BLOW-IN FRACTURE OF ORBITAL ROOF. CASE REPORT.

Orbital fractures may be accompanied with severe damage of the eye bulb and other intraorbital tissues. Early clinical findings can be very mild, therefore it is vital to actively seek not only for any damage done to the soft tissues of the orbit, but also for extraorbital complications such as liquorrhea or meningitis. We report a relatively rare case of blow-in fracture of orbital roof in eleven years old boy. Patient was admitted to the emergency care after falling off a bicycle without impaired consciousness. During admission ophthalmologist evaluated the condition as severe contusion of the left bulb, with hemophthalmia and retinal comotosis. Due to significant swelling of eye lids and periorbital hematoma, it was not possible to perform specific tests to objectify possible oculomotor disorder and diplopia. CT scan findings show dislocated fracture of orbital roof with fragments reaching into the musculus rectus superior. For high risk of bulbus penetration and muscle damage a surgical intervention with bone fragments removal was performed using endoscopic assisted frontal orbitotomy. After operation patient had no signs of functional eye disorder.

Saline injection to determine the volume required for personalised patulous Eustachian tube augmentation with long-standing material.

OBJECTIVE: There is currently no general consensus on patulous Eustachian tube management. Injection of autologous fat, cartilage or hydroxylapatite has been described for Eustachian tube occlusion, with promising results. However, complete resolution of symptoms is not achieved in all cases. This could be connected to the amount of material injected into the surroundings of the Eustachian tube, as this greatly differs among existing studies. Identifying the appropriate volume of injected material could be challenging because anatomical conditions vary among patients, and there is always a risk of chronic Eustachian tube obstruction and its related complications when too much long-standing material is injected.Case reportA case is presented wherein saline was injected under local anaesthesia to determine the volume required and to predict the success of patulous Eustachian tube augmentation with long-standing material. CONCLUSION: This approach could allow more personalised treatment and help identify patients likely to benefit from the procedure.

There is no correlation between signs of reflux laryngitis and reflux oesophagitis in patients with gastro-oesophageal reflux disease symptoms.

The objective of the present study was to determine if there is correlation between signs of reflux laryngitis (RL) and reflux oesophagitis (RE) in patients with gastro-oesophageal reflux disease (GORD) symptoms. Laryngeal photography obtained from patients during oesophagogastroduodenoscopy were examined by two otolaryngologists experienced in the field of extra-oesophageal reflux regarding the presence and severity of RL. The presence of RE was evaluated by gastroenterologist. Smokers, heavy drinkers and patients with bronchial asthma were excluded from the statistical analysis. A total of 681 patients were analysed. RL was diagnosed in 367 (53.9%) cases, of whom 182 patients had mild, 118 moderate and 67 severe (Reflux Finding Score > 7) RL. RE was diagnosed in 103 (28.1%) patients with RL and in 80 (25.7%) patients without RL. Neither the difference between the overall group of patients with RL and those without (OR 1.141, 95% CI 0.811-1.605, p = 0.448), nor the differences between the respective subgroups of patients with mild, moderate and severe RL and those without RL were statistically significant. The OR and 95% CI for mild, moderate and severe RL were 1.042, 95% CI 0.712-1.526, p = 0.834, 1.182, 95% CI 0.764-1.831, p = 0.453 and 1.0, 95% CI 0.566-1.766, p = 0.999 respectively. It can be concluded that there is no correlation between RL and RE in patients with GORD symptoms.

Laryngopharyngeal reflux and herpes simplex virus type 2 are possible risk factors for adult-onset recurrent respiratory papillomatosis (prospective case-control study).

OBJECTIVE: The human papillomavirus (HPV) causes recurrent respiratory papillomatosis (RRP). Although HPV prevalence is high, the incidence of papillomatosis is low. Thus, factors other than HPV infection probably contribute to RRP. This study investigated whether patients with papillomatosis are more often infected with herpes simplex virus type 2 and chlamydia trachomatis (ChT) and whether laryngopharyngeal reflux (LPR) occurs in this group of patients more often. DESIGN: Prospective case-control study. SETTING: Department of Otorhinolaryngology of University Hospital. PARTICIPANTS: The study included 20 patients with adult-onset RRP and 20 adult patients with vocal cord cyst and no pathology of laryngeal mucosa (control group). MAIN OUTCOME MEASURES: Immunohistochemical analysis of pepsin, HPV, herpes simplex virus type 2 and ChT was performed in biopsy specimens of laryngeal papillomas and of healthy laryngeal mucosa (control group) obtained from medial part of removed vocal cord cyst during microlaryngoscopy procedures. RESULTS: Pathologic LPR (pepsin in tissue) was diagnosed in 8/20 (40.0%) patients with papillomatosis and in 0/20 control patients (P = .003). Herpes simplex virus type 2 was present in 9/20 (45.0%) patients with papillomatosis and in 0/20 control patients (P = .001). Five specimens were positive for both pepsin and herpes simplex virus type 2. No samples were positive for ChT. There were no significant differences between groups for age, body mass index, diabetes mellitus and gastrooesophageal reflux disease. Tobacco exposure was not more frequent in RRP group either (P = .01). CONCLUSIONS: Results show that LPR and herpes simplex virus type 2 are significantly more often present in patients with RRP. LPR and herpes simplex virus type 2 might activate latent HPV infection and thereby be possible risk factors for RRP.

Effect of repeated Ribavirin treatment on grapevine viruses.

The effect of Ribavirin treatment for the chemotherapy of several grapevine viruses was evaluated. Four grapevine cultivars were repeatedly treated with Ribavirin in two different concentrations and with three different lengths of treatment. Repeating the Ribavirin treatment always had a significant effect on the number of healthy grapevine plants obtained. Ribavirin concentration and length of exposure showed a significant difference in sanitation of the Grapevine rupestris stem pitting-associated virus. During sanitation of the Grapevine Pinot gris virus and Grapevine fleck virus, those two factors did not show significant differences in the elimination of grapevine viruses.

[Comparing of Treatment Results of Monocanalicular and Bicanalicular Intubation in Inborn Lacrimal Duct Obstruction]. / Srovnání lécebných výsledku monokanalikulární a bikanalikulární intubace u vrozené nepruchodnosti slzovodu.

PURPOSE: To compare the success rate of monocanalicular (MI) and bicanalicular intubation (BI) in congenital nasolacrimal duct obstruction (CNLDO). METHODS: MI through the inferior canaliculus and BI were performed under general anaesthesia in children from 7 to 24 months old with CNLDO. Only children after unsuccessful conservative therapy and two and more probings were included in the study. The tubes were removed 3 months after intubation and the therapeutic success was evaluated 6 months after intubation. RESULTS: There were performed 139 MI in 114 children and 119 BI in 88 children. The success rate 6 months after intubation is 135/139 (97.1%) in MI, 114/119 (95.8%) in BI and the difference in therapeutic results between MI and BI is not significant (p = 0.737). CONCLUSION: Silicone intubation is an effective procedure for treating CNLDO without difference in therapeutic success between MI and BI.Key words: congenital nasolacrimal duct obstruction (CNLDO), monocanalicular intubation (MI), bicanalicular intubation (BI).

[Value of narrow band imaging endoscopy in detection of early laryngeal squamous cell carcinoma]. / Vyuzití Narrow Band Imaging v dia-gnostice casných karcinomu hrtanu.

BACKGROUND: Narrow band imaging (NBI) is an endoscopic method using filtered wavelengths in detection of microvascular abnormalities associated with preneoplastic and neoplastic changes of the mucosa. The aim of the study is to evaluate the value of NBI endoscopy in the dia-gnosis of laryngeal precancerous and early stages of cancerous lesions and to investigate impact of NBI method in prehistological diagnostics in vivo. MATERIALS AND METHODS: One hundred patients were enrolled in the study and their larynx was investigated using white light HD endoscopy and narrow band imaging between 6/ 2013- 10/ 2014. Indication criteria included chronic laryngitis, hoarseness for more than three weeks or macroscopic laryngeal lesion. Features of mucosal lesions were evaluated by white light endoscopy and afterwards were compared with intra-epithelial papillary capillary loop changes, viewed using NBI endoscopy. Suspicious lesions (leukoplakia, exophytic tumors, recurrent respiratory papillomatosis and/ or malignant type of vascular network by NBI endoscopy) were evaluated by histological analysis, results were compared with prehistological NBI dia-gnosis. RESULTS: Using NBI endoscopy, larger demarcation of pathological mucosal features than in white light visualization were recorded in 32/ 100 (32.0%) lesions, in 4/ 100 (4.0%) cases even new lesions were detected only by NBI endoscopy. 63/ 100 (63.0%) suspected lesions were evaluated histologically -  malign changes (carcinoma in situ or invasive carcinoma) were observed in 25/ 63 (39.7%). Prehistological diagnostics of malignant lesions using NBI endoscopy were in agreement with results of histological examination in 23/ 25 (92.0%) cases. The sensitivity of NBI in detecting malignant lesions was 89.3%, specificity of this method was 94.9%. CONCLUSION: NBI endoscopy is a promising optical technique enabling in vivo differentiation of superficial neoplastic lesions. These results suggest endoscopic NBI may be useful in the early detection of laryngeal cancer and precancerous lesions.

[Stevens-Johnson syndrome - a case report]. / Stevensuv-Johnsonuv syndrom-kazuistika.

Stevens-Johnson syndrome (SJS) is a severe skin and mucosal condition, with eruption of hemorrhagic vesiculous to bullous lesions, caused by hypersensitive reaction to certain drugs; rarely, it can be parainfectious. SJS is a minor form of toxic epidermal necrolysis, with involvement of less than 10 % of the skin surface. Cutaneous and mucosal lesions are caused by necrosis of epithelial cells induced by T lymphocytes. The diagnosis is based on clinical features but it has to be confirmed by histologic and immunohistologic examination of the lesions. The treatment consists of high doses of systemic corticosteroids and particularly thorough local, supportive and symptomatic therapy. The authors present a case of parainfectious SJS and discuss the latest knowledge about SJS as well as therapeutic options.

Hyperfractionated accelerated radiotherapy with concomitant integrated boost of 70-75 Gy in 5 weeks for advanced head and neck cancer. A phase I dose escalation study.

BACKGROUND AND PURPOSE: The present study was performed to evaluate the feasibility of a new, 5-week regimen of 70-75 Gy hyperfractionated accelerated radiotherapy with concomitant integrated boost (HARTCIB) for locally advanced, inoperable head and neck cancer. METHODS AND MATERIALS: A total of 39 patients with very advanced, stage IV nonmetastatic head and neck squamous cell carcinoma (median gross tumor volume 72 ml) were included in this phase I dose escalation study. A total of 50 fractions intensity-modulated radiotherapy (IMRT) were administered twice daily over 5 weeks. Prescribed total dose/dose per fraction for planning target volume (PTV(tumor)) were 70 Gy in 1.4 Gy fractions, 72.5 Gy in 1.45 Gy fractions, and 75 Gy in 1.5 Gy fractions for 10, 13, and 16 patients, respectively. Uninvolved lymphatic nodes (PTV(uninvolved)) were irradiated with 55 Gy in 1.1 Gy fractions using the concomitant integrated boost. RESULTS: Acute toxicity was evaluated according to the RTOG/EORTC scale; the incidence of grade 3 mucositis was 51% in the oral cavity/pharynx and 0% in skin and the recovery time was ≤ 9 weeks for all patients. Late toxicity was evaluated in patients in complete remission according to the RTOG/EORTC scale. No grade 3/4 late toxicity was observed. The 1-year locoregional progression-free survival was 50% and overall survival was 55%. CONCLUSION: HARTCIB (75 Gy in 5 weeks) is feasible for patients deemed unsuitable for chemoradiation. Acute toxicity was lower than predicted from radiobiological models; duration of dysphagia and confluent mucositis were particularly short. Better conformity of radiotherapy allows the use of more intensive altered fractionation schedules compared with older studies. These results suggest that further dose escalation might be possible when highly conformal techniques (e.g., stereotactic radiotherapy) are used.

[Transnasal endoscopic surgery approach in intraorbital tumors]. / Transnazální endoskopická chirurgie nádoru ocnice.

OBJECTIVES: To determine the role of transnasal endoscopic approach to orbital lesions. METHODS: Retrospective case series. RESULTS: Three patients underwent endoscopic diagnostic surgery for orbital lesions. In all three patients was successfully finded out the diagnosis, the orbita was decompressed. In two cases it resulted to visual recovery, in one case was determine a diagnosis of metastatic adenocarcinoma. In one case the tumor was removed totally. CONCLUSION: Using endoscopic approach to the orbit allowed good approach to the biopsy of orbital lesions, allowed decompression an in limited count of cases this access allowed a complete tumour removal. On the other hand, generally endoscopic approach is useful only for limited lesions (extraconal), usually it allowed only debunking, not the complete resection of orbital pathology.

Revison endonasal dacryocystorhinostomies: analysis of 44 procedures.

PURPOSE: To determine the success rate of revision endoscopic dacryocystorhinostomies (DCR) and to analyse 44 revision DCRs. METHODS: The operative and postoperative data were collected in 44 revision DCRs. The corrections of associated structural anatomic alterations were performed during the surgery (resection of the scarr, the bone window creating, resection of the head of the middle turbinate, septoplasty, ethmoidectomy etc.) and the intubation was performed in all cases. RESULTS: The follow-up interval ranged from 12 to 36 months. The 44 ReEDCRs were performed in adults and there were only 5 children under the age of 15. The surgery was performed under local or general anaesthesia. The most frequent secondary procedures were scar resections, creating a wider bone window, and partial middle turbinate resection. Four patients were excluded for their follow-up periods had not been completed. An average time of the tubes removal was 5.6 months. The total success rate was 84.0%; the success rate was 85.7% in the group with closed rhinostomy and 1/2 in the group of canalicular and rhinostomy obstructions. CONCLUSIONS: The endonasal revision DCR is a safe and very effective surgical procedure following the failed DCRs. The correction of associated structural anatomic alterations that may be involved in the failure of previous surgeries can be easily performed.

Analysis of multiple virus-infected grapevine plant reveals persistence but uneven virus distribution.

LN33 grapevine plants were artificially inoculated with budwoods originating from a field-cultivated Traminer grapevine which was naturally infected with Grapevine leafroll-associated virus 1 (GLRaV-1), Grapevine virus A (GVA), Grapevine virus B (GVB), Rupestris stem pitting-associated virus (RSPaV), and an unclassified tymovirus. Four years after inoculation, a comparison of the cane weights between healthy and infected grapevines did not show any significant difference. Corky bark symptoms or destructive effects of GVB infection never appeared on the infected grapevines. Dormant canes, sampled before the beginning of the vegetation period, were used for detection of grapevine viruses by ELISA or RT-PCR. ELISA turned out unexpectedly to be more effective than RT-PCR for detecting GLRaV-1 probably due to an insufficient specificity of the primers used, not reflecting the actual genetic variability of the virus. Distribution of viruses in the infected grapevines showed a different degree of irregularity in dependence on individual viruses. Therefore, in order to properly verify the sanitary status of grapevines under testing, several random samples from different parts of a tested plant have to be analyzed.

[Bilateral simultaneous dacryocystorhinostomy and conjunctivocystorhinostomy]. / Oboustranná simultánni dakryocystorinostomie a konjunktivocystorinostomie.

In patients with bilateral symptoms of lacrimal pathways occlusion, the endonasal dacryocystorhinostomy (EDCR) and conjunctivo-dacryocystorhinostomy (CDCR) may be performed simultaneously or consequently. The simultaneous bilateral surgery does not worsen the surgery results. The advantages of this procedure are one anesthesia only, only unsubstantial extension of the surgery duration, and shorter sick leave as well. The authors performed during the period from 1995 to 2007 altogether 630 primary EDCRes and 117 CDCRes. In 92 patients, 184 simultaneous dacryocystorhinostomies were performed. Out of 164 evaluated surgeries, the good results were obtained in 150 cases (91.5 %). Out of 40 simultaneously performed CDCRes (20 patients), they were successful in 14 patients. Unsuccessful they were in 3 patients in whom the silicone drainage implant was used.

Partial molecular characterization of a mild isolate of Grapevine fanleaf virus from South Moravia, Czech Republic.

An atypical mild isolate HV5 of Grapevine fanleaf virus (GFLV) was found in a South Moravian viticulture region in Czech Republic. Partial sequence of its RNA2 was determined and compared with available sequences of typical GFLV isolates. Two genomic regions, namely a 814 nt-long one spanning the movement protein (MP) gene and a 5'-part of the coat protein (CP) gene. and a 1426 nt-long one covering a part of the CP gene and the adjacent 3'-non-coding region (3'-NCR) were analyzed. Although no HV5-specific molecular features could be found in the two regions, marked differences were observed in the 3'-NCR. There was a 54 nt-long portion in which the sequence identity of some compared isolates was only 54.7%. Moreover, an unique one-nucleotide deletion occurred in the HV5 3'-NCR. These changes were also reflected in the predicted RNA secondary structure of this region. Particular biological behavior of GFLV HV5 isolate, namely a symptomless infection, could be related to the observed molecular differences.

Comparison of three techniques for detection of grapevine leafroll-associated virus 1.

Thirty seven plants of grapevine from the Research Station of Viticulture, Karlstejn was examined for the presence of leafroll viruses. Grapevine leafroll-associated virus 1 (GLRaV-1) was detected in the grapevines plants tested using double-antibody sandwich ELISA (DAS-ELISA), RT-PCR and molecular hybridization with non-radioactive RNA probes. Both molecular methods were based on a detection of the GLRaV-1 heat-shock protein 70 (HSP70) gene and showed a higher sensitivity in the detection of GLRaV-1 compared to DAS-ELISA. RNA probes are considered more suitable for the GLRaV-1 detection, as their application can overcome potential minor sequence variability, which may cause the detection by RT-PCR less reliable, especially when the variability occurs in the genome region targeted by RT-PCR primers. Based on additional DAS-ELISA, a mixed infection of GLRaV-1 and Grapevine leafroll-associated virus 3 (GLRaV-3) occurred frequently, while a mixed infection of GLRaV-1 and Grapevine virus A (GVA) or Grapevine fleck virus (GFkV) or a multiple infection of GLRaV-1, GLRaV-3 and GFkV occurred rarely in the tested plants. A mixed infection of all the four viruses mentioned above was not observed.

[Conjunctivocystorhinostomy--seven years of experience--part I (Description of the surgery, groups of patients)]. / Konjunktivocystorinostomie--sedmileté zkusenosti I (Popis operace, sestava).

The principle of conjunctivocystorhinostomy according to Jones consists in creating new way (tunnel) between the conjunctival sac and the nasal cavity where the drainage of tears is possible through a hollow tube made from allogenic material implanted into the tunnel. The main indication for performing the conjunctivocystorhinostomy is the obliteration of the proximal part of both lacrimal canaliculi. The operation consists of two parts--dacryorhinostomy (DCR) and the insertion of the draining tube. DCR may be performed from an external access, or from an endonasal access, which is preferred by the authors. Authors present altogether 74 surgeries, which were performed during the period of 1996-2002 in 59 patients, (55 women, 19 men) mostly in the group of 51-60 years of age. During the surgery, they use the glass tubes only, because, in contrast to the silicone ones, they become not to be obstructed. In 11 cases the loss of the tubing occurred. To prevent the possibility of the loss and the migration of the tube, the authors fixate it always with a stitch to the lower eyelid.

[Conjunctivocystorhinostomy--seven years of experience--part II (Commentary)]. / Konjunktivocystorinostomie--sedmileté zkusenosti II (Komentár).

The authors answer the frequent questions concerning conjunctivo-cystorhinostomy (CDCR) according to Jones. The surgery is successful in 80-90%. The minimal age for the surgery is 10 years of age; patients 70 years old and older tolerate the operation less well. The basic prerequisite for its indication is good motivation of the patient. In the glass tube, the obstruction is not common, and there is the reason why the authors prefer them. The tube remains in situ during the whole life. In contrast to dacryocystorhinostomy, in CDCR the complication ratio is higher--up to 2/5 of patients. Fixation of the tube to the eyelid with a stitch lowers the number of commonest complications (loss and migration of the tube medially).