PENETRATING KERATOPLASTY IN MENTALLY RETARDED PATIENTS

Background. Penetrating keratoplasty (PK) is rarely performed in mentally retarded patients, first of all because of numerous complications after surgery such as inflammation, self-inflicted injury, injury and because of difficult post-operative treatment. The aim of this study was to present the success of PK in this patients. In 16 years (from May 1984 to May 2000) 201 PK were performed, but only three in mentally retarded patients.Methods. We present three cases of PK in mentally retarded patients. All the patients were men. They were 14, 16 and 27 year old. The indication for PK were in two cases acute keratoconus and in one case acute keratoglobus. The mean followup was 24.6 months. Trepanation was made with rotor threpin and donor material was sutured using single continuous 10-0 nylon suture.Results. In two cases keratoplasties stayed clear. Visual acuities were 0,4 and 0,5. In one patient with very aggressive behaviour graft failure developed with significant corneal vascularisation. Re-keratoplasty was not performed.Conclusions. Adequate post-operative care following PK in mentally retarded patients is the most important factor for the success of transplantation. The indication for the surgery must be made very carefully especially in self-aggressive patients in residential care.</p

Primerjava učinkovitosti selektivne laserske trabekuloplastike pri psevdoeksfoliacijskem glavkomu in primarnem glavkomu z odprtim zakotjem

Background. To compare the efficacy of selective laser trabeculoplasty (SLT) as treatment of pseudoexfoliation glaucoma (PG) and primary open-angle glaucoma (POAG) in a prospective clinical study. Methods. Ten eyes of 10 patients suffering from uncontrolled PG (PG group) and 10 eyes of 10 patients with uncontrolled POAG (POAG group) were treated with a frequency-doubled, Q-switched NdČYAG laser (532 nm). The baseline characteristics were similar inboth groups. The intraocular pressure (IOP) was measured before the treatment and 1day, 1 week, 1 month and 3, 6, 9, 12, 15, 18, 24, 30, and 36 months after the treatment. Success was defined as an IOP lowering, exceeding 20% of pretreatment IOP. Any modification of hypotensive medication led to exclude the eye from the study. Statistical analysis comparing the two groups was carried out using the independent-sample t test for continuous variables and the Log-Rank test for survival analysis. All tests were conducted considering p 0.05). Conclusions. SLT is an effective procedure for lowering IOP, although within 3years there has been a substantial failure rate in both PG and POAG eyes, andthe success seems to decline faster in PG eyes.Izhodišča. Primerjati učinkovitost selektivne laserske trabekuloplastike (SLT) pri zdravljenju psevdoeksfoliacijskega glavkoma (PG) in pri primarnem glavkomu z odprtim zakotjem (POAG) s prospektivno klinično raziskavo. Metode. 10 očes 10 bolnikov z neurejenim PG (skupina PG) in 10 očes 10 bolnikov z neurejenim POAG (skupina POAG) je bilo zdravljenih s frekvenčno podvojenim, Q-preklopljenim laserjem Nd:YAG (532 nm). Osnovne značilnosti so bile podobne v obeh skupinah. Očesni pritisk (IOP) je bil izmerjen pred zdravljenjem in nato 1 dan, 1 teden, 1 mesec ter 3, 6, 9, 12, 15, 18, 24, 30 in 36 mesecev po SLT. Uspeh je bil določen z znižanjem IOP, ki je bilo večje kot 20% glede na IOP pred zdravljenjem. Vsaka sprememba lokalnega protiglavkomskega zdravljenjaje vodila v izključitev očesa iz klinične raziskave. Statistična analiza primerjave dveh skupin je bila narejena s testom t neodvisnih vzorcev in testom Log-Rank za analizo preživetja. Pri vseh testih je bil p 0,05). Zaključki. SLT je učinkovita metoda za znižanje IOP, čeprav smo v 3 letih opazovanja ugotovili padec učinkovitosti tako pri očeh s PG kot pri očeh s POAG. Kaže, da uspešnost hitreje pada pri očeh s PG

An integrated strategy for the hierarchical multilevel MINLP synthesis of overall process flowsheets using the combined synthesis/analysis approach

This paper describes an integrated strategy for a hierarchical multilevel mixed-integer nonlinear programming (MINLP) synthesis of overall process schemes using a combined synthesis/analysis approach. The synthesis is carried out by multilevel-hierarchical MINLP optimization of the flexible superstructure, whilst the analysis is performed in the economic attainable region (EAR). The role of the MINLP synthesis step is to obtain a feasible and optimal solution of the multi-D process problem, and the role of the subsequent EAR analysis step is to verify the MINLP solution and in the feedback loop to propose any profitable superstructure modifications for the next MINLP. The main objective of the integrated synthesis is to exploit the interactions between the reactor network, separator network and the remaining part of the heat/energy integrated process scheme

Types, causes and treatment of eyelid trauma

Izhodišča. Poškodba vek je pogost vzrok za pregled pri očesnem zdravniku, vendar v novejši literaturi najdemo le malo takšnih epidemioloških raziskav. Namen naše raziskave je bila analiza poškodb vek glede mehanizma nastanka poškodbe, pregled vzrokov za nastanek poškodb in načinov oskrbe. Metode. V retrospektivno raziskavo smo vključili vse poškodovance s poškodbami vek, ki so bile kirurško oskrbljene na Oddelku za očesne bolezni Splošne bolnišnice Maribor v letih 2000 in 2001. Poškodbe smo razdelili na lažje, ki so bile ambulantno oskrbljene, in težje, ki so zahtevale bolnišnično oskrbo. Glede na mehanizem nastanka smo poškodbe vek razdelili na tope, ostre in kombiniraneglede na prizadeto veko na poškodbe zgornje, spodnje in obeh vek hkrati. Pregledali smo najpogostejše vzroke za poškodbe vek in spremljajoče poškodbe ter različne načine za oskrbo poškodb vek. Rezultati. Med 295 poškodovanci je bilo 239 moških (81%) in 56 žensk (19%). 27 poškodovancev (9%) je imelo težje poškodbe vek in so bili sprejeti na oddelek, 268 poškodovancev (91%) je imelo lažje poškodbe vek, ki so bile ambulantno oskrbljene. Pri 195 poškodovancih (66%) je šlo za topo poškodbo, pri 40 za ostro poškodbo (14%), pri 60 poškodovancih (20%) pa je šlo za kombinirano poškodbo vek. Najpogostejši vzrok poškodb vek so bili padci v 89 primerih (30%), sledijo poškodbe po tretji osebi v 85 primerih (29%). Pri 215 poškodovancih (73%) je bila poškodovana zgornja veka, pri 46 poškodovancih (16%) spodnja, pri 34 poškodovancih (11%) pa obe veki hkrati. Med spremljajočimi poškodbami so prevladovale poškodbe zrkla pri 138 poškodovancih (47%) in poškodbe obraza pri 17 poškodovancih (6%). Pri 251 poškodovancih (85%) smo namestili le šive kože, pri 6 poškodovancih (2%) smo namestili šive kože in podkožja, rob veke je bil oskrbljen v 33 primerih (11%), solzni kanalček pa v 5 primerih (2%). Zaključki. V naši raziskavi smo ugotovili, da so se poškodbe vek pogosteje pojavljale pri moških, večinoma je šlo za tope poškodbe, najpogostejši vzrok so bili padci. Večinoma je šlo za lažje poškodbe, ki so bile ambulantno oskrbljene, le v 9% je šlo za težje poškodbe, ki so zahtevale bolnišnično oskrbo. Pri skoraj polovici poškodovancev je bilo poškodovano tudi zrklo. Zato smo mnenja, da je pri poškodbah vek, zaradi velike raznolikosti in velikega števila spremljajočih poškodb nujen pregled pri očesnem zdravniku in ustrezna oftalmološka oskrba.Background. Eyelid trauma is a common cause of visit to the ophthalmologist, but there are just a few recent epidemiological studies. Purpose of our study was to analyse eyelid injuries according to the mechanism of injury, causes of eyelid injuries and different types of treatment. Methods. A retrospective review of data from patients who received surgical treatment for eyelid injuries at the Ophthalmology Department, Maribor General Hospital in 2000 and 2001 was carried out. Eyelid injuries were divided into a minor trauma with patients treated as outpatients and major trauma patients who needed hospital treatment. According to the mechanism of injury eyelid injuries were divided into a blunt trauma, sharp trauma and combination of both. They according to the localisation injuries were divided into injuries of upper lid, lower lid and both lids at the same time. We looked for causes of eyelid injuries, accompanying injuries and different types of treatment of eyelid injuries. Results. Out of 295 patients 239 were men (81%) and 56 were women (19%). 27 patients (9%) suffered major trauma and needed hospitalisation while 268 suffered minor trauma and they were treated as outpatients (91%). Blunt trauma was present in 195 cases (66%), sharp trauma was present in 40 cases (14%) and in 60 cases (20%) the injury was combination of sharp and blunt trauma. The most common causes were sudden falls in 89 cases (30%), followed by violence in 85 cases (29%). 215 patients (73%) clinically showed injury of upper lid, 46 patients (16%) showed injury of the lower lid and in 34 cases (11%) both lids were injured. Accompanying injury of the eyeball was present in 138 patients (47%) and face injuries in 17 patients (6%). 251 patients (85%) needed skin sutures, 6 patients (2%) needed skin and subcutaneous tissue suturing, lid margin was treated in 33 cases (11%) and canaliculus was treated in 5 cases (2%). Conclusions. Results of our study showed that eyelid injuries were more frequent in man and blunt trauma was the most frequent type of injury. The most common cause of injury was sudden fall. Injuries were mostly minor, and patients were treated as outpatients. Only 9% of patients suffered major trauma and needed a hospitalisation. In almost half of patients additional injury to the eye was present. According to the results of our study of eyelid trauma, which showed big diversity of injuries and high frequency of additional injuries to the eye, ophthalmologic examination and treatment should be performed in all of these cases