Morphometry of the Pelvic Ring in Definition of Biomechanical Factors Influencing the Type of Pelvic Fracture

The aim of the study was to supplement data on pelvic morphology and structural geometry. Using these data, a mathematical and biomechanical model was constructed. The research was divided into two parts. The first part comprised radiogrammetric analysis of pelvic morphology and geometry based on 60 AP x-rays of male and female pelvises. The spatial definition of the pelvis was given by three transverse and one sagittal diameter. Transverse diameters were measured at the level of iliac wings, at the narrowest supraacetabular portion and on the line passing through the center of both femoral heads. The fourth diameter was the height of the pelvis. Geometric properties and structure of pelvic bones and position of muscles in relation to bone elements of the pelvis were analyzed in the second part. Knowing geometric dimensions of the pelvis and the body weight, it is possible to calculate the magnitude of gravitational forces acting upon certain pelvic portions. This biomechanical model serves for simulation of operative methods of fixation and allows search for the optimal solution, which is stable enough to withstand all the forces acting upon fragments of a fractured pelvic ring

Retrospective Clinical Analysis of Free Conjunctival Autograft in Treatment of Pterygia

The paper is a clinical retrospective analysis of free conjunctival autograft in treatment of pterygia. In period from 1998 until 2006, 47 patients with pterygia were operated using free conjunctival autograft. There were 19 female and 38 male, average age 61 years. In the majority of patients (39/47) it was a primary pterygia. Eight patients were on topical antiglaucoma therapy. Free autograft was taken from superotemporal conjunctiva. Introduction of a single nylon suture to mark the epithelial side of the graft as well as the use of running 10–0 nylon suture for the graft that stays in up to two months, were our modifications of the standard technique. The mean follow-up was 18.79.8 months. Free conjunctival autograft was successfully taken in all patients. Four of them experienced transient graft edema. In glaucoma patients, delayed healing of the cornea, conjunctival harvest area and the graft was noted. The best corrected visual acuity was improved in all patients, from 1–3 Snellen lines. Recurrence of the pterygium was noted in three patients, two of them already with recurrent pterygium. Free conjunctival graft is a safe and effective method of pterygium surgery that produces only few complications and has low recurrence rate. We found useful switch from topical to systemic antiglaucoma therapy as well as adjunctive use of autologous serum drops in promoting and accelerating healing in glaucoma patient

Analysis of Muscle Forces Acting on Fragments in Pelvic Fractures

CT was used in 50 adult pelvic fractures to determine the size and the position of relevant muscles with regard to bony elements in order to calculate muscle forces acting upon certain pelvic portions. Muscle length was measured to calculate muscle volume and physiological muscle cross-section. Among others, the size and direction of muscle forces were calculated for iliac, pubic and ischiadic fractures. The strongest muscle acting in iliac fractures is m. gluteus medius. The strongest upward pulling of iliac bone fragments is exerted by the erector muscles, while the major anterior, medial and downward pulling is performed by the iliopsoas muscle. In pubic bone fractures, eight muscles push bone fragments downward, the strongest among them being m. adductor magnus. Two muscles pull them upwards: m.rectus abdominis and m. obliquus externus. Nine muscles are responsible for downward displacement of bone fragments in ischiadic fractures, but the strongest is m. semitendinosus. Calculation of moments of muscle forces acting upon bone fragments using CT of pelvic fractures gives additional data for planning of optimal operative treatment that can guarantee stable fixation in individual patients

Analysis of Muscle Forces Acting on Fragments in Pelvic Fractures

CT was used in 50 adult pelvic fractures to determine the size and the position of relevant muscles with regard to bony elements in order to calculate muscle forces acting upon certain pelvic portions. Muscle length was measured to calculate muscle volume and physiological muscle cross-section. Among others, the size and direction of muscle forces were calculated for iliac, pubic and ischiadic fractures. The strongest muscle acting in iliac fractures is m. gluteus medius. The strongest upward pulling of iliac bone fragments is exerted by the erector muscles, while the major anterior, medial and downward pulling is performed by the iliopsoas muscle. In pubic bone fractures, eight muscles push bone fragments downward, the strongest among them being m. adductor magnus. Two muscles pull them upwards: m.rectus abdominis and m. obliquus externus. Nine muscles are responsible for downward displacement of bone fragments in ischiadic fractures, but the strongest is m. semitendinosus. Calculation of moments of muscle forces acting upon bone fragments using CT of pelvic fractures gives additional data for planning of optimal operative treatment that can guarantee stable fixation in individual patients

Retrospective Analysis of Reconstruction Techniques After Periocular Basalioma Excision

The paper presents our approach to reconstruction after periocular basalioma (pBCC) excision, especially of large lower lid (LL) and medial canthal (MC) pBCC. Retrospective analysis of data of 123 patients with pBCC, confirmed on histologic examination (HE), operated in period from 1998 to 2006, was performed. Oncologic safety margins of 3 mm were marked after local anesthesia was administered. Reconstruction was done in time of surgery. In pBCC away from a lid margin, adjacent myocutaneous flaps were used. For lid margin involving (LM) pBCC, size of 10 mm and less in horizontal diameter (HD), full-thickness lid excision was performed, combined with lateral canthotomy and/or Tenzel or McGregor flap. When size of LM pBCC was more than 10 mm in HD and it was on a LL, ipsilateral upper lid (UL) tarsoconjunctival (TC) graft combined with single pedicle transposition myocutaneous flap were used. The same size of LM pBCC on a UL required ipsilateral full-thickness LL “switch” flap and/or contralateral LL Hübner graft. In MC pBCC combined approach was used. The follow-up was up to 5 years. The 19 patients (15.4%) had positive tumor margin on HE. Five of them refused further surgery, but only two had recurrence. The rest of 121 patients had no recurrence during follow-up. In 5/14 patients, who underwent additional surgery, no tumor cells were found on HE. The 10/123 patients (8.1%) had complications. The imperative of our approach to reconstruction after pBCC was good functional and cosmetic result, avoiding prolonged lid closure. Accordingly, in large LL LMpBCC we used ipsilateral UL TC graft combined with single pedicle transposition myocutaneous flap. In MC pBCC combined approach was mandatory

Modified Operative Technique for Involutional Lower Lid Entropion

The paper presents a modified operative technique for involutional lower lid entropion. The prospective noncomparative study of 101 lower eyelids of 88 patients undergoing surgery for involutional lower lid entropion was conducted in period from September 2005 until March 2012. Indication for the surgery was entropion, previously untreated, with moderate to severe horizontal lid laxity and no clinically relevant medial and lateral canthal tendon laxity. The operative technique is our modification of Quickert and Jones procedures. Photo was taken preoperatively and one month after surgery. Clinical follow-up was at 7th postoperative day, one month and six months after surgery and in case of the recurrence. Long-term follow-up was obtained via telephone interviews. There were 44 male (50%) and 44 female (50%) patients included in the study. The age of patients was in average 73.27±8.1 years (range 53–90 years). Early postoperative complication was localized lid swelling found in two patients starting 4–6 weeks postoperatively at the area of absorbable suture. It resolved spontaneously in two and three weeks respectively. There was recurrence of entropion in 11 eyelids (10.89%) of 10 patients. The mean interval between primary surgery and the recurrence was 17.45±14.84 months (range 4–48 months). In these eyelids Jones procedure was performed. However in four eyelids of four patients from the recurrent group an additional surgery needed to be performed after 6, 12, 12 and 17 months respectively. Our modification of surgical treatment for involutional lower lid entropion was effective in 89.11% of eyelids. Complications of the procedure were scarce

Painless Acanthamoeba Keratitis in a Soft Contact Lens Wearer – Case Report

Aim of our paper is to present a case of painless Acanthamoeba keratitis in a soft contact lens wearer. A 17-year-old male, highly myopic, prolonged soft contact lens wearer, presented to us with painless red watery right eye having remarkably diminished vision. Last six weeks he was treated elsewhere for the microbial keratitis with no improvement. No pain was reported and on the direct questionnaire about it he denied it. There was marked mixed conjunctival and ciliary injection. A central stromal opacity with a pronounced surrounding corneal ring of inflammatory infiltration and epithelial defect was seen on biomicroscopy of the right eye. Circular pannus was already formed reaching epithelial defect overlying corneal ring infiltrate. Acanthamoeba spp in the corneal sample was confirmed. Prolonged therapy with 0.02% chlorhexidine digluconate solution combined with 0.1% hexamidine solution resulted in corneal healing left with a large central dense stromal opacity with circular pannus reaching peripheral third of the cornea but with very thin blood vessels and the best corrected visual acuity of 0.1 tested on Snellen chart. In conclusion, even in a lack of typical symptom for Acanthamoeba keratitis such as pain, this amoeba should be ruled out especially in a soft contact lens wearer

Cross-Sectional Study of Ocular Optical Components Interactions in Emmetropes

Purpose of the paper was to evaluate ocular optical components (OOC) interactions in a large number of emmetropes. A cross-sectional study of 1,000 emmetropes, aged from 18–40 years, has been conducted. Complete ophthalmological examination, corneal radius (CR) measurement, keratometry and echobiometry of both eyes were performed. The highest correlation of OOC was that of axial length (Ax) with vitreal body (CV) on both eyes (r=0.79 for the right eye (RE); r=0.81 for the left eye (LE)). The axial length had a positive correlation with the anterior chamber depth (ACD) on both eyes as well, but the coefficient was very low (r=0.29 for the RE; r=0.32 for the LE). The only negative correlation Ax had on both eyes was with the lens (L) (r=–0.17 for the RE; r=–0.19 for the LE). Keratometry of the horizontal (K1) and vertical meridian (K2) showed a negative correlation with CV and Ax on both eyes (for K1 r=–0.64 for CV, r=–0.54 for Ax; for K2 r=–0.67 for CV, r=–0.68 for Ax). CR had a positive correlation with Ax (r=0.74) and CV (r=0.79). It showed a negative correlation with L (r=–0.58). CV had a high, positive correlation with Ax (r=0.72 for the RE; r=0.75 for the LE). The correlation with K1 and K2 was negative. Our study showed that the axial length, keratometry, corneal radius, lens thickness and vitreal body were the most important OOC that correlated with each other following a pattern in our group of emmetropes. They interacted in such a way that in the subjects with axial length above the average value, the vitreal body was longer but the lens was thinner and the cornea was of less power. This could explain at least one of the mechanisms of emmetropization

Visual Deficiency in Wallenberg’s Syndrome

The aim of this case report of a 47-year-old woman who suffered from acute right-sided medullar ischemic stroke was to define the range of visual impairment in Wallenberg’s syndrome (WS). The patient complained of unbearable environmental tilt and rotating visual perception. On examination, 11 months following the stroke, the patientm anifested rightsided postural inclination and gaze ipsipulsion. The fixation in primary position was unstable, after a conjugate ipsipulsion ensued, spontaneous corrective saccades and a horizontal-rotational jerking nystagmus beating away from the side of the lesion were generated. Monocular visual acuity (right eye: 0.4 logMAR distance and 0.2 logMAR near; left eye: 0.1 logMAR distance and 0.0 logMAR near) was significantly better than binocular (0.63 logMAR distance and near). Fluent reading was impossible. Contralateral smooth pursuits were more impaired. Saccades were defective manifesting right hypermetria and left hypometria. Visual field was constricted to central 10 – 20°. A diagnosis of Wallenberg’s syndrome was made. Occlusion was prescribed. Review of literature demonstrated lack of evidence-based guidelines for ophthalmic assessment and treatment of visual impairment in WS. Oculomotor abnormalities, oscillopsia and tilt illusion cause significant impact to daily life. Early post-stroke ophthalmological evaluation is thus mandatory in order to offer timing treatment

Conjunctival Melanoma - A Case Report

Konjunktivni melanom je relativno rijetka maligna bolest. Obično se javlja kao jednostrana, pigmentirana lezija koja zahvaća intrepalpebralnu bulbarnu spojnicu perilimbalno, a najčešće se razvija iz primarne stečene melanoze. Muškarac star 81 godinu, inače zdrav, došao je na pregled zbog protrudirajućeg tumora desnoga oka koji je polagano rastao unazad dvije godine. Biomikroskopski pregled otkrio je masivan, smeđe pigmentirani tumor koji se izdizao iznad temporalne 4/5 rožnice i susjednih 3 mm bjeloočnice temporalno od limbusa uzrokujući mehanički ektropij s keratiniziranom sponicom donje vjeđe. Samo limbus od 2 do 4 sata nije bio prekriven tumorom. Površina tumora širine 10 mm u bazi i visine 7 mm bila je nepravilna, nekrotična, s bogatom mrežom krvnih žila i točkastim krvarenjima. Citološkim brisom površine tumora nađene su samo upalne stanice. Bojanja na melanomske antigene HMB 45 i BerEp4(EA) bila su negativna. Zahvaljujući nekrotičnoj površini tumora bilo je moguće uzeti komadić tumora i poslati ga na histopatološku analizu kojom je postavljena dijagnoza melanoma. Kao najmanje invazivna palijativna operacija učinjena je enukleacija bez primarnog orbitalnog implanta. Također je cirkularno izrezano 4 mm susjedne vizualno nepromijenjene spojnice. Histopatološkom analizom tumora postavljena je konačna dijagnoza konjunktivnog melanoma.Conjunctival melanoma is a relatively rare malignancy. It is usually a pigmented, unilateral lesion, often in the perilimbal interpalpebral bulbar conjunctiva, mostly arising from primary acquired melanosis. An 81-year-old male, otherwise healthy, presented with a 2-year history of a slowly growing protruding massive pigmented tumor of the right eye. Biomicroscopy showed a massive pigmented brown tumor protruding from 3 mm of the temporal sclera and 4/5 of the temporal cornea causing mechanical ectropion with keratinized conjunctiva of the lower eyelid. The extent of the tumor was 10 o\u27clock with only the limbus from 2 to 4 o\u27clock being tumor-free. The surface of the tumor of 10 mm in size at the base and 7 mm in height was rough, necrotic, with rich feeder vessels and spotting bleedings. Cytology of the tumor surface revealed only inflammatory cells. Melanoma cell staining was negative for both HMB 45 and BerEp4(EA). Since the tumor surface was highly necrotic, a fragment was obtained and referred for histopathology. The diagnosis was: melanoma. Enucleation with no primary orbital implant was performed as a less invasive palliative surgery. An additional 4-mm fragment of the healthy-looking marginal conjunctiva was also excised. Histopathology of the tumor indicated conjunctival melanoma