[Corneal foreign bodies in children]. / Rohovková cizí telíska u detí

UNLABELLED: The purpose of the study was to answered three questions. Which part of all patients with diagnosis of corneal foreign body (CFB) diagnosed in period from 2006 to 2010 were children? Is there any dependence on sex like in adults? Is there any typical mechanism of injury in children? METHODS: Retrospective study analyzed data of 2381 patients with diagnosis of CFB, 2225 men and 156 women. There were in the group 0-17 years 154 patients, 82 boys and 72 girls, in group 18-64 years 2103 men and 80 women and in group patients older than the age of 65 years 40 men and 4 women. Mechanism of injury was analyzed in the group of children. RESULTS: CFB is a common condition in working-age adult men due to occupational exposure, eg grinding, drilling or cutting. CFB is very rare in adult women. Similar dominance of men was in the group of patients older then the age of 65 years. The results demonstrate, that both sex in group of children occurred equally. The majority of the mechanism of injury in children wasnt recognized (115 children). The biggest recognised group was use of swing in case-history of 17 children with corneal metallic foreign body, 15 of them were children younger than the age of 7 years. Seven children suffered injury by part of plants such as thorns or bark from branch of tree. Three boys had in case-history common mechanism of grinding. Remaining mechanisms of injury were less frequent. CONCLUSION: From 2006 to 2010, 154 (6.5 %) pediatric eye injuries of CFB were treated in Department of Ophthalmology for Children and Adults. Both sex in group of children occurred equally. Although majority of mechanism of injury remained unrecognised, use of swing is among children younger then the age of 7 years important unknown mechanism of injury. Is possible to prevent it, eg rust prevention of metallic suspensions of swing, protective eyeweare, cap.

Sense of coherence and disability and the relationship with life satisfaction 6-15 years after traumatic brain injury in northern Sweden.

The objective of the study was to assess sense of coherence (SOC) many years after traumatic brain injury (TBI) and explore the relationship between SOC and self-rated life satisfaction (LS) as well as measures of functioning and disability, sex, age at injury, injury severity and time post-injury. Sixty-six individuals (aged 18-65 years) who were 6-15 years post-injury were interviewed. Data on SOC (SOC-13 item scale), measures of functioning and disability (Mayo-Portland Adaptability Inventory, MPAI-4), LS (Satisfaction with Life Scale, SWLS), and sex, age at injury, injury severity and time post-injury were analysed with hierarchical multiple regression analyses. The results showed that SOC in the study group did not differ from the general population and was strongly associated with LS. Regression analyses revealed that emotional factors, social participation, SOC, and time since injury, were more influential than sex, age at injury, and injury severity in explaining LS. It was concluded that SOC in this group of individuals with TBI who were many years post-injury was similar to nondisabled individuals. SOC, together with emotional factors, social participation and injury-related factors, were determinants of LS. These results confirm that LS after TBI is a complex phenomenon dependent on several factors that are important targets for rehabilitation professionals.

The Traumatic Brain Injury Model Systems: a longitudinal database, research, collaboration and knowledge translation.

In 1988, the National Institute on Disability and Rehabilitation Research (NIDRR) launched the Traumatic Brain Injury Model Systems (TBIMS) program, creating the longest and largest longitudinal database on individuals with moderate-to-severe traumatic brain injury (TBI) available today. In addition to sustaining the longitudinal database, centers that successfully compete to be part of the TBIMS centers are also expected to complete local and collaborative research projects to further scientific knowledge about TBI. The research has focused on areas of the NIDRR Long Range Plan which emphasizes employment, health and function, technology for access and function, independent living and community integration, and other associated disability research areas. Centers compete for funded participation in the TBIMS on a 5-year cycle. Dissemination of scientific knowledge gained through the TBIMS is the responsibility of both individual centers and the TBIMS as a whole. This is accomplished through multiple venues that target a broad audience of those who need to receive the information and learn how to best apply it to practice. The sites produce many useful websites, manuals, publications and other materials to accomplish this translation of knowledge to practice.

Ocular surface injuries in autoimmune dry eye. The severity of microscopical disturbances goes parallel with the severity of symptoms of dryness.

Autoimmune dry eye (Sjögren's syndrome, SS) is a chronic systemic disease characterized by salivary and lacrimal gland inflammation and tissue damage leading to keratoconjunctivitis sicca and xerostomia. In this review attention has been devoted to the cause of the development of oxidative injuries of the ocular surface of patients suffering from SS. It was shown that lacrimal glands and diseased conjunctival epithelium reveal increased expression of pro-inflammatory cytokines which are released into the tear fluid. A high amount of pro-inflammatory cytokines highly induce the elevated expression and activity of enzymatic systems that generate reactive oxygen and nitrogen species. An abundant amount of these toxic products leads to a decrease in antioxidants and to the formation of cytotoxic related oxidants, such as peroxynitrite. All these factors, together with reactive oxygen species from polymorphonuclear leukocytes, contribute to the development of oxidative injuries at the ocular surface. From the clinical point of view it is important that the level of severity of the above described microscopical disturbances found in conjunctival epithelial cells goes parallel with the level of severity of dry eye symptoms.

Decreased expression of antioxidant enzymes in the conjunctival epithelium of dry eye (Sjögren's syndrome) and its possible contribution to the development of ocular surface oxidative injuries.

Previous studies have described elevated lipid peroxidase, myeloperoxidase and xanthine oxidoreductase/xanthine oxidase levels on the ocular surface of patients suffering from autoimmune dry eye (Sjögren's syndrome, SS). Reactive oxygen species generated by various enzymatic systems may be dangerous to the eye if they are not sufficiently cleaved by antioxidants. Because antioxidants have not been investigated in dry eye, the aim of this study was to examine the expression of antioxidant enzymes that cleave reactive oxygen species and play a key role in antioxidant protection. Conjunctival epithelial cells of dry eye (SS) patients were obtained by the method of impression cytology using Millicell membranes. Normal eyes served as controls. In the conjunctival epithelium superoxide dismutase, catalase and glutathione peroxidase were examined immunohistochemically. The enzyme expression levels were determined by image analysis and statistical evaluation. In contrast to normal eyes, where antioxidant enzymes were highly expressed in the conjunctival epithelium, in dry eye their expression was much less pronounced in correlation with the increasing severity of dry eye symptoms. Our study suggests that the decreased expression of antioxidant enzymes in dry eye disease (SS) contributes to the development of anterior eye surface oxidative injuries.

[The first experience with gold eyelid implants in facial nerve palsies]. / První zkusenosti s aplikací zlatých víckových implantátu pri obrne lícního nervu.

The authors in a clinical study refer about their first experience of gold eyelid implants application in lagophthalmos treatment in facial nerve (cranial nerve VII) palsies. The implant, thanks its weight and the gravitation, facilitates to the patients to close their interpalpebral fissure. The implants are implanted in to the subcutis of the upper eyelid and are sutured to the anterior surface of the tarsal plate. The aim of the surgery is to lower the risk of the damage of the eye due to the exposure keratopathy and to allow the patients to control better the eyelid function. The gold as a material is well tolerated by the human body. The shape of the implant and the way of application ensure good functional results. Altogether 5 adult patients were operated on at the Department of Ophthalmology. The House-Brackmann score was used to evaluate the effectiveness of the surgery, or the stage of the closing of the interpalpebral fissure before and after the surgery. This score evaluates the palpebral sphincter function according the grade of involvement. The selection of the implants, their indication and surgery procedure are discussed.

Nitric oxide synthase induction and cytotoxic nitrogen-related oxidant formation in conjunctival epithelium of dry eye (Sjögren's syndrome).

Until now, the expression and possible role of nitric oxide and nitrogen related oxidants in the human dry eye have not been investigated. Therefore, we examined immunohistochemically nitric oxide synthase isomers (NOS), enzymes generated nitric oxide, nitrotyrosine, a cytotoxic byproduct of nitric oxide and malondialdehyde, a byproduct of lipid peroxidation, in conjunctival epithelium of patients with dry eye, Sjögren's syndrome (SS). Moreover, in conjunctival epithelium of patients with dry eye (SS) the immunohistochemical staining of some pro-inflammatory cytokines was demonstrated: mature interleukin-1 beta (IL-1beta), interleukin 6 (IL-6), interleukin 8 (IL-8) and tumor necrosis factor alpha (TNF-alpha). Conjunctival epithelial cells were obtained by the method of impression cytology. Normal eyes served as controls. In contrast to the normal eyes where endothelial nitric oxide synthase (NOS3) as well as inducible nitric oxide synthase (NOS2) were only slightly expressed in conjunctival epithelium, in dry eye both NOS (mainly NOS2) were gradually expressed along the severity of dry eye symptoms which was in accord with pro-inflammatory cytokine immunodetection (IL-1beta, IL-6, IL-8, TNF-alpha) in dry eye conjunctival cytology samples. This was in contrast to normal eyes where the staining of pro-inflammatory cytokines was weak or completely absent. Peroxynitrite formation (demonstrated by nitrotyrosine residues) and lipid peroxidation (evaluated by increased malondialdehyde staining) were also found in conjunctival epithelium of dry eye with highly pronounced symptoms of dryness. In conclusion, results point to the suggestion that reactive nitrogen species are involved in the pathogenesis or self-propagation of autoimmune dry eye (SS).

The role of conjunctival epithelial cell xanthine oxidoreductase/xanthine oxidase in oxidative reactions on the ocular surface of dry eye patients with Sjögren's syndrome.

Previous papers examined lipid peroxidase levels and myeloperoxidase activity as products of oxidative and inflammatory reactions in the tear fluid of patients suffering from dry eye. The aim of the present paper was to investigate whether the enzymes xanthine oxidoreductase/xanthine oxidase known to generate reactive oxygen species contribute to oxidative reactions on the ocular surface. Xanthine oxidoreductase/xanthine oxidase were examined immunohistochemically as well as histochemically in conjunctival epithelial cells of patients suffering from dry eye. Patients with verified autoimmune dry eye (Sjögren's syndrome) participated in our study; normal eyes served as controls. Conjunctival epithelial cells were obtained by the method of impression cytology using Millicell membranes. The results revealed a pronounced expression, as well as activity of xanthine oxidoreductase/xanthine oxidase in the conjunctival epithelium of dry eye. It is suggested that reactive oxygen species which are generated by this enzymatic system, contribute to oxidative reactions on the eye surface of patients with ocular manifestations of autoimmune disease (Sjögren's syndrome).

[Clinical appearance and outcome of zone 1 retinopathy of prematurity (ROP)]. / Klinický obraz a výsledky léby u retinopatie nedonosených v zóne 1 sítnice.

The goal of this clinical trial was to evaluate outcomes of the treatment of retinopathy of prematurity (ROP) located in zone 1 (Zone 1 ROP). This disease has a specific clinical appearance and poor prognosis. Usually it is difficult to identify particular stages of ROP and to indicate treatment while following progression of the disease. In the group of zone 1 ROP it is necessary to separate transient forms (TF), in which vascularizations reach edges of zone 2, from very posterior forms (VPR), in which vascularizations and pathological changes are present only in zone 1. There were 24 eyes with zone 1 ROP (15 children) treated with combination of transcleral laser photocoagulation and cryotherapy during the years 2000 till 2005 in our series. Five eyes suffered from VPR, 19 eyes from TF. Average follow -up was 24 months. We found better outcomes in eyes with TF treated in pre-threshold stage of ROP (10 eyes) than in threshold stage of ROP (9 eyes). All 5 eyes with VPR developed unfavourable ROP stage IV or V. Zone 1 ROP becomes diagnostic and therapeutic challenge considering growing incidence of surviving of newborns with low or very low birth weight. Treatment initiation during prethreshold stage of ROP as it is supported by ETROP study (Early treatment of ROP) seems to be promising.

Non-declarative memory in the rehabilitation of amnesia.

The ability of amnesic patients to learn and retain non-declarative information has been consistently demonstrated in the literature. This knowledge provided by basic cognitive neuroscience studies has been widely neglected in neuropsychological rehabilitation of memory impaired patients. This study reports the case of a 43 year old man with severe amnesia following an anterior communicating artery (ACoA) aneurysm rupture. The patient integrated a comprehensive (holistic) day treatment programme for rehabilitation of brain injury. The programme explored the advantages of using preserved non-declarative memory capacities, in the context of commonly used rehabilitation approaches (i.e. compensation for lost function and domain-specific learning). The patient's ability to learn and retain new cognitive and perceptual-motor skills was found to be critical for the patient's improved independence and successful return to work.

[Use of ruthenuim 106 in retinoblastoma treatment]. / Vyuzití Ru106 pro lécbu retinoblastomu.

The Charles University Teaching Hospital in Prague - Motol started to treat patients with retinoblastoma by means of brachytherapy after obtaining the permission to use closed source of ionizing radiation in the beginning of the year 2003. The applicator containing ruthenium (106Ru) emitting mostly the beta radiation was chosen. Half-life is 369 days and the nominal activity of the source is 21.1 MBq. The applicator is placed in place for one to several days according to the prominence of the tumor and actual activity of the source. Duration of the application is calculated with a special program. In the year 2003, three patients with retinoblastoma were treated. In one case bilateral involvement was determined, and the brachytherapy was used for treatment of both eyes. The next patient was treated twice; one treatment followed the other with different localization of the applicator because of too large basis of the tumor. In 2003, altogether the brachytherapy was used for treatment of retinoblastoma five times. In all cases, the combined treatment (chemoreduction, teletherapy, transpupillary thermotherapy, or cryotherapy) was performed. One eyeball was enucleated because of severe post-radiation retinopathy, the second one for persisting tractional retinal detachment. In remaining cases no serious complications or progression of the malignancy were observed.

[Hemi-hangback recession (retroposition) of extraocular muscles]. / Hemihang-back retropozice okohybných svalu.

In a small clinical study the author evaluates the efficiency of the hemi-hangback recession (retroposition) procedure. This surgical procedure, which weakens extraocular muscles, proceeds from the hangback recession (retroposition) technique (hanging the muscle on a resorbable suture), which combines with the traditional recession. Hemi-hangback recession procedure is suitable in cases when a recession of more than 7 mm is needed. It is experimentally and clinically as well demonstrated in extra large recessions, that a shift towards the original insertion of the muscle occurs. The combination of the classical and hangback recession has its advantages in specific indications. More convenient surgical access and a reduction of the objectionable shift of the muscle backwards are main advantages of this procedure. The surgical procedure is described in this article and results in the group of patients from the Children's and Adult's Department of Ophthalmology at the Faculty Hospital in Motol, Prague, Czech republic. The hemi-hang-back muscles recession is indicated in third and sixth nerve palsies, restrictive forms of strabismus and complicated or successive forms of strabismus.

Prediction of IQ in the Mayo Older Adult Normative sample using multiple methods.

Using the Mayo Older Adult Normative sample (Ivnik et al., 1992) as our database, we developed regression models for estimating premorbid Full Scale (FSIQs), Verbal (VIQs), and Performance (PIQs) IQs for elderly adults. Age, years of education, and sex were the only demographic variables that showed sufficient variability; therefore, they were used as predictor variables in three stepwise procedures. The Mayo Normative FSIQs, VIQs, and PIQs served as the dependent variables. Both education and sex added significantly to the accounting of variance of both FSIQ and VIQ ( p < .001), whereas education ( p < .001) and age ( p < .05) were significant predictors of PIQ. These models produced statistically significant multiple Rs of .54, .58, and .35 ( p < .0001), with standard errors of estimate of 9.02, 8.28, and 10.77 for FSIQ, VIQ, and PIQ, respectively. Estimated FSIQs generated with the present model and the model developed by Barona and colleagues (Barona, Reynolds, & Chastain, 1984) were compared. The correlation between estimated IQs was large, the mean difference between IQs was very small, the standard deviations were nearly equal, and the categorical distributions of the two were similar. Because the Barona model is likely to be familiar to most clinicians, these findings argue in favor of the continued use of the Barona model, even when assessing people older than the WAIS-R normative sample. Extensions of these models to the WAIS-III also are discussed.

[Hang-back retroposition as a variation in oculomotor muscle weakness]. / Hang-back retropozice jako varianta oslabení okohybných svalu.

In a clinical study the authors evaluate efficiency of the operation on oculomotoric muscles by the hang-back retroposition method. A total of 70 children have been operated on, 52 of the patients suffering from esotropia and 18 from exotropia. The mean preoperation deviation in esotropia was 30 +/- 12 pdpt, the postoperation deviation was in the range of 6 +/- 7 pdpt. In the exotropia cases the preoperation deviation improved from original 76.9%, in the exotropia group being 77.8%. The overall success rate of the hang-back retroposition in all these patients was 77.1%. Ina group of children operated on by a traditional retroposition there was an overall success rate 78.7% (77.6% in esotropia and 82.4% in exotropia cases). Hang-back retroposition has been equally effective as the traditional retroposition of oculomotoric muscles. Its main advantages include visibility of the operation field, minimum risk of perforation of sclera and a fair time factor of the intervention. The authors discuss the development, indications, further advantages but also possible disadvantages or limitations of this acknowledged surgical procedure in strabology.

[New views on aberrant innervation of oculomotor muscles ]. / Nový pohled na aberantní inervace okohybných svalu.

Aberrant innervations of oculomotor muscles are a special group of clinical entities, the common sign of which is an abnormal innervation of the oculomotor muscles with nerve fibres which originally were not meant for this purpose. The majority of these anomalies develops during the embryonic period of lesions at the level of nuclei of cranial nerves or peripheral fibres. Congenital aberrations affect most frequently n. VI, less frequently n. III and rarely n. IV. Acquired affections are most frequent in n. III. Abnormal innervation connections concern not only oculomotor muscles but also muscles engaged in mastication and those of the upper eyelid. Clinically they are manifested as eyelid and facial synkinesias. Among aberrant innervations which lack an uniform terminology belong according to the more recent classification the following clinical units: Duan's syndrome, synergic divergence, double-elevator palsy, misdirection syndrome, Marcus Gunn phenomenon, some forms of congenital fibrous syndrome, trigemino-abducens synkinesia, pseudohyperfunction of the lower oblique muscle, crocodile tears syndrome, and aberrant affection of n. III. The authors describe the course, possible etiology of these anomalies and demonstrate, based on their own observations, clinical cases which can be explained by these mechanisms.

[Time factors and instrumental treatment of lacrimal duct obstruction in childhood]. / Casový faktor a instrumentální lécba nepruchodnosti slzných cest v detském veku.

The authors evaluate the effectiveness of probing and rinsing of the lacrimal system in a group of 155 infants and young children (300 eyes) with congenital obstruction of the lacrimal pathways. The mean age during the first treatment was 3.7 months--range 21 days to 24 months. Patency of the lacrimal pathways was achieved in 83.49% of the group. In children treated before the 6th month the passage was restored in 91.30%. The effectiveness of procedures declines with advancing age. In the author's opinion it is best to make the operation between the 4th and 6th month of age. The operation under local anaesthesia ensures in the majority of children a rapid and permanent regression of complaints and a relatively small number of required repeated probings. At a later age the effectiveness of probes or rinsing declines and the solution is rather an indication for intubation of the lacrimal pathways or DCRS. One of the main still open questions for discussion is the optimal age for the operation. The author discusses also views of adverseries of probing and the problem of spontaneous canalization of the lacrimal pathways.

Impact of comprehensive day treatment on societal participation for persons with acquired brain injury.

OBJECTIVES: To evaluate comprehensive day treatment (CDT) for survivors of brain injury by time since injury and to identify outcome predictors. DESIGN: Before and after. SETTING: Rehabilitation center. PARTICIPANTS: Ninety-six program graduates; 17 dropouts with acquired brain injury. INTERVENTIONS: Comprehensive Day Treatment Program: daily group sessions to build cognitive and behavioral skills through a transdisciplinary approach, supportive feedback, and a variety of therapeutic modalities. Obtained outcome measures before and after the program, and at 1-year follow-up. OUTCOME: Independent living status, vocational independence scale at program end and 1-year follow-up; and Rasch-analyzed Mayo-Portland Adaptability Inventory (MPAI-22) and goal attainment scaling (GAS) at program end. PREDICTORS: age, education, severity of initial injury, time since injury, and preadmission MPAI-22. RESULTS: Significant goal achievement on GAS and improvement on MPAI-22; increased societal participation at 1-year follow-up for those treated postacutely and many years after injury: 72% of graduates living independently; 39% working independently, 10% in transitional placements, and 18% in supported or volunteer work. Long-term outcomes were modestly related linearly to preadmission MPAI-22 and nonlinearly to time since injury. CONCLUSIONS: CDT improves societal participation even among persons with a long history of limited participation after brain injury. This de facto extended baseline analysis indicates the effectiveness of CDT and paves the way for randomized control trials of active treatment components. Relationships of predictors to outcomes are not sufficiently strong for patient selection. More effective interventions for vocational reintegration are needed for those most severely disabled after brain injury.

[Treatment of paralysis of cranial nerve VI: evaluation of the Hummelsheim method of transposition surgery of the oculomotor muscles]. / Lécba paralýzy n. VI: zhodnocení transpozicní operace okohybných svalu dle Hummelsheima.

The authors evaluated in a retrospective study the results of surgery in 28 patients with paralysis of the VIth cranial nerve. The standard surgical procedure which was selected as primary achieved orhtophoria in 21 patients. In 7 patients with persisting esotropia and diplopia transposition of the oculomotor nerves according to Hummelshein was indicated. After stabilization of the postoperative finding in all patients parallel position of the eyes and a improved compensatory position of the head was found. Markedly restored motility in abduction was observed only in patient. The method of first choice in treatment of paralysis of the sixth nerve but also of other oculomotor nerves are standard surgical procedures. By retro-position and resection of oculomotor muscles usually a satisfactory state in the primary position is achieved. Transposition operations are rather useful as supplementary operations in previously operated eyes. Indications are persisting diplopia and esotropia. Postoperative results as regards the primary position of the eyes are satisfactory but usually marked improvement of the motility cannot be foreseen.