[On the topical tolerance of aminoglycoside antibiotics--a prospective comparative cytomorphological study]. / Zur Evaluierung der lokalen Verträglichkeit von Antibiotika an der Augenoberfläche am praktischen Beispiel eines Aminoglykosides.

BACKGROUND: The local application of drugs is an efficient method for treating diseases of the external eye. However, some active substances can also cause a chronic toxic reaction at the ocular surface. No results from clinical experiments on the local tolerance of kanamycin which would meet the requirements of evidence-based medicine are as yet available. METHODS: Thus, the cytomorphological processes of the treatment with kanamycin were examined in a prospective randomised placebo-controlled double blind cross-over study. The effect of the topical application (5 times a day for 7 days) of Kanamycin POS® eye ointment on the conjunctival epithelial barrier was studied in comparison with an eye ointment base (placebo) in 25 healthy subjects. To detect cytopathological microchanges of the epithelium, we carried out a standardised impression cytology (primary compatibility parameter). Biomicroscopy, Schirmer II test and non-invasive measurement of the break-up-time (tearscope) were also examined. The subjective compatibility parameters (itching, tearing, foreign body sensation, burning sensation, mucus) were measured on a 0 - 10 visual analogue scale. RESULTS: The cytological findings of 23 subjects were included in the final evaluation of the study. The impression cytology did not reveal a different effect of kanamycin ophthalmic ointment on the conjunctival ocular surface in comparison with the placebo. Only in one subject was a marked shift found in the nuclear-cytoplasmic ratio after application of verum. No signs of increased apoptosis ("snake-like chromatin") were found at the conjunctival epithelial barrier. The mean goblet cell count was 109 goblet cells per mm (2). No significant reduction of the goblet cell density was found in any treatment group. Among the subjective compatibility parameters, only the mean for itching constantly remained above the placebo group after application of kanamycin. Statistically significant differences were not found by the Wilcoxon test. CONCLUSIONS: In contrast to the clinical experience with the systematic application of kanamycin, the standardised evaluation of this study confirmed the very good topical tolerability of the tested kanamycin eye ointment. In view of the continuing clinically relevant aspect of the availability of a wide spectrum of antibiotics to avoid the development of resistance while at the same time keeping within what is reasonable economically, Kanamycin POS® for topical application supplements the options of ophthalmological antibacterial chemotherapy.

[Diurnal variation of ocular pressure in open-angle glaucoma with telemonitoring]. / Tagesschwankungen des okulären Perfusionsdrucks im Telemonitoring bei primärem Offenwinkelglaukom.

BACKGROUND: The aim of this study was to study and analyse distribution, range and intraday variation of ocular perfusion pressure (OPP) in patients with primary open-angle glaucoma (POAG) in the framework of telemedical home-monitoring. METHODS: In the project Teletonometry Mecklenburg-Vorpommern (TTMV) patients were equipped with a home-monitoring system for self-measurement of intraocular pressure and blood pressure. All measurements were transmitted via telephone modem to an electronic patient record that automatically calculated OPP. We present the temporal characteristics of OPP in 70 patients with POAG. After the measurement of blood pressure and intraocular pressure was performed, the individual ocular perfusion pressure was calculated by the formula: (OPP=[2/3 x (2/3 x DBP + 1/3 x SBP)]-IOP). RESULTS: In 3282 OPP measurements the percentage of values less than 50 mmHg was: left eye 2273/69.2%--right eye 2362/71.9 % and less than 40 mmHg: left eye 687/20.9 %--right eye 794/24.2%. 50/51 (left eye/right eye) patients had an individual OPP average of less than 50 mmHg and 10/10 (left eye/right eye) patients less than 40 mmHg. The diurnal OPP trend showed 4 phases (7-12, 12-18, 18-22, 22-7 hour). In the intervals from 22-7 hour and 7-12 hour ocular perfusion pressure values were low. Between 7-12 hour ocular perfusion pressure was significantly depressed as in the other phases (p<0.05). CONCLUSIONS: Ocular perfusion pressure of glaucoma patients calculated using intraocular pressure (self-tonometry) and blood pressure demonstrates a feasible method to evaluate individual diurnal OPP fluctuations. However, this OPP could be described a bit more precisely as the really topical ocular perfusion. Many physiological conditions may not be included, e. g., autonomic circulation. Simultaneous measurement of blood pressure and intraocular pressure enable the detection and analysis of side effects and interactions between glaucoma and hypertension therapy. In clinical practice OPP telemonitoring presents a new way to examine ocular blood circulation in routine glaucoma work-up. The diurnal OPP variations were associated with the fluctuations of systemic blood pressure for the most of part.

[Fluctuation of intraocular pressure in 24-hour telemonitoring compared to tonometry during normal office hours]. / Fluktuationen des intraokularen Augendrucks - ein intraindividueller Vergleich zwischen 24-Stunden-Teletonometrie-Monitoring und ambulanter Augendruckmessung.

BACKGROUND: Elevated intraocular pressure (IOP) is a clinically relevant factor in glaucoma progression. As a dynamic parameter the IOP depends on various internal and exogenic influencing factors. Therefore, we analysed intraindividual IOD variations between ambulant care and 24-h home-monitoring using self-tonometry. PATIENTS AND METHODS: This study is based on paper-based glaucoma cards of 25 patients with primary open angle glaucoma. Additionally, all patients participated in a telemedical home-monitoring study with self-measurements of IOP and blood pressure stored in an electronic patient record. The glaucoma cards contained a total number of 409 IOP values with documentation periods from 0.5 to 10 years. In the teletonometry project all 25 patients were observed for 6 months with 1490 recorded IOP values. Statistical analysis was performed with SPSS software. RESULTS: Average IOP values for all 25 glaucoma patients were 16.3 +/- 2.9 mmHg for both eyes in glaucoma card documentation, whereas the electronic patient records showed IOP averages of 18.9 +/- 4.7 mmHg for right eyes and 18.2 +/- 4.4 mmHg for left eyes. Corresponding to the practice opening hours the glaucoma cards contained no IOP records from 12:00 pm to 01:30 pm as well as between 06:00 pm and 07:15 am. In these time periods 17 % of all IOP values recorded in 24-hour teletonometry were higher than 20 mmHg. However, statistical analysis and clinical evaluation of device parameters and measurement characteristics revealed sporadic measuring errors. CONCLUSIONS: The additional involvement of self-tonometry in telemedical 24-h home-monitoring is a feasible method to record and detect intraday IOP fluctuations. Compared to single IOP measurements documented in common paper-based glaucoma cards, the 24-h electronic patient record showed more frequent circadian IOP variations. As a result, self-tonometry and home-monitoring can be a useful link to fill the gap between singular ambulant IOP measurement and hospitalisation with 24-hour IOP profiles.

[Home-monitoring in ophthalmology--prerequisites for an improvement in quality of life: conclusions from the management research study Teletonometry Mecklenburg-Vorpommern]. / Homemonitoring in der Augenheilkunde--unter welchen Voraussetzungen für mehr Lebensqualität: Schlussfolgerungen aus der Versorgungsforschungsstudie Teletonometrie Mecklenburg-Vorpommern.

Home-monitoring represents an innovative and growing health service area in which suitable conditions have to be created for the attending doctor and also for the patient. For this it is necessary to offer the technical supply and also to establish simultaneously organisational structures in the cooperation between the doctor and the patient based on prevalent experiences of general ambulant care. The medical care as a whole can be optimised to be more patient-orientated by integrating assistant medical staff and by establishing modern IT communication channels. The evolving home-monitoring in consideration of the doctor-patient experiences can contribute to an improvement in the patient's quality of life.

[Self-medication with local anaesthetics by glaucoma patients using teletonometry]. / Selbstmedikation mit Lokalanästhetika durch Glaukompatienten bei der Teletonometrie.

BACKGROUND: Self-tonometry, a supplementary measurement of the intraocular pressure in ophthalmology by glaucoma patients using an automatic tonometer, will become more and more important in the future. As long as the self-tonometry has to work in the contact modus with the ocular surface, home application of a topical anaesthetic by the glaucoma patient will be a requirement for a successful measurement. So far no severe problems within this controlled self-medication have been seen. Nevertheless, public health authorities believe patient health is put at high risk by the application of local anaesthetics during self-tonometry. As there are no clinical studies of the health care, we evaluated the local tolerability of a topical anaesthetic in line with self-tonometry employing a modified tonometer OCUTON S. MATERIAL AND METHODS: A total of 100 glaucoma patients participated in a prospective clinical study of the routine clinical service in which each was monitored for 1 year. The telemonitoring involved self-tonometry for at least 6 months in every case and Ocuton S Proparakain-POS 0.5% eyedrops (proxymetacaine-HCl) were applied by the probands before every measurement of the intraocular pressure with a modified self-tonometer. Information regarding the local tolerability of the topical anaesthetic was analysed using a standardised questionnaire. The intensity of the following subjective symptoms was listed in separate visual analogue scales for: lacrimation, burning, foreign body sensation, mucus aggregation, pruritus and pain. RESULTS: Information from 83 glaucoma patients on local tolerability of proparacaine eyedrops could be analysed. For several reasons no data could be gathered from 17 probands, which were refusal to complete the questionnaire, cancelled participation and, in two test persons, there emerged an allergic reaction (local eyelid redness and swelling) which necessitated a change to a different topical anaesthetic. In all other participants the application was carried out without any significant local or systemic symptoms or side-effects. Immediately after application of the eyedrops 36.1% of the test persons suffered a minor conjunctival hyperaemia which eased off within 1 h in 20.4% of these patients. Of the interviewed glaucoma patients 91.5% judged the single symptoms on the visual analogue scale between zero and medium intensity. The severest effects, according to the subjective evaluation, were felt in symptoms of burning with a score of 94 and lacrimation graded 96. The least intensity was established in the symptom of mucus aggregation where 72.3% rated this symptom in the visual analogue scale between 0 and 10. The other symptoms pruritus, feeling of pressure and foreign body sensation hardly differed in subjective ratings. CONCLUSION: A self-medication with topical anaesthetics on undamaged ocular surfaces for self-tonometry purposes can be performed by glaucoma patients without a high risk potential. However, the application presupposes that routine ophthalmological examinations are carried out according to the ophthalmological associations' recommendations. Therefore, medical care concepts which integrate self-tonometry into routine ophthalmological services and comply with the complex requirements of a modern glaucoma management should be applied more often.

CA-15.3, TPA and MCA as markers for breast cancer.

Serum concentrations of CA-15.3, tissue polypeptide antigen (TPA) and mucinous-like carcinoma-associated antigen (MCA) were measured in 327 women: 81 controls, 93 patients with benign breast disease, 46 patients recently diagnosed with breast cancer and 107 patients during breast cancer follow-up. CA-15.3 was elevated in 16% of the controls, in 29% of the patients with benign breast disease, in 65% of the breast cancer patients and in 74% of the follow-up patients. TPA was elevated in 4%, 11%, 36% and 75%, respectively. The corresponding figures for MCA were 10%, 8%, 30% and 64%. The highest sensitivity for cancer detection (74%) was obtained with a combination of CA-15.3 and TPA, while the specificity of this panel was 75%. The negative predictive value of these combined tests was 93%. MCA scored lower values, being only 30% sensitive. The CA-15.3/TPA panel may increase sensitivity compared with single marker tests and provide additional information for clinical evaluation.

Neutron irradiation of late mouse embryos (15-19 days) in utero.

Pregnant female C57B1/6 mice were irradiated with a single whole-body dose of 0.5 Gy neutrons. The F1 hybrid embryos were exposed to the neutrons in utero on Day 17 +/- 2 of gestation. 178/439 (40.6%) of the irradiated fetuses and 26/217 (12%) of the control mice died within 2 weeks after birth. In both irradiated and control mice, most deaths (95 and 77%, respectively) occurred within 3 days of birth: most animals in both groups died on Day 2. There was no significant difference in the number of living young born per litter (7.2) between the neutron-irradiated mothers and their unirradiated controls. The irradiated mice weighed significantly less than their controls. On the first day after birth, body weights of mice irradiated in utero averaged only 85% of control weights. Body weights did not reach control levels until 6 months after birth. Several organs were weighed at regular intervals in both irradiated and control mice. Spleens and thymus glands showed no significant differences between the two groups. The livers and kidneys of the irradiated mice weighed slightly less than their controls. The brain weight of 21-day-old neutron-irradiated mice was 30-35% less than control brains. The weight loss of the brain was not only a relative loss, but also an absolute one, based on brain weight/body weight ratios. Histological analysis of the central nervous system showed pycnotic nuclei, inhibition of mitosis in neuroblasts, and cell death in the irradiated brains. The weight reduction of the brain was not due to water loss. Our hypothesis is that the early mortality after birth is related to the killing of the radiation-sensitive neuroblasts. When newborn mice (1-7 days old) were irradiated in vivo with the same neutron dose of 0.5 Gy, neither the reduction in brain weight nor the early mortality was observed. The early deaths of the neutron-irradiated mouse embryos does not appear to be caused by either the hematological or the gastrointestinal radiation syndrome.

Inhibition of protein synthesis in developing mouse brain after fission neutron irradiation in utero.

Previous investigations showed that when pregnant mice were exposed to a single whole-body dose of 0.5 Gy fission neutrons on Day 17 +/- 2 of gestation [H. H. Vogel, Jr. and S. Antal, Radiat. Res. 98, 52-64 (1984)] about 40% of the newborn mice died and the body and brain weights of surviving animals decreased by 30-35%. Decreases of body and brain weights were most prominent by the third week after birth, but the content of nucleic acids related to wet weight did not change in liver and brain upon irradiation [S. Antal, A. Fónagy, Z. Fülöp, E. J. Hidvégi, and H. H. Vogel, Jr. Int. J. Radiat. Biol. 46, 425-433 (1984)]. Studies presented in this paper show that after a single whole-body dose of 0.5 Gy neutron irradiation on Day 18 of pregnancy protein synthesis decreased in liver and brain of 3-week-old mice irradiated in utero. Incorporation of labeled amino acids in vivo into acid soluble nuclear proteins decreased by 15% in liver and by 40% in brain. It was significantly reduced into brain histones and certain brain nonhistone proteins (separated by two-dimensional electrophoresis). The amount of H1 and H4 brain histones decreased as well. Investigations with isolated protein synthesizing systems proved that the peptide bond formation was not impaired by irradiation. The aminoacylation of transfer-RNA, however, decreased in both liver and brain by 26-34 and 34-41%, respectively. Comparing the aminoacylation capacities in the two unirradiated organs, a much lower (about one-third) capacity was found in brain than in liver. Moreover, this low aminoacylation capacity of brain decreased further by about 40% after neutron irradiation. These results suggest that in the developing irradiated brain the reduced capacity of aminoacylation of transfer-RNA might be rate limiting for the efficiency of protein synthesis.

Post-thrombotic leg ulcer and its surgical treatment.

The post-thrombotic syndrome is a complex disease to whose development at least three factors contribute: (1) incompetence of the venous valvular system; (2) opening of the local arteriovenous shunts; and (3) disturbances in the lymphatic system. Our surgical treatment considers all three factors by providing: (1) stripping of the saphenous veins; (2) wide excision of the ulcerated region with the fascia, followed by immediate skin graft; and (3) large excision of subcutaneous tissue and fascia. Of fifty-one patients with chronic post-thrombic leg ulcers operated on according to these principles, only one had recurrence, a recurrence rate of only 0.5%. This compares favorably with other published results.

Obstructing carcinoma of the left colon: treatment by extended right hemicolectomy.

Obstructing carcinoma of the left side of the colon causes proximal distension of the colon with subsequent thinning of the colonic wall and vascular impairment. Conventional surgical treatment is multi-staged. Each stage carries its own morbidity and mortality. An alternate treatment, extended right hemicolectomy, requires a single surgical procedure. Fifty-six cases of acute obstructing carcinoma of the left colon are presented: 16 in Group I were treated conventionally; 40 in Group II were treated by extended right hemicolectomy. In Group I, four died within one week of surgery. Six survived with a colostomy; all suffered from poor quality of life until death. For the six who received complete treatment, average total hospitalization was 54 days. Group II suffered no peri-operative mortality. Patients were discharged without a colostomy after an average hospitalization of 15.7 days. Advantages of and conditions for treatment by extended right hemicolectomy are discussed.

Severe acute pancreatitis as the presenting symptom of primary sclerosing cholangitis: treatment by endoscopic insertion of a biliary stent.

Primary sclerosing cholangitis is a chronic, fibrosing, inflammatory condition of unknown origin of extra and intrahepatic bile ducts. Recurrent cholangitis and jaundice are the most frequent clinical manifestation in symptomatic patients. We report a patient with primary sclerosing cholangitis presented with recurrent attacks of acute pancreatitis. Such a combination was not reported till now in the literature. The acute pancreatitis was probably due to reflux of bile and sludge into the pancreatic duct due to stricture of the distal part of a common bile and pancreatic ducts. Endoscopic insertion of a biliary stent managed to prevent jaundice and recurrent pancreatitis.

[Staging of rectal carcinoma by endorectal ultrasonography].

Staging of rectal carcinoma is essential for its management. 23 patients with rectal lesions were examined by endorectal ultrasonography. Of these 19 had rectal carcinoma and in 4 there was an abscess of the rectal wall, previously diagnosed by sigmoidoscopic biopsy. 10 of those with carcinoma were examined by computerized tomography as well, and 10 were operated on. In most cases the staging of rectal carcinoma by endorectal ultrasonography was accurate and compared well with the operative histological results. We conclude that endorectal ultrasonography is the method of choice for staging of rectal carcinoma prior to treatment.

[Experience with the surgical management of rupture of the capsule and ligament of the acromioclavicular joint]. / Tapasztalataink az acromioclavicularis ízületi tok és szalagszakadások mütéti ellátásában.

Evaluating the surgical results obtained with 74 cases of acromioclavicular dislocation the authors review the problems of diagnostics and surgical treatment of the injury. It is pointed out that the restoration of the functional anatomical condition--and simultaneously the reduction of the number of posttraumatic complaints--may be ensured only with operation in cases of severity grade II and III. However the results of the operative techniques applied in a rather wide range at present do not come up to expectation. The disturbances of healing are due in the majority of the cases to the use of implants unsuitable from biomechanical point of view. The application of appropriately solid acromioclavicular plates means significant progress in this field. The time and way of restoration of the injured capsule and ligament system influences decisively the results. Sutures of the ligament applied within 24 hours after the injury heal well. If the ligaments show strong splitting up or the operation is performed delayed plastic reinforcement or completion is justified in each case owing to the partial resorption. From the viewpoint of the surgical technique the use of the softpart flaps formed from the environment appear to be the most favourable.