Benign Occurrence Research Articles

Early Pneumatocele Identification Post-Robotic Assisted Bronchoscopy Cryobiopsy: A Case Series Experience

Introduction: The use of cryobiopsy in conjunction with robotic assisted bronchoscopy is on the rise due to the safety and increased diagnostic yield of cryobiopsy. The incorporation of 3D fluoroscopy in the procedure improves the workflow and helps confirm the accuracy of sampling of peripheral pulmonary nodules. Methods: We describe an observational series of 12 patients comprising 14 nodules where cryobiopsy was performed during shape-sensing robot-assisted bronchoscopy cryobiopsy under general anesthesia. 3D fluoroscopy was used to confirm accurate placement of the cryoprobe. All these patients underwent a second spin with the 3D fluoroscopy either to sample a second lesion intraoperatively or to investigate suspected pneumothorax. Results: The development of a pneumatocele was noted after cryobiopsy in each of the cases. The majority of these were in the upper lobe with the median size of a sampled nodule being 14 mm. The majority of patients were asymptomatic with 1 patient developing mild hemoptysis and 4 patients developing chest tightness or dyspnea. None of the patients required an intervention for the pneumatocele. Conclusion: The development of pneumatoceles appears to be a fairly frequent and benign occurrence following cryobiopsy, likely due to increased tissue destruction. The increased use of intraoperative 3D fluoroscopy is likely to highlight changes to the pulmonary parenchyma that were previously not known. The occurrence of pneumatoceles does not appear to adversely impact the safety or tolerability profile of cryobiopsy.

Overview of male breast cancer

Breast cancer (BC) is an epithelial neoplastic disease that usually begins in the ducts or lobules of the breast with the potential to spread to other parts of the body. BC is primarily a disease that affects females but can also occur in men due to the presence of (limited) male breast tissue. Nevertheless, male breast cancer (MBC) should not be seen as just the occurrence of female breast cancer (FBC) in males. Males share common risk factors with postmenopausal women including age, family history, breast cancer gene (BRCA) mutations, and exposure to therapeutic radiation as well as hormonal factors. MBC is uncommon partly because of the masculine endocrine landscape and the relatively limited volume of mammary tissue in males. There is a general lack of awareness of the occurrence of BC in men due to the extremely high incidence of FBC vis- a-vis the rare incidence of MBC. Some men may easily mistake a suspicious breast mass for gynecomastia, a far more common benign occurrence among males. There are currently no international randomized control trials (RCTs) on MBC. Management guidelines in use today are based predominantly on the results of trials conducted among FBC patients. The most effective therapy for MBC is surgery followed by radiotherapy, chemotherapy, and hormonal therapy. Screening for MBC is limited partly due to the absence of large international RCTs demonstrating its usefulness in decreasing MBC-related mortality.

Discriminant models of the possibility of benign nevi occurrence and features in men depending on the characteristics of anthropo-somatotypological indicators

The multifactorial nature of the origin and development of nevi is the subject of debate so far. One way to understand this process and get an answer to this question is to use a constitutional method of research. The purpose of the study is to build and analyze discriminant models of benign nevi occurrence possibility in men depending on the characteristics of the structure and size of the body. For Ukrainian men aged 22 to 35 years with benign nevi (34 with melanocyte benign simple nevi; 27 with melanocyte benign dysplastic nevi; 14 with melanocyte benign congenital nevi; 17 with nonmelanocyte benign nevus) determined anthropometric indicators according to the scheme of Bunak V. V. (1941), components of the somatotype according to the Heath-Carter scheme (1990), as well as indicators of the component composition of body weight according to Matejko formulas (1921). The control group consisted of anthropometric and somatotypological indicators of 82 practically healthy men of the same age group selected from the data bank of the Research Center of National Pirogov Memorial Medical University, Vinnytsya. Discriminant analysis was performed in the licensed statistical package “Statistica 5.5”. With the help of discriminant analysis, reliable models of the possibility of benign nevi depending on the characteristics of anthropometric and somatotypological indicators are built. It was found that healthy and patients with benign nevi of men can reliably interpret the obtained classification indicators between healthy and sick, and between patients with melanocyte simple or dysplastic nevi and other groups of benign nevi (discriminant function covers 75.7 % of cases; Wilks' Lambda statistics=0.125; р<0.001). Between groups of benign nevi, reliable interpretation of the obtained classification indicators is possible only between patients with melanocyte simple or dysplastic nevi and melanocyte congenital or non-melanocyte nevi (discriminant function covers 48.4 % of cases; Wilks' Lambda statistics=0.662; р<0.001), however, the totality of all anthropological variables has little discrimination. The models of healthy and sick men include the skinfold thickness (42.8 %), girth sizes (28.6 %), shoulder width and endomorphic component of the somatotype (14.3 % each); and among men with benign nevi, only girth sizes of the body. The greatest contribution to discrimination in models of healthy and sick men is made by the circumference of the forearm at the top, the width of the shoulders and the skinfold thickness on the side; and among patients with benign nevi – chest girth on inspiration. The obtained results indicate a significant influence of environmental factors on the occurrence of benign nevi.

Rare malignant adnexal tumour of the skin involving distal phalanx of right thumb with co-existing primary lung cancer in a 72-year-old patient: A case report.

Introduction and importanceMalignant adnexal tumours of the skin are a group of rare malignancies. These tumours can further differentiate into eccrine, apocrine, sebaceous, sweat duct, or ceruminous glands within the skin or follicular cells. Sebaceous carcinoma, a malignant adnexal tumour of the skin, is a rare and malignant tumour of the sebaceous glands. They can occur anywhere in the body where sebaceous glands are present, the most common being the head and neck region.Case reportHere we report a case of a 72-year-old man who presented with a bleeding ulcer on the distal right thumb, which was progressively increasing in size. Biopsy and histology confirmed the diagnosis of MATS with sebaceous differentiation. He had been diagnosed with metastatic non-small cell lung carcinoma six months back.Clinical discussion and conclusionSC is a rare and unusual tumour amounting to less than 1% of all cutaneous malignancies. Phalanges are an infrequent extra-ocular site of involvement, and initial presentation can be mistaken for a benign occurrence. Any patient presenting with extra-ocular SC is advised to undergo genetic and immunohistochemistry testing to rule out complex genetic syndromes like Muir Torre syndrome and Cowden syndrome.

Quality of life and return to work and sports after spinal ependymoma resection

Adult spinal ependymoma presents a rare low-grade tumor entity. Due to its incidence peak in the fourth decade of life, it mostly affects patients during a professionally and physically active time of life. We performed a retrospective monocentric study, including all patients operated upon for spinal ependymoma between 2009 and 2020. We prospectively collected data on professional reintegration, physical activities and quality-of-life parameters using EQ-5D and SF-36. Issues encountered were assessed using existing spinal-cord-specific questionnaires and free-text questions. In total, 65 of 114 patients agreed to participate. Most patients suffered from only mild pre- and postoperative impairment on the modified McCormick scale, but 67% confirmed difficulties performing physical activities in which they previously engaged due to pain, coordination problems and fear of injuries after a median follow-up of 5.4 years. We observed a shift from full- to part-time employment and patients unable to work, independently from tumor dignity, age and neurological function. Despite its benign nature and occurrence of formal only mild neurological deficits, patients described severe difficulties returning to their preoperative physical activity and profession. Clinical scores such as the McCormick grade and muscle strength may not reflect the entire self-perceived impairment appropriately.

Correlation Analysis of Corporate Culture, Performance Management and Employee Development

In the process of development, the most important thing is to train talents and improve the comprehensive quality of employees. As the main content of talent training, corporate culture and performance management can be said to provide theoretical support for performance management.A good corporate culture environment can not only restrain the behavior of staff, but also improve the quality of performance management and promote the benign occurrence of enterprises in society. Based on this, this paper analyzes the correlation between corporate culture, performance management and employee development, and perfects the content and system of performance culture.

Secondary Coronal Synostosis After Early Surgery for Sagittal Craniosynostosis: Implications for Cranial Growth.

Secondary Coronal Synostosis (SCS) in patients operated for non-syndromic Sagittal Craniosynostosis is a postoperative phenomenon with unclear implications. The aim of this study was to investigate whether SCS is a negative or a benign occurrence in the postoperative course. The authors hypothesized that SCS is related to reduced cranial growth and intracranial hypertension. Thirty-one patients operated for SC at an early age with the H-craniectomy technique were included in the study. Associations between SCS and cranial shape, growth, and signs of intracranial hypertension were analyzed. Intracranial volume distribution was assessed by measuring partial intracranial volumes defined by skull base landmarks. A total of 12/31 patients developed SCS during the postoperative course. The presence of SCS was associated with a higher prevalence of gyral impressions and a larger normalization of Cranial Index due to less growth in the anteroposterior plane. The SCS group had a smaller postoperative intracranial volume due to less posterior intracranial volume as well as less growth in head circumference. Whether this is a growth restriction caused by the SCS or a secondary effect of less primary brain growth remains to be determined. However, the correlation between SCS, less cranial growth and gyral impressions does imply that SCS should be taken into consideration during clinical follow-up as a potentially adverse event.

Benign skull and subdural lesions in patients with prior medulloblastoma therapy.

To report on our institutional cohort of patients and review the literature of medulloblastoma patients who developed skull/subdural-based lesions following treatment. Following institutional review board (IRB) approval, we retrospectively reviewed the medical records of four children with a history of treated medulloblastoma who developed non-specific skull-based/subdural lesions incidentally found on surveillance imaging. Biopsies of the lesions proved the pathology to be low grade and included inflammatory myofibroblastic tumor, cortical fibrous defect consistent with fibroma, fibrous tissue, and fibrous dysplasia. The finding of calvarial or subdural fibrous lesions in children following therapy for medulloblastoma was noted in four out of 201 (136 with available follow-up data) medulloblastoma patients seen or discussed in our institution over the past 10years. These lesions can grow over time and pose a differential diagnostic challenge with metastatic disease when identified. The skull and subdural space should be scrutinized for secondary lesions on surveillance imaging of patients with medulloblastoma who have received craniospinal irradiation as knowledge of this benign occurrence will assist with management.

Spontaneous glomerular mesangial lesions in common marmoset monkeys (Callithrix jacchus): a benign non-progressive glomerulopathy.

Common marmosets are known to develop an IgM glomerulopathy, which has been linked with 'wasting marmoset' syndrome. This study investigated renal pathology in a colony of marmosets, with and without weight loss. Renal histology, immunofluorescence, and electron microscopy were performed on marmosets euthanized for research or for weight loss. Serum and urine biochemistry were measured during life and at euthanasia. Histology from 25 adult marmosets (19 research and 6 weight loss) showed mesangial expansion in the majority of glomeruli. Mesangial changes correlated with electron-dense deposits and IgM deposition by immunofluorescence; negligible other pathology was seen. Glomerular basement membrane thickness appeared increased compared to reported human measurements. Low-grade proteinuria was present in all animals, but did not progress. Renal function was normal in all animals. Marmosets develop a glomerulopathy characterized by mesangial expansion, IgM deposition, and proteinuria. This is a benign occurrence and not specifically associated with weight loss.

Abstract W P353: Benign Natural History of Occlusion in Asymptomatic Carotid Stenosis

Introduction: One commonly stated reason for stenting of asymptomatic carotid stenosis is to prevent carotid occlusion. However, the Circle of Willis provides substantial protection against occlusion, so this objective may be misguided. In the NASCET trial, patients with near occlusion of the internal carotid had a lower risk of stroke than did patients with lesser degrees of stenosis. We studied the effects of progression to occlusion among patients with asymptomatic stenosis of the internal carotid artery (ICA). Methods: We studied the outcome of all consecutive patients in our clinic database with asymptomatic carotid stenosis of ≥60% at baseline between 1991 and 2010, who were followed for at least two years with carotid ultrasound and clinical evaluation. Results: 370 patients were included; mean age ± SD 68.8 ± 10.3; 210 (56.8%) were men. Systolic blood pressure was 149.8 ± 22.2, low-density lipoprotein 2.3 ± 1.1 mmol/L, smoking pack-years 24.5 ± 23.3. Only one individual (0.03%) with near occlusion of the ICA developed a new ipsilateral internal carotid artery (ICA) occlusion within a year. This patient experienced episodes of ipsilateral amaurosis fugax before the occlusion (which occurred after he was referred for endarterectomy), but remained asymptomatic after the ICA was totally occluded. Conclusion: Occlusion of asymptomatic carotid stenosis is a rare and usually benign occurrence. In patients with asymptomatic carotid stenosis. The risk of stroke from carotid occlusion is well below the risk of stroke from stenting. Preventing ICA occlusion is not a valid reason to perform carotid stenting in patients with asymptomatic carotid stenosis.

735Nutritionally Variant Streptococci Bacteremia in Cancer Patients: A Relatively Benign Occurrence

species. BMC Infect Dis, 2006. 6:9 http://www.biomedcentral.com/1471-2334/6/9. 2. Ruoff, K.L.; Nutritionally Variant Streptococci. Clinical Microbiol Reviews, 1991. 4(2): p. 184-190. 3. Cargill, J.S., et al; Granulicatella infection: diagnosis and management. J Med Microbiol, 2012. 61: p. 755-761. 4. Liao, C.H., et al; Nutritionally Variant Streptococcal Infections at a University Hospital in Taiwan: Disease Emergence and High Prevalence of β-Lactam and Macrolide Resistance. Clinical Infect Dis, 2004. 38: p. 452-455. 5. Murray, C.K., et al; Abiotrophia Bacteremia in a Patient with Neutropenic Fever and Antimicrobial Susceptibility Testing of Abiotrophia Isolates. Clinical Infect Dis, 2001. 32: p. 140-142. Nutritionally Variant Streptococci Bacteremia in Cancer Patients: A Relatively Benign Occurrence

Pseudorenal Insufficiency With Isopropyl Alcohol Ingestion

Isopropyl ingestion is usually a benign occurrence with little metabolic or renal abnormalities. We describe a case of a false elevation of serum creatinine due to laboratory interference in the setting of a toxic alcohol exposure that could have led to a misdiagnosis of ethylene glycol intoxication and a different treatment plan. Clinicians should be aware of this laboratory anomaly when treating suspected toxic alcohol ingestions.

Letter to the Editor

Letter to the Editor

Local versus GA for Carotid Endarterectomy: Improving the Gold Standard?

The possible benefit of performing carotid endarterectomy (CEA) under local or regional anaesthesia (LA) has been debated for a decade.1Tangkanakul C. Counsell C.E. Warlow C.P. Local versus GA in carotid endarterectomy: a systematic review of the evidence.Eur J Vasc Endovasc Surg. 1997; 13: 491-499Google Scholar The question remains unanswered although the results of the GALA Trial2www.dcn.ed.ac.uk/galaGoogle Scholar (a multicentre RCT of general (GA) versus LA for CEA, 3537 patients) which will be presented at ESVS 2008 should clarify this. In the interim LA CEA continues to gain popularity because of accurate and easy cerebral monitoring and the immediate awareness of neurological status at the end of surgery. This large non-randomised study reports a reduced risk of neurological complications for LA CEA. It benefits from independent neurological review thus removing an important source of bias. This may account for the relatively high frequency of cerebral events, particularly following GA surgery for symptomatic stenoses (8.5%), compared to surgically reported outcomes. Nevertheless other biases remain. In particular the choice of anaesthesia was made, at least in part, by the surgeon. Further, there is no confirmation that surgeons performed a similar proportion of GA and LA procedures. Other important variables including the allocation of significantly more symptomatic patients to GA and an unequal distribution of smoking, diabetes and hypertension between the two groups are also important. In common with previous studies fewer neurological complications occurred following LA CEA reflecting either reporting bias or a real finding. The results are strengthened by the stepwise logistic regression analysis indicating that symptomatic status, anaesthetic type and operating time significantly influenced outcome. The impact of duration of surgery was also examined in ECST3Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST).Lancet. 1998; 351: 1379-1387Google Scholar with optimum outcomes obtained at around 90 mins. CEA took longer in this study with a significant difference between LA and GA (103 versus 111 mins). The reasons for this are unclear unless anaesthetic time was included in this calculation (not described in methods). Enthusiasts for LA CEA generally suggest that the putative neurological benefits of LA reflect preservation of cerebral autoregulation and a reduced requirement for shunting (risks of intimal damage, embolic events, restenosis, technical difficulties). Although the authors do not discuss potential reasons for the advantage shown here (other than reduced operating time) shunt rates were identical for both GA and LA. Data from this study are similar to those reported for non-randomised studies in a recent Cochrane Systematic Review.4Rerkasem K. Bond R. Rothwell P.M. Local versus GA for carotid endarterectomy.Cochrane Database of Systematic Reviews. 2004; (CD000126)Google Scholar On the basis of the advantage shown for LA CEA the authors suggest that future comparisons between CEA and carotid angioplasty/stenting should be based on this type of anaesthesia – a reasonable conclusion. This study also suggests that post-operative hypertension is more common after local anaesthetic surgery. This may not be a benign occurrence and could increase the risk of post-operative intracranial haemorrhage.5Russell D.R. Gough M.J. Intracerebral Haemorrhage following Carotid Endarterectomy.Eur J Vasc Endovasc Surg. 2004; 28: 115-123Google Scholar This relationship requires further elucidation. It is conceivable that whilst LA may reduce the frequency of haemodynamic stroke and the clinical impact of embolic events because of preserved autoregulation it might merely alter the pattern of peri-operative complications. This may well be the last non-randomised study published on this topic. A more definitive answer to this important question should be provided by the GALA Trial, perhaps with additional information to explain any differences that might have occurred.

Analyse laparoskopisch / pelviskopisch operierter Adnextumoren über einen Zehnjahreszeitraum im Carl-Thiem-Klinikum Cottbus (1.1.1996 bis 31.12.2005)

PROBLEM: In this retrospective study the potential of the endoscopic surgery of benign adnexal tumors have been analyzed in regard to their incidence of complications. The available diagnostic procedures have been tested and evaluated in the assessment of findings concerning their practicability. PATTERN: The data was upraised during a period of ten years from January 1 st , 1996, to December 31 st , 2005, in the Carl-Thiem-Clinic Cottbus. The data ascertainment was carried out in retrospect, whereas a total of 2432 patients had been incorporated in the study. FINDINGS: Among the resulting complications during the laparoscopic surgery of adnexal tumors, severe complications, such as physical injury of the organs (0.4 per cent), occur rather seldom. Also hemorrhages, which occurred at 3.2 per cent of the operations, are seldom. The temporary troubles of micturition, which occurred at 1.13 per cent of the cases, are the most common postoperative complication. Severe postoperative complications, such as paralyses or pneumonias occur at less than 0.25 per cent of the operations. The sonography is the medium of choice for the assessment of findings of benign adnexal tumors. At this, cystic changes without inner structure in the screen of the sonography have to be evaluated a benign occurrence at 99 per cent at the ovary. If the tumor marker CA-125 lies within the normal range, a benign tumor exists at a 95 per cent probability. If the CA-125 is elevated, does this not necessarily imply that there is a malignoma. There is a 62 per cent possibility that there is a benign ovarian tumor. SUMMARY: Due to the low rate of complications, the endoscopy is the medium of choice for operations of benign adnexal tumors. The transvaginal sonography, as well as the anamnesis and the clinical bimanual examination serve for the ascertainment of the diagnosis. The use of the tumor marker CA-125 is only advisable as an additional aid for evaluation / assessment of dignity in selected problematic cases.

Clonal gammopathies following alemtuzumab-based reduced intensity conditioning haematopoietic stem cell transplantation: association with chronic graft-versus-host disease and improved overall survival

The presence of clonal gammopathies (CG) has been reported following both conventional myeloablative and autologous haematopoietic stem cell transplantation (HSCT). We monitored the occurrence of CG in a cohort of patients with myeloid malignancies receiving FBC (fludarabine-busulphan-alemtuzumab)-based reduced intensity conditioned (RIC) HSCT, and assessed its correlation with infections, graft-versus-host disease (GvHD) and survival. Serial serum protein electrophoresis was analysed in a total of 138 patients and CG were detected in 49 patients (36%). The predominant Ig isotype was IgG (82%). There was no difference in the incidence of viral infections between patient groups. However, patients with gammopathies were more likely to have had prior chronic GvHD (OR 2.7, 95% CI 1.3-5.5, P<0.001). On multivariate analysis, the only factors that were found to influence overall survival (OS) were presence of gammopathies, which was associated with an improved OS (OR 0.35 95% CI 0.14-0.86, P=0.02) as well as disease stage, patients with advanced disease having a higher risk of death (OR 2.20 95% CI 1.18-4.11, P=0.02). Disease stage was the only variable that influenced relapse incidence on multivariate analysis (OR 4.22 95% CI 1.82-9.78, P<0.01). Clonal gammopathies are a frequent but benign occurrence following alemtuzumab-based RIC HSCT, and their appearance may define a group of patients with a favourable overall outcome.

Cardiac arrhythmias in the fetus and newborn

Arrhythmias are potentially life-threatening problems in the fetus and newborn. Appropriate management depends on accurate diagnosis. Atrioventricular re-entry is the most common type of supraventricular tachycardia in both the fetus and newborn. It should be distinguished from other types of tachycardia - such as atrial flutter, atrial ectopic tachycardia, permanent junctional re-entry tachycardia, and ventricular tachycardia. Neonatal and fetal bradycardias are less common clinical problems. Sustained bradycardia is most often caused by complete atrioventricular block. It can be mimicked by the more common but benign occurrence of non-conducted atrial premature beats.

Giant lipoma of hand: a case report

Lipomas are one of the commonest benign soft tissue tumors but occurrence in hands is rare. They can cause mechanical dysfunction, pain and altered sensibility in hand. Complete resection may not be required.

Clonal Gammopathies Following Reduced Intensity Conditioning Transplantation with Fludarabine, Busulphan and Alemtuzumab for Myeloid Malignancies Predict Improved Overall Survival.

Clonal gammopathies and autoimmune disease following standard conditioning haematopoietic stem cell transplantation (HSCT) are thought to reflect immune dysregulation post HSCT. Serial serum protein electrophoresis was performed on 124 patients with myeloid malignancies undergoing Alemtuzumab based reduced intensity conditioning (RIC) HSCT. The median age of patients was 53 years (range 22–72), with a median follow-up of 521 days (range 82–2096). The median follow-up for survivors was 720 days (range 82–2096). The majority of patients were treated for myeloid malignancies: MDS 84, AML 28, CML 10, others 2. There were 45 sibling and 79 VUD allografts. All patients received the same RIC protocol with FBC (30mg/m2 fludarabine iv day −9 to −5, 4 mg/kg busulphan oral from day −3 to −2; and 20 mg alemtuzumab iv from day −8 to −4) conditioning with cycloporine A for GvHD prophylaxis. Patients with autoimmune disorders or clonal gammopathies prior to transplant were excluded from the study. We observed the presence of clonal gammopathies in 49 patients (40%). On analysis of immunoglobulin sub-classes, the M component was identified as monoclonal in 21 (43%), biclonal in 16 (33%) and oligoclonal in 12 (24%). The predominant Ig isotype was IgG (84%), and gammopathies were present for a median time of 138.5 days (range: 27–462). The kappa:lambda ratio between samples was 1.6:1. The median level of gammopathies was 2.6 g/l (range 1.0–16.5). There was no evidence of plasma cell dyscrasia on bone marrow assessment in any of the patients. We compared the characteristics of patients with and without gammopathies. There were no significant differences in donor or recipient age, sex, disease type, stem cell source, stem cell dose. The incidence of viral infections, acute GvHD, donor lymphocyte infusion (DLI) was similar between the groups. However, patients with gammopathies were more likely to have chronic graft versus host disease (GvHD) (p=0.006). Bone marrow chimerism was available for analysis on 45 patients. At time of detection of gammopathy, 34 patients (76%) had achieved full donor chimerism, and 11 patients (24%) were mixed donor chimerism. Of the entire group of 124 patients, 11 patients (9%) developed autoimmune disorders. There was however no association between the presence of autoimmune disorders and clonal gammopathies (p=0.50). When patients with gammopathies were compared with those without, there was a significant difference in both disease free survival (54% vs 24%, p=0.012), and overall survival (69% vs 45%, p=0.007). On univariate analysis, early disease stage and presence of gammopathy were significant predictive variables for improved disease free survival and overall survival. On multivariate analysis, disease stage was the only independent variable for disease free survival (p<0.01, HR 2.345, 95% CI 1.282–4.288), and both disease stage (p=0.05, HR 1.901, 95% CI 1.000–3.615) and presence of gammopathy (p=0.01, HR 0.421, 95% CI 0.217–0.815) were independent predictors of overall survival. The role of humoral responses following transplantation is still undefined, and it is possible that the gammopathies seen in our cohort are a surrogate response to a heterogenous group of stimuli. Clonal gammopathies are a frequent and benign occurrence following RIC HSCT, and its appearance may define a subgroup of patients with a favourable overall outcome.

Pathological Findings in Eyes with the Ganciclovir Implant

To examine the pathologic findings of eyes treated with ganciclovir implants. Retrospective consecutive case series. Thirty-three eyes from 19 AIDS patients with ganciclovir implants. Pathologic specimens collected from 1993 through 1999 at the National Eye Institute were reviewed. Thirty-three eyes from 19 patients were identified with ganciclovir implants. The submitted eyes then were sectioned through the implant site and stained with hematoxylin and eosin, periodic acid-Schiff, and other special stains when needed. Medical records, including operative and postoperative notes, were reviewed carefully. Light microscopic findings at and around the site of implantation. Scars of surgical perforation were present in all eyes. Fibrous ingrowth developed from the implant site into the vitreous in 32 of the 33 eyes. Vitreous hemorrhage was present in 18 of the 33 eyes. Poor wound apposition was found in 2 of the 33 eyes, both of which had undergone multiple procedures. Foreign body giant cell reactions were observed in most of the eyes related to suture material. Thirty-two of the 37 implant sites were located within the pars plana, whereas the other 5 were either on the border of the pars plana and pars plicata (n = 4) or within the pars plicata (n = 1). Hyalinization, atrophic changes of the ciliary body in the area of implantation, or both were observed in 18 eyes. The ganciclovir implant is well tolerated within the eye. Fibrous ingrowth is present in most eyes and seems to be a benign occurrence because of its limited extension. Microscopic vitreous hemorrhage is present in many eyes, especially those that underwent multiple procedures. Poor wound apposition occurred rarely and was found only in eyes that had undergone multiple procedures.