Association between vascular endothelial growth factor and hypertension in children and adolescents type I diabetes mellitus.

The aim of the study was to analyse the relationship between the serum level of vascular endothelial growth factor (VEGF) and the incidence of hypertension (HT) in children and adolescents with type I diabetes mellitus (T1DM). One hundred and five patients with T1DM were enrolled in the study. The control group consisted of 30 healthy controls. All the T1DM patients were subjected to biochemical analyses, ophthalmologic examination and 24-h blood pressure monitoring. Besides, all the patients and healthy controls had serum VEGF levels measured with the use of the ELISA methodology. The essence of our research is that patients with T1DM and HT and with microalbuminuria (MA) and diabetic retinopathy (DR) (MA/DR) are characterized by a significantly higher level of VEGF (340.23±93.22 pg ml(-1)) in blood serum in comparison with the group of T1DM patients without HT and MA/DR (183.6±96.6 pg ml(-1)) and with healthy controls (145.32±75.58 pg ml(-1)). In addition, the VEGF level was significantly higher in T1DM patients, who presented all three complications, that is HT, retinopathy and MA in comparison with T1DM patients without HT, but with MA/DR (P=0.036). On the other hand, no statistically significant differences (P=0.19) were noted in the level of VEGF in serum between T1DM patients without HT and MA/DR and the healthy control group. At a further stage of analysis, using the method of multiple regression, it was shown that systolic pressure, HbA1c and duration of disease are independent factors influencing the concentration of VEGF. Summarizing, the measurement of VEGF serum levels allows for the identification of groups of patients who have the highest risk of HT and, subsequently, progression of vascular complications.

Interleukin-12 and tumour necrosis factor-alpha equilibrium is a prerequisite for clinical course free from late complications in children with type 1 diabetes mellitus.

The objective of the study was to analyse levels of IL-12 and TNF-alpha and relate the findings to the occurrence of microangiopathy in children with type 1 diabetes mellitus (DM). We examined a group of 123 children with type 1 DM. Serum levels of IL-12 and TNF-alpha were measured by an immunoenzymatic ELISA technique. TNF-alpha and IL-12 tended to be simultaneously present or absent in the sera of 50% of the children who had not developed complications, thus indicating a state of cytokine's equilibrium. Among the patients with an established retinopathy, two IL-12/TNF-alpha combinations were visible. Either a lack of detectable TNF-alpha was accompanied by measurable IL-12 serum concentrations or TNF-alpha incidence was associated with undetectable IL-12 values. Simultaneous lack of TNF-alpha and presence of IL-12 was associated with a better prognosis as these patients had a significantly lower albumin excretion rate. The state of equilibrium between TNF-alpha and IL-12 is beneficial in patients at early stages of the disease, prior to the occurrence of complications. Shifting the equilibrium towards TNF-alpha seems to promote late complications. It may suggest that a disharmony between pro- and anti-angiogenic function of these cytokines underlie the mechanism by which TNF-alpha and IL-12 shape the disease course.

[Clinical advantages of colorimetric exploration in the early diagnosis of glaucomatous neuropathy]. / Intérêt clinique de l'exploration colorimétrique dans le diagnostic précoce de la neuropathie glaucomateuse. Etude préliminaire.

AIM: The purpose of this investigation was to evaluate acquired color vision defects in the early stages of primary glaucoma and in patients at risk for glaucoma. MATERIAL AND METHODS: Patients with primary open-angle glaucoma, normal-tension glaucoma and ocular hypertension were examined with the IF-2 anomaloscope. The Rayleigh equation and the Moreland equation were tested. We studied the relationships between color vision defects and the other tested variables. RESULTS: We found the mean value of the setting range of the Moreland equation significantly increased in all tested groups. Color vision disturbances were found in 57% of eyes with glaucoma and in 31% of eyes with ocular hypertension. We found a positive correlation between the blue-green colour vision defects and the perimetric changes in the glaucomatous eyes. These results indicate a decrease in color discriminating sensitivity in the short wavelength part of the visible spectrum in patients with glaucoma as well as in patients with ocular hypertension. CONCLUSION: Blue-yellow color vision testing with the anomaloscope may serve as an additional test in the early diagnosis of glaucoma but the absence of dyschromatopsia does not exclude the disease.

[Eyelid reconstruction after removal of tumours, using chondroperichondrial grafts from auricular concha]. / Odtwarzanie powiek po wycieciu nowotworów zlosliwych, z wykorzystaniem wolnych przeszczepów ochrzestnowo-chrzestnych z malzowiny usznej.

INTRODUCTION: The main goal in reconstruction of the full thickness defects of the eyelids after tumour resection is the reconstitution of the tarsal plate as supportive layer of the lid. AIM OF STUDY: We report a simple, one stage reconstruction procedure of repairing the eyelid internal lamella. METHOD: The chondroperichondrial graft from auricular concha was used to reconstruct the tarsoconjunctival layer in nine patients with surgical defects following excision of skin cancer. Local cutaneous flaps were used to reconstruct the external lamella. RESULTS: All grafts appeared completely without reabsorption, healing of the wounds was rapid. Epithelialization on the perichondrium from the surrounding conjunctiva occurred between 2 and 3 weeks. The functional and aesthetic results were judged as very good in seven patients after reconstruction of the lower eyelid. One patient after reconstruction of the upper eyelid has good result too. The last patient needed secondary very extensive operation because of the tumour recurrence. CONCLUSIONS: Conchal chondroperichondrial free graft provides simple, one-stage reconstruction of the lower and upper eyelid. Perichondrium substitutes the conjunctiva in early postoperative period and it makes epithelialization possible.

[Ophthalmic complications in the course of opportunistic infections--part I]. / Zmiany chorobowe aparatu wzrokowego w przebiegu zakazen oportunistycznych--Czesc I.

One of the most important problem of contemporary medicine appears to be constantly increasing number of patients with opportunistic infections. The situation is mainly due to world epidemic of AIDS. The progress in transplantology, huge number of immunocompromised patients during oncological and hematological treatment as well as prolongation of life time in children with congenital immunodeficiencies are successive conditions for the development of opportunistic infection. Pathogens infecting immunocompromised individuals have very low virulence, but in these persons disease is often very severe and potentially lethal. Main agents responsible for opportunistic infections are: Toxoplasma gondii, Cytomegalovirus hominis, Herpes simplex virus, Varicella-zoster virus and fungi. In the paper we describe clinical symptoms, diagnostic methods and therapies of ocular toxoplasmosis and viral infections. Knowledge of diagnosing methods and treatment of opportunistic infections which, when untreated, may quickly lead to vision loss, is necessary in contemporary ophthalmological practice.

[Prof. Morawiecki: the oculist and outstanding expert in immunology, immunopathology and serology]. / Prof. Jerzy Morawiecki - okulista, wybitny znwca immunologii, immunopathologii i serologii.

Jerzy Morawiecki (1910-1997) was a man with versatile interests. Being an assistant of Professor Wladyslaw Szumowski in the Jagiellonian University he published papers devoted to the history of medicine. After getting his medical degree in 1937 he worked in the Public Health Department in Warsaw under the very well known Ludwik Hirszfeld. There he carried out pioneer studies on the blood groups, the very beginning of a new science - immunology which moulded the scientific interests to which he was faithful for the rest of his life. Under the Nazi occupation of Warsaw he managed to send his paper on blood groups to Switzerland where it was published in 1941. Between 1946 and 1992 he published 18 papers in the field of immunology mainly of the eye. He did pioneer work on the precipitation of antigens and antibodies. The phenomenon of precipitation lines in the cornea is quoted in the literature as the "Morawiecki phenomenon" or as "Morawiecki' lines". He presented the original hypothesis of immunotherapy of intravitreal hemorrhages - the method of acceleration of hemorrhage absorption. The use of Anti-RhD antibodies subsequently became the most effective method of intraocular hemorrhages.

[The effect of total protein and albumin levels in serum on retinal detachment due to EPH-gestosis]. / Wplyw poziomu bialka calkowitego oraz albumin w surowicy krwi na przebieg odwarstwienia siatkówki w wyniku EPH-gestozy.

The purpose of the report is to describe a 31-year-old pregnant woman with EPH-gestosis presenting typical clinical features of bilateral retinal detachment. We noticed that it was associated with low degree of total protein and albumin in serum. Shortcoming protein balance was associated with adhibition of retinae. Attention is paid to the fact that elevation of retinal detachment responded to the treatment involving parenteral administration of albumin. In this case we achieved reattachment of retinae and regained full visual acuity.

[Evaluation of binocular vision in persons employed at high work posts]. / Ocena widzenia obuocznego u osób zatrudnionych na wysokosci.

The study covered 250 workers, aged 20-63 years, employed at workposts over 3 meters high. We analysed visual acuity, refraction, anterior segment, eye ground, visual field, colour vision and binocular vision. The study revealed that 20% of persons examined lack the stereoscopic vision ability. In conclusion it is suggested to use combined methods in order to evaluate binocular vision and certify ability to work at high workposts.

[Our results of orbital fracture treatment]. / Wyniki leczenia zlamania scian oczodolu.

PURPOSE: To present our results of orbital fracture treatment. MATERIAL AND METHODS: There were 28 patients with orbital fracture hospitalized at Ophthalmology Department of Medical University in Gdansk during last 5 years. Most of them had a blow-out fracture type. We reconstructed it using artificial materials (cranioplast). It was shaped according to the defect of the bone. Fracture of zygomatico-frontalis and zygomatico-maxillaris suture was fixed by bone sutures. The same method was used to treat gaps in medial and superior wall of the orbit. RESULTS AND CONCLUSIONS: We took into consideration the period of time between the trauma and surgical procedure. Full recovery (lack of diplopia) was achieved in 10 cases which underwent operation in less then 14 days after trauma and only in 2 cases in the group where patients were operated later than 14 days after accident.

[Optic symptoms in Arnold-Chiari syndrome]. / Objawy oczne w zespole Arnolda-Chiariego.

An unusual case of 47-years-old female with progressive deterioration of visual acuity, which occurred during the Arnold-Chiari syndrome, is presented. Normally, most clinical manifestations are related to cerebellum lesion and cranial nerves paresis. The described case resulted in optic nerve atrophy.

[Simultaneous bilateral retinal detachment as a delayed consequence of retinopathy of prematurity]. / Jednoczesne, obuoczne odwarstwienie siatkówki jako pózne nastepstwo retinopatii wczesniaków.

The case of prematurely born woman, aged 22, with bilateral retinal dialysis and detachment in high myopic eyes is presented. The minor head-trauma preceded the onset of the detachment. The segmental scleral buckling procedures were performed in both eyes. The attachment of the retina and some improvement of visual acuity were achieved.