Presenting signs of retinoblastoma

A retrospective chart review was performed on the charts of 1265 patients with retinoblastoma who were on file at New York Hospital and whose conditions had been diagnosed between the years 1960 and 1990. The mean follow-up was 90 months, ranging from 0 to 409 months. Thirty-two distinct presenting signs of retinoblastoma were identified, the most common of which were leukocoria (56.2%), strabismus (23.6%), poor vision (7.7%), and family history (6.8%). No correlation was found between any of the presenting signs and laterality, sex, race, or survival. Leukocoria correlated to Reese-Ellsworth Group Va or Vb, whereas strabismus was invariably associated with either macular tumors or macular retinal detachments. Eighty-three (96.5%) patients presenting with a family history did so before the age of 24 months. The presenting sign leading to a diagnosis of retinoblastoma was correlated with degree of advancement and tumor location. Leukocoria and strabismus are the most common presenting signs, with leukocoria correlated to more advanced disease and strabismus always associated with macular involvement. Vitreous hemorrhage (1 case, 0.1%), microphthalmos (4 cases, 0.3%), and orbital cellulitis (3 cases, 0.2%) are extremely rare presenting findings in retinoblastoma.

Umbilical cord blood gases and mortality and morbidity in the very low birth weight infant

Umbilical cord blood gas values and morbidity and mortality were correlated in 191 very low birth weight (VLBW) infants (500-1500 g). The mean umbilical arterial pH and base excess differed significantly between survivors and non-survivors. The presence of at least moderate acidosis (arterial pH 7.15 or lower) was related significantly to mortality, particularly in infants younger than 26 weeks. The mean cord blood gas values did not predict the presence or severity of hyaline membrane disease or intraventricular hemorrhage, but Apgar scores did. Bronchopulmonary dysplasia, neurologic sequelae, necrotizing enterocolitis, and sepsis also did not correlate with mean cord gas values, but neither did Apgar scores. Furthermore, the severity and type of acidosis did not relate to morbidity. Combining cord blood gases and Apgar scores did not help predict morbidity, which was not surprising because cord pH values correlated poorly with Apgar scores (all r values less than or equal to 0.26). We urge caution in interpreting cord gases as predictors of morbidity in the VLBW infant.