Silver nanoparticles formulation of Marrubium alysson L. phenolic extract potentiates cytotoxicity through apoptosis with molecular docking study as Bcl-2 inhibitors

Crude or semi-purified extracts of plants can play a significant role as antitumor agents. They were used as stabilizing and reducing agents in the preparation of silver nanoparticles (AgNPs) that allows these particles to have more efficient cytotoxic activity. In the current study, the extract of Marrubium alysson L., a plant of common occurrence in Egypt was used to synthesize AgNPs for the first time, where comparison of anticancer activity of crude and phenolic extracts with the AgNPs were extensively studied against cancer cell lines PC-3 and HCT-116. Interestingly, AgNPs of the crude extract exhibited promising cytotoxicity with IC50 values of 10.4 and 16.3 μg/ml, while AgNPs of the phenolic extract exhibited very potent cytotoxicity with IC50 values of 2.66 and 1.34 μg/ml compared to Doxorubicin (as a standard reference drug) that exhibited IC50 values of 5.13 and 4.36 μg/ml, respectively against the tested cells. Additionally, AgNPs of the phenolic extract induced apoptosis in HCT-116 with a higher ratio than in PC-3 cells. It induced apoptosis in PC-3 cells by 79.3-fold change, while it induced total colon apoptotic cell death by 228.3-fold change compared to untreated control. Finally, the apoptotic activity of AgNPs of the phenolic extract in the treated PC-3 and HCT-116 cells was confirmed using RT-PCR. As a result, AgNPs of the phenolic extract could be considered a promising anticancer candidate through apoptosis-induction.Communicated by Ramaswamy H. Sarma.

Therapeutic potential and protection enhancement of mesenchymal stem cell against cisplatin-induced nephrotoxicity using hyaluronic acid-chitosan nanoparticles as an adjuvant

A newly synthesized nanoplatform of hyaluronic acid and chitosan nanoparticles (HA/CNPs) was applied to improve the therapeutic efficacy and protection of bone marrow mesenchymal stem cells (BM-MSCs) against cisplatin (CDDP)-induced nephrotoxicity in rats. CDDP administration causes significant increases in levels of serum creatinine (SCr), urea, and KIM-1 coupled with significant albumin level falls, as indicative of acute renal dysfunction. Moreover, the level of the antioxidant enzyme (GSH) was significantly decreased, while the levels of lipid peroxidation (MDA) and inflammatory (IL-6) and apoptotic (caspase-3) markers were significantly increased, indicating a decline in the kidney's antioxidant defense and increased inflammation. In contrast, when rats were pre-treated with either MSCs or MSCs-HA/CNPs before receiving CDDP, the levels of SCr, urea, KIM-1, MDA, IL-6, and caspase-3 were significantly decreased with simultaneous significant rises in GSH and albumin, impelling a great improvement in the antioxidant and anti-inflammatory defenses of the kidney as well as its functions. Intriguingly, MSCs-HA/CNPs were more effective against caspase-3 than MSCs alone, revealing the high anti-apoptotic capability of HA/CNPs. This finding suggests that HA/CNPs could effectively protect MSCs from oxidative stress and apoptosis and thus increase their stability and longevity.

Development, Optimization, and In Vitro/In Vivo Evaluation of Azelaic Acid Transethosomal Gel for Antidermatophyte Activity

Treatment of dermatophytosis is quite challenging. This work aims to investigate the antidermatophyte action of Azelaic acid (AzA) and evaluate its efficacy upon entrapment into transethosomes (TEs) and incorporation into a gel to enhance its application. Optimization of formulation variables of TEs was carried out after preparation using the thin film hydration technique. The antidermatophyte activity of AzA-TEs was first evaluated in vitro. In addition, two guinea pig infection models with Trichophyton (T.) mentagrophytes and Microsporum (M.) canis were established for the in vivo assessment. The optimized formula showed a mean particle size of 219.8 ± 4.7 nm and a zeta potential of -36.5 ± 0.73 mV, while the entrapment efficiency value was 81.9 ± 1.4%. Moreover, the ex vivo permeation study showed enhanced skin penetration for the AzA-TEs (3056 µg/cm²) compared to the free AzA (590 µg/cm²) after 48 h. AzA-TEs induced a greater inhibition in vitro on the tested dermatophyte species than free AzA (MIC₉₀ was 0.01% vs. 0.32% for T. rubrum and 0.032% for T. mentagrophytes and M. canis vs. 0.56%). The mycological cure rate was improved in all treated groups, specially for our optimized AzA-TEs formula in the T. mentagrophytes model, in which it reached 83% in this treated group, while it was 66.76% in the itraconazole and free AzA treated groups. Significant (p < 0.05) lower scores of erythema, scales, and alopecia were observed in the treated groups in comparison with the untreated control and plain groups. In essence, the TEs could be a promising carrier for AzA delivery into deeper skin layers with enhanced antidermatophyte activity.

Characterization, antibacterial, antioxidant, antidiabetic, and anti-inflammatory activities of green synthesized silver nanoparticles using Phragmanthera austroarabica A. G. Mill and J. A. Nyberg extract

Introduction

Diabetes mellitus is a chronic metabolic disorder that exhibited great expansion all over the world. It is becoming an epidemic disease adding a major burden to the health care system, particularly in developing countries.

Methods

The plant under investigation in the current study Phragmanthera austroarabica A. G. Mill and J. A. Nyberg is traditionally used in Saudi Arabia for the treatment of diabetes mellitus. The methanolic extract (200 mg/kg) of the plant and pure gallic acid (40 mg/kg), a major metabolite of the plant, as well as their silver nanoparticle formulae (AgNPs) were evaluated for their antidiabetic activity.

Results and Discussion

The results showed a decrease in body fat, obesity, an improvement in lipid profiles, normalization of hyperglycemia, insulin resistance, and hyperinsulinemia, and an improvement in liver tissue structure and function. However, the results obtained from AgNPs for both extract and the pure gallic acid were better in most measured parameters. Additionally, the activity of both the crude extract of the plant and its AgNPs were evaluated against a number of gram-positive, gram-negative bacteria and fungi. Although the activity of the crude extract ranged from moderate to weak or even non-active, the AgNPs of the plant extract clearly enhanced the antimicrobial activity. AgNPs of the extract demonstrated remarkable activity, especially against the Gram-negative pathogens Proteus vulgaris (MIC 2.5 μg/ml) and Pseudomonas aeruginosa (MIC 5 μg/ml). Furthermore, a promising antimicrobial activity was shown against the Gram-positive pathogen Streptococcus mutants (MIC 1.25 μg/ml).

Design, Formulation, and Characterization of Valsartan Nanoethosomes for Improving Their Bioavailability

The objective of this study was to formulate and evaluate valsartan (VLT) ethosomes to prepare an optimized formula of VLT-entrapped ethosomes that could be incorporated into a sustained release transdermal gel dosage form. The formulation of the prepared ethosomal gel was investigated and subjected to in vitro drug release studies, ex vivo test, and in vivo studies to assess the effectiveness of ethosomal formulation in enhancing the bioavailability of VLT as a poorly soluble drug and in controlling its release from the transdermal gel dosage form. The acquired results are as follows: Dependent responses were particle size, polydispersity index, zeta potential, and entrapment efficiency. The optimized VLT-ETHs had a nanometric diameter (45.8 ± 0.5 nm), a negative surface charge (-51.4 ± 6.3 mV), and a high drug encapsulation (94.24 ± 0.2). The prepared VLT ethosomal gel (VLT-ethogel) showed a high peak plasma concentration and enhanced bioavailability in rats compared with the oral solution of valsartan presented in the higher AUC (0-∞). The AUC (0-∞) with oral treatment was 7.0 ± 2.94 (μg.h/mL), but the AUC (0-∞) with topical application of the VAL nanoethosomal gel was 137.2 ± 49.88 (μg.h/mL), providing the sustained release pattern of VLT from the tested ethosomal gel.

Comparative Estimation of the Cytotoxic Activity of Different Parts of Cynara scolymus L.: Crude Extracts versus Green Synthesized Silver Nanoparticles with Apoptotic Investigation

Different parts of Cynara scolymus L. and their green synthesized eco-friendly silver nanoparticles (AgNPs) were screened for their cytotoxicity and apoptotic activity. Results showed that flower extract AgNPs exhibited more potent cytotoxicity compared to the normal form against PC-3 and A549 cell lines with IC₅₀ values of 2.47 μg/mL and 1.35 μg/mL, respectively. The results were compared to doxorubicin (IC₅₀ = 5.13 and 6.19 μg/mL, respectively). For apoptosis-induction, AgNPs prepared from the flower extract induced cell death by apoptosis by 41.34-fold change and induced necrotic cell death by 10.2-fold. Additionally, they induced total prostate apoptotic cell death by a 16.18-fold change, and it slightly induced necrotic cell death by 2.7-fold. Hence, green synthesized flower extract AgNPs exhibited cytotoxicity in A549 and PC-3 through apoptosis-induction in both cells. Consequently, synthesized AgNPs were further tested for apoptosis and increased gene and protein expression of pro-apoptotic markers while decreasing expression of anti-apoptotic genes. As a result, this formula may serve as a promising source for anti-cancer candidates. Finally, liquid chromatography combined with electrospray mass spectrometry (LC-ESI-MS) analysis was assessed to identify the common bioactive metabolites in crude extracts of stem, flower, and bract.

Silver Nanoparticles Formulation of Flower Head’s Polyphenols of Cynara scolymus L.: A Promising Candidate against Prostate (PC-3) Cancer Cell Line through Apoptosis Activation

Cynara scolymus L. (Family: Compositae) or artichoke is a nutritious edible plant widely used for its hepatoprotective effect. Crude extracts of flower, bract, and stem were prepared and evaluated for their in vitro antioxidant activity and phenolic content. The flower crude extract exhibited the highest phenolic content (74.29 mg GAE/gm) as well as the best in vitro antioxidant activity using total antioxidant capacity (TAC), ferric reducing antioxidant power (FEAP), and 1,1-diphenyl-2-picrylhyazyl (DPPH) scavenging assays compared with ascorbic acid. Phenolic fractions of the crude extracts of different parts were separated and identified using high-performance liquid chromatography HPLC-DAD analysis. The silver nanoparticles of these phenolic fractions were established and tested for their cytotoxicity and apoptotic activity. Results showed that silver nanoparticles of a polyphenolic fraction of flower extract (Nano-TP/Flowers) exhibited potent cytotoxicity against prostate (PC-3) and lung (A549) cancer cell lines with IC₅₀ values of 0.85 μg/mL and 0.94 μg/mL, respectively, compared with doxorubicin as a standard. For apoptosis-induction, Nano-TP/Flowers exhibited apoptosis in PC-3 with a higher ratio than in A549 cells. It induced total prostate apoptotic cell death by 227-fold change while it induced apoptosis in A549 cells by 15.6-fold change. Nano-TP/Flowers upregulated both pro-apoptotic markers and downregulated the antiapoptotic genes using RT-PCR. Hence, this extract may serve as a promising source for anti-prostate cancer candidates.

Upgrading the Transdermal Biomedical Capabilities of Thyme Essential Oil Nanoemulsions Using Amphiphilic Oligochitosan Vehicles

(1) Background: Thymus vulgaris L. (thyme) essential oil (TEO) has gained much attention because of its long history of medicinal usage. However, the lack of precise chemical profiling of the TEO and methods to optimize the bioactivity and delivery of its constituents has hampered its research on quality control and biological function; (2) Methods: The current study aimed to analyze the TEO’s chemical composition using the GC-MS method and identify its key components. Another objective of this work is to study the impact of the protective layer of amphiphilic oligochitosan (AOC) on the physicochemical stability and transdermal potentials of TEO multilayer nanoemulsions formulated by the incorporation of TEO, Tween80, lecithin (Lec), and AOC; (3) Results: The AOC protective layer significantly improved the stability of TEO-based NEs as revealed by the constancy of their physicochemical properties (particle size and zeta potential) during storage for a week. Excessive fine-tuning of thyme extract NEs and the AOC protective layer’s persistent positive charge have been contributed to the thyme extract’s improved anti-inflammatory, transdermal, and anti-melanoma potentials; (4) Conclusions: the AOC-coated NEs could offer novel multifunctional nanoplatforms for effective transdermal delivery of lipophilic bioactive materials.

Design, Synthesis, Anticancer Activity, and Solid Lipid Nanoparticle Formulation of Indole- and Benzimidazole-Based Compounds as Pro-Apoptotic Agents Targeting Bcl-2 Protein

Cancer is a multifactorial disease necessitating identification of novel targets for its treatment. Inhibition of Bcl-2 for triggered pro-apoptotic signaling is considered a promising strategy for cancer treatment. Within the current work, we aimed to design and synthesize a new series of benzimidazole- and indole-based derivatives as inhibitors of Bcl-2 protein. The market pan-Bcl-2 inhibitor, obatoclax, was the lead framework compound for adopted structural modifications. The obatoclax’s pyrrolylmethine linker was replaced with straight alkylamine or carboxyhydrazine methylene linkers providing the new compounds. This strategy permitted improved structural flexibility of synthesized compounds adopting favored maneuvers for better fitting at the Bcl-2 major hydrophobic pocket. Anti-cancer activity of the synthesized compounds was further investigated through MTT-cytotoxic assay, cell cycle analysis, RT-PCR, ELISA and DNA fragmentation. Cytotoxic results showed compounds 8a, 8b and 8c with promising cytotoxicity against MDA-MB-231/breast cancer cells (IC₅₀ = 12.69 ± 0.84 to 12.83 ± 3.50 µM), while 8a and 8c depicted noticeable activities against A549/lung adenocarcinoma cells (IC₅₀ = 23.05 ± 1.45 and 11.63 ± 2.57 µM, respectively). The signaling Bcl-2 inhibition pathway was confirmed by molecular docking where significant docking energies and interactions with key Bcl-2 pocket residues were depicted. Moreover, the top active compound, 8b, showed significant upregulated expression levels of pro-apoptotic/anti-apoptotic of genes; Bax, Bcl-2, caspase-3, -8, and -9 through RT-PCR assay. Improving the compound’s pharmaceutical profile was undertaken by introducing 8b within drug-solid/lipid nanoparticle formulation prepared by hot melting homogenization technique and evaluated for encapsulation efficiency, particle size, and zeta potential. Significant improvement was seen at the compound’s cytotoxic activity. In conclusion, 8b is introduced as a promising anti-cancer lead candidate that worth future fine-tuned lead optimization and development studies while exploring its potentiality through in-vivo preclinical investigation.

Comprehensive Study of Atorvastatin Nanostructured Lipid Carriers through Multivariate Conceptualization and Optimization

The aim of the current study is to establish a comprehensive experimental design for the screening and optimization of Atorvastatin-loaded nanostructured lipid carriers (AT-NLCs). Initially, combined D-optimal screening design was applied to find the most significant factors affecting AT-NLCs properties. The studied variables included mixtures of solid and liquid lipids, the solid/liquid lipid ratio, surfactant type and concentration, homogenization speed as well as sonication time. Then, the variables homogenization speed (A), the ratio of solid lipid/liquid lipid (B), and concentration of the surfactant (C) were optimized using a central composite design. Particle size, polydispersity index, zeta potential, and entrapment efficiency were chosen as dependent responses. The optimized AT-NLCs demonstrated a nanometric size (83.80 ± 1.13 nm), Polydispersity Index (0.38 ± 0.02), surface charge (-29.65 ± 0.65 mV), and high drug incorporation (93.1 ± 0.04%). Fourier Transform Infrared Spectroscopy (FTIR) analysis showed no chemical interaction between Atorvastatin and the lipid mixture. Differential Scanning Calorimetry (DSC) analysis of the AT-NLCs suggested the transformation of Atorvastatin crystal into an amorphous state. Administration of the optimized AT-NLCs led to a significant reduction (p < 0.001) in serum levels of rats' total cholesterol, triglycerides, and low-density lipoproteins. This change was histologically validated by reducing the relevant steatosis of the liver.

Celecoxib Loaded In-Situ Provesicular Powder and Its In-Vitro Cytotoxic Effect for Cancer Therapy: Fabrication, Characterization, Optimization and Pharmacokinetic Evaluation

INTRODUCTION

Several recent studies have shown that the role of cyclooxygenase 2 (COX-2) in carcinogenesis has become more evident. It affects angiogenesis, apoptosis, and invasion, and plays a key role in the production of carcinogens. It has also been reported that COX-2 inhibitors such as celecoxib (CLX) might play an effective role in preventing cancer formation and progression. Formulation of CLX into nanovesicles is a promising technique to improve its bioavailability and anticancer efficacy.

AIM

The aim of this study is to optimize and evaluate the anticancer efficacy of CLX-loaded in-situ provesicular powder composed of surfactants and fatty alcohol-based novel nanovesicles in-vitro and determine its pharmacokinetic parameters in-vivo.

METHODS

The novel provesicular powders were prepared by the slurry method and optimized by 3² full factorial design using the desirability function.

RESULTS

Small mean particle size was achieved by the formed vesicles with value of 351.7 ± 1.76 nm and high entrapment efficacy of CLX in the formed vesicles of 97.53 ± 0.84%. Solid state characterization of the optimized formulation showed that the powder was free flowing, showed no incompatibilities between drug and excipients and showed smooth texture. The cytotoxic study of the optimized formula on HCT-116, HepG-2, A-549, PC-3 and MCF-7 cell lines showed significant increase in activity of CLX compared to its free form. The pharmacokinetic study on albino rabbits after oral administration showed significant increase in the area under the curve (AUC)_{0-24 h} and significantly higher oral relative bioavailability of the optimized formulation compared to Celebrex^® 100 mg market product (p < 0.05).

CONCLUSION

All findings of this study suggest the potential improvement of efficacy and bioavailability of CLX when formulated in the form of in-situ provesicular powder composed of surfactants and fatty alcohol-based novel nanovesicles for its repositioned use as an anticancer agent.

Quality by Design for the Development and Analysis of Enhanced In-Situ Forming Vesicles for the Improvement of the Bioavailability of Fexofenadine HCl in Vitro and in Vivo

Drug absorption from the gastrointestinal tract (GIT) is one of the major problems affecting the bioavailability of orally absorbed drugs. This work aims to enhance Fexofenadine HCl oral bioavailability in vivo, the drug used for allergic rhinitis. In this study, novel spray-dried lactose-based enhanced in situ forming vesicles were prepared using different absorption enhancer by the slurry method. Full factorial design was used to obtain an optimized formulation, while central composite design was used to develop economic, environment-friendly analysis method of Fexofenadine HCl in plasma of rabbits. The optimized formulation containing Capryol 90 as absorption enhancer has a mean particle size 202.6 ± 3.9 nm and zeta potential -31.6 ± 0.9 mV. It achieved high entrapment efficiency of the drug 73.7 ± 1.7% and rapid Q3h release reaches 71.5 ± 2.7%. The design-optimized HPLC assay method in rabbit plasma could separate Fexofenadine HCl from endogenous plasma compounds in less than 3.7 min. The pharmacokinetic study and the pharmacological effect of the fexofenadine-loaded optimized formulation showed a significant increase in blood concentration and significantly higher activity against compound 48/80 induced systemic anaphylaxis-like reactions in mice. Therefore, enhanced in situ forming vesicles were effective nanocarriers for the entrapment and delivery of Fexofenadine HCl.

Laparoscopically assisted balloon vaginoplasty for management of vaginal aplasia

OBJECTIVE

To report the intra-operative and post-operative results of laparoscopically assisted balloon vaginoplasty, a new technique for management of vaginal aplasia.

METHODS

Eight women with vaginal aplasia due to Mullerian agenesis who were referred for apareunia, dyspareunia. All had a poor penetration score and sexual satisfaction score. A Foley's catheter was laparoscopically inserted in the space between the urethra and rectum. Gradual traction and distension were used to create a neovagina. Outcomes measured were intra-operative complications, post-operative complications, length of the neovagina and post-operative complications and sexual satisfaction score in both partners.

RESULTS

Mean operative time was 25.5+/-5.5 min. No operative complications were recorded. Pain scores ranged from zero to 30 points at rest and from 30 to 60 points during dressing, traction and distension. Penetration and satisfaction scores increased significantly after the operation.

CONCLUSIONS

Balloon vaginoplasty is a simple, safe and satisfactory technique for management of blind vagina.

Conservative or surgical management of distal femoral fractures. A retrospective study with a minimum five year follow-up

We report the outcome of conservative and surgical management in 50 skeletally mature patients (average age 64.6 years, 36 females patients) with 51 supracondylar femoral fractures treated in our unit between June 1991 and December 1993. Thirty-six fractures were caused by low-energy trauma, and 15 were due to high-energy trauma. Open fractures occurred in 5 patients. Of the 34 patients (35 fractures) treated conservatively, 15 (46%) achieved a satisfactory result. Of the 16 patients treated by internal fixation, 10 (62%) reached a satisfactory outcome. Osteoporosis, severe comminution of the fracture, involvement of the knee joint, and soft tissue injury in open fractures were associated with unsatisfactory results. Conservative management of these fractures is associated with a lesser chance of achieving a good functional result. With the advent of new fixation devices and our experience that conservative management can actually lead to many complications, the proportion of patients operated upon is likely to increase.

The epidemiology of schistosomiasis in Egypt: Qena governorate

Qena is the southernmost governorate of Egypt included in the Epidemiology 1, 2, 3 national study. A probability sample selected 17,822 individuals from 2,950 households in 34 ezbas and 10 villages from a total rural target population of 1,731,252 (based on the most recent 1986 census of the population by the Egyptian Central Agency for Public Mobilization And Statistics). Parasitologic examination of urine and stool were made for Schistosoma haematobium and S. mansoni, respectively, and physical and ultrasound examinations were made on a 20% subsample. The overall estimated prevalence of S. haematobium was 4.8 +/- 0.7% (+/-SE) and geometric mean egg count (GMEC) was 7.0 ova per 10 ml of urine. Considerable variation in prevalence was observed between the villages and ezbas, ranging from 0.0% to 20%, with the smaller ezbas having a slightly higher overall prevalence. The age- and sex-specific patterns of S. haematobium showed typical peak prevalence in early adolescence, with males having a higher prevalence than females. A history of hematuria was associated with current infection (odds ratio = 3.6, 95% confidence interval = 2.32-5.63). Hepatomegaly and splenomegaly determined by physical examination present in 7.9% and 3.0%, respectively. Ultrasonography-determined hepatomegaly of the left liver lobe was found in 10.1%. Ultrasonography-detected hepatomegaly in both the left and right lobes increased in prevalence from approximately 5% in children to 15-20% in adults. The prevalence of ultrasonography-detected splenomegaly increased slightly with age. Grade III periportal fibrosis was detected in only 2 individuals in the sample. Bladder wall lesions and obstructive uropathy were also very infrequent. Other associations with these measures are given. Most villages and ezbas had an S. mansoni prevalence of less than 1%. The exception was Nag'a El-Sheikh Hamad, where the prevalence was 10.3 +/- 0.5% (GMEC = 57.4 +/- 2.6). Two other communities also had a prevalence >1% (Ezbet Sarhan and Kom Heitin).

Penetrating orbital injury with organic foreign bodies

OBJECTIVE

The authors reviewed the clinical features, diagnostic workup, and management of patients of penetrating orbital injuries with retained organic foreign bodies.

DESIGN

Retrospective, noncomparative case series.

PARTICIPANTS

Nineteen patients (15 males, 4 females) with penetrating orbital injuries due to organic foreign bodies.

RESULTS

The series included 15 (78.9%) males and 4 (21.1%) females who ranged in age from 6 months to 40 years (mean = 14.6 years); 12 (63.2%) patients were younger than 12 years of age. Twelve (63.2%) right and 7 (36.8%) left orbits were involved. Time between injury and presentation varied from a few hours to 9 months. Most common injury site was the superior orbit in 11 (57.9%) patients leading to abnormal extraocular motility (84.2%), proptosis (68.4%), and upper lid ptosis (47.4%). Associated pathologies also included acute cellulitis in 11, orbitocutaneous fistula in 5, and osteomyelitis in 2 patients. Preoperative computed tomography (CT) and magnetic resonance imaging (MRI) identified the foreign bodies in 42% and 57% of the patients, respectively.

CONCLUSION

Preoperative identification of the foreign material in the orbit was found to be very helpful for patient management but was only possible in approximately 50% of our cases with the use of CT and MRI. The vision in our patients usually improved shortly after treatment; the long-term complications more often included extraocular muscle and eyelid motility problems and periorbital scarring.

Anterior orbital varix presenting as a lacrimal sac mucocele

A 35-year-old woman was referred to the Oculoplastics Clinic because of a left nasal swelling and intermittent tearing of 1 year's duration. The clinical examination and echographic and radiologic findings were consistent with an anterior venous anomaly. Complete surgical excision was performed and histopathology confirmed the diagnosis of a varix.

Orbital hemangiopericytoma: clinical and morphologic features

PURPOSE

To report the clinical and histopathologic features of orbital hemangiopericytoma.

METHOD

We review the clinical and histopathologic features in seven patients.

RESULTS

Ultrasonography, computed tomography, and magnetic resonance imaging defined the location and extent of the tumor in each patient but did not disclose pathognomonic features for the specific diagnosis of hemangiopericytoma. The predominating histopathologic feature of each tumor was a mixed pattern of ovoid cells and sinusoidal space formations. Five patients showed mild to severe cellular atypia; three had obvious pleomorphism and increased number of abnormal mitotic figures. Tumor cells disclosed cytoplasmic reactivity for vimentin but in five cases were negative for other immunologic markers. Six patients received surgical treatment with an attempt for total removal of the tumor; one had biopsy and radiation therapy. In two patients, radiation therapy was given in addition to tumor removal with orbital exenterations. Three patients died with recurrent and metastatic disease, and four patients are alive without tumor for a follow-up period ranging from 3 to 9 years.

CONCLUSIONS

Orbital hemangiopericytoma may behave as a malignant tumor, leading to local recurrence or metastasis, or both. Clinical and histopathologic findings should be considered jointly to evaluate the clinical course; histopathologic findings alone are not sufficient to predict the biologic behavior of this tumor.

Unilateral enophthalmos secondary to acquired hemilipodystrophy

PURPOSE

To report a case of acquired hemilipodystrophy with ipsilateral enophthalmos.

METHODS

Case report. We examined a 25-year-old woman who developed progressive unilateral enophthalmos secondary to fat atrophy on the corresponding left side of her body.

RESULTS

Computed tomography confirmed that atrophy in the left orbit, loss of fat in the preorbital area, and partial loss of eyebrow cilia on the same side were present. A biopsy specimen from the left arm was consistent with lipodystrophy. The systemic examination and laboratory values were within normal limits.

CONCLUSION

Although it is a rare condition, lipodystrophy may be a cause of unilateral enophthalmos.

Secondary squamous cell carcinoma of the orbit

OBJECTIVE

To evaluate the origin and biological behavior of secondary orbital squamous cell (SCC) and mucoepidermoid carcinoma.

METHODS

A retrospective review of 30 consecutive patients with SCC and mucoepidermoid carcinoma of the orbit seen over a period of 8 years at a large ophthalmic hospital in Saudi Arabia.

RESULTS

A total of 51 secondary orbital tumors were seen in the 8-year period from 1983 through 1991; 30 (60%) of the 51 cases were SCC. There were 16 male and 14 female patients, with an age range of 38 to 80 years and a mean age of 65 years. In 28 (93%) of the 30 patients, the tumor originated in the conjunctiva. Orbital involvement by conjunctival SCC was the most common cause of secondary orbital tumors encountered in patients older than 19 years. Four patients had concomitant paranasal sinus involvement, 4 patients exhibited intraocular invasion, and 2 others were found to have intracranial extension of the SCC. Six (20%) of the 28 patients developed regional lymph node metastases during the course of their illness. All patients were treated by orbital exenteration, with or without radiation therapy. Seven (23%) of the 28 patients died of their disease.

CONCLUSIONS

Orbital SCC is an aggressive and life-threatening condition. Most cases result from secondary extension of conjunctival SCC, a common disease in Saudi Arabia. Several factors contribute to the aggressiveness of conjunctival SCC in this geographic location, including continual exposure to UV rays, chronic irritation, and genetic factors. Delay in presentation for treatment, inadequate initial resection of conjunctival lesions, and the aggressive mucoepidermoid carcinoma variant of SCC are also factors contributing to orbital invasion.

Orbital volume augmentation with subperiosteal room-temperature-vulcanized silicone implants: a clinical and histopathologic study

Enophthalmos, a clinical feature of the anophthalmic orbit, often produces a considerable cosmetic deformity. Management of this condition includes surgical volume augmentation with orbital implants. Several types of materials with different shapes have been used with variable success rates. Between 1984 and 1990, we treated 84 anophthalmic patients with room temperature vulcanized (RTV) subperiosteal silicone implants. Adequate volume augmentation and correction of the apparent enophthalmos was achieved in 75 patients. Extended patient follow-up, analysis of data and results, histopathologic assessment of implant capsules, and management of complications have provided a unique opportunity to study the efficacy of the surgery. We present our experience in the management of this condition.

Retroscleral-intraconal RTV silicone implants: an alternative technique for volume replacement post-extruding eviscerated spherical implants

Two patients with extruded implants postevisceration were assessed and managed with room temperature vulcanized (RTV) silicone implants placed in the retroscleral-intraconal space. The technique described is an alternative and simple surgical method that provides utilization of the remaining sclera, anterior support for the implant, and adequate volume replacement. The postoperative follow-up is relatively short, and clinical and radiologic (CT scan) investigations support the efficacy of the procedure. To the best of our knowledge, such a surgical alternative has not been reported.

Silastic intubation in congenital nasolacrimal duct obstruction: a study of 129 eyes

Congenital nasolacrimal duct (NLD) obstruction, the most common cause of congenital epiphora, occurs in approximately 5% of newborns. Before the advent of canaliculodacryo intubation, management of most cases of partial lacrimal obstruction that failed conservative management and probing necessitated bypass surgery such as dacryocystorhinostomy. Noninvasive closed system lacrimal intubation improved the success rate and provided a non-surgical therapeutic alternative. We present 129 eyes with congenital NLD obstruction managed with silastic lacrimal intubations. Early management is recommended with a minimum of 7 months' retention of the stents. Statistical assessment of results and management of complications is presented.

Ectopic (extradural) meningioma of the orbit: a report of two cases in children

Meningiomas arising from the optic nerve or secondarily invading the orbit from the intracranial cavity are uncommonly encountered in children. Ectopic (extradural) meningiomas are exceedingly rare orbital tumors that do not originate from either the optic nerve or the intracranial meninges. We evaluated and treated two boys aged 7 and 10 years with probable primary ectopic (extradural) orbital meningiomas. Both patients presented with a gradual onset of progressive, painless proptosis. In addition, computed tomographic scans demonstrated involvement of the superomedial orbit without bony erosion or hyperostosis, but with expansion of the adjacent sinus. Neither tumor demonstrated attachment to the optic nerve or intracranial extension at the time of surgery. Both patients were successfully treated with complete surgical excision. Evaluation did not reveal the presence of neurofibromatosis in either child.

Eyelid complications in trachoma: diagnosis and management

We present our experience (at the King Khaled Eye Specialist Hospital in Riyadh, Saudi Arabia) with the management of the trachomatous eyelid disease. Four major eyelid complications: cicatricial entropion, eyelid retraction, secondary blepharospasm and brow ptosis, are described and their management outlined. Nine hundred sixty patients with cicatricial entropion are presented with thorough discussion of the surgical procedures and results. The surgical management of eyelid retraction, blepharospasm and brow ptosis is geared to provide the ophthalmologist with a complete overview of the disease pattern.

Enchondromatosis and hemangioma (Maffucci's syndrome) with orbital involvement

Maffucci's syndrome is a rare, congenital disease of unknown cause characterized by the development of multiple enchondromas and soft-tissue hemangiomas. We treated a 34-year-old man with Maffucci's syndrome, bilateral proptosis secondary to multiple intraorbital hemangiomas, corneal exposure secondary to a left facial nerve palsy, and multiple intra-abdominal tumors. The skeletal manifestations were not clinically apparent and were only discovered after a careful radiologic survey. Simultaneous bilateral orbital cavernous hemangiomas should alert the physician to the possibility of Maffucci's syndrome.

Eyelid complications in trachoma. I. Cicatricial entropion

Trachoma is an infectious disease affecting the conjunctival membranes of the eye that results in scarring of the conjunctiva with secondary eyelid malformations and lacrimal pathology. Of the four eyelid complications secondary to trachoma--cicatricial entropion, eyelid retraction, secondary blepharospasm, and brow ptosis--by far, cicatricial entropion is the most common. One thousand two hundred patients with cicatricial entropion underwent surgery at the King Khaled Eye Specialist Hospital between 1984 and 1988. The classification and management of these cases are discussed, emphasizing the various surgical techniques used.

Conjunctival lymphocyte subsets in trachoma

Monoclonal antibodies were used to assess the lymphocyte populations in conjunctival biopsy specimens obtained from patients with trachoma (active or inactive) undergoing tarsotomy for the correction of trachoma-induced entropion and in three control patients. Peroxidase-labelled monoclonal antibodies OKT4 (identifies T-helper/inducer lymphocytes), OKT8 (identifies T-suppressor/cytotoxic lymphocytes), OKIal (identifies B-lymphocytes) and antisera specific for IgG, IgA and IgM were used to identify lymphocyte subpopulations and immunoglobulins in the conjunctival biopsy specimens. When grouped by disease activity, conjunctival tissue specimens revealed predominant T-helper/inducer lymphocytes in the substantia propria of patients with active trachoma while inactive trachoma patients had predominant T-suppressor/cytotoxic lymphocytes in the conjunctival biopsy specimens. B-lymphocytes were seen in moderate numbers in all conjunctival biopsy specimens from patients with active trachoma and all specimens from active cases stained for IgG, IgM, and IgA. Immunoglobulin staining was strongest with IgG and IgM.

Congenital generalized multicentric myofibromatosis with orbital involvement

We studied a rare case of congenital myofibromatosis of the orbit as part of a generalized multicentric disease in a 5-month-old boy. The ultrasonographic and computed tomographic findings were those of a low-reflective, firm, vascularized, lesion with heterogeneous internal structure. The histopathologic findings showed vascular channels with large polygonal cells and transition toward myofibroblasts with interwoven collagen fiber bundles.

Waardenburg's recessive anophthalmia syndrome

A family with a rare form of autosomal recessive anophthalmia, syndactyly and multiple congenital deformities is reported. The authors propose that this be recognized as a well defined autosomal recessive syndrome.

Standardized echographic-histopathologic correlations in liposarcoma

A 57-year-old woman had metastatic liposarcoma of the left orbit that underwent transformation. The primary focus in the abdomen, resected in 1975, was a well-differentiated liposarcoma. Later metastases to the neck and orbit were poorly differentiated, pleomorphic, and highly anaplastic liposarcomas. The ultrasonographic and histopathologic correlations of the different stages of the tumor during the disease process were analyzed and compared. This patient's disease had echopathologic similarities to other orbital sarcomas and adult cavernous hemangiomas.

Cicatricial ectropion secondary to herpes zoster

We present three patients with cicatricial ectropion of the upper and lower lids secondary to herpes zoster. Surgical release of the lid traction, excision of scars, and full thickness skin grafting were performed with satisfactory results.

Repair of the lacerated canaliculus using a modified silver wire lacrimal rod

Several techniques have been used to repair lacerated canaliculi with varying success in achieving functional results. In this communique, we describe a new procedure using a modified Johnson silver wire lacrimal rod.

Ocular pulse in high myopia: a study of 40 eyes

The ocular pulse amplitude of 20 myopic individuals (40 eyes) with refractive errors of -5.00 diopters and above was determined, using the Alcon Pneumatonograph. When compared to a group of normal individuals, the myopic group was found to have a significantly smaller mean ocular pulse amplitude but a significantly higher mean intraocular pressure. The importance of pulse-pressure relationship in the two groups is discussed.