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J Sach

Publications and source records attributed to J Sach.

At least 19 recordsLinked to original sources
PubMed2006

[Optical coherence tomography in pars plana vitrectomy for idiopathic macular hole].

26 eyes of 25 patients after macular hole surgery were followed-up for 6 months in average (range of 2-25 months). The overall anatomic success rate was 77 %. The internal limiting membrane was peeled after its staining with trypan blue in all closed macular holes. The macular hole surgery resulted in anatomic success of stage Ib or II in 11 (100 %) eyes, of stage III in 7 (64 %) eyes and in stage IV in 2 (50 %) eyes. There was an improvement or a stabilisation of the best corrected visual acuity (BCVA) in 85 %. BCVA improved from 4/20 to 4/12 in average. 45 % of patients with closed macular hole attained BCVA 4/10 or better, 5 (25 %) of them with the best visual acuity at presentation improved to 4/8 in average. In 23 % cases of clinically normal fellow eyes, optical coherence tomography (OCT) detected an abnormality of the vitreoretinal surface. OCT is essential for evaluation of anatomical success after macular hole surgery. It is necessary to perform it also in a fellow eye to exclude clinically silent abnormality of the vitreoretinal surface.

Aged↗
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

[Intraocular lymphoma--a clinical study of 14 patients with non-Hodgkin's lymphoma].

AIM: To evaluate the course of clinical picture of intraocular lymphoma, possibilities of examination of this disease and the association with general symptoms of the non-Hodgkin lymphoma (NHL) in patients with manifestations of uveitis. PATIENTS AND METHODS: A retrospective study in 14 patients followed in the period of 1996-2001 in the Center for Diagnostics and Therapy of Uveitis, Ocular Clinic of General Faculty Hospital and 1st Medical Faculty, Charles University in Prague. RESULTS: The group included 7 women and 7 men at the average age of 57.3 years (18-82) with clinical picture of uveitis. The time period from the first symptoms to the diagnosis of NHL was 5-38 months (mean, 14.6 month). In two patients the diagnosis of systemic NHL preceded ocular symptoms, in four other patients the diagnosis of systemic or central nervous system NHL (CNS NHL) was established during ocular manifestations of uveitis. Intraocular lymphoma was the only first manifestation of CNS NHL in six patients for the period of 9-34 months (mean, 15.2). Two patients have been so far affected by primary intraocular lymphoma (PIL) for 8 and 14 months respectively, and presently do not display any signs of systemic or CNS NHL. Clinical signs of intraocular inflammation of both eyes were encountered in 71.4% of patients. Vitritis (85.7%) and tumor infiltration of retina (65.3%) were the most frequent manifestations of NHL. Intraocular NHL was diagnosed on the basis of cytological examination of samples of intraocular fluids in 8 patients (57.1%). In four patients radiotherapy was applied onto 5 eyes and in 5 patients radiotherapy of CNS was used. Nine patients were treated with chemotherapy. 50% of patients died until the end of 2001, the survival from the establishment of diagnosis was 20.6 months on the average. CONCLUSIONS: Intraocular lymphoma should be considered as the eye and life-threatening disease. Cytological examination of intraocular fluids in patients with uveitis who do not respond to the therapy with steroids in the usual way may give more precision and shorten the establishment of diagnosis in this masquerade syndrome. Early diagnosis and therapy may improve the prognosis of NHL.

Adolescent↗
PubMed2003

[Correlation of ultrasound and biopsy measurements of the size of intraocular tumors].

The authors investigated the relationship between ultrasonic assessment of tumour size (in vivo) and bioptic examination (in situ) in 52 patients with the diagnosis of a uveal melanoma where enucleation of the eyeball was indicated and performed. The patients were treated at the Ophthalmological Department of Vinohrady Faculty Hospital in 1992 to 2001. The period between the last echographic examination and the subsequent enucleation of the eyeball did not exceed one month (15 +/- 9 days). The authors investigated the maximal height of the tumour (prominence) and maximal diameter of the base of the tumour (so-called LTD-large tumour diameter) by ultrasound and bioptic measurement. They also assessed the mean prominence of the tumour and the mean diameter of its base. The results were compared statistically by the t-test. The difference between mean values of tumour prominence in the two types of assessment was not statistically significant at the 10% level of significance (t = 1.4; p > 0.10), the difference between mean values of the diameter of the base made by the two measurements is statistically significant at the 5% level of significance (t = 2.1, p < 0.05).

Biopsy↗
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

[Postoperative fasciitis after laparotomy].

Postoperative infectious and necrotizing abdominal wall fasciitis is a serious wound complication. Authors present own analysis of their experience with the treatment of this disease. They refer a possibility to accelerate the healing with active approach using the combination of surgical debridement with a suitable local therapeutic witch results in better healing shortening the interval between the drainage of the pus and the secondary wound suture, bettering the cosmetic look of the scar and the earlier start of postoperative chemo/radiotherapy.

Abdominal Wall↗
PubMed2003

[Importance of diagnostic and therapeutic pars plana vitrectomy in endogenous uveitis].

OBJECTIVE: To evaluate the importance of diagnostic-therapeutic pars plana vitrectomy in patients with clinical manifestations of endogenous uveitis. PATIENTS AND METHODS: The diagnostic-therapeutic pars plana vitrectomy (DT PPV) has been performed at the Eye Clinic of General Faculty Hospital and 1st Medical Faculty on Prague on 62 eyes in 49 patients at the mean age of 45 years. The DT PPV was indicated in patients with uveitis of unusual clinical picture or poorly reacting to treatment, suspected infection or tumor etiology. In the beginning of PPV, 0.5 to 1.5 ml of undiluted vitreous body was samples and subsequently examined by microbiology, immunology and molecular genetic methods. PPV was performed on both eyes in 10 patients, on one eye twice in each of three patients. The authors evaluated 62 samples of vitreous body on the whole. The patients were observed for up to 96 months. RESULTS: Laboratory examination of the samples of vitreous body from 22 eyes (35.4%) supported our notion on infection etiology of intraocular inflammation, manifestations of intraocular tumor were in 12 eyes (19.3%), vascular or vitreoretinal pathology was present in 6 eyes (9.6%). Nonspecific inflammatory changes were detected in 22 eyes (35.4%). Drugs were administered into the vitreous body in 16 eyes. In the observation period the authors detected marked late complications in connection with DD PPV in 18 eyes (29%). Visual acuity improved by two or more lines of the Snellen optotypes in 43 eyes (69.3%), remained unchanged in 11 (17.7%) eyes. The vision deteriorated in 8 eyes (12.9%). CONCLUSION: Based on this experience the authors are of the opinion that DT PPV is indicated in patients with uveitis for giving more precision to the diagnosis of intraocular inflammation or a masking syndrome. DT PPV also represents a therapeutic procedure to cure complications connected with a severe form of inflammation and makes it possible to save central visual acuity.

Adolescent↗
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

[Retrospective study of histologically confirmed intraocular tumors at the Eye Clinic of the Vinohrady Faculty Hospital in Prague].

The authors evaluated statistically in a retrospective study the histological findings of a total of 182 intraocular tumours assembled at the Ophthalmological Clinic, Vinohrady Faculty Hospital Prague in 1992-2000. The histological material was obtained from 147 patients by enucleation of the bulbus and in 35 patients by surgical resection. In 97.2% the authors proved the malignant character of the tumour. In 95% an uveal melanoma was involved. In malignant melanomas of the choroid the following parameters were investigated: site, size, histological type, state of Bruch's membrane and extrascleral propagation of tumour. In 67% the melanoma was in the choroid, in 21% in the ciliary body and in 12% in the iris. As to size, large and extremely large melanomas predominated (66%). Histologically melanomas of the mixed and spindle-cell type were most frequent (93%). Bruch's membrane was damaged in 48% melanomas. Transscleral extension of the tumour was present in 9% malignant choroid melanomas.

Eye Neoplasms↗
PubMed2000

[Ultrastructural analysis of tissue removed during surgery of idiopathic macular holes].

AIM: To analyze the ultrastructural features of epimacular tissue removed during idiopathic macular hole (IMH) surgery and to compare them with those of idiopathic epimacular membranes. METHODS: Three consecutive patients with unilateral stage 3 IMH underwent pars plana vitrectomy with surgical removal of delicate gelatinous membranous epimacular tissue. One patient was previously treated with laser photocoagulation. The excised material was investigated by means of light and transmission electron microscopy. Results were compared with the findings of the excised material in two idiopathic epimacular membranes. RESULTS: The excised material included variable proportions of cellular and membranous material. Glial cells (Müller cells, fibrous astrocytes) and fibroblast-like cells dominated in the cellular component both in the specimens from IHM eyes and in the comparative material. Neural elements were revealed in two of three specimens from IMH eyes. Membraneous material was formed by fragments of internal limiting membrane. CONCLUSIONS: Dominance of the glial cells in the cellular component of epimacular formations may reflect the important role of these cells both in formation and in healing process of IMH. The presence of neural elements in the removed epimacular tissue suggests that, at least in some cases, IMH surgery with peeling of an epimacular membrane can be associated with some injury of the macula.

Aged↗
PubMed1998

[2 years' experience with treatment of uveal melanoma using the Leksell gamma knife].

In the last years, the therapy of ocular melanoma with Leksell's gamma-knife was indicated at several clinics in Prague. It referred to bulky tumors and to unfavourably localized tumors so that only enucleation of the eyeball was the only alternative in our conditions. The results of the treatment of 11 patients have been evaluated in this article. Some other patients treated with this method have not been included in this sample for various reasons (short-term follow-up, combination of radiotherapy with gamma-knife with other therapeutic modality etc.) Gradual decrease in tumor size developed in 10 patients during follow-up. The decrease in tumor size has been observed on repeated ultrasound examinations and magnetic resonance imaging. The growth of tumor was reappeared in one patient, which led to the necessity of enucleation of the eyeball. The complications in other patients were numerous but not serious to such extent that would lead to enucleation. Marked deterioration in visual acuity connected with the treatment occurred in 6 patients. The results achieved by this method are comparable with those achieved by other therapeutic modalities and with the results from other clinics employing gamma-knife for the treatment of uveal melanoma. The results lead to the conclusion that this is an effective method of treatment of uveal melanoma and that this method is able to go through further development, especially in combination with other therapeutic modalities.

Adult↗
PubMed1997

Issues for palliative care in rural Australia.

A project funded by the Commonwealth Government's National Palliative Care Program examined rural (non remote) palliative care services in eight rural regions of Australia with the aim of identifying sound service delivery models. The research methodology included, development of a palliative care service baseline, postal survey of all services in the selected regions followed by field examinations, and section of four regions for in depth analysis using interviews and group sessions with medical practitioners, clinicians, former carers and service managers. The research established that patients and carers want palliative care services to first address symptom management and pain control. The service should then place experienced care as the next highest priority, in conjunction with the provision of family supports. Service models should aim to deliver services in the home or in environments which are home-like and located close to families. Research has demonstrated that even the smallest hospitals can incorporate a palliative care unit. Palliative care service planning in rural areas needs to make a distinction between the main provincial city in the region and the rural hinterland as different planning approaches will often apply. Palliative care teams should vary according to the nature of the service catchment. Particular attention should be given to the method of providing palliative care nursing expertise in a region. This project concluded that when active treatment is no longer beneficial, palliative services in rural regions are commonly of a high quality, although access to tertiary services remains as a limitation during the pre-palliative treatment phase.

Australia↗
PubMed1994

[Clinico-histopathologic correlations in cytomegalovirus retinitis in the acquired immunodeficiency syndrome].

The authors describe histological changes of the retina and chorioid in cytomegalovirus retinitis in a patient with manifest AIDS who died after a severe opportunic infection. Consistent with data in the literature, they describe in addition to necrotic changes also inflammatory manifestations in the retina and chorioid and the presence of intranuclear inclusions typical for CMV infection.

AIDS-Related Opportunistic Infections↗
PubMed1994

[Therapy of malignant melanoma of the uvea].

The author gives an account of different therapeutic possibilities as regards treatment of malignant melanomas of the uvea. She describes factors which influence the selection of therapy and indications of different methods.

Humans↗
PubMed1994

[The International Eye Bank of Prague--its second year of activity].

The job and results of International Eye Bank of Prague in 1993 are described. The experience from the work of Eye Bank and some results of statistical processing of basic information about donors and recipients are presented. The necessity of close cooperation between Eye Bank and ophthalmological clinics and particularly between Eye Bank and various units from hospitals cooperating in the search for suitable donors is stressed in conclusion.

Adolescent↗