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Biomedical subjects

J Krásný

Publications and source records attributed to J Krásný.

At least 19 recordsLinked to original sources
PubMed2006

[The orbital implant after exenteration of the orbit with the preservation of the eyelids and the conjunctival sac].

In ophthalmology, the orbital exenteration presents the most mutilating surgical procedure. The surgical technique presented by authors, preserves the eyelids and conjunctival sac. This surgical procedure was suggested and repeatedly performed in adult patients with extensive benign tumors (mostly meningeomas) by J. Otradovec and J. Safár. The enucleation of the eyeball preceded this type of surgery. The final state made it possible to put the prosthesis into the conjunctival sac. Today we inform about further development of this surgical technique and according to our own experiences we widen its indications to some malignant tumors (rhabdomyosarcoma and metastases of the retinoblastoma, etc.) in children. The initial cutaneous incision starts in the eyebrow area and is directed toward the bone of the orbital rim. The preparation of the tissue underneath the intact conjunctival sac to the lower aspect of the bone orbital rim follows. After folding the conjuctival-cutaneous sac back, the real content of the orbit is exenterated in the classical manner. After the hemostasis in the orbital apex, the flap is returned to its primary position and suturing of the primary incision in anatomical layers terminates the surgery. The authors refer about a boy, now 17 years old, who underwent at the age of three years the exenteration of the orbit in this manner due to a rhabdomyosarcoma. The authors also refer about the development and application of a special type of prosthesis made from silicone rubber--implant grade--filling out the orbital space and forming the anterior segment of the eye. The prosthesis was created from a classical orbital implant, regularly used in enucleation surgery and a conjunctival implant, a convex-concave plate with diameter of 20 mm. Both parts are made from the same type of silicon rubber and were connected together by vulcanization. The orbital implant was eliptically extended according to the measurements of the orbital casting made from dental impression matter. The cosmetic part, simulating the colored iris and the pupil, was prepared from a polyester sheet, painted with acrylic paint. It was fixated on the conjunctival prosthesis and covered with a transparent silicone foil. For the first time, the prosthesis was applied at the age of seven years, and during the next ten-years period, it was three times exchanged mostly for a bigger model. This procedure guaranteed proper growing of the orbital area and symmetrical development of the face. The prosthesis also carries out the prosthetic role and cosmetically it looks similarly like after the enucleation without the implant.

Child, Preschool↗
PubMed2006

[The human lens' transparence changes in children, adolescents, and young adults with diabetes mellitus type I].

Authors followed up the changes' development of the human lens' transparence in 213 children and young adult patients with diabetes mellitus type I. As initial changes of the lens' transparence they considered the posterior "Y" suture accentuation, because it was noticed in 44.4 % of lenses during the first 10 years of the metabolic disease duration, in contrast to 28.1 % representation of this dissociation in the control group of patients without diabetes (p = 0.012), and it was always markedly more often in patients with myopia. Substantial changes were detected predominantly during the sixth until the tenth year of duration of the basic disease as fine subcapsular opacities graded as first degree of lens transparency changes in 48 % of eyes. After 10 years of the disease duration, the lenses were never clear. Consequently, the changes in the transparency in the anterior subcapsular layer associated in 18 %. After 15 years of diabetes duration, we detected opacities in the anterior and posterior subcapsular layers of the lenses, graded as second degree of lenses transparence changes in 85 % of eyes. This subjective evaluating of lenses' opacity changes by means of the slit lamp examination was correlated with densitometric examination by means of Pentacam camera in a representative sample of 29 patients. In the first degree of lenses' transparence changes, the posterior subcapsular layer was affected in 50 %, and in the second degree, the opacities in this layer were found practically in 90 % of cases. False positive result in clear lenses or congenital opacities or "Y" suture was not detected. In general, the affected lens transparency did not basically influence the visual acuity and the decrease of contrast sensitivity was not statistically significant (p = 0.34). For the initial change of the lenses' transparency is also determining the patient's age at the onset of the diabetes mellitus type I. The changes are more common if the onset of the disease is after the fifteenth year of age as before that (p = 0.026). The authors also detected sporadic opacities in 4.2 % of eyes, probably of congenital origin (out of them, in two patients there was bilateral finding of the cerulean cataract) without visual acuity decrease.

Adolescent↗
PubMed2006

[Multidisciplinary use of contrast sensitivity].

BACKGROUND: Contrast sensitivity (CS) gives information about quality of different spatial frequency sent from sensory cells to the brain cortex through different pathways. METHODS AND RESULTS: From the age of 6 to 10 years average CS threshold was defined for each frequency. 3c/deg=1,82 (SD 0,13), 6 c/deg=2,04 (SD 0,14), 12 c/deg=1,74 (SD 0,15), 18 c/deg=l,29 (SD 0,11). In the age between 11 and 19 years following values were determined: 3c/deg=1,92 (SD 0,09), 6 c/deg=2,19 (SD 0,12), 12 c/deg=1,89 (SD 0,10), 18 c/deg=1,42 (SD 0,12). There was no significant difference between each frequency on CS curve. Average threshold for all frequencies was the 6th contrast level of circle in younger children and the 7th contrast level of circle in older. According to the standard deviations the threshold for all the frequencies was the 5th contrast level of circle in children from 6 to 10 and the 6th contrast level of circle in children older then 11. As the CS can be distorted by hidden form of anisometric amblyopia, proper correction of refractive error is essential. CS helps to detect hidden neuropathy in Graves disease or in Septo-optic dysplasia. Initial stages of demyelinisation of optic nerve in Multiple Sclerosis are manifested always by decrease of CS. This helps to evaluate the affection of the optic pathway and CNS in Alzheimer disease, in Parkinson's disease and schizophrenia. Decrease of CS goes along with retinopathy and with some forms of preretinopathy in Diabetes mellitus. Dynamic changes of CS can be related to treatment of several diseases including Cystic fibrosis, Chronic renal insufficiency, Neonatal hypothyreosis, Menopause or Osteoporosis. CONCLUSIONS: Author proves that CS can be reliably examined using the device CSV-1000 in children from the age of 6 years within the framework of multidisciplinary use.

Adolescent↗
PubMed2005

[Ligneous conjunctivitis: complication of inborn plasminogen deficiency (a case report)].

Authors refer about detailed analysis of ten years follow up of a child patient with ligneous conjunctivitis. They document presence of all typical eye findings (especially recurrent formation of granulomatous pseudotumors in affected mucous membrane) related to this rare pseudomembranous conjunctivitis. The clinical picture of the disease includes plasminogen deficiency, a factor newly considered as primary cause of the disease. The diagnosis was confirmed histologicaly by repeated probatory excisions. Pseudomembranous inflammation with mixed inflammatory infiltrate containing large amount of elements of chronical as well as acute inflammatory reaction is typical. Granuloma with the accumulation of the PAS-positive amorphous matrix with high content of the fibrin and with the network of newly formed vessels is the component of the inflammatory picture. The treatment was based on successively discovered knowledge of the possible etiopathogenesis of the disease. Only the ninth, last surgical procedure induced longer-term remission, which lasts sixteen months until now. The granuloma excision was combined with the mitomicin application on the wound surface and a conjunctivoplasty. During the postoperative period, the ointment with heparin, corticosteroid and antibiotic was applied. The purpose of the mitomicin use is to slow down the fibroproliferative reparative reaction. Covering of the wound surface decreases the number of microtraumas on the uneven postoperative scleral surface. Heparin in the interstitial tissue of the wound surface blocks the conversion of fibrinogen to fibrin.

Adolescent↗
PubMed2004

[Congenital cataract--the growth of the eyeball after the PC IOL implantation].

The authors followed the influence of PC IOL (posterior chamber intraocular lens) implantation in congenital cataract to the growth of the eyeball (six bilateral cataracts and 6 monolateral cataracts). The development of the eye growth was compared to the 6 healthy eyes of patients of this group. The intraocular lens implantation was performed at the age of 1 to 5.5 year, in average at the age of 3 years. The follow up period was 4 to 7 years, mean 6 years. In operated, as well as in non-operated eyes, an equal average growth of the eyeball 0.2 mm per year was detected. All operated eyes were slightly hypermetropized according to the physiological values of growth of healthy eyes. The absolute mean deviation from emmetropia was 1.8 diopters. The author established the suitability of intraocular lens implantation in small children because of positive influence to the growth as well as to the final visual acuity, which ranged from 0.05 to 1.0, mean 0.4.

Cataract↗
PubMed2003

[Anophthalmos--a conjunctival implant].

The authors submit information on the completed development of a conjunctival implant and its use for modelling of the conjunctival sac in inborn and acquired anophthalmos. Plastic solution in inborn types is used for cosmetic reasons in unilateral degenerative and consecutive anophthalmos. The orbit and adnexa are usually only little affected. The other indication is secondary anophthalmos after enucleation of the bulbus when the conjunctival sac is threatened by retraction due to actionotherapy of the orbital area or a scarry process after a previous injury. The implant is a convex concave circular-shaped plate with a diameter of 20 mm the centre of which is thinner to facilitate manipulation during insertion. It is made from silicone rubber which has properties characterized as implant grade. Before the implantation proper the plate is adjusted by cutting to the desired size. The surgical procedure proper in inborn anophthalmos involves external canthotomy with gradual preparation of the conjunctiva into the Tenon space in the region of the eyelids to create a broad crevice into which the adjusted implant can be inserted. The operation is completed by closing the canthotomy supplemented by partial tarsorrhaphy using unabsorbable suture. Thus the implant is sufficiently fixed in the newly created ocular space. The silicone inlay is left for 3-6 months to allow epithelization of the surgical site round the implant. In acquired anophthalmos with retraction of the conjunctival sac in the first stage the lower transitory fold is released before insertion of the implant by the cul-de-sac method. The function of the implant is modelling of the conjunctival space in anophthalmos to maintain an adequate space for fornices for later insertion of the permanent prosthesis. The implant is manufactured at present by ELLA-CS.

Anophthalmos↗
PubMed2003

[Chlamydia pneumoniae--etiology of ophthalmia neonatorum].

The authors observed mucous discharge in palpebral aperture, accompanied by a different degree of effusion of eyelids and chemosis of conjunctivae, particularly the tarsal ones, in 12 physiological newborns. Chlamydia pneumoniae proved to be the etiological agent in the newborn ophthalmia. The eye infection was not detected in the same period of time and in the same maternity hospital in the period of observation from September 1999 to March 2001. The detection of Chlamydia pneumoniae was performed in conjunctiva smears. The impression films on slides were examined by the method of indirect immunofluorescence with the use of specific monoclonal antibodies (medac, Germany). In the early stages the secretion included a sanguineous component, which was then changing into a mucoid or mucopurulent form. The character of conjunctival symptoms was changing in the course of inflammation. Effusion of the lower transitory fold (plica) was gradually accompanied by a picture of pseudofollicular changes on the tarsal conjunctiva. Clarithromycin in the form of syrup at daily doses of 15 mg/kg/day for the period of two weeks offered an efficient therapy of the affection. Control smears after 14 days were always negative and, at the same time, the pathological finding on the conjunctivae disappeared. The nasolacrimal obstruction was the only complication of this chlamydia infection, taking place in seven sucklings, i.e. in 58%. The passage through lacrimal drainage system reappeared in all the affected infants until they reached one year of age. The remaining question to be answered is the way the newborns encountered the infection. A nosocomial infection may be the case, but Chlamydia pneumoniae could also be present in the urogenital tract of mothers and transferred to the newborn via the birth canal similarly as is the case of Chlamydia trachomatis infection. The mode of infection deserves further investigation.

Chlamydia Infections↗
PubMed2003

[Angiolymphoid hyperplasia with eosinophilia or Kimura disease?].

Angiolymphoid hyperplasia with eosinophilia (ALHE) and Kimur's disease are two rarely occurring and mutually very similar, yet independent nosological units. For the frequency of similar features these diseases were long considered to be modifications of one disease. In the last years most authors considered these diseases to be independent entities with certain specific clinical and morphological features. The case of a 76-year white man, suffering from occurrence of subcutaneous tumor formations in various part of the body for the period of six years, is described. Six years after the first signs of the disease, swelling of eyelids on the right eye with palpable resistance under the upper temporal margin of eye socket developed. A similar finding also developed on the left side eight months later. The tumors were removed by surgery and subjected to histological examination. One year later a unilateral relapse developed to be again subjected to surgical treatment and histological examination. In the first two orbital excisions the tumor infiltrate was in topical connection with structure of the tear gland, the third excision did not contain such structures. The histological diagnosis was established as ALHE in spite of some common features with the Kimur's disease. The diagnosis of ALHE was especially supported by absence of the formation of lymphatic follicles, absent fibrotization in the infiltrate and epithelium-like or even histiocyte-like appearance of proliferating endothelia, which formed minute vascular lumina. A substantial exceptionality in the occurrence of the Kimur's disease in white Europeans further supported the diagnosis of ALHE. Our own experience indicates that both units mutually overlap even in features considered to be of distinctly different character. A question arises, whether the strict division of these two nosological units is really possible in practice with unequivocal certainty.

Aged↗
PubMed2003

[Chlamydia pneumoniae--the etiologic agent of follicular conjunctivitis followed by keratoconjunctivitis sicca in adult patients].

The authors refer to 21 adult patients at the age of 22 to 87 years, who have suffered from a chronic form of follicular conjunctivitis, found to be caused by Chlamydia pneumoniae as the etiological agent. The observation was made in the period from July 1999 to December 2002. Chl. pneumoniae was detected by a direct demonstration of the conjunctiva smears and by means of serological examination. The print preparations on glass were examined by the method of indirect immunofluorescence by means of specific monoclonal antibodies (Medac, Germany). The serological examination included detection of genus-specific IgG, IgA, IgM antibodies, respectively (Medac, Germany) and species-specific anti-Ch. pneumoniae IgG, IgA abd IgM antibodies, respectively (FOCUS Technologies, U.S.A.). The clinical picture included various long-term subjective complaints (within the range of several months to ten years), particularly a pathological secretion or increased lacrimation, cutting, burning or feeling of a foreign body in the eye. The objective examination revealed chronic changes characterized by a mild edema of bulbar conjunctiva with increased meandering in vessels of irregular caliber and edema in the lower transition plica with follicular structure crossing into the tarsal conjunctiva. In the fornix there was an apparent sticking aqueous or mucinous secretion. The therapy was indicated by the positive smears alone in four patients or positive IgA and/or IgM of genus- or species-specific antibodies in 12 patients. The therapy in the remaining five patients was recommended by the combination of suspect-positive smears in combination with positive genus- or species specific antibody reaction. The therapy made use of systemic administration of a macrolide antibiotic, azithromycin, for the period of 12 to 14 days in a single course of treatment. The pretreatment was always followed by control smears after two weeks and by serological examinations after three and six months. The serological findings remained virtually unchanged during that period of time in all patients under observation. In two of them only the species-specific antibodies anti-Ch. pneumoniae IgA antibodies disappeared six months after the therapy. The clinical findings disappeared slowly, particularly the follicular changes occurred after more than six months after the therapy ended. The subjective complaints, accompanied by a transient hyperemia of conjunctives in particular, remained after the therapy in nine patients older than 45 years, who were found to suffer from kieratoconjnunctivitis sicca. The ocular symptomatology was not accompanied by symptoms of autoimmune disease. The general treatment by antibiotics and the results supportive treatment succeeded in 67% of patients who were completely free of subjective complaints and the pathological process in conjunctives was inhibited.

Adult↗
PubMed2003

[Indications for refractive procedures in adult patients with strabismus and results of the subsequent therapeutic procedures].

The authors estimated the contribution of the refraction intervention and a possible evolution in the position of eyes in 102 adult individuals considering a refraction intervention. The indications for this intervention were a disorder in eye position or amblyopia in those who were interested in this operation and were examined in the years 1996 to 2002. The basic refraction examination was always supplemented by a detailed orthoptic analysis. Based on this examination the intervention was not recommended in 14 examined subjects (14%). ARK represented the contraindication of the refraction intervention in 9 patients, since subsequent changes in the size of the deviation or operation adjustment of strabismus could result in diplopia. An excessive convergence with a high AC/A in hyperopia was also considered as an unsuitable indication, since a lasting cosmetic and functional significant convergent deviation into near distances could not be excluded. Five patients declined from the refraction intervention on the basis of this explanation. The paper is mainly dealing with an analysis of the development of position of the eyes and binocular functions in 46 adult patients, who decided to undergo a refraction intervention and further orthoptic care after a complex stroboscopic and refraction examination. The adjustment of refractive error was made by the LASIK methods (Laser in Situ Keratomileusis) on 69 eyes (80%) and CLE (Cleans Lens Extraction) on 17 eyes (20%). The orthoptic analyses before and the refraction intervention revealed that in all 29 even only partially accommodating esotropia, the deviation was diminished after the refraction intervention on the average by +11.2 degrees (in the rage of +2 degrees to +30 degrees) to 5.4 degrees (in the range of parallel position to +20 degrees) in the predominantly represented hyperopia, but also in 6 myopias. The improved position of the bulbs was not directly associated with the degree of hyperopia with the original deviation. The deviation after the refraction intervention in 23 patients (79%) with esotropia was not higher than degrees. The cosmetic position of the eyes was completely satisfactory and did not therefore represent even indication for the operation. The 9 patients (35%) with esotropia and hyperopia there were an improvement of binocular functions. It could be theoretically due to the newly developed emetropia making permanent optimal sensory information possible. In all 17 exotropias there were not any significant changes in the size of deviation and the binocular functions were not reestablished, if they were not retained before. The position of eyes was solved surgically in 12 patients, while exotropia predominated in two thirds of them. The weakening or strengthening interventions on horizontal straight muscles were selected according to character of strabismus in 11 patients. Recession of the lower oblique muscle was indicated one case only for the simultaneously present torticollis with exotropia. The residual deviation was not greater than 5 degrees immediately after the operation or during the following months. Binocular functions were not reestablished in any patients. A alternate suppression or suppression of perception on one eye were proved.

Adult↗
PubMed2002

[Detection of tumor circulating cells in patients with ocular melanoma].

The authors investigated a group of 51 patients (29 men and 22 women) with intraocular melanoma: 41 patients with melanoma of the chorioid, 10 patients with melanoma of the ciliary body. They evaluated the clinical and pathological finding according to the TNM classification recommended by UICC (International Union Against Cancer). In all investigated patients they assessed circulating tumour cells (melanocytes) in the peripheral blood stream based on the detection of mRNA tyrosinase and marker MART 1. When evaluating the presence of markers according to the diagnosis irrespective of time, they found in patients in the clinical stage of T2 choroidal melanoma a 19% positivity of different markers and very rare a concurrent positivity of both markers. Patients in the clinical stage T3 had a 51% positivity of one marker and 34% concurrent positivity of both markers. In melanoma of the ciliary body evidence of individual markers was positive in 17% and only in 11% both markers were positive concurrently. On comparison of therapeutic procedures from the aspect of development in time in patients treated by brachytherapy only rare positivity was found at the time of administration the radioactive plaque, following an eight-month interval after brachytherapy the positivity of markers increased to 28%. On evaluation of markers of choroidal melanoma and ciliary body melanoma resolved by enucleation had their positivity at the time of operation was 36%, and during check-ups up to one year or longer it persisted at similar levels. Concurrent presence of both markers before this operation was rare, during postoperative check-up examinations it was within a range of 23 and 33%. The presence of both markers was repeatedly proved in five patients with chooidal melanoma after enucleation of the eye, in four of them in direct correlation with a metastatic process.

Antigens, Neoplasm↗
PubMed2002

[Spontaneous reduction and absorption of cataracts in childhood].

The authors give an account on spontaneous reduction and absorption of cataracts in nine children. The initial symptom where leukocoria predominated was as a rule detected already in infant age. In one case the affection was bilateral and was manifested by partial pseudoaphakia. The observation comprised also classical secondary aphakia in a 4-year-old girl. Resorption of lenticular masses of cataracts into the shape of membranous discs or reduced masses of a fibrous character took on average 18 months on seven eyes and this process was associated with vascular activity in four lenses. In two of these patients during resorption panuveitis was observed with a hyperergic response in humoral and cellular immunity without obvious general antigenic action which caused atrophy of the optic nerve. Surgical solution of cataract was used in four eyes, PC IOL was implanted in one patient which had a favourable effect on visual function. Histological examination was successful of the extracted reduced lens only in one case. Inside the lenticular capsule was a mixture of the original fibrotically altered cataract masses with ingrowing vascular tissue.

Aphakia↗
PubMed2001

[Duane's retraction syndrome--surgical treatment].

The author presents possible surgical approaches in Duane's syndrome I. The weakening operation of the medial rectus muscle by means of marginal myotomy is recommended in case of striking ocular torticolis. The bifurcation recession of the lateral rectus muscle is recommended in case of change of palpebral fissure. The author documents the indications and the after-surgery results.

Adolescent↗
PubMed1999

[Treatment of ptosis in children and adults].

Pathological ptosis of the eyelids can be manifest already at birth but may develop also in advanced age. In children the congenital form predominates with or without affection of the elevators of the eyes (Congenital fibrous syndrome or Misdirection syndrome). A special form is blepharophimosis, juvenile blepharochalasis and Marcus-Gunn's syndrome. In adult age the etiology of acquired ptosis of the upper eyelid is more varied. There are mechanical causes incl. dermatochalasis or it develops on a myogenic and neurogenic background or as the aponeurotic form. The group comprises 46 patients 3-70 years old where in the course of the last three years at the Ophthalmological Clinic of the Faculty Hospital Prague Vinohrady a total of 54 operations of ptoses were made. Resection of the tarsal plate according to Fasanella-Servat was used in 29 instances. In four eyes a plastic operation of the aponeurosis of the levator was performed. Frontotarsal suspension in the authors modification of Fox method using deep freeze-dried allogenei fasciae was used in the paretic form of ptosis in 21 eyes. The authors give also an account of the technological preparation of a fascial graft kept at a temperature of -80 degrees C.

Adolescent↗
PubMed1998

[Alomide, a preventive immunopharmaceutical agent, in the treatment of ocular atopy].

The author presents an account on initial experience with 0.1% lodoxamide in the treatment of atopy of the eyes. A positive effect was found in vernal catarrh. A favourable result was recorded in two sub-types of seasonal allergic conjunctivitis, mostly in the lower tarsal form with a follicular reaction in children and in purely limbal irritation in adults. The good effect in these two atypical forms of seasonal allergic conjunctivitis as a purely preventive immunopharmaceutical drug during the pollen season was remarkable.

Adult↗
PubMed1998

[Ocular torticollis].

The author presents an account on different causes of ophthalmological torticollis and rotational nystagmus in paresis of the trochlear nerve and abducent nerve, in Duan's syndrome I or acute Brown's syndrome or in bilateral ptosis combined with paresis of the levators. He recommends different surgical techniques and prefers combined operations performed with a single anaesthesia in pareses of the levators, the abducent nerve and trochlear nerve. For release of the horizontal direct muscles within the framework of paretic affections of the eye he recommends adjustable elongations as described by Gonin-Hollwich. In ptosis he uses frontotarsal suspension as described by Fox, using lyophilized fasciae. The paper contains also a family history of congenital fibrous syndrome.

Adult↗
PubMed1997

[An open and controlled study of effectiveness and tolerance of Livostin eyedrops].

The authors present the result of an open controlled trial of the effectiveness of a new antiallergic ophthalmological preparation, Livostin, for local use, a product of Janssen-CILAG. They evaluate the results obtained in 86 patients with symptoms of allergic conjunctivitis. The preparation was followed up for four weeks, in particular the rate of onset of effect and its duration. Evidence was provided that this preparation is a highly effective local antiallergic drug with a long-term effect.

Adolescent↗