Vergleich von Eigenserum und Hyaluronsäure zur Behandlung kornealer Erosiones nach Vitrektomie bei Diabetikern

PURPOSE

The purpose of this study was to evaluate whether treatment with autologous serum exhibits better epitheliotropic properties than hyaluronic acid in patients with reduced wound healing (diabetics).

PATIENTS AND METHOD

This prospective randomized study included all diabetic patients undergoing pars plana vitrectomy with abrasion of the corneal epithelium. In addition to the usual topical therapy one group was treated with hourly application of autologous serum, the other group with hyaluronic acid drops. We evaluated the time needed for closure of the corneal epithelium as well as other parameters such as patient's age, sex, duration of surgery, history of diabetes, and the current HbA1C.

RESULTS

There were 23 patients enrolled in the study. The epithelium healed a mean of 2 days earlier in the autologous serum group. Based on the statistically significant difference in favor of autologous serum, the study was terminated after treatment of 23 patients.

CONCLUSIONS

Autologous serum eye drops lead to earlier closure of the corneal epithelium after intraoperative abrasion in diabetic patients when compared with artificial tears.

Vermessung der skotopischen Pupille im Vergleich zwischen Grünlichttest und Wellenfrontanalyser WASCA

OBJECTIVE

The aim of this study was to compare the accuracy and the reproducibility of scotopic pupil measurements using 2 different methods.

METHODS

Scotopic pupil diameter was measured in 56 eyes of 28 volunteers and the results were compared between the green light test at the slit lamp (Haag-Streit, Switzerland) and the automatic measurements of the wave-front analyser WASCA (Carl-Zeiss-Meditec) by 2 independent examiners. Non-parametric sign test as well as All Pairwise Multiple Comparison Procedures (Student-Newman-Keuls method) were performed for the comparison of means for each individual eye as well as the results of both eyes tested by both examiners.

RESULTS

Mean age of the subjects was 34.9 years. The colour of iris was green or blue in 22 cases and brown in 6 cases. REPRODUCIBILITY: For the green light test we found for the first investigator in the right eye a mean pupil diameter of 6.58 mm (SD 0.68). The measurement of the second investigator for the same eye was 6.64 mm (SD 0.61). The left eye values were as follows: 6.36 mm (SD 0.68) and 6.75 mm (SD 0.68). For WASCA we found for the first investigator in the right eye 6.33 mm (SD 0.64) vs. 6.30 mm (SD 0.64) for the second investigator, in the left eye 6.39 mm (SD 0.69) vs. 6.36 mm (SD 0.60). There was a statistically significant difference between the two investigators when the green light test was used (6.47 mm vs. 6.69 mm for both eyes). No difference was found using the WASCA integrated pupillometer (6.35 mm vs. 6.33 mm). There was a significant difference between the means of combined data for both measurement methods: 6.58 mm for the green light test (SD 0.57) vs. 6.34 mm for WASCA (SD 0.62).

CONCLUSIONS

The integrated pupillometry of the WASCA analyser showed better reproducibility of measurements than the green light test. The green light test measures a slightly larger diameter (in the mean by 0.25 mm) than WASCA. Because of the fair and clinically sufficient reproducibility as well as virtually non-existing additional costs the green light test can be strongly recommended to referring ophthalmologists and low-volume refractive surgeons.

[Supratentorial primitive neuroectodermal tumor: a single center experience and comparison with the literature]

Supratentorial primitive neuroectodermal tumors (stPNETs) are malignant tumors. We saw within three years six children with stPNETs. In four of the six children radical resection could be achieved. All had craniospinal irradiation and chemotherapy according to the HIT-91 protocol. The two children with incomplete resection died due to tumor progression after 7 and 10 months. Two of the 4 children with complete tumor resection had local relapses 8 months after diagnosis and died after 14 and 18 months. One child had a diffuse meningeal relapse 12 months after diagnosis. Despite (high-dose) systemic chemotherapy and intraventricular mafosfamide, he died 21 months after diagnosis due to tumor although remission could be achieved. Only one child is still in remission 86 months after diagnosis.

Facilitating phenomenological interviewing by means of reflexology

The aim of this article is to show how reflexology could facilitate phenomenological interviewing by probing the life-world of individual participants. It presents a hybrid study of phenomenological interviewing and reflexology as a holistic method of health care. In this sense, it is an interparadigmatic study, since it rests on the interface of Western and Oriental thought. This article reports on seven cases which were included in the qualitative, empirical investigation. During the sessions, reflexological readings served as impetus for inquiry into the experiences of the participants, as congestions on reflex points and along meridians were interpreted in terms of physical organs and functions. These readings were related to corresponding emotions as accepted within the reflexology paradigm. It was, however, up to the participants to inform the researcher of events and/or circumstances that caused the emotions. Thus, nonverbal data communicated information that facilitated verbal exchange concerning the life-world of each individual participant.

Computed tomography scanning and recurrence after laparoscopic ventral hernia repair

Laparoscopic ventral hernia repair is an advancing surgical method. It seems to have fewer recurrences than open surgery. However, with patients suspected of recurrence after laparoscopic hernia repair, it can be very difficult to determine whether or not there is recurrence by clinical examination alone. The purpose of this article is to show that computed tomography is a valuable diagnostic tool in excluding recurrence after laparoscopic ventral hernia repair. A total of 35 patients were included in a prospective study. They underwent laparoscopic ventral hernia repair, and all patients suspected of recurrence were computed tomography scanned. Four patients were suspected of recurrence. They all presented symptoms of swelling or pain or both. The computed tomography scanning did not show the presence of recurrence in any of the 4 cases. Computed tomography scanning can provide exact information about the content of swelling and whether there is recurrence or not. We conclude that computed tomography scanning is suitable as a valid imaging method in doubtful cases considering ventral hernia recurrence after laparoscopic ventral hernia repair.

Expression of glycodelin A in decidual tissue of preeclamptic, HELLP and intrauterine growth-restricted pregnancies

During pregnancy, the placenta produces a variety of proteins that are responsible for the establishment of the foeto-maternal tolerance and circulation. The aim of this study was to investigate the expression of glycodelin A (formerly named PP14) in decidual tissue of placentas with intrauterine growth restriction (IUGR), preeclamptic patients, hemolysis, elevated liver, low-platelet (HELLP) patients and normal decidual tissue. Slides of paraffin-embedded decidual tissue of patients with IUGR, preeclamptic patients, HELLP patients and normal-term placentas were incubated with either polyclonal or monoclonal antibodies against glycodelin A. Staining reaction was performed with the ABC reagent. Intensity of immunohistochemical reaction on the slides was analysed using a semi-quantitative score. In addition, expression of glycodelin mRNA was analysed by in situ hybridisation. Expression of glycodelin A was significantly reduced in decidual cells of placentas with IUGR and HELLP, as investigated with both monoclonal and polyclonal antibodies and in situ hybridisation. However, preeclamptic decidual tissue showed no significantly different expression of intensity of glycodelin mRNA compared with normal placental tissue controls. A reduced expression of glycodelin A by decidual cells seems to be related to IUGR and HELLP. Therefore, glycodelin A might play an important role in the pathogeneses of these diseases.

Biological tissue adhesive for mesh-application in pigs: An experimental study

BACKGROUND

Tissue damage during herniotomy may attribute to postoperative complications including chronic pain, bleeding and infection. Thus the aim of this study was to evaluate a due and simple operative procedure with intraperitoneal application of mesh with glue in an experimental model prior to use in humans.

METHOD

Laparoscopic insertion of a mesh was performed in three pigs. The meshes were fixed with a collagen glue. The pigs were sacrificed after 8 weeks and macroscopic and microscopic evaluation of the meshes, were performed.

RESULTS

The intraperitoneal placed meshes did not migrate through the study period, and there was no sign of inflammation in surrounding tissue or adhesions around the meshes.

CONCLUSIONS

If these findings can be applied to human inguinal herniotomy, this may lead to significant fewer complications including development of acute and chronic pain, formation of seroma and infection. Furthermore the operation technique is very simple.

The relationship between adolescent depressive symptomology and substance abuse

The research aimed to investigate the phenomena of adolescent depressive symptomology, substance abuse and the relationship between the two phenomena in a South African context. The influence of moderator variables was also examined. Another objective was to determine risk factors for the before mentioned. This was done by using a questionnaire with a sample of 1298 conveniently selected adolescents in a South African high school. It was determined that adolescents become progressively unhappier from 13 to 17 years of age. Girls are more depressed than boys. This research also revealed that adolescent depressive symptomology is significantly and positively correlated with earlier age of onset of substance abuse as well as frequency of usage. There appear to be no gender differences in substance abuse but teenagers from different ethnic and language groups differ in their use of substances. Risk factors for depression and substance abuse included a conflict relationship with parents, the experience of major stressful events, dissatisfaction with school grades and friends’ use of substances.

[Reduction of decentration after LASIK using a modified eye tracker ring for the MEL-70 excimer laser]

BACKGROUND

The aim of this study was to determine and compare the rate of eccentric laser ablation after LASIK depending on the eye tracker ring used.

PATIENTS AND METHODS

All LASIK treatments were carried out using the MEL-70 flying spot excimer laser (Zeiss-Meditec, Jena). The flap was produced using a Corneal Shaper trade mark or Hansatome trade mark Microkeratome (B and L Surgical, Heidelberg). Initially we used an 11 mm eye tracker ring without hinge protector. At the end of February 2001 this ring was replaced by a 10 mm and a 9.5 mm ring with built-in hinge protector. An additional modification was introduced by us: at 1 mm separations little teeth-like spikes were engraved into the eyeward side of the ring, thus stabilising the position of the ring on the globe and allowing free liquid to flow through the spaces between each spike. The built-in calibration system of the corneal topography (TMS 3, Tomey, Erlangen) from patients with a follow-up of one month or longer was used to determine the distance between the centre of the ablation zone from the fixation point.

RESULTS

In group I patients (old ring) 42 eyes were treated. In 4 eyes ablation was perfect, in 21 eyes the ablation centre was located 0.1 to 0.49 mm from the fixation point, in 11 eyes 0.51 to 0.99 mm and in 5 eyes 1.1 to 1.49 mm whereas one eye showed a decentred ablation of 1.53 mm. In group II (new ring) 42 eyes were investigated also. In 11 eyes ablation was perfect, in 20 eyes the ablation centre was located 0.1 to 0.49 mm from the fixation point, in 10 eyes 0.5 to 0.99 mm and one eye had an eccentric ablation of 1.28 mm from the fixation point.

CONCLUSION

The further development of our eye tracker ring for the MEL-70 laser considerably reduced the rate of decentred ablations. An enhanced grip of the ring onto the globe reduces a slow slide during the laser procedure.

An EST survey of the sugarcane transcriptome

Its large genome and high polyploidy makes sugarcane (Saccharum spp.) a singularly challenging crop to study and improve using genetic approaches. To provide large numbers of functionally characterized candidate genes that might be tested for direct association (rather than distant linkage) with economically important traits, we sequenced the 5' ends of 9,216 clones from three cDNA libraries (apex, leaf and mature internode), representing 3,401 non-redundant sequences. About 57% of these sequences could be assigned a tentative function based on statistically significant similarity to previously characterized proteins or DNA sequences. Another 28% corresponded to previously identified, but uncharacterized, sequences. Some of the remaining unidentified sequences were predicted to be genes which could potentially be new to plants or unique to sugarcane. Comparisons of the sugarcane ESTs to a large sorghum EST database revealed similar compositions of expressed genes between some different tissues. Comparison to a detailed Arabidopsis protein database showed some highly conserved sequences, which might be useful DNA markers for pan-angiosperm comparative mapping. These EST sequences provide a foundation for many new studies to accelerate isolation of agronomically important genes from the cumbersome sugarcane genome.

Assessment of microbial natural attenuation in groundwater polluted with gasworks residues

Intrinsic biodegradation, representing the key process in Natural Attenuation, was examined at a tar-oil polluted disposal site. Methods to assess microbial natural attenuation of BTEX and PAH included analysis of groundwater hydrochemistry, pollutant profiles, composition of the microflora, and microcosm studies. In the polluted groundwater downgradient the disposal site, oxygen and nitrate were only available adjacent to the groundwater table and at the plume fringes. In the anaerobic core of the plume, a sequence of predominating redox zones (methanogenic, sulphate-reducing, Fe(III)-reducing) was observed. Changing pollutant profiles in the plume indicated active biodegradation processes, e.g. biodegradation of toluene and naphthalene in the anaerobic zones. High numbers of microorganisms capable of growing under anaerobic conditions and of aerobic pollutant degrading organisms confirmed the impact of biodegradation at this site. In microcosm studies, the autochthonous microflora utilised toluene, ethylbenzene, and naphthalene under sulfate- and Fe(III)-reducing conditions. Additionally, benzene and phenanthrene were degraded in the presence of Fe(III). Under aerobic conditions, all BTEX and PAH were rapidly degraded. The microcosm studies in particular were suitable to examine the role of specific electron acceptors, and represented an important component of the multiple line of evidence concept to assess natural attenuation.

T-cell-depleted peripheral blood stem cell transplantation for alpha-mannosidosis

Alpha-mannosidosis (alpha-mannosidosis) is a lysosomal storage disease characterized by accumulation of oligosaccharides in various tissues leading to symptoms such as coarse facial features, dysostosis multiplex, hearing disabilities, mental developmental delay and skeletal involvement (dysostosis multiplex). Without treatment, the severe infantile onset form of this autosomal recessive disease leads to progressive neurodegeneration and sometimes to early death. Stem cell transplantation has been shown to be an effective treatment. In the five patients published so far, correction of skeletal abnormalities and improvement of neuropsychological capabilities have been observed. We report the first patient who received a T-cell-depleted peripheral blood stem cell transplantation (PBSCT) for alpha-mannosidosis. The diagnosis of alpha-mannosidosis was made at the age of 14 months. At the age of 24 months, he underwent PBSCT with T-cell depletion by CD34-positive selection from his HLA phenotypically identical mother. Conditioning was carried out with busulfan (20 mg/kg), cyclophosphamide (200 mg/kg), OKT3 and methylprednisolone. The patient is alive and well 27 months after PBSCT and has made significant developmental progress. The pattern of urinary oligosaccharides has returned to almost normal. CD34-positive-selected PBSCT is a feasible option to reduce risk for GVHD for these patients.

Endoscopic retrograde cholangiopancreatography causes reduced myocardial blood flow

BACKGROUND AND STUDY AIMS

Previous studies have shown that up to 50% of healthy patients may develop ST-segment changes during upper gastrointestinal endoscopy. The aim of the study was to evaluate myocardial blood flow in patients during endoscopic retrograde cholangiopancreatography (ERCP).

PATIENTS AND METHODS

11 patients scheduled for ERCP were monitored with a Holter tape recorder and underwent myocardial perfusion scintigraphies, to evaluate myocardial perfusion at rest and during ERCP.

RESULTS

Ten patients completed the study. Eight patients had no sign of myocardial ischemia with either of the two methods, while two patients developed signs of ischemia during ERCP with both the Holter tape recording and on myocardial scintigraphy (P = 0.02).

CONCLUSIONS

Patients undergoing ERCP may develop true myocardial ischemia with reduced myocardial blood flow. Although this is a small-scale study, these findings strongly support the use of alternative methods for diagnostic evaluation of the pancreatic duct and biliary tree.

[Evaluation of Doppler sonographic criteria for the differentiation of hepatocellular carcinomas and regenerative nodules in patients with liver cirrhosis]

AIM

In order to improve the differentiation between hepatocellular carcinomas and regenerative nodules in patients with liver cirrhosis, Doppler-sonographic criteria for the tumours were evaluated.

METHOD

Patients with histologically proven hepatocellular carcinoma (n = 35) and regenerative nodules (n = 10) were investigated by B-mode sonography as well as fundamental and echo-enhanced power-Doppler sonography focusing on specific properties of the tumours. The results were correlated to the histological findings.

RESULTS

Hepatocellular carcinomas and regenerative nodules showed a different contrast behaviour with echo-enhanced power-Doppler sonography. The following features of hepatocellular carcinomas were frequently found: peritumoural signal detection in the early arterial phase, chaotic and centripetal contrast enhancement in the arterial phase, hypervascularization in the capillary phase, and loss of portalvenous blood flow.

CONCLUSION

Hepatocellular carcinomas and regenerative nodules display different vascularization patterns in the echo-enhanced power-Doppler sonography. These characteristics can be useful for their differential diagnosis.