[Transpupillary thermotherapy combined with 106Ru as a method of managing choroidal melanoma]. / Przezzreniczna termoterapia w skojarzeniu z brachyterapia 106Ru jako metoda postepowania w czerniaku naczyniówki.

BACKGROUND: A study was carried out to evaluate the effectiveness of transpupillary thermotherapy (TTT) with diode laser applied as adjuvant treatment to 106Ru brachytherapy in choroidal melanoma. These two methods coined as "sandwich therapy" are complementary and allow to decrease the dose of radiation. MATERIAL AND METHODS: Between November 1996 and December 1997, 45 patients with choroidal melanoma were treated simultaneously with 106Ru and TTT. There were 18 males and 27 females, aged 20 to 78 (mean 57). There were 7 tumors with height of 5 mm or less, 28 ranging 5.43-8.63 mm and 10 with height 9 mm or more. The anterior tumor margin was located in the equator area or posterior to it in 71.1% of cases. The laser treatment was delivered using spots 2-3 mm in size, at a mean power 600 mW, for about 1 minute. The mean radiation dose was 60 Gy to the tumor apex. The follow-up ranged from 12 to 24 months. RESULTS: Reduction in tumor height by at least 30% was exhibited in 35 (77.8%) tumors, in one evaluated as positive result it was 27%. There was no improvement after treatment in 4 cases, 2 eyes were enucleated. A significant relationship was found between tumor thickness and the result of treatment. CONCLUSION: Our preliminary observations suggest that TTT combined 106Ru brachytherapy is an effective method of treatment. A longer follow-up is needed to assess final local results and the impact of treatment on survival.

[Application of automated perimetry in diagnosis of macular diseases]. / Przydatnosc kliniczna perymetrii statycznej w diagnostyce chorób plamki.

PURPOSE: Evaluation of automated perimetry application in diagnosis of macular diseases. MATERIAL AND METHODS: Examinations were performed in 27 patients with central chorioretinopathy (CSCR), 29 patients with diabetic maculopathy, 12 patients with drusen, 13 patients with macular hole, 55 patients with age-related macular degeneration (AMD) and 23 healthy volunteers. Central visual fields were tested with automated threshold-measuring perimetry using the LED-PERS perimeter. Localisation, depth and spread of defect in central visual field were estimated. All threshold values, mean sensitivity, fixation, fluctuation and visual acuity were calculated. Statistical comparison of examined parameters and multidimensional analysis of variance (MANOVA) was performed using software. RESULTS: Significant differences were found when comparing all threshold values, mean sensitivity, fixation and fluctuation between the control and the other groups, and between patients with CSCR, with drusen and with AMD. Good results of MANOVA were obtained in 3 distinguishable classes between patients with CSCR, diabetic maculopathy and AMD. Positive correlation between threshold values of fields and visual acuity was noticed. CONCLUSIONS: Automated perimetry has been confirmed to be very useful in differential diagnosis of patients with macular diseases.

[Diagnostic problems in intraocular melanoma]. / Problemy diagnostyczne w czerniaku wewnatrzgalkowym.

PURPOSE: To evaluate accuracy of the diagnosis, rate of advancement and therapeutic possibilities of intraocular malignant melanomas, basing on our one-year clinical material. MATERIAL AND METHODS: The total of 288 consecutive patients with suspicion or diagnosis of intraocular malignant melanoma, referred in the year 1997 to the Department of Ophthalmology CM UJ, were analysed. There were 121 males and 167 females, aged 22-76, mean 50. The period of time between the patient's first ocular symptoms and his visit to the ophthalmologist ranged between 7 days and several years. Besides routine ophthalmological examination each patient underwent USG and, if necessary AF, ICG, CT and IMR. RESULTS: Diagnosis of malignant melanoma was confirmed in 141 cases. Among these patients in 69 brachytherapy was applied, in 20 surgical resection of the tumor and in 52 enucleation. In 111 cases other following diseases were diagnosed: iris cysts, deficient iridectomy, iris nevus, choroidal nevus, metastatic tumors, age-related macular degeneration, myelinated nerve fibres, Leber-Coats syndrome, toxoplasmosis and granulomatous uveitis. In 36 cases the diagnosis was not exact and those patients remained under periodic clinical observation. CONCLUSIONS: Our study shows that in many patients intraocular malignant melanoma is diagnosed too late and in these cases enucleation is the only method of treatment. The most diagnostic challenges are connected with differentiation of choroidal melanoma from choroidal nevus and exudative form of age-related macular degeneration.

[Brachytherapy in choroidal melanoma]. / Brachyterapia w czerniaku naczyniówki.

BACKGROUND AND PURPOSE: Brachyterapy in the management of intraocular tumors was introduced in the Department of Ophthalmology in Cracow in the late sixties, soon after it was applied by Stallard. For many years, similar to other oncological centers, we used 60Co and in 1994 we started with 106Ru and at the end of 1997 with 125J. The aim of this paper is to present our experiences with 106Ru and 125J brachytheray in posterior uveal melanoma. MATERIAL AND METHODS: Our studies comprised 164 patients with choroidal melanoma, treated in the years 1995-1997 with 106Ru and 19 patients treated between December 1997 nad April 1998 with 125J plaque brachytherapy. There were 93 women and 90 men, aged 18-86. Tumor thickness was beneath 6 mm in 85 cases, 6-9 mm in 63 and above 9 mm in 35. In 121 eyes anterior margin of the tumor was located in equatorial region or posterior to it, 62 the tumor situated anterior to the equator attached to the ciliary body. The usual dosage was 60-100 Gy to the tumor apex; in 33 eyes transpupillary thermotherapy (TTT) with diode laser was added. The follow-up ranges from 3 months to 3 years after 106Ru plaque brachytherapy and 1-3 months after 125J. RESULTS: Criteria of the treatment efficacy were decrease of tumor thickness at least 10%, increase of its density and vessel obliterations. Among 164 patients treated with 106Ru improvement was achieved in 84 (51.2%) of cases, stabilization in 50 (30.5%) and negative results in 30 (18.3%). Enucleation was performed in 16 (9.7%) cases. Among 19 patients treated with 125J preliminary evaluation indicates positive reaction for treatment in 14 cases. CONCLUSIONS: Our studies confirm the opinion that brachytherapy is a method of choice in the management of many cases of posterior uveal melanoma. There are significant relationships between the results of treatment and the size of tumor and its location. The adequate choice of the kind of radioactive isotope in the plaque is very important.

[Age related macular degeneration as a cause of blindness]. / Zwyrodnienie plamki zwiazane z wiekiem jako przyczyna utraty wzroku.

PURPOSE: To present our studies concerning the causes of blindness in age-related macular degeneration, including the relationship with risk factors for this disease. MATERIAL AND METHODS: A total number of 158 eyes with AMD in 99 patients were examined. Among them there were 21 cases with visual acuity 0.1 or less in the better eye. This group of patients underwent a detailed analysis in order to determine the factors responsible for visual impairment in comparison to the patients with better visual function. RESULTS AND CONCLUSIONS: Blindness is connected mostly with exudative AMD. There are no significant differences in prevalence of risk factors for AMD between the group of patients with visual loss and that of patients with visual acuity above 0.1. The majority of patients referred to the ophthalmologist too late and on account of that is should be necessary to perform prophylactic examinations of the people above sixty.

[Risk factors for age-related macular degeneration]. / Czynniki ryzyka zwyrodnienia plamki zwiazanego z wiekiem.

PURPOSE: To present the results of examinations of the risk factors for age-related macular degeneration (AMD) carried out in the last 3 years. MATERIAL AND METHODS: Our clinical material comprised 119 patients, 69 women and 50 men, aged 43-85, mean age 70 years. Using classification according to the worse eye, there were 20 patients with drusen, 27 with atrophic changes and 72 with exudative form and AMD. The following risk factors were evaluated: age, sex, body mass index, history of general medical conditions, cigarette smoking, sun exposure, family history of AMD and ocular conditions such as iris color, lens opacities, hyperopia, gerontoxon and changes in retinal vessels. RESULTS: The significant relationships were found between the development of AMD and the age of patients, as well as between the advanced forms of AMD and the history of cardiovascular diseases and sclerotic changes in retinal vessels, 87% of examined patients have light iris and 52% body mass index above 26. CONCLUSIONS: The studies confirmed the role of age in the development of AMD and indicated cardiovascular disturbances, increased body mass index and light iris as the possible risk factors for AMD that are most worth further studying. The special attention should be also paid to drusen as the risk factor of AMD.

[Results of treating malignant conjunctival melanoma]. / Wyniki leczenia czerniaków zlosliwych spojówki.

28 patients with histologically confirmed conjunctival melanoma were treated between 1968 and 1987. In all the cases, the lesion was excised and in 15 cases, it was secondarily irradiated with 60Co or 27Sr. In 9 cases, recurrence appeared and, among them, twice as often in the group treated only surgically. 6 patients with the recurrence of conjunctival melanoma died because of metastases, 2 are alive and there is no information about 1.

[6 cases of bilateral melanoma of the uvea]. / Szesc przypadków obuocznego czerniaka blony naczyniowej.

Six patients with bilateral ocular melanoma were treated in the period 1967-1989. In one case both eyes were enucleated, in 4 one eye only, the other eye was treated. In all enucleated eyes the clinical diagnosis of melanoma was confirmed histopathologically. Two patients died because of metastases to the lungs and liver, one is alive and remains in a periodical control; there are no informations on the remaining 3 patients.

[Surgical treatment of pigmentary nevi of the conjunctiva]. / Leczenie operacyjne znamion barwnikowych spojówki.

Eighty persons with histopathologically confirmed diagnosis of pigmentary conjunctival naevi were operated upon in the period 1977-1986. Subjected to an analysis were the age and the sex of the patients as well as the localization, size and histopathological type of the change. Neither of the treated patients showed any naevus turning malignant and there were no recurrences.

[Results of surgical treatment for anterior uveal malignant melanoma]. / Wyniki leczenia operacyjnego czerniaków przedniej jagodówki.

The authors observed for 5 to 18 years 41 patients (22 women and 19 men) with malignant iris melanoma and/or malignant melanoma of ciliary body. The age of the patients was 20 to 80 years. All patients underwent surgical treatment with preservation of the eye ball. In 21 cases iridectomy, in 18 cases iridocyclectomy, and in the remaining cases iridocyclectomy-choroidectomy was performed. In 25 eyes the tumour occupied less than 1/4, and in 16 eyes between 1/4 and 1/2 of the iris circumference. During the period of observation 7 eye balls were enucleated, and in 6 recidivation of the tumour was diagnosed. These patients belonged to the group of 18 people with the tumour occupying the iris and the ciliary body, or the ciliary body only. Mortality in this group was 28%. Among 5 patients who died, in 3 the tumour occupied more than 1/4 of the iris circumference. In 3 patients from this group recidivation was diagnosed, in 4 enucleation was necessary. In 4 eyes secondary glaucoma was diagnosed. Therefore, among risk factors one ought to list size of the tumour, recidivation, and secondary glaucoma. On the other hand infiltration of the sclera and of the optic nerve was found only in one deceased person. The authors have not been able to obtain current information about 2 patients. In the whole studied group mortality was 5 out of 39, that is 12.8%. The most common complication during the surgery was hemorrhages. Two other complications: complicated cataract, usually stationary, and secondary glaucoma occurred both before and after treatment. Despite of complications 68.3% of patients maintained good visual acuity.

Protein A in the stable L-forms of Staphylococcus aureus.

The presence of protein A in the stable L-form of S. aureus BM 3041 was proved. Its amino acid composition and electrophoretic characteristics were compared with the parent strain. The location of protein A on the cytoplasmic membranes of the L-form cells, as well as on the extracellular membranes were established by immunoelectron microscopy. In the cells of the parent bacterium its location on the cell wall was observed.

Adhesion and phagocytosis of Staphylococcus aureus L-forms.

Electron microscopical investigations on in vitro and in vivo interactions of normal Staphylococcus aureus cells with rat peritoneal macrophages showed that these bacteria were rapidly endocytosed and digested even in the absence of specific antibodies. In contrast to the parental strains oxacilin-induced and stable variante lacking a cell wall (L-forms) were ingested without subsequent formation of phagolysomes and digestive vacuoles. The intracytoplasmic L-form bodies retained their characteristic ultrastructure, i.e. no visible alterations occurred. Some morphological aspects of the L-forms and their persistence in macrophages 7 days after intraperitoneal administration of L-form to rats, suggest the possibility of their intracellular survival.

[Evaluation of remission of progressive tumors treated with a simultaneous combination of radiation and platinum therapy]. / Remissionsbeurteilung einer simultan kombinierten Strahlen-Platin-Therapie bei progressiven Tumorerkrankungen.

UNLABELLED: Since January 1982, we have treated in a phase-II study 28 patients with a low-dose cis-platinum therapy combined with radiotherapy. We wanted to study the effect of reduced doses of cis-diamino-dichloroplatinum (II) in three different dose patterns: 1. "higher" dosage (150 mg/m2 within six weeks), single dose: 25 mg/m2 one time per treatment week), 2. "medium" dosage (80 mg/m2 within six weeks), single dose: 20 mg/m2 two times weekly during the first, fourth, seventh, and tenth treatment week, 3. "lower" dosage (75 mg/m2 within six weeks), single dose: 12.5 mg/m2 three times weekly during the first, fourth, seventh, and tenth treatment week. In one patient group the simultaneous radiotherapy was performed with a tumoricide dose of 2 Gy single dose with 4 fractions per week in two series (first series about 40 to 48 Gy tumor dose, pause of three to four weeks, second series about 16 Gy focal dose). The other group received palliative radiation doses (10 to 35 Gy tumor dose in one series), and the total platinum doses were lower corresponding to the shorter irradiation time. All patients were in advanced or recurrent stages of the disease. They suffered from different carcinomas and sarcomas with measurable parameters of response. RESULTS: 1. Manifestations beyond the irradiation field showed no remission. Within the irradiation field, all cases responded (CR/PR) for at least two months. 2. There was no reliable dependence from the platinum dose. A tendency in favor of higher single doses could be supposed. The response of even extreme palliative cases with low radiation and platinum doses was surprising. Limitating toxicities were not observed.

[Antigenic characteristics of the L forms of Streptococcus group B]. / Nekotorye antigennye osobennosti L-form streptokokka gruppy B.

Stable L-forms of group B streptococci (GBS) have been obtained and their antigenic features have been studied by the serological methods (the passive hemagglutination test, the aggregate agglutination test, the gel diffusion test), as well as by using ferritin and peroxidase labels with the subsequent electron microscopy. The use of the serological methods has made it possible to reveal the antigenic differences between the stable L-forms of GBS and their bacterial forms. Specific antigenic substances can be found in the supernatant fluid obtained after the sedimentation of the ultrasonically disintegrated cellular mass of streptococcal L-forms and bacterial cultures. The use of ferritin and peroxidase labels has revealed the specificity of GBS L-form antigen and its localization on the cytoplasmic membrane of all L-form structural elements.