[ChatGPT and the German board examination for ophthalmology: an evaluation]. / ChatGPT und die deutsche Facharztprüfung für Augenheilkunde: eine Evaluierung.

PURPOSE: In recent years artificial intelligence (AI), as a new segment of computer science, has also become increasingly more important in medicine. The aim of this project was to investigate whether the current version of ChatGPT (ChatGPT 4.0) is able to answer open questions that could be asked in the context of a German board examination in ophthalmology. METHODS: After excluding image-based questions, 10 questions from 15 different chapters/topics were selected from the textbook 1000 questions in ophthalmology (1000 Fragen Augenheilkunde 2nd edition, 2014). ChatGPT was instructed by means of a so-called prompt to assume the role of a board certified ophthalmologist and to concentrate on the essentials when answering. A human expert with considerable expertise in the respective topic, evaluated the answers regarding their correctness, relevance and internal coherence. Additionally, the overall performance was rated by school grades and assessed whether the answers would have been sufficient to pass the ophthalmology board examination. RESULTS: The ChatGPT would have passed the board examination in 12 out of 15 topics. The overall performance, however, was limited with only 53.3% completely correct answers. While the correctness of the results in the different topics was highly variable (uveitis and lens/cataract 100%; optics and refraction 20%), the answers always had a high thematic fit (70%) and internal coherence (71%). CONCLUSION: The fact that ChatGPT 4.0 would have passed the specialist examination in 12 out of 15 topics is remarkable considering the fact that this AI was not specifically trained for medical questions; however, there is a considerable performance variability between the topics, with some serious shortcomings that currently rule out its safe use in clinical practice.

[Indication and Results of the Anderson Procedure]. / Indikation und Ergebnisse der Anderson-Operation.

The major goal of extraocular muscle surgery for nystagmus is to reduce the abnormal head turn (AHT) which is caused by an eccentric null zone of the nystagmus. Shifting the null zone to the primary gaze position will eliminate the AHT. The Kestenbaum procedure consists of bilateral recession of the yoke muscles opposite to the AHT, combined with bilateral resection or plication of their antagonists. The Anderson procedure is confined to bilateral recession of the yoke muscles and is therefore less invasive. We report on our experience with the Anderson procedure. Patients and Methods: From September 2013 to June 2015, we performed the Anderson procedure in 11 consecutive orthotropic patients with infantile idiopathic or sensory defect nystagmus. Patients responsive to convergence inducing prisms who could benefit from artificial divergence surgery were excluded. Results: Medians and ranges (minimum-maximum) were: Age 7 years (4-30); binocular BCVA 0.5 (0.05-1.0); AHT 30° (20-40); equal recessions on the horizontal yoke muscles opposite to the AHT of 12 mm (10-17), in one case using bovine pericardium grafts. Three (3-6) months post surgery, the AHT was reduced to 7° (0-20). First step success rates, defined by residual AHT ≤ 10° and ≤ 15°, were 73 % (95 % CI 39-93 %) and 82 % (95 % CI 48-97 %). No over-correction or other adverse effects were observed. Two patients later received augmenting surgery. One patient with pre-existing exophoria later required strabismus surgery for exotropia. Conclusion: The AHT can be significantly reduced or completely corrected by the Anderson procedure. Recessions of at least 10 mm on both yoke muscles were performed. The success rates equaled success rates of augmented Kestenbaum surgery. Compared to the latter, the Anderson procedure is less invasive. It is followed by a shorter healing process. It is a vessel sparing method - an advantage for potential future surgery.

[Palsy of CVI caused by ecchordosis physaliphora]. / N.-VI-Parese durch Ecchordosis physaliphora.

We report a case of symptomatic ecchordosis physaliphora (EP) in a 34-year-old woman who presented with progressive diplopia due to palsy of the left sixth cranial nerve. Repeated magnetic resonance imaging (MRI) disclosed typical characteristics of a congenital EP lesion with compression of the left abducens nerve presumably because of a secondary herniation of the arachnoid mater. We performed an augmenting combined recess resect procedure on the left eye. No progression of the lesion was observed over a period of 5 years. For differential diagnostics an EP has to be distinguished from skull base tumors, such as chordoma and chondrosarcoma.

High Estradiol Levels During Postmenopause - Pitfalls in Laboratory Analysis.

A 54-year-old woman was admitted with a result of high serum estradiol levels (> 4300 pg/ml) and typical postmenopausal symptoms. She had a history of an adnexectomy (normal histopathology) due to the elevated estradiol levels. After surgery, estradiol levels were as high as before. Analyzing the anti-mullerian hormone (AMH), inhibin B, DHEA-S and estrone, typical postmenopausal levels were found. Serum estradiol levels were controlled several times with rabbit-derived polyclonal as well as monoclonal antibodies to optimize the selectivity of the test system. Secondary, a radioimmunoassay was performed to exclude interferences of the detection system where lower, but still elevated estradiol levels (186 pg/ml) were found. Hypothesizing that our patient underwent a cross reaction with irregular antibodies, a control was done using sheep-derived antibodies, which proved a postmenopausal hormone level (estradiol level < 5 pg/ml). This result was confirmed using a fluorescence enzyme immunoassay (FEIA) revealing high levels of irregular antibodies (> 200 mg/l; reference < 30 mg/l). This case depicts the pitfalls of estradiol measurement detecting false elevated estradiol levels in a postmenopausal woman.

Ultrasound-guided diagnosis of fractures of the distal forearm in children.

PURPOSE: Distal radius and forearm fractures are injuries that are frequently seen in trauma surgery outpatient clinics. Usually, the wrist is X-rayed in 2 planes as standard diagnostic procedure. In contrast, we evaluate in our study the accuracy of ultrasonography (US) in diagnosing these fractures. METHODS: This prospective study includes the patients who presented at two trauma surgery clinics with a presumptive diagnosis of distal radius or forearm fracture between January and December 2012. After a clinical examination, US imaging of the distal forearm was first carried out on 6 standardized planes followed by radiographs of the wrist made in two planes. The age limit was set at the end of 11 years. RESULTS: In total, 201 patients between 4 and 11 years of age were recruited with an average age of 9.5 years at the time of the trauma. There were 104 (51.7%) fractures distributed as follows: 89 (85.9%) injuries of the distal radius, 9 (8.7%) injuries of the distal ulna, and 6 (5.8%) combined injuries (radius and ulna). Sixty-five greenstick fractures were detected. Surgery was necessary in 34 cases. Specificity and sensitivity of ultrasound diagnosis were 99.5%. CONCLUSION: Ultrasound imaging is suitable to demonstrate fractures of the distal forearm. It is a highly sensitive procedure in detecting distal forearm fractures. In our opinion, a negative result in ultrasound may reduce the need for further radiographs in children with distal forearm lesions. But in any doubtful situation the need for conventional radiographs remains.

[Special prosthesis implant with partial femoral replacement. Operation after periprosthetic femoral fracture and ipsilateral long-stem knee prosthesis and fixed-angle osteosynthesis]. / Implantation eines Femurteilersatzes nach periprothetischer Femurfraktur. Operation bei einliegender Knietotalendoprothese und winkelstabiler Plattenosteosynthese.

The development of modular prostheses is becoming increasingly important in revision surgery due to the rising need of arthroplasty in knee and hip joints. The demand for suitable prostheses is high because of the desire for a higher mobility and a good postoperative functionality, whereby preliminary experience with megaprostheses using modular implant systems in orthopedic oncology have already been obtained. Considering the clinical outcome of our 58-year-old patient (obesity III, BMI 58) and the third revision operation after two periprosthetic fractures, a megaprosthesis was implanted (Mega C-system, co. Link, Hamburg). We aimed both at good clinical functionality and good stability of the knee joint. After the implant, a good functional result was observed at the beginning; however, there were some indices for prosthesis loosening. During the fourth revision we implanted a total femoral replacement. Postoperatively, a good clinical outcome after intensive physiotherapy was observed. Nevertheless, the use of megaprostheses has to be judged cautiously because of a lack of long-term results. In addition, it should not be used as a standard implant in periprosthetic joint surgery because of the risk of aseptic loosening during its course.

Detection of RNAP-DNA complexes using solid state nanopores.

Transcription is the first step in gene expression where DNA is copied into RNA. It is extensively studied at the bulk level especially the regulation mechanism, which in cancerous cells is impaired. We were interested in studying E. coli RNAP enzyme at the single-molecule level for its functional as well as molecular motor properties. With nanopore sensing, we were able to observe RNA polymerase-DNA complexes translocate through nanopores and able to distinguish between individual complexes and bare RNA polymerase. We were also able to observe orientation of RNA polymerase in the nanopore whether flow or electric field predominates. The complexity of the signals from the protein-DNA complexes experiment motivated us to develop level detection software. This software is based on a change detection method called the CUSUM algorithm. OpenNanpore software was designed to analyze in details current blockages in nanopore signals with very little prior knowledge on the signal. With this work one can separate events according to their number of levels and study those sub-populations separately.

[Bilateral medial rectus recession with posterior fixation suture for large infantile esotropia]. / Beidseitige Medialis-Rücklagerung mit Fadenoperation bei großer frühkindlicher Esotropie.

BACKGROUND: Surgery for infantile large angle esotropia is not uniform. Bilateral medial rectus recession (BMR), combined recess-resect procedure, also combined with simultaneous contralateral medial rectus recession or secondary other procedures are common. Alternatively, bilateral medial rectus recession with posterior fixation suture (BMRF) has been used. We analysed the effect of BMRF for this specific indication. PATIENTS AND METHODS: We undertook a retrospective evaluation of squint angles in simultaneous (S) and alternating (A) prism cover test before and 3 months after BMRF with and without additional oblique muscle surgery as primary surgery for esotropia ≥ 20° performed at our department between 1997 and 2009, as well as the rate of second procedures. RESULTS: Sixty-one children (0.5 % of all patients who received eye muscle surgery during the same time interval) were included. Medians (10 % and 90 % quantiles) were: age at surgery 48.4 months (23.6; 76.0), refraction (spherical equivalent)2.25 dpt (0.25; 5.50), posterior fixation 5.5 mm + 13.0 mm (12.5; 13.0) from limbus, recession 5.0 mm (4.0; 5.0), inferior oblique recession in 29 children (27 bilateral), preoperative squint angles at 5 m S/A 29° (20; 40), at 0.3 m S/A 35° (24; 45), postoperative at 5 m S 0° (-6; 10), A 2° (-6; 11), at 0.3 m S 1° (-5; 12), A 3.5° (-5; 13), S ≤ 5° in 70.2 % at 5 m and 60.3 % at 0.3 m, consecutive exotropia 6-10° and > 10° in 7.0 and 3.5 % at 5 m and 8.6 and 1.7 % at 0.3 m, residual esotropia 6-10° and > 10° in 10.5 and 8.8 % at 5 m and 13.8 and 15.5 % at 0.3 m. Seven children (11.5 %) were re-operated for esotropia, four for exotropia (6.6 %). CONCLUSION: Bilateral medial rectus recession with retroequatorial myopexy (Cüppers procedure) is an effective one-step procedure for large infantile esotropia. In roughly two-thirds of the cases, the squint angle was corrected within ±â€Š5° with one surgery, which is similar to reported success rates of BMR.

How to deal with diplopia.

Diplopia is a frequent neuro-ophthalmologic symptom with diverse etiologies. This article describes elementary diagnostic tests and frequent causes of diplopia. Monocular diplopia persists when the other eye is closed and usually disappears when the patient looks through a pinhole. It is usually caused by errors in the optical media of the eye and has to be differentiated from spectacle-induced side effect and non-organic disorders. A sign of non-organic etiology is absence of change in image position when the head is tilted. Binocular diplopia disappears regardless of which eye is closed. Binocular diplopia occurs when the images of both eyes cannot be fused. The most frequent direct cause of diplopia is acquired strabismus. Knowledge of several specific types of strabismus enables efficient patient management. Congenital and decompensating strabismus like accommodative esotropia, pathophoria, strabismus surso- and deorsoadductorius, retraction syndrome, Brown's syndrome and esotropia in high myopia only need ophthalmologic treatment. Orbital injury, orbital tumor, ocular myositis, Graves orbitopathy and vascular disease usually require multidisciplinary management. Neurogenic paresis, superior oblique myokymia, ocular neuromyotonia, myasthenia, chronic progressive external ophthalmoplegia (CPEO), internuclear ophthalmoplegia (INO) and skew deviation require specific neurologic examination. Treatment of diplopia includes treatment of the fundamental disorder, monocular occlusion, prisms and strabismus surgery.

SU-D-213AB-04: Evaluation of the Dose Calculation in a Commercial Planning System for a Breast Cancer Brachytherapy Technology Using Monte Carlo Simulation.

PURPOSE: To evaluate the dose calculation in a commercial treatment planning system (TPS) for a breast cancer brachytherapy technology using Monte Carlo simulation for 21 patients. METHODS: Plans for 21 patients who received SAVI treatments were modeled using data from the TPS including CT images, structures and source information. The MC code PENELOPE was used, inputting images in voxel format, where density and material (tissue, air, bone and Nitinol) for each voxel were assigned based on its calibrated Hounsfield units and contoured structure sets, respectively. For the source model only gamma-rays and fluorescence X-rays of the NuDat database 192Ir spectrum were used, leaving out photons with emission intensity less than 0.1% and X-rays with energies below 10 keV. Source positions were entered into the plan and run individually. Dose was totaledby individually weighting the dose for each source position using the original TPS plan dwell times and then summing the weighted dose for all positions. RESULTS: Dose from the Monte Carlo plan was compared with dose from the original plan using isodose lines at 50, 100, 150 and 200% of the prescription dose of 34Gy. Dosimetric coverage of the target was compared by evaluating the V100, V150 and V200 (volume of the target covered by 100%, 150 and 200% of the dose respectively). The V200 and V150 had an average increase (and standard deviation) of 9.1% (3.2%) and 3.8% (1.4%) respectively, while the average change in V100 was 1.2% (1.0%). Where variance for the entire simulation was 0.9%. CONCLUSION: We have compared dose distributions of a commercial TPS using Monte Carlo simulation for SAVI breast cancer brachytherapy and found that a dose increase near the air-tissue interface.

[Surgery for strabismus sursoadductorius (congenital superior oblique palsy) in childhood]. / Behandlung des Strabismus sursoadductorius (congenital superior oblique palsy) im Kindesalter.

PURPOSE: The aim of this study was to evaluate the effect of inferior oblique muscle recession (IOR) in children with pure unilateral strabismus sursoadductorius (so-called congenital superior oblique palsy, CSOP) operated before age 11 years. PATIENTS AND METHODS: A retrospective study of IOR in children with unilateral CSOP and surgery before age 11 years was undertaken. In most cases, recession and anteroposition of the anterior part of the inferior oblique tendon next to the lateral edge of the inferior rectus muscle was performed without fixation of the posterior part of the tendon. Main outcome measures were change in abnormal head tilt, change in vertical deviation, both in straight and contralateral side gaze, and evaluation of squint angles. RESULTS: Between 1997 and 2007, 36 consecutive children (aged 2 -10 years; 27 boys, 9 girls) received IOR for unilateral CSOP. The dose of IOR ranged between 6 and 12 mm. Vertical deviation in straight and contralateral gaze was reduced from median 5° (range 0 - 11°) and 12° (3 - 20°) to 0° (-2 - 8°) and 1° (-5 - 13°), respectively. Abnormal head tilt towards the contralateral shoulder was reduced from median 10° (0 - 20°) to 0° (-2,5 - 10°). Three children (8 %) received further extraocular muscle surgery within 2 years, one because of persistent hyperdeviation, and two because of consecutive hypodeviation of the operated eye. CONCLUSIONS: The results indicate that IOR with fixation of only the anterior part of the inferior oblique to the sclera is an effective treatment for strabismus sursoadductorius/CSOP in children. Undercorrection into a residual, well compensated stage is a satisfying result. Both overcorrection and elevation deficiency were rare.

[Inferior nasal transposition of the lateral rectus muscle for third nerve palsy]. / Nasal-inferiore Transposition des M. rectus lateralis bei Okulomotoriusparese.

OBJECTIVE: The choice and extent of extraocular muscle surgery in N.III palsy are based on the specific pattern and degree of the palsy. In severe paralysis the eye has to be shifted from an exotropic to a straight ahead position. Additionally, a change in vertical position may be desirable. To reach this aim, transposition of the integral lateral rectus muscle to the nasal hemisphere of the eye was performed in 3 patients. PATIENTS AND METHOD: Patient #1 (50 y, m) had vertical gaze palsy and N.III palsy RE with 35° exo-, 25° hyper- and 9° incyclotropia. Patient #2 (41 y, m) had vertical gaze palsy and asymmetric bilateral N.III palsy. The RE was 35°exo-, 8° hyper- and 8° incyclotropic. Adduction was limited to the sagittal plane in both patients. Patient #3 (61 y, f) had vertical gaze palsy together with bilateral N.III paralysis. The eyes were immobile. The RE was 40° abducted and blind. The LE was in 40° abduction. The patient could hardly use this eye for everyday demands. In all 3 patients, the lateral rectus muscle was transposed between the inferior rectus muscle and the globe to the lower margin of the medial rectus muscle, passing behind the inferior oblique muscle. During general anaesthesia, the location of the attachment site from the corneal limbus was determined such that the eye was moved into the desired position. RESULTS: In all patients, the resulting eye position was slightly below primary position. As expected, incyclotropia had increased. Patient #1 had a residual deviation of 2° exo-, 9° hypo-, and 17° incyclotropia. Horizontal motility of the RE ranged from 5° adduction to 5° abduction. As a second side effect, depression occurred on attempted abduction. Patient #2 had no horizontal deviation, but 10° hypo- and 25° incyclotropia. Horizontal motility of the RE ranged from 0° to 5° adduction. Patient #3 could use her eye in a nearly straight ahead position in slight down gaze. Her RE was still 15° exotropic. These results remained stable after 18, 12 and 10 months, respectively. None of the patients was disturbed any more by either confusion or diplopia or image tilt. CONCLUSIONS: Transposition of the entire lateral rectus muscle to the nasal hemisphere is an efficient method to correct for exotropia associated with vertical deviation in specific cases of N.III palsy. The cyclotorsional effect of the procedure has to be considered. The vertical effect is useful to correct for hypertropia and induce a durable, slightly depressed eye position which is profitable for monocular visual demands and aesthetically appealing.

[Diagnosis and treatment of trochlear nerve palsy]. / Diagnose und Therapie der Trochlearisparese.

The diagnosis of unilateral trochlear nerve palsy is based on acute onset vertical deviation which increases in contralateral side gaze, down gaze and ipsilateral head-tilt together with excyclodeviation which also increases in both down gaze and ipsilateral head-tilt. Both vertical deviation and excyclodeviation decrease in contralateral head-tilt. To detect excyclotropia one must ask the patient whether there is a tilted double image in down gaze. Bilateral trochlear nerve palsy causes a change of vertical deviation between right and left gaze and between head-tilt to the right and to the left shoulder. In severely asymmetric bilateral palsy, this change of vertical deviation may be absent. Bilateral symmetric trochlear nerve palsy regularly causes only slight vertical deviation in side gaze and slight head-tilt phenomenon. Major symptoms of symmetric palsy are significant excyclodeviation increasing in down gaze and V-incomitance. Objective assessment of vertical and eventually horizontal deviation is performed by the alternate prism and cover test. Cyclodeviation can be measured by Maddox rods. Differentiated assessment of subjectively localised horizontal, vertical and cyclotorsional deviations in definite gaze directions is preferably being performed at the Harms tangent scale. Treatment of trochlear nerve palsy is nearly exclusively surgical. Prisms are rarely helpful due to incomitance of vertical deviation and since they are not suitable to correct for cyclodeviation. Surgery should be scheduled not earlier than 12 months after onset of the palsy. The preferred surgical strategies include weakening procedures on the inferior oblique, tucking or advancement of the superior oblique tendon, combination of both and, if fitting with the motility pattern rarely as a primary procedure, but usually as a possible second procedure contralateral inferior rectus recession. Surgery will not alter the neurogenic palsy but it modulates the squint angle pattern resulting from the movements of both eyes. Normal binocular vision in all directions of gaze for slight palsy and in large part of the daily used gaze area for severe palsy can be achieved by one or sometimes two operations.

[Correction of supramalleolar deformities with the Taylor spatial frame]. / Korrektur von sprunggelenksnahen Deformitäten mit dem Taylor Spatial Frame.

BACKGROUND: Post-traumatic supramalleolar deformities and malunions of ankle fusion require mostly a multiplanar correction. In cases of severe soft tissue damage, external fixation and gradual correction is a definite treatment alternative. METHOD: Between 2003 and 2007 a correction of supramalleolar deformities was performed in 9 patients with the Taylor spatial frame external fixator. The mean age was 30 years (min. 12, max. 68). There were 6 patients with deformities after malunion of supramalleolar fractures and 3 patients with malunion after ankle fusion. The mean angular deformity was 30 degrees and 5 patients had a rotational malposition of 13.6 degrees (min. 5 degrees, max. 25 degrees). 5 patients needed also lengthening (min. 10 mm, max. 40 mm) of the post-traumatic deformed tibia. The mean time of the follow-up examination was 23 months (min. 12, max. 41). RESULTS: Anatomic correction could be achieved in all patients. The average correction time was 36 days (min. 10, max. 82) with an average time period of 163 days (min. 130, max. 218) until the fixator was removed. The healing index of the leg lengthening cases was 77 d/cm. There were 2 pin-tract infections, 1 prolongated callus formation and 1 insufficient callus formation. CONCLUSION: In cases of post-traumatic supramalleolar deformities with poor soft tissue and bone quality the Taylor spatial frame is a useful tool. Angular, axial, translational and rotatory deformities are corrected simultaneously without complex and time-consuming fixator reconstructions.

[Operative management and fracture care of the lower leg with the Ilizarov fixator in morbidly obese patients: literature review and results]. / Operatives Management und Frakturversorgung der unteren Extremität bei morbider Adipositas : Literaturübersicht und Erfahrungen mit dem Ilizarov-Ringfixateur.

Given the rising prevalence of obesity, surgeons and hospitals must become more familiar with the treatment and operative management of obese patients. Several additional pre- and postoperative considerations must be involved such as appropriate assessment of comorbidities and requirements for special equipment. There are still very few data regarding morbidly obese patients with BMIs >50 kg/m(2). After a general literature review of operative management of obese patients, we report on fracture care of the lower limb in such patients with custom-made Ilizarov ring fixators. We found them suited to bear enormous weight-loading but that associated comborbidities can limit successful fracture care.

[The Taylor Spatial Frame. Correction of posttraumatic deformities of the tibia and hindfoot]. / Der Taylor Spatial Frame : Korrektur von posttraumatischen Deformitäten an Unterschenkel und Rückfuss.

INTRODUCTION: Posttraumatic deformities in the lower limb are mainly multidirectional, with angulation, translation, and rotatory deformities. Acute corrections with internal fixation are often not possible due to the soft tissue damage and the extent of the deformity. The Taylor Spatial Frame (TSF) allows correction in a virtual hinge with 6 axes, thus enabling the correction of multidirectional deformities simultaneously. METHODS: From February 2003 until December 2006, we applied 31 TSFs to 20 patients with a posttraumatic deformity of the tibia and hindfoot. The mean patient age was 41 years (range 12-73). 9 patients had a nonunion of the tibia with deformity, 6 had a malunion of the lower tibia and ankle, 3 had an angular deformity after ankle fusion, and 2 had malaligned Ilizarov bone segment transports. The mean follow-up time was 25.3 months (range 10-82). RESULTS: In all 20 patients, full correction of the deformity was achieved. The mean time for correction was 29 days (range 5-82). On average, the frame was worn (time to healing) 164.2 days (80-300) and the mean distraction rate was 1.1 mm/day (0.5-2.0). The Web-based planning was done two times per case for full deformity correction. Complications were 3 pin-site infections, 2 insufficient callus formations and 1 pinhole stress fracture. CONCLUSIONS: The main advantage of the TSF compared with other external frames is the ability to perform simultaneous correction of angular, axial, translational, and rotatory deformities. This enables a reduced correction time and increased patient comfort.

[Surgery for acquired trochlear nerve palsy]. / Operative Behandlung der erworbenen Trochlearisparese.

BACKGROUND: Various surgical procedures are recommended as treatment for trochlear nerve palsy. Recession of the inferior oblique muscle (IOR), tucking or advancement of the superior oblique tendon, combination of both procedures (COP), and recession of the contralateral inferior rectus muscle are recommended. In this study, the effects of IOR and COP were compared. PATIENTS AND METHODS: Patients with isolated acquired unilateral trochlear nerve palsy were examined at a distance of 2.5 m from the Harms tangent scale before and 3 months after surgery. The onset of the palsy was 1-35 years previously (median 2 years). Subjective squint angles without diagnostic occlusion were measured with a dark red glass in front of the nonparetic eye. The field of binocular fusion was determined with an additional light bar and Bagolini striated glasses for control. The head-tilt phenomenon was defined as the difference between the vertical deviations at 45 degrees of head tilt to the right and to the left. For statistics, squint angles of left-sided palsy were transformed corresponding to palsy on the right side. RESULTS: The vertical and cyclodeviations were similar before IOR (n=13) and COP (n=21). The reduction of vertical deviation by IOR vs. COP was (median and range) 3 degrees (1; 9) vs. 6 degrees (0; 14) in primary position (PP), in side gaze 5 degrees (1; 11) vs. 9 degrees (3; 17), and in down gaze 3 degrees (-7; 11) vs. 8 degrees (2; 16). Excyclodeviation in down gaze was reduced by 4 degrees (-4; 11) vs. 7 degrees (0; 14), and the head-tilt phenomenon was improved by 1.5 degrees (-5; 7) vs. 6 degrees (-8; 14). Three months after surgery there was residual hyperdeviation of 1 degrees (0; 6) vs. 0 degrees (-7; 5) with excyclodeviation of 2 degrees (-2; 5) vs. 1 degrees (-2; 4) in PP, increasing to 2 degrees (-1; 8), ex 1 degrees (-1; 8) vs. 0 degrees (-8; 5), ex 1 degrees (-2; 5) in contralateral side gaze, and 6 degrees (-3; 13), ex 2 degrees (1; 9) vs. +1 degrees (-1; 8), ex 1 degrees (-4; 10) in down gaze. COP caused more or less significant Brown's syndrome. A second surgery was performed in one patient (4%) after COP. Augmenting surgery was done in four patients (22%) after OIR. CONCLUSIONS: Cyclovertical deviation and head-tilt phenomenon were significantly reduced when recession of the inferior oblique muscle was combined with tucking of the superior oblique tendon. To permanently minimize squint angles and abnormal head posture, initial postoperative incyclodeviation is necessary, which decreases during subsequent months due to both purely mechanical factors and modulation of cyclovertical innervation. Patient discomfort caused by this may be an argument to perform IOR as an initial procedure with fewer side effects but also fewer effects that may require further treatment.

Distribution of cadmium among geochemical fractions in floodplain soils of progressing development.

Initial soil development in river floodplains influences soil properties and processes. In this study, suites of young floodplain soils sampled at three European rivers (Danube/Austria, Ebro/Spain and Elbe/Germany) were used to link soil development to the soils' retention capacity for cadmium. Geochemical fractionation of original and metal-spiked soils was conducted. Cadmium remained in weakly bound fractions in both original and spiked soils, representing an entirely different behaviour than observed for copper in an earlier study. The tendency of incorporation into more stable forms over time was only slightly expressed. Correlation analysis revealed the involvement of different sorption surfaces in soil, with no single soil constituent determining cadmium retention behaviour. Nevertheless, in the calcareous soils of the Danube floodplain, we found increased cadmium retention and decreased portions of desorbable cadmium with progressing soil development.

[Influence of prism overcorrection on residual postoperative strabismus]. / Einfluss der Prismenüberkorrektur auf den postoperativen Restschielwinkel.

BACKGROUND: Prism overcorrection is a complementary procedure to reduce the residual postoperative esotropia caused by anomalous retinal correspondence (ARC) after surgery for esotropia. We have investigated the results of this treatment. PATIENTS AND METHODS: For Group 1, the files of 63 patients treated with postoperative prism overcorrection in the Department of Ophthalmology, University of Giessen, were evaluated regarding the pre-and postoperative squint angles (SPCT, simultaneous and APCT, alternate prism and cover test) and the angle of ARC, determined by the red filter test and by the increase of esotropia after neutralisation of the squint angle (APCT). Postoperatively, squint angles had been measured immediately (APCT) after removal of the eye patch and 10 minutes to 2 hours later (SPCT and APCT). Subsequently, prism overcorrection was performed with a Fresnel prism foil (40 PD basis temporally) in front of the fellow eye for a maximum of 3 months. After 3 months, SPCT and APCT were performed. For Group 2, the files of 28 patients with a preoperative angle of ARC of 5 degrees or more, treated in the Department of Ophthalmology, University of Heidelberg, were evaluated. These patients had not been treated with prism overcorrection. The squint angles had been measured (SPCT and APCT) on the preoperative day, on the first postoperative day, a few hours after removing the eye patch, and after three months. RESULTS: For Group 1, at surgery, the patients were 4 to 12 years old (median: 6.2 years). The preoperative squint angle ranged from + 5 degrees to + 27 degrees (median: + 12 degrees) in the SPCT and from + 7 degrees to + 27 degrees (median: + 14 degrees) in the APCT. The angle of ARC was between + 4 degrees and + 15 degrees (median: + 7 degrees). Both combined recess and resect surgery (with or without additional oblique muscle surgery) or bilateral retroequatorial medial rectus myopexy, in part depending on the squint angle pattern with medial rectus recession, were performed. Immediately after removing the patch, the squint angle (APCT) was between - 10 degrees and + 5 degrees (median: + 1 degrees). Ten minutes to 2 hours later, the manifest squint angle ranged from 0 to + 12 degrees (median: + 7 degrees). The angle had decreased significantly to - 6 to + 12 degrees (median: + 5 degrees) after 3 months. For Group 2, the patients' ages were between 5 and 12 years (median: 6.5 years). The squint angles ranged from + 11.5 degrees to + 35 degrees (median: + 20 degrees) in the SPCT and APCT. The angle of ARC was between + 5 degrees and + 17 degrees (median: + 8 degrees). Combined recess and resect surgery or bilateral recession of the medial rectus (with or without oblique muscle surgery both) were performed. The SPCT several hours after removal of the patch showed angles of - 4 degrees to + 14 degrees (median: + 4.25 degrees). Three months later the manifest squint angles ranged from - 5 degrees to + 14 degrees (median: + 3 degrees). DISCUSSION: After prism overcorrection (Group 1), there was a significant reduction of the residual esotropia. Without this additional treatment (Group 2), there was no significant change in the postoperative squint angle. However, neither the positive outcome in Group 1 nor the difference to Group 2 do unequivocally prove that there is a beneficial effect of prism overcorrection, since preoperative conditions were different and the sample size in Group 2 was small, especially after matching for equal preoperative conditions. A spontaneous reduction of the postoperative esotropia cannot be excluded. Further studies are necessary in order to investigate the specific effect of prism overcorrection.

The neuro-steroid, 3beta androstene 17alpha diol exhibits potent cytotoxic effects on human malignant glioma and lymphoma cells through different programmed cell death pathways.

The neuro-steroids 3beta-androstene-17alpha-diol (17alpha-AED), 3beta-androstene-17beta-diol (17beta-AED), 3beta-androstene-7alpha,-17beta-triol (7alpha-AET) and 3beta-androstene-7beta,-17beta-triol (7beta-AET) are metabolites of dehydroepiandrosterone and are produced in neuro-ectodermal tissue. Both epimers of androstenediols (17alpha-AED and 17beta-AED) and androstenetriols (7alpha-AET and 7beta-AET) have markedly different biological functions of their chemical analogue. We investigated the cytotoxic activity of these neuro-steroids on human T98G and U251MG glioblastoma and U937 lymphoma cells. Proliferation studies showed that 17alpha-AED is the most potent inhibitor, with an IC(50) approximately 15 microM. For T98G glioma, 90% inhibition was achieved with 25 muM of 17alpha-AED. Other neuro-steroids tested only marginally suppressed cell proliferation. Reduced cell adherence and viability could be detected after 18 h of 17alpha-AED exposure. Treatment with 17alpha-AED induced a significant level of apoptosis in U937 lymphoma cells, but not in the glioma cells. Cytopathology of 17alpha-AED-treated T98G cells revealed the presence of multiple cytoplasmic vacuoles. Acridine orange staining demonstrated the formation of acidic vesicular organelles in 17alpha-AED-treated T98G and U251MG, which was inhibited by bafilomycin A1. These findings indicate that 17alpha-AED bears the most potent cytotoxic activity of the neuro-steroids tested, and the effectiveness may depend on the number of hydroxyls and their position on the androstene molecule. These cytotoxic effects may utilize a non-apoptotic pathway in malignant glioma cells.