Serum concentrations of VEGF and bFGF in the course of propranolol therapy of infantile hemangioma in children: Are we closer to understand the mechanism of action of propranolol on hemangiomas?

BACKGROUND: Propranolol has become the treatment of choice for infantile hemangiomas (IH). Neither the pathogenesis of IH nor the mechanism of action of propranolol on them are well understood. Possible explanations include the inhibition of angiogenesis by decreasing vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF), induction of vascular endothelial cell apoptosis and vasoconstriction. OBJECTIVES: The aim of the study was to assess serum concentrations of VEGF and bFGF in the course of propranolol therapy of IH in children, and to assess their clinical implications. MATERIAL AND METHODS: The study included 51 children with IH treated with propranolol. The participants were assessed before, during and after the therapy with Hemangioma Activity Score (HAS), Doppler ultrasound (US) of the lesions, as well as VEGF and bFGF serum concentrations. RESULTS: All children showed clinical improvement measured in the HAS. A complete involution of the IH was reported in 32 (63%) children at the time of decision of the gradual withdrawing of propranolol, and in 28 (61%) patients at the end of the treatment (out of 46 patients present at the follow up after 1.5 months). Doppler US at the follow-up showed a complete disappearance of the blood flow in the lesion in 24 (52%) children and its reduction in 12 (26%) children. There was a significant decrease in VEGF and bFGF during and after treatment compared to pretreatment values. There was a correlation between the outcome of the Doppler US and changes in bFGF during and after treatment. Changes in VEGF during treatment did not correlate with changes in the Doppler US. CONCLUSIONS: Serum concentrations of VEGF and bFGF decreased during the propranolol treatment of IH, which may indicate the effect of propranolol on both. However, the statistical analysis showed their low prognostic value as biochemical markers of propranolol treatment. Clinical evaluation combined with Doppler US is the most valuable method of monitoring the therapy.

Propranolol as an effective treatment for inoperable periocular haemangiomas in children.

Introduction: Infantile haemangiomas located in the periocular region are a signi􀏐icant clinical problem. When untreated, they can lead to serious complications that can inhibit the proper development of vision. As they are often inaccessible surgically, a noninvasive eye -saving therapy is required. The aim of the study was to assess the effectiveness of propranolol treatment for inoperable periocular haemangiomas (PH) in children. Material and methods: Seventeen children with haemangiomas of the upper and lower eyelid and internal eyelid angle were thoroughly examined. Lesions were seriously affecting movement of eyelids leading to ptosis in most of cases, but anisometric astigmatism and exophtalmia were also diagnosed. Patients were carefully quali􀏐ied for propranolol treatment and were re -evaluated when therapy was completed. Results: In all of the described cases brightening and softening of the lesion were observed from the 􀏐irst days of therapy. Ninety percent of patients showed signs of complete involution. In 5 cases a mild discolouration or skin enhancement persisted. All children presented signi􀏐icant functional improvement. An 86% reduction of astigmatism was found in cases that were diagnosed initially. Conclusions: In conclusion, early diagnosis and introduction of propranolol for PH reduce the risk of complications that pose a threat to eye function. Measurement of astigmatism reduction may be a useful tool to establish a proper moment to cease the therapy. Propranolol is the 􀏐irst choice treatment option in PH based on its effectiveness, speed of action, and low rate of side effects.

The Efficiency of a Visual Skills Training Program on Visual Search Performance.

In this study, we conducted an experiment in which we analyzed the possibilities to develop visual skills by specifically targeted training of visual search. The aim of our study was to investigate whether, for how long and to what extent a training program for visual functions could improve visual search. The study involved 24 healthy students from the Szczecin University who were divided into two groups: experimental (12) and control (12). In addition to regular sports and recreational activities of the curriculum, the subjects of the experimental group also participated in 8-week long training with visual functions, 3 times a week for 45 min. The Signal Test of the Vienna Test System was performed four times: before entering the study, after first 4 weeks of the experiment, immediately after its completion and 4 weeks after the study terminated. The results of this experiment proved that an 8-week long perceptual training program significantly differentiated the plot of visual detecting time. For the visual detecting time changes, the first factor, Group, was significant as a main effect (F(1,22)=6.49, p<0.05) as well as the second factor, Training (F(3,66)=5.06, p<0.01). The interaction between the two factors (Group vs. Training) of perceptual training was F(3,66)=6.82 (p<0.001). Similarly, for the number of correct reactions, there was a main effect of a Group factor (F(1,22)=23.40, p<0.001), a main effect of a Training factor (F(3,66)=11.60, p<0.001) and a significant interaction between factors (Group vs. Training) (F(3,66)=10.33, p<0.001). Our study suggests that 8-week training of visual functions can improve visual search performance.

The Effects of Sports Vision Training on Binocular Vision Function in Female University Athletes.

Binocular vision is the most important visual cue for spatial orientation in many sports. In this study, we investigated how binocular vision was influenced by an eye training program that may be used to improve individual's oculomotor function. The experiment involved twenty-four female student athletes from team ball sports (soccer, basketball, handball). After an initial testing session, 12 participants were randomly allocated to the experimental group. Optometric investigation which included synoptophore testing and a test of dissociated horizontal phoria based on the Maddox method was performed three times: before the experiment, after eight weeks of eye training (3 times a week for 20 minutes), and four weeks after the experiment was terminated. Eye exercise methodology was based on orthoptic, sport and psychological aspects of performance. The phoria screening examination showed that exophoria was the most frequent disorder of binocular vision. Low fusional vergence range was also observed. Following the training period, 3 of the 6 oculomotor variables improved. The greatest effect was observed in near dissociated phoria (χ(2) =14.56, p=0.001 for the right eye; χ(2) =14.757, p=0.001 for the left eye) and fusional convergence (χ(2) =8.522, p=0.014). The results of the retention test conducted four weeks after the experiment confirmed the effectiveness of the vision training program. The results of the study suggest that binocular functions are trainable and can be improved by means of appropriate visual training.

[The ophthalmologic signs in cerebellum tumor. Preliminary report].

Introduction: The aim of the study was an analysis of ophthalmic symptoms coexisting with the tumour of the cerebellum. Material and methods: The study included 14 patients in the age between 21­55 years old with the tumor of cerebellum, who were operated in the Neurosurgery Clinic of the Pomeranian Medical University in Szczecin. The comprehensive ophthalmic examination were performed before and after 5 days from surgery. The examinations included evaluation of: pupillary reactions, visual acuity, fundus ophthalmoscopy, intraocular pressures, eye motility, visual field, optometrical tests and visual manual localization test. Results: The symptoms found before surgery of cerebellum tumors: diplopia (3 persons), early papilloedema (4 persons), nystagmus (2 persons), lack (5 persons) and weakened of convergence reô€lex (3 persons), latent strabismus (5 persons), manifest strabismus (3 persons). On the 5th day after the surgery were found: nystagmus (1 person), lack (5 persons) and weakened of the convergence reô€lex (3 persons). Visual manual localization was disparate depending on location of the tumor in the cerebellum; prevailed crossed and uncrossed localizations. Conclusions: 1. The natural dynamic of the tumor and surgical damage to the posterior cranial cavity structures can be monitored by assessment of the condition of the organ sight. 2. It is recommended to make the visual manual localization tests such as exponent disorders of senso-motorical deviations, which may occur in the patients with the cerebellum tumor.

The ophthalmologic signs in case of C1 neurinoma without hydrocephalus - case report.

INTRODUCTION: We present a case of the patient suffering from the tumor of cranio-spinal junction in whom a wide spectrum of ophthalmic and neuroophtalmic signs was noted. METHODS: The comprehensive neuro-ophthalmic examination were performed (pupillary reactions, visual activity, fundus ophthalmoloscopy, intraocular pressures, eye movements, visual field, MRI, MR angiography). Additionally immunohistochemistry and laboratory tests were made. RESULTS: The case of 24 years male with peripapillary subretinal hemorrhage, that occurred after a surgical excision of a tumor at cranio-cervical junction. The mechanism of the dynamics of the expanding intracranial space occupying processes is also discussed. CONCLUSIONS: Space occupying lesion of the level of cranio-spinal junction causes vascular changes in the fundus of the eye of the high dynamic and diversity. Surgical decompression in such cases is a maneuver of choice to maintain the reversibility of changes if proceeded in early stage.

Ophthalmic treatment and vision care of a patient with rare ring chromosome 15: a case report.

The Aim. Ring chromosome 15 is a very rare genetic abnormality with a wide spectrum of clinical findings. Up to date, about 50 cases have been documented, whereas no reports on ophthalmological treatment of such patients have been published. The aim of this study is not only to describe a new patient, but also, for the first time, to present the results of nonoperative management of divergent strabismus. Material and Methods. We present an amblyopic patient with 46,XX, r(15) karyotype: treated conservatively for exotropia of 60 prism diopters. The management consisted of refractive and prismatic correction, eye occlusion, and orthoptic exercises between the age of 15 months and 8 years. Results. The deviation angle of exotropia was decreased to 10 prism diopters, the visual acuity improved to 1.0 in both eyes (Snellen chart) and the fixation pattern was normal. The prisms enabled permanent symmetrical stimulation of the retina, which lead to a development of normal single binocular vision (Maddox test, filter test, and synoptophore tests). Conclusions. Parental karyotype was normal; the analysis of a three-generation pedigree has shown no genetic abnormalities or pregnancy losses so the child's karyotype anomaly was classified as de novo that is a single occurrence of this type of chromosomal disorder in this family. Strabismus in ring chromosome 15 patients is a difficult condition to manage, although success may be achieved.

[Plexiform neurofibroma of the upper eyelid and orbit in a patient with von Recklinghausen's disease--case report]. / Nerwiakowlókniak splotowaty powieki górnej i oczodolu w przebiegu choroby von Recklinghausena--opis pacjenta.

Neurofibromatosis type 1 is an autosomal dominant genetic disease, which belongs to the neuro-oculo-cutaneous syndromes (phakomatoses). The authors present a case of a girl with familial neurofibromatosis. In addition to typical skin lesions and Lisch nodules on the iris, the plexiform neurofibroma of the upper eyelid and orbit as well as hamartoma of the central nervous system were observed. Due to the massive infiltration of the left upper eyelid causing its complete ptosis and, in turn, the amblyopia of the left eye, the tumour was partially rexcised. This lesion is not totally removable in most cases due to the early development of neurofibroma during the fetal period and its strong adhesion to the healthy tissues. A massive eyelid infiltration causing amblyopia and dissociation of binocular vision is an indication for early surgery.

Rapid onset anterior segment complication following diode laser photocoagulation for retinopathy of prematurity: a case report.

Laser treatment for retinopathy of prematurity (ROP) has been proven to be beneficial. We present a case of uncommon, progressive anterior eye segment complication treated with diode laser photocoagulation for ROP which subsequently required surgical management. A 1210 g premature infant, born at 28 weeks of gestation, had bilateral stage 3 threshold ROP on his first screening, at 5 weeks of age. Confluent, laser ablation of avascular retina (Iris Medical, OcuLight S) in order to prevent the progression of ROP was applied. On the next ophthalmological examination, only in the right eye, an uncommon complication, not responding to conservative treatment, was noted. It was described as excessive conjunctiva hypertrophy, misdirected toward the center of the cornea. Indispensable surgical excision of hypertrophied conjunctiva was required, yielding a beneficial outcome. Histology revealed the presence of fibrous tissue. Hypertrophy of conjunctiva after diode laser photocoagulation requires surgical removal in order to prevent vision impairment.

[Oral status as a potential source of infection in AMD patients--introduction]. / Stan jamy ustnej pacjentów chorych na zwyrodnienie plamki zwiazane z wiekiem (AMD)--doniesienie wstepne.

PURPOSE: The aim of this work was to assess oral status as a potential source of infection in AMD patients. MATERIAL AND METHODS: The study was done in 56 patients at the age 45 to 90 years, suffering from AMD. The dry form of AMD was diagnosed in 37 and the exudative (wet) form in 19 patients. Three age groups were formed: group I - 45-65 years, group II - 66-75 years, and group III - 76-90 years. There were 13 patients at the age 45-65 years, 23 patients at the age 66-75 years, and 20 patients at the age 76-90 years. The dental examination included anamnesis, as well as determination of the status of teeth, periodontium, and oral mucosa. Radiographs were read also. RESULTS: A total of 235 lesions in the oral cavity were disclosed in 56 patients. In group I (49 lesions), grade I lesions dominated (18), chiefly teeth with incomplete root canal fillings, untreated teeth with necrotic pulp, and teeth with root amputation. Most of the lesions (61) in group II (90 lesions) were found in the periodontium, including 44 teeth with pathologic pockets. In group III (96 lesions), the majority of the lesions (48) were disclosed in the periodontium (30 teeth with pockets and loss of epithelial attachment, 18 loose teeth). CONCLUSIONS: Most of the patients with AMD had inflammatory lesions in the oral cavity. The overwhelming majority of the lesions were located in the periodontium. Periapical lesions were the next most frequent form. It is currently believed that periodontal lesions are the most dangerous ones. Is there an association between oral status in AMD patients and susceptibility to the disease? More observations are needed to find the answer.

[Radiotherapy of age-related macular degeneration. Case reports]. / Radioterapia w starczym zwyrodnieniu plamki zwiazanym z wiekiem (AMD). Opis przypadku.

The radiotherapy is worth to remember in the most progression causes of AMD, when there is no possibility for application the modern methods of the treatment. We present cause of patient with bilateral advanced changes and low visual acuity in course AMD, who had applied rtg therapy and laser fotocoagulation. The right eye was radiated with foton beam energy 10 MeV using linear accelerator. Dosage of 9 Gy was delivered in 3 fractions through 5 days. In right eye we observed increase of visual acuity from 2/50 before treatment to 3/50 after 12 months, and 0.1 after the 48 months of radiation. The visual acuity in the left eye decreased from 0.2 to 2/50 after the 48 months. The improvement of acuity vision after rtg therapy allowed the patient self-dependence life.

[Sudden loss of vision as the result of the decompression after the removal of the arachnoid cyst of the temporal region. A case report]. / Nagle zaniewidzenie jako nastiepstwo dekompresji po usunieciu torbieli pajeczynówki okolicy skroniowej. Opis przypadku.

INTRODUCTION: The neurosurgical treatment of arachnoid cyst consist in evacuation of the cyst and in consequence the decrease of the endocranial pressure. From the neurosurgical point of view, both the endocranial hypertension and the sudden hypotension inside a skull after a surgical motion are very dangerous. The sudden loss of vision is the most adverse surgical complication for the patient. The aim of the work is the presentation of the child, who suddenly and completely lost the sight after performing a neurosurgical evacuation of the cyst of the arachnoidea. CASE REPORT: We introduce 6-year-old boy, who went blind after executed puncture of the arachnoidea cyst of temporal region of the brain. The dramatic, sudden lack of the feeling of light perception that lasted for about 2 weeks caused confusion and anxiety of the child. The vision slowly began to come back as time goes by, at first light perception recovered in one eye, and only after several months in the second eye too. Ptosis of one of the eyelid subided entirely. We observed the diminution of the squint angle, which appeared after the surgical intervention, as the result of applied treatment too. DISCUSSION: The mechanism of the origin of this occurrence has not been fully identified, most likely it comes into being as a result of disturbances in the microcirculation of the optical nerve and the chiasma optical. The boy has been treated three times with Trental during the first year. After eight months from the incident of loss of vision, the acuity vision in right eye was 1/50 and 0.2 in left eye. We applied the intensive treatment of amblyopia and squint according to Szczecin's school of the strabismus treatment. The child obtained the improvement of the eyesight in the right eye to 0.1 and in the left eye to 0.9 (according to Snellen test). CONCLUSION: The operative treatment of the arachnoidea cyst is an efficient conduct, though, at times complications happen which make the result of the treatment worse.

[The neurological and ophthalmic symptoms in the child after the serious head injury due to the fall from the fifth storey. A case report]. / Objawy neurologiczne i oczne u dziecka po ciezkim urazie glowy na skutek wypadniecia z piatego pietra. Opis przypadku.

INTRODUCTION: The prognosis in the case of head injury may be different, Serious head injures are the leading causes of the death. In the remaining cases, the child recovers entirely, or disturbances of the cognitive and motor activities remain. The aim of the work is to show neurological and ophthalmological complications at the child after the fali down from the fifth storey. CASE REPORTS: A four-year-old girl with severe injuries of the body as result of the fall down from the fifth storey has been described. She had serious changes within head--the bruise of the brain with typical symptoms after brain trauma. The period spent in coma lasted for quite long time, therefore the return of the base life activities also stretched over months. Control computer tomography scan of the head showed multiple fractures of the skull bones and of brain tissue injury. The organ of sight complications concerned visual acuities, the large angle squint, the entire lack of the convergence reflex and post-traumatic symptoms on the fundus of eyeballs. RESULT: The long-term suitable medical care let the child to survive and then slowly recover. CONCLUSION: The intensive treatment and the rehabilitation of the child after the heavy head trauma allowed to obtain the astounding improvement of the psychomotor activities. It is very important for the children after the head trauma to conduct for the multispecialist treatment and proper long-term rehabilitation of children.

[Neurological symptoms and visual disturbance triggered by anaphylactic shock the sting of a hornet. Case report]. / Objawy neurologiczne i zaburzenia widzenia wywolane wstrzasem anafilaktycznym po uzadleniu przez szerszenia. Opis przypadku.

INTRODUCTION: Neurological symptoms after the insect stings are comparatively seldom described. They may have the character of the inflammation of the peripherial nerves, convulsive seizures or take the form of the depression or the psychoorganic syndrome. The aim of this work is to present a case of a child with serious neurological and ophthalmological complications after the sting of a hornet. CASE REPORT: The girl with untypical course of reactions after the sting of a hornet is presented in this article. Neurological symptoms, which were growing in first days after the sting, dominated, providing picture of a serious psychomotor deterioration in 14-year-old girl. Several months later after the sting, problems with sight during close-up work and the headaches, which caused accommodation disturbances and lack of convergence, remained. It is believed that the cause of the problems might be the toxins of insect venom, which had negative effect on centres responsible for accommodation and convergence of eyes. RESULTS: The treatment and rehabilitation, despite the serious complications after the sting of a hornet, allowed slowly recovery of physiological processes and let her get back to her normal activity. Her sight also improved. The headaches during close-up work subsided and her her accommodation and convergence of eyes improved. The girl came back to the normal life after two-year dramatic struggle with serious complications after the sting of a hornet, and she undertook the learning in normal school.

[Post-traumatic unilateral vision loss caused by carotid-cavernous fistula]. / Pourazowa utrata widzenia jednego oka spowodowana przetoka tetniczo-jamista.

PURPOSE: We show the subject with unilateral vision loss after head trauma. The carotid-cavernous fistula was a cause of one eye blindness recognized after 2 months. MATERIAL AND METHODS: 21 years old student with hard trauma of the head and brain after traffic accident. He had skull bones without optic canals bones broke. After 2 months he came to the Ophthalmology Clinic with no light perception, proptosis and swelling of conjunctiva and disturbances of motility of the left eye. We suspected a carotid-cavernous fistula as a cause of loss of light perception in this eye. The patient was sent to Neurosurgery Clinic where he had left carotid artery in the brain closed. RESULTS: After 8 days from the surgery he was in good physical condition but we didn't save the vision of the left eye.

[Eyeballs motility in oblique plane among healthy persons]. / Ruchomosc galek ocznych w plaszczyznie skosnej u osób zdrowych.

PURPOSE: The aims of the work was to evaluate the average range of vertical rectus and oblique muscles activity in subjects with no strabismus and with normal organ of sight. I intended to study, if there are some differences in eye motility for each particular muscles according to patients age. MATERIAL AND METHODS: 333 individuals of both genders with normal organ of vision, without strabismus or any history of chronic or inborn diseases, were enrolled. Three equal (n = 111) age groups were formed: group I comprising children aged 6-7 years; group II with youth aged 14-15 years; group III consisting of adults aged 22-26 years. Eyeball motility was studied with Wessely's keratometer. Separately for each eye, in the up-temple and down-temple direction at an angle of 23 degrees to the vertical plane, and in the up-nose and down-nose directions at an angle of 51 degrees to the vertical plane. RESULTS: 1. Mean motility in the up-temple(action of superior rectus muscle) and up-nose (action of inferior oblique muscle) directions ranged from 7 to 8 mm in all groups. 2. Mean motility ranged from 9 to 11 mm in the down-temple (action of inferior rectus muscle) and from 9 to 12 mm in down-nose(action of superior oblique muscle) directions in all groups. CONCLUSIONS: 1. In physiological conditions some of the persons examined, did not stay within the range of normal motility reference. 2. There is an inclination to increase the range depressing eyeball motility with age.

[The visual manual localisation in oblique plane among healthy persons]. / Wzrokowa lokalizacja reczna w plaszczyznie skosnej u osób zdrowych.

PURPOSE: The investigation of the visual manual localisation in horizontal plane was led among healthy people to study its behaviour. In medical literature is lack of assessment of visual manual localisation in oblique plane. The aim of the work was to estimate the visual manual localisation in the action of the vertical rectus and oblique muscles in healthy persons. MATERIAL AND METHODS: I studied healthy people with no strabismus, who were divided into three groups. The first group consisted of children aged 6-7 years (111 persons), the second group was aged 14-15 years (111 persons) and the third group consisted of adults aged from 22-26 years (111 persons). The patients were examined by an ophthalmologist to check for eye acuity. The investigation of localisation was done on the special reconstructed vertical manual localisator. RESULTS AND CONCLUSION: From results of study localisation in oblique plane were observed three patterns of localisation; the first--exact localisation, the second--ancrossed localisation and the third--crossed localisation. The most often were represented precise localisation in three study groups. The visual manual localisation in oblique plane changes together with age of patient.

[Efficacy of hyaluronidaze in reducing vitreous opacites--preliminary report]. / Skutecznosc hialuronidazy w redukcji metów w ciele szklistym--doniesienie wstepne.

THE AIM OF THE WORK: the assessment of hyaluronidase as reducer of floaters in vitreus body. We present one patient with the floaters in vitreus body treated by subconjunctival injection with hyaluronidase. Research work was carried out on a rabbit, which had been given 10 subconjunctival injections of hyaluronidaze. After treatment we noted subjective and local improvement. By using biochemical tests we proved, that subconjunctival hyaluronidaze application is a good way, to obtain an effect in the vitreous.