Morphological and Biochemical Assessment of the Cornea in a Gaucher Disease Carrier with Keratoconus

Ocular abnormalities such as corneal opacities and some specific alterations in ocular movements have been described in the neuropathic forms of Gaucher disease. This study was designed to correlate the clinical, morphological and biochemical findings in the corneal button obtained after keratoplasty in a Gaucher disease carrier with keratoconus. Morphologically, the cornea showed keratocytes with marked dilatations of the rough endoplasmic reticulum and intracytoplasmic "dark inclusions"; the acidic lipid profiles presented alterations in the cornea of the Gaucher disease carrier when compared with healthy controls and a clear deficiency in beta-glucosidase activity was detected as well. Our data suggest that the cornea may serve as a good marker of an early target organ in lipid metabolism disorders such as Gaucher's disease.

Visceral obesity assessed by computed tomography predicts cardiovascular events in chronic kidney disease patients

BACKGROUND AND AIM

Cardiovascular disease is the leading cause of death among patients with chronic kidney disease (CKD). Although there is emerging evidence that excess visceral fat is associated with a cluster of cardiometabolic abnormalities in these patients, the impact of visceral obesity evaluated by a gold-standard method on future outcomes has not been studied. We aimed to investigate whether visceral obesity assessed by computed tomography was able to predict cardiovascular events in CKD patients.

METHODS AND RESULTS

We studied 113 nondialyzed CKD patients [60% men; 31% diabetics; age 55.3 ± 11.3 years; body mass index (BMI) 27.2 ± 5.3 kg/m(2); estimated glomerular filtration rate (GFR) 33.7 ± 13.6 ml/min/1.73 m(2)]. Visceral and subcutaneous abdominal fat were assessed by computed tomography at L4-L5. Visceral to subcutaneous fat ratio >0.55 (highest tertile cut-off) was defined as visceral obesity. Cardiovascular events including acute myocardial infarction, angina, arrhythmia, uncontrolled blood pressure, stroke and cardiac failure were recorded during 24 months. Cardiovascular events were 3-fold higher in patients with visceral obesity than in those without visceral obesity. The Kaplan-Meier analysis indicated that patients with visceral obesity had shorter cardiovascular event-free time than those without visceral obesity (P = 0.021). In the univariate Cox analysis, visceral obesity was associated with higher risk of cardiovascular events (hazard ratio = 3.4; 95% confidence interval = 1.1-10.5; P = 0.03). The prognostic power of visceral obesity for cardiovascular events remained significant after adjustments for sex, age, diabetes, previous cardiovascular disease, smoking, sedentary lifestyle, BMI, GFR, hypertension, dyslipidemia and inflammation.

CONCLUSION

Visceral obesity assessed by computed tomography was a predictor of cardiovascular events in CKD patients.

Fine-needle aspiration features of pilomatrixoma

BACKGROUND

Pilomatrixoma (PMX) is a benign skin neoplasm of hair matrix origin. The fine-needle aspiration (FNA) features of PMX frequently lead to a misdiagnosis of carcinoma.

METHODS

Nine cases of PMX in which a preoperative FNA was performed were reviewed. The cytologic features were compared with the histologic appearance of corresponding surgical specimens as well as with cytologic features of tumors that arose in the differential diagnosis.

RESULTS

Unequivocal benign diagnoses were rendered in three cases; the correct preoperative diagnosis of PMX was rendered in two of these cases and considered in an additional case. In four additional cases, carcinoma was diagnosed or could not be excluded. A noncommittal diagnosis of epithelial tumor, most likely of skin adnexal origin, was rendered in an additional single case. Retrospective review of the FNA smears in all nine instances disclosed cytologic features that corresponded well with the histologic components of PMX. Diagnostic cytologic features included cellular aspirates; clusters of small, primitive-appearing basaloid epithelial cells; a high nuclear-cytoplasmic ratio; evenly dispersed chromatin; prominent nucleoli; pink, fibrillary material enveloping clusters of basaloid cells; multinucleated giant cells; and sheets of ghost cells.

CONCLUSIONS

The FNA cytologic diagnosis of PMX may be extremely difficult; its distinction from various primary cutaneous carcinomas is most problematic. Recognition of a unique constellation of cytologic features in FNA smears in the appropriate clinical context is most helpful in making this distinction.

Fine-needle aspiration characteristics of hibernoma

BACKGROUND

Hibernoma is a rare, benign lipomatous tumor with features of brown fat. The preoperative diagnosis of hibernoma is difficult at times because its clinical, radiographic, and fine-needle aspiration (FNA) characteristics overlap with those of liposarcoma.

METHODS

The preoperative FNA findings of eight surgically excised hibernomas from seven patients (three men and four women, ages 24-60 years) were reviewed. The cytologic features were compared with the histologic features of the corresponding surgical specimens as well as lipomatous tumors and other lesions that may cause confusion in the differential diagnosis.

RESULTS

The FNA cytologic features of the hibernomas were found to correspond well with their histologic appearance. The FNA findings included small, round, brown fat-like cells with uniform, small cytoplasmic vacuoles and regular, small, round nuclei; delicate branching capillaries; and variable numbers of mature fat cells.

CONCLUSIONS

The FNA cytologic features of hibernoma are characteristic and useful in the preoperative investigation of lipomatous tumors, particularly with regard to excluding a diagnosis of liposarcoma.

Near vision contrast sensitivity after photorefractive keratectomy

BACKGROUND

To evaluate near vision contrast sensitivity as a measure of visual performance after photorefractive keratectomy (PRK).

SETTING

LSU Eye Center, New Orleans, Louisiana.

METHODS

Using Holladay Contrast Acuity Test cards, near (reading) vision for five levels of contrast sensitivity was evaluated in a cross section of 53 eyes of 31 patients 25 to 732 days after PRK. Twenty-four normal eyes of 22 myopic patients served as controls.

RESULTS

Near contrast sensitivity decreased at all tested contrast levels for approximately 7 months after PRK and then returned to baseline. This phenomenon paralleled the fluctuation in best corrected distance Snellen acuity.

CONCLUSIONS

These preliminary results indicate that Snellen visual acuity and near contrast sensitivity returned to baseline within 1 year after PRK.

[Cerebral metastasis as the form of presentation of a basaloid carcinoma of the esophagus]

A case of oesophageal basaloid carcinoma is reported. The disease was revealed as a brain metastasis and was found ad initium to be in an advanced stage, with evidence of brain, lung and liver metastasis. The treatment performed was palliative subtotal oesophagectomy followed by roentgen therapy. A year and a half later, the patient is still alive and in home care follow up. The authors end stressing this uncommon presentation for an oesophageal neoplasm and the rarity of its histologic type. They also stress the role of surgery, although palliative, in long survival, very unlike the rapid evolution of the few published cases.

Excimer laser photorefractive keratectomy after radial keratotomy

BACKGROUND

Correction of residual myopia after radial keratotomy may be attempted with repeated keratotomy surgery, but predictability can be less than satisfactory. Excimer laser photorefractive keratectomy (PRK) provides an alternative approach to improving the refractive result in these patients.

METHODS

Twenty-five eyes of 20 patients at five clinical locations underwent PRK for residual myopia after radial keratotomy. The number of incisions ranged from 4 to more than 16. Clear zones ranged from 3 mm to 4 mm. Best corrected visual acuity was 20/20 or better in 16 of the 25 eyes, with a range from 20/12 to 20/80. Uncorrected visual acuity was 20/200 or worse in 15 of the 25 eyes, with a range from 20/25 to finger counting. The interval between radial keratotomy and PRK averaged 33.5 months, with a range from 5 to 96 months. Nineteen eyes had 6 months or more of follow up; 15 had 12 months or more.

RESULTS

Corneal haze was maximal 1 month after surgery (mean +/- SE, 0.65 +/- 0.09), and declined to 0.35 +/- 0.16 at 12 months. Twelve months after PRK, mean keratometric readings were 40.19 +/- 0.81 diopters (D) and mean spherical equivalent refraction was -1.42 +/- 0.47 D. Nine (60%) of the 15 eyes with 12 months follow up were within 1 D of emmetropia and 12 (80%) were within 2 D. Eight (53%) of the 15 eyes had uncorrected visual acuities of 20/40 or better. Spectacle-corrected visual acuity in the eyes with 12 months follow up improved in 4, did not change in 4, and worsened in 6.

CONCLUSIONS

The results of PRK are less predictable in eyes that have previously undergone radial keratotomy, and these eyes respond with more haze after PRK than normal eyes.

Primary lipid keratopathy: a morphological and biochemical assessment

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