: http://dx.doi.org/10.3747/co.21.1768 CLINICAL MANIFESTATIONS IN AFP PRODUCING GASTRIC CANCER ORIGINAL ARTICLE Clinicl mnifesttions in ptients with lph-fetoprotein
More informationPNEUMOVAX 23 is recommended by the CDC for all your appropriate adult patients at increased risk for pneumococcal disease 1,2 :
PNEUMOVAX 23 is recommended y the CDC for ll your pproprite dult ptients t incresed risk for pneumococcl disese 1,2 : Adults ged
More informationP (RCC) was first done in the late 1930s and reported in
Pulmonry Resection of Metsttic Renl Cell Crcinom Robert J. Cerfolio, MD, Mrk S. Allen, MD, Clude Deschmps, MD, Richrd C. Dly, MD, Steven L. Wllrichs, BS, Victor F. Trstek, MD, nd Peter C. Pirolero, MD
More informationSkull fracture vs. accessory sutures: how can we tell the difference?
Emerg Rdiol (2010) 17:413 418 DOI 10.1007/s10140-010-0877-8 PICTORIAL ESSAY Skull frcture vs. ccessory sutures: how cn we tell the difference? Thoms Snchez & Deorh Stewrt & Mtthew Wlvick & Leonrd Swischuk
More informationLung cancer is the leading cause of cancer death worldwide, EGFR Mutation and Brain Metastasis in Pulmonary Adenocarcinomas
Originl Article EGFR Muttion nd Brin Metstsis in Pulmonry Adenocrcinoms Dong-Yeop Shin, MD,* Im Il N, MD,* Cheol Hyeon Kim, MD, PhD, Sunhoo Prk, MD, PhD, HeeJong Bek, MD, PhD, nd Sung Hyun Yng, MD, PhD*
More information27 June Bmnly L. WALTER ET AL.: RESPONSE OF CERVICAL CANCERS TO IRRADIATION
27 June 1964 Bmnly MEDICAL JOURNAL L. WALTER ET AL.: RESPONSE OF CERVICAL CANCERS TO IRRADIATION x 1,638.) FIG. 2.-Foci of sme tumour s in Fig. 1 contining vible tumour cells with scnty cytoplsm, reltively
More informationEvidence for preserved direct pupillary light
442 Deprtment of Ophthlmology, Kitsto niversity School of Medicine, Sgmihr, Jpn M Wkkur J Yokoe Correspondence to: Msto Wkkur, MD, Deprtment of Ophthlmology, Kitsto niversity School of Medicine, 1-15-1
More informationA Case of Intraductal Papillary Mucinous Carcinoma in the Head of the Pancreas Associated With Absence of the Duct of Wirsung
CASE REPORT A Cse of Intrductl Ppillry Mucinous Crcinom in the Hed of the Pncres Associted With Asence of the Duct of Wirsung Ismu Mkino, Tkhis Ymguchi, Mitsuyoshi Okzki, Tomohru Miyshit, Hidehiro Tjim,
More informationBLISTER-SPREAD INDUCED BY FINGER-PRESSURE, A DIAGNOSTIC SIGN
BLSTER-SPREAD NDUCED BY FNGER-PRESSURE, A DAGNOSTC SGN N PEMPHGUS* A dignostic nd pthognomonic feture of pemphigus vulgris (cutus) is the reduction or loss of cohesion between the epiderml cells. This
More informationReal-world outcomes of anti-vegf treatment for retinal vein occlusion in Portugal
EJO ISSN 1120-6721 Eur J Ophthlmol 2017; 00 (00): 000-000 DOI: 10.5301/ejo.5000943 ORIGINAL RESEARCH ARTICLE Rel-world outcomes of nti-vegf tretment for retinl vein occlusion in Portugl Sr Vz-Pereir 1,2,
More informationLATE RESULTS OF TRANSFER OF THE TIBIAL TUBERCLE FOR RECURRENT DISLOCATION OF THE PATELLA1
LATE RESULTS OF TRANSFER OF THE TIBIAL TUBERCLE FOR RECURRENT DISLOCATION OF THE PATELLA1 W. G. J. HAMPSON nd P. HILL, BRISTOL, ENGLAND The uthors wished to determine the lte results of the Huser opertion,
More informationPolypoidal choroidal vasculopathy associated with Doyne s familial choroiditis: treatment with thermal laser
E u ropen Journl of Ophthlmology / Vol. 14 no. 3, 2004 / pp. 2 6 4-2 6 8 S H O RT COMMUNICAT I O N Cse re p o r t Polypoidl horoidl vsulopthy ssoited with Doyne s fmilil horoiditis: tretment with therml
More informationStenosis or Occlusion of the Right Subclavian and Common Carotid Arteries Is More Common than That of the Innominate Artery in Takayasu Arteritis
Vsculr Specilist Interntionl Vol. 31, No. 4, December 2015 pissn 2288-7970 eissn 2288-7989 Stenosis or Occlusion of the Right Subclvin nd Common Crotid Arteries Is More Common thn Tht of the Innominte
More informationWSU Tree Fruit Research and Extension Center, Wenatchee (509) ext. 265;
FINAL REPORT WTFRC Project # AH-1-5 WSU Project # 13C-355-3 Project title: PI: Orgniztion: Coopertors: of Sunburn in Apples with RAYNOX Lrry Schrder, Horticulturist WSU Tree Fruit Reserch nd Extension
More informationAnalysis of Regulatory of Interrelated Activity of Hepatocyte and Hepatitis B Viruses
Interntionl Journl of Biomedicl Mterils Reserch 8 6(): -7 http://www.sciencepublishinggroup.com/j/ijbmr doi:.648/j.ijbmr.86. ISSN: 33-756 (Print) ISSN: 33-7579 (Online) Anlysis of Regultory of Interrelted
More informationInput from external experts and manufacturer on the 2 nd draft project plan Stool DNA testing for early detection of colorectal cancer
Input externl experts nd mnufcturer on the 2 nd drft project pln Stool DNA testing for erly detection of colorectl cncer (Project ID:OTJA10) All s nd uthor s replies on the 2nd drft project pln Stool DNA
More informationSUPPLEMENTARY INFORMATION
TM TM tip link horizontl top connectors 1 leucine-rich (21 %) otoncorin-like 1809 ntigenic peptides B D signl peptide hydrophoic segment proline/threonine-rich (79 %) Supplementry Figure 1. () The outer
More informationPatterns of Single Gene Inheritance
M1 Humn Genetics Types of Genetic Disese Ptterns of Single Gene Inheritnce Virgini A. Pllnte, M.S. vpllnte@mcvh-vcu.edu Chromosoml Single gene (Mendelin) Multifctoril Tertogenic 1 2 3 4 A A A 1 2 homozygote
More informationClassic Papillary Thyroid Carcinoma with Tall Cell Features and Tall Cell Variant Have Similar Clinicopathologic Features
The Koren Journl of Pthology 2014; 48: 201-208 ORIGINAL ARTICLE Clssic Ppillry Thyroid Crcinom with Tll Cell Fetures nd Tll Cell Vrint Hve Similr Clinicopthologic Fetures Woo Jin Oh 1 Young Sub Lee 1 Uiju
More informationGlobal Intellectual Deficits in Cystinosis
Americn Journl of Medicl Genetics 49:83-87 (1994) Globl Intellectul Deficits in Cystinosis Brbr L.H. Willims, Jerry A. Schneider, nd Doris A. Truner Deprtments of Neurosciences (B.L.H.W.. D.A.T.) nd Peditrics
More informationTHE EVALUATION OF DEHULLED CANOLA MEAL IN THE DIETS OF GROWING AND FINISHING PIGS
THE EVALUATION OF DEHULLED CANOLA MEAL IN THE DIETS OF GROWING AND FINISHING PIGS THE EVALUATION OF DEHULLED CANOLA MEAL IN THE DIETS OF GROWING AND FINISHING PIGS John F. Ptience nd Doug Gillis SUMMARY
More informationOriginal Research. Oral mucocutaneous lesions - Histopathological and immunofluorescence study Rameshkumar A et al
Received: 18 th Septemer 2014 Accepted: 20 th Decemer 2014 Conflicts of Interest: None Source of Support: Nil Originl Reserch Orl Mucocutneous Lesions A Comprtive Clinicopthologicl nd Immunofluorescence
More informationOrofacial Manifestations of Encephalotrigeminal Angiomatosis: A Case Report and Review of Literature
CASE REPORT Orofcil Mnifesttions of Encephlotrigeminl Angiomtosis: A Cse Report nd Review of Literture V. Bhvn, B. Blji Bu, J. Shilp Ro, M. Mounik Reddy Deprtment of Orl Medicine nd Rdiology, Kmineni Institute
More informationMassive Pulmonary Embolism Thrombolysis: Early Clinical Markers of Treatment Efficacy
Originl Article 17 Mssive Pulmonry Emolism Thromolysis: Erly Clinicl Mrkers of Tretment Efficcy Elie Portnoy 1 Vihor Wdhw 2 Mrin de Crvlho Bros 3 Clifford R. Weiss 1 Brin Holly 1 Mrk L. Lessne 1,4 Kelvin
More informationSignificance of Expression of TGF- in Pulmonary Metastasis in Non-small Cell Lung Cancer Tissues
Originl Article Significnce of Expression of in Pulmonry Metstsis in Non-smll Cell Lung Cncer Tissues Hisshi Sji, Hruhiko Nkmur, Idiris Awut, Norihito Kwski, Msru Hgiwr, Akihiko Ogt, Mkoto Hosk, Tkmoto
More informationEfficacy of Sonidegib in Patients With Metastatic BCC (mbcc)
AAD 216 eposter 3368 Efficcy of Sonidegib in Ptients With Metsttic BCC (mbcc) Colin Morton, 1 Michel Migden, 2 Tingting Yi, 3 Mnish Mone, 3 Dlil Sellmi, 3 Reinhrd Dummer 4 1 Stirling Community Hospitl,
More informationEtiology of Vocal Cord Paralysis
Originl Pper ORL 2007;69:167 171 DOI: 10.1159/000099226 Received: Mrch 6, 2006 Accepted fter revision: August 25, 2006 Published online: Jnury 30, 2007 Etiology of Vocl Cord Prlysis Hsin-Chien Chen Yee-Min
More informationSupplementary Online Content
Supplementry Online Content Zulmn DM, Pl Chee C, Ezeji-Okoye SC, et l. Effect of n intensive outptient progrm to ugment primry cre for high-need Veterns Affirs ptients: rndomized clinicl tril. JAMA Intern
More informationJournal of Personality
T5r 19c2,4-J uytie& çln 0 Journl of Personlity EDTORAL BOARD GORDON W. ALLPORT Hrvrd University MERTON GLL Austen Riggs Foundtion JOHN GLLN University of North Crolin DONALD. HEBB McGill University DAVD
More informationIntroduction. These patients benefit less from conventional chemotherapy than patients identified as MMR proficient or microsatellite stable 3-5
Nivolumb + Ipilimumb Combintion in Ptients With DNA Mismtch Repir-Deficient/Microstellite Instbility-High Metsttic Colorectl Cncer: First Report of the Full Cohort From CheckMte-142 Abstrct 553 André T,
More informationFindings Regarding an Intracranial Hemorrhage on the Phase Image of a Susceptibility-Weighted Image (SWI), According to the Stage, Location, and Size
pissn 2384-1095 eissn 2384-1109 imri 2015;19:107-113 http://dx.doi.org/10.13104/imri.2015.19.2.107 Findings Regrding n Intrcrnil Hemorrhge on the Phse Imge of Susceptiility-Weighted Imge (SWI), According
More informationWORKSHOP FOR SYRIA. A SHORT TERM PROJECT A Collaborative Map proposal Al Moadamyeh, Syria
Al Modmyeh is city locted south-west Dmscus, in Syri. It is fcing post-conflict sitution, fter yers of siege nd displcement of its inhbitnts. Now, the popultion is coming bck, s lso new incomers. Therefore,
More informationDental Rehabilitation of Patients with Amelogenesis Imperfecta using Zirconia Crowns, Stainless Steel Crowns, and Composite Veneers: A Case Report
Cse Report Print ISSN: 2321-6379 Online ISSN: 2321-595X DOI: 10.17354/ijss/2016/641 Dentl Rehilittion of Ptients with Amelogenesis Imperfect using Zirconi Crowns, Stinless Steel Crowns, nd Composite Veneers:
More informationMedical Thoracoscopy vs CT Scan-Guided Abrams Pleural Needle Biopsy for Diagnosis of Patients With Pleural Effusions
CHEST Originl Reserch PLEURAL DISEASE Medicl Thorcoscopy vs CT Scn-Guided Abrms Pleurl Needle Biopsy for Dignosis of Ptients With Pleurl Effusions A Rndomized, Controlled Tril Muzffer Metints, MD; Guntulu
More informationTrunk muscle involvement in late-onset Pompe disease: Study of thirty patients
Avilble online t www.sciencedirect.com Neuromusculr Disorders 22 (2012) S148 S154 www.elsevier.com/locte/nmd Trunk muscle involvement in lte-onset Pompe disese: Study of thirty ptients Aíd Alejldre,b,
More informationHIROATSU NAKASHIMA, MASAHIRO YOSHIDA & KENTARO MIYAMOTO. Department of Orthopedic Surgery, Aichi Hospital, Aichi Cancer Center, Okazaki, Japan
Upsl Journl of Medicl Sciences. 2012; 117: 460 464 CASE REPORT Antomicl reconstruction of the ptellr tendon using the fsci lt ttched to the ilic one following resection for soft tissue srcom: A cse report
More informationFindings in spontaneous intramural intestinal hematoma imaging
Brief report Findings in spontneous intrmurl intestinl hemtom imging F. Mirs Azcón, A. Mrtínez Mrtínez, A. Sntigo Chinchill*, A. Medin Benítez, E. Ochndo Pulido nd M.A. Pérez Rosillo Imging deprtment,
More informationPostinfective physeal bars MRI features and choice of management
Postinfective physel rs MRI fetures nd choice of mngement Murry Hyes, MB ChB Svvs Andronikou, MB BCh, FC Rd, FRCR, PhD Crey Mckenzie, MB ChB, FCRd Jco du Plessis, MB ChB Reen George, MB BS, MMed Rd Slomine
More informationRecurrent Giant Phyllodes Tumour in a Young Female: A Case Report
CASE REPORT J. Trnsl. Med. Res 2016;21(3):210-214 DOI: 10.21614/jtmr-21-3-96 Recurrent Gint Phyllodes Tumour in Young Femle: A Cse Report Mhim Koshriy 1, Ashish Shrm 1, Ajy Gehlot 1, Surhi Grg 1, M.C.
More informationResults of the Tokyo Consensus Meeting Tokyo Guidelines
J Heptobiliry Pncret Surg (2007) 14:114 121 DOI 10.1007/s00534-006-1163-8 Results of the Tokyo Consensus Meeting Tokyo Guidelines Toshihiko Myumi 1, Tdhiro Tkd 2, Yoshifumi Kwrd 3, Yuji Nimur 4, Mshiro
More informationof comorbid conditions, interventions Diagnosis and treatment, treatment reduction of risk factors for CVD to slow disease progression,
Tble 5.1. NKF Clssifiction of Chronic Kidney Disese nd Clinicl Fetures Stge Description GFR (ml/ min/1.73 m 2 ) U.S. Prevlence, b # Affected (%) Clinicl Fetures Action Pln c At incresed risk for CKD >60
More informationAnalysis of 18 F-fluorodeoxyglucose positron emission tomography findings in patients with pituitary lesions
ORIGINAL ARTICLE Koren J Intern Med 2013;28:81-88 http://dx.doi.org/10.3904/kjim.2013.28.1.81 Anlysis of F-fluorodeoxyglucose positron emission tomogrphy findings in ptients with pituitry lesions Hnnh
More informationCharacteristics of hip involvement in patients with ankylosing spondylitis in Korea
ORIGINAL ARTICLE Koren J Intern Med 2017;32:158-164 Chrcteristics of hip involvement in ptients with nkylosing spondylitis in Kore Hyemin Jeong, Yeong Hee Eun, In Young Kim, Hyungjin Kim, Jejoon Lee, Eun-Mi
More informationSupernormal scotopic ERG in cone dystrophy
British Journl of Ophthlmology, 1984, 68, 69-78 Supernorml scotopic ERG in cone dystrophy KENNETH R. ALEXANDER AND GERALD A. FISHMAN From the Deprtment of Ophthlmology, University ofillinois Eye nd Er
More informationAgilent G6825AA MassHunter Pathways to PCDL Software Quick Start Guide
Agilent G6825AA MssHunter Pthwys to PCDL Softwre Quick Strt Guide Wht is Agilent Pthwys to PCDL? Fetures of Pthwys to PCDL Agilent MssHunter Pthwys to PCDL converter is stnd-lone softwre designed to fcilitte
More informationCase Report Surgical Resection of a Leiomyosarcoma of the Inferior Vena Cava Mimicking Hepatic Tumor
Cse Reports in Medicine Volume 2013, Article ID 235698, 5 pges http://dx.doi.org/10.1155/2013/235698 Cse Report Surgicl Resection of Leiomyosrcom of the Inferior Ven Cv Mimicking Heptic Tumor Junji Ued,
More informationmsmr MEDICAL SURVEILLANCE MONTHLY REPORT INSIDE THIS ISSUE: A publication of the Armed Forces Health Surveillance Center Summary tables and figures
VOL. 17 NO. 09 SEPTEMBER 2010 msmr A publiction of the Armed Forces Helth Surveillnce Center MEDICAL SURVEILLANCE MONTHLY REPORT Source: CDC INSIDE THIS ISSUE: Contct trnsfer of vccini virus from U.S.
More informationNeuroendocrine Carcinoma with an Adenocarcinoma Component on the Ampulla of Vater Causing Acute Pancreatitis: A Case Report
CASE REPORT Neuroendocrine Crcinom with n Adenocrcinom Component on the Ampull of Vter Cusing Acute Pncretitis: A Cse Report Reiko Ymd 1, Kenichiro Nishikw 2, Msshi Kishiwd 3, Hiroyuki Inoue 1, Tkshi Skuno
More informationPressure Ulcers ecourse: Module 2 Quiz II
Pressure Ulcers ecourse: Moule 2 Quiz II 1. Yellow or white tissue tht heres to the ulcer be in strings or thick clumps or is mucinous is:. Eschr b. Slough c. Grnultion tissue. Epithelil tissue 2. New
More information3D RECONSTRUCTION OF THE TEMPORAL BONE IN COCHLEAR IMPLANT SURGERY
3D RECONSTRUCTION OF THE TEMPORAL BONE IN COCHLEAR IMPLANT SURGERY M.C. Dhm, H.L. Seldon, B.C. Pymn nd G.M. Clrk Humn Communiction Reserch Centre, Deprtment o/otolryngology, University 0/ Melbourne, The
More informationClinical Study Report Synopsis Drug Substance Naloxegol Study Code D3820C00018 Edition Number 1 Date 01 February 2013 EudraCT Number
EudrCT Number 2012-001531-31 A Phse I, Rndomised, Open-lbel, 3-wy Cross-over Study in Helthy Volunteers to Demonstrte the Bioequivlence of the Nloxegol 25 mg Commercil nd Phse III Formultions nd to Assess
More informationEmerging Options for Thromboprophylaxis After Orthopedic Surgery: A Review of Clinical Data
Emerging Options for Thromboprophylxis After Orthopedic Surgery: A Review of Clinicl Dt Bob L. Lobo, Phrm.D. In four rndomized, controlled studies of ptients undergoing orthopedic surgery, the ntithrombotic
More informationEffects of physical exercise on working memory and prefrontal cortex function in post-stroke patients
Effects of physicl exercise on working memory nd prefrontl cortex function in post-stroke ptients M Moriy, C Aoki, K Sktni Grdute School of Helth Sciences Reserch, Mjor of Physicl Therpy, TeikyoHeisei
More informationInformative Value of Magnetic Resonance Imaging and EEG in the Prognosis of Infantile Spasms
Epilepsi, 43(3):246 252, 2002 Blckwell Publishing, Inc. Interntionl Legue Aginst Epilepsy Informtive Vlue of Mgnetic Resonnce Imging nd EEG in the Prognosis of Infntile Spsms *Sem Sltik, Nci Kocer, nd
More informationAnalysis of Risk Factors for the Development of Incisional and Parastomal Hernias in Patients after Colorectal Surgery
Originl Article Journl of the Koren Society of J Koren Soc Coloproctol 2012;28(6):299-303 http://dx.doi.org/10.3393/jksc.2012.28.6.299 pissn 2093-7822 eissn 2093-7830 Anlysis of Risk Fctors for the Development
More informationSurgical Neurology International
Surgicl Neurology Interntionl SNI: Unique Cse Oservtions, supplement to Surgicl Neurology Interntionl OPEN ACCESS For entire Editoril Bord visit : http://www.surgiclneurologyint.com Editor: Jmes I. Ausmn,
More informationNatural History and Treatment of Wilms's Tumour : An Analysis of 335 Cases Occurring in England and Wales
24 October MEDCL JOURNL 15 Ppers nd Originls Nturl History nd Tretment Wilms's Tumour : n nlysis 335 Cses Occurring in Englnd nd Wles 12- E. M. LEDLE,* M.B., B.S., D.M.R.; L. S. MYNORS,* M.B., B.S.; G.
More informationPrevalence of TMJ Disc Displacement in a Pre-Orthodontic Adolescent Sample
Originl Article Prevlence of TMJ Disc Displcement in Pre-Orthodontic Adolescent Smple B. Nebbe, BDS, MDent, FFD(SA)Ortho, PhD ; P. W. Mjor, DDS, MSc, MRCD b Abstrct: This study evluted the prevlence of
More informationThe Efficacy of Low-Energy Selective Laser Trabeculoplasty
c l i n i c l s c i e n c e The Efficcy of Low-Energy Selective Lser Treculoplsty Min Tng, MD; Yng Fu, MD; Ming-shui Fu, MD; Ying Fn, MD; Hi-dong Zou, MD; Xio-dong Sun, MD; Xun Xu, MD n BACKGROUND AND
More informationThe Selective Arterial Calcium Injection Test is a Valid Diagnostic Method for Invisible Gastrinoma with Duodenal Ulcer Stenosis: A Case Report
Hiroshim J. Med. Sci. Vol. 65, No. 1, 13~17, Mrch, 2016 HIJM 65 3 13 The Selective Arteril Clcium Injection Test is Vlid Dignostic Method for Invisile Gstrinom with Duodenl Ulcer Stenosis: A Cse Report
More informationEffect of fungicide timing and wheat varietal resistance on Mycosphaerella graminicola and its sterol 14 α-demethylation-inhibitorresistant
Effect of fungicide timing nd whet vrietl resistnce on Mycospherell grminicol nd its sterol 14 α-demethyltion-inhiitorresistnt genotypes Didierlurent L., Roisin-Fichter C., Snssené J., Selim S. Pltform
More informationIntraventricular CNS lesions: A pictorial essay
s_s_nner Journl of Medicl Imging nd Rdition Oncology 59 (2015) 453 460 MEDICAL IMAGING PICTORIAL ESSAY Intrventriculr CNS lesions: A pictoril essy Jne Wtts, 1 Kelvin K Yp, 1 Dniel Ou, 2 Con Trtgli, 1 Nichols
More information