Vismodegib for periocular basal cell carcinoma: an international multicentre case series

INTRODUCTION

Vismodegib (Erivedge, Genentech) is a first-in-class inhibitor of the hedgehog (Hh) pathway, which is licensed for use in locally advanced basal cell carcinoma (BCC) and metastatic BCC. The National Institute for Health and Care Excellence withdrew recommendation for use of vismodegib secondary to a lack of data comparing vismodegib to standard supportive care. The purpose of this multicentre, international case series is to report outcomes of patients with locally advanced periocular BCC who have been treated with vismodegib.

METHODS

The medical records of all patients treated with vismodegib were retrospectively reviewed across seven institutions in the United Kingdom, Australia, and New Zealand.

RESULTS

Thirteen patients were identified. Seven (54%) patients were male. All BCCs were ill-defined, with seven (58%) having orbital involvement at presentation. Median treatment time was 7 months (range 2-36 months). Eleven out of 13 patients developed side effects, the most common being fatigue in six patients (46%). Median follow-up was 24 months (range 12-48 months). Complete response was found in 5/13 patients (38%) and a partial response in 8/13 patients (62%). Six patients had further surgery after vismodegib, with three classed as globe-sparing operations. Three patients developed recurrence (23%). Three patients (23%) ultimately underwent exenteration.

DISCUSSION

This study demonstrates vismodegib to be a well-tolerated treatment which may, in some cases, facilitate globe-sparing surgery and hence avoid disfiguring operations such as exenteration. Uncertainty does remain regarding the long-term outcomes of patients treated with vismodegib.

Experimental and modelling of Arthrospira platensis cultivation in open raceway ponds

In this study, the growth of Arthrospira platensis was studied in an open raceway pond. Furthermore, dynamic model for algae growth and CFD modelling of hydrodynamics in open raceway pond were developed. The dynamic behaviour of the algal system was developed by solving mass balance equations of various components, considering light intensity and gas-liquid mass transfer. A CFD modelling of the hydrodynamics of open raceway pond was developed by solving mass and momentum balance equations of the liquid medium. The prediction of algae concentration from the dynamic model was compared with the experimental data. The hydrodynamic behaviour of the open raceway pond was compared with the literature data for model validation. The model predictions match the experimental findings. Furthermore, the hydrodynamic behaviour and residence time distribution in our small raceway pond were predicted. These models can serve as a tool to assess the pond performance criteria.

Chordoma presenting as pseudoprolactinoma

Chordomas are relatively rare neoplasms that appear to originate from benign remnants of primitive notochord. They account for about 0.15% of all intracranial neoplasm and are the most common of extradural neoplasms that involve the clivus. Although they present mostly with signs and symptoms of other intracranial lesions they rarely present with high prolactin levels mimicking prolactinomas. We report a case of chordoma presenting as a pseudoprolactinoma. We discuss the presentation, radiological features and treatment of this rare presentation.

Polyurethanes as potential substrates for sub-retinal retinal pigment epithelial cell transplantation

Transplantation of cultured retinal pigment epithelial (RPE) cells under the failing macular is a potential treatment for age related macular degeneration. An important step in the development of this procedure is the identification of a suitable membrane on which to grow and transplant the cells. This paper evaluates the potential of using polyurethanes in this application since they possess several of the required properties, such as, flexibility, robustness, biostability and good biocompatiblilty although their hydrophobicity can limit cell adhesion. Three commercially available polyether urethanes (Pellethane, Tecoflex and Zytar) were evaluated in terms of their wettability using dynamic contact angle analysis and their ability to support a monolayer of functioning RPE cells (ARPE-19) . Furthermore Pellethane and Tecoflex were treated with a simple air plasma treatment and analysed as above. In the "as received condition" only a few RPE cells attached to the Pellethane and Tecoflex and remained clumped. RPE cells grew to confluence on the Zytar substrate by 7 days without further surface modification. Air gas plasma treatment of both Pellethane and Tecoflex increased the wettability of the surfaces and this resulted in the growth of a monolayer of well-spread RPE cells on both materials. Morphologically these cells grew with a normal 'cobblestone' phenotype. These results demonstrate the potential of these polyurethanes for this application.

Adjustable versus non-adjustable sutures for strabismus

BACKGROUND

Strabismus, or squint, can be defined as a deviation from perfect ocular alignment and can be classified in many ways according to its aetiology and presentation. Treatment can be broadly divided into medical and surgical options, with a variety of surgical techniques being available, including the use of adjustable or non-adjustable sutures for the extra ocular muscles. There exists an uncertainty as to which of these techniques produces a better surgical outcome, and also an opinion that the adjustable suture technique may be of greater benefit in certain situations.

OBJECTIVES

The objectives of this review were to examine whether adjustable or non-adjustable sutures are associated with a more accurate long-term ocular alignment following strabismus surgery and to identify any specific situations in which it would be of benefit to use a particular method.

SEARCH STRATEGY

We searched the Cochrane Central Register of Controlled Trials - CENTRAL on The Cochrane Library (which includes the Cochrane Eyes and Vision Group Trials Register) (Issue 3 2004), MEDLINE (1966 to July 2004), EMBASE (1980 to August 2004), LILACS (Latin American and Caribbean Literature on Health Sciences) (July 2004). We contacted experts in the field for further information. There were no language restrictions in the electronic searches.

SELECTION CRITERIA

We planned to include only randomised controlled trials comparing adjustable to non-adjustable sutures for strabismus surgery.

DATA COLLECTION AND ANALYSIS

No studies were found that met the inclusion criteria for this review.

MAIN RESULTS

No studies were found that met the inclusion criteria for this review, therefore none were included for analysis. Results of non-randomised studies that compared these techniques are reported.

AUTHORS' CONCLUSIONS

No reliable conclusions could be reached regarding which technique (adjustable or non-adjustable sutures) produces a more accurate long-term ocular alignment following strabismus surgery or in which specific situations one technique is of greater benefit than the other. High quality randomised controlled trials are needed to obtain clinically valid results and to clarify these issues.