Introduction. For the past several decades, there has been a discussion as to whether elevated intraocular pressure is just ocular hypertension in a healthy eye, or a sign of glaucoma. Objective. To study the IOP values in patients with primary open-angle glaucoma at the beginning of the study and to correlated them with the disease progression and to determine optimal IOP levels. Material and methods. The final protocol included data from 812 right eyes of 637 glaucoma patients and 175 healthy subjects; the latter formed the control group. The mean age of examined patients was 71.8 ± 0.28 years; 72.00 (66.00; 77.00). Mean disease duration in glaucoma patients was 5.41 ± 0.17 years. The following parameters were assessed: visual acuity, clinical refraction, IOP level by Maklakov tonometry, central corneal thickness and IOP-lowering medication use. Results. In the age group - between 60 and 69 y.o., the IOP level in patients with advanced glaucoma was significantly higher than in patients with moderate glaucoma and healthy subjects. There was no significant difference in central corneal thickness either between glaucoma patients and healthy subjects (both male and female) or between glaucoma patients with different glaucoma changes. The IOP level was higher in patients treated with non-fixed combination of beta-blockers (BB) and prostaglandins (PG) regardless of the disease stage. According to the common standards the IOP level was found to be controlled in 69.93 % of patients with moderate glaucoma and 14.42 % of patients with advanced glaucoma. Conclusion. The results of the study could be used as clinical guidelines for determination of the optimal IOP range, choosing the optimal IOP-lowering medication(s) for starting therapy and during the follow-up in patients with moderate and advanced glaucoma stages.
ZusammenfassungZiel der Studie ist es, die distale, motorische Latenz (DML) und die residuale Latenz (RL) in frühen Stadien der diabetischen und alkoholischen PNP zu vergleichen. Es wurden 74 Patienten mit Diabetes, 40 mit Alkoholkrankheit und 70 gesunde Probanden untersucht. Die Patienten wurden in zwei Gruppen entspre− chend der konventionell gemessenen Nervenleitgeschwindigkeit eingeteilt. Gruppe 1: Patienten mit normaler Leitgeschwindig− keit (NLG); Gruppe 2: Patienten mit verlangsamter NLG im Ver− gleich zur Kontrollgruppe. Die Untersuchungen wurden am N. medianus und N. ulnaris durchgeführt. Die Muskelantworten wurden in üblicher Weise mit Oberflächenelektroden vom M. abductor pollicis brevis und M. abductor digiti minimi abgeleitet. Die DML für die Gesunden betrugen 2,91 0,24 ms für den N. ul− naris und 3,01 0,15 ms für den N. medianus. Die entsprechen− den Werte für die RL lagen bei 1.59 0,16 ms für den N. Ulnaris und 1,71 0,15 ms für den N. medianus. Es fand sich eine signifi− kante Verlängerung (p < 0,001) der DML und der RL bei den Neu− ropathien betreffend beide Nerven im Vergleich zur Kontroll− gruppe. Die Verzögerungen waren größer in Gruppe 2, wobei die Differenzen zwischen Gruppe 1 und Gruppe 2 nur für den N. medianus signifikant waren. Für den N. medianus war im Gegen− satz zum N. ulnaris der Mittelwert der RL signifikant größer als der der DML sowohl für Gruppe 1 als auch für Gruppe 2. Somit erscheint die RL als sensitiver als die DML und kann als wertvol− ler diagnostischer Parameter im frühen Nachweis der beschrie− benen Neuropathien gelten. AbstractThe aim of the present study was to compare the residual latency (RL) with the distal motor latency (DML) in the evaluation of ear− ly diabetic and alcoholic neuropathy. Patients with diabetes mel− litus (74), alcohol dependence (40) and healthy subjects (70) were included. Patients were divided into two groups based on conventional nerve conduction studies: Group 1: normal motor conduction velocity (MCV) and group 2: decreased MCV compar− ed with the control group. MCV of the median and ulnar nerve was examined. Compound muscle action potentials of the ab− ductor digiti minimi and abductor pollicis brevis muscles were recorded using standard surface techniques. The mean DML in healthy subjects was 2.91 0.24 and 3.01 0.15 ms for the ulnar and median nerve, respectively. The corresponding values for the RL were 1.59 0.16 and 1.71 0.15 ms. There was a significant prolongation (p < 0.001) of DML and RL in the neuropathy groups for both nerves compared with the control group. These prolon− gations were higher in group 2 for both neuropathies but the dif− ferences between mean values for group 1 and group 2 were sig− nificant only for the median nerve. The mean normalized in− crease of RL was significantly greater in the median nerve than in the ulnar nerve as compared with the increase of the DML.The residual latency appears to be more sensitive than the DML and can be a useful diagnostic parameter for early detection of distal neuropathies.
Two-stage repair is a well-developed method that is commonly used to repair chronic ruptures of flexor digitorum profundus tendons. However, its use in pediatric hand surgery is limited due to the absence of tendon implants adapted for children. The article describes a modified Paneva-Holevich/Hunter technique for two-stage tendon reconstruction using original, oval, Lavsan-reinforced silicone prosthetic implants of four sizes (depending on patients' age). The surgery was performed in 34 children aged 1.5-17 years. Long-term outcomes were assessed in 12 patients (8 boys and 4 girls) using the Total Active Motion scale. The follow-up period was 30 months. The average active range of motion accounted for 178.8° in boys and 218.8° in girls. The results of treatment (TAM %) were considered good in all the girls (average score of 84.3 %), and in those boys who received surgery for fingers IV and V (average score of 80.0 %). The boys who received tendon repair for fingers II and III had "good" and "poor" results (average score of 67.0 %). The proposed method of two-stage tendon repair of chronic tendon ruptures in fibro-synovial channels in children was shown to provide good results with minimal complication rates and acceptable donor site deficiency.Двухэтапная тендопластика сухожилий сгибателей пальцев кисти у детей с застарелыми повреждениями в зоне фиброзно-синовиальных каналов Two-stage repair of finger flexor tendons in children with chronic tendon ruptures in fibro-synovial canals Двухэтапная тендопластика -хорошо разработанный метод лечения застарелых повреждений сухожилий глубоких сгибателей пальцев кисти, однако его применение в детской кистевой хирургии ограничивается отсутствием адаптиро-ванных для детей эндопротезов сухожилий. В статье описана модификация метода двухэтапной тендопластики Пане-вой-Холевич и Hunter с использованием оригинальных силиконовых эндопротезов овального сечения, армированных лавсановой лентой, четырех типоразмеров, соответствующих различным возрастным группам. Были прооперированы 34 ребенка в возрасте 1,5-17 лет, у 12 из них (8 мальчиков и 4 девочек) были оценены отдаленные результаты лече-ния по шкале Total Active Motion (срок наблюдения -30 мес.). Средний активный объем движений поврежденного пальца в группе мальчиков составил 178,8°, в группе девочек -218,8°. Хорошие результаты лечения (TAM %) были отмечены у всех девочек (в среднем 84,3 %), а также у мальчиков, которым оперировали IV и V пальцы (в среднем 80,0 %). У мальчиков, которым оперировали II и III пальцы, наблюдали хорошие и плохие результаты (в среднем 67,0 %). Предложенный метод двухэтапной тендопластики при застарелых повреждениях сухожилий в области фиброзно-си-новиальных каналов у детей позволяет достичь хорошего результата с минимальными осложнениями и приемлемым донорским дефицитом.Ключевые слова: двухэтапная тендопластика, сухожильные силиконовые эндопротезы, сухожилия глубоких сгиба-телей пальцев кисти, застарелые повреждения
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