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Abstract The Aria cryogenic distillation plant, located in Sardinia, Italy, is a key component of the DarkSide-20k experimental program for WIMP dark matter searches at the INFN Laboratori Nazionali del Gran Sasso, Italy. Aria is designed to purify the argon, extracted from underground wells in Colorado, USA, and used as the DarkSide-20k target material, to detector-grade quality. In this paper, we report the first measurement of argon isotopic separation by distillation with the 26 m tall Aria prototype. We discuss the measurement of the operating parameters of the column and the observation of the simultaneous separation of the three stable argon isotopes: $${}^{36}\hbox {Ar}$$ 36 Ar , $${}^{38}\textrm{Ar}$$ 38 Ar , and $${}^{40}\textrm{Ar}$$ 40 Ar . We also provide a detailed comparison of the experimental results with commercial process simulation software. This measurement of isotopic separation of argon is a significant achievement for the project, building on the success of the initial demonstration of isotopic separation of nitrogen using the same equipment in 2019.

Despite the increasing number of applications of nano-sized particles (NP), there is a lack of systematic basic experimental studies on the physical basics of the interactions between NP and cell membranes. Here, we follow a bottom-up approach and investigate the intake of silica NP by giant unilamellar vesicles. We observe a massive nanoparticle uptake by fluid phase vesicles, but only above a specific ionic strength of the surrounding buffer solution. The uptake rates increase for decreasing NP size and increasing NaCl concentration. A correlation of ionic strength and adhesion force between the lipid membrane and the NP can explain this dependency. We discuss these effects employing a model which considers NP diffusion and an effective membrane permeability due to uptake-induced pores. Our findings contribute to a deeper understanding of the physics behind NP-membrane interactions as well as endocytotic particle uptake in living cells. [ABSTRACT FROM AUTHOR]

The objective of this study was to assess subsequent contralateral slip (SCS) in the unaffected hip in patients with primary unilateral slipped capital femoral epiphysis (SCFE) using three radiographic parameters: posterior sloping angle (PSA), center-edge angle (CEA) and triradiate cartilage (TC) appearance. A total of 152 patients admitted to two pediatric units between 2001 and 2015 were divided into three groups: A - underwent prophylactic fixation of the unaffected hip at the time of index surgery- high clinical risk of SCS; B - no clinical risk factors but SCS occurred; C - no issues regarding the contralateral hip during follow-up. The mean PSA for groups A, B and C were 22°(6-49), 17°(9-24) and 13°(0-27), respectively. PSA was significantly higher in Group A than in Group C ( P < 0.0001). The differences in PSA between groups A and B, but also B and C were insignificant ( P = 0.12 and p=0.21, respectively). The mean CEA in groups A, B and C was 33(25-43), 35(26-42) and 37(17-53), respectively. CEA did not differ significantly between groups A, B and C ( P = 0.25). Assessment of TC did not differ significantly between the groups ( P = 0.66). Observation of TC in groups B and C combined revealed that the cartilage was open in 65% of 77 patients and 14% of them developed SCS; whereas among the 35% of patients with ossified TC only 7% developed SCS (OR=2.0). PSA and CEA alone have no predictive value in determining the risk of contralateral slip. The absence of TC results in a two-fold decrease in the likelihood of developing an SCS. The decision of prophylactic surgical treatment of the contralateral hip in primary unilateral SCFE should not be based solely on radiographic findings., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

The study evaluated femoroacetabular impingement (FAI) in the unpinned contralateral hip in patients with unilateral slipped capital femoral epiphysis (SCFE) and verified initial age, posterior sloping angle (PSA) and center-edge angle (CEA) as predictors of FAI in the contralateral hip. 152 patients with unilateral SCFE with a mean index age of 13.2 years (8.2-17.2 years) were enrolled retrospectively into the study. Mean follow-up was 8 years (3-14 years). PSA and CEA were measured on initial radiographs of the unaffected hip. Alpha-angle and CEA were measured on radiographs taken at the last follow-up to identify FAI. Four groups of patients were distinguished: (1) no FAI (10 patients, 17.54%); (2) CAM-type FAI (41 patients, 71.9%); (3) pincer-type FAI (3 patients, 5.26%) and (4) mixed-type FAI (13 patients, 22.8%). The mean PSA was 12.1°, 12°, 16.8°, 11.9° for groups 1, 2, 3 and 4, respectively, with no significant difference ( P  = 0.65). The mean initial CEA for groups 1, 2, 3 and 4 was 34.4°, 35.5°, 42° and 42° respectively, with significant differences between groups 1 versus 4 ( P  = 0.034) and 2 versus 4 ( P  = 0.009). Conclusions are as follows: 1. Radiographic features of FAI were present in 85.1% of unpinned contralateral hips in patients with unilateral SCFE. 2. 71.9% of unpinned contralateral hips developed CAM deformity. 3. CEA can be used in predicting pincer-type FAI in the contralateral hip in unilateral SCFE. 4. PSA and age revealed negligible value in predicting FAI., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

The aim of this study was to evaluate the results of surgical treatment of developmental dysplasia of the hip (DDH) with periacetabular osteotomy (PAO) and determine the values of radiological parameters that would allow us to obtain an optimal clinical result. Radiological evaluation included determining the center-edge angle (CEA), medialization, distalization, femoral head coverage (FHC), and ilioischial angle as measured on a standardized AP radiograph of the hip joints. Clinical evaluation was based on the HHS, WOMAC, Merle d'Aubigne-Postel scales and Hip Lag Sign. The results of PAO presented decreased medialization (mean 3.4 mm), distalization (mean 3.5 mm), and ilioischial angle (mean 2.7°); improvement in femoral head bone cover; an increased CEA (mean 16.3°) and FHC (mean 15.2%); clinically increased HHS (mean 22 points) and M. Postel-d'Aubigne (mean 3.5 points) scores; and a decrease in WOMAC (mean 24%). HLS improved in 67% of patients after surgery. Qualification of patients with DDH for PAO should be based on the following values of three parameters: CEA < 26°, FHC < 75%, and ilioischial angle >85.9°. To achieve better clinical results, it is necessary to increase the average CEA value by 11° and the average FHC by 11% and reduce the average ilioischial angle by 3°., Competing Interests: The authors declare no conflicts of interest.

Background: The aim of this study was to analyze the treatment results of fungal periprosthetic joint infections (PJI) caused by Candida species from a single orthopedic center and to compare them with reports from other institutions., Methods: Eight patients operated on from January 2014 to December 2021 met the inclusion criteria and were analyzed in terms of clinical outcomes. A systematic review of the literature identified 153 patients with Candida PJIs extracted from 12 studies according to the PRISMA (Preferred Reporting Item for Systematic Reviews and Meta-Analyses) guidelines., Results: The success rate of the treatment in the case series was 50%. The most frequent pathogens were Candida albicans (three cases; 37.5%) and Candida parapsilosis (three cases; 37.5%). In one patient (12.5%), bacterial co-infection was noted, and in five patients (62.5%) significant risk factors of PJI were confirmed. The overall success rate on the basis of data collected for systematic review was 65.5%. A sub-analysis of 127 patients revealed statistically significant differences ( p = 0.02) with a higher success rate for the knees (77.6%) than for the hips (58%). In 10 studies the analysis of risk factors was performed and among 106 patients in 77 (72.6%) comorbidities predispose to fungal PJI were confirmed. Bacterial co-infection was noted in 84 patients (54.9%). In 93 patients (60.7%) Candida albicans was the culprit pathogen, and in 39 patients (25.5%) Candida parapsilosis was the culprit pathogen. Based on these two most frequent Candida species causing PJI, the success rate of the treatment was statistically different ( p = 0.03), and was 60.3% and 83.3%, respectively. The two-stage strategy was more favorable for patients with Candida parapsilosis infections (94.4% success rate) than the one-stage protocol (50% success rate; p = 0.02); as well as in comparison to the two-stage treatment of Candida albicans (65% success rate; p = 0.04)., Conclusions: The analysis of the literature showed no differences in the overall success rate between one- and two-stage surgical strategies for all Candida species, but differed significantly comparing the two most frequent strains and concerning PJI localization. The frequent presence of bacterial co-infections makes it necessary to consider the additional administration of antibiotics in the case of fungal PJI.

Aims: Developmental dysplasia of the hip (DDH) describes a pathological relationship between the femoral head and acetabulum. Periacetabular osteotomy (PAO) may be used to treat this condition. The aim of this study was to evaluate the results of PAO in adolescents and adults with persistent DDH., Methods: Patients were divided into four groups: A, adolescents who had not undergone surgery for DDH in childhood (25 hips); B, adolescents who had undergone surgery for DDH in childhood (20 hips); C, adults with DDH who had not undergone previous surgery (80 hips); and D, a control group of patients with healthy hips (70 hips). The radiological evaluation of digital anteroposterior views of hips included the Wiberg angle (centre-edge angle (CEA)), femoral head cover (FHC), medialization, distalization, and the ilioischial angle. Clinical assessment involved the Harris Hip Score (HHS) and gluteal muscle performance assessment., Results: Significant improvements in radiological parameters were achieved in all measurements in all groups (p < 0.05). The greatest improvement was in CEA (mean of 19° (17.2° to 22.3°) in Group B), medialization (mean of 3 mm (0.9 to 5.2) in Group C), distalization (mean of 6 mm (3.5 to 8.2) in Group B), FHC (mean of 17% (12.7% to 21.2%) in Group B), and ilioischial angle (mean of 5° (2.3° to 8.1°) in Group B). There were significant improvements in the mean HHS and gluteal muscle performance scores postoperatively in all three groups., Conclusion: The greatest correction of radiological parameters and clinical outcomes was found in patients who had undergone hip surgery in childhood. Although the surgical treatment of DDH in childhood makes subsequent hip surgery more difficult due to scarring, adhesions, and altered anatomy, it requires less correction of the deformity and has a beneficial effect on the outcome of PAO in adolescence and early adulthood. Cite this article: Bone Joint J  2022;104-B(7):775-780.

The aim of this study was to evaluate the bone union, complication rate, clinical and functional outcomes of long-stemmed total knee arthroplasty (TKA) in patients with periprosthetic femoral or tibial shaft fractures and in patients with femoral or tibial shaft fractures with coexisting advanced knee osteoarthritis (OA). This retrospective study comprised 25 patients who underwent surgery due to tibial or femoral shaft fractures: (1) with coexisting severe knee OA or (2) with a periprosthetic fracture requiring implant exchange. In all cases, fracture stabilization was performed intramedullary with the use of long-stemmed implants without the use of additional fixation material (plates, screws, or cerclage). Bone union was achieved in 22/25 patients (88%). One patient required revision with additional plate stabilization due to non-union, and asymptomatic partial bone union was observed in two cases. The group with periprosthetic fractures demonstrated good clinical (mean 73.1 ± 13.3) and moderate functional (mean 59.2 ± 18.8) outcomes in the Knee Society Scoring system (KSS). In the group with shaft fracture and coexisting OA significantly higher clinical (excellent results, mean 84.1 ± 11; p = 0.03) and functional (good results, mean 76.2 ± 20.6; p = 0.04) results were noted. There were no statistically significant differences in terms of range of motion (ROM) or complication rate between these two groups. One-stage TKA with a long-stemmed implant without the use of additional fixation material is an effective method for the treatment of femoral or tibial shaft fractures in patients who require joint replacement. Despite being technically demanding, the approach yields bone union and moderate to excellent clinical and functional outcomes with a relatively low complication rate.

The aim of this study was to analyse the effect of the first year of the COVID-19 pandemic on total hip arthroplasty (THA) and total knee arthroplasty (TKA) surgical volume in Poland. A retrospective analysis of data concerning THA and TKA collected by the National Health Fund in Poland in 2019 and in 2020 has been conducted. The number of primary hip or knee arthroplasties in 2020 was around 71% and 67% of the number registered in 2019, respectively. There was also a decline in the volume of revision arthroplasties observed, with 65% and 63% of THA and TKA revisions performed in 2019. The most significant decrease was observed in April and May, and during the second wave of the pandemic in November 2020, with a decline of 87%, 55% and 56%, respectively. The results of this study show the significant impacts that the COVID-19 pandemic had on the volume of elective hip and knee arthroplasties in Poland in 2020. In comparison with 2019, a decrease of around 30% for primary and of 40% for revision arthroplasties was observed. The most significant decline was observed in April and May 2020, and during the second wave of the COVID-19 pandemic in Poland in November 2020.

Aims: The aim of the study was to compare two methods of calculating pelvic incidence (PI) and pelvic tilt (PT), either by using the femoral heads or acetabular domes to determine the bicoxofemoral axis, in patients with unilateral or bilateral primary hip osteoarthritis (OA)., Methods: PI and PT were measured on standing lateral radiographs of the spine in two groups: 50 patients with unilateral (Group I) and 50 patients with bilateral hip OA (Group II), using the femoral heads or acetabular domes to define the bicoxofemoral axis. Agreement between the methods was determined by intraclass correlation coefficient (ICC) and the standard error of measurement (SEm). The intraobserver reproducibility and interobserver reliability of the two methods were analyzed on 31 radiographs in both groups to calculate ICC and SEm., Results: In both groups, excellent agreement between the two methods was obtained, with ICC of 0.99 and SEm 0.3° for Group I, and ICC 0.99 and SEm 0.4° for Group II. The intraobserver reproducibility was excellent for both methods in both groups, with an ICC of at least 0.97 and SEm not exceeding 0.8°. The study also revealed excellent interobserver reliability for both methods in both groups, with ICC 0.99 and SEm 0.5° or less., Conclusion: Either the femoral heads or acetabular domes can be used to define the bicoxofemoral axis on the lateral standing radiographs of the spine for measuring PI and PT in patients with idiopathic unilateral or bilateral hip OA. Cite this article: Bone Joint J  2021;103-B(8):1345-1350.

The aim of this study is to evaluate the value of D-dimers in the diagnosis of periprosthetic joint infection (PJI). The analysis was performed for revision total hip (rTHA) and revision total knee arthroplasty (rTKA) together and separately with two thresholds, one calculated by statistical methods and the second adopted from the ICM 2018 definition. The study group comprised 133 patients who underwent rTHA or rTKA: 68 patients diagnosed according to the ICM 2018 definition (PJI group) and 65 with aseptic implant loosening, instability, malposition, or implant failure with the exclusion of infection (aseptic revision total joint arthroplasty or arTJA group). Mean D-dimer concentrations were 0.36 ± 0.25 μg/ml in the arTJA group and 0.87 ± 0.78 μg/ml in the PJI group (p < .001). For rTHA and rTKA together, the sensitivity and specificity of the evaluation were 75% and 73.8% according to the calculated cut-off value (0.45 μg/ml), and 33.8% and 95.4% based on the ICM 2018 threshold (0.85 μg/ml). Separately, for rTHA, sensitivity and specificity were 62.5% and 62.1% for the calculated value (0.43 μg/ml) and 6.3% and 96.6% for the ICM 2018 threshold; for rTKA, sensitivity was 86.1% and specificity was 88.9% for the calculated threshold (0.48 μg/ml) and 58.3% and 94.4% for the ICM 2018 value. Our findings indicate that plasma D-dimers have potential as markers of knee PJI, but moderate to low value for hip PJI., (© 2020 Orthopaedic Research Society.)

Study Design: Case report., Background: It is a case of dracunculiasis of the spine mimicking lumbar intervertebral disc herniation., Case Presentation: A 57 year-old Caucasian male was admitted to the hospital because of the left L5 radiculopathy lasting for 2 months. The pain in the left lower limb was associated with muscle weakness on dorsal flexion of the foot, paresthesia of the dorsal aspect of the foot and tingling in the big toe. Neurological examination revealed: muscle weakness on dorsal flexion of the foot, impaired light touch and pin prick test on the dorsal aspect of the foot and positive Lasègue's sign. Magnetic resonance imaging (MRI) examination revealed L4-L5 intervertebral disc herniation with sequester compressing the left L5 nerve root. The open L4-L5 left side discectomy was performed. During the sequester evacuation 3 pieces of nematodes were removed and preserved in 10% of formaldehyde solution. After the surgery the patient was pain free with normal neurological examination. The diagnosis of dracunculiasis was based on the morphology of the nematode and on exclusion of the other parasites. DM infestation could not be confirmed with molecular testing that was impaired by the formaldehyde., Conclusions: Parasite infestation should be considered even in cases with obvious MRI of lumbar intervertebral disc herniation. If a nematode was found accidentally during any surgery it should be preserved in a 0.9% saline, not in formaldehyde, not to disturb the molecular tests.

Purpose: Idiopathic scoliosis is a developmental deformation of the vertebral column of an unknown aetiology. Its clinical symptoms and hypothetical causative factors may affect the stomatognathic system. The aim of this study was to analyse the relationships between the prevalence and type of malocclusions, and the presence of idiopathic scoliosis, its location and severity., Methods: This was a prospective longitudinal study. The study group consisted of 80 patients with idiopathic scoliosis and the control group of 61 healthy individuals. Standard standing long-cassette radiographs were taken of all of the patients in the idiopathic scoliosis group in order to confirm diagnosis, to determine localization and the Cobb angle of the curve. Both groups underwent standard clinical dental examination., Results: The most commonly observed types included right main thoracic (R-MT) and thoracolumbar or left lumbar scoliosis (Cobb angle 11° to 125°). In the idiopathic scoliosis group, prevalence of malocclusions was greater than in the control group (95% versus 82%). In the idiopathic scoliosis group more than one type of malocclusion was observed with a higher incidence than that in the control group (63.8% versus 37.7%; p = 0.002). A correlation between the left proximal thoracic (L-PT) curve with anterior partial open bite was demonstrated (p = 0.323), between thoracic dextroscoliosis main thoracic with lateral partial cross bite (p = 0.230) and a correlation between scoliosis severity and malocclusion in the event of L-PT and anterior partial open bite (p = 0.330) and R-MT and scissors bite (p = 0.248)., Conclusion: The incidence of malocclusions is greater in children with idiopathic scoliosis than in their healthy peers., Level of Evidence: III., (Copyright © 2019, The author(s).)

Introduction: The most significant blood vessel supplying the hip joint is the medial femoral circumflex artery (MFCA). MFCA with lateral femoral circumflex artery (LFCA) are the first branches of the deep femoral artery (DFA) or they originate directly from the common femoral artery (CFA) or superficial femoral artery (SFA)., Purpose and Methods: We analyzed 100 CT angiogram of the hip region [72 men, 28 women; mean age 46.4 (14-80)] to assess the frequency of each type of division of the MFCA and LFCA from either the DFA or directly from the CFA or SFA. To assess the variations on each side in one individual we analyzed both hips in 73 patients [mean age 46.6 (14-80)]., Results: Many different types of division have been described. The most frequent one in which both the MFCA and LFCA originate from the DFA, was observed in 50% of patients. In 31% of hips the MFCA originates from the CFA. In our study, a normal origin of the obturator artery from the internal iliac artery was observed in 67% of patients and an atypical origin, called corona mortis was observed in 33% of patients., Conclusions: The deep branch of the MFCA is the main artery supplying the femoral head, it is at risk during surgical approach to the hip joint. The atypical anastomosis called corona mortis is also at risk while performing the approach to pubic bone. Therefore, knowledge of their topography is very important.

Around 10-15% of pregnancies result in a spontaneous first trimester miscarriage, which is most frequently caused by chromosomal abnormalities, mainly aneuploidies. Genetic analysis of pregnancy loss includes conventional G-banding karyotyping and various molecular methods. Apart from variable methodological limitations, the effectiveness of genetic analysis depends on the type and quality of the tested sample. To improve the reliability of genetic testing, we present methods of appropriate collection and pre-laboratory preparation of chorionic villi from first trimester miscarriage. We also discuss issues of maternal cell contamination, placental mosaicism and reciprocal and Robertsonian translocations in the context of interpretation of the results and genetic counseling., (© 2016 Japan Society of Obstetrics and Gynecology.)

Interferon alpha-producing plasmacytoid dendritic cells (pDC) are crucial contributors to pro-inflammatory or tolerogenic immune responses and are important in autoimmune diseases such as psoriasis. pDC accumulate in the lesional skin of psoriasis patients, but are rarely found in the affected skin of patients with atopic dermatitis (AD). While homeostatic chemokine CXCL12 and inducible pro-inflammatory CXCR3 chemokine ligands may regulate pDC influx to psoriatic skin, the mechanism responsible for selective pDC recruitment in psoriasis vs. AD remains unknown. Circulating pDC from normal donors express a limited number of chemoattractant receptors, including CXCR3 and CMKLR1 (chemokine-like receptor 1). In this work, we demonstrate that circulating pDC from normal donors as well as psoriasis and AD patients express similar levels of CXCR3 and responded similarly in functional migration assays to CXCL10. We next found that blood pDC from normal, AD, and psoriasis patients express functional CMKLR1. In contrast to normal skin, however, lesional skin from psoriasis patients contains the active form of the CMKLR1 ligand chemerin. Furthermore, in affected skin from psoriatic patients the level of active chemerin was generally higher than in AD skin. Taken together, these results indicate that local generation of active chemerin may contribute to pDC recruitment to psoriatic skin.

Background: Staphylococcus aureus colonization is accepted to be an important triggering factor in patients with atopic dermatitis (AD) and antibiotic resistance has been recognized to be a serious problem as a consequence and for the management of AD treatment., Objectives: To investigate the antibiotic resistance pattern of S. aureus strains isolated from patients with AD with apparent (lesional and nonlesional skin areas) and recurrent skin colonization and strains obtained from healthy nasal carriers., Methods: Eighty-seven patients (age 23+/-11.5 years) with mild to severe AD (SCORAD 46.9+/-16.6), 21 patients (age 19.8+/-6.7 years) before antistaphylococcal treatment and 177 healthy nasal carriers (age 27.5+/-8.4 years) were microbiologically assessed for carriage of S. aureus. Colonization of lesional and nonlesional skin areas was quantified by counting the number of colony forming units on the skin surface (log(10) CFU cm(-2)). Antimicrobial susceptibility and resistance phenotypes of 179 S. aureus strains were assessed with the agar disc-diffusion method., Results: Staphylococcus aureus was isolated from 87% of lesional and 44% of nonlesional skin samples from patients with AD. The colonization density of S. aureus was markedly higher in lesional than in nonlesional skin (P<0.001), and was positively correlated with AD severity (P<0.001) and total serum IgE (P<0.05). Patients with AD had a significantly higher prevalence of chloramphenicol-resistant S. aureus than nasal carriers (P<0.01). Similar rates of resistance were expressed to tetracycline, erythromycin, mupirocin, clindamycin and penicillin. Nearly 35% of S. aureus strains from the lesional skin demonstrated different antimicrobial sensitivity pattern compared with strains from nonlesional skin of the same patients with AD. The trend of increasing resistance to chloramphenicol, erythromycin and fusidic acid was observed among S. aureus strains recovered from patients after approximately 75 days of antibiotic treatment. Methicillin-resistant S. aureus isolates were cultured from two patients, one during exacerbation and the other after subsequent bacterial recolonization., Conclusions: Discrepancies in antibiotic sensitivity pattern were observed among S. aureus strains colonizing different sites of AD skin (lesional and nonlesional areas), and also in AD patients with prior antibiotic treatment. Therefore, clinicians should consider repeat microbial susceptibility testing on different body sites of patients with AD when clinically indicated.

Introduction: We asked whether in atopic dermatitis (AD) increased T cell apoptosis in staphylococcal enterotoxin B (SEB)-activated cultures of peripheral blood mononuclear cells (PBMCs) is characteristic of the exacerbation of the disease or connected with skin colonization by Staphylococcus aureus., Material/methods: The clinical status of the patients was evaluated using the SCORAD index. The number of bacteria colonizing patients' skin lesions was determined by the cfu method. Mononuclear cells isolated from peripheral blood were stimulated by SEB and the apoptosis of CD3+ cells in culture was determined by flow cytometry using the monoclonal antibody APO2.7. The cytokine production in the culture supernatants was determined by ELISA and Cytometric Bead Array kits., Results: T cell apoptosis was increased, while the production of interferon (IFN)-gamma was reduced in cultures of PBMCs of AD patients during exacerbation. The proportion of CD3+ APO2.7+ cells positively correlated with the density of S. aureus recovered from skin lesions, but not with SCORAD index. By contrast, SCORAD index, but not S. aureus density, negatively correlated with IFN- gamma production. Furthermore it was found that the presence of S. aureus on uninvolved skin distinguishes a group of severe cases with high serum IgE level, increased T cell apoptosis, and reduced production of tumor necrosis factor alpha in SEB- -stimulated cultures., Conclusions: Among AD patients the increased activation-induced T cell apoptosis observed in SEB- -stimulated cultures is related to skin colonization by S. aureus. The presence of bacteria on uninvolved skin is a feature of a distinct group of AD patients.

Purpose: This paper describes complications due to the posterior polymorphous corneal dystrophy in one patient., Material and Methods: Medical history of misdiagnosis and subsequent wrong procedures, to which patient with binocular posterior polymorphous corneal dystrophy was exposed, where presented. The eye misdiagnosed with profound keratitis was initially treated with high doses of steroids, what could possibly lead to extensive fungal corneal ulceration and complicated cataract., Results: Thanks to the detailed examination of the fellow eye in the slit lamp and specular microscope, correct diagnosis was made., Conclusions: Since posterior polymorphous corneal dystrophy is one of the rare conditions, especially with coexisting eye irritation, wrong diagnosis of this disorder is possible to be made. Therefore, extremely important in every day ophthalmological practice precise examination of the both eyes and special care during steroid treatment is essential.

Purpose: Evaluation of the usefulness of corneal scanning topography performed with Orbscan for the localization of corneal graft due to keratoconus., Material and Methods: We examined 33 eyes in 33 individuals (23 men 10 women) during one year 2000/2001. Corneal topography was performed with Orbscan apparatus before the transplantation of the cornea due to the keratoconus. Trepanning depended of the thickness of peripheral cornea. Visual acuity without correction was compared with the control group of 33 eyes, after corneal transplantation done due to the corneal cone between 1998-1999, without consideration of scanning topography., Results: Significant differences in the post-surgical visual acuity in favor of the examined group in the range from 5/5 to 5/7 and from 5/25 to 5/50 were observed., Conclusions: Scanning corneal topography will probably facilitate proper qualification for the transplantation and better postoperative visual acuity.

The purpose of this study was to compare grafts performed because of keratoconus in our clinic in years 1990-1999. These years were chosen for analysis because in this time some methods of grafting were changed, particularly: material for transplantation, graft's size, method of trephination and graft suturing, also management after operation. The study included 51 patients (17 females, 34 males) with keratoconus, aged 16 to 46 (mean age 31.3), which have had penetrating keratoplasty done in years 1990-1999. The amount of surgery, sex of patients, preoperative preparation, kind of graft material, technique of operation, methods of graft suturing, postoperative procedure, the time of patients hospitalization, time of suture removing, postoperative visual acuity and complication were compared.

Purpose: To check post penetrating keratoplasty (PK) corneal wound healing characteristics after epidermal growth factor (EGF) application and to compare it with controls., Material and Methods: The PK was performed in the group of 72 young, healthy New Zealand rabbits (36 females and 36 males). Slit-lamp examination, tonometry and corneal topography by Tomey's corneal modeling system (TMS-1) were carried out before and after surgery. The PK was performed in both eyes. Half of animals were used as a bilateral donor for the other half, with a rule: right eye cornea to the right eye and left eye cornea to the left eye. As a result, after completed surgery 36 rabbits had bilateral grafts. The animals were divided into 3 equal groups (12 in each). Two drops of the human recombined EGF dissolved in the saline solution with concentration varied from 500 to 1500 ng in each drop were applied to the right eye according to schedule. The left eye was used as a control and did not receive EGF. Time of observation varied from 24 hours to 6 months. The tensinometry and the histopathologic study--light and electron microscopy were performed to determine corneal scarring., Results: The wound healing pattern after PK was characteristic and constant in each group. The corneal wound healing significantly accelerated in the EGF treated group of rabbits compared with the controls (p < 0.05). In the group of rabbits receiving 1000 ng of hrEGF 3 times/day, after two weeks of application we noted increase of the wound strength up to 600 folds, comparing with controls. Well-organized scar was histologically seen on the 21st post-surgery day. The post-operative corneal astigmatism was less expressed in the eyes treated with EGF comparing to controls., Conclusions: These preliminary results of our experimental study indicated accelerated effect on the corneal wound healing after PK with topical, low dose hrEGF application. Clinical observation of utilization of similar low doses of the hrEGF after PK--is in progress.

A case of 21 year old woman with corneal degeneration similar to Salzmann's degeneration and binocular cataract is presented. A successful corneal transplantation combined with extracapsular cataract extraction followed by posterior chamber lens implantation was performed. Patient is undergoing a treatment in endocrinology ward. A rare idiopathic hypoparathyroidism with Fahr syndrome was ascertained.

In the period of 1985-1992 we performed in our centres 34 operations of a double procedure and 12 operations of a triple procedure. During the observation--from 2 months to 7 years--we obtained favourable results encouraging to connect the corneal grafting with cataract extraction in high myopia and with extracapsular cataract extraction with implantation of an artificial lens in emmetropic eyes. Presented is the appropriate technique of operation and the results obtained.

The discussion on this topic was considered as advisable because of frequent diagnostic faults and an incorrect treatment of keratoconus. The authors presents the diagnosis, foundations of the general and topical treatment of keratoconus.

One of the main problems of corneal transplantation is the postoperative astigmatism. In the last period the intraoperative application of the kerato-scope, new type of needles and threads in stitching the corneal patch created a chance for solving this problem. The authors present the methods used for stitching of the corneal patch, their advantages and the defects with consideration of differences resulting from the thickness and kind of the thread, from the length and form of the needle. Basing on personal experience and data from the literature they propose the technique of the suture which they are using.

Eleven re-transplantations of the cornea were performed between October 1988 and October 1991. Utilized was the material selected according to a partial compatibility of the HLA factor in 11 men with opacified transplants performed previously without antigen selection in high risk leukoma (in 10 cases after severe eye burns). In 3 patients the transplant was the fifth one, in 1 patient the fourth, in two--the third and in 5 the second one. Favourable results (transparent and semi-transparent grafts) were obtained in 8 patients (72.7 p.c.).

The study presents conditions mostly described as co-existing with the keratoconus in 7 patients (from among 300 examined) born from an uni-ovular twin pregnancy. Only one pair of twins showed keratoconus of both eyes and developing identically in both eyes.

On examining about 300 patients with keratoconus in the period of 20 years the authors detected in a number of cases variations of the intraocular pressure. By means of a pneumo-tonometer Digilab 30R periodic variations of the IOP were measured in 76 patients and daily variations in 42. The statistical analysis showed that the application of Timolol and reduction of the IOP variations has a decisive influence on the improvement of objective changes and the visual acuity without correction. Presently in our Department Timolol is used successfully in 160 patients. There was no deterioration in either patient at that time and many patients showed an improvement of the condition of keratoconus.

Fifteen corneal grafts were performed in 15 men with high risk leukoma (5+) in the period October 1988--November 1990. The age of the patients oscillated between 11 and 76 years. In 5 patients the grafting was done in only eye. The period of observation after surgery amounted 4-29 months. The favourable results (transparent and ++semi-transparent grafts) were obtained in 9 eyes (60 p.c.) and partly opacified grafts in 6 (40 p.c.). Neither of the grafts opacified. In the preceding years--without taking into account the antigenic selection of the donor--favourable results in similar leukoma cases were achieved in ca. 42 p.c. of cases.

Ten corneae from donors selected in respect of partial compatibility of the HLA antigens were transplanted in the period October 1988--October 1989. The grafting was performed in 10 patients with leukomas included in the group of maximal risk (5+). In 9 patients the leukomas were due to ocular burns (chemical in 8 patients and thermal in 1 patient). In 1 patient, a 74 years old man the grafting was performed in the single eye with Salzman's corneal dystrophy with a simultaneous cataract extraction. During observation, which lasted 2 to 12 months 6 grafts remained transparent, 1--partly opacified. Not any transplant did totally opacify.