[Dacryocystorhinostomy as part of the interdisciplinary treatment of lacrimal duct]. / Dakryozystorhinostomie nach West in der interdisziplinären Behandlung von Tränenwegsstenosen.

INTRODUCTION AND METHODS: Epiphora, which leads to blurry vision, is the leading symptom for intra- and/or postsaccal lacrimal duct stenosis. Due to the anatomy of the tear duct system, which lies between the fields of ophthalmology and otorhinolaryngology, and due to newly available techniques in interventional radiology to diagnose and treat patients with intra- and postsaccal lacrimal duct stenosis, various methods for diagnosis and treatment are available. We report the results of 107 patients who underwent endonasal dacryocystorhinostomy (DCR) between 2005 and 2011. RESULTS: Prior to the DCR, dacryocystography was performed in 95 of the 107 patients. In 68 of these 95 cases, balloon dilatation was unsuccessful. Histological examination of 64 patients showed chronic inflammation in 61 patients, non-Hodgkin's lymphoma was diagnosed in 2 patients and aspergilloma in1 patient. Over a follow-up time of 6 months to a maximum of 7 years we revised 15 of 107 patients, due to reocclusion after removal of the stent. None of these patients showed recurrence of epiphora. DISCUSSION: In comparison to transcutaneous DCR, endonasal DCR has certain benefits: it is less invasive, no visible scars occur because of the endonasal approach, and the function of the lacrimal pump remains uneffected. Furthermore, the possibility of co-treatment of endonasal pathologies during DCR exists. We observed no serious adverse events in our study group and the success rate was similar to other studies.

Characterisation of severe rod-cone dystrophy in a consanguineous family with a splice site mutation in the MERTK gene.

AIM: To characterise the ocular phenotype of a family segregating the splice site mutation c.2189+1G>T in the tyrosine kinase receptor gene MERTK. METHODS: Five affected children of a consanguineous Moroccan family were investigated by ophthalmic examinations, including fundus photography, autofluorescence (FAF) imaging, optical coherence tomography (OCT), psychophysical and electrophysiological methods. RESULTS: Affected children were between 5 and 19 years of age, allowing an estimation of disease progression. Electroretinography demonstrated loss of scotopic and photopic function in the first decade of life. Younger siblings showed drusen-like deposits with focal relatively increased FAF in the macular area. With increasing age, a yellowish lesion with relatively increased FAF and subsequent macular atrophy developed. Visual acuity deteriorated with age and ranged between 20/50 in the best eye of the youngest affected and 20/400 in the worst eye of the oldest affected sibling. Spectral-domain OCT revealed debris-like material in the subneurosensory space. CONCLUSION: The splice site mutation c.2189+1G>T in MERTK causes rod-cone dystrophy with a distinct macular phenotype. The debris in the subneurosensory space resembles that in the Royal College of Surgeons (RCS) rat being the mertk animal model. Patients might therefore benefit from advances in gene therapy that were previously achieved in the RCS rat.

[Interdisciplinary diagnostics for examination of lacrimal disorders]. / Interdisziplinäre Spezialdiagnostik bei Stenosen und Verschlüssen der ableitenden Tränenwege.

The ophthalmologist is the primary consultant for patients with disorders of the lacrimal duct. The basic examination includes inspection and slit-lamp microscopy of the ocular surface and its adnexa as well as irrigation of the lacrimal pathway. For further treatment, interdisciplinary examination methods offer precise diagnostic findings. Good cooperation among ophthalmologists, otorhinolaryngologists, and radiologists can be highly beneficial for the patient. Rhinogenic causes of lacrimal obstruction can be found by rhinoscopy and nasal endoscopy. Further information is gained by radiologic imaging, which offers dynamic pictures and a good overview of the lacrimal system and neighbouring structures. Lacrimal endoscopy allows direct viewing of the causes of stenosis. These precise and complete diagnostics make consultation easier, especially regarding new minimally invasive surgical techniques.

FK506 does not affect cardiac contractility and adrenergic response in vitro.

FK506 (tacrolimus) is a new immunosuppressant being used in cardiac allograft transplantation. While cyclosporine A has been shown to exert an acute negative inotropic effect on isolated heart muscle preparations, little is known of the inotropic influence of FK506. The Ca(2+) release channel of human skeletal muscle and cardiac muscle is associated with FK506 binding proteins (FKBP), FKBP12 and FKBP12.6, respectively. FKBPs can be dissociated by treatment with FK506. As a consequence of FK506 exposure, isolated skeletal muscle and cardiac muscle ryanodine receptors show altered gating characteristics. Therefore, we analyzed the direct inotropic effect of FK506 exposure to isolated, intact heart muscle preparations from the human and rabbits. Experiments were performed on isolated, electrically stimulated right atrial auricular muscle strips obtained from human myocardium during elective open heart surgery and on intact right ventricular trabeculae from rabbit hearts. The human preparations were exposed to concentrations of 8 x 10(-9), 8 x 10(-8) and 8 x 10(-6) M FK506 followed by a cumulative dose-response curve with isoprenaline as a non-selective beta-adrenoceptor agonist. Our data suggest that FK506 does not exert any positive or negative inotropic effect in either human or rabbit myocardium.

Cobalt metal inhalation studies on miniature swine.

Cobalt is considered to be the chief component in the tungsten carbide mixture responsible for hard-metal disease. An animal inhalation study was undertaken simulating conditions under which these workers in the tungsten carbide industry are exposed to cobalt. In this semichronic study, miniature swine were exposed to an inhalation of pure cobalt metal powder at concentrations of 0.1% mg/m3 (present TLV) and 1.0 m/m3. At peroidic intervals, the following studies were performed: pulmonary function tests, electrocardiograms, x-ray examinations, blood and urine tests, electron microscopy, and light microscopic pathology. Early detection of pulmonary disease is apparent from the pulmonary function tests showing a mark decrease in lung compliance, and from electron microscopy showing an increase in the amount of septal collagen. This study demonstrates that the present TLV of 0.1 mg/3 for cobalt seems to be too high, even at this relatively brief duration of exposure.