Expression of vascular endothelial growth factor and microvascular density assessment in different histotypes of basal cell carcinoma.

PURPOSE: In this study, we investigated the expression of vascular endothelial growth factor (VEGF) and tumor microvascular density (MVD) in different histotypes of basal cell skin carcinoma (BCC). METHODS: We used a total 101 histological archival specimens, including superficial, nodular, cystic, keratinocytic, adenoid infiltrative types and cases of metatypical BCC. Routine hematoxylin/eosin (H&E) and immunohistochemical ABC method with NOT AE1/AE3, anti VEGF anti CD34 antibodies were used. VEGF expression in tumor cells was studied in relation to the BCC histotype and demographic characteristics. For statistical analysis ANOVA (F test), Student's t-test, and Karl Pearson coefficient were used. RESULTS: VEGF expression was significantly lower in the superficial histotype compared to all other types of BCC. No significant difference in VEGF expression between infiltrative, metatypical, adenoid and nodular types was found, but the highest expression of VEGF was seen in the infiltrative and metatypical types. Significantly higher MVD was found in infiltrative, adenoid, metatypical and nodular types. CONCLUSION: Our results suggest that the angiogenic potential of BCC correlated with tumor histotype, and histological growth pattern BCC enable distinction of the patients with increased risk of recurrence and / or metastasis.

Quality of Life of Children Engaged in Regular Physical Activities.

Background: We aimed to examine the quality of life of children who engage in regular physical activities. Methods: We conducted a cross-sectional study with intersectional 301 children (182 boys and 119 girls) involved in regular sporting activities and the control group of 100 children (67 boys and 33 girls), not involved in extracurricular sports. Children in both groups were from 8 to 13 years, attending elementary school, and without any associated illnesses. The quality of life (QOL) was assessed using the Quality of Life questionnaire Kidscreen-27 version for parents. For comparison of groups, we used χ2 test, and for comparison of mean values among groups we used ANOVA test. Results: More boys were engaged in sport than girls and the choice of sport is gender-dependent (P<0.01). Boys preferred collective sports, while girls were more oriented towards individual sports (P<0.01). A significant statistical difference in the mean values of the socializing dimension was given to children who trained football (P=0.04) and basketball (P=0.02). In children engaged in volleyball, a statistical difference in the mean values was observed in all dimensions of the questionnaire. In children who trained water polo, a statistically significant difference in the mean values for dimensions of health (P<0.01), mood (P<0.01) and friendship (P=0.01) was seen. Conclusion: KIDSCREEN scores were significantly higher in the examined group than in the control group, with a statistically significant difference between scores for different sports. Children involved in regular extracurricular physical activities had better QOL.

Vascular changes in the retina in patients with chronic respiratory insufficiency.

BACKGROUND/AIM: Chronic respiratory insufficiency is a pathological state which occurs as a result of respiratory system inability to maintain normal gas exchange between the outside air and circulating blood. For the purposes of human organism's proper functioning, it is necessary that a certain amount of air in the lungs comes into contact with a certain amount of blood within a unit of time, so that an adequate hemoglobin oxygenation could be achieved. Then, hemoglobin from erythrocytes in the blood supply delivers oxygen to all the tissues and cells of the body including the eye. Direct impact of hypoxemia and hypercapnia on the wall of arterioles, venules and capillaries results in a severe vasodilatation along with the increased permeability of the walls causing clinically evident changes in the retina. The aim of this study was to determine the degree of ocular changes in retina with patients suffering from chronic respiratory insufficiency. METHODS: A prospective study was conducted on 80 patients, 40 patients with respiratory failure and 40 patients with chronic obstructive pulmonary disease an and bronchial asthma (the control group). In all the patients direct and indirect ophthalmoscopy and fluoresceine angiography was performed. Clinically visible fundus and retina changes in patients suffering from chronic respiratory failure were categorized as mild (dilatation and retinal veins and arteries tortosion up to the mid-periphery), moderate (retinal hemorrhage) and severe (optic nerve edema, macular edema, superficial and deep retinal hemorrhages and venous occlusion). RESULTS: In the patients suffering from respiratory insufficiency the changes in retinal blood vessels were found [in 18 (45%) mild, in 13 (32.5%) moderate, and in 9 (22%) severe], while in the patients with chronic obstructive pulmonary disease and bronchial asthma (without respiratory insufficiency) no changes were recognized. CONCLUSION: The results of this study indicate the need for ophthalmologic examination in patients with chronic respiratory insufficiency. It is important to recognize, identify and quantify the changes on retinal blood vessels which are clinically significant. It is necessary to provide their monitoring and to prescribe proper therapeutic treatment in order to preserve visual functions.

Evaluation of central corneal thickness in patients with ocular hypertension and primary open-angle glaucoma.

AIM: To determine correlation between central corneal thickness (CCT) and applanation intraocular pressure (IOP) in normal patients with primary open angle glaucoma and patients with ocular hypertension. METHODS: Two-year retrospective study designed to determine correlation between CCT and IOP. Records of 121 patients were included in the study. Inclusion criteria were: IOP higher than 22 mm Hg for a group with ocular hypertension but without functional, morphological damage and progression, diagnosis of glaucoma for a group with open-angle glaucoma and normal ophthalmological results for a control group. Patients who were mono-oculus, patients with secondary glaucoma and who had surgical treatment were excluded. The patients were selectively grouped according to types of glaucoma, by gender and age. The IOP values were measured by Goldman's applanation tonometer, CCT values were determined using ultrasonic pachymeter, in the period from January 2011 to December 2012. RESULTS: Of total 121 subjects, 51 had primary open angle glaucoma (POAG), 40 had ocular hypertension (OHT) and 30 had normal ophthalmological findings (control group). The CCT values in OHT group 529.37+/-25.18 µm were greater than of both POAG, 501.02+/-14.04 µm and control group, 497.37+/-14.90 µm. The IOP values in OHT group were 20.25+/- 3.62 mm Hg, and in POAG group were 18.25+/-2.70 mm Hg, while in the control group they were 13.53+/- 3.62 mm Hg. CONCLUSION: Determination of CCT in patients with glaucoma is crucial, considering its impact on IOP values, which represents a parameter in glaucoma diagnosis, as well as monitoring further progress of ocular hypertension and patients diagnosed with glaucoma.

Congenital blindness and visual impairment cause infection or non infection.

CONFLICT OF INTEREST: none declared. INTRODUCTION: Authors are from reference documentation to archive at Organization of Federation of blind and visually impaired in central Serbia (Kragujevac), by retrograde analysis, of 2007-2012, comprehend two groups by etiology-clinical characteristics of congenital blindness and visually impaired, caused infection or non infection example. AIM: to analyze relationship between infectious and non infectious of congenital blindness and visually impaired in our referent region and compare with world references. MATERIAL/METHODS: With 6-years analysis included the most frequency cases of congenital blindness and visually impaired in two groups, according to presence or absence infectious causes. From infectious causes of congenital blindness and visually impaired are included: CMV - infection, congenital rubella syndrome, congenital toxoplasmosis, congenital syphilis and rare mixed syndrome. From non infectious causes are included: retinitis pigmentosa, retinopathy prematurity, primary congenital glaucoma, Leber's congenital amaurosis and rare syndrome. RESULTS: From total number of registered blind and visually impaired - 1308 (100%), over the last 6 years, the registration was 349 (26.68%) with congenital blindness and visually impaired. From recorder with the number of the most common congenital blindness and visually impaired-194 (55.59%) with infections cause, and 155 (44.41%) non infection cause. CONCLUSION: Congenital blindness has shown permanent increase in past 6 years, in group with infectious and with non infectious causes. Congenital blindness and visually impaired of the most common etiology among registered members of our association in Kragujevac is subject of our correlation and global trends mentioned observation of these diseases.

[Clinical evaluation of Graves ophthalmopathy].

INTRODUCTION: Graves ophthalmopathy is an autoimmune disease, which is the consequence of thyroid dysfunction. Ocular manifestations occur in 50% of patients with Graves disease. The changes occur due to the inflammatory cell infiltration of retrobulbar fat tissue and extraocular muscles. Ultrasonography of eye orbit provides important information about the condition of retrobulbar adipose tissue and the thickness of extraocular muscles. OBJECTIVE: The aim of our study was to show the clinical significance of orbital ultrasonography in the diagnostics and follow-up of patients with Graves disease. METHODS: The authors examined 154 patients with Graves ophthalmopathy at the Clinic of Ophthalmology of the Clinical Centre in Kragujevac during the period 2008-2010. Ophthalmological examination included visual acuity testing (Snellen chart), biomicroscopy and applanation tonometry, direct and indirect ophthalmoscopy, dry eye testing and exophthalmometry (Hertel). Orbital ultrasonography examination and extraorbital muscle measurement was done by ultrasound B-scan. RESULTS: The disease was more frequent in women (79.87%) aged from 36-45 years. Most patients had hyperthyreoidism (54.55%). In relation to the duration of the disease, the most frequent clinical signs were bilateral ptosis, conjunctival chemosis and periorbital edema. According to our data the highest number of patients had enlarged medial straight muscle. CONCLUSION: Graves ophthalmopathy is the most frequent sign of thyroid disease. By orbital ultrasonography we detected extended echogram and measured the thickness of the extraocular muscle. Computerized tomography and magnetic resonance scan were utilized for cases of insufficiently manifested clinical signs of the disease. The advantages of ultrasonography lie in easy handling, patients' comfort, short time of examination and possibilities of repetition.

Cyclocryotherapy in neovascular glaucoma treatment.

The main goal in the struggle with neovascular glaucoma is to control intraocular pressure (IOP) and pain. 152 patients, e.g., 203 eyes, were examined at the Clinic of Ophthalmology, Clinical Centre of Kragujevac, Serbia, in period between 01. 01. 2005 - 31. 12. 2010. Cyclocryoanemisatio was performed for all patients. Measurments of IOP showed statistical significant changes before and after the treatment for every patients. There was no difference in sex distribution, but a difference was noted in age distribution. Early posttreatment complications included hyphema, fibrin's exudation, chemosis. Cyclocryotherapy is usefull and accessible method for control of intensive pain in neovascular glaucoma.

Prostatic carcinoma bilateral iris metastases.

We described a patient with bilateral iris metastases resulted from prostatic cancer. Slit lamp and ultrasonography examination of the both eye demonstrated tumor of the iris, as an amelanotic vascular mass located on the superior temporal quadrant. On open biopsy revealed undifferentiated tissue that stained strongly positive for prostate carcinoma, confirming the diagnosis of metastasis prostate adenocarcinoma. Early diagnostic procedures are essential for the causal therapy of prostate carcinoma as the primary neoplasm.

[Epidemic keratoconjunctivitis].

INTRODUCTION: Keratocnjunctivitis is corneal and conjunctival inflammation. Clinical signs involve the irritating trio: mixed hyperemia of conjunctival membranes, corneal subepthelial infiltrates and regional lymphadenopathy. The most common causes of epidemic are adenovirus, herpes virus, and rarely cytomegalovirus, which are now occurring with higher frequency as secondary infections. OBJECTIVE: The aim of the study was to present and analyze keratoconjunctival epidemics in the region of Kragujevac from September 2008 to February 2009, as well as to analyze clinical features related to virusological findings and etiology. METHODS: In 329 patients we performed clinical examination (biomicroscopy, fluorescent test, corneal sensitivity test), collecting standard specimen of the conjuctiva and cornea, made serological examination, and sent the specimens to the Virusology Institute "Torlak" in Belgrade for the confirmation of epidemic etiology. The patients were treated with local and symptomatological therapy. The epidemic was eradicated in cooperation with a regional referent institution. All outpatients activities were ceased, while hospital hygienic, sanitary, intra-, extra-hospital and therapeutic procedures were undertaken. RESULTS: The distribution of 329 patients by gender was equivalent. Most patients were aged from 27 to 34 years (25%) of working population. The distribution of patients by clinical features showed the predominance of follicular hyperplasy (93.62%). The distribution according to the time of the first symptoms onset showed the frequency of 50% of corneal infiltrate in the second week. The period elapsed from the diagnosis to cure was three weeks in 50% of patients. Serological tests confirmed the mixed distribution of the cause. CONCLUSION: Based on the authors' experience, in order to eradicate epidemics as fast as possible and achieve efficient treatment, it is recommended that the epidemic should be reported, guidelines of referent institutions be obeyed, all of which diminishes the recognizable professional risk and decreases mistakes.

Bilateral retinal detachment in a case of preeclampsia.

Serous retinal detachment is an unusual cause of visual loss in preeclampsia. We report the case of 24-years-old primipara with severe preeclampsia who developed bilateral serous retinal detachment a few hours after delivery. A few weeks after delivery there was spontaneous resorption of the subretinal fluid and complete resolution bilateral serous retinal detachment, with residual pigmentary changes of the retinal pigment epithelium. Visual acuity was normal in each eye. The management of retinal detachment as a complication in preeclampsia is conservative and the prognosis is usually good.

Tumor of orbit / Tumor orbitário

The cavernous hemangiomas are the most common intra orbital tumors found in adults of the middle age. Although histological benign, they can encroach on intra orbital or the adjacent structures (optic nerve) and be considered anatomically or positional malignant. We present a case report of orbital cavernous hemangioma of right orbit in young women after pregnancy, from Topola near Kragujevac (Central Serbia) with visual compromise and it's by trans-nasal endoscopic surgical management. Our patient was controlled and treated with the symptomatic therapy, topical therapy with artificial tears and surgical treatment. Our patient has optimal visual acuity of affected right eye after surgical treatment of orbital tumor. Surgical treatment of symptomatic orbital cavernous hemangioma is safe and effective, so that the cosmetic results are the important parameter to evaluate the clinical outcome.

Os hemangiomas cavernosos são os tumores intraorbitais mais comuns encontrados em adultos de meia-idade. Embora histológico benigno, eles podem invadir a área orbital ou intraorbital ou ainda as estruturas adjacentes (nervo óptico) e ser considerado anatomicamente ou posicional maligno. Apresentamos um relato de caso de hemangioma cavernoso orbital da órbita direita em mulheres jovens após a gravidez, a partir de Topola perto Kragujevac (Central Sérvia), com comprometimento visual e medicado por tratamento cirúrgico endoscópico transnasal. O paciente foi controlado e tratado com terapia, terapia tópica sintomático de lágrimas artificiais e tratamento cirúrgico. Nosso paciente tem acuidade visual ideal do olho direito afetada após o tratamento cirúrgico de tumor orbital. O tratamento cirúrgico do sintomático hemangioma cavernoso orbital é segura e eficaz, de modo que os resultados cosméticos são o parâmetro importante para avaliar o resultado clínico.