Turbidity in oil-in-water-emulsions - Key factors and visual perception.

The aim of the present study is to systematically describe the factors affecting turbidity in beverage emulsions and to get a better understanding of visual perception of turbidity. The sensory evaluation of the human visual perception of turbidity showed that humans are most sensitive to turbidity differences between two samples in the range between 1000 and 1500 NTU (ratio) (nephelometric turbidity units). At very high turbidity values >2000 TU in NTU (ratio) were needed to distinguish between samples that they were perceived significantly different. Particle size was the most important factor affecting turbidity. It was shown that a maximum turbidity occurs at a mean volume - surface diameter of 0.2µm for the oil droplet size. Additional parameters were the refractive index, the composition of the aqueous phase and the presence of excess emulsifier. In a concentration typical for a beverage emulsion a change in the refractive index of the oil phase may allow the alteration of turbidity by up to 30%. With the knowledge on visual perception of turbidity and the determining factors, turbidity can be tailored in product development according to the customer requirements and in quality control to define acceptable variations in optical appearance.

[Current status of total hip and knee replacements in Germany - results of a nation-wide survey]. / Aktueller Status der Hüft- und Knieendoprothetik in Deutschland - Ergebnisse einer bundesweiten Umfrage.

BACKGROUND: Total hip and knee replacements are very frequently performed operative procedures in German hospitals. Despite the high number of cases, only few data on treatment procedures of the clinical routine and their impact on postoperative length of stay and clinical outcome are available. The aim of our survey was to gain detailed insights of the treatment procedures in patients scheduled for elective hip or knee replacement in order to extract recommendations for improving patient care. METHODS: In a nation-wide survey, we asked leading physicians of 694 trauma surgery and orthopaedic surgery departments and their corresponding colleagues in the departments of anaesthesia for treatment procedures including the process of patient admission, surgical techniques, postoperative analgesia, discharge management and follow-up. We used a multiple linear regression for analysing variables impacting on the postoperative length of stay. RESULTS: Altogether, 303 replies representing 31.8 % of the contacted hospitals could be evaluated. For hip arthroplasty, the anterolateral approach was most commonly chosen. For knee arthroplasty, the parapatellar approach was most frequently used. Tourniquet and wound drainage (mostly removed on the second postoperative day) were widely used with more than 90 %. The avoidance of wound drainage was associated with a lower postoperative length of stay for patients following total hip or knee replacement. Only 70 % of the German departments followed up their patients after discharge checking especially the range of motion of the artificial joint replacement. CONCLUSION: The treatment procedures for elective hip and knee replacement are very heterogeneous in German hospitals. The quality of the clinical outcome cannot be related to a single procedure; in fact the choice and complementary interaction of interventions are essential for improving patient care. These results provide first important evidence to which extent organisational structures and treatment procedures affect patient care and length of stay. Therefore, the analyses show relevant indications for an optimised standard in patient care.

[Management of vesical diverticula]. / Traitement des diverticules vésicaux.

Vesical diverticula refer to hernias of the vesical mucous membrane in the detrusor. The diverticulum wall is therefore constituted by the chorion urothelium. The muscular dehiscence that is at the origin of the diverticulum may be either congenital or degenerative. Two important complications of the diverticulum-that are sometimes interwoven-may occur: a draining defect (responsible for infections, lithiasis, and functional signs of the lower urinary tract), and the development of an urothelial tumour in the diverticulum cavity. For such complicated diverticula, surgery is indicated, by endoscopic or retropubic approach. Results may be excellent, provided the surgical intervention focuses at the same time on the management of the associated sub-vesical obstacle in case of acquired diverticulum.

Modulated structure of Ag2SnO3 studied by high-resolution electron microscopy

The modulated structure of Ag2SnO3, disilver tin trioxide, was investigated by high-resolution electron microscopy and electron diffraction along four different directions. Electron diffraction showed an incommensurate one-dimensional modulated structure with a modulation wavevector of 1/6.4a*. High-resolution images showed a large number of superstructure domains with the size range 10-100 nm and orientations related by hexagonal rotation. The modulation was determined to be displacements along the c axis of the Ag atoms both in octahedral and linear coordination. An approximate structure model with a commensurate sixfold superstructure, with an orthorhombic cell (P2(1)2(1)2(1), a = 2.922, b = 1.267, c = 0.562 nm), is proposed. Calculated images and electron diffraction patterns, based on this model, agree well with experimental observations.

Correcting postoperative astigmatism using curved lamellating keratotomy.

PURPOSE: To ascertain whether the change in refraction caused by paired lamellating corneal incisions in cadaver eyes could be achieved in living eyes and whether wound healing influences this effect. SETTING: Virchow Hospital Eye Clinic, Humboldt University, Berlin, Germany. METHODS: This prospective study included 45 patients who had a follow-up of 15 months. All had astigmatism of at least 2.00 diopters (D) induced by previous cataract surgery. Optical zones of 7.0 and 8.0 mm and chordal lengths of 3.0 and 5.0 mm were used. All incisions were paired. RESULTS: Mean preoperative astigmatism measured with a keratometer was 3.64 D +/- 0.89 (SD). After 15 months, it was 1.00 +/- 0.76 D, and mean induced astigmatism was 3.18 +/- 1.30 D. The 7.0 mm group had a mean induced astigmatism of 3.93 +/- 1.52 D, which was significantly higher than that in the 8.0 mm group (mean 2.60 +/- 0.74 D) at a uniform chordal length of 3.0 mm. Mean uncorrected visual acuity was 0.26 +/- 0.14 preoperatively and 0.50 +/- 0.28 after 15 months; mean corrected visual acuity improved from 0.58 +/- 0.21 to 0.76 +/- 0.21. Mean endothelial cell count was 1799 +/- 595 cells/mm2 preoperatively and 1784 +/- 589 cells/mm2 after 6 months; the difference was not significant. CONCLUSION: Curved lamellating keratotomy gives stable postoperative refractive results without significantly affecting endothelial cell count or visual acuity.

[Curved lamellar keratotomy for correction of astigmatism. Experimental and initial clinical results]. / Bogenförmige lamellierende Keratotomie zur Astigmatismuskorrektur. Experimentelle und erste klinische Ergebnisse.

BACKGROUND: The first experiments for surgical correction of higher astigmatism were reported more than 100 years ago. A lot of different procedures were strongly recommended at the beginning but then abandoned later on because they could not fulfill the expectations regarding the postoperative results and the complications. On the other hand, lamellar preparation of the cataract incision has been considered a major advance in ophthalmology. The main advantage of this incision is that it yields stable postoperative refraction as well as high mechanical stability very early (postoperatively). These findings prompted us to combine the advantages mentioned above with those of the arcuate transverse incision. In this report we present our experimental and clinical results with arcuate lamellar keratotomy. MATERIALS AND METHODS: Experiments were carried out on 22 cadaver bulbi. The optical zones ranged from 6 to 8 mm and the length of the arcuate incisions was between 2 and 7 mm. The clinical data presented here were obtained from 20 patients with a 4-week follow-up. These 20 patients had undergone cataract surgery previously with an induced astigmatism ranging from 2.5 to 5 D. Patients were treated with an optical zone of 7 mm or 8 mm. The length of the arcuate incision was 3 mm. All incisions were paired. RESULTS: Our experiments (cadaver bulbi) showed an approximately linear decrease of the effect with increasing width of the optical zone and increasing are length. Our clinical results demonstrate that the astigmatism induced by our procedure (including potential overcorrection) was 3.41 +/- 1.33 D on the the first day postoperatively. All astigmatism was measured with the Zeiss keratometer. After 1 and 4 weeks the results were 3.98 +/- 1.35 and 3.71 +/- 1.29 D, respectively. The induced astigmatism also depended on the width of the optical zone. In the group with a 7 mm optical zone the induced astigmatism was 4.5 +/- 1.56 D after 4 weeks. This effect was remarkably higher than in the 8 mm group with an average of 3.35 +/- 0.94 D of induced astigmatism. There were no significant differences between visual acuity under glare conditions and the number of endothelial cells preoperatively and at 4 weeks follow-up, nor were there variations in refraction, depending on the time of day. CONCLUSIONS: Due to the relatively high standard deviation of the induced astigmatism we must keep trying to make the results of our procedure more predictable.

Changes in urinary magnesium, citrate, and oxalate levels due to cola consumption.

The serum concentration and urinary excretion of four potential stone constituents: calcium, oxalate, phosphate, and uric acid; and of two potential inhibitors of urinary stone formation, citrate and magnesium, were studied before and during ingestion of a carbonated cola beverage. Four participants, after baseline serum determinations, abstained for forty-eight hours from cola consumption and then attempted to drink 3 quarts per day of cola in the following forty-eight hours. One participant failed to drink more than two quarts per day of cola. In all 4 participants twenty-four-hour urinary excretion of magnesium decreased by an average of 2.6 mg. In the 3 participants who succeeded in drinking 3 quarts of cola per day, twenty-four-hour urinary excretion of oxalate increased an average of 8.3 mg and excretion of citrate decreased an average of 122 mg. These results demonstrate changes in urine constituents which could contribute to enhanced kidney stone formation in patients who drink large quantities of cola-flavored carbonated beverages.

Cyclophosphamide-associated carcinoma of urothelium: modalities for prevention.

The relationship between the cyclophosphamide metabolite acrolein and hemorrhagic cystitis is well documented. Its role in inducing bladder cancer is not clear. There are at least 35 cases of cyclophosphamide-associated bladder cancer in the literature to date. We report 3 additional cases of transitional cell carcinoma of the bladder. Literature assessing the relative risk of bladder cancer associated with cyclophosphamide therapy is reviewed as are methods for decreasing the toxic effects on the urothelium of the metabolite acrolein.

The acoustic fields of the Wolf electrohydraulic lithotripter.

Electric sparks are used as the sources for both intra- and extracorporeal shock wave lithotripters. Upon ignition, a pressure pulse, headed by a shock, is generated that propagates as a spherically diverging wave. Simultaneously, a bubble is created that, in the case of the Wolf Model 2137.50 Electrohydraulic Lithotripter, expands to a radius of approximately 5 mm and collapses spontaneously after approximately 1 msec. Upon rebound, the bubble generates a second pressure pulse that is almost equal in amplitude and acoustic energy to the first shock wave. Measured pressures are almost entirely positive and decrease in amplitude with the reciprocal of the distance from the source. For the Wolf lithotripter at its maximum output setting, the pressure amplitude at a distance of 3 cm from the spark is typically 3 MPa.

Renal loss following extracorporeal shock wave lithotripsy.

A patient with life-threatening retroperitoneal hemorrhage after extracorporeal shock wave lithotripsy is presented. Despite angioinfarction of the involved renal unit, nephrectomy ultimately was required to control bleeding. The urological and hematological aspects of the management are discussed.

Penile abscess involving the corpus cavernosum: a case report.

A patient with a penile abscess containing mixed colonies of bacteria is presented. Ultrasound scan confirmed the physical examination findings of involvement of the corpus cavernosum. After incision and drainage the patient has normal erectile function.

Prevalence of cytoplasmatic islet cell antibodies and insulin autoantibodies is increased in subjects with genetically defined high risk for insulin-dependent diabetes mellitus.

The presence of cytoplasmatic islet cell antibodies (ICA) and IgG insulin autoantibodies (IgG-IAA) has been observed in the prediabetic state of type 1 (insulin-dependent) diabetes (IDDM). We therefore analyzed the prevalence of these markers in sera from 1117 healthy HLA-typed first-degree relatives (1 degree Rel) of IDDM patients. ICA was determined by indirect immunofluorescence on cryostat sections of human pancreas. For IgG-IAA measurement a competitive solid-phase ELISA was used. ICA were present in 3.5% of 1 degree Rel vs 0.4% of controls (P less than 0.025). The highest frequencies of ICA were found in individuals of IDDM multiplex families (7.7%) and HLA-DR1,3 (5.4%), -DR1,4 (5.8%), and -DR3,4 (6.7%) positive subjects. We therefore conclude that the prevalence of ICA is increased in 1 degree Rel with high genetic risk for diabetes. IgG-IAA occurred in 9.9% of 1 degree Rel vs 1.4% of controls (P less than 0.01). Like ICA, IgG-IAA were significantly increased in a group of subjects being positive for either HLA-DR1,3 -DR1,4, or -DR3,4 (16.5%, P less than 0.01). In multiplex families, however, prevalence of IgG-IAA was not increased. In contrast to ICA there was an additional influence of age and sex: IgG-IAA were found more often in siblings (mean age, 16.6 years; prevalence, 15.0%) than in parents (mean age, 44.1 years; prevalence, 8.3%) of IDDM patients (P less than 0.01). In brothers the prevalence of IgG-IAA is higher than in other 1 degree Rel. Only a weak association between ICA and IgG-IAA was observed in subjects (n = 810) tested for both antibodies.(ABSTRACT TRUNCATED AT 250 WORDS)

Ultrasound and spermatogenesis in the rat.

Using exposure conditions comparable to those which have been associated by others with positive results, we tested for effects of ultrasound on sperm production over a period of 12 weeks following treatment. Continuous wave exposure with spatial average intensities of 1, 2 and 4 W/cm2 and exposure times up to 10 minutes were used. In some experiments, the exposures were repeated after an elapsed time of 48 h. No significant changes in spermatogenesis were related to any of the exposure conditions in spite of the fact that some of the treatments caused thermal tissue damage near bone. No effects of exposure were found in weights of the testis, prostate, seminal vesicle, or whole body.

Recovery of glomerular and tubular function in autotransplanted dog kidneys preserved by hypothermic storage or machine perfusion. Relation of initial function to long-term function.

Sixteen male dogs had split renal function studies prior to unilateral nephrectomy and autotransplant. Kidneys were preserved for 24 hr by either simple hypothermic storage in Collins C2 solution (SHS) or machine-perfused (MP) on a Waters machine (MOX 100) with plasmanate perfusate. Renal function studies were repeated at 1 hr and at 7, 14, and 28 days, and the statistical relationship between initial and 1-month function was determined for a number of parameters. All MP kidneys functioned immediately, whereas 1/3 of SHS kidneys had delayed function. Recovery was more rapid in MP kidneys and was essentially complete by 14 days, at which time MP kidneys had higher rates of creatinine clearance and sodium reabsorption. However, by one month 3/7 MP kidneys (P = 0.15 compared with SHS) had lower creatinine clearance rates than at 2 weeks, and para-aminohippurate (PAH) clearance and fractional sodium reabsorption were significantly decreased. During the same period SHS kidneys either showed continued improvement or maintained stable function. Thus, by one month there were no differences between the groups in clearances of creatinine and PAH, plasma creatinine and blood urea nitrogen concentrations, or fractional reabsorption of sodium, potassium, and water. For SHS kidneys, the 1-hr creatinine clearance and the absolute rate of sodium reabsorption were strong predictors of the eventual function of the kidneys at one month (r = 0.93 and r = .83, P less than 0.05, respectively). No such correlations were found in MP kidneys (r = less than .01, P greater than 0.9 for both variables). The data show that MP results in significantly better function early after transplant, but this advantage does not persist, and that SHS kidneys early function is a good predictor of long-term recovery, but this is not true for MP kidneys.

Early indices of warm ischemic damage in autotransplanted canine kidneys preserved by simple hypothermic storage.

After measurement of normal renal function, dog kidneys (n = 52) were subjected to 3, 15, or 30 min of normothermic warm ischemia (WI). After 24 hr of preservation by simple hypothermic storage (SHS) in a modified Collins solution, autotransplant was done and renal function was again measured beginning at 1 hr. Compared with preharvest values, kidneys with minimal (3 min) WI had significantly decreased clearances of creatinine (Cr) and para-aminohippuric acid (PAH), PAH extraction, absolute and fractional Na reabsorption, Na excretion, and urinary Na concentration; no change in urine flow rate or K excretion; and significantly increased fractional excretion of Na, K, and H2O. Compared with minimal WI, 30-min WI produced further significant decreases in clearances of Cr, PAH, and PAH extraction; and further increases in fractional excretion of Na, K, and H2O. Urine flow was also decreased by about half and urine Na concentration rose significantly. Several parameters were very significantly correlated with the length of WI, but the most reliable index was the fractional reabsorption of Na. When several functional parameters were used together, kidneys with significant (30 min) WI prior to preservation could be identified with a high degree of statistical reliability.

Glomerular filtration response to acute ureteral obstruction in the dog.

In order to assess the glomerular filtration responses to acute ureteral obstruction in the dog we employed an established method that does not require timed urine collections. Our results show a 57 per cent increase in renal blood flow (baseline: 203.8 +/- 50.9 vs. 319 +/- 69.4 ml./min. at 105 minutes; no. = 7) that was associated with a monophasic decrease in filtration fraction to -70 per cent at 120 minutes (0.26 +/- 0.025 vs. 0.08 +/- 0.007) and an increase in ureteral pressure to 63.1 +/- 6.1 mm. Hg at 120 minutes. A biphasic GFR response was noted with an initial small increase (baseline: 32.5 +/- 7.5 vs. 36.3 +/- 11.0 ml./min. at 2 minutes) followed by a continual decline to -55 per cent at 120 minutes (to 14.5 +/- 2.6 ml./min.). This investigation has confirmed the results of micropuncture studies showing maintenance of GFR early after complete ureteral ligation.

Ultrasound diagnosis of tunica albuginea cyst: clinical perspective.

Two case reports of tunica albuginea cysts are presented. Imaging of this lesion by high resolution ultrasonography and the impact of this technique on management are considered.

Selective pre-transplant nephrectomy: indications and perioperative management.

From May 1977 to June 1983, 198 patients were accepted as candidates for renal transplantation at our university. We review our experience with 14 consecutive patients who underwent selective pre-transplant nephrectomy during this interval. Indications for this procedure included recurrent or chronic pyelonephritis, structural abnormalities of the urinary tract predisposing the patient to infection, malignant or renin-dependent hypertension, Goodpasture's disease, certain cases of rapidly progressive glomerulonephritis and selected patients with polycystic kidneys. All patients underwent dialysis 1 day preoperatively. Perioperative fluid losses were measured carefully with prompt and vigorous replacement therapy. Patients received an average of 5,890 cc fluid replacement before postoperative dialysis. All patients underwent dialysis within 29 hours postoperatively. There were no postoperative deaths and 8 complications. Selective pre-transplant nephrectomy has spared 93 per cent of potential renal transplant candidates from a major surgical procedure. No patient has required removal of the original kidneys during the post-transplant period. Our experience has shown that the reluctance to hydrate these patients is unwarranted and that prompt postoperative dialysis, if required, is safe. Since some end stage kidneys are physiologically active and the associated surgical risk is high, pre-transplant nephrectomy should be performed only in carefully selected patients. In contrast to previous reports, which advocated minimal fluid administration and delayed postoperative dialysis, our recent experience indicates that vigorous fluid replacement therapy, carefully monitored with serial vital signs, weights, serum electrolytes and central venous pressure readings, will avert many of the complications encountered previously.

Urachal abnormalities in the adult.

A spectrum of rare urachal abnormalities in the adult is described, including urachal cyst, infected urachal cyst and abscess, and urachal carcinoma. The clinical and radiographic features are presented, and diagnosis using ultrasound, computed tomography, and needle aspiration is discussed. Treatment of infected urachal cysts with percutaneous catheter drainage is described.