Orbital space-occupying lesions: an 11-year study of cases with histopathologic analysis seen at Hospital das Clínicas of FMUSP

OBJETIVO: Estudar a incidência das lesões expansivas orbitárias submetidas à biópsia em uma casuística de 11 anos no Hospital das Clínicas da FMUSP, e avaliar quais as principais especialidades envolvidas no diagnóstico e no tratamento de tais afecções. CASUÍSTICA E MÉTODOS: Solicitou-se ao setor de arquivos do hospital todos os casos de tumores e lesões de órbita submetidas à biópsia no período de 1993 a 2004. Dos 924 prontuários obtidos, 115 foram separados após análise dos dados segundo os resultados histopatológicos obtidos. Outros 111 pacientes foram obtidos por meio dos arquivos pessoais da patologista encarregada da Oftalmologia no Departamento de Patologia, dos quais 45 pacientes foram excluídos por coincidirem com a fonte anterior. Os dados foram contabilizados e comparados com os de outros serviços. RESULTADOS: Das 181 lesões orbitárias estudadas, 70% eram primárias, 23% eram secundárias, 6% consistiam de metástases e linfomas e 1% não foi classificada. Em relação à especialidade responsável diretamente pelo paciente, 72,37% dos pacientes foram assistidos por oftalmologistas, 14,36% por cirurgiões de cabeça e pescoço, 6,62% por neurocirurgiões e 6,62% por outros setores do hospital. CONCLUSÕES: As afecções orbitárias são atendidas em sua maioria pelos oftalmologistas especializados em tal área, e ao se incluir nesta casuística outras especialidades, nota-se um aumento no número de casos de lesões tumorais secundárias quando comparada ao de outros trabalhos realizados em serviços no exterior. Há necessidade de criar-se um registro confiável dos casos de lesões expansivas orbitárias nos serviços especializados brasileiros, e confirma-se o caráter multidisciplinar do objeto deste estudo.PURPOSE: To report the incidence of orbital space-occupying lesions in an 11-year interval study of patients examined at the Hospital das Clínicas of FMUSP, and to evaluate which are the main specialties involved in the diagnosis and treatment of such conditions. METHODS: All cases of orbital space-occupying lesions in the period from 1993 to 2004 were revised. Of 924 obtained medical records, 155 were selected after histopathological analysis. Another 111 cases were gathered from the personal archives of a pathologist responsible for Ophthalmic Histopathology, from which 45 cases were excluded because they had already been included in the first source analysis. The data were analyzed and compared with the results from other institutions. RESULTS: Of the studied 181 orbital space-occupying lesions, 70% were primary, 23% secondary, 6% metastatic and lymphomas, and 1% was not classified. The most common specialties involved ophthalmologists in 72.37% of all 181 cases, head and neck surgeons in 14.36%, neurosurgeons in 6.62%, and others in 6.62%. CONCLUSIONS: The orbital mass lesions were treated mostly by an expert ophthalmologist. When other specialties were included, there was a modest increase in secondary tumor incidence when the final result was compared with previous studies on this subject. Our findings indicate that the creation of a trustworthy register of all orbital space-occupying lesions in Brazilian specialized services is necessary. The multidisciplinary character of the orbital mass lesions is corroborated by this review

A review of guidelines for cross-cultural adaptation of questionnaires could not bring out a consensus

International audienceOBJECTIVES:The aim of cross-cultural adaptation (CCA) of a questionnaire is to achieve equivalence between the original and adapted questionnaire. Here, we aimed to review the state of the art in CCA methods.STUDY DESIGN AND SETTING:We reviewed cross-disciplinary bibliographic databases for articles on methods and guidelines for CCA of questionnaires. Articles were first selected by their abstract and title, and then, we retrieved full-text English articles. References of selected articles were searched for additional relevant studies.RESULTS:We identified 31 guidelines and found no consensus in CCA methods. Most methods included use of committees, focus groups, and back translations. Evidence for the best methods is lacking, although clues indicate that back translation may not be mandatory.CONCLUSION:Several methods are available for CCA of questionnaires. According to experts only, most would achieve comparable results, and choosing one is a matter of preference and logistic. More evidence is needed to support recommendations. Adaptation and validation of a questionnaire are two different processes that should be distinguished and undertaken with care

Perspectivas no tratamento da alergia ocular: revisão das principais estratégias terapêuticas

RESUMO As alergias oculares englobam uma série de doenças inflamatórias da superfície ocular, causadas por diferentes mecanismos de hipersensibilidade. Acometem aproximadamente 20% da população e podem ser classificadas em formas mediadas por hipersensibilidade tipo I (CAS, CAP), tipo I e IV (CCV, CCA) e tipo IV (BCC, CPG). As formas mais prevalentes são CAS e CAP. As formas crônicas (CCV, CCA) estão mais frequentemente relacionadas a complicações e comprometimento da função visual decorrentes do processo inflamatório e consequente remodelação da superfície ocular. Comorbidades como olho seco e ceratocone podem estar presentes. O tratamento envolve diagnóstico e afastamento dos fatores etiológicos envolvidos, uso de drogas anti-inflamatórias que atuem na ação de linfócitos Th2, eosinófilos, mastócitos e células dendríticas Avanços no conhecimento da ativação e tráfego de células do sistema imune têm sido promissores na perspectiva de novas abordagens terapêuticas

Congenital retinoblastoma: report of a case Retinoblastoma congênito: relato de caso

The authors present an unusual case of bilateral retinoblastoma, showing early appearance (bilateral leukocoria at 1 month of age), "phthysis bulbi" in OD and massive calcification of the vitreous cavity.<br>Os autores apresentam um caso raro de retinoblastoma bilateral caracterizado por aparecimento precoce (leucocoria bilateral com um mês de idade), grande redução do volume em OD por "phthysis bulbi" e calcificação maciça da cavidade vítrea

Enhancing the cross-cultural adaptation and validation process: linguistic and psychometric testing of the Brazilian–Portuguese version of a self-report measure for dry eye

International audienceOBJECTIVES:To provide a reliable, validated, and culturally adapted instrument that may be used in monitoring dry eye in Brazilian patients and to discuss the strategies for the enhancement of the cross-cultural adaptation and validation process of a self-report measure for dry eye.METHODS:The cross-cultural adaptation process (CCAP) of the original Ocular Surface Disease Index (OSDI) into Brazilian-Portuguese was conducted using a 9-step guideline. The synthesis of translations was tested twice, for face and content validity, by different subjects (focus groups and cognitive interviews). The expert committee contributed on several steps, and back translations were based on the final rather than the prefinal version. For validation, the adapted version was applied in a prospective longitudinal study to 101 patients from the Dry Eye Clinic at the General Hospital of the University of São Paulo, Brazil. Simultaneously to the OSDI, patients answered the short form-36 health survey (SF-36) and the 25-item visual function questionnaire (VFQ-25) and underwent clinical evaluation. Internal consistency, test-retest reliability, and measure validity were assessed.RESULTS:Cronbach's alpha value of the cross-culturally adapted Brazilian-Portuguese version of the OSDI was 0.905, and the intraclass correlation coefficient was 0.801. There was a statistically significant difference between OSDI scores in patients with dry eye (41.15 ± 27.40) and without dry eye (17.88 ± 17.09). There was a negative association between OSDI and VFQ-25 total score (P < 0.01) and between the OSDI and five SF-36 domains. OSDI scores correlated positively with lissamine green and fluorescein staining scores (P < 0.001) and negatively with Schirmer test I and tear break-up time values (P < 0.001).CONCLUSION:Although most of the reviewed guidelines on CCAP involve well-defined steps (translation, synthesis/reconciliation, back translation, expert committee review, pretesting), the proposed methodological steps have not been applied in a uniform way. The translation and adaptation process requires skill, knowledge, experience, and a considerable investment of time to maximize the attainment of semantic, idiomatic, experiential, and conceptual equivalence between the source and target questionnaires. A well-established guideline resulted in a culturally adapted Brazilian-Portuguese version of the OSDI, tested and validated on a sample of Brazilian population, and proved to be a valid and reliable instrument for assessing patients with dry eye syndrome in Brazil