51 research outputs found
Epitelioidni hemangiom orbite: prikaz sluÄaja
Epithelioid hemangioma (EH) and Kimuraās disease (KD) were once considered different stages of the same disease, as they share many clinical and histopathologic similarities. Nowadays, they are considered as two different entities, but some authors still confuse these terms. Our objective is to present a case of EH occurring in a very uncommon location and to emphasize the microscopic and clinical differences between EH and KD. We present a case of EH of the orbit in an 83-year-old man diagnosed after histopathologic evaluation of a mass that was surgically removed from the orbit. The tumor showed typical microscopic appearance with pathognomonic epithelioid endothelial cells. The diagnosis was also confirmed by immunohistochemical analysis. Our case clearly illustrates typical appearance of EH and the main differences between EH and KD are thoroughly discussed.Epitelioidni hemangiom (EH) i Kimurina bolest (KD) su zbog mnogih kliniÄkih i histopatoloÅ”kih sliÄnosti smatrani razliÄitim stadijima iste bolesti. Danas se smatraju dvama razliÄitim entitetima, ali neki autori joÅ” uvijek poistovjeÄuju ova dva pojma. NaÅ” cilj je predstaviti sluÄaj EH koji se pojavio na vrlo neuobiÄajenom mjestu te naglasiti mikroskopske i kliniÄke razlike izmeÄu EH i KD. Predstavljamo sluÄaj EH orbite koji se pojavio kod 83-godiÅ”njeg muÅ”karca. Dijagnoza EH potvrÄena je patohistoloÅ”kom analizom kirurÅ”ki uklonjenog tumora iz orbite u kojem su naÄene specifiÄne epitelioidne endotelne stanice koje nikad nisu prisutne kod oboljelih od KD. Dijagnoza je potvrÄena imunohistokemijskom analizom. Opisani sluÄaj rijetkog orbitalnog tumora jasno pokazuje znaÄajke specifiÄne za EH, uz podrobno prikazane razlike izmeÄu EH i KD
PenetrirajuÄa keratoplastika: desetgodiÅ”nja retrospektivna studija
The purpose of this study is to analyze the results of penetrating keratoplasty 5 to 10 years after operation, i.e. long term results. Patients operated in the University Department of Ophthalmology of Sestre milosrdnice University Hospital from January 1991 to January 1996 are included in this retrospective study. The enrolment consists of 95 operated eyes in 86 patients. The most common reason for keratoplasty was bullous keratopathy, corneal dystrophy and keratoconus. Graft failure was noticed in 17 eyes or 18%. In the group with keratoconus there was no graft failure. More then 80% of operated eyes 5 to 10 years after operation still have visual acuity of over 0.1- 5 to 10 years after operation.Cilj studije je analiza rezultata keratoplastike 5 do 10 godina nakon operacije - dugogodiÅ”nji rezultati. U ovu retrospektivnu studiju ukljuÄeni su bolesnici operirani na Klinici za oÄne bolesti KB "Sestre milosrdnice" od sijeÄnja 1991. do sijeÄnja 1996. godine. UkljuÄeno je 95 operiranih oÄiju kod 86 bolesnika. NajÄeÅ”Äa indikacija za keratoplastiku bila je bulozna keratopatija, distrofija rožnice i keratokonus. ZamuÄenje transplantata zabilježeno je kod 17 oÄiju ili 18%. U grupi bolesnika s keratokonusom nije bilo odbacivanja transplantata. ViÅ”e od 80% operiranih oÄiju i 5 do 10 godina nakon operacije imaju vidnu oÅ”trinu bolju od 0,1
Blepharoplasty: Radiosurgery versus Conventional Surgery
Cilj ove studije bio je istražiti uÄinkovitost monopolarne radiokirurÅ”ke tehnike kod operacije blefaroplastike. Radilo se o prospektivnom istraživanju gdje su operirane gornje vjeÄe 28 bolesnika. Bolesnici su podvrgnuti jednoj operaciji, jedna vjeÄa je operirana monopolarnom raiokirurÅ”kom tehnikom, dok je druga operirana klasiÄnom kirurÅ”kom metodom, a zatim su bolesnici praÄeni u seriji do 6 mjeseci. Operater i lijeÄnik koji nije znao koja je strana operirana odreÄenom tehnikom ocjenjivali su kvalitetu ožiljka. VeÄina bolesnika imala je do treÄeg mjeseca praÄenja neÅ”to bolji izgled ožiljka na strani operiranoj radiokirurÅ”kom tehnikom, ali ta razika nije bila znatna. Nisu zabilježene veÄe komplikacije. Gornje vjeÄe mogu se sigurno operirati monopolarnom radiokirurÅ”kom tehnikom. Uz primjenu radiokirurÅ”ke tehnologije cijeljenje je jednako ili neÅ”to bolje na strani operiranoj radiokirurÅ”kom tehnikom.The aim of the study was to evaluate the efficacy of a monopolar radiosurgery for blepharoplasty. This was a prospective trial in which upper eyelids of 28 patients were treated. Patients underwent a single treatment session: one eyelid was performed with monopolar radiosurgery while contra-lateral eyelid was performed with conventional surgery. The follow-up was 6 months. Assessments were made by the surgeon and by masked physician. The majority of patients, till 3th months postoperatively achieved the slightly better aesthetic results at radiosurgery sides, but no achieved dramatic results were acived. There were no serious adverse sequelae. Human eyelids can be safely treated with monopolar radiosugical device. Using this technology healing were the same or slightly better on side treated with radiosurgery
Granulomatozna upala orbite: dijagnoza, praÄenje i terapija
During the 2000-2005 period, we treated 32 patients with unilateral or bilateral granulomatous inflammation of the orbit. After careful exclusion of specific systemic and local diseases, the diagnosis was based on a combination of clinical and radiological findings. Examinations were performed to exclude the presence of a malignant or other form of tumor. Subsequently, we started treatment with high-dose steroids or a combination of steroids and surgical therapy. After therapy, we analyzed visual acuity, exophthalmometry, intraocular pressure and visual fields. There was no tumor recurrence during the follow up of 1-4 years. The findings suggested the treatment with high-dose steroids or a combination of steroids and surgical therapy to be an efficient therapeutic option for granulomatous inflammation.U razdoblju od 2000. do 2005. godine na Klinici za oÄne bolesti KliniÄke bolnice .Sestre milosrdnice. lijeÄili smo 32 bolesnika s jednostranom ili obostranom granulomatoznom upalom orbite. Nakon pažljivo uÄinjenih pretraga kako bi se iskljuÄilo postojanje specifiÄnih sustavnih ili lokalnih bolesti postavili smo dijagnozu koja se temeljila na kombinaciji kliniÄkih i radioloÅ”kih nalaza. Kod svih bolesnika prije i nakon lijeÄenja analizirana je vidna oÅ”trina, mjeren je oÄni tlak, uÄinjena egzoftalmometrija po Hertelu te vidno polje po Goldmannu. Svi bolesnici najprije su bili podvrgnuti kirurÅ”kom zahvatu orbitotomije, eksploracije i uklanjanja tumorskog tkiva, potom su svi primili pulsnu dozu kortikosteroida kroz tri dana, a nakon toga se nastavilo s lijeÄenjem per os kroz dva mjeseca. Kod 75% bolesnika nakon zavrÅ”etka lijeÄenja doÅ”lo je do porasta vidne oÅ”trine za jedan ili viÅ”e redova po Snellenu, a kod 96.88% bolesnika doÅ”lo je do smanjenja protruzije oÄne jabuÄice za 2 ili viÅ”e mm. Tijekom razdoblja praÄenja nismo zabilježili znakove reaktiviranja upale. ZakljuÄuje se kako se pažljivim kliniÄkim pretraživanjem i primjereno postavljenom dijagnozom te kombiniranim lijeÄenjem steroidima i kirurÅ”kim zahvatom postižu dobri rezultati kod bolesnika s granulomatoznom upalom orbite
UÄinak amiodarona na rožnicu
The most common side-effect of the anti-arrhythmic amiodarone is keratopathy. The goal of this study was to assess the frequency of this side-effect in our population of cardiology patients treated with amiodarone. We also wanted to assess the consequences on eye sight. The study was conducted as collaboration between the divisions of ophthalmology and cardiology of Sestre milosrdnice University Hospital, Zagreb and it included patients receiving amiodarone for longer than 6 months (100-800 mg/ day). Changes on the cornea were objectively evaluated using a biomicroscope and have been classified into three stages. Clinical changes on the cornea have been observed in 92% of the patients. Changes in eye sight were not observed. Amiodarone keratopathy is related to dosage and duration of treatment. This keratopathy progresses even with reduced dosage; however, complete regression occurs once administration of medication is discontinued. Taking this study into account, as well as the available published data, we are of the opinion that amiodarone therapy should not be discontinued due to changes in the eye-sight and if the amiodarone therapy is of critical importance to the welfare of the patient.Kod primjene antiaritmika amiodarona najÄeÅ”Äe registrirana nuspojava je keratopatija. Cilj ovog rada je ispitati koliko je ova nuspojava frekventna u populaciji naÅ”ih kardioloÅ”kih pacijenata na terapiji amiodaronom i od kakvog je znaÄaja za kvalitetu vida. Ispitivanje je provedeno u suradnji klinike za oftalmologiju i kardiologiju KB "Sestre milosrdnice", Zagreb. UkljuÄeni su pacijenti na terapiji amiodaronom duže od 6 mjeseci (100-800 mg/dan). Promjene na rožnici objektivno su registrirane biomikroskopom i svrstane u tri stupnja. One su registrirane kod 92% pacijenata. Promjene kvalitete vida nisu registrirane. Amiodaronska keratopatija u korelaciji je s dnevnom dozom i duljinom trajanja terapije. Smanjenje dnevne doze ne dovodi do regresije keratopatije, dok je kompletna regresija zabilježena nakon prestanka primjene lijeka. S obzirom na ovo istraživanje i podatke iz literature, miÅ”ljenja smo, da nije potrebno prekidati terapiju amiodaronom zbog promjena na rožnici ukoliko nema poremeÄaja vida i ako je terapija amiodaronom od vitalnog znaÄenja za pacijenta
Amnijska membrana u lijeÄenju neuroparalitiÄne keratopatije
The aim of the study was to determine whether amniotic membrane could be used to treat neuroparalytic keratopathy. Amniotic membrane transplantation was performed in 19 patients with neuroparalytic ulcer. All patients were younger than 61 and all developed corneal problems due to interruption of the sensory afferent fiber innervating the cornea. In all patients, the follow up period was longer than 18 months. Postoperatively, all patients underwent fluorescein test and biomicroscope examination as well as subjective pain evaluation. Postoperatively, the pain was reduced in study patients. In one patient, retransplantation for disease recurrence was performed two months after the first operation. After the second operation, the pain was minimized for more than 18 months. Amniotic membrane transplantation appears to be a good method for pain reduction and better epithelial healing in patients with neuroparalytic keratopathy.Cilj rada bio je utvrditi može li se amnijska membrana rabiti u lijeÄenju neuroparalitiÄne keratopatije. Transplantacija amnijske membrane je uÄinjena kod 19 bolesnika s neuroparalitiÄnim ulkusom. Svi bolesnici bili su mlaÄi od 61 godine i kod svih su se problemi s rožnicom razvili kao rezultat prekida senzornih aferentnih vlakana koja inerviraju rožnicu. Razdoblje praÄenja je kod svih bolesnika bio duži od 18 mjeseci. Poslijeoperacijski je kod svih bolesnika uÄinjen fluoresceinski test i biomikroskopski pregled, kao i subjektivna procjena boli. Nakon operacije bol je bila smanjena kod svih bolesnika. Kod jednog bolesnika uÄinjena je druga transplantacija, dva mjeseca nakon prve, zbog recidiva. Nakon druge operacije bol je bila smanjena viÅ”e od 18 mjeseci. Transplantacija amnijske membrane Äini se kao dobra metoda smanjenja boli i postizanja boljeg epitelijalnog cijeljenja kod bolesnika s neuroparalitiÄnom keratopatijom
Operacijsko lijeÄenje penetrirajuÄe rane mozga i pridružene perforirajuÄe ozljede oka uzrokovane metalnim objektom male brzine kretanja: prikaz sluÄaja i uvid u literaturu
Penetrating traumatic brain injury accompanied by perforating ocular injury
caused by low-velocity foreign bodies is a life-threatening condition, a surgical emergency and a major
challenge in surgical practice, representing a severe subtype of non-missile traumatic brain injury,
which is a relatively rare pathology among civilians. Optimal management of such an injury remains
controversial, requiring full understanding of its pathophysiology and a multidisciplinary expert approach.
Herein, we report a case of penetrating brain and associated perforating eye injury and discuss
relevant literature providing further insight into this demanding complex multi-organ injury. We
present a case of 39-year-old male patient with transorbital penetrating brain and perforating ocular
injury undergoing emergency surgery to remove a retained sharp metallic object from the left parietal
lobe. Following appropriate and urgent diagnostics, a decompressive left-sided fronto-temporo-parietal
craniectomy was immediately performed. A retained sharp metallic object (a slice of a round saw)
was successfully removed, while primary left globe repair and palpebral and fornix reconstruction were
performed afterwards by an ophthalmologist. A prophylactic administration of broad-spectrum antibiotics
was applied to prevent infectious complications. Early postoperative recovery was uneventful.
The patient was discharged on day 45 post-injury having moderate right-sided motor weakness, ipsilateral
facial nerve central palsy, and light motoric dysphasia. The vision to his left eye was completely
and permanently lost. In conclusion, management of non-missile transorbital penetrating brain injury
can be satisfactory when proper clinical and radiologic evaluation, and amply, less radical surgical
approach is performed early. A multidisciplinary routine is a prerequisite in achieving a favorable
management outcome.PenetrirajuÄa ozljeda mozga i pridružena perforirajuÄa ozljeda oka uzrokovana stranim tijelima male brzine kretanja po
život je opasno, hitno kirurŔko stanje koje predstavlja veliki izazov u kirurŔkoj opskrbi, kao i teŔku podvrstu mirnodopske ozljede
mozga, koja je relativno rijetka u civilnoj populaciji. Optimalno lijeÄenje ovakve ozljede i nadalje je dvojbeno te zahtijeva
potpuno razumijevanje patofiziologije njezinog razvoja, kao i multidisciplinarni ekspertni pristup. U ovom radu donosimo
prikaz sluÄaja penetrirajuÄe ozljede mozga i pridružene perforirajuÄe ozljede oka te uvid u recentnu literaturu, kako bi podrobno
raspravili o ovoj zahtjevnoj i složenoj viŔeorganskoj ozljedi. MuŔkarac u dobi od 39 godina zadobio je transorbitalnu
penetrirajuÄu ozljedu mozga i perforirajuÄu okularnu ozljedu zbog Äega je podvrgnut hitnom kirurÅ”kom lijeÄenju kako bi
se uklonilo oÅ”tar metalni objekt zaostalo u podruÄju lijevog tjemenog režnja. Nakon provedene žurne dijagnostike, odmah
je uÄinjena dekompresijska ljevostrana fronto-temporo-parijetalna karniektomija te je uspjeÅ”no uklonjeno zaostalo metalno
strano tijelo (odsjeÄak cirkularne pile), nakon Äega je po oftalmologu uÄinjena primarna opskrba ozljede lijeve oÄne jabuÄice
i rekonstrukcija vjeÄa i forniksa kroz slojeve lijevo. ProfilaktiÄka primjena antibiotika Å”irokoga spektra provedena je kako bi
se sprijeÄio nastanak infekcijskih komplikacija. Rani poslijeoperacijski oporavak bio je zadovoljavajuÄi. Bolesnik je otpuÅ”ten
iz bolnice 45. dan nakon ozljede s umjerenom motoriÄkom slaboÅ”Äu desnih udova, istostranom centralnom facioparezom i
blagom motoriÄkom disfazijom. Vid na lijevome oku trajno je i potpuno izgubljen.
ZakljuÄujemo kako lijeÄenje mirnodopske transorbitalne penetrirajuÄe ozljede mozga može biti uspjeÅ”no ako je provedena
pravodobna primjerena kliniÄka i radioloÅ”ka provjera i ako je primijenjen ogovarajuÄi manje radikalan rani kirurÅ”ki
pristup. Multidisciplinarna opskrba preduvjet je postizanju povoljnog uÄinka lijeÄenja
Visko i fakoviskokanalostomija: kratkoroÄni rezultati
PURPOSE: In this study we evaluated a nonfiltering glaucoma technique viscocanalostomy alone or in combination with small incision phacoemulsification and intraocular lens (IOL) implantation.
MATERIAL AND METHODS: From January 1999 to February 2001 we performed viscocanalostomy in 18 patients with medically uncontrolled primary open angle glaucoma. In 10 patients with cataract and primary open angle glaucoma we performed a combined operation of phacoemulsification and viscocanalostomy.
RESULTS: The mean IOP reduction remained statistically significant after 6 months in both groups (P<0,01). There was also a significant decrease in the antiglaucoma medications in both groups postoperatively.
CONCLUSION: We achieved good hypotensive effect and had very low complications rate. Such a low complication rate makes this operation particularly attractive to surgeons who perform an increasing number of operations in outpatient\u27s bases.CILJ: U ovoj studiji željeli smo prikazati uspjeÅ”nost nepenetrirajuÄe antiglaukomske operacije-viskokanalostomije primijenjene kao samostalni zahvat, odnosno u kombinaciji s fakoemulzifikacijom s ugradnjom intraokularne leÄe.
BOLESNICI I METODE: Od sijeÄenja 1999. godine do veljaÄe 2001. godine uÄinili smo viskokanalostomiju kod 18 bolesnika s nekontroliranim glaukomom otvorenog kuta. U istom vremenskom razdoblju uÄinili smo i 10 kombiniranih operacija fakoemulzifikacije s viskokanalostomijom kod bolesnika s kataraktom i glaukomom otvorenog kuta.
REZULTATI: 6 mjeseci postoperativno intraokularni tlak ostao je znaÄajno niži od preoperativnih vrijednosti. Postignuto je takoÄer statistiÄki znaÄajno smanjenje upotrebe antiglaukomskih lijekova.
ZAKLJUÄAK: Postigli smo zadovoljavajuÄi hipotenzivni uÄinak uz nizak broj komplikacija. Tako malen broj komplikacija Äini ovu vrstu zahvata aktualnom obzirom na sve veÄu potrebu ambulantnog izvoÄenja operacija
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