The Kaleff-Hollwich technique and results of external dacryocysto-rhinostomy operation

After a review of the history of lacrimal surgery the author describes the techniques of dacryocystorhinostomy which are currently performed. The ideal method is that of Ohm (1921) and Dupuy-Dutemps (1921) with its totally closed mucosal anastomosis. Because of the technical problems demonstrated with this technique the author recommends that of Kaleff (1937), modified by Hollwich (1977). The advantages of this method are: 1. The almost closed mucosal cavity which permits primary would healing. 2. The easy strain-free practicability particularly in cases of small scarred sac and pre-positioned ethmoid cells. 3. The sure fixation of the mucosal roof at the subcutis particularly in cases of marked swelling. Finally a survey of long-term and short term observations on all 324 cases from 1964 to 1977 is given.

Genesis and therapy of dacryocystitis neonatorum

By means of post mortem dacryocystograms and photomicrographs of histological slides, the topography and morphology of the lacrimal ducts in newborn infants are demonstrated. Because of bends in the course of the lower tear duct a percentage of probings will fail to effect satisfactory perforation of Hasner's membrane. In most cases the soft texture of this membrane requires no more than syringing under pressure, using the hollow probe as described by Bangerter (1953).

[Fundus changes due to arteriosclerosis and chronic-arterial hypertension (author's transl)]

The authors report on difficulties in ophthalmoscopac differential diagnosis of fundus changes due to arteriosclerosis and hypertension. An attempt is made to present a classification of hypertensive alterations which -- in close association with the scheme published by Keith, Wagner and Neubauer -- uses the same descriptive terms but restricts itself to distinguish between changes of the vascular system on the one hand and changes of the parenchym as a consequence of the vascular changes on the other hand.

[First results with hydrophile tear duct prosthesis (author's transl)]

The author reports on a new tear duct prosthesis from hydrophile silicone. The advantage of this material is its hydrophilia absorbing the tears to the medial angle, and its softness preventing pressure necrosis and allowing an exact fixation in the medial angle of the lid. The implantation of the prosthesis in combination with conjunctivo-dacryocystotomy seems to be the best technique but also other techniques are demonstrated and discussed.

[Retinitis septica Roth (author's transl)]

The authors report on a case of retinitis septica Roth in a 27-year-old pregnant woman with septic pyelonephritis caused by enterobacter aerugines.

[Obligation to tolerance and reasonability of cataract extraction (author's transl)]

The reasonability of cataract extractions is mentioned with exposition of the interests of the insuring bodies and of the patient. We discuss individually the terms "medical treatment", "obligation to tolerance" and "reasonability". The surgical method and the general physical assessment of the patient earn special consideration for a "reasonable" cataract extraction. We also discuss the special situation of the surgeon.

[Results of Nandrolone therapy (Keratyl) in lesions and diseases of the cornea (author's transl)]

The authors report on clinical experiences with the topical application of the synthetic hormone Nandrolon (Keratyl) in diseases of the cornea caused by exogenic, neurogenic, and combined exogenic-endogenic factors. In all cases a positive regenerative effect on epithelium and stroma of the cornea seemed to exist. The present results seem to allow the following range of indications: 1. injuries of the epithelial tissue; 2. ulcera of the cornea (combined with antibiotics); 3. dystrophic diseases of the cornea; 4. certain postoperative treatment after keratoplastic surgery.

[Conjunctival covering (Harms) (author's transl)]

The authors report on 7 cases of conjunctival flap cover in the technique of Harms and Mackensen (1963) in cases of leackage of the bleb after filtering operations. The technique consists in excision of the thin conjunctiva of the bleb, undermining of the conjunctiva until the fold, arched incision of the cornea in front of the bleb, incarceration of the conjunctival lip in the corneal incision with fixation by continuous suture with monophile nylon-string (10X0). In 6 of 7 cases the intraocular pressure was spontaneously regulated after the operation with morphological functioning bleb in 4 cases.

Anatomy of the naso-lacrimal duct in new-borns: therapeutic considerations

The topography and morphology of the lacrimal ducts in newborn infants was demonstrated by means of post mortem dacryocystograms and microphotograms of histologic slides. Because of bends in the course of the lower tear duct, a percentage of probings will fail to effect satisfactory perforation of the Hasner membrane. In most cases, the soft texture of this membrane requires no more than syringing under pressure, using a hollow probe as described by Bangerter (1953).

[On the conservation of the tear ducts in tumor surgery in the eyelid region (author's transl)]

The conservation of the tear ducts, as well as their partial conservation, must be considered when operating on smaller tumors, depending on the clinical picture and the histological aspect. However, the preparation should be done under magnification to facilitate delineation of the borders of the tumor and to immediately recognize when the tear ducts are opened. The histological description of the kind of tumor and the answer to the question of excision into the healthy tissue decide the further procedure. The placing of an indwelling tear duct probe in the form of a supramid thread or of a polyethylene tube has proved favorable. In case partial resection of the peripheral parts of the canal system is necessary, the remains of the posterior wall of the vertical or horizontal part of the canaliculus must be opened with Vanna's scissors. The remaining vertical or horizontal part of the canaliculus does not lose its suctionpressure pump capillarity when it is opened, but ensures tear drainage.

[Metastatic deposits of carcinoma in the choroid (author's transl)]

The authors report on choroid metastatic deposits from primary tumors of other organs with regard to a survey of the literature and personal observations. 85% of the choroid secondary growths occur after breast cancer in women with an average latency of 3 1/2 years. The ophthalmological appearances and the fluorescence-angiographical phenomena are discussed with regard to the differential diagnosis of melanoma and haemangioma of the choroid. The therapeutic procedure for secondary deposits of mamma carcinoma is considered.

[The Custodis procedure--technic and results (author's transl)]

Within the post 11 years 2,722 retinal detachments needed surgery. The mostly used procedure of Custodis consists in an implant, which covering the area of the hole is impressed into the sclera by mattress sutures. In 70% of our cases--due to Custodis--we succeeded in avoiding drainage of the subretinal fluid. Since 1966 the additional diathermy and/or lightcoagulation was mostly replaced by cryopexy. Summarizing the number of retinal detachments operated in the University clinic of Münster during 1955--1957 (Pau), 1958--1961 (Böke) as well as ours (1966--1977), 4,030 retinal surgeries (minus 10% encircling procedures) underwent within 18 years a Custodis procedure. The success rate of 85% indicates that Custodis' technic enables to optimal results.

[The diagnosis of venous malformation of the orbits (author's transl)]

The authors describe the frequency, clinical features and methods of diagnosis of venous malformations of the orbits based on their own experience and on the relevant literature. Special attention is paid to plain film diagnosis and angiographic methods of investigation. Orbital phlebography is the most suitable method for demonstrating cavernous haemangiomas and orbital varices and for demonstrating the anatomy of the supplying vessels. For this, special apparatus and skills are necessary in order to obtain adequate, or optimal, phlebograms. The radiological features of venous malformation are described and a selection of typical phlebographic findings are illustrated. An attempt is made to evaluate other forms of examination. Possible aetiological factors in the development of venous malformation in the head and neck region are discussed.

[Short and long-term results after external Dacryocystorhinostomy by Kaleff-Hollwich's method (author's transl)]

By means of a short and long-term study the recanalising effect of Kaleff-Hollwich's (1977) Dacryocystorhinostomy was determined and compared with Ohm's (1921) and Dupuy-Dutemps (1921) methods. With both procedures a high percentage (75-85) of permanent patency of the tear ducts is obtained. With Kaleff-Hollwich's method a practically continuous mucosa anastomosis can be formed. Stenosis by insufficiency of the canaliculi can be avoided in the opinion of the authors by exact refixing of the medial palpebral ligament. Information in the literature of patency in over 90 percent of cases is revealed after critical evaluation in the great majority of such reports as post-operative ability to rinse the tear ducts in one direction and give no indication of the end result.

[Ophthalmological long-term effects of malar fractures (author's transl)]

In the years 1964 to 1974 138 patients with malar fractures were treated by operation. After follow-up examination on an average of 3 years and 10 months after the operations the occuring complications in 61 patients were revealed. On the first stationary admission to hospital 14 patients complained of diplopia; on the follow-up examination only 5 paresiae were found. On the first examination after the accident 35 patients had hypoaesthesiae, anaesthesiae or paraesthesiae in the area of supply of the ophthalmic and maxillary nerves. It is remarkable that in the follow-up examination 29 patients complained still of these disturbances. Perforating injuries were not found in these patients. 2 patients had however traumatic macular foramina. 2 further patients had partial optic atrophy, a result of fracture in the region of the optic canal.

The importance of retrograde phlebography in the diagnosis of orbital lesions

The authors describe a technique for retrograde phlebography of the orbit. A selection of the typical findings in 51 cases of orbital phlebography is presented. The diagnostic importance of the examination in cases of similar clinical symptoms has been stressed. This method is best suited to the investigation of cases of venous malformation, especially of the intra-orbital, peri-orbital and retro-orbital area. Side-effects and complications have been described. A comparative assessment against other competetive methods of investigation, like the computer tomography has been attempted.

[On the operative treatment of tear opening atresia (author's transl)]

The authors describe a method of identifying and opening tear canaliculi when the openings are closed. For this purpose the common canaliculus under the medial palpebral ligament by the lateral wall of the tear sac is exposed by lamellar dissection under the microscope and opened. The roof of the tear point (where the tear opening should be) is excised over conical sounds laid retrogradely. Finally a vein catheter is placed from the upper and lower tear duct openings through the tear sac into the nasal cavity and left in situ for 12 weeks.

Ethanolaminosis. A newly recognized, generalized storage disease with cardiomegaly, cerebral dysfunction and early death

A storage disease with cardiomegaly, generalized muscular hypotonia, cerebral dysfunction, failure to thrive and early death is described in two siblings. The first one died at the age of 10 months, the second at the age of 17 months. The symptoms were mainly due to lysosomal storage of a substance which had a positive reaction to PAS and Best's stain and which was resistant to diastase. This substance was stored in nearly all the organs, especially in the heart, liver, spleen and less in the brain and skeletal muscles. An increased renal excretion of ethanolamine, a greatly increased hepatic concentration of ethanolamine and diminished hepatic ethanolamine kinase activity could be demonstrated. Ethanolamine is essential for the synthesis of phospholipids. Both parents showed increased renal excretion of taurine. In several aspects, this syndrome is similar to the glycogenosis type II described by Pompe.

[The radiological anatomy of the tear ducts in neonates (author's transl)]

This position and relationship to the facial skeleton of the tear ducts in neonates were studies during 25 post mortem examinations by injection of contrast material into them and the findings were correlated with microscopic appearances. This produced the following results: in more than 50% cases there was unilateral or bilateral narrowing of the distal end of the duct due to persistence of Hasner's membrane. The ration of length of the tear duct and the ductus in neonates is 1:2 (adults 1:3). The proximal portions of the ducts between the saccus and the ductus show multiple transverse mucosal folds. There are several more or less acute curves in both planes. The examination indicates that in the treatment of neonatal dachryostenosis it is necessary to use a combination of dilatation and pressure injections.

[Spinalioma in the eyelid region (author's transl)]

The authors describe the characteristic features of spinaliomas in the lid region, which were observed in a study of 44 patients with this clinical picture. From this we could conclude that the presence of a spinalioma is revealed by: atypical localisation in the eyelids (upper lid, lateral or medial lid angle), accelerating rate of growth or involvement of youngerer patients. And, certainly not in the last position of importance, there is a very definite inclination to recurrences, which necessitates a sufficiently radical surgical removal into the healthy tissue.

[Malformation of the tear ducts associated with clefts in the face (author's transl)]

A case of malformation of the tear duct associated with clefts in the face is described. To our knowledge this combination has not been described before. The whole symptoms complex consisted of: bilateral cleft lip upper jaw and gum, choanalatresia, mucocele of the left nasal cavity from adhesions of the lower concha with the nasal septum, cystic dilatation of the tear sac at the connection to a bony naso-lacrimal duct. Right inguinal hernia, syndactyly of the first and second left toes, iris-chroid coloboma right with congenital cataract and unilateral right convergent squint. Because of the advanced dacryocystitis on the basis of the congenital dacryostenosis, and external dacryostorhinostomy (modified after Kaleff 1937) was performed after pre-treatment by instillation of antibiotic solutions in the tear ducts. At the same time the nasal cavity mucocele was opened by partial excision of the lower concha and opening the choanal atresia. After a post-operative course free of complications and with clear patency of the tear ducts the oral surgical operation was done--closure of the face clefts. The chromosome analysis was normal the only abnormal result here was an unexplained slow rate of multiplication of lymphocytes in four cultures inoculated at various points of time. Because we could not find any hereditary factors, this symptom complex is probably due to exogenous embryo damage during the early development phase.

[A variable pressure and distance impression funnel for fundus examination (author's transl)]

We describe a variable pressure and variable distance impression funnel for the Goldmann-3-mirror contact glass. The advantage of this apparatus lies in the possibility of denting the bulbus up to the equator for the diagnosis of holes while the retina is still attached. This funnel has proved itself especially in light coagulation through the contact glass with the slitlamp.

[Development of idiopathic dacryostenosis (clinical and pathologico-anatomical findings)]

The authors describe microsurgical appearances of tear-sac and nasal mucous membranes from 45 patients suffering from dacryostenosis without clinically manifest nose or sinus conditions. In addition the observations of Henle (1865), that described the continuation of expandible conchal mucous membrane up to the lower part of the tear duct were controlled. The observations gave the following results: 1. In all cases of dacryostenosis there was a past history of more or less severe acute or chronic inflammation of the nasal and tear-duct mucous membrane. 2. The submucose of the ductus naso-lacrimalis surrounded by bone contains arterioles with sphincters and cavernous vessel complexes which can cause swelling up to displacement of the canal lumen, according to the blood flow. The results support the hypothesis of the authors that "idiopathic" dacryostenosis is caused by ascending inflammations from the region of the nose and sinus cavities, which can be clinically quite inconspicuous.

[On the therapy of tractional retinal detachment without hole formation (author's transl)]

The authors describe 6 cases of tractional retinal detachment without hole formation--five as a result of intraocular metal splinter injuries and the sixth after scleral perforation following windshield injury which was overlooked. Splinter extraction was performed twice through the perforation and three times though the pars plana from the ouside. The time between the injury and appearance of the retinal detachment varied between four months and nine years. In every case there was a diffuse falt detachment without obvious tent formation. Reattachment was successful in five cases by release of the traction from the outside by cerclage with folding of the point of traction in the vitreous body and diathermy with drainage of the subretinal effusion. This method described gives relief only when vitreous strands traverse the whole bulbus crosswise. The follow-up period is up to the present three months to a year.

[Pilocarpine as a diagnostic agent for early recognition of a tendency to glaucoma. (Comparable results between Hollwich's pilocarpine-test and tonography) (author's transl)]

In a group of 20 patients Hollwich's pilocarpine-test and tonography were performed repeatedly at regular intervals, for diagnostic purposes. The results of the pilocarpine-test were compared with those of tonography. Hence it was shown, that the pilocarpine-test performed at the peak of the daily pressure curve, gives comparable results to tonography and hence can be useful when glaucoma suspicion exists in the eye-doctor's surgery.

[Clonidine as ointment (author's transl)]

From 15 eyes in 12 patients with chronic simple glaucoma a comparison of the IOP-diminishing effect between 1 drop 0.25% aqueous solution of Clonidine and a 2 cm long application of 0.2% Clonidine-ointment was made with special regard of local and general side effects, especially on the blood pressure. The reduction of the IOP and the blood pressure was greater and of longer duration after ointment application has a definite depôt-effect. Older patients should be fully digitalized beforehand in order to support the cardiovascular system during Clonidine application.

[Misdiagnosis of "chalazion" (author's transl)]

The diagnosis of the often occurring "chalazion" usually puts no problems in diagnostic and therapeutical view. It must be considered, however, that already small particularities of the clinical findings point to other i.e. benign or even malignant processes. An analysis of a number of cases from 1969 to 1975 of the University Eye Clinic Münster showed in 21 out of 89 histologically examined tissue specimen another diagnosis. In 8 patients a malignant degeneration of tissue was histologically stated. The authors describe some cases, where during a longer period of time the malignant character of the disease was not diagnosed due to the misdiagnosed "chalazion".

[Non-pigmented extrabulbar sarcomas of the eye-region (author's transl)]

The authors report on 30 cases with non-pigmented extrabulbar sarcomas of the eye-region which occurred in our clinic within the period of 1955 till 1975. The primary sarcomas of the orbit predominate with 11 cases over the secondary involvement with 9 cases. More seldom (5 cases) is the involvement of the lids and the epibulbar space. The various groups of lymphosarcoma predominate with 16 cases over the spindle-cell sarcoma with 6 cases. The age distribution shows that these tumors prefer the first three decades and the fifth and the following decennia. The prognosis is bad for the conservation of the eye as well as for the preservation of life. With reference to the localisation the distribution at the time of the beginning of the therapy as well as the histological findings an intensive therapy (operation, radiation, chemo-therapy) has to be accomplished.

[Plasmocytoma of the orbit (author's transl)]

After a survey of the clinical picture of plasmcytoma including histological, internal and radiological findings the special aspects of affections of the orbit are described and demonstrated by four own cases since 1955. The authors propose the differentiation between plasmocytomas with bony erosive changes, solitary or multiple, and extrameudllary myeloma for theapeutical and prognostical reasons. The extramedullary myeloma of the orbit has a better prognosis and should be treated by local excision of the tumor with following radiation (CO-60). In case of bony erosive changes the extension of the tumor has to be considered, in case of multiple involvement of the body the radiation should be prefered as a palliative treatment in combination with chemotherapy.

[One year's experience with pilocarpin-ocusert in the therapy of glaucoma (author's transl)]

The authors report on their own treatment results with the drug carrier Ocusert (Federal Rep. of Germany: Chemie Grunenthal). Furthermore the effect on the IOP and the compatibility including the accomodative myopia is discussed. The effect on IOP was approximately equal to Pilocarpine 2% four times daily. The accommodation myopia was significanly less than using Pilocarpin drops. A short time after insertion the conjuntiva was irritated but the irritation faded within a short time.

[Anterior-cleavage-syndrome (author's transl)]

The authors report on local and general changes in dysgenesis mesodermalis iridis et corneae Rieger on the basis of own observations and literature survey. This genetically caused inhibitory deformation is outlined with regard to the differential diagnosis of other anomalies in the angle part of iris. The conservative and surgical therapeutic experiences of other authors are contrasted with our own.

Oscillatory Oxidation of Malonic Acid by Bromate 3. CO2 and BrO3--Titration

The reaction of malonic acid and bromate in the presence of catalytic amounts of cerious ion under oscillating conditions in sulphuric acid was investigated. After two hours reaction time 26 mM bromate were consumed and 42 mM CO2 produced. No formic acid was detected. Furthermore, 14C-tracer experiments suggest that malonic acid is first brominated and subsequently decarboxylated.