[The Influence of Intravitreal Injections on Outpatient Cataract Operations in Germany]

PURPOSE

The number of outpatient operations in Germany is not registered in a centralised manner. To estimate the development of the outpatient intraocular surgery especially since the implementation of the intravitreal injections, surveys among ophthalmic surgeons were analysed.

METHODS

Between 2006 and 2013 surveys were done among ophthalmic surgeons in Germany using questionnaires. An average of 318 completed questionnaires were sent back. The mean participation ratio was 37 %.

RESULTS

Between 2006 and 2013 an extrapolated mean of 347 564 cataract operations and 139 946 intravitreal injections were reported. Whereas the number of cataract operations was constant in the observation period, the number of injections increased considerably from 35 135 in 2006 to 274 714 in 2013.

CONCLUSION

A saturation in the development of the numbers of the intravitreal injections could not yet be observed. Other outpatient operations, especially cataract procedures were not replaced by the increase of the injections in the recent years.

[Systematic analysis of the annual quality reports of the Federal Joint Committee with regard to cataract surgery]

BACKGROUND

Cataract is one of the most common diseases in ophthalmology. Up to now the only way to estimate the total number of carried out surgeries in Germany were the surveys done by DOG, BVA, DGII and BDOC or reports of the federal statistical office.

OBJECTIVES

Objective of this paper is to evaluate the annual quality reports of the Federal Joint Committee with a view to how the hospitals are participating in the nationwide comprehensive coverage concerning cataract surgery and if there is a continuing trend to more outpatient cataract surgeries in German eye hospitals.

MATERIAL AND METHODS

The number of outpatient and inpatient cataract surgeries included in the annual quality reports of 2006, 2008 and 2010 were put into relation with population density for every provincial state.

RESULTS

In 2006, 2008 and 2010 a total of 765,179 cataract surgeries were recorded. Median number of cataract surgeries per 1000 inhabitants showed an only slight increase (2006: 2.8; 2008 and 2010: 3.0; p = 0.82). The ratio of outpatient to inpatient surgeries showed only a slight increase from 0.84 (2006) to 0.86 (2010).

CONCLUSIONS

Lack of spatial and temporal variations imply that hospitals take a part in supplying the population with cataract surgery. There is no trend to more outpatient cataract surgeries at the moment. This implies that there might be a stable patient population that is not suitable for outpatient care.

[Visual experiences during cataract surgery under topical anesthesia]

BACKGROUND

Cataract patients observe structures, colors and movements during surgery. Is there any pattern to their visual experiences?

METHODS

From 2005 to 2011 a total of 20,000 phacoemulsification procedures were performed using topical anesthesia. From these patients we received 45 pictures which had been painted to reflect intraoperative their visual impressions so that approximately 1 out of 500 of the patients painted a picture. A further 98 patients were questioned postoperatively about their intraoperative visual impressions and were shown the 45 pictures. They described their own visual experiences and any similarities with the 45 pictures were documented.

RESULTS

All patients were awake and cooperative during surgery. Afterwards they described their visual experiences whereby 36 patients saw mainly blue, 32 red/pink and 27 saw yellow colors. Out of the 45 pictures 30 (67%) were identified as being similar to their own visual images and 10 patients could not describe any postoperative visual phenomena.

CONCLUSION

Patients notice optical phenomena during cataract surgery under topical anesthesia with eye drops. Visual images are often similar among patients. The surgeon can use this knowledge to explain these experiences while talking to the patient intraoperatively. This may reassure patients during surgery.

Stabilität des Ferricinium-Kations und seine cytostatische Wirkung / Stability of Ferricinium and its Cytostatic Effect

The relative stabilities of different ferricinium cations were studied in buffer or serum-containing solution and in vivo and compared with their cytostatic effects in cultures of Yoshida ascites tumor cells.

Although the ferricinium cation itself was the most unstable cation compared with the dimethyl-ferricinium cation and the deuterated ferricinium derivatives it showed the highest cytostatic effect.

Markierung kohleadsorbierter Verbindungen mit Tritium nach Wilzbach bei 20°C und —196°C

Bei der Markierung nach Wilzbach lassen sich die spezifischen Aktivitäten der 3H-markierten Verbindungen erhöhen, wenn man Tritium auf aktivkohle-adsorbierte Verbindungen einwirken läßt. Arbeitet man bei Temperaturen um - 200 °C, so wird auch das Tritium quantitativ an die Kohle adsorbiert und die spezifischen Aktivitäten werden dadurch abermals erhöht. Gleichzeitig wird bei den adsorbierten Verbindungen der Anteil an radioaktiven Nebenprodukten oft erniedrigt und damit die Reinigung der markierten Verbindungen erleichtert.

Toxizität und cytostatische Wirkung von PtCl2(NH3)2 nach i. v. und intratumoraler Injektion / Toxicity and Cytostatic Effect of PtCl2(NH3)2 after i. v. and i. t. Injection

oxizität und cytostatisch e W irkung von PtCl2(NH3)2 nach i. v. und intratumoraler Injektion Toxicity and Cytostatic Effect of PtCl2(NH3)2 after i. v. and i. t. Injection In tumor bearing mice intratumoral injection of PtCl2(NH3)2-solution increases the cytostatic effect while decreasing its toxicity in comparison to i. v. injection. In­ tratumoral injections of water-in-oil emulsions of the platin-compound are less cytostatic but have a consider­ ably lower toxicity.

Biochemie der Metallocene, II Organ-Verteilung und Thymus-Anreicherung von [103Ru]Cinnamoyl-ruthenocen / Biochemistry of Metallocenes, II. Organ-Distribution and Thymus Affinity of Cinnamoyl-[103Ru] Ruthenocene

Metallocenes, labelled with 103Ru, are potential radiopharmaceuticals for use in nuclear medicine diagnosis. Ruthenocene derivatives with oxopropene side-chains were administered to mice and rats to study their biochemical properties. Excretion rates and organ distributions of 103RuCl3 and Cinnamoyl-[103Ru] ruthenocene were very different. While 103RuCl3 was relatively evenly distributed in the body, the metallocene derivative was concentrated in liver, lungs and spleen after intravenous (i.v.) injection. After i.p. injection however a high thymus affinity was observed and autoradiography proved that the site of 103Ru accumulation was in thymocytes. The thymus affinity can be diminished by corticoid pretreatment and raised by inhibition of phagocytosis (BeSO4). The mechanism of accumulation in the thymus and a possible clinical application are discussed.

Der protektive Effekt von D2O bei Bakterien (E. coli) / he Protective Effect of Heavy Water (D2O) on Bacteria (E. coli)

E. coli suspended in D2O showed a better survival than in H2O when the bacteria were treated with various damaging agents like UV , heat and freezing. On the contrary E. coli grown in D2O - containing media - therefore being fully deuterated - were more sensitive than normally grown bacteria.

Einbauhemmung 14C-markierter Nucleoside in DNS und RNS von Ascites-Tumorzellen durch D-und L-Glycerinaldehyd

D-Glycerinaldehyd [10-2-m.] hemmt den Einbau von 14C-Thymidin in DNS von Asciteszellen unter aeroben und anaeroben Bedingungen um 80 bis 90 Prozent. Der Einbau von 14C-Uridin in RNS wird durch D-Glycerinaldehyd kaum gehemmt. L-Glycerinaldehyd [10-2-m.] hemmt den Thymidineinbau in DNS und den Uridineinbau in RNS und DNS unter aeroben Bedingungen nur schwach, bei Anaerobiose dagegen um zwei Zehnerpotenzen. Die Wirkung des D-Aldehyds auf den Thymidineinbau in DNS wird durch Auswaschen des Glycerinaldehyds kaum abgeschwächt.

Verfolgung der in vivo-Oxydation von 17-Hydroxy- zu 17-Ketosteroiden durch Messen der Tritium-Aktivität im Körperwasser

Östradiol-17 α-T wird durch die 17-Hydroxy-Steroid-Dehydrogenase, mit DPN oder TPN als Coenzym, zu Östron oxydiert. Dabei entstehen DPN-T bzw. TPN-T, die das Tritium in die Atmungskette einschleusen. Das gebildete Tritiumwasser erscheint im Harn und in der Atemluft und wird bei Kleintieren (Ratte, Maus) unmittelbar gemessen. Der Gehalt an Tritium in der Atemluft bzw. im Harn ist somit ein Maß für die Reaktionsgeschwindigkeit Östradiol-17 α-T → Östron.

Es wurde gefunden, daß Rattenweibchen, ohne und nach Progesterongabe, Tritium gleich schnell aus dem Östradiol-17 α-T umsetzen und nach 7—9 Stdn. etwa 80% ins Körperwasser überführen.

Östradiol-6.7-T gibt dagegen kein Tritium ins Körperwasser ab.

[Characteristics of several humidifiers for CPAP-therapy, invasive and non-invasive ventilation and oxygen therapy under standardised climatic conditions in a climatic chamber]

INTRODUCTION

Patients receiving mechanical ventilation and oxygen therapy frequently complain about the dryness of their airways. Humidifiers increase air humidity by generating water vapour and thus preventing the mucosa from desiccation. In this bench study, we compared the efficiency of several humidifiers.

METHODS

Two identical humidifiers of each type (HC 602, HumiCare 200, Humid Aire 2i, minni-Max, MR 730 AGM, REMstar, Sirius, Somnia2, Somno Comfort2, VENTIclick, VIVO 30) were measured at three different heating intensities (low, medium, high) and three different flow rates (20, 55 and 90 l/min). The relative humidity at the exit of the tube and the temperature of the water in the heating chamber were registered. Additionally, we measured the humidity of the oxygen humidifier Respiflo at 1 - 5 l/min, the Respiflo was filled with either NaCl 0.9% or Aqua dest. Measurements were taken in a climatic chamber at 20 degrees C and 50% relative humidity. The atmospheric pressure was taken into consideration.

RESULTS

The MR 730 AGM and Humicare 200 generated a constant relative humidity of 100%. Among the remaining humidifiers, only the HC 602, HumidAire 2i and REMstar reached a humidity of about 95% at high flow rates. The Minni-Max, Somnia2 and VIVO 30 generated a humidity of 95% still at a flow rate of 55 l/min. The Sirius, Somno Comfort2 and the VENTIclick generated this amount of humidity only at low flow rates of 20 l/min. The three humidifiers mentioned last generated a relative humidity of only 68 - 76 at high flow rates of 90 l/min. The Respiflo generates a humidity of about 90% at each flow rate (1 - 5 l/min.), independent of being filled with NaCl 0.9% or Aqua dest.

CONCLUSION

Factors determinating the efficacy of humidifiers are the velocity of the airstream, the temperature of the water, the contact surface of the air and water compartments and the turbulence of the airstream. In vivo the amount of leakage is a very important determinant for the velocity of the airstream. In the care of mechanically ventilated patients one should have an approximate idea of the magnitude of the applied air flows. The limitations of some humidifiers should be known. The simple presence of a humidifier in combination with a respirator does not mean that the problem of dryness of the airway mucosa is eliminated.

Telemetric implantable pressure sensor for short- and long-term monitoring of intracranial pressure

Patients with hydrocephalus, idiopathic intracranial hypertension and head injury frequently require monitoring of intracranial pressure (ICP) and may need repeated episodes of monitoring months or years apart. The gold standard for measurement of ICP remains the external ventricular catheter. This is a fluid-filled catheter transducer system that allows regular recalibration and correction of zero drift by its position relative to a fixed anatomical reference. It also allows drainage of cerebrospinal fluid (CSF), providing a means of lowering the ICP. Several catheter tip transducer systems are currently in clinical use, including using strain gauges or fiber-optical pressure sensing techniques. In these devices, zero drift and calibration cannot be checked in vivo. All the ICP monitoring devices in current clinical use require a physical connection between the brain and the external environment. This is a source of infection and limits the duration of monitoring. A number of telemetric monitoring devices, in which data is in some way transmitted transcutaneously, have been developed over the last twenty years, but significant technical problems have precluded their use in routine clinical practice. All current ICP monitors are temporary percutaneous implanted devices. Placement of these devices carries significant morbidity, particularly infection. Patients undergoing repeated monitoring require multiple surgical procedures. Apart from decreasing the risk of infection in patients with severe head injury, the clinical value of an accurate telemetric ICP monitoring system which maintains its reliability over a long period of implantation is high.

[Expiratory pressure reduction (C-Flex Method) versus fix CPAP in the therapy for obstructive sleep apnoea]

INTRODUCTION

The REM star C-Flex (Fa. Respironics) was introduced in 2003. In contrast to the conventionel fix CPAP mode, the C-Flex mode is characterised by a pressure reduction at the beginning of expiration. In a randomised cross-over design, we investigated if this C-Flex-mode has advantages compared to the fix CPAP mode in terms of treatment quality and patient satisfaction.

METHODS

In this prospective randomised single-blinded cross-over study we investigated 20 patients with obstructive sleep apnoea treated with fix CPAP versus treatment with the C-Flex mode (level 2) for 6 weeks, respectively. We compared the polysomnographically measured quality of treatment and the subjective satisfaction of either form of therapy. Additionally, we measured long-term compliance of the C-Flex therapy in a 3-year follow-up with the integrated counter of the C-Flex devices.

RESULTS

The mean levels of pressure of the fix CPAP and the C-Flex therapies were 8.4 +/- 2.9 mbar in both groups. There was an identical quality of treatment in terms of respiratory events, arousal index, slow wave sleep and Epworth sleepiness scale. The compliance of nocturnal use of the C-Flex and the fix CPAP was identical (6.0 +/- 0.67 C-Flex use vs. 5.8 +/- 0.98 CPAP use [h/night]). The subjective satisfaction was higher in the C-Flex mode at the end of the study since 18 of 20 patients (90%) subjectively prefered the C-Flex mode because of the easier expiration. 19 patients received a C-Flex device for long-term therapy. The 3-year-follow-up showed a regular utilisation of the C-Flex by 16 of 19 (84.2%) of these patients (mean nocturnal use 6.0 +/- 0.9 h/night). 3 of the 19 patients (15.8%) did not use their C-Flex regulary. None of the patients has terminated therapy completely.

CONCLUSION

C-Flex mode and the conventional fix CPAP therapies show an equivalent treatment quality according to polysomnographic data. The expiratory pressure reduction compared to conventional CPAP was felt to be more comfortable by 90% of patients. The long-term-compliance as measured by regular use of the C-Flex device was 84.2% (16 out of 19 patients) after 3 years, these numbers are higher than published data on compliance with conventional CPAP therapy.