Visual Exam Research Articles

Early and Late Outcome of Premature Newborns with History of Neonatal Intensive Care Units Admission at 6 Years Old in Zanjan, Northwestern Iran.

Premature birth is an important factor for mortality and morbidity of neonates. This study was designed to evaluate the outcome of preterm neonates who needed neonatal intensive care (NICU) hospitalization after 6 yr at their entrance to the school. This cross sectional study was conducted on premature neonates consecutively hospitalized in NICU of Valie Asr Hospital (the Academic Pediatric Hospital, Zanjan, Northwestern Iran) from September 2001 to September 2003. All children with a history of prematurity and NICU treatment were evaluated at their entrance to the school. Demographic findings, clinical examinations, IQ test, hearing and visual acuity exams were recorded. From 179 neonates, 78 (43.6%) survived and were discharged from hospital. Fifty-four of them were available and entered first grade in primary school. Only one case had severe mental retardation. One case had severe retinopathy of prematurity (ROP). Hearing abnormality was not detected in any case. There was no significant relation between IQ score, visual as well as hearing findings and gestational age. We did not find significant disability in the outcome of surviving infants. This could be explained by the high mortality rate of neonates during hospitalization.

A Rare Case of Oriental Cholangiohepatitis

Introduction: Oriental cholangiohepatitis is commonly seen in Asian with prevalence of < 1% in Western countries. It is thought to be secondary to parasitic infection of bile system with concomitant biliary infection that leads to production of beta-glucuronidase that play key roles in bilirubin precipitation, stone and stricture formation. Case: A 73 year-old caucasian female with history of diabetes mellitus presented with nausea, vomiting, epigastric abdominal pain, diarrhea for 1 week. Reported 70-lb weight loss over past year. CT scan was concerning for possible pancreatic mass, omental metastasis, numerous tumor nodules in mesentery and possible thrombus in portal vein. Labwork showed ALP 230, albumin 1.6, CA 19/9 45.2. US Liver showed moderate intrahepatic biliary dilation, dilated proximal common duct measuring 1.4cm. MRCP showed moderate intra and extrahepatic biliary ductal dilatation with multiple large filling defects within both intrahepatic and extrahepatic bile ducts, consistent with stones (Fig 1). EUS was done which showed normal visual exam, diffuse pancreas with mixed echogenicity. FNA of pancreatic head/body negative for malignancy. ERCP showed CBD of 1.8 cm with atleast 4 (˜1cm stones) with largest being ˜1.2cm (Fig 2). Biliary sphincterotomy was performed followed by mechanical lithotripsy, balloon extraction. A 10 Fr 9cm plastic biliary stent was placed in CBD proximal to retained stones. Repeat ERCP was done in OR with laser lithotripsy and residual stone removal in 2-3 weeks.Figure 1Figure 2Discussion: It is a serious condition owing to its intractability, frequent recurrence and predisposition of cholangiocarcinoma. Presenting symptoms include abdominal pain, jaundice, cholangitis and can lead to production of strictures and liver abscesses. US liver is first diagnostic modality as it can clearly show intrahepatic stones and biliary dilation. MRCP is the best non-invasive imaging that shows intrahepatic stones, biliary strictures and hepatic abscess. Direct cholangiography remains the gold standard with sensitivity of almost 100% in the detection of obstruction. The goals of treatment include treating cholangitis (fluids/antibiotics), preventing recurrence, clearance of stones, correction of strictures, restoration of biliary drainage and to stop the progression of the disease. There is no definitive treatment owing to the complicated nature of the disease. Urgent endoscopic biliary decompression prevents patient from going into shock. Hepatic resection has shown to reduce the risk of recurrence of stones, since it removes not only intrahepatic stones but also the associated pathological bile ducts damaged by strictures. Liver transplantation is usually the only treatment option in cases of diffuse liver parenchyma involvement and development of cirrhosis.Table 1: Grading the severity of hepatolithiasis

Clinical evaluation of video imaging technology during visual field exams

PurposeVideo imaging consists in recording the entire visual field process in synchrony with the video of the patient's head. Several clinical applications have been investigated to evaluate the clinical usefulness of this new technology.MethodsThe study included results from 48 visual field exams performed on a MonCvONE full field projection perimeter with synchronized video recording.The video from a large viewing field camera was recorded in synchrony with the position of the visual stimulus, with other test parameters such as luminance and size and with the patient's response obtained from the patient's press button or from the operator judgment. The study included patients who were unable to perform automated perimetry due to young age or handicap, patients with abnormal eye movements, head posture or ptosis and controls performed after automated perimetry.ResultsVideo recording was extremely useful in the majority of clinical cases. 24 exams were performed on young children (age between 2 and 5 years) using attraction perimetry. The eye orientation responses could be interpreted and validated after the exam. In other cases, the video recording facilitated the interpretation and documentation of visual field results with the inclusion of video snapshots in the examination report. Additional applications included the recording of cardinal eye gaze positions and of the fusion visual field.ConclusionsSynchronized video imaging performed during visual field exams is a clinically useful tool for the examination of patients who cannot perform automated perimetry and for the documentation of artefacts and situations such as ptosis, abnormal eye movements, abnormal head posture and incorrect position of refraction.

Optic disc drusen with subretinal hemorrhage

PurposeTo report a rare and interesting case of optic disc drusen with subretinal hemorrhage.SettingThe hemorrhagic complications of the optic disk drusen are rare and interesting.MethodsA 25 year old white man complained of an acute blurred vision in his left eye over the past 6 days. Visual acuity in the right eye was 20/20 and in the left eye 20/200. He had photoreactive and anisocoric pupils (left &gt; right). Fundus examination in both eyes showed an elevated optic nerve head with blurred and irregular disc margins. In the left eye was present a subretinal hemorrhage.ResultsThe neurological examination and brain computed tomography were normal. Fluorescein angiography (FA) of the left eye showed hypofluorescence (blocked) due to subretinal hemorrhage. No fundus autofluorescence was detected. Indocyanine green angiography was performed to exclude a neovascular choroidal membrane. Goldmann visual field exam showed in the right eye enlargement of the blind spot and paracentral scotoma and in the left eye a small constriction of the isopters and central scotoma. Ocular ultrasound demonstrates an echogenic focus within the optic nerve head. No treatment was performed. Spontaneous resolution of the subretinal hemorrhage was observed. At 3‐months follow‐up the visual acuity of the right eye was 20/20 and left eye 20/25.ConclusionsOptic disc drusen may be associated with subretinal hemorrhage as a result of direct mechanical compression and rupture of subretinal vessels at the optic disc. Optic disc drusen often mimic papilledema and must be distinguished from true papilledema. The subretinal hemorrhage can resolve spontaneously.

Proximal caries lesion detection in primary teeth: does this justify the association of diagnostic methods?

The aim of this clinical study was to evaluate and compare the performance of visual exam with use of the Nyvad criteria (visual examination - (VE)), interproximal radiography (BW), laser fluorescence device (DIAGNOdent Pen-DDPen), and their association in the diagnosis of proximal lesions in primary teeth. For this purpose, 45 children (n = 59 surfaces) of both sexes, aged between 5 and 9 years were selected, who presented healthy primary molars or primary molars with signs suggestive of the presence of caries lesions. The surfaces were clinically evaluated and coded according to the Nyvad criteria and immediately afterwards with the DDPen. Radiographic exam was performed only on the surfaces coded with Nyvad scores 2, 3, 5, or 6. Active caries lesions and/or those with discontinuous surfaces were restored, considering the depth of lesion as reference standard. Sensitivity, specificity, accuracy, and area under ROC curve were calculated for each technique and its associations. Visual exam with Nyvad criteria presented the highest specificity, accuracy, and area under ROC curve values. The DDPen presented the highest sensitivity values. Association with one or more methods resulted in an increase in specificity. The performance of visual, radiographic, and DDpen exams and their associations were good; however, the clinical examination with the Nyvad criteria was sufficient for the diagnosis of interproximal lesions in primary teeth.

Lamina Cribrosa-Related Parameters Assessed by Optical Coherence Tomography for Prediction of Future Glaucoma Progression

Purpose: To evaluate the value of lamina cribrosa (LC)-related parameters assessed by optical coherence tomography (OCT) in the future prediction of glaucomatous progression.Methods: Glaucoma or glaucoma suspect eyes were followed up for more than 2 years. Glaucoma progression was defined by optic disc/retinal nerve fiber layer (RNFL) photographic assessment or serial visual field exams. LC thickness, anterior LC distance (ALD) and prelaminar tissue thicknesses were determined with optic disc images obtained by Spectralis OCT enhanced depth imaging. Kaplan–Meier life table analyses were carried out, and survival experience was compared between eyes with thicker baseline LC (HLC) and thinner baseline LC (LLC) by a log rank test. Hazard ratios (HRs) of various risk factors, including LC-related parameters, for future glaucomatous progression, were determined using uni- and multi-variate Cox’s proportional hazard models.Results: Among the 118 eyes, 33 showed progression during follow-up period. The progression group had a significantly thinner average circumpapillary RNFL (cRNFL, p = 0.005), LC (p = 0.005) and prelaminar tissue (p = 0.023) than the non-progression group at baseline. The LLC group showed a greater cumulative probability of glaucoma progression than did the HLC group (p = 0.001). Average cRNFL thickness (HR, 0.972, p = 0.007), prelaminar tissue thickness (0.990, p = 0.028) and LC thickness (0.971, p = 0.002) were significantly associated with progression of glaucoma. In multivariate analysis, only LC thickness (0.975, p = 0.015) showed significant association with progression.Conclusion: Thinner baseline LC was independently associated with glaucoma progression in our study. LC thickness may be a risk factor for predicting future glaucoma progression.

Existem cáries ocultas ou é outra limitação para o diagnostico de exames convencionais?

Objective: To verify the existence of hidden caries and compare the diagnosis agreement among different Examiners between the visual and radiographic exam and computed microtomography images of incipient dental lesions on the occlusal surface of extracted molars. Methods: Two hundred and fifteen healthy teeth were extracted from the corpses of children with a mean age of 12 years and analysed by visual examination. However, only 11 teeth were included in current study because they showed suggestive caries image when examined by microtomography (micro CT scan). Occlusal sites were examined both visually and by dental radiograph by 3 different dental practitioners and results were compared and validated independently by each Examiner with computed microtomography, henceforth a gold-standard in current investigation. The coefficient of agreement was calculated by Cohen’s kappa test. Results: the coefficient of agreement among Examiners for the diagnosis by standard microtomography was excellent (K = 0.924) and moderate for both the visual (K=0.515) and the radiographic (K=0.583) examinations. Computed microtomography-produced images allowed the Examiners to visualize radiolucent areas, unseen in previous radiographic images and visual exams, in which there existed communication between enamel and/or dentine and the external environment. Conclusion: Hidden caries was the product of the conventional exam´s limitations, or rather, the lesion was due to enamel non-collapse. Consequently, conventional exams were not accurate enough to detect the lesions.

Unilateral fronto-temporal headache with ocular pain caused by lens subluxation due to spontaneous zonulysis.

A 52-year-old man presented to the emergency department (ED) for left frontotemporal headache and left eye pain. In the ED, visual exam with extra-ocular movement was performed to rule out ocular pathology and brain imaging to rule out cerebral pathology. No abnormal finding was noted after evaluation of ED. Initial exam by an ophthalmologist was also negative with normal intraocular pressure. Left lens dislocation was found only after brain imaging. In subsequent second exam by an ophthalmologist with iridodilator, lens dislocation due to spontaneous zonulysis was finally confirmed. Hence, ED physicians should carefully review ocular as well as brain anatomy in such cases.

Different methods of dental caries diagnosis in an epidemiological setting

Aim: To evaluate the performance of dental caries detection when adjunct methods are associated and their applicability in epidemiological survey of dental caries, at D3 (cavitated carious lesions at dentin layer) and D1+D3 (non cavitated and cavitated carious lesions at enamel/dentin layer) diagnostic thresholds. Methods: A total of 2189 posterior teeth from 165 12-year-old schoolchildren underwent visual examination without (CL1) and with artificial lighting (CL2), radiographic bitewing (BW), fiber-optic transillumination/FOTI (FT), DIAGNOdentTM (DD) and associations of these methods. Reproducibility was calculated by Kappa statistics and validity was calculated by sensitivity, specificity and accuracy tests. ANOVA (Scott-Knott test) was performed in order to compare the average values of DMF-S obtained by the diagnostic methods. Results: The CL2FTDDBW (D3) and CL2BW (D1+D3) exams presented the highest values for accuracy at epidemiological setting. The DMF-S index obtained for those exams was statistically different at D3 and D1+D3 thresholds. Conclusions: The association of adjunct methods increased the validity of dental caries examination in an epidemiological setting. However, the potential of CL2BW (traditional caries detection methods) or visual exam performed under a more refined diagnostic criteria must be considered in dental caries epidemiological surveys.

Ophthalmological screening of students in Campinas, Brazil

Objective: To analyze eye health and visual acuity in children and teenagers to promote the early detection and treatment of visual impairments. Methods: Public school students were pre-screened by teachers, and those that presented behaviors, signs, or symptoms of decreased visual acuity (VA) or any type of ophthalmological disorder, participated in a VA screening. The measurement was made monocularly, with or without optical correction (i.e., if the patient was already wearing glasses). Children with VA less than or equal to 0.18 (logMAR) in the worst eye, and/or with complaints of asthenopia, eye irritation and itching, strabismus, conjunctival or corneal lesions, were referred for a complete ophthalmological evaluation at the Ophthalmology Department of Celso Pierro Hospital. Results: 50 patients (52.63%) were male and 45 (47.37%) were female. The average age of the participants was 10 years. Their eyes were evaluated and 114 (77.03%) presented with refractive errors; 9.64% of the patients who were referred to the clinic already wore prescription eyeglasses, and all of them had inappropriate refractive correction. Conclusion: These results demonstrate the relevance of visual health campaigns and screening exams for early diagnosis of ophthalmologic disorders.

Disposición del conducto dentario inferior en el cuerpo mandibular. Estudio anatómico y tomográfico

El objetivo del presente estudio fue determinar la distancia entre el conducto dentario inferior (CDI) y las tablas óseas lingual (TL), vestibular (TV) y basal (RB) en cuatro sectores del cuerpo mandibular. Se utilizaron diez mandíbulas que presentaban la región premolar y molar edéntula.Se evaluaron a través de tomografía espiral convencional (Cranex TOME multifuctional unit, Soredex, Finlandia) y en examen visual directo posterior a la osteotomía. Se realizaron mediciones desde el CDI hasta TL, TV y RB; a nivel del segundo premolar, primer molar, segunda molar ytercer molar. Los resultados obtenidos se evaluaron con las pruebas ANOVA, Kolmogorov-Smirnov y test de Levene que demostraron homogeneidad entre las medidas de los especimenes y las tomografías (p&gt;0,05). Para referir las medidas se utilizó ANOVA y Kruskal-Wallis donde se encontró que el diámetro del CDI y la distancia hacia la TL eran constantes en los cuatro sectores del cuerpo mandibular (p&gt;0,05). El diámetro del CDI presentó un rango de 2,3 mm a 2,6 mm y la distancia a TL de 2,5 mm a 2,8 mm. Las distancias a RB y TV presentaban diferencias estadísticamente significativas (p&lt;0,05). El presente estudio demuestra que el diámetro del CDI en el cuerpo mandibular tiende ha ser constante y el CDI recorre el cuerpo mandibular con mayor proximidad a la TL.

In Vitro Evaluation of Midwest Caries ID: A Novel Light-emitting Diode for Caries Detection

Traditional detection techniques have limits in diagnosing occlusal caries. Thus, more accurate methods are needed. This study evaluates the ability of the Midwest Caries ID (Midwest) to detect caries. Two hundred sixty-four extracted, nonrestored premolars and molars were cleaned and stored in 0.2% sodium azide. Teeth were divided into three groups of 88. One examination site on each occlusal surface was chosen. Each site was inspected by a calibrated examiner via visual, Midwest, and histologic exams. First, a visual exam was performed following the International Caries Detection and Assessment guidelines. Next, the same site was inspected using the Midwest device. Finally, the tooth was sectioned mesiodistally through the site. The half with greater caries progression was visualized under a stereomicroscope (64×). Histologic appearance was scored based on the Downer system. Data were analyzed using Kendall tau-b, partial correlation coefficients, and the receiver operating characteristics curve. Overall, the Midwest scoring assessment correlated with histologic assessments (tau = 0.32; p<0.0001), but the visual exam had a stronger correlation (tau = 0.53; p<0.0001) with the histologic exam. The sensitivity and specificity of the Midwest was also reported at 0.56 and 0.84, compared with 0.92 and 0.43, respectively, for the visual exam. Midwest Caries ID is a novel caries detection device that has limitations and should not be used as the sole means to detect occlusal caries.

A chemiluminescent light system in combination with toluidine blue to assess suspicious oral lesions-clinical evaluation and review of the literature.

The aim of the study was an evaluation of an acetic acid wash and chemiluminescent light system in combination with toluidine blue in order to detect visual identified, potentially malignant lesions. Forty-four patients with 50 oral lesions of primary uncertain visible dignity were included. Next to a clinical examination, a screening with ViziLite® (VL) as well as toluidine blue (TB; together ViziLite® Plus (VLP)) was conducted. Histopathology served as gold standard and sensitivity (SE), specificity (SP), positive as well as negative predictive value (PPV, NPV) was calculated descriptively. Additionally, a PubMed literature search using the key words "ViziLite" and "chemiluminescence oral cancer" was conducted. Histological diagnosis showed 40 lesions of reactive/inflammatory nature, moderate dysplasia (n = 3) and oral squamous cell carcinoma (OSCC n = 7). All OSCCs and one dysplasia were identified correct via clinical diagnosis (SE 90%, SP 100%, PPV 100%, NPV 97.5%). VL examination could show all malignancies with low specificity (SE 100%, SP 30%, PPV 26%, NPV 100%). TB and VLP were positive in all cases of cancer and in one case of inflammation (SE 80%, SP 97.5%, PPV 89%, NPV 95%). In the review, eight clinical trials with similar results were included. The adjunct of TB to VL reduces the number of false positives without increasing the rate of false negatives. Clinical evidence to justify the additional cost of the system for diagnosis of suspicious lesions is weak. However, for the potential role of VLP in detection of lesions not otherwise identified in the visual exam in general dental practice further studies are required.

Cystic fibrosis and new trends by ophthalmological evaluation: a pilot study.

Background. Cystic fibrosis (CF) is characterized by hypoxia that affects several organic tissues. Retinal ganglion cells may suffer from the hypoxic status, and this may lead to alterations of retinal nerve fiber. Methods. Twenty-two eyes in CF patients were analyzed. A complete ocular evaluation and visual field exams of the 30 central degrees were performed using the frequency doubling technology (FDT). Forced expiratory volume in one second (FEV1%), forced vital capacity (FVC%), oxyhaemoglobin saturation (SpO2%), and hematocrit (Ht%) have been calculated. FDT analyzed parameters were mean deviation (MD) and pattern standard deviation (PSD). Pearson's correlation was chosen as statistical analysis. Results. Data showed statistically significant relationship between MD and Ht% (r value −0.18; P = 0.04), MD and FEV1% (r value −0.68; P = 0.001), and MD and FVC% (r value −0.45; P = 0.005). Moreover, there were correlations between PSD and Ht% (r value 0.29; P = 0.03), PSD and SpO2% (r value −0.31; P = 0.01), PSD and FEV1% (r value 0.71; P = 0.0005), and PSD and FVC% (r value 0.63; P = 0.003). Conclusions. The oxygen supply alterations might determine hypoxia of the ganglion cells causing a decrease of receptive optic nerve fiber activity. This method could be also useful to evaluate indirectly pulmonary activity of the CF disease.

Community Detection as a Tool for District Metered Areas Identification

Water losses, the portion of water introduced in a pipe network but not consumed by users, represent a significant problem in water distribution system (WDS) management. Modern guidelines suggest to divide the pipe network in clusters, in order to compute a water balance and measure water consumption by each group. These clusters are called district metered areas (DMAs). The division of a pipe network in DMAs is usually realized with a visual exam supported by technical experience. This approach, which is convenient for small WDSs, becomes difficult to apply to large WDSs characterized by thousands of user nodes and pipes. Therefore, it is necessary to have an automatic tool to recognize the affinity degree of neighbouring nodes and to decide how to assign a node to a particular DMA. We propose an automated approach to subdivide pipes, that only requires flow rates through the network. The method has been tested to a large WDS often used as benchmark. The approach successfully divides the pipe network in an acceptable number of DMAs. Each resulting DMA is characterized by a low number of external links and by a proper number of users.

Evaluation of prevalence of acquired color vision impairment in detergent factory workers

Background and Aim: Color vision is an important function of the visual system. Therefore, this study was aimed to evaluate the effect of chronic occupational exposure to detergents on color vision ability in different group. Materials and Methods: This descriptive study was conducted in a detergent producer factory on all (300) workers who were in detergents production hall. After considering exclusion criteria, 279 persons were qualified to participate in the study. General visual exam and color vision test was performed for participants. Their color vision was evaluated by Ishihara and Farnsworth D-15. Results: 12.9% of participants showed color vision disorder , the prevalence of which was mostly related to powder groups. Conclusion: Chronic occupational exposure to excess amount of detergents can cause acquired color vision disorder. Key words: Color vision, Occupational exposure, Detergents workers

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Introduction: Introduction End organ dysfunction related to infective endocarditis (IE) is a common cause for the referral to the intensive care unit. A thorough history and physical examination remains an integral part of management of patients with IE. Intensivists should maintain a high index of suspicion towards detecting rare manifestations of IE. We present a case of Methicillin sensitive Staphylococcus aureus (MSSA) endocarditis with two such rare complications in the form of bilateral endophthalmitis and parotitis which were diagnosed early and treated promptly. Case presentation A 63 year old male with a past history of mitral valve annuloplasty was hospitalized for fever with rigors of four day duration. His admission vitals were notable for fever (103 F), tachycardia and tachypnea. Physical examination revealed an apical holosystolic murmur and painful erythematous finger nodules (Osler's nodes).Pertinent positive labs included thrombocytopenia (count of 40,000), elevated BUN (60) and creatinine (1.7). Appropriate antibiotics were initiated for concern of IE; blood cultures grew Methicillin sensitive Staphylococcus aureus (MSSA) and subsequent work up with Trans-esophageal echocardiography showed mitral valve vegetation's (> 2 cm) on the anterior leaflet of the mitral valve with concomitant severe mitral regurgitation. Hospital course was complicated by the development of sudden painful bilateral parotid gland enlargement, bilateral decreased visual acuity and confusion. A thorough visual, neck and neurological exam revealed findings of bilateral endophthalmitis which was emergently treated with vitreous aspiration and intravitreal antibiotic instillation leading to an improvement in vision. Vitreal fluid cultures were positive for MSSA. Bilateral Parotid gland enlargement- acute parotitis secondary to disseminated sepsis was successfully treated with antibiotics and hydration. MRI of brain revealed multiple small cerebral infarcts and small areas of intracerebral hemorrhage consistent with septic infarcts and secondary hemorrhagic conversion. While the risks and benefits of emergent mitral valve replacement surgery were being contemplated, unfortunately only four days into the hospital course patient suffered a massive intracerebral hemorrhage and passed away. Discussion The pathogenesis for complications in IE includes embolic, local spread of infection, metastatic infection or immune-mediated damage. Embolization remains a distressingly common complication of IE and can occur even after appropriate therapy. Endogenous endophthalmitis is a rare complication of infective endocarditis that occurs due to direct invasion of ocular tissues (septic emboli) or by changes in vascular endothelium caused by substrates released during infection. The most common cause of the infection is Staphylococcus aureus. Endogenous endophthalmitis due to MSSA infective endocarditis is an extremely rare complication. Intravitreal and systemic antibiotic therapy should be initiated promptly. Acute bilateral parotitis is rare and is associated with mumps and connective tissue disorders; while in our case it seems to be secondary to MSSA bacteremia and septic emboli. Bilateral Endophthalmitis and Parotitis are very rare complications of infective endocarditis with only a few case reports published to date. Our patient is the first case in literature where both manifestations occurred together as a part of embolic phenomenon. Most common pathogen implicated in the setting of endocarditis is Staphylococcus aureus. Conclusion: Infective endocarditis (IE) is associated with a myriad of complications. It is important to recognize rare complications of IE like bilateral endophthalmitis and parotitis and act rapidly to prevent morbidity associated with it.

Efficacy of Chemiluminescence (ViziLite™) as a Screening Method in the Detection of Clinically Suspicious Oral Cancerous and Precancerous Lesions

Several screening techniques based on light interaction with tissue have been described to aid clinicians in the detection of early oral cancerous lesions. One of the most studied techniques is chemiluminescence. This method has been used in different studies but always by Oral Medicine specialists. Objective: To evaluate the chemiluminescence system as a screening method in the detection of clinically suspicious cancerous and precancerous oral lesions when used by clinicians without an Oral Medicine Speciality. Study Design: A total of 100 patients attending the Oral Medicine Unit at the Dental School of the University of Seville were enrolled. All patients were current smokers and were above the age of 40. The clinical examination was performed by dental students who were instructed in the location and recognition of potentially malignant oral disorders, using visual examination and the chemiluminescence test ViziLite Plus (Zila Pharmaceuticals, Phoenix, AZ, USA). To assess the validity of the chemiluminescence test as a screening method, a visual exam was performed by a specialist in Oral Medicine which was used as a gold-standard. Results: Conventional oral visual examination by the Oral Medicine Specialist found 13 lesions suspicious for malignancy, out of which 7 were also detected using the chemiluminescence test. Furthermore, 87 patients were diagnosed as lesion-free, of which 49 obtained negative results during the chemiluminescence test and 38 patients had some sort of lesion. With these results, the test yielded a sensitivity of 0.56 and a specificity of 0.56. These results indicate values similar to other studies, in fact lower sensitivity values, possibly due to the lack of experience of the clinician. Conclusions: The chemiluminescence test (ViziLite Plus) did not present any advantages in terms of cost-benefit compared to conventional examination as a screening method for cancerous and precancerous oral lesions.

Oral HPV infection in HPV-positive oropharyngeal cancer cases and their spouses.

CRA6031 Background: Incidence of human papillomavirus-positive oropharyngeal cancer (HPV-OPC) is increasing, and spouses of these patients have high anxiety about their own HPV-related cancer risk. Methods: Partner study of 149 HPV-OPC and 81 of their spouse/long-term partners. Data collection included a 30-second rinse and gargle (at diagnosis and again 1 year later for 103 cases and 46 partners), computer-assisted risk factor survey, tumor collection (cases), and visual oral examination (spouses). Oral rinse samples were tested for 36 types of HPV DNA using PGMY09/11 primers and line-blot amplification, and HPV16 copy-number using real-time PCR. Results: Cases were primarily male (89%), white non-Hispanic (92%), had performed oral sex (94%), and never-smokers (51%) with a median age of 56 years. Twelve-month survival was high among never- and ever-smoking HPV-OPC (100% vs 93%, p=0.18). The 81 spouses of HPV-OPC were primarily female (81%), white non-Hispanic (92%), never-smokers (54%), with a median age of 53 years. Spouses were significantly less likely than cases to have &gt;10 lifetime oral sex partners (11% vs 39%, p&lt;0.001). Prevalence of any oral HPV (65%) and oral HPV16 (52%) was high among HPV-OPC at diagnosis. Four (7.7%) of 52 HPV-OPC with HPV16 DNA detectable before therapy, had HPV16 persistently detected one year after diagnosis/therapy. Prevalence of any oral HPV DNA among partners was significantly lower than among HPV-OPC (7.3% vs 65%, p&lt;0.001). Oral HPV prevalence was significantly higher among the 7 male partners than the 74 female partners (29% vs 5%, p=0.025). Oral HPV infections among partners included HPV16 (n=2), HPV62 (n=2), HPV 83 and 51 (1 each). Both partners with oral HPV16 infections were female and no longer had oral HPV16 detected at the one year follow-up. 64% of spouses had a visual oral exam, and no pre-cancers or cancers were identified. However, two (2.5%) enrolled spouses reported a personal history of cervical cancer, and 6 HPV-HNC cases (4.0%) reported a previous spouse who developed cervical or vaginal cancer. Conclusions: Oral HPV16 DNA is common among HPV-OPC, but not among their spouses. Spouses of HPV-OPC may have an elevated risk or history of cervical cancer.

Effect of Radiation Therapy on Intraocular Pressure in Patients with Graves’ Orbitopathy

Purpose: To describe the effect of radiation therapy on intraocular pressure in patients who have had orbital radiation for Graves’ orbitopathy, and to provide a descriptive analysis of these patients.Design: Retrospective case series.Participants: 24 consecutive patients referred for orbital radiation therapy for Graves’ orbitopathy from December 1st, 2001 through July 31st, 2009.Intervention: Patients received a total of 2000 cGy fractionated over 10 days.Main Outcome Measures: Medical records were reviewed for: demographics, tobacco history, ocular history, history related to Graves’ disease, medications, visual field tests, retinopathy, and physical exam findings. The two-tailed Student’s t-test was used to determine statistically significant differences in intraocular pressure before radiation therapy and 0–3 (T1), 4–6 (T2), 7–12 (T3), and 13–18 (T4) months following radiation therapy.Results: 34 eyes were available for analysis. There was no correlation between intraocular pressure and SPECS scores. Mean intraocular pressure prior to radiation therapy was 18.15 ± 3.83 mm Hg. Patients who had orbital decompression, eye muscle surgery, or glaucoma were excluded from the final analysis. There were 7, 11, 14, and 11 eyes with data at times T1, T2, T3, and T4 following radiation therapy, respectively. There was a significant decrease in mean intraocular pressure at T2, T3 and T4 of 26.00% ± 9.25%, 11.75% ± 27.58%, and 16.72% ± 13.94%, respectively.Conclusions: There was a significant drop in mean intraocular pressure between 4 and 18 months after radiation therapy in our patient population. The mechanism by which this decrease in intraocular pressure occurs is not understood.