Intraocular Pressure Measurements Referring to the Corneal Thickness in Keratoconic Eyes After Corneal Crosslinking with Riboflavin and Ultraviolet A.

AIM: To determine the possible relation between intraocular pressure (IOP), central corneal thickness (CCT) and corneal resistance (CR) in kerotoconic eyes before, 3,6 and 12 months after collagen crosslinking procedure (CXL) with aim to find out does the thicker cornea means already more resistance cornea followed with higher IOP. METHODS: Thirty eyes (30 patients) with central keratoconus (KC)were evaluated in retrospective cross sectional study. The corneal biomechanical parameters were taken with Wave Light Allegro Oculyzer produced by Alcon before the CXL, 3, 6 and 12 months after the procedure. IOP were checked by Goldmann applanation tonometry (GAT) before, 3, 6 and 12 months after CXL. RESULTS: The value of IOP before the CXL was 12,0 mmHg (10,62-15,25 mmHg), 3 months later 13,5 mmHg (11,0-16,0 mmHg), 6 months 14,0 mmHg (11,0-16,0 mmHg) and 12 months later 15,0 mmHg (10,37-17,25 mmHg) and was statistically significant higher (p=0,015) comparing to the value of IOP 3 months after the CXL, IOP 12 months after CXL procedure was statistically significant higher comparing to preoperative values (p=0,010). There were no statistically significant difference between the values 3 and 6 months after CXL. The CCT before the CXL procedure was 449 (433-505,75 microns), 3 months after CXL was 420 (383-473microns, p < 0,005), 6 months later 437 (401,25-480,25, p=0,001), 12 months after CXL 437 (401-503 microns, p=0,001). However there is statistically significant difference in CCT 12 months after CXL 437 (401-503microns p=0,032) and the value of CCT 3 months later the procedure (p=0,004) and the CCT 12 months after CXL and the value of CXL 6 months after CXL (p=0,036). The value of CCT did not show any statistically significant difference 3 and 6 months postoperatively. CONCLUSION: After riboflavin-UVA CXL in eyes with KC there was significant decrease in central corneal thickness 3 and 6 months after the procedure and the thickness is almost the same 12 months later. However IOP is low before CXL, raising up 3 and 6 months after CXL but significant increase is seen 12 months later. It means the regular measurement of IOP could be the serious and confident indicator of increasing of corneal resistance which is the main goal of CXL treatment.

Assessment of the tomographic values in keratoconic eyes after collagen crosslinking procedure.

GOAL: This study aimed to investigate the differences in values of K1 and K2 readings, the central corneal thickness (PAH) before the collagen crosslinking procedure (CXL) and 3, 6, 12 months later. METHODS: 64 eyes were evaluated in retrospective cross sectional study. The corneal biomechanical parameters were taken with WaveLight Allegro Oculyzer produced by Alcon before the CXL, 3,6, 12 months after the procedure. The curvature of K1 reading and K2 reading were taken and the central corneal thickness were considered due to the time after CXL. RESULTS: The value of K1 reading before the treatment was 48.8 diopters (D) (46.65-50.50) and was statistically significant lower comparing to the value of K1 3 months after the collagen CXL procedure 46.30 D (43.57-49.45) (p=0.0006), K1 reading one year post collagen CXL procedure was 47.20 D (44.35-50.07) (p=0.002). The value of K2 reading before the collagen CXL procedure was 52.65 D (47.55-54.72), 3 months after the procedure was 51.4 (45.05-54.0), 6 months later 48.55 D (47.20-50.62), 12 months later 51.30 D (47.22-54.77). There is statistically significant lower value of K2 reading 6 months after the treatment comparing to the values 3 months postoperatively (p=0.014). However there is significantly lower values of K2 reading 12 months postoperatively comparing to preoperative period (p=0.006). The value of central corneal thickness preoperative was 431.0 microns (398.0-446.25), 3 months after collagen CXL procedure was 373.50 microns (363.25-430.75), 6 months later 435.0 microns (360.0-464.75), 12 months after the CXL procedure was 429.50 microns (357.75-496.25). There is statistically significant lower values of central corneal thickness 3 months after collagen CXL treatment comparing to the central corneal thickness preoperative (p<0.005). There is statistically significant lower values of pachymetry 12 months after the CXL procedure comparing to the values 6 months later (p=0.036) and those preoperativelly (p=0.032). There is no statistically significant difference in the values of central corneal thickness in the period from 3 and 6 months postoperatively. CONCLUSION: After riboflavin-UVA CXL in eyes with keratokonus there was significant decrease in central corneal thickness 3 and 6 months after the procedure and the thickness is almost the same 12 months. However, K2 (Kmax) reading is significantly changed 3 and 6 months later and is followed by changing of K1 reading.

Etiological and clinical characteristics of lymphadenopathy at child age in Tuzla Canton.

UNLABELLED: Lymphadenopathy is defined as an abnormality in the size or character of lymph nodes, is caused by the invasion or propagation of either inflammatory cells or neoplastic cells into the node. Numerous factors, such as age, localization, size and consistency, present and previous pathological conditions are very important in order to define the future diagnostic and therapeutic course. OBJECTIVE: The aim of this study was to determine the etiological and clinical characteristics oflymphadenopathy in children in the area of the Tuzla Canton. PATIENTS AND METHODS: This retrospective-prospective study analyzed the medical records of the Department of Pediatrics in Tuzla of 334 patients in age from 0 to 14 years, in which the clinical signs of palpable lymph nodes of one or more regions was diagnosed in the period from January 1st 1998 to June 30th 2003. The anamnesis data, clinical findings, diagnostic procedures results, therapeutic approach and disease outcome etiology defined lymphadenopathy were analyzed. RESULTS: Out of 334 children, localized lymphadenopathy have been verified in 230, and generalized in 104. Male/female ratio was 1:1.8. Final results of our study have shown the etiologies as following: Infectious etiologies, 79.34%, neoplastic 11.34%, and non-neoplastic 9.28%. In neoplastic etiologies, lymphoblastic leukemia has been the most often verified neoplastic disease (68.4%), not related to the age or sex of patient, and equally presented as localized and generalized lymphadenopathy. In this study lymphomas were presented by generalized lymphadenopathy. CONCLUSION: The regional and generalized lymphadenopathy in children depends on their etiology and has significant prognostic value for the disease.

[Brucellosis spondilitis in a ten year boy]. / Brucelozni spondilitis u desetogodisnjeg djecaka.

INTRODUCTION: Brucellosis is acute infectious disease classified as zoonosis, which can leave humans with chronic damages and disability. It can appear as sporadic cases or a smaller epidemic anywhere in the world but it is more common in some areas and there it presents significant public health issue. Clinical picture is very variegated. A long period of latency is possible, unnoticed asymptomatic start or forms with mild clinical picture up to the forms with per acute septic-toxic shock and possible lethal outcome. Symptoms of general infectious syndrome, wave like (undulating) temperature, profuse night sweat, muscle, bone and joint pain can be considered to be characteristic. Diagnosis is made based on epidemiological data, clinical findings, microbiological and serological tests. Differentially diagnostic all long-lasting febrile diseases may be considered and disease with neuralgic and arthralgic syndromes. Therapy includes antibiotics and prevention implies sanitary veterinary control, food control and measures of professional protection. METHODS: This paper descriptively describes clinical course of the disease in ten year old boy with brucellosis spondylitis. CASE REPORT: Ten year old boy was hospitalized for febrile condition and acute pain in back and abdomen of unknown etiology. We did diagnostic and therapeutic treatment with multidisciplinary approach and due to information on previous cases of brucellosis in family we also added tests to brucellosis. Diagnosis of brucellosis spondylitis is made based on MRI of lumbosacral spine and is confirmed with positive serological tests and positive blood cultures to Brucella melitensis. The boy had no other localized foci of the disease in other organs or systems. Etiological treatment was done in accordance to recommended antimicrobic scheme. A complete recovery was achieved with further need for observation of condition and Elisa titer to this agent. CONCLUSION: Osteoarticular form of brucellosis is relatively common focal form of the disease in adult patients but not so common in children. Syndrome of acute lumbosacral pain in children is of unknown etiology and diagnostic procedures must include infectious diseases with possible osteo-articular symptoms including brucellosis.

[Characteristics of broncho-obstruction in childhood]. / Karakteristike bronhoopstrukcije u djecijoj dobi.

INTRODUCTION: The prevalence of broncho-obstruction in children is in permanent increase at any age and in global. According to many studies, about 50% of children have at least one episode of broncho-obstruction in the first six years of life. Risk factors for broncho-obstruction in children include not only intrinsic, but a lot of extrinsic factors which could accelerate beginning of early symptoms. Globally, there is increase in first hospitalization with broncho-obstruction and many authors described decrease in rehospitalizations, thanks to therapy improvements. There is evidence of seasonal distribution of children treated for broncho-obstruction. Depending on country and author, different periods of year are related to increased number of patients, which could be explained by seasonal agents. Many studies described geographic variation in incidence and prevalence of respiratory diseases, which could also be explained by seasonal agents. PURPOSE: The aim of this paper is to establish frequency of broncho-obstructive syndrome, comparing the age, gender, place of inhabitance and seasonal agents in children treated at the Department of Intensive care at the Pediatrics Clinic in Tuzla trough analysis of their personal histories, clinical, radiography and laboratory findings. METHODS: Analysis was based on population of patients treated at the Department for Intensive care of Pediatrics Clinic in Tuzla with broncho-obstructive syndrome, from January 1st to 31st December 2006. All selected patients were from Tuzla Canton. Source of the data for research were Admission protocol for Pediatric Clinics, Intensive care unit protocol and personal histories of children treated. Method of work was retrospective study which analyzed anamnesis' data, clinical, radiography and laboratory findings, therapeutic procedures and length of hospitalization at the Intensive care unit and outcome of the treatment. RESULTS AND DISCUSSION: Total number of 767 children were treated during the investigated period at the Intensive care unit. Out of this number 332 children (43,3%) were treated for syndrome of broncho-obstruction. The frequency of broncho-obstructive syndrome in children was different regarding age, gender, place of inhabitance and year season. Broncho-obstructive syndrome was most common at nursing age (40,0%) and 76,5% patients were under age of five. Boys dominated at all age groups except for repeated admissions of school age where this relation was equal. Spatial distribution demonstrated that the highest number of children treated for broncho-obstruction was from Tuzla, Lukavac and Zivinice. The incidence of patients from these municipalities was significantly above the participation of these municipalities in total population. Season distribution demonstrated that the highest numbers of children were treated in December, and lowest in July and August. Number of treated children was statistically significant higher during winter months. Broncho-obstructive syndrome in 67,5% patients was with radiography confirmed pneumonia and in 13,8% with lung athelectasis. The most common isolated agents were Staphylococcus, Klebsiella and Pseudomonas. CONCLUSION: The frequency of broncho-obstructive syndrome in children was different regarding age, gender, place of inhabitance and year season. Broncho-obstructive syndrome was found in 67,5% patients with radiography confirmed pneumonia.

[Monitoring fluid balance in pediatric intensive care]. / Monitoring bilansa tecnosti u pedijatriskoj intenzivnoj njezi.

The dynamic metabolism as far as bigger amount of water versus solid tissues in child demand much better skilfulness in calculating liquid input and excretion in intensive care. It is very important fact in prevention of life threatening conditions in children and adults, especially in conditions with multiorganic disorders, because their treatment is reciprocally opposite. Considering experiences of ICU UZ Gent-Belgium we made in Paediatric intensive care unit at Paediatric clinic in Tuzla unique method of monitoring liquid balance in children within specific conditions in which standard method of monitoring just the amount of planed liquid, body weight and diuresis is not reliable enough. With this new monitoring we prescribe dynamics of parenteral input of crystalloid and colloids as well as peroral income much more precise and much more confidence in positive result and prevention of harder disorders as well. In this paper we present our own method of observation as well as results in period July 1999. Till September 2002. We did the intensive volume control in 88 or 45 of total number of 2255 patients treated in PICU in this period. We followed the liquid balance 399 days or 9576 hours. Primary nephrologic diseases were indication for balance in 17 or 19.3% children, while in other 71 or 80.6% children, were other diseases like cardiac failure, diabetic ketoacidosis, chronic systemic diseases, the Toxic shock syndrome, the conditions of intracranial hypertension. We notice the signs of threatening renal failure in 7 or 7.9% of children and signs of manifesting renal failure in 10 or 11.3%. Our experiences tell that the model we made is applicable in working conditions of ICU. Evidence of organism responds the planned input is much better and safer than in standard way of observation. The possibility of in time intervention against threatening renal failure as well as other organic disorders is much greater. We recommended this model for all life threatening conditions in Paediatric intensive care units.