The typical symptoms of Retraction syndrome (Stilling-Türk-Duane) are severe limitation of abduction, slight limitation of adduction and convergence, which are always accompanied by retraction of the globe, narrowing of the palpebral fissure, vertical deviation and elevated intraocular pressure, and a remarkable motility of the globe in the orbital axis. All symptoms are explicable by the cocontraction of the horizontal rectus muscles. In cases of single binocular vision, surgery is indicated only when the head posture is intolerable. We restrict surgery to recession of horizontal rectus muscles according to the head posture and the deviation. The surgical results of this procedure are satisfactory concerning the horizontal and the vertical deviation and the head posture.

• MeSH
• Duaneův retrakční syndrom * diagnóza   chirurgie   MeSH
• lidé MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

The author presents a postgraduate review of the problem. In the introduction he reviews typical features of Duane's retraction syndrome (DS) and its main symptoms and reminds of the main approaches to classification: (1) Malbrane s (Duane I, II and III), (2) Huber's which is based on EMG findings in ZOS and (3) Kaufman's which classifies DS according to the enforced position of the head. The author maintains that even according to the above many atypical rare pictures cannot be classified or explained pathogenetically. Some are mentioned: (1) "Inverse" DS, which was recorded and documented by Chytilová-Divisová (1949) in a girl with congenital paralysis of abduction on both eyes retraction of the bulbus developed and narrowing of the palpebral aperture when attempting abduction (1) of the eye, (2) Bilateral acquired DS in a female patient with a tumour of the brain stem confirmed by EMG records of both horizontal muscles. (3) Unilateral DS in a child from a family with familial incidence of congenital ZOS fibrosis with an obscure ratio of the neurogenic and myogenic and fibrous component of the two pictures. In another member of this family the Marcus Gunn phenomenon was present. The latter findings support the idea that in the development of the fairly uniform picture of DS a combination of neurogenic, myogenic and connective tissue changes participate.

• MeSH
• Duaneův retrakční syndrom * klasifikace   diagnóza   etiologie   MeSH
• lidé MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

BACKGROUND: Retraction pocket (RP) of the tympanic membrane (TM) is a common pathology in children that can cause ossicular chain erosion, cholesteatoma formation, and potentially life-threatening complications of cholesteatoma. This study assessed the functional and anatomical results of cartilage grafting in children with severe RP of the TM. METHODS: This was a retrospective review of 212 children from a tertiary referral center. RESULTS: We identified significant differences in hearing results, indication criteria, and location of TM fixation between stages II and III of RP (according to Charachon). We observed a significantly higher incidence of RP in boys than in girls. CONCLUSIONS: Cartilage tympanoplasty for retraction pocket of the tympanic membrane in children is a safe procedure with good anatomical and hearing results.

• Klíčová slova
• cartilage tympanoplasty, children, hearing, retraction pocket, tympanic membrane,
• Publikační typ
• časopisecké články MeSH

AIMS: Histological and histochemical analysis of retraction pocket of pars tensa of tympanic membrane in children. Identification of morphological abnormalities in comparison with a healthy tympanic membrane as it is described in standard textbook. Identification of signs typical for cholesteatoma and support for a retraction theory of cholesteatoma formation. STUDY DESIGN: A prospective study analysing 31 samples of retraction pockets taken during surgery. DEPARTMENTS: University Hospital, Children's Medical Centre METHODS: Samples of retraction pockets were processed by a standard process for light microscopy, stained by haematoxylin-eosin. Van Gieson's stain was used for differential staining of collagen, Verhoeff's stain for elastic fibre tissues, Alcian blue for acidic polysaccharides and PAS (Periodic Acid Schiff) method for basement membrane polysaccharides. RESULTS: The following findings were observed in the samples of retraction pockets: hyperkeratosis (100%), hypervascularisations (100%), subepithelial fragmented elastic fibres (96%), myxoid changes (87%), subepithelial inflammatory infiltration (84%), rete pegs (71%), papilomatosis (71%), intraepithelial inflammatory cellularizations, (48%), intraepithelial spongiosis (16%) and parakeratosis (3%). No basement membrane continuity interruptions were observed. Thickness of retraction pocket, thickness of epidermis, occurrence of rete pegs and frequency of fragmented elastic fibres was higher in a Grade III stage RP than Grade II stage RP (according to Charachon). CONCLUSION: Morphological abnormalities in the structure of retraction pockets in comparison with a healthy tympanic membrane were described. The changes are typical for a structure of cholesteatoma (these changes are common in matrix and perimatrix), supporting retraction theory of its origin. Our observations show that it is inflammation that probably plays a key role in the pathogenesis of retraction pocket. The frequency of some of the changes increases with the stage of retraction pocket (II-III according to Charachon). Basement membrane continuity interruptions are not typical for retraction pockets.

• Klíčová slova
• Children, Cholesteatoma, Histological analysis, Retraction pockets,
• MeSH
• cholesteatom středního ucha patologie   MeSH
• dítě MeSH
• kolagen MeSH
• lidé MeSH
• membrana tympani patologie   MeSH
• mladiství MeSH
• prospektivní studie MeSH
• studie případů a kontrol MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• kolagen MeSH

• MeSH
• agregace trombocytů účinky léků   MeSH
• batroxobin farmakologie   MeSH
• koagulační faktory fyziologie   MeSH
• lidé MeSH
• proteasy farmakologie   MeSH
• retrakce koagula * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• batroxobin MeSH
• koagulační faktory MeSH
• proteasy MeSH

Several theories describe the development of the retraction pocket of the tympanic membrane (RP). Many authors suggest that the negative middle ear pressure is the main reason responsible for developing this condition. A narrative review has been undertaken, and conclusions are drawn reflecting a current knowledge with our new observations in the histological and immunohistochemical study. Recent studies show the important role of inflammation in the development and progression of RP. A review of the available literature shows that the inflammation plays a key role in pathogenesis of the RP and its progression to the cholesteatoma. We support this statement with our new results from histological and immunohistochemical analysis of the RPs.

• Klíčová slova
• cholesteatoma, chronic otitis media, pathogenesis, pathology, retraction pocket, tympanic membrane,
• MeSH
• cholesteatom středního ucha * MeSH
• lidé MeSH
• membrana tympani * MeSH
• zánět MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

The purpose of this comparative study was to evaluate a long-term efficacy of lateral rectus muscle resection in the affected eye of patients with Duane retraction syndrome (DRS) with esotropia and limited abduction and to compare it with bilateral medial rectus recessions. We reviewed and compared the data of the group A with 23 patients who underwent a recession-resection procedure and the group B with 26 patients in whom we performed medial rectus recessions. In each group, we evaluated pre- and postoperatively the ocular alignment, head position, ocular ductions, severity of retraction, and binocular visual field. Statistical analysis of the data was performed. Postoperatively, both groups had similar mean esotropia and mean face turns. However, the mean limitation of abduction in the affected eye was greater in the group B, mean adduction was also significantly worse in the group B. Globe retraction improved in all subjects of the group B, but worsened in 6 patients of the group A. Seventeen of 23 patients with Duane retraction syndrome, selected on the basis of esotropia, limited abduction, and mild retraction, benefited from a recession-resection procedure in the affected eye. The ability of abduction achieved higher level than in the group B after bilateral medial rectus recessions. We assume that unilateral recession-resection procedure should be performed in patients with mild retraction of the globe and good preoperative adduction.

• MeSH
• dítě MeSH
• Duaneův retrakční syndrom patofyziologie   chirurgie   MeSH
• lidé MeSH
• mladiství MeSH
• okulomotorické svaly chirurgie   MeSH
• předškolní dítě MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• předškolní dítě MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• srovnávací studie MeSH

AIMS: Immunohistochemical analysis of retraction pocket pars tensa of tympanic membrane in children. Identification of signs typical for cholesteatoma and support of retraction theory of cholesteatoma. STUDY DESIGN: a prospective study analysing 31 surgically removed retraction pockets. DEPARTMENT: University Hospital, Children's Medical Centre Methods: Retraction pockets processed by a standard process for immunohistochemical analysis. The observed findings were specified using antibodies CD45 LCA (leukocyte common antigen), CD31 (platelet endothelial cell adhesion molecule), D2-40 (marker of lymphatic endothelium), MMP9 (marker of degradation of connective tissue extracellular matrix) and Ki67 (cellular marker of proliferation). RESULTS: All observed parameters except for MMP9 had a significantly higher incidence in retraction pocket stage III compared to stage II according to Charachon. CONCLUSION: We described immunohistochemical signs of retraction pocket pars tensa of tympanic membrane in children resulting in cholesteatoma. All the observed signs occur in the structure of matrix and perimatrix of cholesteatoma. A significantly higher incidence of all observed parameters except from MMP9 was proved in retraction pocket stage III, unlike in stage II. This observation proves the fact that retraction pocket is a progressive disease and is a procholesteatoma stage.

• Klíčová slova
• Chidren, Cholesteatoma, Immunohistochemistry, Pars tensa, Retraction pocket,
• MeSH
• antigen Ki-67 metabolismus   MeSH
• antigeny CD31 metabolismus   MeSH
• antigeny CD45 metabolismus   MeSH
• biologické markery metabolismus   MeSH
• cholesteatom středního ucha metabolismus   MeSH
• dítě MeSH
• imunohistochemie MeSH
• lidé MeSH
• matrixová metaloproteinasa 9 metabolismus   MeSH
• membrana tympani metabolismus   MeSH
• prospektivní studie MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• antigen Ki-67 MeSH
• antigeny CD31 MeSH
• antigeny CD45 MeSH
• biologické markery MeSH
• matrixová metaloproteinasa 9 MeSH
• MMP9 protein, human MeSH Prohlížeč
• PTPRC protein, human MeSH Prohlížeč

The author presents possible surgical approaches in Duane's syndrome I. The weakening operation of the medial rectus muscle by means of marginal myotomy is recommended in case of striking ocular torticolis. The bifurcation recession of the lateral rectus muscle is recommended in case of change of palpebral fissure. The author documents the indications and the after-surgery results.

• MeSH
• dítě MeSH
• Duaneův retrakční syndrom diagnóza   chirurgie   MeSH
• lidé MeSH
• mladiství MeSH
• předškolní dítě MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• kazuistiky MeSH

The aim of this in vitro study was to evaluate the cytotoxic effects of the vasoconstrictor experimental gingival retraction agents (VEGRAs) in a dynamic setting. The strong cytotoxic effects of the astringent-based conventional gingival retraction agents (ACGRAs) on human gingival fibroblasts (HGFs) in vitro was our motivation to evaluate the biocompatibility of the vasoconstrictor-based experimental gingival retraction agents (VEGRAs) for the selected minimally invasive chemical agent. These agents were used to create three self-made retraction gels. Human gingival fibroblasts (HGFs) were treated with two groups of retraction agents: 1) three α- and β-adrenergic agents (VEGRA-αβ-s) based on 0.1%, 0.01% and 0.05% HCl-epinephrine, and 2) seven α-adrenergic agents (VEGRA-α-s), including two commercially available 0.05% HCl-tetrahydrozoline solutions, one 0.05% HCl-oxymetazoline solution, 10% HCl-phenylephrine solution, and three new self-made experimental 0.05% HCl-tetrahydro zoline-based gels. The methyl thiazolyl tetrazolium (MTT) colorimetric assay was performed to determine the oxidoreductive mitochondrial function after 3, 5, 10 min and 24 h of incubation. The cytotoxic effect, measured by cell viability lower than the 50% threshold, was not observed at any time period, even 24 h after application of 0.05% HCl-tetrahydrozolinebased self-manufactured retraction gels. High cell viability values of human gingival fibroblasts after the treatment with the three self-made 0.05% HCl-tetrahydrozoline- based gels may serve as a basis for further studies aimed at selecting the best retraction agents biocompatible with gingival margin tissues.

• MeSH
• adrenalin farmakologie   MeSH
• adstringencia farmakologie   MeSH
• buněčná smrt účinky léků   MeSH
• fibroblasty cytologie   účinky léků   MeSH
• gingiva cytologie   MeSH
• kultivované buňky MeSH
• lidé MeSH
• techniky odtažení gingivy * MeSH
• vazokonstriktory farmakologie   MeSH
• viabilita buněk účinky léků   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• adrenalin MeSH
• adstringencia MeSH
• vazokonstriktory MeSH