Biomedical subjects

B Mirkiewicz-Sieradzka

Publications and source records attributed to B Mirkiewicz-Sieradzka.

At least 19 recordsLinked to original sources

PubMed2006

Clinical risk factors and the role of VDR gene polymorphisms in diabetic retinopathy in Polish type 2 diabetes patients.

Evidence exists that some clinical, metabolic and genetic risk factors are associated with the development of diabetic retinopathy (DR). The aim of the study was: (1) to define the prevalence of DR in the examined group of 267 patients with type 2 diabetes mellitus (T2DM) from a Polish population; (2) to identify in cross-sectional analysis, the clinical features associated with DR in the study group; and (3) to search for the association of 4 markers of vitamin D receptor (VDR), a candidate gene for vascular complications in diabetes, with DR. The examined group consisted of 146 female and 121 male T2DM patients (mean age at examination: 61.3+/-9.4 years; age at T2DM diagnosis: 50.0+/-9.2; T2DM duration: 11.3+/-7.8 years; body mass index (BMI): 30.5+/-5.5 kg/m(2); HbA1c: 7.8+/-1.5%). In all patients, the clinical and metabolic profile was determined. Diagnosis of DR was determined by a trained ophthalmologist by ophthalmoscopy after pupillary dilatation. Colour photographic documentation was made. The examined T2DM patients were genotyped for FokI, ApaI, BsmI and TaqI frequent VDR polymorphisms based on the restriction fragment length polymorphism method. The statistical analysis was performed using univariate and multivariate logistic regression (SAS) and haplotype analysis (Haplostat). DR was detected in 85 (31.8%) patients with T2DM. The multivariate analysis revealed that significant predictors of this complication were: never-smoking status (odds ratio 2.2, 95% confidence interval 1.2-4), urea serum level (1.3, 1.1-1.5), HbA1c level (1.4, 1.1-1.8) and insulin treatment (2.7, 1.4-5.1). Other features such as age of T2DM diagnosis, T2DM duration prior to ophthalmic exam, obesity (BMI>30), serum creatinine level, albumin/creatinine ratio and arterial hypertension were univariate predictors of DR, however they lost significance as independent predictors in multivariate analysis. Similarly, the alleles, genotypes, haplotype and haplotype combination of VDR were not associated with the examined complication. However, there was a suggestion of a possible slight association between the fbaT haplotype and DR (p=0.11). In conclusion, our study showed that DR in T2DM patients remains a frequent complication in Polish T2DM patients. We were able to confirm the role of some clinical risk factors, surprisingly including not-smoking status, as was previously shown in the UK Prospective Diabetes Study (UKPDS). VDR gene polymorphisms did not constitute a risk factor for this size of study group.

Body Mass Index↗

PubMed2000

[Graves-Basedow ophthalmopathy in light of current views].

Ophthalmopathy developing in the course of Graves-Basedow disease, although known for years, still causes controversy both about classification of eye symptoms, treatment modalities and terminology. The paper gives an update view on the etiopathogenesis of ophthalmopathy, terminology, classification and dynamics of clinical symptoms, as well as it presents the methods for treating its most important symptoms. Particular attention was focused on surgical treatment of lid retraction and strabismus, as well as on the present requirements in pharmacological and surgical treatment of the most serious complication of ophthalmopathy i.e. optic neuropathy. The role of an ophthalmologist in the process of diagnosis and monitoring of Graves' ophthalmopathy was also emphasised.

Eyelids↗

PubMed2000

[Surgical correction of strabismus in Graves-Basedow ophthalmopathy. Personal experiences].

UNLABELLED: The aim of the study was to evaluate long-term results of surgical treatment of strabismus and diplopia connected with Graves' ophthalmopathy. Surgery of extraocular muscles was performed in 64 patients, previously with different methods for their Graves' ophthalmopathy. All patients showed stabilization of the strabismus angle and diplopia as well as euthyroidism. Before the operation ultrasonography, orbital computed tomography and forced duction test were performed. Before the operation horizontal strabismus with vertical deviation and vertical strabismus were most frequent (36.6% and 35.2%, respectively). A total of 136 operations had been performed. Postoperative follow-up ranged from 6 months to 15 years, including 30 patients with the follow-up exceeding one-year. Recovery or recovery without binocular single vision after surgery was observed in 47 patients (73.4%), including 34 patients (53.1%) with single binocular vision. Improvement was seen in 15 patients (23.4%). No improvement was observed in two cases (3.1%) due to marked vertical strabismus before surgery, they were referred for further surgical treatment. Overcorrection after surgery in 3 cases was observed, and in one case we applied prismatic correction successfully, the two others required reoperation. CONCLUSIONS: 1. Surgical treatment of strabismus and diplopia in Graves' ophthalmopathy is very useful because of high percentage of positive results, confirmed in long-term observation. 2. Diplopia and a large angle of strabismus are a necessary indication for surgical correction of extraocular muscles. 3. A prerequisite for surgical treatment is stable euthyreosis and stabilization of the strabismus angle as well as diplopia and performation of forced duction test for evaluation of stage disease. 4. Prior treatment of ophthalmopathy and duration of strabismus as well as diplopia do not appear to influence this outcome.

Adult↗

PubMed2000

[Ophthalmologic aspects of treating optic neuropathy during the course of Graves-Basedow disease].

UNLABELLED: The aim of the present study is to evaluate the efficacy of conservative treatment of optic neuropathy in the course of Graves' disease. Nineteen patients with neuropathy out of 520 patients with Graves' disease, including 15 women and 4 men were treated. Age of the patients ranged from 36 to 69 years, mean age was 51.3. In all patients thyroid function was normalized, 4 patients underwent strumectomy. Bi- and unilateral neuropathy was found in 13 and 6 cases respectively. The therapy consisted of high-dose steroids (Prednisone in 12 cases or Dexamethasone i.v. in 3 cases) or they were combined with gamma cobalt-60 irradiation of orbit tissues (2000 c Gy in 10 fractions) in 8 cases. In 2 cases radiotherapy alone was performed. Two cases were excluded from treatment because of optic atrophy during the first examination. In all patients full ophthalmological investigation, ultrasonography and computed tomography of the orbit before and after the treatment were performed. Follow-up ranged from 5 to 46 months, mean 21.4. Improvement of visual acuity and perimetry (p < 0.05) after the treatment was observed and changes of the fundus after the treatment were significantly (p = 0.000) improved. Exophthalmos significantly decreased (p < 0.05) but only in the right eye. In all patients the therapy reduced the ophthalmopathy index from mean 7.5 to 4.1 (p = 0.000). IN CONCLUSION: 1. Early diagnosis and appropriate, constant conservative treatment of optic neuropathy in Graves' disease prevent from blindness and surgical intervention. 2. Corticotherapy in combination with radiotherapy of the orbit is a beneficial method of the treatment of optic neuropathy in Graves' disease.

Adult↗

PubMed2000

[Risk factors for occurrence of ophthalmopathy in the course of Graves-Basedow disease].

Ophthalmopathy is a serious complication of Graves-Basedow disease. It is a common and the most significant symptom of this illness and usually persists even when other symptoms associated with abnormal thyroid function disappear. Despite of well-known auto-immunologic patho-genesis of ophthalmopathy it is still hard to predict when this severe complication will occur. This condition is thought to be associated with diagnosis and treatment errors. We studied the patients suffering from Graves-Basedow disease with and without ophthalmopathy. We concluded that the risk factors for ophthalmopathy were: many non-treated episodes of hyperthyroidism, delayed diagnosis and initiation of therapy, no thyroxine supplementation, improper preparation to strumectomy.

Adult↗

PubMed1999

[Scleritis resembling choroidal melanoma: a case report].

The clinical manifestations of the disease, its course and response to the therapy were typical of the inflammatory state in the eye. However, magnetic resonance imaging suggested the presence of an intraocular tumour. Immunoscintigraphic studies using technetium-labelled antimelanoma antibodies initially and 9 months later yielded positive results with the increasing antibody titer. Fine-needle aspiration biopsy did not reveal the presence of neoplastic cells. The eyeball was removed due to a chronic inflammatory process and loss of vision. Histopathological examination demonstrated a tumour-like lesion with the signs of inflammatory infiltration without mitotic activity.

Biopsy, Needle↗

PubMed1999

[Attempts of orbit irradiation after enucleation of the eye with malignant choroidal melanoma. Part I].

PURPOSE: The problem of orbit irradiation after enucleation of the eye with choroidal melanoma is controversial. We have decided to analyse our own material in order to estimate the effectiveness of this method. MATERIAL AND METHODS: The clinical material comprised 202 patients, 97 women and 105 men, in the age of 15-84 years, whose eyeballs were enucleated because of choroidal melanoma. In 72 patients the orbit was irradiated after enucleation with 60Co applicator (CKA4). The dose was about 50 Gy, 5 mm deep. The height of tumour, its location, histological type, infiltration of the sclera or beyond the eyeball and the treatment of tumour before enucleation were analysed. The follow-up time was 5-20 years. RESULTS AND CONCLUSIONS: The survival time of patients in the age below 30 years (p < 0.05) and of patients with choroidal melanoma of the height above 3 mm (p < 0.01) was significantly longer when the orbit was irradiated. Also the survival time of patients with scleral infiltration and with spindle-cell type of tumour was longer (but statistically not significantly) in those, whose orbits were irradiated after enucleation. Exenteration of the orbit was necessary in 4 cases not irradiated after enucleation, only in 1 case after irradiation. The probability of survival after irradiation of the orbit was significantly higher than in cases not irradiated (0.6971 vs. 0.6219). The estimated mean survival time (in months) was longer, but not significantly, in patients after irradiation of the orbit (197.017 vs. 181.409). We conclude that irradiation of the orbit after enucleation of the eye with choroidal melanoma should be recommended. Further investigations will be continued with collaboration of Institute of Oncology in Cracow.

Adolescent↗

PubMed1998

[The surgical treatment of strabismus and diplopia in Graves-Basedow ophthalmopathy].

PURPOSE: The aim of the study is to evaluate results of surgical treatment of strabismus and diplopia in Graves-Basedow ophthalmopathy. MATERIAL AND METHODS: The surgical procedure was performed in 40 patients with horizontal strabismus, horizontal strabismus with vertical deviation or isolated vertical strabismus. There were performed 86 surgical procedures on the eye muscles (in 20 cases adjustable sutures were used). RESULTS: Recovery or recovery without binocular single vision was observed in 27 cases (67.5%) and improvement in 11 cases (27.5%). CONCLUSIONS: The necessary conditions of surgical treatment are stabile euthyreoid state, the stabilization of the angle of strabismus and diplopia. The best results of operation are in the prefibrosis period of the muscle directly. The surgical procedures of weakening the function of muscles and adjustable sutures are recommended. The operations of several stages and atraumatic should be performed.

Adult↗

PubMed1992

[Evaluation of the effectiveness of prostacyclin in the treatment of thrombosis of the central retinal vein using a double-blind method].

The patients were divided by chance into 2 groups: the first one (15 persons) was given a natrium salt of prostacyclin (Epoprostenol Wellcome or Chinoin) in a dose of 5 mg/kg/min. intravenously by an infusion pump in 5 infusions; the control group (15 persons) received instead of prostacyclin a placebo (0.1 M glycine buffer of pH 10.5). Besides all the patients were given Doxium or Calcium dobesilate, Rutinoscorbin, Vitamin C, and Polopyrin S (Soluble Aspirin). Immediately after the completion of the treatment the authors did not find any essential differences between the examined groups. In prolonged observations however one demonstrated a significantly smaller frequency of the development of neovascularization in the eyes of persons treated by prostacyclin in comparison with the control group.

Adult↗

PubMed1991

Diabetic retinopathy and previous insulin therapy as compared with insulin requirement.

The aim of study was the comparison of the Biostator-determined insulin requirement with the degree of diabetic retinopathy and previous insulin therapy. Twenty-three patients with insulin-dependent diabetes mellitus of more than 10 years' duration were studied. The mean insulin dosage during the last ten years was calculated, and the degree of retinopathy and insulin requirement during a 2-day connection to the Biostator were determined. In comparing the mean insulin supply during the last ten years with the Biostator-determined insulin requirement in patients with proliferative retinopathy, the significant difference occurred only in patients with diabetes of less than 15 years' duration (P less than 0.05). Such a difference was not found in patients with background retinopathy. We conclude that the patients with more advanced changes in the eye fundus, particularly those with diabetes of shorter duration, had received generally less insulin than was required as determined by the Biostator. It may be inferred that long-term inadequate insulin supply accelerates the development of microvascular complications in diabetes.

Adult↗

PubMed1988