[Bilateral amaurosis after spinal trauma]. / Beidseitige Amaurose nach Wirbelsäulentrauma.

This article presents the case of a 72-year-old male patient who suffered severe trauma of the spinal column. The patient developed persistent, bilateral, complete blindness after prolonged emergency neurosurgical treatment in a prone position. A bilateral surgical posterior ischemic optic neuropathy (PION) was diagnosed, which is a rare but severe complication of prolonged non-ocular surgery with circulatory stress. The massive, mostly bilateral, irreversible visual loss up to complete blindness leads to severe and permanent impairment of affected patients.

Management of injuries of the eye and its adnexa.

The face plays the main role in interpersonal communication and in aesthetic perception. What is more, on account of the complex eyelid anatomy required to ensure the functioning of the eye, the treatment of periocular injuries requires a profound knowledge of anatomy and plastic reconstructive surgery, even if a loss of soft tissue is involved. Many methods for the reconstruction of eyelid defects have been described in the current literature. These methods must be guided by the site and extent of the defect on the one hand and by cosmetic requirements on the other to produce best results in terms of form and function. The treatment of injuries in the area of the eyelid involves some peculiarities that must be considered. The management of large defects in particular requires the cooperation of all head surgery disciplines.

[Curse and blessing of combat ophthalmology in the 20th and 21st centuries]. / Fluch und Segen der Kriegsophthalmologie im 20./21. Jahrhundert.

BACKGROUND: Combat injuries in the literature are dominated by reports on the rescue of life and body trauma treatment of casualties. In the 20th and 21st centuries, preservation of the eyes would be more and more an extremely important goal. In World War I and II and along with the trends in current warfare, automatic weapons and conventional munitions like shrapnel will continue to cause a significant percentage of all ocular trauma in combat. There are also laser weapons which have the potential to cause blinding eye injuries. In spite of the curse of war there are also blessings of combat ophthalmology like the invention of the intraocular lens after the Second World War, when the plexiglas of a broken cockpit canopy was found to be inert in penetrating eye injuries. A significant ly better eye protection was developed following terror attacks, such as terrorist blasts in the 21st century. Finally, every new generation of military ophthalmologists has had to learn on its own from earlier armed conflicts and some of this knowledge could be helpful for our patients in more peaceful times.

[Afghanistan--ophthalmology in a state of emergency]. / Afghanistan--Ophthalmologie im Ausnahmezustand.

BACKGROUND: During the ISAF mission the authors want to accompany the colleagues on their daily duties in the outpatient clinics, the wards and theatre to have an overview about handling the different and some specialised diseases in the only ophthalmic centre for northern and central Afghanistan. At least we want to answer the question, is there a possibility of cooperation and support? HISTORY: In Afghanistan the ophthalmologist population ratio was 1:200 000. More than about 2/3 are working in urban areas and less than 1/2 in rural areas. There were no eye sub-specialists like retina or paediatric ophthalmologists at all. The reason for the lack of eye doctors and ophthalmic technicians is the prolonged war conditions in Afghanistan as well as professional migrations and missing good management. PRESENT SITUATION: One of two clinics in Northern Afghanistan was able to practice intraocular operations. Because of the incredible situation in old reconstructed buildings, there was no evidence of clinical hygiene, but nevertheless they performed mainly cataract and glaucoma surgery. Despite the ridiculous situation of hygiene in the theatre, there was not a higher rate of intraocular infections. The international assistance mission (IAM) NOOR project has been the most successful programme in eye care in Afghanistan since war started 30 years ago. There is a need for more support in Government centres with the help of ISAF initiating funds and technical equipment.

Diagnosis of invasive fungal infections in hematology and oncology--guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO).

Invasive fungal infections are a primary cause of morbidity and mortality in patients with hematological malignancies. Establishing a definite diagnosis of invasive fungal infection in febrile neutropenic patients is particularly challenging and time-consuming, but a delay of antifungal treatment leads to higher mortality. This situation has lead to the strategy of initiation "empirical" antifungal therapy prior to the detection of fungi. Meanwhile, improvements in diagnostic procedures are achieved, especially with imaging techniques and non-culture based methods which include antigen-based assays, metabolite detection and molecular detection of fungal DNA from body fluid samples using conserved or specific genome sequences. The AGIHO presents recommendations for the diagnosis of invasive fungal infections with risk-adapted screening concepts for the neutropenic and febrile episodes of patients with hemato-oncological disorders.

Intravitreous injection of tissue plasminogen activator and gas in the treatment of submacular hemorrhage under various conditions.

OBJECTIVE: To investigate the efficacy and safety of treating submacular hemorrhages secondary to age-related macular degeneration (ARMD) with intravitreous recombinant tissue plasminogen activator (rt-PA) and gas under various conditions. DESIGN: Prospective, noncomparative case series. PARTICIPANTS: Forty-three consecutive eyes of 42 patients with recent (range, 2-28 days) subfoveal hemorrhage secondary to ARMD were included in this study. The size of subretinal hemorrhage ranged from 0.25 to 30 disc areas. METHODS: All patients were treated with intravitreous injections of rt-PA (50 microg) and sulfur hexafluoride (0.5 ml). Postoperative prone positioning was maintained for 24 to 72 hours. Patient follow-up ranged from 4 to 18 months (mean, 6 months). MAIN OUTCOME MEASURES: Best and final postoperative visual acuity in relation to size and onset of hemorrhage, displacement of subretinal blood, and surgical complications. RESULTS: Best postoperative visual acuity compared with preoperative visual acuity was improved two or more Snellen lines in 19 eyes (44%) and stable in 24 eyes (56%). Final visual acuity was improved two or more lines in 13 eyes (30%), stable in 26 (61%), and two or more lines worse in 4 eyes (9%). Duration of hemorrhage

Vitreous concentrations of TPA and plasminogen activator inhibitor are associated with VEGF in proliferative diabetic vitreoretinopathy.

PURPOSE: In angiogenesis, matrix degradation is an important step in endothelial cell migration and proliferation. There is evidence that serine proteases, such as tissue plasminogen activator (TPA), urokinase-type plasminogen activator (UPA), and plasminogen activator inhibitor (PAI), are involved in this process. We hypothesized that in eyes in which neovascularization is active, such as in proliferative diabetic vitreoretinopathy (PDVR), vitreous levels of these proteases are increased. Furthermore, correlation was sought between intraocular concentrations of serine proteases and vascular endothelial growth factor (VEGF), a multifunctional cytokine that has been shown to play a major part in mediating active neovascularization in patients with ischemic retinal diseases. METHODS: Undiluted samples of vitreous fluid were obtained from patients who underwent vitreoretinal surgery for PDVR or retinal detachment. Vitreous levels of VEGF, TPA, UPA, and PAI were determined by enzyme-linked immunosorbent assay. RESULTS: We found a statistically significant correlation between levels of VEGF and TPA (P<0.01) and VEGF and PAI (P<0.026) in the vitreous fluid of patients with PDVR. Concentrations of VEGF (P<0.03), TPA (P<0.042), and PAI (P<0.0098) in diabetic eyes were significantly higher than in nondiabetic eyes. Of 14 eyes with PDVR, 6 contained detectable levels of UPA. CONCLUSIONS: A correlation between increased levels of VEGF and TPA or PAI in the vitreous fluid of eyes with PDVR reflects the possible role of plasminogen activators in the progression of this disease. An understanding of the endogenous inhibition of matrix degradation in ocular angiogenesis may be useful in the development of new treatment strategies.

Increased efficacy of aphidicolin killing of human neuroblastoma cells in vitro by encapsulation in liposomes.

Aphidicolin is a tetracyclic diterpene antibiotic which kills human neuroblastoma cells (NB) in vitro while it has no significant effect on the viability of different human cell types including normal embryonal cells. In the present study, we tested whether aphidicolin encapsulated in liposomes kills NB cells with the efficacy superior to that of unencapsulated aphidicolin. The drug was entrapped in vesicles composed of phosphatidylcholine, phosphatidylserine and cholesterol in a molar ratio of 83:5:12. The treatment with encapsulated aphidicolin at a concentration of 200 nmol for 5 days killed all cells of three human NB cell lines. In contrast, at least 30% of the cells survived 5 days of treatment with 200 nmol unencapsulated aphidicolin. The results showed that aphidicolin killing of human NB cells may be increased by encapsulation in liposomes.

[Regulation of glutathione level in venous plasma and aqueous humor in cataracta senilis provecta]. / Regulation der Glutathionspiegel im venösen Plasma und im Kammerwasser bei Cataracta senilis provecta.

UNLABELLED: Glutathione is a major component of the mechanisms protecting the eye against oxidants. To analyse the functional status and the regulation of the glutathione system in the eyes of patients with advanced cataract, glutathione concentrations were quantified in venous plasma and aqueous humor. METHODS: In all, 42 patients with advanced cataract (29 women, 13 men; mean age (+/- SEM) 70 +/- 2 years; vision < or = 0.3) were evaluated. Aqueous humour and venous plasma were obtained at the beginning of cataract surgery. RESULTS: Levels of total glutathione [reduced (GSH) + oxidized glutathione (GSSG)] in plasma were 2.34 +/- 0.23 microM. There was 2.08 +/- 0.15 microM in the reduced form and 0.27 +/- 0.17 microM oxidized glutathione, which means that 94.7 +/- 2.1% of the total glutathione was GSH, the form fully functional as an antioxidant. Levels of total glutathione in the aqueous humor were 1.2 +/- 0.16 microM, i.e. 54.5 +/- 4.8% of plasma levels. Surprisingly, the percentage of GSSG in aqueous humor (0.24 +/- 0.07 microM, 31 +/- 10.5% of the total glutathione) was much higher than that in plasma (P < 0.001). The correlation between glutathione concentrations in plasma and aqueous humor was on the borderline of significance (rs = 0.32, P < 0.04). CONCLUSION: The proportion of oxidized glutathione is higher in aqueous humor than in plasma of patients with advanced senile cataracts, indicating increased oxidant stress in the eye. Further, the regulation of the glutathione system in the eye, at least in aqueous humor, is dependent on plasma glutathione levels. This correlation reflects the importance of sufficient glutathione levels in venous plasma and suggests the possibility of modulating the glutathione system in the eye via manipulation of plasma glutathione levels.

[Laser therapy of eyelid and conjunctival tumors, especially in AIDS patients]. / Lasertherapie von Lid- und Bindehauttumoren, insbesondere bei AIDS-Patienten.

We treated patients with Kaposi's sarcoma of the lid or conjunctiva, molluscum contagiosum and papilloma of the lid with dye laser photocoagulation. This therapeutic device is extremely efficient as the chosen wavelength of 577 nm is absorbed selectively by haemoglobin. Since Kaposi's sarcoma is a haemoglobin-containing tumour composed of endothelial cells and papilloma is a benign tumour composed of connective tissue and branching vessels, dye laser photocoagulation causes selective damage to abnormal vessels and surrounding connective tissue. After local anaesthesia a small incision was made at the margin of the lesion five patients each with papilloma and with molluscum contagiosum. In six patients with Kaposi's sarcoma no incision had to be done. Starting from the incision or the margin of the Kaposi's sarcoma 50-100 shots of 0.3-0.5 mm diameter and 1 s duration were applied until the lesion was completely gone. We used a dye laser with 577 nm wavelength and 1 W energy. In patients with papilloma, the tumour basis was coagulated and the tumour itself underwent histological examination. There was a marked decrease of the size of the lesion or even complete disappearance. Since Kaposi's sarcoma in AIDS patients can be relatively fast growing, resulting in cosmetically irritating manifestations and, rarely, haemorrhages, treatment may become necessary. AIDS patients with molluscum contagiosum may also benefit from treatment, as spreading of DNA virus particles may result in viral follicular conjunctivitis. Dye laser photocoagulation, however, cannot protect against relapse.

Induction of myogenic differentiation in a human rhabdomyosarcoma cell line by phenylacetate.

Sodium phenylacetate (NaPA) at concentrations ranging from 2 to 10 mM promoted myogenic differentiation of the human alveolar rhabdomyosarcoma cell line KFR. These concentrations inhibited DNA synthesis of the cells in a dose-dependent manner without significant effect on cell viability. The morphological differentiation of small mononuclear elements to terminal, elongated multinuclear structures resembling myotubes was accompanied by the expression of skeletal muscle myosin. The proportion of differentiated myosin-positive cells which was around 0.8-1.7% in control cultures 12 days after seeding was increased by NaPA treatment up to 47%. In the cytoplasm of differentiated cells, features of sarcomerogenesis were observed. These results suggest that NaPA is an effective inducer of rhabdomyosarcoma cell differentiation at concentrations that have been achieved in humans with no significant adverse effects.

Suspension culture of HeLa cells in protein-free medium: sensitivity to human pathogenic viruses.

Human adherent HeLa-PF cells grown for 5 years in a protein-free 1:1 nutrient mixture of Dulbecco's modified MEM and Ham's F12 (DMEM-F12) were established in suspension culture. The cells grew in protein-free DMEM-F12 (using magnetically stirred flasks) as a monodisperse suspension with a population doubling time of 28 h. The cells were infected with poliovirus types 2 and 3, herpes simplex virus types 1 and 2 (HSV-1 and HSV-2), respiratory syncytial virus (RSV), echovirus 6 and adenoviruses 3 and 7. Polioviruses replicated in suspension culture of HeLa-PF cells to a similar extent as in protein-free and serum-supplemented adherent cultures. RSV and HSV developed significantly lower titers while adenoviruses and echovirus 6 developed significantly higher titers in suspension than in adherent cultures. The results show that suspension culture of HeLa-PF may both provide the advantage of a high virus yield and enable cultivation of viruses which are not contaminated by serum or other proteins usually added to the culture medium.

In vitro anti-human immunodeficiency virus activity of 2',3'-dideoxynucleosides and their effect on clonal growth of hemopoietic cells from human bone marrow.

Seven 2',3'-dideoxynucleosides synthesized by substitution of nucleosides using nucleoside deoxyribosyltransferase from Lactobacillus leichmanii were tested for their anti-human immunodeficiency virus (HIV) activity. Two of them, including 2,6-diaminopurine-2',3'-dideoxyriboside (DAPDDR) and 6-chlorpurine-2',3'-dideoxyriboside (CPDDR) demonstrated high antiviral activity against several strains of HIV-1 and one strain of HIV-2. The selectivity index of the drugs (SI; ratio of the drug concentration required for 50% of cell killing to drug concentration required to inhibit 50% of virus-induced cell killing) was established by application of tetrazolium (MTT) colorimetric assay. SI ranged for different HIV strains from 501 to 850 and from 60 to 118 for DAPDDR and CPDDR, respectively. Both DAPDDR and CPDDR retained their antiviral activity against HIV-1 strain D148/88 which was resistant to Zidovudine (3'-azido-3'-deoxythymidine, AZT). Assays for clonal growth of human bone marrow cells in semisolid fibrin clot culture medium demonstrated that DAPDDR possesses significantly lower inhibitory activity for erythroid (BFU-E), multipotent (GEMM-CFC) and granulocyte-monocyte (GM-CFC) bone marrow progenitor cells than CPDDR or AZT. These results suggest that DAPDDR is a nucleoside analog which should be further tested as an anti-HIV compound especially in combination with other anti-retroviral drugs.