[Advantages and disadvantages of the circumferential retinal cryocoagulation before vitrectomy in proliferative diabetic vitreoretinopathy]

BACKGROUND

It is unclear if a circumferential cryocoagulation 4 weeks before pars plana vitrectomy is useful for reducing the risks of surgery such as retinal detachment, secondary glaucomas or rebleeding. Otherwise it seems possible that this surgery itself, done in local anaesthesia, could be an additional risk.

PATIENTS AND METHODS

We retrospectively evaluated the reports of all patients who underwent vitrectomy as primary surgery due to proliferative diabetic vitreoretinopathy between 1997 and 2000. Besides age and sex, all additional surgery (like phacoemulsification, endolaser coagulation, kind of tamponade etc.) and all intra- or postoperative complications were reported after a follow-up of at least 3 months. We created and compared 2 groups of patients, showing in group 1 patients who underwent vitrectomy 4 weeks after cryocoagulation and in group 2 patients undergoing vitrectomy combined with circumferential cryocoagulation.

RESULTS

We evaluated the reports of 226 patients (103 men, 123 women, mean age 58.6 +/- 13.0 years). Follow-up was in the mean 16.3 months. Group 1 contained 150 patients (66.4 %), group 2 76 patients (33.6 %). 63.7 % received air as endotamponade, 8.0 % C(2)F(6) gas, 7.1 % silicon oil and 21.2 % BSS, 34.1 % were operated in combination with phakoemulsification. We observed 9 postoperative retinal detachments (4.0 %), with no significant difference between the two groups (6 detachments in group 1, 2 detachments in group 2). For other surgical risks like rebleeding, rubeosis iridis, secondary glaucoma etc. we also found no statistically significant differences.

CONCLUSION

Circumferential retinal cryocoagulation is a useful preparation before pars plana vitrectomy, when done due to vitreous haemorrhage, because improved resorption lowers the vitrectomy rate. In all other cases it can be done during vitrectomy. Adjuvant circumferential cryocoagulation seems to decrease the risk of postoperative retinal detachments and rebleedings as documented in literature comparison.

Expression of galectin-1, -3 (gal-1, gal-3) and the Thomsen-Friedenreich (TF) antigen in normal, IUGR, preeclamptic and HELLP placentas

BACKGROUND

Galectin-1 (gal-1) and galectin-3 (gal-3), which are members of the mammalian beta-galactoside-binding proteins, recognise preferentially (Galbeta1-4GlcNAc) sequences of several cell surface oligosaccharides. In addition, gal-1 also binds to the Thomsen-Friedenreich (TF) antigen (Galbeta1-3GalNAc-).

MATERIALS AND METHODS

Slides of frozen and paraffin-embedded placental tissue of patients with fetal intrauterine growth retardation (IUGR), preeclampsia, haemolysis, elevated liver enzymes, low platelets (HELLP) and normal term placentas were incubated with monoclonal and polyclonal antibodies against gal-1, gal-3 and TF. Staining reaction was performed with the avidin-biotinylated peroxidase complex (ABC) reagent. The intensity of the immunohistochemical reaction on the slides was analysed using a semi-quantitative score. The identity of galectin-expressing cells was analysed by using a double immunofluorescence method.

RESULTS

We demonstrated immunohistochemically that the expression of gal-1 and gal-3 on the extravillous trophoblast (EVT) is significantly up-regulated in preeclamptic and HELLP placentas and unchanged compared with normal controls in IUGR placentas. The expression of the TF antigen is significantly up-regulated in IUGR and preeclamptic extravillous trophoblast cells and unchanged in HELLP placentas compared with normal controls. In addition, the expression of gal-1 is significantly up-regulated in the decidual tissue of preeclamptic placentas and in the villous trophoblast tissue of HELLP placentas.

CONCLUSION

Our data showed that gal-1, gal-3 and TF were up-regulated on the membrane of EVT in preeclamptic placentas. In addition, the expression of gal-1 is significantly up-regulated in decidual tissue of preeclamptic placentas and villous trophoblast tissue of HELLP placentas. Taking into consideration the results of this study, we speculate that expression of both galectins and TF on the membrane of preeclamptic EVT and up-regulation of gal-1 in preeclamptic decidual cells may at least in part compensate for the apoptotic effects of maternal immune cells.

[Unexpected foreign bodies in eyelid surgery. Three cases of unexplained lid tumors]

Foreign bodies are quite commonly found incorporated in the lid area after injuries. Normally the patient's description of the injury and the usually fresh clinical findings leave little room for doubt about their composition. In isolated cases, however, patients are admitted with "lid tumors" following an accident in the rather distant past, so that sometimes no connection can be seen with the symptoms present on admission and it is not even clear whether there is still foreign material in the wound. Subcutaneous swellings can then easily be mistaken for cicatricial tissue, granulomas or old hematomas. In all these cases there can be a big difference between what the surgeon expects and the actual intraoperative findings. We present three cases in which unexpected foreign bodies have been extracted from the eyelid region.

Development and characterization of monoclonal antibodies for the immunohistochemical detection of glycodelin A in decidual, endometrial and gynaecological tumour tissues

AIMS

Glycodelin is a glycoprotein with a molecular weight of 28 kDa. Unusual LacdiNAc structures have been identified on glycodelin A, isolated from amniotic fluid. Three major functions of this glycoprotein have been identified. Glycodelin is an immunosuppressive molecule, a marker of morphological differentiation, and a contraceptive. Because no monoclonal antibodies for glycodelin A are commercially available, our aim was to develop and characterize three monoclonal antibodies against this glycoprotein.

METHODS AND RESULTS

Glycodelin A was purified from amniotic fluid by three chromatographic steps and its purity was checked by SDS-PAGE. Antibodies were generated from immunized BALB/c mice. Three IgG1 monoclonal antibodies detecting glycodelin A were cloned. All three antibodies recognized carbohydrate structures of glycodelin A and did not cross-react with glycodelin S. They are applicable to immunohistochemistry (frozen and paraffin sections), ELISA and Western blots.

CONCLUSION

The new antibodies can be used for the detection of glycodelin A in frozen and paraffin-embedded decidual and endometrial tissue. One antibody (A87-B/D2) can be used for the detection of glycodelin in endometrial and ovarian tumour tissues. Because glycodelin A is a major secretory endometrial product during the luteal phase, in early pregnancy and in gynaecological tumours, the new antibodies are, potentially, valuable tools for the study of endometrial development and tumour progression.

Expression of Inhibin/activin Subunits alpha (-α), beta A (-β A) and beta B (-β B) in Placental Tissue of Normal and Intrauterine Growth Restricted (IUGR) Pregnancies

During human pregnancy the placenta produces a variety of proteins like steroid hormones and their receptors that are responsible for the establishment and ongoing of the feto-placental unit. Inhibins are dimeric glycoproteins, composed of an alpha-subunit and one of two possible beta-subunits (beta (A) or beta (B)). Aims of the present study were the determination of the frequency and tissue distribution patterns of the inhibin/activin subunits in human placental tissue of normal pregnancies and pregnancies complicated with fetal growth restriction (IUGR). Slides of paraffin embedded placental tissue were obtained after delivery from patients diagnosed with IUGR (n = 6) and normal term placentas (n = 8). Tissue samples were fixed and incubated with monoclonal antibodies inhibin/activin-subunits -alpha, -beta (A), -beta (B). Intensity of immunohistochemical reaction on the slides was analysed using a semi-quantitative score and statistical analysis was performed (P<0.05). A significant lower expression of the inhibin-alpha subunit in IUGR extravillous trophoblast compared to normal pregnancies was observed, while the inhibin-alpha immunostaining was significantly upregulated in syncytiotrophoblast. Additionally, a significant down-regulation of inhibin-beta (B) subunit in extravillous trophoblast cells in IUGR syncytiotrophoblast cells was demonstrated. A co-localisation of inhibin-alpha and the beta-subunits was also observed, suggesting a production and secretion of intact inhibin A and inhibin B. Although the precise role of these inhibin/activin subunits in human placenta and IUGR pregnancies is still unclear, they could be involved in autocrine/paracrine signalling, contributing to several aspects like angiogenesis and tissue remodelling.

Novel valproic acid derivatives with hemoglobin F inducing activity

Pharmacological induction of hemoglobin F expression may be a promising approach for the treatment of beta-thalassemia and sickle cell disease. Valproic acid, a drug frequently used for the treatment of seizure disorders, has been shown to enhance fetal hemoglobin synthesis in erythroid cells. However, this effect is only modest and requires relative high concentrations. Therefore, the drug appears not to be applicable for the treatment of beta-globin chain disorders. Here, we describe the identification of novel valproic acid derivatives with potent hemoglobin F inducing activities at concentrations that presumably can be obtained in vivo.

[Value of different measurements of the preoperative visual acuity and perception of Purkinje's vessel shadows for prediction of the postoperative visual acuity after vitrectomy in diabetic vitreous hemorrhage]

BACKGROUND

In cases of strong vitreous hemorrhage due to diabetic vitreo-retinopathy there is an uncertainty for the prediction of postoperative visual acuity after vitrectomy. This study compares the value of different preoperative measurements for the prognosis of postoperative visual acuity.

METHOD AND PATIENTS

We evaluated retrospectively the reports of all patients who have been operated by vitrectomy due to diabetic vitreous hemorrhage at our hospital in 2004 (first vitreoretinal surgery). The following measurements were evaluated: preoperative distance and reading VA, last known VA before hemorrhage, laser interference VA, Purkinje's vessel shadow and postoperative distance VA.

RESULTS

42 patients had entire documentation of all evaluated parameters. The preoperative distance VA was 20/1000 (light perception to 20/60), only 3 patients had a reading VA. Laser interference VA was better than red light perception in 13 patients (7 without red light perception). Purkinje's vessel shadows were positive in 22 patients, negative in 17 patients, but 3 patients did not understand the procedure. Prehemorrhage VA was known in 19 patients. Laser interference VA and last known VA prior to hemorrhage (in mean 20 months old) had the best correlation to postoperative VA (p > 0.05). Purkinje's vessel shadow predicts -- if positive -- a postoperative VA of 20/300 or better.

CONCLUSIONS

Postoperative VA after vitrectomy due to diabetic vitreous hemorrhage is best predicted by prehemorrhage VA or laser interference VA, especially if no prehemorrhage VA is known. Positive Purkinje's vessel shadow predicts a postoperative VA of 20/300 or better.

350 COMPARATIVE TIME-LAPSE STUDIES ON PORCINE EMBRYOS FERTILIZED IN VITRO WITH FLOW CYTOMETRICALLY SEX SORTED SPERMATOZOA

The objective of the present time-lapse studies was to compare developmental characteristics of porcine embryos after in vitro fertilization with flow cytometrically sexed spermatozoa during an in vitro culture period. Immature oocytes were matured (n = 851) and fertilized in vitro using 50 spermatozoa of either sex per oocyte. Additionally, in vivo-matured oocytes (n = 700) were derived from hormonally stimulated (eCG/hCG) prepuberal gilts, which were slaughtered 38 h after hCG treatment. Potential zygotes were introduced into the time-lapse system (50 µL-microdrops, NCSU-23) 18 h after the onset of in vitro fertilization. The onset and duration of cell cycles and blastomere rotation as well as collapses and re-expansion of cytoplasm were investigated. At the end of the culture period (168 h), embryos were labeled with Hoechst 33342 to identify the number of cell nuclei. The time-lapse system consisted of an incubation chamber installed on an inverted phase-contrast microscope and gassed with 5% CO2 in maximally humidified air. Computer controlled positioning of the chamber allowed the capture and storage of digital images of individual embryos every 30 min over a 7-day period. Converted time values were tested by ANOVA or ANOVA on ranks. In total, 700 in vivo-matured oocytes were fertilized in vitro (Y-sperm: 342; X-sperm: 358). Cleavage rates were 45.6% for male and 40.2% for female embryos. Out of these, 45.5% developed to male and 62.5% to female blastocysts, respectively. The onset and duration of cell cycles differed significantly at the 2-cell and morula stages (P < 0.01). The onset and number of rotations as well as collapses and re-expansion of cytoplasm were not different. Mean cell numbers of blastocysts were equal for both sexes (male: 35.2; female: 38.8). In parallel, 851 in vitro-matured oocytes were fertilized in vitro (Y-sperm: 431; X-sperm: 422). Cleavage rates were 45.5% for male and 49.3% for female embryos. Out of these, 54.1% developed to male and 56.7% to female blastocysts, respectively. The onset and duration of cell cycles and rotations as well as collapses were not significantly different between sexes. Mean cell numbers of blastocysts were equal for both sexes (male: 29.5; female: 27.7). Comparison between male embryos derived from in vivo (VV) or in vitro (VT)-matured oocytes showed a delay of the onset of the second cell cycle for VV (P < 0.001) and at the blastocyst stage for VT (P < 0.001). Accordingly, in these stages the duration of the cell cycle was shortened (P < 0.001). The onset and duration of rotations as well as collapses and re-expansion of cytoplasm were not different. Similar data were obtained for the female embryos. The data suggest slight sex related differences (onset of cell cycles), but these might be masked in embryos produced from in vitro-matured oocytes due to their higher individual variability. The experiment also shows the advantages of a time-lapse system to identify dynamic cell processes. It might also be a useful tool to precisely correlate cell cycle events to activation of certain marker genes.

Expression of inhibin/activin subunits alpha (-alpha), betaA (-betaA), and betaB (-betaB) in placental tissue of normal, preeclamptic, and HELLP pregnancies

During human pregnancy the placenta produces a variety of proteins for the establishment of the fetoplacental unit, including inhibins and activins. Inhibins are dimeric glycoproteins, composed of an alpha-subunit and one of two possible beta-subunits (betaA or betaB). Aims of the present study were (a) the determination of the frequency and tissue distribution patterns of the inhibin/activin subunits in human placental tissue of normal pregnancies and pregnancies complicated with preeclampsia and HELLP syndrome (hemolysis, elevated liver enzymes, low platelets) and (b) the assessment of a combined expression of inhibin-alpha- and both beta-subunits (betaA-and betaB-subunits) using double immunofluorescence technique. A significant lower expression of the inhibin-alpha subunit in preeclamptic and HELLP placental tissue compared to normal pregnancies was observed, while the inhibin-alpha immunostaining was significantly upregulated in syncytotrophoblast. Additionally, we demonstrated a significant down-regulation of inhibin-betaB subunit in extravillous trophoblast cells between normal and preeclamptic compared to HELLP placental tissue, while inhibin-betaA-subunit was significantly higher in preeclamptic syncytotrophoblast cells. A colocalization of inhibin-alpha and the beta-subunits could be demonstrated, suggesting a production and secretion of intact inhibin A and inhibin B. Therefore, inhibin A and activin A might be useful markers in preeclampsia. Valuable parameters in HELLP syndrome could be inhibin A, rather than inhibin B, and activin B. Furthermore, the lower betaB-subunit production in extravillous trophoblast cells demonstrates that this subunit might have an important role in the pathogenesis of HELLP syndrome. Additionally, the higher production of the betaA-subunit in syncytotrophoblast cells suggest a higher production of activin A rather than inhibin A in preeclampsia that might be utilized as a marker of placental function.

Diskrepanz zwischen objektiver Messung und subjektiver Wahrnehmung einer Sicca-Symptomatik vor und nach kosmetisch oder medizinisch indizierten Blepharochalasis-Operationen

BACKGROUND

This study was designed to examine if patients undergoing the same operative procedure (blepharochalasis operation) have different subjective recognition of dry eye problems depending n whether they had he operation for cosmetic or medical reasons.

PATIENTS AND METHOD

The study included 32 patients (25 women, 7 men, mean age 57.8 +/- 12.1 years), who underwent blepharochalasis operation between 1/2005 and 5/2005. In 17 patients (group 1) the operation was done for cosmetic reasons, in 15 patients we found a medical indication (group 2). We evaluated the subjective discomfort from the lid problems as well as the satisfaction with the operation in general and pre- or postoperative recognition of dry eye problems (all done by scales). Additionally we measured tear secretion by Schirmer's test and break-up time before and after operation.

RESULTS

The subjective recognition of a dry eye was stronger in group 1 than in group 2 before and after operation (p < 0.005), but objective data were nearly identically (BUT, Schirmer's test).

CONCLUSION

When operated due to cosmetic reasons the stronger recognition of sicca problems (while objectively lacking) is may be caused by a stronger fixation on the lid disease itself. It seems necessary to document objective data for that reason.