Thermography in clinical ophthalmic oncology.

PURPOSE: The aim of this study was to present our own experience with the use of thermography as a complementary method for the initial diagnosis and differentiation of intraocular tumors, as well as for the evaluation of the efficacy of treatment of intraocular melanomas. METHODS: The study group comprised 37 patients with intraocular tumors, including 9 with uveal melanoma, 8 with uveal melanoma after I125 brachytherapy, 12 with a focal metastasis to the uvea, and 8 with retinal capillary hemangioblastoma. A FLIR T640 camera was used to capture images in the central point of the cornea, eye area, and orbital cavity area. RESULTS: Eyes with uveal melanoma had higher temperature compared with the fellow normal eye of the patient in the range of all measured parameters in the regions of interest. In the group of patients with melanoma after unsuccessful brachytherapy, higher temperature was observed at the central point of the cornea. In patients with tumor regression, all measured parameters were lower in the affected eye. We observed lower tempe-ratures in the range of all tested parameters and areas in eyes with choroidal metastases. Eyes with diagnosed intraocular hemangioblastoma were characterized by higher parameters for the regions of interest versus eyes without this pathology. CONCLUSIONS: A thermographic examination of the eye can be used as an additional first-line diagnostic tool for the differentiation of intraocular tumors. Thermography can be a helpful tool in monitoring the treatment outcome in patients with intraocular melanoma.

Correlation analysis of cortisol concentration in hair versus concentrations in serum, saliva, and urine.

INTRODUCTION: Cortisol concentration is measured in blood, urine, and saliva samples. It has been recently proven that cortisol could also be detected in hair samples. Cortisol measurements in different samples have their own individual characteristics and clinical utility. We aimed to investigate the correlation between hair cortisol concentration and standard cortisol measurements used in clinical practice. MATERIAL AND METHODS: Fifty adult volunteers with a negative history of endocrine disorders were enrolled in the study. Morning serum cortisol (MSC), evening serum cortisol (ESC), evening free salivary cortisol (EFSC), urine free cortisol (UFC), and hair cortisol concentration (HCC) were analysed in all participants. Eventually, 41 volunteers were included into the study, whose cortisol concentration in the 1 mg overnight dexamethasone suppression test (1 mg ONDST) were < 50 nmol/L, and cortisol levels in serum, saliva, and urine were within reference ranges. Hair cortisol concentration test was performed for 20 mg of hair strands of the proximal 1 cm hair segments. RESULTS: Hair cortisol concentration ranged from 0.3036 to 2.65 nmol/mg, and the average value was 0.8125 ± 0.4834 nmol/mg. No significant correlations were found between HCC and MSC (rho = 0.04419, p = 0.7838), HCC and ESC (rho = -0.2071, p = 0.1938), HCC and EFSC (rho = 0.1005, p = 0.532), or HCC and UFC (rho = 0.1793, p = 0.262). CONCLUSIONS: This work is another step in the discussion on the application of HCC determinations in clinical practice. Our results have showed no correlations between HCC and single point cortisol assessment in blood, saliva, and urine in patients with reference cortisol levels.

Infrared thermography for the analysis of ocular surface temperature after phacoemulsification / Termografia infravermelha na análise da temperatura da superfície ocular após facoemulsificação

ABSTRACT Purpose: In this study, we present our observations on changes in the surface temperature of the cornea, eye, and orbital cavity after cataract surgery. Methods: A total of 39 patients who underwent cataract surgery based on phacoemulsification were enrolled. Temperature was measured at the center of the cornea, on the eye surface, and in orbital cavities using the FLIR T640 thermal imaging camera at days 1, 14, and 28 after cataract phacoemulsification and compared with preoperative baseline values. Results: The mean value of ocular surface temperature of the orbital cavity 14 days after cataract surgery was significantly different compared with the preoperative temperature (p£0.05). Temperature of the investigated areas showed a reduction, with the greatest decrease on day 14 after surgery, followed by an increase on day 28 after surgery, which was comparable to the temperature measured prior to surgery. Conclusions: The reduction in ocular surface temperature toward the end of post-cataract surgery follow-up may be associated with increased instability of the tear film after phacoemulsification. Therefore, patient awareness regarding the possibility of clinical symptoms of dry eye syndrome during the first month after surgery should be part of clinical management of cataract surgery. Ocular surface temperature did not increase after cataract surgery, suggesting the absence of significant inflammation, and the temperature about 1 month after cataract surgery was comparable to that before surgery. Nevertheless, the negative correlation between age and ocular surface temperature should be of concern in the elderly.

RESUMO Objetivo: Este artigo descreve observações sobre mudanças na temperatura da superfície da córnea, olho e cavidade orbital após a cirurgia de catarata. Métodos: 39 pacientes, previamente submetidos à cirurgia de catarata com base em facoemulsificação, foram incluídos no estudo. A temperatura foi medida no centro da córnea, na superfície do olho e nas cavidades orbitárias, com câmera de imagem térmica FLIR T640 nos dias -1, 14 e 28 após a facoemulsificação da catarata e comparada aos valores basais pré-operatórios. Resultados: Diferenças estatisticamente significantes foram encontradas apenas para o valor médio da temperatura superficial mediana da cavidade orbital 14 dias após a cirurgia de catarata, em comparação com a temperatura pré-operatória (p£0,05). A análise revelou uma tendência decrescente na temperatura das áreas investigadas, com a maior diminuição no 14º dia após a cirurgia, seguida por um aumento de temperatura comparável à medida antes da cirurgia no dia 28 após a cirurgia. Conclusões: A temperatura da superfície ocular após a cirurgia de catarata dimimuiu gradativamente até o final do acompanhamento pós-operatório. A queda de temperatura pode estar associada ao aumento da instabilidade do filme lacrimal. Cerca de um mês após a cirurgia de catarata, a temperatura superficial ocular foi comparável à temperatura medida antes da cirurgia. A temperatura superficial ocular não aumentou após a cirurgia de catarata, sugerindo que não houve aumento significativo na reação inflamatória. Houve uma tendência de correlação negativa entre a idade e a temperatura da superfície ocular. Devido ao aumento da instabilidade do filme lacrimal após a facoemulsificação, deve-se considerar informar o paciente sobre a possibilidade de sintomas clínicos da síndrome do olho seco durante o primeiro mês após a cirurgia.

Infrared thermography for the analysis of ocular surface temperature after phacoemulsification.

PURPOSE: In this study, we present our observations on changes in the surface temperature of the cornea, eye, and orbital cavity after cataract surgery. METHODS: A total of 39 patients who underwent cataract surgery based on phacoemulsification were enrolled. Temperature was measured at the center of the cornea, on the eye surface, and in orbital cavities using the FLIR T640 thermal imaging camera at days 1, 14, and 28 after cataract phacoemulsification and compared with preoperative baseline values. RESULTS: The mean value of ocular surface temperature of the orbital cavity 14 days after cataract surgery was significantly different compared with the preoperative temperature (p£0.05). Temperature of the investigated areas showed a reduction, with the greatest decrease on day 14 after surgery, followed by an increase on day 28 after surgery, which was comparable to the temperature measured prior to surgery. CONCLUSIONS: The reduction in ocular surface temperature toward the end of post-cataract surgery follow-up may be associated with increased instability of the tear film after phacoemulsification. Therefore, patient awareness regarding the possibility of clinical symptoms of dry eye syndrome during the first month after surgery should be part of clinical management of cataract surgery. Ocular surface temperature did not increase after cataract surgery, suggesting the absence of significant inflammation, and the temperature about 1 month after cataract surgery was comparable to that before surgery. Nevertheless, the negative correlation between age and ocular surface temperature should be of concern in the elderly.

Hair cortisol concentration in a population without hypothalamic-pituitary-adrenal axis disorders.

BACKGROUND: Measuring hair cortisol seems to be a good alternative to laboratory tests used thus far in routine endocrine diagnostics, primarily because it is independent of the circadian rhythm of cortisol. Due to the average hair growth of 1 cm per month, the results are related to the average blood cortisol levels over the previous weeks, months or years (depending on the length of the hair sample). OBJECTIVES: The aim of this study is an attempt to apply hair cortisol concentration (HCC) measurements to clinical endocrine diagnostics, based on reference cortisol concentrations in the blood in a population without disorders of the hypothalamic-pituitary-adrenal axis (HPA). MATERIAL AND METHODS: In the final selection process, 44 patients were enrolled in the study, all with negative interviews regarding disorders of the HPA and with reference levels of cortisol concentration obtained in routine laboratory tests. In the pre-analytic phase, we used 1 cm proximal hair strands cut from the posterior vertex area of the head, followed by the incubation of a 20 mg hair sample in methanol. The final cortisol measurement was done using an enzyme-linked immunosorbent assay (ELISA). RESULTS: The results of HCC ranged from 2 pg/mg up to 51.63 pg/mg. The diurnal decrease in cortisol levels was significantly lower in females than in males (p = 0.031), but we do not consider that difference to be clinically significant. The difference in the HCC between males and females was not statistically significant (p = 0.767). The linear regression coefficient for age was not statistically significant (p = 0.847). Neither the regression coefficients for gender nor the gender and age interactions were statistically significant (p = 0.815). CONCLUSIONS: Hair cortisol concentration measurement, unlike other endocrinological tests, gives information about the cortisol concentration in the long-term perspective. The results obtained in this study may be used as a reference for further research aimed at determining normal values of HCC.

Cushing's syndrome due to ectopic ACTH secretion.

Cushing's syndrome (CS) is defined as a constellation of clinical signs and symptoms occurring due to hypercortisolism. Cortisol excess may be endogenous or exogenous. The most common cause of CS is glucocorticoid therapy with supraphysiological (higher than in the case of substitution) doses used in various diseases (e.g. autoimmune). One possible CS cause is ectopic (extra-pituitary) ACTH secretion (EAS) by benign or malignant tumours. Since its first description in 1963, EAS aetiology has changed, i.e. as well as small cell lung cancer (SCLC), higher incidence in other malignancies has been reported. Ectopic ACTH secretion symptoms are usually similar to hypercortisolism symptoms due to other causes. A clinical suspicion of CS requires laboratory investigations. There is no single and specific laboratory test for making a CS diagnosis, and therefore multiple dynamic tests should be ordered. A combination of multiple laboratory noninvasive and invasive tests gives 100% sensitivity and 98% specificity for EAS diagnosis. If the EAS is caused by localised malignancy, surgery is the optimal treatment choice. Radical tumour excision may be performed in 40% of patients, and 80% of them are cured of the disease. The authors present an interesting clinical case of EAS, which is always a huge diagnostic challenge for clinicians. (Endokrynol Pol 2016; 67 (4): 458-464).

Recurrent acute suppurative thyroiditis due to pyriform sinus fistula in an adult--case report.

We present a case study of acute suppurative thyroiditis (AST) with frequent recurrence due to anatomical malformation described as pyriform sinus fistula (PSF). Difficulty in diagnosis and treatment may be explained by the rarity of the disease in adult patients. AST had been observed in our patient five times before a radical surgery treatment was performed. The most typical symptoms and signs in our patient include: fever, difficulty in swallowing and tender tumour in the left side of the neck. Computed tomography (CT), barium swallow study and endoscopic examination gave us an opportunity to confirm the presence of an anatomical abnormality. After fistulectomy, we have not observed AST up to the date of this publication.