Clinical and pathologic characteristics of biopsy-proven iris melanoma: a multicenter international study

OBJECTIVE

To collaborate with multiple centers to identify representative epidemiological, clinical, and pathologic characteristics of melanoma of the iris. This international, multicenter, Internet-assisted study in ophthalmic oncology demonstrates the collaboration among eye cancer specialists to stage and describe the clinical and pathologic characteristics of biopsy-proven melanoma of the iris.

METHODS

A computer program was created to allow for Internet-assisted multicenter, privacy-protected, online data entry. Eight eye cancer centers in 6 countries performed retrospective chart reviews. Statistical analysis included patient and tumor characteristics, ocular and angle abnormalities, management, histopathology, and outcomes.

RESULTS

A total of 131 patients with iris melanoma (mean age, 64 years [range, 20-100 years]) were found to have blue-gray (62.2%), green-hazel (29.1%), or brown (8.7%) irides. Iris melanoma color was brown (65.6%), amelanotic (9.9%), and multicolored (6.9%). A mean of 2.5 clock hours of iris was visibly involved with melanoma, typically centered at the 6-o'clock meridian. Presentations included iritis, glaucoma, hyphema, and sector cataract. High-frequency ultrasonography revealed a largest mean tumor diameter of 4.9 mm, a mean maximum tumor thickness of 1.9 mm, angle blunting (52%), iris root disinsertion (9%), and posterior iris pigment epithelium displacement (9%). Using the American Joint Commission on Cancer-International Union Against Cancer classification, we identified 56% of tumors as T1, 34% of tumors as T2, 2% of tumors as T3, and 1% of tumors as T4. Histopathologic grades were G1-spindle (54%), G2-mixed (28%), G3-epithelioid (5%), and undetermined (13%) cell types. Primary treatment involved radiation (26%) and surgery (64%). Kaplan-Meier analysis found a 10.7% risk of metastatic melanoma at 5 years.

CONCLUSIONS

Iris melanomas were most likely to be brown and found in the inferior quadrants of patients with light irides. Typically small and unifocal, melanomas are commonly associated with angle blunting and spindle cell histopathology. This multicenter, Internet-based, international study successfully pooled data and extracted information on biopsy-proven melanoma of the iris.

Decision support for the initial triage of patients with acute coronary syndromes

Early revascularization of acute coronary syndromes improves the prognosis. It is of vital importance that the decision to treat the patient is taken as early as possible. The aim of this study was (i) to develop an automated tool for the analysis of electrocardiograms (ECGs) with regard to changes that indicate possible transmural ischaemia and (ii) to assess the influence of the tool on the ECG classifications of three interns with less than 12 months of experience in ECG reading. An artificial neural network was trained to automatically interpret ECGs using 3000 ECGs recorded at an emergency department. Thereafter, the performance of the network was evaluated using 1000 test ECGs. In the second step, three interns classified these test ECGs twice on different occasions, with and without the advice of the neural network. The gold standard was the classification made by two experienced cardiologists. On average, the three interns showed a sensitivity of 68% at a specificity of 92% without the advice of the neural network and a sensitivity of 93% at a specificity of 87% with the advice. The neural network itself showed a sensitivity of 95% at a specificity of 88%. The increase in sensitivity of 23-26% was significant (P<0.001) for all three interns. In conclusion, an artificial neural network can be trained to the improve performance in the interpretation of ST-segment changes in accordance with that of the experienced cardiologists.

One-year low-dose erythromycin treatment of persistent chronic sinusitis after sinus surgery: clinical outcome and effects on mucociliary parameters and nasal nitric oxide

OBJECTIVE

In 17 patients with chronic sinusitis persistent after sinus surgery, long-term, low-dose erythromycin therapy was tested. The aim of the investigation was to study the clinical outcome and effects on nasal nitric oxide (NO), ciliary beat frequency (CBF), and mucociliary transport (saccharine transit time).

STUDY DESIGN AND SETTING

We conducted a prospective open study at a tertiary teaching hospital. Symptoms were assessed using visual analog scales. NO was measured using a chemiluminescence analyzer, and mucociliary transport was measured with the saccharine crystal technique. CBF was measured in nasal brush samples using a phase contrast microscope. All patients were treated with erythromycin succinate 250 mg 2x daily or clarithromycin 250 mg 1x daily and were assessed after 3 months. In cases where there was no response, treatment was abandoned. The remaining patients (responders) were reassessed after 12 months of treatment.

RESULTS

Of 17 patients, 12 responded to treatment. The 12-month follow-up showed an improvement in saccharine transit time (P < 0.05) but no significant change in CBF. There was a trend toward an increase in NO (P = 0.12). Endoscopic nasal examination scoring improved significantly (P < 0.01). In the visual analog scale scoring, the most pronounced improvements were seen in nasal congestion, sticky secretion, and runny nose at 3 and 12 months (P < 0.01). Improvements were also seen in headache (P < 0.05).

CONCLUSION

The present study suggests that long-term, low-dose treatment with erythromycin is effective in persistent chronic sinusitis that does not respond to sinus surgery or systemic steroid/antibiotic treatment.

SIGNIFICANCE

Long-term, low-dose erythromycin therapy seems to be a promising alternative when more conventional therapy fails. However, placebo-controlled studies are needed to validate the potential of this treatment.