Faculty Bibliography

PURPOSE/OBJECTIVE:To report an unusual case of orbital floor implant migration across the ethmoidal sinuses and nasal septum. METHOD/METHODS:Case report. A 61-year-old woman with a history of right orbital floor fracture repair 25 years earlier is described. RESULTS:The patient presented with sinus congestion and difficulty breathing through the right nostril. Computed tomographic scan disclosed medial migration of the right orbital floor implant across the ethmoidal sinuses and nasal septum. The patient underwent transorbital and transnasal endoscopic surgery with removal of the implant. CONCLUSIONS:When an alloplastic orbital floor implant is required, size and fixation of the implant are important. Late paranasal sinus or nasal airway problems may be sequelae, and the possibility of implant migration should be considered.

To evaluate the prognostic value of DNA content-ploidy, agoraphilic nucleolar organizing regions (AgNORs) and proliferating cell nuclear antigen (PCNA) for survival among patients with choroidal melanoma choroidal melanomas managed by enucleation in 55 patients with a follow-up of 5 years were studied. AgNor counts were evaluated by two examiners after sections were specifically processed. Immunohistochemistry was performed to evaluate PCNA expression. Kaplan-Meier estimation of survival curves, the log-rank test, and Cox regression analysis were used to compare survival according to the above mentioned factors. Five years after enucleation 62% of patients had died. Patients with spindle cell type melanomas had the best and those with epithelioid cell type had the worst survival (p=0.004). Patients with small tumors had better survival than those with medium or large tumors (p=0.02). Patients having tumors with aneuploid nuclear DNA content had worse survival than those having tumors with diploid DNA content (p=0.004). A high PCNA level correlated with lower survival rates (p=0.02). Patients having a high AgNor count had a worse survival than those with lower counts (p=0.02). DNA content, PCNA level, and AgNOR count each showed a clinically significant influence on patient survival. However, each of these new evaluated prognostic factors was strongly related to one or both of the classic prognostic factors. It is therefore difficult to separate the effects of the two categories of prognostic factors. Results of the Cox regression analysis suggested that these newer evaluated prognostic factors provided little additional information about patient prognosis.

Tumor-associated antigens (TAA) provide appropriate targets for selective manipulation of the patient's immune response in the immunotherapy of cancer. Active specific immunotherapy utilizing antiidiotypic antibodies to anti-TAA antibodies has been implemented in phase I clinical trials both in patients with colorectal carcinoma and in those with melanoma. The theoretical basis for immunotherapy with antiidiotypic antibodies, the results of these clinical trials, and an evaluation of appropriate parameters for future clinical trials of active specific immunotherapy with antiidiotypic antibodies in patients with solid tumors are reviewed.