[Keratoconjunctivitis sicca during folicular conjunctivitis in adult patients with Chlamydia pneumoniae etiology (summarizing twelve years study)]. / Keratoconjunktivitis sicca (KCS) pri folikulární konjunktivitide u dospelých pacientu s etiologií Chlamydia pneumoniae (souhrnná dvanáctiletá studie).

AIM: Following the previous study observing keratoconjunctivitis sicca (KCS) after treated follicular conjunctivitis of chlamydial etiology from the years 1999-2002, at this time the authors would like to point out the possible connection between KCS appearance and Chlamydia pneumoniae infection. MATERIAL: In the Department of Ophthalmology, during the period of 12 months (in the years 2009 - 2010), there were treated 11 adult patients (6 women and 5 men) in the age of 28 - 81 years (median, 50 years) with follicular conjunctivitis lasting on average 2.5 years and caused by Chlamydia pneumoniae, and simultaneously were diagnosed the symptoms of KCS, out of the total number of 37 examined patients with similar clinical findings. METHODS: The diagnosis of chlamydial infection in clinical symptoms of follicular conjunctivitis and simultaneous signs of KCS was established partly according to the serologic positivity of chlamydial genus (anti-LPS) and/or species (anti-Ch. pneumoniae and anti-Ch. trachomatis) IgG, IgM, and IgA antibodies together with simultaneous anti-cHSP60 IgG positivity, further using conjunctival prints examined by means of indirect immunofluorescence method using specific monoclonal antibodies; in conjunctival smears and peripheral leucocytes was tested also the presence of Chlamydia pneumoniae DNA. The main subjective complaints of the patients were burning sensation, sticking, or foreign-body sensation; the itching and lacrimation were less common. Among clinical signs dominated the hyperemia and the edema of the lower fornix; the tortuosity of the vessels and the follicles were not always present. The KCS diagnosis was confirmed by Bengal rose staining. RESULTS: In 10 patients, the positive IgA and/or IgM anti-Ch. pneumoniae antibodies were detected. Simultaneously, the positive anti-cHSP60 IgG were confirmed, out of them medium- and high-positive findings were in 7 patients, and anti-LSP antibodies IgA and/or IgM in 8 of them. Positive smears were found in 6 patients. In 2 persons of this group of treated patients, the general serologic findings were not significant, but the Chlamydia pneumoniae infection was confirmed by Chlamydia pneumoniae DNA positivity in peripheral leucocytes; in these 2 patients, the symptoms lasted for one half of the year. As the side findings were the confirmations of active Chlamydia trachomatis infection in other 4 patients of the whole group. The patients with Chlamydia pneumoniae infection were treated systemically by macrolide antibiotic azithromycine for 12 days. After the treatment, above all else the clinical signs of conjunctival inflammation disappeared, but remained KCS symptoms, which were disappearing only slowly. The optimal supporting therapies were lubricant drops with different concentration of sodium hyaluronide without preservatives. Control microbiological examinations during 6 months after the treatment termination confirmed negative smears findings, but the antibody levels were not decreased significantly. CONCLUSION: This study confirmed the possible connection between the KCS and Chlamydia pneumoniae infection in simultaneous clinical signs of follicular conjunctivitis. Along with that the study pointed out the necessity of simultaneous evaluating of the microbial findings and clinical symptoms to consider the systemic antibiotic treatment.

[Chlamydia pneumoniae in the etiology of the keratoconjunctivitis sicca in adult patients (a pilot study)]. / Chlamydia pneumoniae v etiologii keratoconjunctivitis sicca u dospelých pacientu (pilotní studie).

AIM: In the pilot study the authors refer to the possible connection between the appearance of keratoconjunctivitis sicca (KCS) and Chlamydia pneumoniae (CP) infection. MATERIALS AND METHODS: At the Department of Ophthalmology, 10 adult patients older than 45 years were followed up during the period of 5.5-7 years, where in the chronic folicular conjunctivitis caused by CP, the KCS was revealed as the same time. METHODS: The chlamydial infection diagnosis was established due to the positivity to the familiar (anti-LPS) and species (anti-CP) immunoglobulins (IgG, IgM, and IgA) and to the conjunctival impression specimen, using the indirect immunofluorescence of specific monoclonal antibodies. The patients were treated by means of systemically administered macrolide antibiotics Azithromycine. After the termination of the treatment, the signs of the clinical inflammation of the conjunctival inflammation subsided but the KCS problems remained. After 6 years, the control examinations of the familiar and species antibodies of the CP were performed and the clinical findings of the KCS and its treatment were evaluated. RESULTS: The decrease of the antibody levels was proved and objective findings and subjective symptoms of KCS in all patients subsided. Altogether 7 patients were without clinical signs of the KCS and without regular application of local artificial tears treatment. At the same time, in two thirds of the patients, the levels of the antibodies decreased or remained unchanged. In the last three patients, the signs of the dry eye decreased, but they didn't disappeared permanently. These patients had to apply artificial tears several times a day. The suspect signs of this serologically active infection persisted despite the antibodies levels' decrease. CONCLUSION: This pilot study until now didn't confirm the direct dependence between the KCS and CP, but it didn't exclude it as well.

Correlations of somatophysiological, biochemical, psychosocial and behavioral risk factors of cardiovascular diseases in a sample of employees of Prague enterprises and institutions.

The study is aimed at the detection and intervention of risk factors for cardiovascular diseases (CVD) and at the part played by stress in their development. The methods applied are designed to eliminate the risks and, simultaneously, to identify the function of the two main parts of stress reaction, i.e., in terms of the extent, level and type of the stressors experienced, and in terms of the level of mental resilience and related psychosocial factors which affect the experiencing of and coping with stress. The purpose of medical examination based on the patient's history, subjective complaints and objective tests, including a study of dietary habits and psychological methods was to establish the status praesens and identify the main risk factors and symptoms leading to ischemic heart disease (IHD). Intervention was performed in subjects with increased cardiovalscular risk factors.

[Angiolymphoid hyperplasia with eosinophilia or Kimura disease?]. / Angiolymfoidní hyperplazie s eozinofilií nebo Kimurova choroba?

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.