Apparent diffusion coefficient in the evaluation of cerebral gliomas malignancy.

BACKGROUND/AIM: Magnetic resonance imaging (MRI) is a key modality not only for lesion diagnosis, but also to evaluate the extension, type and grade of the tumor. Advanced MRI techniques provide physiologic information that complements the anatomic information available from conventional MRI. The aim of this study was to determine whether there is a correlation between apparent diffusion coefficient (ADC) maps of intracranial glial tumors and histopathologic findings and whether ADCs can reliably distinguish low-grade from high-grade gliomas. METHODS: This retrospective study included 25 patients with MRI examination up to seven days before surgery, according to the standard protocol with the following sequences: T1WI, T2WI, FLAIR, DWI and post contrast T1WI. Data obtained from DW MRI were presented by measuring the value of ADC. The ADC map was determined by utilizing Diffusion-Perfusion (DP) Tools software. All the patients underwent surgical resection of the tumor. Histological diagnosis of tumors was determined according to the World Health Organization (WHO) classification. The ADC values were compared with the histopathologic findings according to the WHO criteria. RESULTS: The ADC values of astrocytomas grades I (0.000614 +/- 0.000032 mm2/s) were significantly higher (< 0.001) than the ADC values of anaplastic astrocytomas (0.000436 +/- 0.000016 mm2/s) and the ADC values of glioblastomas multiforme (0.000070 +/- 0.000008 mm2/s). The ADC values of astrocytomas grades II (0.000530 +/- 0.000114 mm2/s) were significantly higher (< 0.001) than the ADC values of anaplastic astrocytomas (0.000436 +/- 0.000016 mm2/s) and glioblastomas multiforme (0.000070 +/- 0.000008 mm2/s). The ADC values of anaplastic astrocy-omas (0.000436 +/- 0.000016 mm2/s) were significantly higher (< 0.001) than the ADC values of glioblastomas multiforme (0.000070 +/- 0.000008 mm2/s). The ADC values in the cystic part of the tumor for astrocytomas grades I (0.000775 +/- 0.000023 mm2/s) were significantly higher (< 0.001) than the ADC values of anaplastic astrocytomas (0.000119 +/- 0.000246 mm2/s) and glioblastomas multiforme (0.000076 +/- 0.000004 mm2/s). The ADC values astrocytomas grades II (0.000511 +/- 0.000421 mm2/s) were significantly higher (< 0.001) than the ADC values of glioblastomas multiforme (0.000076 +/- 0.000004 mm2/s). CONCLUSION: DWI with calculation of ADC maps can be regarded as a reliable useful diagnostic tool, which indirectly reflects the proliferation and malignancy of gliomas. The ADCs maps can both predict the results of histopathological tumor and distinguish between low- and high-grade gliomas, and provide significant information for presurgical planning, treatment and prognosis for patients with high-grade astrocytomas.

Aseptic intrafascial and extrafascial abscesses 10 years after a 2-level DIAM insertion procedure.

With the aim to prevent the so-called adjacent-segment disease in spinal fusion surgery and to serve as the primary surgical procedure for the management of low-back pain syndrome or neurogenic claudication in spinal stenosis, the so-called dynamic spine stabilization is applied using specifically designed implants: interspinous spacers, such as DIAM (Device for Intervertebral Assisted Motion), Coflex, and X-stop. It is commonly accepted that interspinous spacers are made from material that is well tolerated by the body, that their placement is simple, that complications are rare, and that they can greatly benefit the patients. So far, there have not been published studies reporting infective or other complications 10 or more years after the placement of DIAM spacers. The aim of this paper was to present a case of an extremely late complication (after 10 years) in the form of intra- and extrafascial dumbbell abscesses, concomitantly appearing at both levels treated with the DIAM spacer. The paper presents the existence of a significant correlation between CT and MRI findings as well as the deterioration in Oswestry Disability Index and visual analog scale scores. Over time, dynamic spine stabilization might possibly impact reactive accumulation of sterile fluid in the vicinity of an implant and could therefore be related to delayed complications even 10 years after surgery. The finding of a growing layer composed of thick aseptic fluid around the DIAM implant, with a simultaneous occurrence of spinous process osteolysis and formation of a mineralized pseudocyst, bears a considerable risk of delayed inflammatory complications, including abscess, and therefore requires the explantation of the DIAM implant.

Morphological and functional outcome of scleral buckling surgery compared to primary vitrectomy in patients with retinal detachment.

BACKGROUND/AIM: Among the proposed operative techniques for retinal detachment (RD) the most commonly applied are classical method with scleral buckling and pars plana vitrectomy (PPV). The aim of this paper was to determine which surgical intervention of these two leads to better morphological results in terms of the applied retina and better functional outcomes in terms of visual acuity (VA) of the operated eye in patients with RD. METHODS: A retrospective study on the comparative section of the effects of scleral buckling surgery and PPV in uncomplicated rhegmatogenous RD was performed. In a 2-year period 97 patients, i.e. 98 eyes with RD were operated on (68 eyes with scleral buckling surgery vs 30 by PPV). RESULTS: In the group with classically operated detachment, the retina was applied in 52 (76.5%) cases vs 30 (100%) patients in PPV group (p < 0.05). Postoperative VA in logMAR was significantly better in both groups compared to preoperative VA: in the classically operated was 1.89 ± 1.04 preoperatively vs 0.98 ± 0.70 postoperatively, while in the PPV group, preoperative value was 2.56 ± 0.67 vs 1.31 ± 0.74 postoperatively (p = 0.001). CONCLUSION: PPV in uncomplicated forms of RD gives better anatomical results than scleral buckling surgery. VA was significantly improved in both observed groups, while its mean value was postoperatively better in the group that was operated with the classical method. The reason for this could be due to better VA in baseline in the scleral buckling surgery group.

Glutathione S-transferase omega-2 polymorphism Asn142Asp modifies the risk of age-related cataract in smokers and subjects exposed to ultraviolet irradiation.

BACKGROUND: Glutathione S-transferase omega-1 and 2 have a unique range of enzymatic activities, including the regeneration of ascorbate by their dehydroascorbate reductase activities. Because these enzymes could have a protective role from oxidative damage in the lens, the question of whether the two coding glutathione S-transferase omega polymorphisms confer the risk of age-related cataract was addressed. METHODS: rs4925 (Ala140Asp) of glutathione S-transferase omega-1 and rs156697 (Asn142Asp) of glutathione S-transferase omega-2 polymorphisms in 100 patients with age-related cataract and 130 controls were assessed. RESULTS: Presence of one mutant GSTO1*Asp or GSTO2*Asp allele did not contribute independently towards the risk of cataract; however, homozygous carriers of GSTO1*Asp/GSTO2*Asp haplotype demonstrated 3.42-fold enhanced risk of cataract development (95% confidence interval = 0.84-13.93; P = 0.086). When GSTO genotype was analysed in association with smoking or professional exposure to ultraviolet irradiation, carriers of at least one mutant GSTO2*Asp allele had increased risk of cataract development in comparison with individuals with wild-type GSTO2*Asn/Asn with no history of smoking or ultraviolet exposure (odds ratio = 6.89, 95% confidence interval = 1.81-16.21, P = 0.005; odds ratio = 4.10, 95% confidence interval = 1.23-13.74, P = 0.022, respectively). Regarding the distribution of particular glutathione S-transferase omega genotype and cataract type, the highest frequency of mutant GSTO2*Asp allele was found in patients with nuclear cataract. CONCLUSION: The results indicate that mutant GSTO2*Asp genotype is associated with increased risk of age-related cataract in smokers and ultraviolet-exposed subjects, suggesting a role of inefficient ascorbate regeneration in cataract development.

Influence of intravitreal injection of bevacizumab on systemic blood pressure changes in patients with exudative form of age-related macular degeneration.

INTRODUCTION: The aim of our study was to examine blood pressure (BP) changes in hypertensive and nonhypertensive patients after intravitreal bevacizumab injections and to assess whether intravitreal bevacizumab carries an associated vascular risk in patients with exudative ocular disease. We also aimed to estimate the influence of gender. METHODS: The study included 57 patients with age-related macular degeneration who received an intravitreal injection of 1.25 mg (0.1 mL) of bevacizumab. We analyzed systolic and diastolic BP values separately. Patients were divided into males and females, and into hypertensives and normotensives based on their BP values. BP was measured before bevacizumab administration, and 10 minutes, 1 hour, 2 days, 7 days and 6 weeks after the injection. RESULTS: Males had a statistically significant decline in systolic BP values 1 hour and 6 weeks after drug administration (p<0.05). The most notable significant decline in diastolic BP values was for males and for normotensive participants 1 hour after drug administration (p<0.05), while the most notable decline in diastolic BP values for females and for hypertensive participants was 7 days after drug administration, with statistical significance only for hypertensive patients (p<0.01). For males it was noticed that a statistically significant decline in diastolic BP persisted after 6 weeks (p<0.05). CONCLUSIONS: An intravitreal bevacizumab injection is safe as regards BP changes over 6 weeks post administration. Regular follow up for 6 weeks should be mandatory in order to promptly recognize individuals who have changes in BP values and include them in BP treatment in order to prevent complications.

[Big intraocular foreign body: case report].

INTRODUCTION: Penetrated injuries are most difficult injuries of the eye. Intraocular foreign body (IOFB) may lodge in any of the structures it encounters, from anterior chamber to the retina and choroid. Notable effects caused by foreign body injury include traumatic cataract, vitreous liquefaction, retinal and subretinal hemorrhages, retinal detachment and development of endophtalmitis. CASE OUTLINE: A 49-year-old man sustained injury of the right eye with a piece of metal wire. On admission visual acuity was VOD: 1.0 and lower intraocular tension TOD = 6 mmHg (10-22 mmHg). Corneal entry wound was noticed near limb on 11 h with a prominating foreign body of 18 mm in length that passed through the iris, lens and vitreous. X-ray findings confirmed existence of a large foreign body extending along the entire length of the globe. IOFB removal was done with anatomic forceps. On postoperative detailed clinical examination we observed retinal rupture in the upper temporal quadrant fitting in the area of the IOFB damaged retina. Laser photocoagulation of retinal tear (laser retinal barrage) was done. Visual acuity on discharge was the same (1.0) and intraocular tension was within normal limits (10 mmHg). CONCLUSION: Penetrated injury of eye requires detailed examination of all eye structures, beginning from the anterior to posterior segment. Timely diagnosed ruptures of the posterior segment of eye before the development of traumatic cataract, and adequate therapeutic procedures prevent serious complications of IOFB penetrated eye injury such as retinal detachment and permanent reduction of visual acuity.

[Pars plana vitrectomy with extraction of intraocular foreign body in patients with siderosis of the eye: report of two cases].

INTRODUCTION: Penetrating injury is characterized by the existence of entry wound only, and it can be with or without an intraocular foreign body (IOFB). IOFB can lead to a mechanical injury of the eye and to cause infection or to manifest other toxic effects on intraocular structures. Iron and copper can dissolve and cause siderosis, i.e. chalcosis of the eye. Ocular siderosis is diagnosed by clinical and electroretinogram (ERG) findings. OUTLINE OF CASES: The first patient was a 37-year-old male who was injured by a metal foreign body. He presented at the Clinic two years after the injury. Visual acuity of the right eye (VOD) on admission was VOD=L+P+ (light projection). Pars plana phaco-vitrectomy with IOFB extraction was done. Visual acuity on discharge was VOD=3/60 cc + 7.50 Dsph=0.2. The second patient was a 55-year-old male who presented at the clinic 18 months after injury. On admission visual acuity in his left eye was VOS 1/60. Pars plana phacovitrectomy with IOFB extraction was done.Visual acuity on discharge was VOS=0.7 through the stenopeic slit. CONCLUSION: In penetrating injuries caused by a metal IOFB pars plana vitrectomy with IOFB extraction is indicated. In cases with IOFB, when visual acuity is preserved, the lens is transparent, while the eye is without signs of infection, urgent pars plana vitrectomy is not necessary. Such patients need regular followup with obligatory ERG findings.

Persistent submacular fluid diagnosed with optical coherence tomography after successful scleral buckle surgery for macula-off retinal detachment.

Crataegus species have been widely used in herbal medicine, especially for the hearth diseases. In the present study, the effect of Crataegus aronia var. dentata Browicz extract on partially hepatectomized rats was investigated with biochemical and TUNEL apoptosis assays. The extracts of the plant at the concentrations of 0.5 and 1 ml/100 g body weight/day were administered orally to the two experimental groups including partially hepatectomized rats for 42 days. At the end of the experimental period, animals were sacrificed, blood was collected for the assessment of serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma-glutamyltransferase (GGT), and the liver tissue was used for TUNEL assay. In biochemical assay, it was found a significant decrease in the levels of serum ALT and AST in the experimental groups. On the other hand, the plant extract did not cause any significant changes in the level of GGT in these groups. In apoptosis assay, TUNEL positive hepatocytes could not be detected in both experimental groups. The present findings can suggest that Crataegus aronia var. dentata Browicz extract can decrease the levels of serum ALT and AST and play a role in apoptosis of hepatocytes in the liver of partially hepatectomized rats. However, further studies are required to confirm the effects of the plant extract on hepatoprotection and apoptosis in the regenerating liver after partial hepatectomy in animal models.

Spontaneous dislocation of a transparent lens to the anterior chamber--a case report.

INTRODUCTION: The causes leading to dislocation of the natural lenses are different involving injuries, hereditary diseases and spontaneous dislocation. Spontaneous dislocation of a transparent natural lens is extremely rare, especially dislocation of the anterior eye chamber. We report a case of spontaneous dislocation of the transparent natural lens to the anterior eye chamber in a patient who had no history of eye injuries. CASE OUTLINE: The patient was a 17-year-old boy. Lens dislocation was spontaneous, and the patient presented for ophthalmological consultation due to a sudden vision impairment of the left eye. Biomicroscopic examination verified that the transparent lens was in the anterior chamber, and it was spherophakia of lesser diameter; there were no signs of increased intraocular pressure, as typically expected in lens dislocation to the anterior chamber. The patient was operated on in general anaesthesia. Surgery involved intracapsular extraction of the dislocated lens through a corneoscleral incision. CONCLUSION: This case report shows that a spontaneous dislocation of the natural lens may occur in younger people. The dislocated spherophakic lens to the anterior eye chamber did not contribute to the rise of the intraocular pressure and development of acute glaucoma. The acute glaucoma resulted from the pilocarpine narrowing of the pupil due to pupillary block. The intracapsular instrumental extraction of the dislocated transparent lens from the anterior chamber was successfully completed through a corneoscleral incision.

[Topographic localization of an intraocular foreign body by B-scan echography].

BACKGROUND/AIM: In cases of blurred optic media the ultrasound diagnostics offers useful data about eventual presence of intraocular foreign body as well as about its precise localization in the eye. The aim of this study was to retrospectively analyze echographic findings in patients with the diagnosis of intraocular foreign body with a special interest in localizations of a intraocular foreign body in the eye and the presence of an eventual infection - endophthalmitis. The aim of this study was also to confirm the localization of intraocular foreign body by echography and to test the precision of this method. METHODS: We performed analysis of all cases that had been referred to the ultrasound diagnostices, in which the presence of intraocular foreign body had been confirmed in the period of one year. All examinations were done with B-scan and were confirmed during the surgery - vitrectomy. RESULTS: In the one-year period we were contacted by 27 patients with intraocular foreign body. In one injured eye the intraocular foreign body was in the lens (3.70%), in 10 injured eyes (37.03%) intraocular foreign body was in the vitreal body. In 15 patients (55.5%) intraocular foreign body was fixed in the retina. In one patient (3.70%) there was a perforating injury, intraocular foreign body was found in the retrobulbar part of the orbit. In 7 injured eyes (25.9%), with the presence of intraocular foreign body, we found signs of endophthalmitis (organized blurring in vitreal space, thickened choroid). Other accompanying echographic findings were: blood in vitreal space, haemophthalmus in 12 cases (44.4%), retinal detachment in 5 cases (18.5%) and subretinal hemorrhagies in 4 cases (14.8%). CONCLUSION: Ultrasound diagnostics can very precisely show the localization of intraocular foreign body in the eye that is very important in the choice of approach and timing of surgical treatment. Also the echographic diagnostics may find an accompanying endophthalmitis in the posterior segment of the eye, that is very important for an urgent therapeutic approach.

Orbital dermoid and epidermoid cysts: case study.

INTRODUCTION: Dermoid and epidermoid cysts of the orbit belong to choristomas, tumours that originate from the aberrant primordial tissue. Clinically, they manifest as cystic movable formations mostly localized in the upper temporal quadrant of the orbit. They are described as both superficial and deep formations with most frequently slow intermittent growth. Apart from aesthetic effects, during their growth, dermoid and epidermoid cysts can cause disturbances in the eye motility, and in rare cases, also an optical nerve compression syndrome. CASE OUTLINE: In this paper, we described a child with a congenital orbital dermoid cyst localized in the upper-nasal quadrant that was showing signs of a gradual enlargement and progression. The computerized tomography revealed a cyst of 1.5-2.0 cm in size. At the Maxillofacial Surgery Hospital in Nis, the dermoid cyst was extirpated in toto after orbitotomy performed by superciliary approach. Postoperative course was uneventful, without inflammation signs, and after two weeks excellent functional and aesthetic effects were achieved. CONCLUSION: Before the decision to treat the dermoid and epidermoid cysts operatively, a detailed diagnostic procedure was necessary to be done in order to locate the cyst precisely and determine its size and possible propagation into the surrounding periorbital structures. Apart from cosmetic indications, operative procedures are recommended in the case of cysts with constant progressions, which cause the pressure to the eye lobe, lead to motility disturbances and indirectly compress the optical nerve and branches of the cranial nerves III, IV and VI.

[Ultrasound biomicroscopy in diagnosis of anterior segment pathology].

INTRODUCTION: Ultrasound biomicroscopy (UBM) is a non-invasive diagnostic procedure, developed in order to achieve better visualization of the anterior segment of the eye. The first clinical images were made in March 1990. The use of UBM at the Institute for Eye Diseases, Clinical Centre of Serbia, began in February 2007. OUTLINE OF CASES: Due to a drop in visual acuity, the first patient was sent to the Institute for Eye Diseases, Clinical Centre of Serbia. The existence of the ciliary body tumour was suspected, so she underwent a UBM diagnostic procedure. UBM showed fibrin in the anterior chamber of the eye, occlusion of the pupil, and the absence of tumour. The second patient had a part of the chamber angle filled with solid lesion. UBM showed a solid tumour lesion filling the chamber angle in the lower part of the anterior chamber. The origin of the tumour was the ciliary body rather than the choroid which was shown by the B scan ultrasound. Lipodermoid was found by clinical examination of the third patient. He underwent UBM in order to exclude the involvement of the sclera under the lesion. UBM visualized a subconjunctival lesion lying on the sclera, reaching the limbus of the cornea.The difference in ultrasound reflection of the two tissues helped us to confirm that the sclera was not involved. Our fourth patient underwent an antiglaucomatous procedure, and the assessment of the chamber angle opening was the reason for the UBM examination. Parameters measured in the lower quadrants (6 o'clock) that we managed to obtain were the following: AOD (250 microm)--180 microm, AOD (500 microm)--400 microm, TIA--34.39 deg., ARA--0.25 mm2. Comparing them to normal values, we came to the conclusion that the chamber angle was open in the lower part of the anterior chamber. CONCLUSION: Ultrasound biomicroscopy gives us plenty of useful information when it comes to diagnosing the anterior chamber pathology.