Age-Related Maculopathy: a biochemical and immunohistochemical study

Age-related maculopathy (ARM) is an age-related degenerative disorder of the central part of the retina, the macula lutea (yellow spot). Essentially, ARM is a clinical diagnosis based on funduscopical changes. It is customary nowadays to call the late stages of ARM, geographic atrophy and neovascular (disciform) macular degeneration, age-related macular degeneration (AMD)(Bird, et ai., 1995). These late stages result in severe and irreversible visual impairment and tend to progress to the center of the macula (the fovea), where visual acuity is affected most. Because AMD is usually a bilateral disorder, affected people loose their ability to read, drive, and watch television (Macular-photocoagulation-study-group, 1993). The prevalence of AMD is 1-7% in people over 60, up to 14% over age 85. Obviously, the number of people affected by AMD will enlarge, because of the increasing age of the population (Ferris, 1983; Klein, el ai., 1992; Leibowitz, el ai., 1980; Vinding, 1989; Vingerling, et ai., 1995c). In fact, AMD is the mosl common cause of blindness in the elderly in the weslern world and it is estimated that 640.000 people in the USA aged 75 years or older have signs of AMD (Klein, et ai., 1992), while in The Netherlands 57.000 persons suffer from AMD in at least one eye (Vingerling, et ai., 1995d). Although this disease has been known for more than a century (Haab, 1888), knowledge on the patllOgenesis of the affliction is still incomplete. Some risk-factors for ARM have been found in epidemiologic studies. Current smokers have a three times increased risk to develop this disease (Vingerling, et ai., 1995b), and cardiovascular diseases and early-menopause are reported to be risk-factors as well (Vingerling, et ai., 1995a; Vingerling, et aI., 1995e). There is still no adequate therapy for the majority of people disabled by AMD. Therefore, it is necessary to intensify the research on ARM and AMD in order to understand the pathogenesis of this disease. This knowledge may eventually lead to an adequate therapy or to preventive measures for this severely invalidating disease

Giant-cell Arteritis of the Ovarian Arteries: A Rare Manifestation of a Common Disease

We describe a 58-year-old woman presenting with headache and an elevated erythrocyte sedimentation rate (ESR), who was diagnosed with and successfully treated for giant-cell arteritis (GCA). Seven months after the end of treatment, ovarian GCA was incidentally found after ovariectomy for a simple cyst. GCA of extracranial vessels like the ovarian arteries is rare. Nevertheless, we stress that extracranial GCA should be considered in patients older than 50 years with an elevated ESR, even if a temporal artery biopsy is negative or specific symptoms are absent. Moreover, we discuss the importance of imaging techniques when GCA of the extracranial large vessels is suspected

Soft tissue sarcomas at a glance: clinical, histological, and MR imaging features of malignant extremity soft tissue tumors

Soft tissue sarcomas comprise approximately 1% of malignant tumors. There are more than 50 subtypes, but pleomorphic sarcoma, liposarcoma, leiomyosarcoma, synovial sarcoma, and malignant peripheral nerve sheath tumor account for 75%. Differentiation between these subtypes is difficult because they often present with a painless enlarging mass, and share many histological and MR imaging features. Nonetheless, subdifferentiation is important because the different subtypes have different prognoses and therapeutic strategies. In this manuscript we discuss the clinical, histological, and MR imaging features of soft tissue sarcomas according to the WHO classification. An overview is provided and differentiating features are discussed that can help to narrow down the differential diagnosis

Giant solitary fibrous tumour of the liver

BACKGROUND: Solitary fibrous tumour (SFT) is an uncommon mesenchymal neoplasm that most frequently affects the pleura, although it has been reported with increasing frequency in various other sites such as in the peritoneum, pericardium and in non-serosal sites such as lung parenchyma, upper respiratory tract, orbit, thyroid, parotid gland, or thymus. Liver parenchyma is rarely affected. Clinically, SFTs cause symptoms after having reached a certain size or when vital structures are involved. In recent years, SFTs are more often identified and distinguished from other tumours with a similar appearance due to the availability of characteristic immunohistochemical markers. CASE PRESENTATION: In this manuscript we report the case of a large tumour of the liver, which was histologically diagnosed as a SFT, and showed involvement of a single hepatic segment. Because of the patient's presentation and clinical course, it may represent a radiation-induced lesion. CONCLUSION: When a SFT has been diagnosed, surgery is the treatment of choice. The small number of patients with a SFT of the liver and its unknown natural behaviour creates the need to a careful registration and follow-up of all identified case

Somatostatin receptor 2A expression in choroidal neovascularization secondary to age-related macular degeneration

PURPOSE: The growth of ocular neovascularization is regulated by a balance between stimulating and inhibiting growth factors. Somatostatin affects angiogenesis by inhibiting the growth hormone-insulin-like growth factor axis and also has a direct antiproliferative effect on human retinal endothelial cells. The purpose of our study is to investigate the expression of somatostatin receptor (sst) subtypes and particularly sst subtype 2A (sst2A) in normal human macula, and to study sst2A in different stages of age-related maculopathy (ARM), because of the potential anti-angiogenic effect of somatostatin analogues. METHODS: Sixteen eyes (10 enucleated eyes, 4 donor eyes, and 2 surgically removed choroidal neovascular [CNV] membranes) of 15 patients with eyes at different stages of ARM were used for immunohistochemistry. Formaldehyde-fixed paraffin-embedded slides were incubated with a polyclonal anti-human sst2A antibody. mRNA expression of five ssts and somatostatin was determined in the posterior pole of three normal human eyes by reverse transcriptase-polymerase chain reaction. RESULTS: The immunohistochemical expression of sstA in newly formed endothelial cells and fibroblast-like cells was strong in fibrovascular CNV membranes. mRNA of sst subtypes 1, 2A, and 3, as well as somatostatin, was present in the normal posterior pole; sst subtypes 4 and 5 were not detectable. CONCLUSIONS: Most early-formed CNV in ARM express sst2A. The presence of mRNA of sst subtype 2A was observed in normal human macula, and subtypes 1 and 3 and somatostatin are also present. sst2A receptors bind potential anti-angiogenic somatostatin analogues such as octreotide. Therefore, somatostatin analogues may be an effective therapy in early stages of CNV in ARM

Somatostatin receptor 2A expression in choroidal neovascularization secondary to age-related macular degeneration

PURPOSE: The growth of ocular neovascularization is regulated by a balance between stimulating and inhibiting growth factors. Somatostatin affects angiogenesis by inhibiting the growth hormone-insulin-like growth factor axis and also has a direct antiproliferative effect on human retinal endothelial cells. The purpose of our study is to investigate the expression of somatostatin receptor (sst) subtypes and particularly sst subtype 2A (sst2A) in normal human macula, and to study sst2A in different stages of age-related maculopathy (ARM), because of the potential anti-angiogenic effect of somatostatin analogues. METHODS: Sixteen eyes (10 enucleated eyes, 4 donor eyes, and 2 surgically removed choroidal neovascular [CNV] membranes) of 15 patients with eyes at different stages of ARM were used for immunohistochemistry. Formaldehyde-fixed paraffin-embedded slides were incubated with a polyclonal anti-human sst2A antibody. mRNA expression of five ssts and somatostatin was determined in the posterior pole of three normal human eyes by reverse transcriptase-polymerase chain reaction. RESULTS: The immunohistochemical expression of sstA in newly formed endothelial cells and fibroblast-like cells was strong in fibrovascular CNV membranes. mRNA of sst subtypes 1, 2A, and 3, as well as somatostatin, was present in the normal posterior pole; sst subtypes 4 and 5 were not detectable. CONCLUSIONS: Most early-formed CNV in ARM express sst2A. The presence of mRNA of sst subtype 2A was observed in normal human macula, and subtypes 1 and 3 and somatostatin are also present. sst2A receptors bind potential anti-angiogenic somatostatin analogues such as octreotide. Therefore, somatostatin analogues may be an effective therapy in early stages of CNV in ARM