Effects of celecoxib in human retinoblastoma cell lines and in a transgenic murine model of retinoblastoma

BACKGROUND/AIM

Celecoxib, a cyclooxygenase-2 inhibitor and antiangiogenic agent, has demonstrated potent anticancer effects in preclinical studies and in human clinical trials. To evaluate the potential utility of this agent in the treatment of retinoblastoma, the authors investigated the effects of celecoxib in retinoblastoma cell lines and in a murine model of this disease.

METHODS

Growth inhibitory effects of celecoxib were evaluated in Y79 and Weri-RB1 human retinoblastoma cell lines by WST-1 cell proliferation assay. For animal study, two groups of 24, 8 week old LHbeta-TAg transgenic mice were treated with celecoxib (250 mg/kg, orally once a day) or vehicle control, 5 days/week for 6 weeks. Mice were sacrificed on day 43. Enucleated eyes were serially sectioned and ocular tumour burden was quantified by histopathological analysis.

RESULTS

Celecoxib did not inhibit proliferation of Y79 or Weri-RB1 cells, even at concentrations far exceeding clinically achievable levels. No significant difference in ocular tumour burden between celecoxib treated and control mice (p=0.73) was found.

CONCLUSION

Celecoxib was ineffective at inhibiting proliferation of retinoblastoma cells in vitro and was ineffective at controlling retinoblastoma tumour growth in a murine model of this disease. On the basis of these findings, oral celecoxib therapy is unlikely to have clinical utility in the treatment of retinoblastoma.

Skeletal muscle metastasis from uterine leiomyosarcoma

A case of a 68-year-old woman who presented with a rapidly enlarging painful right thigh mass is presented. She had a known diagnosis of uterine leiomyosarcoma following a hysterectomy for dysfunctional uterine bleeding. She subsequently developed a single hepatic metastatic deposit that responded well to radiofrequency ablation. Whole-body MRI and MRA revealed a vascular mass in the sartorius muscle and a smaller adjacent mass in the gracilis muscle, proven to represent metastatic leiomyosarcoma of uterine origin. To our knowledge, metastatic uterine leiomyosarcoma to the skeletal muscle has not been described previously in the English medical literature.

Coexistence of aneurysmal subarachnoid haemorrhage and pituitary apoplexy: Case report and review of the literature

A case of aneurysmal subarachnoid haemorrhage with associated haemorrhagic infarction of a growth hormone secreting pituitary macroadenoma is presented. The subarachnoid haemorrhage was not identifiable on CT, but was apparent on MRI. Angiography revealed a 7mm right posterior communicating aneurysm, a 3mm left A1 segment anterior cerebral aneurysm, and vasospasm. Surgery was performed through a right pterional/subfrontal approach, clipping both aneurysms and debulking the tumour. The left A1 aneurysm was the site of subarachnoid haemorrhage. There was evidence of haemorrhagic infarction of the pituitary tumour. Although rupture of an aneurysm into a pituitary tumour has been previously reported, this is the first case reported of aneurysmal subarachnoid haemorrhage with coexisting pituitary apoplexy where the aneurysm had not bled directly into the pituitary tumour. The literature regarding the association between pituitary tumours and aneurysm is reviewed.

Methylcellulose gel is a superior contrast agent for ultrasound examination of the cervix in obstetric patients

OBJECTIVE

To determine the superior contrast agent for cervical sonography: water-soluble methylcellulose gel vs. normal saline.

METHODS

Women with an indication for cervical sonography underwent placement of 10 mL water-soluble methylcellulose gel or normal saline. Assessment of cervical dimensions and contour was performed via transperineal sonography prior to and after contrast placement.

RESULTS

Twenty-five patients with similar demographic characteristics and indications for ultrasonography were enrolled into each group. Administration of contrast improved the ability to visualize the external os or vaginal fornices in 18 women in the gel group vs. six in the saline group (P = 0.002). In the gel group, 17 patients had easier identification of the external os and visualization of the fornices was enhanced in 13 patients. The assessment of cervical length prior to and after contrast administration was not statistically different with the use of either of these agents.

CONCLUSION

Intravaginal soluble gel is superior to normal saline as a cervical contrast agent. Intravaginal contrast may allow for easier identification of cervical anatomy during ultrasonographic examination in selected patients.

Funneling to the stitch: an informative ultrasonographic finding after cervical cerclage

OBJECTIVE

The purpose of this study was to evaluate the utility of ultrasound surveillance after cerclage placement and to propose a rationale for cervical sonography in this setting.

SUBJECTS AND METHODS

This was a retrospective analysis of 53 women undergoing cervical cerclage by a maternal-fetal medicine specialist, regardless of indication, and delivering between January 1999 and April 2001. Transvaginal ultrasonographic assessment of cervical length and the degree of cervical funneling after cerclage were compared to preoperative values and to outcomes including gestational age at delivery. Funneling to the cerclage was defined as membranes prolapsing down the endocervical canal until they reached the plane of the cerclage.

RESULTS

Cervical cerclage resulted in a significant increase in cervical length from 2.1 +/- 1.2 cm to 2.9 +/- 0.8 cm after the procedure, P < 0.001; however, this measure was not correlated with gestational age at delivery. Funneling to the level of the cerclage was associated with an earlier gestational age at delivery 31.3 +/- 5.6 weeks vs. 36.8 +/- 2.8 weeks for those cases without this finding, P < 0.001. A statistically significant association between funneling to the cerclage and preterm delivery was identified irrespective of the indication (prophylactic or emergency) for the procedure. When descent of the membranes to the level of the cerclage was noted, it occurred by 28 weeks' gestation in all patients studied. The incidence of premature rupture of the membranes was also significantly greater postcerclage in women with descent of the membranes to the cerclage (52%) compared to those without this finding (9%) P= 0.002.

CONCLUSIONS

Funneling to the cerclage is significantly associated with earlier preterm delivery in patients who have undergone cervical cerclage. Serial sonography up to 28 weeks' gestation is useful in identifying patients at higher risk for premature rupture of the membranes and preterm delivery.

Maternal benefit of corticosteroid therapy in patients with HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome: impact on the rate of regional anesthesia

OBJECTIVE

Our purpose was to assess the impact of glucocorticoid administration on the rate of regional anesthesia in women with hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome.

STUDY DESIGN

Maternal records of pregnancies with HELLP syndrome managed between April 1994 and December 1999 were analyzed retrospectively.

RESULTS

Sixty-nine patients were identified with antepartum HELLP syndrome and 46 (66%) received glucocorticoids. The presence of thrombocytopenia at admission and the interval from presentation to delivery was evaluated to assess the impact of glucocorticoid use. In the 37 women who had platelet counts of <90,000/mm3, 0 in the untreated group (0 of 11) versus 42% in the steroid group (11 of 26) received regional anesthetic, P =.015. Furthermore, the rate of regional anesthesia increased from 0 in the untreated group delivered within 24 hours (n = 10) to 57% (8 of 14) in the glucocorticoid group, in which women attained a 24-hour latency from presentation to delivery, P =.006. The need for general anesthesia also decreased significantly in treated women who attained a 24-hour latency compared to untreated women who did not, 100% (n = 7) versus 22% (n = 9), P =.003.

CONCLUSIONS

Administration of glucocorticoids increases the use of regional anesthesia in women with antepartum HELLP syndrome who have thrombocytopenia, particularly in those who achieve a latency of 24 hours before delivery.

Ocular manifestations of leukemia: leukemic infiltration versus infectious process

OBJECTIVE

To determine whether specific guidelines can be developed to distinguish whether retinal infiltration in leukemia patients represents infection or neoplasia.

DESIGN

Retrospective noncomparative interventional case series.

PARTICIPANTS

Six patients recently seen at University of California San Francisco with retinal infiltrates in a setting of leukemia, for which adequate written and photographic information of disease course was available.

INTERVENTION

Observation consisted of retrospective review of clinic charts, hospital medical records, and fundus photographs.

MAIN OUTCOME MEASURES

Determination of whether retinal infiltrates represented neoplasia or infection was made by review of medical records.

RESULTS

In this series, neoplastic retinal infiltrates were found in patients who had newly diagnosed leukemia and those who were in blast crisis. In contrast, the two patients who were in complete remission, but had undergone bone marrow transplantation, had retinal infiltrates attributable to infection.

CONCLUSIONS

Every patient with retinal infiltrates in the setting of newly or previously diagnosed leukemia requires a systemic and central nervous system workup before the initiation of ophthalmologic treatment. The systemic status of the patient is highly informative in determining whether infection or neoplasia is responsible for the infiltration.

An in vitro model and case report that used gelatin sponge to restore amniotic fluid volume after spontaneous premature rupture of the membranes

OBJECTIVE

The purpose of this project was to study an in vitro model for plugging membrane defects with gelatin sponge and to develop a method with which to use this material to treat premature rupture of the membranes.

STUDY DESIGN

Fetal membranes were fixed over the opening of a flask that was filled with saline solution and gelatin sponge. Defects of various sizes were created, and the usefulness of differing sizes of gelatin sponge to obstruct the defects was observed. This technique was then applied to a case of previable, spontaneous premature rupture of the membranes.

RESULTS

Fifteen amniotomies were performed in the in vitro model. The gelatin sponge obstructed all defects less than 7 mm in length, when pieces up to 1 x 1 cm in dimension (n = 8 amniotomies) were used. For larger defects or those defects with a complex shape (such as cruciate), gelatin sponge was not effective at arresting fluid loss (n = 4 amniotomies). An inspection of larger gelatin sponge pieces, after instillation through a 12-gauge angiocatheter, revealed 36% (15 of 42 pieces) of 1 x 1 - cm pieces remained intact. A case of spontaneous, previable premature rupture of the membranes was treated with this material. A favorable outcome was observed.

CONCLUSION

Gelatin sponge is successful at arresting the egress of fluid through membrane defects when smaller defects are present. Complex or larger linear defects may not be treated by this method alone and necessitate adjuvant therapies. This therapeutic strategy can be applied to cases of previable, spontaneous premature rupture of the membranes.

Nonviral transfer of the gene encoding coagulation factor VIII in patients with severe hemophilia A

BACKGROUND

We tested the safety of a nonviral somatic-cell gene-therapy system in patients with severe hemophilia A.

METHODS

An open-label, phase 1 trial was conducted in six patients with severe hemophilia A. Dermal fibroblasts obtained from each patient by skin biopsy were grown in culture and transfected with a plasmid containing sequences of the gene that encodes factor VIII. Cells that produced factor VIII were selected, cloned, and propagated in vitro. The cloned cells were then harvested and administered to the patients by laparoscopic injection into the omentum. The patients were followed for 12 months after the implantation of the genetically altered cells. An interim analysis was performed.

RESULTS

There were no serious adverse events related to the use of factor VIII-producing fibroblasts or the implantation procedure. No long-term complications developed, and no inhibitors of factor VIII were detected. In four of the six patients, plasma levels of factor VIII activity rose above the levels observed before the procedure. The increase in factor VIII activity coincided with a decrease in bleeding, a reduction in the use of exogenous factor VIII, or both. In the patient with the highest level of factor VIII activity, the clinical changes lasted approximately 10 months.

CONCLUSIONS

Implantation of genetically altered fibroblasts that produce factor VIII is safe and well tolerated. This form of gene therapy is feasible in patients with severe hemophilia A.

Brain areas sensitive to coherent visual motion

Detection of coherent motion versus noise is widely used as a measure of global visual-motion processing. To localise the human brain mechanisms involved in this performance, functional magnetic resonance imaging (fMRI) was used to compare brain activation during viewing of coherently moving random dots with that during viewing spatially and temporally comparable dynamic noise. Rates of reversal of coherent motion and coherent-motion velocities (5 versus 20 deg s-1) were also compared. Differences in local activation between conditions were analysed by statistical parametric mapping. Greater activation by coherent motion compared to noise was found in V5 and putative V3A, but not in V1. In addition there were foci of activation on the occipital ventral surface, the intraparietal sulcus, and superior temporal sulcus. Thus, coherent-motion information has distinctive effects in a number of extrastriate visual brain areas. The rate of motion reversal showed only weak effects in motion-sensitive areas. V1 was better activated by noise than by coherent motion, possibly reflecting activation of neurons with a wider range of motion selectivities. This activation was at a more anterior location in the comparison of noise with the faster velocity, suggesting that 20 deg s-1 is beyond the velocity range of the V1 representation of central visual field. These results support the use of motion-coherence tests for extrastriate as opposed to V1 function. However, sensitivity to motion coherence is not confined to V5, and may extend beyond the classically defined dorsal stream.

Prenatal diagnosis and outcome of a ruptured aneurysm arising from the left atrium

Prenatal diagnosis of a fetal cardiac aneurysm or diverticula is rare. We report what we believe to be the first case of an atrial wall aneurysm diagnosed as ruptured or leaking by fetal pericardiocentesis. Spontaneous resolution of the anomaly was observed in the third trimester with delivery of a vigorous newborn at term. The infant did not require surgical intervention after birth and has done well at follow-up examinations.

Evaluation of chemoprophylaxis in patients with unilateral retinoblastoma with high-risk features on histopathologic examination

OBJECTIVES

To identify risk factors for metastatic disease on histopathologic specimens of enucleated eyes from patients with unilateral retinoblastoma, and to evaluate the value of chemoprophylaxis in preventing disease dissemination.

METHODS

Medical records from patients with unilateral retinoblastoma who underwent primary enucleation were reviewed at the University of California, San Francisco (1977-1998) and Bascom Palmer Eye Institute, University of Miami, Miami, Fla (1991-1998). All routine histopathologic specimens were reexamined. The extent of tumor invasion into the optic nerve or ocular coats and the prescribed chemoprophylactic regimen were recorded.

RESULTS

This retrospective study included 129 patients followed for a median of 54 months. Three patients had tumor invading the sclera. The optic nerve was involved to some extent in 82 patients, 11 of whom had tumor extension beyond the lamina cribrosa. The surgical margin of the optic nerve was involved in an additional 4 patients. The choroid was involved in 43 patients, and was considered massively affected in 12 patients. Anterior segment involvement was observed in 10 patients. Postenucleation chemoprophylaxis was administered to 4 of 4 patients who had tumor cells at the surgical margin of the optic nerve and to 7 of 11 patients with postlaminar disease, all of whom had at least 1 mm of postlaminar tumor extension. External beam radiotherapy was administered to 3/4 and 1/11 of these patients, respectively. Chemoprophylaxis was not administered to patients with choroidal or anterior chamber involvement unless the optic nerve was also involved beyond the lamina cribrosa. One patient with tumor extending to the surgical margin of the optic nerve died of metastatic disease.

CONCLUSIONS

Chemoprophylaxis is necessary for patients with tumor extending to the surgical margin of the optic nerve and is likely to be beneficial in preventing metastases in patients with tumor extending beyond the lamina cribrosa. We did not offer chemoprophylaxis to patients with prelaminar optic nerve disease or isolated choroidal involvement, and these patients remained free of disseminated disease.

Collagen vascular diseases: cutaneous manifestations in ophthalmology

PURPOSE

To describe the effects of collagen vascular diseases on the eyelids and periorbital tissues.

METHODS

Retrospective review of dermatologic pathology slides at Massachusetts General Hospital and eye pathology slides at Massachusetts Eye and Ear Infirmary, Boston, Massachusetts.

RESULTS

A spectrum of dermatologic manifestations of collagen vascular diseases was observed, affecting the eyelids and periorbital region.

CONCLUSIONS

Collagen vascular diseases may present complicated diagnostic and clinical challenges for the practicing ophthalmologist. Familiarity with the cutaneous periocular manifestations of these diseases may facilitate early recognition, diagnosis, and ophthalmologic intervention where necessary.

Subconjunctival carboplatin in retinoblastoma: impact of tumor burden and dose schedule

OBJECTIVE

To evaluate the impact of tumor burden and chemotherapy dose scheduling on the response to subconjunctival carboplatin treatment in a murine transgenic retinoblastoma model.

METHODS

Eighty simian virus 40 T antigen-positive mice were treated at age 5 or 10 weeks. Six control animals received placebo treatment. Twenty-four 5-week-old mice received 6 subconjunctival carboplatin injections at doses of 30 to 300 microg delivered at 72-hour intervals. Fifty 10-week-old mice received either 6 or 12 subconjunctival carboplatin injections at doses of 30 to 300 microg delivered at 72-hour intervals. All eyes were obtained at age 16 weeks for histopathologic examination. Eyes were graded as positive if any tumor was present.

RESULTS

All simian virus 40 T antigen-positive control eyes contained large tumor foci throughout the retina. Subconjunctival carboplatin injections controlled tumors in a dose-dependent manner. Tumor control was observed in 50% of treated eyes at 138.3 microg for the 10-week-old 6-injection group, 94.3 microg for the 5-week-old 6-injection group, and 85.9 microg for the 10-week-old 12-injection group.

CONCLUSION

Increased tumor burden requires an increase in subconjunctival carboplatin dose scheduling to maintain local tumor control in this murine model of retinoblastoma.

CLINICAL RELEVANCE

This study documents the efficacy of subconjunctival carboplatin in the treatment of an animal model of retinoblastoma. These data establish a framework for further human clinical trials. Arch Ophthalmol. 2000;118:1549-1554

Impact of high-dose corticosteroid therapy for patients with HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome

OBJECTIVE

The purpose of this study was to determine whether corticosteroid administration to patients with antepartum HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome would alter laboratory values diagnostic for the disease.

STUDY DESIGN

Cases of 37 women with antepartum HELLP syndrome managed between March 1995 and July 1999 were reviewed. Patients were classified on the basis of exposure to corticosteroids and to the dose used. Group 1 did not receive corticosteroids. Group 2 received a standard corticosteroid dosage regimen for promotion of fetal lung maturation. Group 3 received a high-dose corticosteroid regimen of >24 mg/d (most frequently 10 mg dexamethasone as an intravenous bolus dose every 6 hours for 2 doses followed by 6 mg as an intravenous bolus dose every 6 hours for 2 to 4 doses). Antepartum changes in laboratory values from diagnosis to delivery were evaluated by means of the Kruskal-Wallis test.

RESULTS

Eleven patients did not receive corticosteroids, 15 were given a standard dose, and 11 received high-dose therapy. For each laboratory value assessed (platelet count, aspartate aminotransferase activity, and lactate dehydrogenase activity), the corticosteroid groups differed significantly from the no-treatment group (P </=.002 for all). A further, significantly greater improvement in platelet count was noted between the high-dose group (81%) and the standard-dose group (17%; P =.04). The interval from diagnosis to delivery was also longer for patients treated with the high-dose protocol (51 +/- 25 hours) than for both those treated with a standard regimen (26 +/- 20 hours) and those who received no treatment (13 +/- 11 hours; P <. 001).

CONCLUSION

Administration of corticosteroids to patients with antepartum HELLP syndrome improves platelet count, reduces liver enzyme abnormalities, and prolongs latency to delivery in a dose-dependent manner. Higher doses of corticosteroid than those traditionally prescribed for promotion of fetal pulmonary maturation should be considered for maternal and fetal benefits in cases of severe preeclampsia.

Form and motion coherence activate independent, but not dorsal/ventral segregated, networks in the human brain

There is much evidence in primates' visual processing for distinct mechanisms involved in object recognition and encoding object position and motion, which have been identified with 'ventral' and 'dorsal' streams, respectively, of the extra-striate visual areas [1] [2] [3]. This distinction may yield insights into normal human perception, its development and pathology. Motion coherence sensitivity has been taken as a test of global processing in the dorsal stream [4] [5]. We have proposed an analogous 'form coherence' measure of global processing in the ventral stream [6]. In a functional magnetic resonance imaging (fMRI) experiment, we found that the cortical regions activated by form coherence did not overlap with those activated by motion coherence in the same individuals. Areas differentially activated by form coherence included regions in the middle occipital gyrus, the ventral occipital surface, the intraparietal sulcus, and the temporal lobe. Motion coherence activated areas consistent with those previously identified as V5 and V3a, the ventral occipital surface, the intraparietal sulcus, and temporal structures. Neither form nor motion coherence activated area V1 differentially. Form and motion foci in occipital, parietal, and temporal areas were nearby but showed almost no overlap. These results support the idea that form and motion coherence test distinct functional brain systems, but that these do not necessarily correspond to a gross anatomical separation of dorsal and ventral processing streams.