[The use of telemetric intracranial pressure monitoring in the differential diagnosis of idiopathic intracranial hypertension - a case report]. / Vyuzití telemetrického monitorování intrakraniálního tlaku v diferenciální diagnostice idiopatické nitrolební hypertenze - kazuistika.

Idiopathic intracranial hypertension is a disorder that results from an increase of intracranial pressure with unknown cause. A single measurement of intracranial pressure only provides data at one given point in time. Therefore, telemetric monitoring of intracranial pressure was performed in a patient with fluctuating headache and significantly impaired vision, which together accounted for 226.2 hours of recording during normal daily activities. Elevated intracranial pressure was not found during monitoring, so we did not indicate the patient for shunt surgery.

[The ERG contribution in early diagnosis of chloroquine and hydroxychloroquine maculopathy]. / Prínos ERG v casné diagnostice chlorochinové a hydroxychlorochinové makulopatie.

Derivates of chloroquine (Plaquenil, Delagil), used for long-term treatment of rheumatic diseases, may cause clinically proven irreversible maculopathy, which may progress even after the discontinuation of their application. The optimal early diagnosis of ocular toxicity of chloroquine or hydroxychloroquine drug remains controversial up to now. The aim of this review paper was to evaluate how appropriate is the indication of the electroretinographic (ERG) examination due to the early diagnosis of cumulative drug-related maculopathy. Photopic, pattern, and multifocal ERG (Retiscan, according to the ISCEV methodology) were examined in 10 patients (20 eyes) treated by means of antimalarics, 9 due to the rheumatoid arthritis (RA) and 1 due to the systemic lupus erythremathodes (SLE). The average age of the patients was 60 +/- 15 years, the treatment period was 10 +/- 11 years; the median of the treatment period was 5 years. The control group consisted of 12 healthy, age matched patients (20 eyes) without any obvious ocular pathology. In all of them, the complete ophthalmologic examination was performed: the best corrected visual acuity (BCVA) for far using the Snellen charts, intraocular pressure (IOP) measured by means of the non contact tonometer NIDEK NT-2000, the Amsler grid test, examination of the anterior segment and the posterior segment with the slit lamp. The entry criteria in both groups were BCVA 5/7,5 (0.67) and better, the IOP in the normal range, negative Amsler grid test, anterior segment without significant decrease of the transparency, and physiological posterior segment or with subtle granular pigment dysgrupancies in the macula only. The significant difference between the group treated with chloroquine or hydrochloroquine and the control group at the 1% level of significance was found in following parameters: in the photopic ERG the value of the b wave latency [ms], in pattern ERG, the values of the waves N35 - P50 [microV] and P50 - N95 [microV] amplitudes, and at the 5 % level of significance in photopic ERG, the wave a amplitude value [microV] and in multifocal ERG, the value of the P1 [ms] a N1 [ms] parts latency in the pericentral ring. It follows from the results, that the ERG examination is suitable for the early diagnosis drug cumulative maculopathy caused by chloroquine derivates. Optimal is the individual comparison of the ERG values of the patient before and in certain time intervals after the beginning of the chloroquine derivates treatment.

[Immunohistochemical detection of the gene p53 and p21 expression in cells of the malignant melanoma of the uvea]. / Imunohistochemická detekce exprese genu p53 a p21 v bunkách maligního melanomu uvey.

AIM: To examine by means of immunohistochemistry the expression of the tumor suppressing gene p53 and gene p21 in cells of malignant melanoma of the uvea from formalin-paraffin material from patients, who were during the period 2000 - 2006 surgically treated due to malignant melanoma of the uvea at the Department of Ophthalmology in the University Hospital in Brno (Brunn), Czech Republic, E.U., and to correlate the results of the immunohistochemical detection with clinical signs of the tumor of each patient. METHODS: Twenty-nine malignant melanomas of the uvea were examined by means of monoclonal antibody DO-1 (Novocastra company) and all 29 samples of malignant melanoma of the uvea were immunohistochemically examined for the p21 gene expression by means of the monoclonal antibody SX 118 (DAKO company). We evaluated the percentage of positive nuclei and the intensity of the staining in immunohistochemically detected p53 and p21 genes expression. RESULTS: Results suitable for evaluation we obtained in 28 samples of malignant melanomas, one sample was not suitable for evaluation due to extremely high presence of melanin pigment. In 3 patients, weak nuclear p53 gene expression was detected in 5-15% of cells, in 1 patient, the very weak intensity of staining in 5-15% of cells was found. In three patients, in 5-15% of cells, weak expression of p21 gene, and in one patient, very weak expression of p21 gene in 5-15% of cells (in all 4 cases, the p53 expression was established) were found. In one of those 4 patients with p53 gene expression it was the malignant melanoma of the iris, in one of them it was malignant melanoma of the ciliary body, and in 2 of them it was malignant melanoma of the choroid. CONCLUSION: The expression of the p53 gene and the expression of the gene p21 were established in 4 out of 28 patients (14.3%). From the above-mentioned results we can assume that stabilizing mutations of p53 gene are rare in the melanoma of the uvea. The proved expression p53 in 4 patients is probably result of the expression of the standard (wild-type) p53 gene, especially according to the ability to induce the expression of p21 gene. In our group, there were not proved marked nuclear accumulation of p53, which would suggest the presence of p53 gene mutation.

[Malignant melanoma of the uvea in the Department of Ophthalmology, Faculty Hospital Brno Bohunice, Czech Republic, EU]. / Maligní melanom uvey na Ocní klinice FN Brno Bohunice.

PURPOSE: The malignant melanoma of the uvea (MMU) is the most common intraocular tumor among adults. The aim of the retrospective study was to evaluate the stage of the malignant melanoma of the uvea (MMU) at the time of diagnosis in a group of patients, to whom it was diagnosed in the Department of Ophthalmology, Faculty Hospital Brno. In the years 2005 and 2006, there had been diagnosed the MMU in 19 patients (11 women and 8 men) with the average age of 64.6 +/- 9.0 years. METHODS: The group of 19 patients was analyzed in accordance to various criteria: age, sex, location of MMU (iris, ciliary body, and choroid), size of MMU at the time of diagnosis, clinical signs of MMU, methods used in the diagnostic evaluation of the MMU, its treatment, histological type, TNM classification, and metastases. RESULTS: MM of the choroid was diagnosed in 14 cases, MM of the ciliary body in 4 cases and MM of the iris in 1 patient. The MMU was asymptomatic in 3 patients, in 2 patients manifested with the pain, and in all other cases (in 14 patients) manifested with the decrease of the visual acuity. The patient with MM of the iris was treated by means of therapeutic partial iridectomy and lamelar keratectomy, 5 patients were treated by means of brachytherapy, 3 patients were treated by means of Leksell gama knife and 10 patients underwent the enucleation because of large size of the tumor. At the time of the MMU diagnosis, there were no metastases present in any of the 19 patients. CONCLUSION: Despite to the currently diagnostic possibilities available, the majority of MMU is diagnosed at late stage, which requires radical surgical treatment. The variety of MMU clinical signs' knowledge may help to the early diagnosis of MMU, which will contribute to the opportunity to use the treatment, which particulary spares the visual functions.