Current thromboprophylaxis in urological cancer patients during COVID-19 pandemic.

Introduction: Venous thrombosis is a well-known complication of cancer disease, especially in Urology. However, even though proper antithrombotic prophylaxis is crucial in most urological procedures, we have insufficient high-quality studies on this topic. The European Association of Urology (EAU) Guidelines are outdated and lack data on COVID-19 increased risk of thrombosis. This review aimed to summarize data on thromboprophylaxis after radical prostatectomy, cystectomy, and nephrectomy during COVID-19 pandemic. Material and methods: A thorough analysis of the EAU Guidelines of Thromboprophylaxis was performed and compared to PubMed search, considering updated literature on thromboprophylaxis of radical prostatectomy, cystectomy, nephrectomy, as well as COVID-19 influence on venous thrombosis and urological practice. Results: Each patient should be evaluated individually to balance bleeding and venous thromboembolism (VTE) risk. There is still much uncertainty in low and medium-risk patients and all endoscopic procedures, where thromboprophylaxis could be omitted. Patients with COVID infection bear a significantly higher risk of VTE. All patients should be tested for COVID infection prior to a planned surgery during bursts of infections, undependably of vaccination status. Efforts to maintain early cancer diagnosis and treatment during the pandemic should be maintained. Conclusions: The quality of evidence is inadequate, and when deciding on thromboprophylaxis, we need to base it on individual risk, cancer advancement, procedure type, and our own experience.

Long-term follow-up of cataract surgery in eyes filled with silicone oil.

AIM: To evaluate the refractive and long-term outcome of eyes filled with silicone oil (SO) undergoing phacoemulsification cataract surgery (PCS). METHODS: This retrospective study evaluated patients with SO tamponade who were scheduled for PCS. RESULTS: Subjects (n=26) were followed for 29.5±13.9mo after cataract surgery. The median spherical equivalent refraction (SER) was +5.3 D [interquartile range (IQR) +2.9 to +6.7] before PCS, and +3.4 D (IQR +2.0 to +4.4) after PCS. Within the follow-up period retinal reattachment after SO removal was achieved in 15 out of 26 eyes (57.7%). In 13 eyes assessment of refraction after SO-removal was possible, and showed a myopic shift of -4.6 D (IQR -2.9 to -7.3) in the SER. After SO removal, 5 of the 13 eyes (38.5%) were within ±1.0 D of the target refraction, while 9 out of the 13 eyes (69.2%) were within ±2.0 D. CONCLUSION: In our study, the refraction after PCS for eyes filled with SO manifested low predictability, as did the myopic shift following SO removal. A significant percentage of the eyes that underwent SO administration required a long-term tamponade.

Complications of cataract surgery in eyes filled with silicone oil.

INTRODUCTION: The aim of the study was to evaluate complications of cataract surgery in eyes filled with silicone oil. METHODS: This retrospective, noncomparative, consecutive case series analyzed medical files of patients with eyes filled with silicone oil undergoing cataract surgery. Phacoemulsification with posterior chamber intraocular lens implantation was conducted with or without concurrent silicone oil removal. RESULTS: In this study, 121 eyes of 120 patients were included. In 32 eyes (26.4%) with evident silicone oil microemulsification or silicone oil-associated open-angle glaucoma, silicone oil was removed prior to phacoemulsification through a pars plana incision and no cases of posterior capsular rupture occurred during the subsequent cataract surgery. In the remaining 89 eyes, phacoemulsification was performed with silicone oil in the vitreous cavity. In these eyes, the rate of posterior capsular rupture was 9/89 (10.1%) and the rate of silicone oil migration into the anterior chamber through an apparently intact posterior capsule was 5/89 (5.6%). In 94 eyes (77.7%), an intraocular lens was inserted into the capsular bag, in 3 eyes (2.5%) into the sulcus, and in 1 eye (0.8%) a transscleral suturing was performed. CONCLUSIONS: In this series, complications related to the silicone oil were not uncommon during cataract surgery. In the majority of patients without evident silicone oil microemulsification or silicone oil-associated open-angle glaucoma, cataract surgery and posterior chamber intraocular lens implantation were performed while leaving the silicone oil in place.

Enzymatic vitreolysis with recombinant tissue plasminogen activator for vitreomacular traction.

AIMS: The aim of our research was to gain data about the efficacy of intravitreal injections of a recombinant tissue plasminogen activator (rTPA) in dissolving vitreoretinal tractions (VRTs). MATERIALS AND METHODS: The study group consisted of patients of our Ophthalmology Clinic who had received an injection of rTPA (TPA Group) for an existent vitreomacular traction confirmed by optical coherence tomography and stereoscopic examinations. The control group consisted of patients who had declined treatment despite the existence of a vitreomacular traction confirmed by the same diagnostic methods. Each group consisted of 30 people (30 eyes). The observation period was 6 months. CONCLUSION: In both groups some of the VRTs had dissolved. In the TPA group the traction dissolved in 10 patients (33.33%) and in the control group only in 5 (16.67%). It is also important to point out that the mean baseline membrane thickness was higher in the TPA group than in the control group. Observing patients in both groups we noticed that the dissolution of vitreoretinal membrane occurred most frequently in those cases where the membrane was thin. In the TPA group, the mean membrane thickness after 6 months decreased considerably. At the same time, no significant change in the membrane thickness could be observed in the control group. Observation of the retinal thickness allows us to draw the following conclusion: in the TPA group, the retinal thickness in the macular area (edema) had decreased over the study period, whereas in the control group it had increased. In those cases where the traction had dissolved, the edema of the retina decreased by the end of the 6-month period in both groups. In the TPA group, the dissolution of the membrane occurred most often within 3 months from the primary injection. Based on statistics, we can confirm that in the control group there was a decrease in visual acuity during the 6 months of the study period. At the same time, visual acuity in the TPA group underwent a small improvement. A 6-month observation had shown that in patients with strong VRTs, and in particular with VRTs accompanied by epiretinal membranes, a single intraocular injection is not enough to achieve posterior vitreous detachment. We have also shown that rTPA is a safe drug, with no adverse effects observed during the study period.

[Orbital pseudotumor due to Ormond's disease]. / Guz rzekomy oczodolu w przebiegu choroby Ormonda.

Retroperitoneal fibrosis (RPF) is characterized by the presence of a fibro-inflammatory tissue, which usually surrounds the abdominal aorta and the iliac arteries and extends into the retroperitoneum. Up to 15% of patients have additional fibrotic processes outside the retroperitoneum. Retroperitoneal fibrosis is generally idiopathic, but can also be secondary to the use of certain drugs, malignant diseases, infections and surgery. The etiology of idiopathic retroperitoneal fibrosis, so called "Ormond's disease", remains unknown. In this study we present the 54-years-old woman with orbital pseudotumour of right lacrimal gland associated with retroperitoneal fibrosis. Diagnosis was confirmed with computed tomography of abdominal cavity and orbit. Needle biopsy from the tumour in the orbit revealed only fibrous tissue with signs of chronic inflammation. Together with typical findings of an idiopathic retroperitoneal fibrosis, the final diagnosis of Ormond's disease with orbital pseudotumorous fibrosis was made. It is important that both, the ophthalmologist and the urologist are aware of the existence of this association, so that suitable treatment can be initiated without delay.

The role of vascular endothelial growth factor, tumor necrosis factor alpha and interleukin-6 in pathogenesis of diabetic retinopathy.

The aim of the study was to analyze the relation between early diabetic retinopathy and the pro-inflammatory cytokines tumor necrosis factor alpha (TNF-alpha), interleukin-6 (IL-6), vascular endothelial growth factor (VEGF) in children with diabetes mellitus type 1. Two hundred and two children with diabetes mellitus type 1 aged 13.2+/-3.83 years and 85 healthy controls were analyzed. Patients were divided into two subgroups: children with retinopathy (Group 1, n=39) and children without retinopathy (Group 2, n=163). All the children had 24h urine albumin secretion rate, glycosylated hemoglobin HbA1c level, and C-reactive protein level measured, underwent 24h blood pressure monitoring and had ophthalmologic examination performed. Additionally, all the children had serum TNF-alpha, IL-6 and VEGF level measured using an ELISA test (Quantikine High Sensitivity Human). Statistically significant higher blood serum levels of HbA1c, VEGF, TNF-alpha and IL-6 were found in the Group 1 in comparison with the Group 2. Additionally, the children of the Group 1 showed statistically significant correlation between serum VEGF and serum TNF-alpha (R=0.35, p=0.000), CRP level (R=0.23, p=0.006), 24h albumin urine secretion rate (R=0.45, p=0.000) and duration of the disease (R=0.26, p=0.002). The results of the current study suggest that there is a relationship between VEGF, TNF-alpha, IL-6 and the development of the diabetic retinopathy in children with diabetes mellitus type 1.

[The assessment of the correlation between vascular endothelial growth factor (VEGF), tumor necrosis factor (TNF-alpha), interleukin 6 (IL-6), glycaemic control (HbA1c) and the development of the diabetic retinopathy in children with diabetes mellitus type 1]. / Ocena zwiazku pomiedzy naczyniowym czynnikiem wzrostu sródblonka (VEGF), czynnikiem martwicy nowotworu (TIF-alpha), interleukina 6 (IL-6), wyrównaniem metabolicznym (HbA1c) a rozwojem retinopatii cukrzycowej u dzieci z cukrzyca typu 1.

The aim of the work is to assess the correlation between HbA1c, VEGF, TNF-alpha, IL-6 and the development of diabetic retinopathy in children diagnosed with diabetes mellitus type 1. One hundred fourty nine children with long-standing diabetes mellitus type 1 were enrolled in the study. The patients were divided into two subgroups: children with retinopathy (Group 1; n=28) and children without retinopathy (Group 2, n=121). The control group consisted of 62 healthy children. All the examined children had VEGF, TNF-alpha and IL-6 measured in the blood serum using highly sensitive ELISA tests. Statistically significant higher blood serum levels of HbA1c, VEGF, TNF-alpha and IL-6 were found in the group 1 in comparison with the group 2. Children of the group 2 in relation to healthy controls showed statistically significant higher blood serum levels of VEGF, TNF-alpha and IL-6. Elevated levels of VEGF, TNF-alpha, IL-6, HbA1c in blood serum of children with diabetes mellitus type 1 detected before development of overt signs of diabetic retinopathy might indicate the possibility of the occurrence of changes in the eye shortly.

[Interleukin-12, vascular endothelial growth factor and tumor necrosis factor-alpha in the process of neoangiogenesis of diabetic retinopathy in children]. / Interleukina-12, naczyniowy czynnik wzrostu sródblonka oraz czynnik martwicy nowotworu-alpha w procesie neoangiogenezy u dzieci z retinopatia cukrzycowa.

PURPOSE: Neoangiogenesis is a complex process, in which crucial role seems to be played by Vascular Endothelial Growth Factor (VEGF), Tumor Necrosis Factor-alpha (TNF-alpha) and Interleukin-12 (IL-12). Therefore it appeared to be worth of analysis to investigate the relation between IL-12, VEGF, TNF-alpha and the clinical course of the disease in children with Diabetes Mellitus type 1 (DM1). MATERIAL AND METHODS: One hundred and twenty six children in age 14.9+/-3.2 years diagnosed with DM1 from the Department of Paediatrics, Haematology, Oncology and Endocrinology of the Medical University of Gdansk were enrolled in the study along with 54 healthy children (as the control). All the children had their daily urine albumin secretion, HbAlc, C-peptide measured; 24 hrs blood pressure monitoring and ophthalmologic examination. Additionally, all of them had serum IL-12, VEGF, TNF-alpha measured using highly-sensitive ELISA tests (Quantikine High Sensitivity Human by R&D Systems, Minneapolis, Minn., USA). RESULTS: The children were divided into 2 groups: with retinopathy and without retinopathy. Between the groups statistically significant differences in age, duration of the disease, HbAlc serum level, C-reactive protein, daily albumin urine secretion and the systolic and diastolic blood pressure were found. Besides, statistically significant higher levels of VEGF, TNF-alpha and IL-12 were found in the group with retinopathy in comparison without retinopathy and healthy control group. CONCLUSIONS: Our results suggest that VEGF, TNF-alpha and IL-12 are engaged in neoangiogenesis regulation of diabetic retinopathy children.

Serum TNF-alpha level predicts nonproliferative diabetic retinopathy in children.

The aim of this study was identification of the immunologic markers of the damage to the eye apparatus at early stages of diabetes mellitus (DM) type 1 children. One hundred and eleven children with DM type 1 were divided into two groups: those with nonproliferative diabetic retinopathy (NPDR) and without retinopathy. All the children had their daily urine albumin excretion, HbA1c, C-peptide measured, 24-hour blood pressure monitoring, and ophthalmologic examination. Levels of TNF-alpha, IL-6, and IL-12 in serum were measured by ELISA tests (Quantikine High Sensitivity Human by R&D Systems, Minneapolis, Minn, USA). The NPDR children demonstrated a significantly longer duration of the disease in addition to higher HbA1c, albumin excretion rate, C-reactive protein, systolic blood pressure, as well as TNF-alpha and IL-6 levels than those without retinopathy. The logistic regression revealed that the risk of NPDR was strongly dependent on TNF-alpha [(OR 4.01; 95%CI 2.01-7.96)]. TNF-alpha appears to be the most significant predictor among the analyzed parameters of damage to the eye apparatus. The early introduction of the TNF-alpha antagonists to the treatment of young patients with DM type 1 who show high serum activity of the TNF-alpha may prevent them from development of diabetic retinopathy.

[Interleukin 12 as an anti-angiogenic mediator in type 1 diabetic children]. / Interleukina 12 jako mediator antyangiogenny u dzieci z cukrzyca typu 1.

UNLABELLED: The objective of the study was to analyse levels IL-12 and to relate the findings to the clinical course of type 1 diabetes mellitus (DM1). MATERIAL AND METHODS: We examined a group of 102 children with DM1 and 39 healthy children (as the control). All the children with DM1 had their daily urine albumin excretion, HbA1c, C-peptide measured, 24hrs blood pressure monitoring and ophthalmologic examination. In accordance to the ophthalmologic examination and level IL-12 in the serum the diabetic children were divided into 3 groups: group A: IL-12>0 pg/ml; group B: IL-12=0 pg/ml; group C: IL-12=0 pg/ml and IL12>0 pg/ml. Serum levels of IL-12 and TNFalpha were measured by the immunoenzymatic ELISA method, Quan-tikine High Sensitivity Human by R&D Systems (USA). RESULTS: Children of group A were characterized by significantly high level of IL-12 and by the absence of TNFalpha as compared with the children of group B, who had undetectable IL-12 along with high TNFalpha level. Additionally, children of group A had significantly lower urine albumin excretion and had only developed retinopathy. However, the children of group B not only had retinopathy, nephropathy but also arterial hypertension. The patients of group A were also analysed against the children of group C, who were characterized by high IL-12 level and some of them had also detectable TNFalpha, but without retinopathy and nephropathy. CONCLUSIONS: The results of our study imply the existence of balance between IL-12 and TNFalpha in type 1 DM children, which seems to warrant the stage of disease without diabetic complications. However, the IL-12 domination tends to prevent or delay nephropathy development but does not protect from retinopathy.

The activity of N-acetyl-beta-D-glucosaminidase and tumor necrosis factor-alpha at early stage of diabetic retinopathy development in type 1 diabetes mellitus children.

OBJECTIVE: The assessment of the clinical significance of TNF-alpha, IL-10 and NAG with its A and B isoforms concentrations in children with DM type 1 for the detection of early stages of both diabetic retinopathy and nephropathy. PATIENTS AND METHODS: One hundred and two children with DM type 1 and 35 healthy controls were analyzed. Levels of TNF-alpha, IL10 and total NAG enzyme activity with its A and B isoforms were measured in serum and urine of all participants. RESULTS: Children with diabetic retinopathy had a significantly higher levels of TNFalpha in serum (P=0.01) in comparison to those without retinopathy. The activity of NAG (P=0.002) and its isoform A (P=0.006) and isoform B (P=0.001) were significantly higher in children with diabetic retinopathy in comparison to those without this complication. Conversely, within the group with retinopathy, more children had detectable concentrations of IL10 in serum as compared to those without retinopathy (P=0.01). CONCLUSIONS: These results suggest that NAG activity and TNF-alpha concentration in diabetic retinopathy patients might show a relationship with a degree of renal glomeruli epithelial cells and renal proximal tubules damage.

[Selected immunologic and biochemical risk factors of the retinopathy and nephropathy development in children with diabetes mellitus type 1]. / Wybrane czynniki immunologiczne i biochemiczne ryzyka rozwoju retinopatii i nefropatii cukrzycowej u dzieci z cukrzyca typu 1.

INTRODUCTION: Despite that numerous investigations on the nature of diabetic microangiopathy were carried out, its pathomechanism remains unclear. OBJECTIVE: The aim of the study was to analyze the relation between early diabetic microangiopathy and the proinflammatory cytokines, NAG and its A and B isoforms in blood and urine in children diagnosed with diabetes mellitus type 1. MATERIAL AND METHODS: The study was carried out on the group of 56 children with diabetes mellitus 1 (age 13.6+/-3.74) and 35 healthy children selected as the controls. All the patients had 24 hrs albuminuria, HbA1c, C-peptide as well as the NAG enzyme and its A and B isoforms serum and urine activities measured. Additionally, all the children had TNF-a and IL6 level in serum measured. Each patient had 24 hrs blood pressure monitored and underwent ophthalmologic examination. RESULTS: Children with long-standing diabetes mellitus and retinopathy (group 1, n=15) were older and were characterized by a statistically significant longer duration of the disease and higher HbA1c level in comparison with the patients who presented with no sign of diabetic retinopathy (group 2, n=41). In the group 1 statistically significant higher TNF-alpha serum level (p=0.01), NAG (p=0.002) and its isoforms A (p=0.007) and B (p=0.001) urine activities were measured in relation to the group 2. Additionally the level of IL-6 and NAG and its isoforms A and B serum activities were higher in group 1 than in group 2, however the differences were of no statistical significance. Moreover the children from group 2 in comparison with the healthy controls showed statistically significant higher TNF-alpha serum activity (p=0.016) and NAG (p<0.001) and its A (p<0.001) and B (p<0.001) isoforms both serum and urine activities. CONCLUSIONS: The occurrence of the detectable serum TNF-alpha activity in children with diabetes mellitus type 1 showing no sign of diabetic retinopathy and nephropathy and no microalbuminuria with the concomitant increase of NAG and its isoforms serum and urine activities might point toward prompt occurrence of these changes in the eye and the kidneys.

[Advantage of using echography for optic nerve head estimation of glaucoma patients]. / Przydatnosc ultrasonografii typu B w diagnostyce jaskry.

PURPOSE: To evaluate the possibility and advantages of using echography for optic nerve head estimation of glaucoma patients. MATERIAL AND METHODS: 146 patients (146 eyes) - group A and 20 glaucoma patients (24 eyes)- group B underwent ultrasound investigation. On B - scan the optic nerve head was evaluated with the help of 10 MHz probe. In the patients with the possibility of glaucoma with transparent ocular media the C/D ratio was measured. RESULTS: In 6 patients of group A large cup of the optic disc was detected, which correlated with the eye fundus picture. In group B only in one case there was no correlation between echographic image of the optic cup and the eye fundus picture. CONCLUSIONS: During the ultrasound investigation of the eyes of patients before cataract extraction, corneal transplantation or vitreoretinal surgery we suggest the echography imaging of the optic cup as a routine procedure, which will be helpful in the diagnosis and treatment of glaucoma.

[Orbital tumors in the material of Department of Ophthalmology of Medical University of Gdansk in years 1991-2002]. / Guzy oczodolu w materiale Kliniki Chorób Oczu Akademii Medycznej w Gdansku w latach 1991-2002.

PURPOSE: Aim of the study was to determine the types and frequency of orbital tumors and to assess the method of treatment relevant to patient, orbital and tumor data. MATERIAL AND METHODS: Current classification of orbital tumors is presented. The retrospective analysis of 127 patients with orbital tumor treated in the Ophthalmology Clinic in Gdansk in years 1991-2002 was carried out. The diagnosis was made with orbital biopsy in available cases, the clinical findings, imaging studies and histopatological examination. RESULTS: There were 91 cases of primary tumors, 33 of secondary lesions and 3 metastatic neoplasms. The surgical treatment was involved in 87 cases. 14 of them required the synergic action with radiotherapy and 4 with chemotherapy. CONCLUSIONS: The age of the studied group is an important factor affecting relative incidence of orbital tumors. With increasing age, malignant orbital tumors become more common. Orbital lesion may manifest the systemic neoplastic disease.

[Retinal hemorrhages as a case for shaking trauma. Case report]. / Wylewy krwawe w siatkówkach jako istotny dowód wskazujacy na okolicznosci ich powstania.

An interesting shaking trauma case was reported. A detailed analysis of the pattern of injuries and their progress allowed to reconstruct the mechanism and time point of cerebral lesions in a 6 week old infant who survived the impact. The necessity of postmortem investigation of the fundus and cranial nerves in fatal cases of shaking trauma is stressed.