Renal cell carcinoma metastasis to the ciliary body responds to proton beam radiotherapy: a case report

<p>Abstract</p> <p>Introduction</p> <p>We report an unexpected presentation of metastatic renal cell carcinoma (RCC) to the ciliary body and an interesting response to proton beam radiotherapy.</p> <p>Case presentation</p> <p>We encountered a case of angle-closure glaucoma as the initial presentation of ocular metastasis to the ciliary body in a 65-year-old Caucasian man who had undergone right radical nephrectomy for RCC 15 years earlier. He underwent YAG (yttrium aluminium garnet) laser peripheral iridotomy while further metastatic workup took place. His condition was eventually diagnosed as stage IV metastatic RCC of the clear cell type and involved multiple sites, including the ciliary body, brain, lungs, liver, and pancreas. The progression of RCC metastasis to the ciliary body was studied for 16 months. The ciliary body mass continued to grow despite systemic treatment with temsirolimus and interleukin-2 and intravitreal injections of bevacizumab. The tumor size peaked at 6.11 × 6.06 mm before the start of proton therapy, which reduced the tumor size to 5.07 × 4.39 mm.</p> <p>Conclusions</p> <p>RCC can produce metastases involving unusual sites many years after resection of the primary tumor. Proton therapy was found to be effective in treating RCC metastasis to the ciliary body in settings in which other treatment modalities failed.</p

DIABETIC COMPLICATIONS AND RISK FACTORS IN RECENTLY DIAGNOSED TYPE II DIABETES: A CASE-CONTROL STUDY

&nbsp; Abstract INTRODUCTION: Due to a worldwide increase in the incidence of type II diabetes, it will likely continue to be a major cause of morbidity and mortality in the future. Given that usually a mean of 4-7 years has passed from the initial onset of type II diabetes until the time of diagnosis, a great number of patients have already been affected by one or more diabetic complications by the time of diagnosis. Our objective was to evaluate the prevalence of diabetic complications and risk factors in recently diagnosed type II diabetic patients in the city of Mashhad, Northeast Iran. methods: This cross-sectional prevalence study was performed between March, 2002 and September, 2002. The study group included 200 type II diabetics whose disease had been diagnosed within one year prior to the start of our study. The collected data included medical history, physical examination and clinical tests, including urinalysis (for evaluation of macroproteinuria), blood sampling (for evaluation of serum glucose and lipid levels), and electrocardiography (EKG). Several common indicators of diabetic complications were analyzed. results: Of the 200 patients studied, 66 were male and 134 were female. The mean age of the patients was 52.2 years for men and 46.8 for women at the time of diagnosis. Overall, 74.2% of the patients were shown to have been affected by one or more diabetic complications prior to diagnosis with type II diabetes. CONCLUSIONS: Formulating a new screening program may help us diagnose type II diabetes earlier and control it more effectively. This may lead to a reduction in morbidity and mortality in type II diabetes patients. &nbsp; &nbsp; Keywords: Type II diabetes mellitus, retinopathy, neuropathy, nephropathy, macrovascular complications, body mass index.</div

IL-4 AND INTERFERON GAMMA IN RECENTLY DIAGNOSED TYPE I DIABETES, A CASE-CONTROL STUDY

&nbsp; Abstract INTRODUCTION: The aim of this study was to measure serum levels of interferon-gamma (IFN-&gamma;) and interleukin-4 (IL-4), the two major cytokines secreted by Th-1 and Th-2 cells, in islet cell autoantibody (ICA)-positive, newly-diagnosed type I diabetic patients. methods: The study was conducted on 30 newly diagnosed, ICA-positive type I diabetics and 30 age- and sex-matched healthy controls. Cytokine levels in serum were quantified by indirect sandwich ELISA in pg/ml. results: We observed no significant difference in concentration of IL-4 in ICA-positive diabetics (median=126.535) compared with healthy controls (median=136.440) (P&gt;0.05). IFN-&gamma; levels were significantly higher in patients (median=11.305) compared with healthy controls (median=8.200) (P&lt;0.05). CONCLUSIONS: Increased levels of IFN-&gamma; in patients may be suggestive of its destructive role in the pathophysiology of type I autoimmune diabetes. &nbsp; &nbsp; Keywords: Type I diabetes mellitus, interleukin-4 (IL-4), interferon-gamma (IFN-&gamma;), islet cell autoantibody (ICA), T-helper 1 (Th-1) response, T-helper 2 (Th-2</div

Coronary Atherosclerotic Plaque Detected by Computed Tomographic Angiography in Subjects with Diabetes Compared to Those without Diabetes.

ObjectivesLittle data are available regarding coronary plaque composition and semi-quantitative scores in individuals with diabetes; the extent to which diabetes may affect the presence and extent of Coronary Artery Calcium (CAC) needs more evaluation. Considering that this information may be of great value in formulating preventive interventions in this population, we compared these findings in individuals with diabetes to those without.MethodsMulti-Detector Computed Tomographic (MDCT) images of 861 consecutive patients with diabetes who were referred to Los Angeles Biomedical Research Institute from January 2000 to September 2012, were evaluated using a 15-coronary segment model. All 861 patients underwent calcium scoring and from these; 389 had coronary CT angiography (CTA). CAC score was compared to 861 age, sex and ethnicity matched controls without diabetes after adjustment for Body Mass Index (BMI), family history of coronary artery disease, hyperlipidemia, hypertension and smoking. Segment Involvement Score (SIS; the total number of segments with any plaque), Segment Stenosis Score (SSS; the sum of maximal stenosis score per segment), Total Plaque Score (TPS; the sum of the plaque amount per segment) and plaque compositionwere compared to 389 age, sex and ethnicity matched controls without diabetes after adjustment for BMI, family history of coronary artery disease, hyperlipidemia, hypertension and smoking.ResultsDiabetes was positively correlated to the presence and extent of CAC (P&lt;0.0001 for both). SIS, SSS and TPS were significantly higher in those with diabetes (P&lt;0.0001). Number of mixed and calcified plaques were significantly higher in those with diabetes (P = 0.018 and P&lt;0.001 respectively) but there was no significant difference in the number of non-calcified plaques between the two groups (P = 0.398).ConclusionsPatients with diabetes have higher CAC and semi-quantitative coronary plaque scores compared to the age, gender and ethnicity matched controls without diabetes after adjustment for cardiovascular risk factors. Since mixed plaque is associated with worse long-term clinical outcomes, these findings support more aggressive preventive measures in this population

Correlation coefficients of semi-quantitative scores with coronary artery calcium scores or age.

<p>*p<0.05</p><p>**p<0.001</p><p>Correlation coefficients of semi-quantitative scores with coronary artery calcium scores or age.</p

Baseline risk factor distributions for patients with semi-quantitative scores.

<p>CAC = coronary artery calcium. Data are expressed as mean ± standard deviation, as number (percentage), or as median (inter-quartile range).</p><p>Baseline risk factor distributions for patients with semi-quantitative scores.</p

Baseline risk factor distributions by groups.

<p>CAC = coronary artery calcium. Data are expressed as mean ± standard deviation, as number (percentage), or as median (inter-quartile range). There were 389 patients with SIScore, TPScore, or SSScore.</p><p>*p<0.05</p><p>**p<0.001 across groups</p><p>Baseline risk factor distributions by groups.</p

Presence, Characteristics, and Volumes of Coronary Plaque Determined by Computed Tomography Angiography in Young Type 2 Diabetes Mellitus.

Prevention and management of coronary artery disease (CAD) is of great concern in patients with diabetes mellitus. Although the impact of coronary atherosclerosis is described well for subjects older than 40&nbsp;years, the prevalence and types of coronary atherosclerosis in young patients are not well known. The aim of this study was to evaluate the prevalence, extent, severity, and volumes of coronary plaque in type 2 diabetes mellitus (T2DM) population younger than of 40&nbsp;years. This prospective study enrolled 181 subjects (25-40&nbsp;year old) undergoing coronary computed tomography angiography, with 86 T2DM and 95 nondiabetic age/gender-matched subjects. Coronary artery calcium (CAC), plaque assessment including total segment stenosis (sum of individual segmental stenosis), total plaque scores (sum of semiquantitative segmental plaque burden), segment involvement scores (number of segments with plaque) were evaluated. In addition, we quantitatively measured plaque volumes in total, fibrous, fibrous fatty, dense calcified, and low-attenuation plaque using novel plaque software. Compared with nondiabetic patients, the prevalence of CAD, calcified, and noncalcified plaques was higher in patients with T2DM (19% vs 58%; p &lt;0.001). In patients with a zero CAC, T2DM had a higher prevalence (46%) of noncalcified plaque (p &lt;0.0001). In multivariate linear regression models after adjusting for traditional cardiovascular risk factors, increased total segmental stenosis, total plaque scores, and segment involvement scores were associated with T2DM. Regarding quantitative plaque assessment, all volumes in noncalcified plaque type were approximately threefold higher in patients with T2DM. In conclusion, young patients with T2DM are susceptible to premature CAD with more calcified and noncalcified plaques. Early prevention program using computed tomography angiography might be helpful in identifying young diabetic patients with subclinical atherosclerosis