Postural habits of young adults and possibilities of modification.

BACKGROUND: The aim of the study was to assess postural habits in young, healthy people, identify correlations between postural errors and pain and attempt to modify bad habits. MATERIAL AND METHODS: 144 people, aged 18-23 were enrolled. The intervention consisted of 4 stages: Stage 1 - identification of postural habits, description of responses to stress, back pain frequency and intensity (Jackson & Moskowitz); Stage 2 - correction of habitual position with the help of a physiotherapist, briefing about ergonomic everyday behaviours and consequences of continued non-ergonomic behaviours, Stage 3 - follow-up examination: self-assessment of changes, evaluation of the effects of modifications, determination of causes for discontinuing the behaviour modification programme, where applicable; and Stage 4 - final examination, assessment of results. Correlations were sought between inappropriate postural behaviour in various positions and between non-ergonomic postural behaviour and pain location and response to stress. Statistical analysis was carried out with Excel and Statistica v. 7.1. A non-parametric χ(2) test was used at p<0.005. RESULTS: All participants presented poor postural patterns in the standing, sitting and recumbent position. Back pain was reported by half of the participants. Statistically significant relationships between pain and habitual positions were noted with regard to the cervical and lumbar spine and also for abdominal pain as a response to stress in people with excessive thoracic kyphosis. Behaviour modifications caused or intensified lumbar pain or thigh muscle pain. Positive outcomes included better urination and/or defecation and greater comfort in assuming the different positions and performing activities of daily living in these positions. Some examinees discontinued behaviour modification during the first month after the initial instruction and the majority did so over the next three months. CONCLUSIONS: 1. Non-ergonomic postural behaviours are common among young people. 2. Changing the body position does not eliminate the impact of the inappropriate habit. 3. An attempt to modify non-ergonomic postural behaviours usually results in pain, which may act as a demotivating factor. 4. Discomfort associated with the modification of habitual postural behaviours is reduced after 3-4 months of regular training.

[The Vogt-Koyanagi-Harada syndrome in 11-year-old girl]. / Zespól Vogta-Koyanagi-Harady u 11-letniej dziewczynki.

PURPOSE: The Vogt-Koyanagi-Harada syndrome is an idiopathic, multisystem disorder which typically affects pigmented individuals between 20-50 years old. The typical symptoms include granulomatous panuveitis with characteristic extraocular dermato-neurological manifestations. The case of VKH syndrome affecting Polish girl is very rare. CASE REPORT: A 11-year-old girl had an important decrease of visual acuity in both eyes (RE 0.1 and LE 0.2), with the presence of bullous serous retinal detachment in both eyes. Besides, in right eye some keratic precipitates were noted. The routine laboratory evaluation failed to provide a diagnosis. The patient was treated with an intravenous bolus of corticosteroid therapy and then, high dose of oral prednisone. RESULTS: After administered therapy the visual acuity improved rapidly in both eyes (RE 1.0 and LR 0.9), and the exudative retinal detachment resolved. After 5 months, the patient's examination showed a sunset glow fundus with several whitish rounded lesions in peripheral fundus, which is typical for the VKH syndrome. CONCLUSIONS: The VKH syndrome rarely affects young children, so the diagnosis may be difficult in the absence of the typical extraocular manifestations. In such atypical cases the diagnosis is based on the clinical evolution of the disease.

[Macular corneal dystrophy including histologic and ultrastructural changes]. / Dystrofia plamkowata rogówki z uwzglednieniem zmian histopatologicznych i ultrastrukturalnych.

PURPOSE: The study reports the results of a histological and ultrastructural examination of the corneal button, obtained during penetrating keratoplasty from patient with clinically recognized macular corneal dystrophy. MATERIAL AND METHODS: 34-year-old male patient suffering from macular corneal dystrophy (MCD) has been treated on corneal epithelium defect and photophobia since his early childhood. Visual acuity was decreased on the Snellen test chart to 0.02. Slit-lamp examination, and ultrasonographical measurement of the cornea's thickness were performed. Removed during penetrating keratoplasty corneal button was divided into two pieces. One of them was prepared in standard procedure for histological examination in the light microscopy after having been stained with hematoxylin and eosin, alcian blue and paS-method. From the other part, slides for ultrastructural examination in the transmission electron microscopy were prepared with the use of standard method. The family history from the patient was also taken, and available relatives have undergone examination in search of typical MCD symptoms. RESULTS: Slit-lamp examination findings revealed diffuse, from limbus to limbus, stromal opacification. In measurement by pachymeter cornea's thickness was reduced. In the light microscopy, in typical stained slides, delaminations within stroma and deficit of endothelial cells were observed. After being stained with alcian blue, dark blue deposits in the places of delamination became visible. By transmission electron microscopic examination, intracellular and extracellular deposits were detected in the stroma, Descemet membrane and endothelium. Distended keratocytes with enormous vacuoles containing abnormal material were found. Pedigree was typical for autosomal recessive inherited disease. CONCLUSIONS: Histological and ultrastructural diagnosis is a basis of recognition of macular corneal dystrophy. Analysis of the pedigree as well as ultrasonographical measurement of the cornea's thickness is very helpful to establish the right diagnosis.

Pars plana vitrectomy foreign body extraction assisted with a 24-gauge needle tunnel.

A 54-year-old man presented with corneal laceration, traumatized iris, small vitreous hemorrhage, lens opacity, and a 13-mm intraocular foreign body embedded in the retina. Pars plana vitrectomy and argon laser photocoagulation were performed. Using intraocular forceps, the object was forced into a 24-gauge needle that was inserted through the sclerotomy. The foreign body and the needle were removed from the eye. Phacoemulsification with foldable intraocular lens implantation in the ciliary sulcus was performed. Seven days after the surgery, the patient's visual acuity was 20/20 with spectacle correction of -3.5 diopters. The use of a needle tunnel during pars plana vitrectomy should be considered in similar cases of large, irregular intraocular foreign bodies to avoid severe and irreversible damage to the adjoining tissues.

[Limbal stem cell transplantation from HLA-compatible living donors. Long term observation]. / Przeszczepy rabkowych komórek macierzystych od zgodnych pod wzgledem HLA dawców rodzinnych. Obserwacja dlugoterminowa.

PURPOSE: The assessment of clinical outcome in patients after Ir-CLAL procedure. MATERIALS AND METHODS: Retrospective, interventional case series including 11 patients (12 eyes), all with non-ambulatory visual acuity (from light perception to hand movements). Mean age was 39.4 years (ranging from 18 to 76 years). In 7 eyes Limbal Stem Cells Deficiency (LSCD) resulted from chemical burn, in 2 eyes from ocular cicatricial pemphigoid, in one eye from Stevens-Johnson syndrome (SJS). In one eye congenital LSCD was diagnosed and in another one post-inflammatory LSCD. Mean follow-up was 16.2 months (from 10 to 32). Among donors prospective class I HLA matching was performed. Maximal two mismatches were accepted. General immunosuppressive therapy was switched-on in all subjects. Surgical excision of corneal pannus with clearing of limbal area was performed. Five clock hours stem cells tissue grafts from living related donors were harvested and transplanted to the recipient eye. Three penetrating keratoplasty, one deep lamellar keratoplasty and seven amniotic membrane transplantations were additionally performed. Main outcome measures were graft survival as a restoration of corneal epithelium, visual acuity improvement and complication in donors and recipients. Kaplan-Meyer survival curve and generalized Peto test were used for comparison. RESULTS: The graft survival was 83.6% in mean 20.3 months follow-up (from 10 to 32 months). Two cases of graft failure concern eye with SJS and eye with PKP regrafting after chemical burn. Visual improvement in 7 cases (58.3%), the same visual acuity in 4 cases (33.3%) and deterioration one case (8.3%) were noted. Ambulatory vision in 50% of patients was achieved. Graft rejection syndrome in four eyes was noticed also when ideal matching and CsA serum level 220 ng/ml. Two cases were treated with success and another two grafts failed. No complications in donors eyes were noticed. Impression cytology in eyes with successful grafts not related to pathological changes. CONCLUSIONS: Lr-CLAL are effective in ocular surface restoration. Living-related donors are suitable source of stem cells for cultivation in vitro. The prognosis for stem cells grafting is definitely worse when eyelid anomaly and adhesions exist.

[The prognostic significance of shape of demarcation line and ridge in clinical course of active phase of retinopathy of prematurity]. / Znaczenie prognostyczne ksztaltu linii demarkacyjnej i walu w przebiegu klinicznym fazy czynnej retinopatii wczesniaków.

PURPOSE: We planed out a comparison of clinic significance between eyes with acute ROP with "bays" and ROP without "bays". Retinopathy of prematurity (ROP) is a main reason of blindness in premature babies. There are no studies about shape of demarcation line and ridge in acute retinopathy of prematurity and its influence for clinical significance of ROP. In 11.42% of eyes with acute ROP we observed irregularities of demarcation line and ridge, which we called "bays". MATERIAL AND METHODS: We observed 140 premature babies (280 eyes) with acute ROP. In 32 eyes (11.42%) we stated "bays". We compared progression to stage ROP3c between group I (eyes with acute ROP and "bays") and group II (eyes with ROP without "bays). RESULTS: In 87.5% eyes with "bays" we observed progression to stage 3 c retinopathy of prematurity. In group without "bays" progression to stage 3c was observed only in 33.47%. CONCLUSIONS: We suppose, that presence of "bays" of demarcation line and ridge brings about worse prognosis at the course of acute retinopathy of prematurity.

[Applying deep lamellar keratoplasty in corneal disorders without endothelial abnormalities]. / Zastosowanie glebokiej keratoplastyki warstwowej w leczeniu schorzen rogówki bez zmian w sródblonku.

PURPOSE: To present own experiences in the surgery of deep lamellar keratoplasty. MATERIALS AND METHODS: 25 eye of 25 patients suffering from various corneal pathologies with preserved endothelium: 22 with keratoconus eyes, 2 with post-inflammatory scar and one eye with leucoma in Stevens-Johnson syndrome. Mean follow-up was 25.5 months (from 6 to 32). Main outcome measures were Non-Corrected and Best Corrected Visual Acuity (NCVA, BCVA), astigmatism, refractive error, IOP and corneal transparency. The surgery was performed in general anesthesia. In majority of cases the recipient stroma was trephined to a depth of 70% with 7.5 mm diameter vacuum trephine. In cases of intraoperative perforation of Descemet membrane with shallow anterior chamber we converted the procedure into penetrating keratoplasty. The donor lenticule was trephined in the artificial chamber with the 0.5 mm oversized manual trephine to a depth of 90%. In two cases after DLK was finished, limbal stem cell grafting was additionally performed. RESULTS: Postoperative NCVA ranged from 0.01 to 0.8 and BCVA from 0.1 to 0.8. Astigmatism ranged from 0.5 to 10.0 D. Refractive error ranged from -8.0 to +1.0 D. In follow-up period all grafts maintained transparent. The complications were mainly intraoperative perforations of Descemet membrane (9 cases): in 7 cases we convert the procedure into penetrating keratoplasty. In 2 cases the double chamber-forming was observed: in one case on 7 day following surgery the penetrating keratoplasty was performed, in other a spontaneous attachment was observed. We also observed loose sutures in 2 cases, inflammatory infiltrates in one case. Two cases of ocular hypertension was successfully treated by medication. CONCLUSIONS: Deep lamellar keratoplasty is an effective procedure for treating various diseases of corneal stroma with unaffected endothelium.

The use of the radioisotope method in studies of pesticide penetration into the eyeball.

The studies concerning the effects of pesticides on the human body focused mainly on their local action or chronic poisoning of the organism. In this study we examine the pesticide penetration into the eyeball resulting from direct contact with the eye. We used an isotope-labelled carbamate pesticide -- carbaryl. The determinations of the amount and concentration of this substance in the cornea, aqueous humour, vitreous humour and retina were performed using the method measuring beta radiation emitted by radioactive carbon. The results revealed measurable concentrations of labelled carbamate in the cornea and aqueous humour 10 and 30 min after application. The levels of this pesticide in the vitreous humour and retina were very low and difficult to analyse statistically. The described method appears to be useful in determining the range and rate of eye penetration by environmental toxins having direct contact with the eyeball.