Sarkoidosis and its Eye Ocular Manifestation (an Analysis of Six Case Report).

AIM: To introduce the range of eye changes in sarcoidosis in the individual casuistics. MATERIALS: At the Ophthalmic Clinic of Teaching Hospital Královské Vinohrady in Prague were examined and treated six patients with ocular forms of sarcoidosis in the years from 1998 to 2015. Three patients were unilateral lesions of the lacrimal gland without systemic symptoms. One patient experienced orbital inflammatory syndrome that accompanied the hilar form of pulmonar sarcoidosis. Two other patients underwent intraocular inflammation, panuveitis / iridocyclitis and bilateral intermedial uveitis. Both of these patients also had systemic affections of mediastinal lymph nodes and lung, in the first of these, signs of neurosarcoidosis first appeared. RESULTS: In the treatment of lacrimal glands, the diagnosis was determined by histological examination of the removed lacrimal gland in external orbitotomies, also, the orbital process has been verified by biopsy and the subsequent comprehensive examination revealed the systemic process. Definitive diagnosis of sarcoidosis was established bioptically in both uveitides and has also been demonstrated in imaging methodologies including galli scintigraphy. All patients were successfully treated with corticosteroid therapy. CONCLUSION: Biopsy results have always been a surprise in orbital processes. Both cases of uveitis were associated with systemic involvement and initiated comprehensive investigation which showed the need for interdisciplinary collaboration in the diagnosis and treatment of sarcoidosis. Key words: sarkoidosis, biopsy, corticosteroids, gallii scintigraphy, MRI, uveitis.

[Pancreatic panniculitis with multiple osteolytic lesions]. / Pankreatische Pannikulitis mit multiplen osteolytischen Läsionen.

A 62-year-old man with a history of chronic alcohol abuse presented with severe pancreatic panniculitis associated with an acute exacerbation of chronic pancreatitis.

[Orbital tumors in adults--a 10-year study]. / Orbitální tumory u dospelých--desetiletá studie.

UNLABELLED: The authors refer about diagnostic procedures, treatment and follow-up of 87 adult patients with orbital tumors during the period 1998 - 2007 in the Department of Ophthalmology, Faculty Hospital Královské Vinohrady, Charles University, Prague, Czech Republic, E.U. The group consists of 42 men and 45 women, age range 18-89 years. In 49 patients, the tumors were of benign origin (age 18-80 years, median, 48 years), and 38 patients suffered from malign tumors (age 38-89 years, median, 61 years). Among basic examinations methods ranked the magnetic resonance imaging and the histological verification of the tumor. Sixty-four tumors were treated by means of 70 surgical procedures. The anterior diagnostic or therapeutic orbitotomy was used in 72.5% of the cases, lateral osteoplastic orbitotomy (Kronlein) in 14.5%, and exenteration of the orbit in 13% of the cases. Altogether 23 patients were treated without surgery by means of corticosteroids, or are followed-up due to a benign tumor only. As the most common, the inflammatory pseudotumors of the orbit were diagnosed in 40%. Clinically they were of the anterior nodular, or posterior diffuse form, dacryoadenitis or orbital myositis. All patients were treated by means of prednisolon for at least three months; due to the relapse of the immunopathologic process, in 16 % of the cases the therapy was supplemented with azathioprime. The surgical procedure was the choice of treatment in 66% of inflammatory processes in the lacrimal gland region. In four cases the sarcoidosis was established.The second tumor in the final ranking was lymphoma in 19.5%; the MALT-lymphoma was diagnosed in 59% of these cases. The chemotherapy was chosen for the treatment in 2/3 of the cases, and in all cases the remission was reached.The actinotherapy was chosen especially in other types of lymphoma; the follicular form and "molding" lymphoma were the causes of the death in two patients. Among malignant tumors, the most serious clinical courses were histological different primary carcinomas of the orbitopalpebral region in 14% of the cases, and secondary melanoma spreading from the conjunctiva in 5.5%. Both these tumors, counting the same number as lymphomas, were the only indications to the exenteration of the orbit, and causes of the death in four patients. CONCLUSION: Among orbital tumors in adults, the most common were inflammatory pseudotumor and lymphoma. The decisive procedure was always the histological verification, which directed the following therapy.

[Relation between insulin resistance and amount of visceral adipose tissue]. / Vztah inzulíinové rezistence a mnozství viscerálního tuku.

BACKGROUND: Association of obesity with metabolic and cardiovascular complications depends on the adipose tissue distribution. The role of intraabdominal, i.e. visceral, adipose tissue in pathogenesis of insulin resistance is still not elucidated. The aim of this study was to investigate the relation between insulin resistance and contribution of visceral and subcutaneous fat in a group of women with a wide range of body weight. METHODS AND RESULTS: 62 women (age 21-66 years) among which 32 were non-obese and 30 obese (BMI > 30 kg/m2) were examined. The amount of visceral and subcutaneous fat was evaluated using computerized tomography, total body fat evaluated using bioimpedance, and the degree of insulin resistance was evaluated using glucose disposal (M) during euglycemic hyperinsulinemic clamp. Obese women had lower insulin sensitivity than non-obese (5.88 +/- 2.17 vs 3.32 +/- 1.44 mg/min/kg, p <0.001) and higher absolute amount of visceral fat. However, the relative amount of visceral fat (related to total body fat or subcutaneous fat) was not different between the two groups. In the entire study group, the magnitude of insulin sensitivity did correlate with absolute amount of total and visceral fat, but no correlation with relative amount of visceral fat was found. CONCLUSIONS: The results suggest that the absolute amount of fat, either total or visceral, is a stronger predictor of the degree of insulin resistance than the relative contribution of visceral fat.

[Diagnostics of the retrocalcaneal bursitis: possibilities of the use of new anatomical data]. / Diagnostika retrokalkaneárních burzitíd: moznosti vyuzití nových anatomických poznatku.

The anatomy and histology of the normal retrocalcaneal bursa (RB) was studied on both embalmed and fresh cadaverous material. The bursa is a constant structure, its upper and posterior walls are completely covered with the unilayered synovial membrane. Its anterior wall represents the superior facet of the calcaneal tuberosity, the posterior one corresponds to the anterior surface of the insertional part of the Achilles tendon. The superior wall is formed by the adipose tissue of the inferior part of Kager's triangle, extending into the cavity of the bursa in a form of constant large and irregularly shaped synovial fold. The normal anatomical features as well as some pathological changes of the bursa and its neighbourhood were demonstrated on examples of some case reports, by use of the ultrasonography and magnetic resonance investigations. In healthy individuals the space of the bursa was not figured in the ultrasonographic investigations, but was well apparent in the MR images. The pathological changes of the bursa are detectable by using of both methods, but the MR images present substantially precise quality of depiction. The authors recommend the use of presented new anatomical data for the improvement in differential diagnostic of the wide spectrum of achillar enthesopathies.

Retinol-binding protein 4 expression in visceral and subcutaneous fat in human obesity.

Retinol binding protein 4 (RBP4) is a novel adipokine which might be involved in the development of insulin resistance. The aim of the study was to investigate the expression of RBP4 mRNA in subcutaneous and visceral fat depots and the relationship between RBP4 plasma and mRNA levels relative to indices of adiposity and insulin resistance. In 59 Caucasian women (BMI 20 to 49 kg/m(2)) paired samples of subcutaneous and visceral fat were obtained for RBP4, leptin and GLUT 4 mRNA analysis using reverse transcription-quantitative PCR. Euglycemic hyperinsulinemic clamp and computed tomography scans were performed. RBP4 mRNA levels as well as GLUT 4 mRNA and leptin mRNA levels were lower (P<0.001, P<0.01 and P<0.001, respectively) in visceral compared to subcutaneous fat. No differences were found in RBP4 mRNA expression in the two fat depots or in RBP4 plasma levels between subgroups of non-obese subjects (n=26), obese subjects without metabolic syndrome (n=17) and with metabolic syndrome (n=16). No correlations between RBP4 mRNA or plasma levels relative to adiposity, glucose disposal rate and GLUT 4 mRNA expression in adipose tissue were found. There was a weak positive correlation between plasma RBP4 and plasma triglycerides (r = 0.30, p<0.05) and between plasma RBP4 and blood glucose (r = 0.26, p<0.05). Regardless of the state of adiposity or insulin resistance, RBP4 expression in humans was lower in visceral than in subcutaneous fat. We found no direct relationship between either RBP4 mRNA or its plasma levels and the adiposity or insulin resistance.

[Atypical aneurysms of the abdominal aorta]. / Atypická aneurysmata brisní aorty.

The authors submit a report on two patients with pseudoaneurysmatic bulging in the subrenal portion of the abdominal aorta. They present detailed histological findings in the two operated patients and discuss the aetiology of these formations. They draw attention on the failure of aortographic examinations in the diagnosis of these formations and the necessity of sonographic or CT examination. During surgery only partial resection of these formations is possible with subsequent reconstruction of the arterial circulation. The long-term results of these operations are favourable.

[Evaluation of the size of the spleen using computer tomography]. / Hodnocení velikosti sleziny pomocí výpocetní tomografie.

The authors describe the examination, diagnostic possibilities and difficulties associated with the diagnosis of the spleen by means of computed tomography. The finding obtained by computed tomography is evaluated as splenomegaly when two of the three main dimension are greater than the maximal values reported, or when the lienal index is higher than 440. From the practical aspect the decision on splenomegaly is facilitated by the position of the anterior margin of the spleen in relation to the medioaxillary line. Splenomegaly is the most frequent pathological finding on the spleen. The authors give an account of causes of splenomegaly and their own experience with the diagnosis of anomalies, cystic processes, tumours, injuries and obstructions of the lienal vessels.

[Computer tomography of the renal bed after nephrectomy]. / Výpocetní tomografie luzka po nefrektomii.

An early diagnosis of the tumour relapse after performed nephrectomy for a malignant kidney tumour is necessary in order to influence further fate of the patient. The most suitable method for determining a correct diagnosis is computer tomography. The authors present a cohort of 79 patients with a pathological finding in 21 of them. In the other patients the finding after the operation proved to be normal, i.e. the bed was free after the performed nephrectomy, retroperitoneal vessels were free and the line of m. psoas on the surgically treated side proved to be intact. Computer tomography can prove not only the relapse, but also metastatic affection of other organs, particularly in the liver and adrenals.

[Computer tomography of the kidneys after long-term dialysis]. / Výpocetní tomografie ledvin u dlouhodobe dialyzovaných.

In patients with chronic kidney failure in the long-term dialysis programme multiple minute cysts frequently develop in the shrunken kidneys. In addition to the cysts, in 20% of patients there are also multiple kidney tumours causing severe complications. In most cases the clinical picture of the disease is insignificant, hematuria being the most frequent manifestation. The authors present their cohort of 21 patients with irreversible kidney failure, who have been examined by computer tomography in the 1986-1987 years. The mean period of dialysis programme was 5.7 years, chronic glomerulonephritis and interstitial nephritis being the basic disease. The patient were, according to the results of computer tomography, divided into four groups: 1. the presence of cysts or tumours was not demonstrated, 2. multiple cysts were found in bilateral localization, 3. less than 3 cysts were found, 4. there was a kidney tumour. A factor causing the development of the cysts has not yet been identified. It is presumed that the disease is caused by a biologically active substance which is not efficiently dialyzed. On the basis of the present work the authors recommend the aimed examination of the kidneys in patients at the stage of chronic kidney insufficiency and particularly in patients subjected to dialysis for long period of time. The recommended examination is by computer tomography and the attention should be centered to possible occurrence of acquired cystic disease of kidney tumours.

[Examination of the injured spleen using computer tomography]. / Vysetrení poranené sleziny výpocetní tomografií.

In blunt abdominal injury the most frequently injured organ is the spleen. A rapid and precise diagnosis of an injured spleen is therefore of great importance for early and correct therapeutic procedure. The authors present a group of 56 patients, who have been examined in the 1981-1987 years after blunt injuries of the belly by computer tomography. In 12 cases there was the diagnosis of subcapsular haematoma of the spleen, intraparenchymatous rupture was present in eight patients. In the remaining 36 cases the trauma of abdominal organs was not confirmed. All findings were verified by surgery or a control computer tomography and clinical examination of the patients. The authors demonstrate typical traumatic conditions. Computer tomography is a very useful method which enables a rapid, precise and non-invasive diagnosis of different degree of the spleen injury, its possible complications and differentiates these conditions from uninjured spleen. The authors present a brief survey of pictures of injured spleen in other methods of examination. In comparison with those methods, computer tomography is the most effective one, which provides a complex information of other organs of abdominal cavity. It also enables a considerate examination of patients severely injured and in non-cooperating ones.

[Spontaneous perforation of a pancreatic pseudocyst into the duodenum]. / Spontánní perforace pseudocysty pankreatu do duodena.

The authors describe a rare observation of a spontaneous perforation of a pseudocyst of the head of the pancreas into the duodenum with haemorrhage into the digestive tract. The case is documented by the clinical finding, computed tomography and endoscopic fistulography.

[Computer tomography in the diagnosis and classification of retrocaval ureters]. / Príspevek výpocetní tomografie k diagnostice a klasifikaci retrokaválního mocovodu.

A retrocaval ureter is an infrequent congenital defect. Its diagnosis depends on radiodiagnostic methods. Some may be replaced by computed tomography computed tomography. They submit the classification of retrocaval ureters elaborated by Kenawi-Williams.

Computed tomography of the spleen.

Computed tomography is a very useful method in the diagnosis of splenopathy--any anomalies, inflammatory, neoplastic as well as traumatic states of the spleen. Although these processes are not too frequent, their correct determination is an important part of radiodiagnosis. Computed tomography is so far the best method used for the identification of the congenital varieties of the spleen that may be mistaken, in another examination, for a pathological process of an adjacent organ. In the study a total of 185 pathological spleen findings was evaluated. These were obtained from the total of 18,960 CT examinations of the abdomen. The most frequent finding was splenomegaly (69.2%), less frequent were haematomas and splenic cysts (12.4%) and congenital varieties of the spleen (8.1%). Sporadically, splenic infarction (2.7%), thrombosis of the splenic vein (3.8%), tumour (2.2%) and splenic abscess (1.6%) were demonstrated.