Therapeutic effect of methotrexate encapsulated in cationic liposomes (EndoMTX) in comparison to free methotrexate in an antigen-induced arthritis study in vivo.

OBJECTIVES: Cationic lipid complexes bind to angiogenic endothelial cells of solid tumours and microvessels of chronic inflammatory tissue. Methotrexate (MTX) is one of the drugs used in the therapy of rheumatoid arthritis (RA); it is applied systemically but can have serious side-effects. The aim of this study was to investigate the impact of MTX encapsulated in cationic liposomes (EndoMTX) in comparison to treatment with free MTX. METHOD: We used an antigen-induced arthritis (AiA) model and investigated the leucocyte- and platelet-endothelial cell interaction in arthritic female C57/Bl6 mice and in healthy controls. The arthritic animals were divided into four different groups receiving either trehalose, free MTX, EndoMTX placebo, or EndoMTX. These parameters and functional capillary density (FCD) were measured and assessed by intravital microscopy (IVM). We controlled clinical parameters such as the knee joint diameter (KJD) throughout the observation period. RESULTS: Animals treated with EndoMTX showed a significant and superior reduction in leucocyte- and platelet-endothelial cell interaction, FCD, and KJD. Free MTX or empty liposomes also showed a reduction in these parameters but not to a significant level. FCD decreased in the EndoMTX group in comparison to using free drugs or empty carrier-like liposomes. CONCLUSIONS: This study demonstrates the advantage of using MTX encapsulated in cationic liposomes in contrast to free and generic MTX, with a higher efficacy in anti-inflammatory and anti-angiogenic abilities. Targeting with cationic liposomes may be a promising treatment option and should be elucidated in further experiments regarding dose reduction and side-effects due to MTX usage.

Continuous-wave Pr³âº:BaY2F8 and Pr³âº:LiYF4 lasers in the cyan-blue spectral region.

We report on the first, to the best of our knowledge, continuous-wave quasi three-level lasers emitting in the cyan-blue spectral range in praseodymium-doped crystalline materials. Applying Pr(3+):BaY2F8 as an active medium, up to 201 mW of output power at 495 nm could be obtained with a slope efficiency of 27% under pumping with an optically pumped semiconductor laser (2ω-OPSL) at 480 nm. In the same pumping scheme using Pr(3+):LiYF4, output powers up to 70 mW were realized at 491 and 500 nm, respectively. With Pr(3+):BaY2F8, diode-pumped laser operation with up to 11% slope efficiency and 44 mW output power was also achieved. In the latter case, detailed investigations on the temperature dependency of the laser output were conducted. Moreover, comparative experiments were carried out for the first time, to the best of our knowledge, with green-emitting Pr(3+):BaY2F8 lasers at 524 and 553 nm both under diode and 2ω-OPSL excitation.

Simvastatin reduces leucocyte- and platelet-endothelial cell interaction in murine antigen-induced arthritis in vivo.

OBJECTIVES: The use of statins in the prevention and treatment of cardiovascular diseases is well established. Their use as anti-inflammatory and immunomodulatory agents in the treatment of rheumatoid arthritis (RA) has also been investigated, with several clinical and experimental studies indicating an anti-inflammatory effect of statins for RA, but other studies showing no effect or even the opposite. The current study was designed to examine the effect of simvastatin in an in vivo murine model of arthritis using intravital microscopy. METHOD: We assigned four groups (n = 7, female C57Bl6 mice), two with and two without antigen-induced arthritis (AiA), from which one of the non-AiA groups and one of the AiA groups were treated with simvastatin 40 mg/kg i.p. daily for 14 consecutive days after induction of arthritis. Platelet- and leucocyte-endothelial cell interaction was assessed by measurement of rolling and adherent fluorescence-labelled platelets and leucocytes, functional capillary density (FCD) was evaluated, and knee joint diameter was determined as a clinical parameter. RESULTS: In arthritic mice treated with simvastatin, a significant reduction in platelet- and leucocyte-endothelial cell interaction was observed in comparison to arthritic mice treated with vehicle. In addition, a significant reduction in FCD was seen in arthritic mice treated with simvastatin, along with a reduction in knee joint swelling of the AiA mice. CONCLUSIONS: Treatment of AiA mice with simvastatin showed significant reductions in platelet- and leucocyte-endothelial cell interactions, in FCD, and in the swelling of the knee joint. These results support the hypothesis of the anti-inflammatory effects of statins in the treatment of RA.

Efficient visible laser operation of Pr,Mg:SrAl12O19 channel waveguides.

We report the fabrication and visible laser operation of Pr,Mg:SrAl12O19 waveguides. Waveguiding structures were created by focusing the radiation of a femtosecond Ti:sapphire laser into bulk material. Guiding losses were determined to be as low as 0.12 dB cm(-1) at 632.8 nm. By employing a frequency-doubled optically pumped semiconductor laser, waveguide laser operation was realized at wavelengths of 525.3, 644.0, and 724.9 nm with output powers as high as 36, 1065, and 504 mW, respectively. To the best of our knowledge this is the first demonstration of green laser operation in a Pr(3+)-doped crystalline waveguide laser.

Diode pumped laser operation and spectroscopy of Pr3+:LaF3.

We report on the first results of diode pumped laser operation of Pr3+:LaF3 in a quasi continuous wave (qcw) mode with average output powers of up to 80.0 mW (≈ 161.3 mW qcw) and a maximum slope efficiency of 37% at 719.8 nm. Furthermore it was possible to operate the laser at 537.1 nm and 635.4 nm and to tune the emission wavelength from 609 nm to 623 nm. The pump source was an InGaN laser diode with a maximum output power of 1 W at a central emission wavelength of 442 nm.

Efficient laser operation of Pr3+, Mg2+:SrAl12O19.

In this Letter, we report on laser operation of Pr3+,Mg2+:SrAl12O19 pumped by a frequency-doubled optically pumped semiconductor laser. By employing a V-type cavity, we demonstrate cw laser operation at room temperature in the green spectral range in a doped oxide host for the first time to the best of our knowledge. Furthermore, efficient laser operation was realized in the orange, red, and deep red spectral range with output powers exceeding 1.1 W at emission wavelengths of 643.6 and 724.4 nm.

[Postoperative monitoring of anastomosis after radical retropubic prostatectomy Transrectal ultrasound can replace cystography?]. / Postoperative Anastomosenkontrolle nach radikaler retropubischer Prostatektomie. Kann der transrektale Ultraschall die Zystographie ersetzen?

OBJECTIVE: We determined if transrectal ultrasound (TRUS) is as reliable as cystography in detecting vesicourethral extravasates after radical retropubic prostatectomy (RRP). PATIENTS AND METHODS: Between October 2005 and February 2006 we prospectively investigated 100 consecutive patients undergoing RRP. The vesicourethral anastomosis was proven 6 days after operation by a combined investigation with TRUS and cystography. RESULTS: In the majority of patients (79%) the vesicourethral anastomosis was watertight on postoperative day 6 (POD) or showed minimal leakage (8%) so that the urinary catheter was removed. Different degrees of paravasates were detected in 21 patients. Because of small, moderate, or marked paravasations the indwelling catheter was removed on POD 9, 14, and 21 in 5, 3, and 5 patients, respectively. Every paravasate documented by cystography had been detected by TRUS before. Therefore, TRUS showed no false-negative result in detecting insufficient anastomosis. In two patients paraurethral fluid was detected by TRUS mimicking anastomotic paravasation, without confirmation by cystography. CONCLUSIONS: TRUS can safely replace cystography to detect anastomotic leakage after radical prostatectomy.

[En Route for Objective Evaluation of Form, Volume, and Symmetry in Plastic Surgery using 3-D Intraoperative Scans]. / Auf dem Weg zur objektiven Evaluation von Form, Volumen und Symmetrie in der Plastischen Chirurgie mittels intraoperativer 3D Scans.

BACKGROUND: There has been ongoing development in the field of 3-dimensional (3-D) Surface Imaging by laser scanner and digital 3-D photography (Photogrammetry) in recent years. Manufacturers tend to make new 3-D cameras compact, light-weighted, mobile, and user-friendly, similar to the development on the smartphone market. Although 3D scans have been used for patient consultations and digital documentation in Plastic Surgery since the 1980, there has been no significant development lately regarding its use for objective assistance during surgery. PATIENTS, MATERIAL AND METHODS: Our research team presents a new intraoperative 3-D scanning method for plastic-surgical procedures with selected mobile 3-D scanner systems. In the future, these might assist surgeons with the pre-, post-, and intraoperative 3-D analysis, choice of therapy, consultation, and documentation. RESULTS: The 3-D scanners were successfully validated for their intraoperative application to several patients. With their introduction, an intraoperative, objective measurement of volume to evaluate form and symmetry was possible. CONCLUSION: In this work, we share our first experience with the intraoperative use of new mobile 3D camera systems, discuss pros and cons, and show selected patient examples.

Low dose loop diuretics in essential hypertension. Experience with torasemide.

Diuretics belong to the class of antihypertensive drugs recommended for first-line therapy of essential hypertension. Although they are widely and effectively used for the treatment of hypertension, the question remains whether their possible negative influence on metabolic and electrolyte parameters could partly offset the benefit of blood pressure reduction with respect to reduction of coronary artery disease. Recently published data demonstrate that much lower doses of thiazides exert the same antihypertensive effect as the higher doses used in the past and even prescribed today. These lower doses produce relatively little change in biochemical parameters. Thus, the postulated risks can be avoided by using the lowest effective dose. Traditionally, loop diuretics of the furosemide (frusemide) type are rarely used as first-line antihypertensive agents. They seem to display less efficacy coupled with an intense diuresis when used in standard available doses. However, there is evidence that newly developed loop diuretics, in lower doses than used in congestive heart failure, are effective antihypertensive agents. For example, torasemide 2.5mg once daily, which does not exert a significant diuresis over 24 hours compared with placebo, lowers elevated blood pressure to a similar extent than thiazides or related compounds. This antihypertensive effect is accompanied by less, if any, changes in metabolic or electrolyte parameters compared with widely used standard diuretics such as hydrochlorothiazide, indapamide or chlorthalidone. The influence on serum potassium and magnesium is similar to or even less than fixed combinations of hydrochlorothiazide and triamterene or amiloride. Thus, low-dose torasemide constitutes an alternative to established thiazide antihypertensive therapy.

Use of the rhomboid flap after partial vulvectomy.

Primary closure of vulvar excisions is usually satisfactory in the anterior vulva, where the skin is mobile. In the posterior and posterolateral areas, however, closure often must be accomplished under tension with resulting wound breakdown and scar formation that can be disfiguring and cause dyspareunia. The rhomboid skin flap was described as early as 1946. Initially described for closure of facial defects, the technique has found application in the closure of a variety of traumatic and surgical defects. The authors present eight patients who underwent closure of vulvar defects using single or multiple rhomboid flaps. The applicability of the procedure to vulvar surgery is discussed and the technique is described.

Gracilis muscle repair of perineal hernia following pelvic exenteration.

This report describes the use of a rotated gracilis muscle to repair a perineal hernia that occurred 18 months following pelvic exenteration for recurrence of cervical carcinoma. The anatomy of the gracilis muscle and the operative technique of the hernia repair are described. The gracilis muscle procedure offers a satisfactory correction for this complication of pelvic exenteration. The ability to mobilize the gracilis muscle for reconstructive procedures in the pelvis is a valuable procedure for the gynecologist.

Penile circumference and erection.

Simultaneous registration of penile circumference and intracavernous pressure during artificial erection was performed in 6 fresh cadavers. Maximal penile circumference was obtained at an intracavernous pressure below the pressure required for full erection. This reduces the clinical value of penile tumescence measurement in evaluation of erectile function.

New operation for "krummerik" (penile curvature).

A corrective operation for penile curvature using plication of the tunica albuginea on the opposite side of the angulation is described. The operation is fast, easy to perform, and complications are rare.

[3D-imaging and analysis for plastic surgery by smartphone and tablet: an alternative to professional systems?]. / 3D Bilderfassung und Analyse in der Plastischen Chirurgie mit Smartphone und Tablet: eine Alternative zu professionellen Systemen?

BACKGROUND: A new approach of using photographs from smartphones for three-dimensional (3D) imaging was introduced besides the standard high quality 3D camera systems. In this work, we investigated different capture preferences and compared the accuracy of this 3D reconstruction method with manual tape measurement and an established commercial 3D camera system. METHODS: The facial region of one plastic mannequin head was labelled with 21 landmarks. A 3D reference model was captured with the Vectra 3D Imaging System®. In addition, 3D imaging was executed with the Autodesk 123d Catch® application using 16, 12, 9, 6 and 3 pictures from Apple® iPhone 4 s® and iPad® 3rd generation. The accuracy of 3D reconstruction was measured in 2 steps. First, 42 distance measurements from manual tape measurement and the 2 digital systems were compared. Second, the surface-to-surface deviation of different aesthetic units from the Vectra® reference model to Catch® generated models was analysed. For each 3D system the capturing and processing time was measured. RESULTS: The measurement showed no significant (p>0.05) difference between manual tape measurement and both digital distances from the Catch® application and Vectra®. Surface-to-surface deviation to the Vectra® reference model showed sufficient results for the 3D reconstruction of Catch® with 16, 12 and 9 picture sets. Use of 6 and 3 pictures resulted in large deviations. Lateral aesthetic units showed higher deviations than central units. Catch® needed 5 times longer to capture and compute 3D models (average 10 min vs. 2 min). CONCLUSION: The Autodesk 123d Catch® computed models suggests good accuracy of the 3D reconstruction for a standard mannequin model, in comparison to manual tape measurement and the surface-to-surface analysis with a 3D reference model. However, the prolonged capture time with multiple pictures is prone to errors. Further studies are needed to investigate its application and quality in capturing volunteer models. Soon mobile applications may offer an alternative for plastic surgeons to today's cost intensive, stationary 3D camera systems.

[Replacement of perioperative blood loss for cancer patients. Results of a survey among surgical departments in Germany]. / Ersatz des perioperativen Blutverlusts bei Karzinompatienten. Ergebnisse einer Umfrage in chirurgischen Kliniken in Deutschland.

BACKGROUND: The need for red blood cell units in cancer surgery is increasing. The role of the better immunological options, such as preoperative blood donation or intraoperative autologous blood salvage is not known. The aim of this survey was to clarify the transfusion setting and options for cancer patients in Germany. METHOD: A questionnaire was send to 90 directors of surgical departments in Germany. RESULTS: A total of 60 directors answered the questionnaire. In most cases the blood loss is compensated by allogenic blood transfusions. The possibility of preoperative blood donation exists in 85% of the hospitals and is offered in 3% for cancer patients. The intraoperative blood salvage is possible in 93% of the hospitals and 10% use this procedure without an additional purifying process for cancer patients. Of the hospitals 31% are able to irradiate blood collected intraoperatively, but only 11% use this for cancer patients. CONCLUSION: Perioperative blood loss is compensated by allogenic blood transfusion. The better immunological procedures, such as preoperative blood donation or intraoperative blood salvage, are not used because of the higher costs and the possible retransfusion of tumor cells.