BACKGROUND:The incidence, risk factors, time course, and impact on survival of venous thromboembolism (VTE) in a large, population-based study of patients with bladder cancer have not been identified previously. METHODS: The California Cancer Registry was merged with the California Patient Discharge Data Set to determine the incidence of VTE in patients with newly diagnosed bladder cancer within a 6-year period. Cox proportional hazards models were used to determine the risk factors for VTE and the effects of VTE on survival. RESULTS: Among 24,861 patients with bladder cancer, the 2-year incidence of VTE was 1.9%. The highest incidence of VTE occurred in the first 6 months regardless of age, sex, race, tumor stage, or histologic subtype. In a multivariate model, significant risk factors for the development of VTE included major surgery, advancing disease stage, and increasing number of comorbidities. Compared with the general population, the 1-year standardized incidence ratio for VTE in the bladder cancer cohort was 5.3 (95% confidence interval, 4.8-5.9). Among patients with bladder cancer, significant risk factors for death included advancing disease stage, increasing comorbidities, African-American race, nontransitional cell carcinoma histology, and the development of VTE. CONCLUSIONS: Patients with bladder cancer had a 1.9% 2-year incidence of VTE. Metastatic disease was the strongest predictor of both VTE and death. It was noteworthy that cancer-associated surgery was associated with a higher risk of VTE, which differed from the results reported from other studies in solid tumors. VTE was a significant predictor of death in the first 2 years.
Morgellons disease is characterized by complaints of uncomfortable skin sensations and fibers emanating from nonhealing skin lesions. Morgellons disease is well-known in the dermatology and psychiatry literature, where it is typically considered a subtype of delusional parasitosis, but it has not yet been described in the ophthalmology literature. A patient with self-reported Morgellons disease is presented, who was referred for evaluation of left lower eyelid ectropion. She reported that her skin was infested with fibers that were "trying to get down into the eyelid." On examination, she had ectropion of the left lower eyelid, broken cilia, and an ulcerated left upper eyelid lesion concerning for carcinoma. Biopsy of the lesion was consistent with excoriation. Treatment of her ectropion was deferred out of concern for wound dehiscence, given the patient's aggressive excoriation behavior. This case is presented to make the ophthalmologist aware of this disorder and to highlight the appropriate clinical management.
Objective To assess the association between correction of myopia, hyperopia and astigmatism with self-reported near and distance visual function. Design Population based, cross-sectional study. Participants A random sample of 4272 Latinos over 40 years old from Arizona with both ophthalmic exam and questionnaire data, including answers to the NEI VFQ-25. Methods Cases of refractive error (RE) were defined as subjects who met at least one of the following criteria in both eyes: myopia, sphere ≤-0.5 diopters (D); hyperopia, sphere ≥1.0D; astigmatism, cylinder≥0.75D. Uncorrected refractive error (URE) was defined as having RE and achieving ≥2 line improvement in visual acuity in both eyes after refraction. The association between RE category and near and distance vision difficulty (as measured by the National Eye Institute Visual Functioning Questionnare-25 near and distance vision subscores) was modeled with ordinal logistic regression, adjusting for age, sex, diabetes, hypertension, income, education and acculturation. Main Outcome Measures Association between RE correction and near and distance vision difficulty by type of RE (myopia, hyperopia, and astigmatism). Results Of 4272 participants, 54% had RE. 48% of these had myopia, 41% hyperopia, and 11% astigmatism. 14% of myopes, 21% of hyperopes, and 22% of astigmatics had URE. Subjects with myopia, astigmatism, and hyperopia were significantly more likely to report more distance vision difficulty than subjects without RE, whether or not they had correction (Odds Ratios (OR) from 1.7-3.7; p<0.005 for all). Subjects with corrected myopia reported less near vision difficulty than subjects without RE (OR 0.8, Confidence Interval (CI) 0.7-0.9). Subjects with uncorrected hyperopia and uncorrected astigmatism reported more near vision difficulty than those without RE (OR 1.6, CI 1.2-2.2 and OR 1.7, CI 1.0-3.0, respectively). Self reported distance and near visual function scores were sensitive to non-vision variables; namely, age, sex, diabetes, high blood pressure, acculturation score, income, and education. Conclusions in our population, correction of any type of RE is not entirely sufficient to restore distance visual function to the level of those without RE. More research is necessary to determine the reasons for this shortcoming.
This is a unique case of frosted branch angiitis associated with granulomatosis with polyangiitis. The authors are not aware of a previous report of this association. Although rare, retinal vasculitis should be recognized as a potential complication of granulomatosis with polyangiitis and can respond rapidly to prompt initiation of therapy.
PurposeTo report 3 cases of corneal protein deposition occurring in association with systemic disease, with one case demonstrating a novel technique for clearing corneal deposits.ObservationsThree patients presented with corneal deposits associated with systemic disease. Corneal involvement was noted prior to diagnosis of systemic disease in two patients, leading to subsequent diagnosis of multiple myeloma or monoclonal gammopathy of undetermined significance. OCT revealed protein deposition at various corneal levels, including at different stromal depths in the two cases of multiple myeloma. A novel technique of posterior endothelial scraping was performed in one case with deep stromal deposits, leading to significant corneal clearing.Conclusions and ImportanceThis case series demonstrates that recognition of corneal deposits may precede the diagnosis of systemic disease. It incorporates the use of anterior segment OCT to characterize corneal deposits, and demonstrates a novel surgical technique for clearing certain types corneal deposits.
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