[Bluish-gray discoloration of skin and conjunctiva]. / Blaugraue Verfärbung von Haut und Bindehaut.

Colloidal silver used as a suspension for (alternative) therapeutic purposes or silver exposure due to environmental or working conditions can lead to irreversible deposits of silver granules in the skin (bluish-gray hue of the skin), mucosa, cornea, retina and internal organs. Silver-induced discoloration of the conjunctiva should therefore be taken into account when a bluish-gray discoloration raises the suspicion of conjunctival melanoma.

[Evaluation of corneal biomechanics in keratoconus using dynamic ultra-high-speed Scheimpflug measurements]. / Evaluation kornealer Biomechanik bei Keratokonus mithilfe dynamischer Ultra-High-Speed-Scheimpflug-Messung.

BACKGROUND: The in vivo analysis of corneal biomechanics in patients with keratoconus is especially of interest with respect to diagnosis, follow-up and monitoring of the disease. OBJECTIVE: For a better understanding it is necessary to describe the potential of dynamic Scheimpflug measurements for the detection and interpretation of biomechanical changes in keratoconus. MATERIAL AND METHODS: The current state of analyzing biomechanical changes in keratoconus with the Corvis ST (Oculus Optikgeräte GmbH, Wetzlar, Germany) is described. This technique represents a new approach for understanding corneal biomechanics. Furthermore, it was investigated whether the device can biomechanically quantify a rigidity increasing effect of therapeutic UV-crosslinking and whether early stages of keratoconus can be detected using dynamic Scheimpflug analysis. RESULTS AND DISCUSSION: In patients with keratoconus, the in vivo analysis of corneal biomechanics using dynamic Scheimpflug measurements as a supplementary procedure can be of advantage with respect to disease management. By optimization of screening of subclinical keratoconus stages, this method widens the analytic spectrum regarding diagnosis and follow-up of the disease; however, further studies are required to evaluate whether visual outcome of affected patients can be improved by earlier diagnosis.

[Retinal vascular diseases reflecting generalized vascular alterations. What can be mutually learnt?]. / Vaskuläre Netzhauterkrankungen als Spiegel generalisierter Gefäßveränderungen. Was können wir voneinander lernen?

Retinal vascular diseases are mostly caused by systemic vascular diseases. In some cases the systemic disease is already known but in other patients ocular anomalies often provide the first indications of a systemic disease. Treating patients with vascular fundus diseases requires close cooperation between ophthalmologists and specialists in other fields and deciding which routine and specialized diagnostic examinations are necessary in light of the potential risk factors involved requires interdisciplinary communication. This article aims to provide an overview of the most important vascular retinal diseases and which examinations are required to ensure an accurate diagnosis. The retinal vascular diseases with the highest frequency or clinical relevance are hypertensive retinopathy, diabetic retinopathy, retinal vein occlusion and retinal artery occlusion.

[The eye, vision and vertigo]. / Auge, Sehen und Schwindel.

Although ocular alterations alone rarely cause vertigo, the ophthalmologist can play an important role in the interdisciplinary context by testing visual function. Assessment of ocular motility is the most important individual examination in the diagnostic evaluation of vertigo. Methods that analyze specific visual functions, like the dynamic visual acuity test, may play an important role in the future. In addition to neuro-ophthalmologic disorders, ocular alterations are also receiving increasing attention. They are postulated to be a key element in the development of multifactorial age-related vertigo. However, further investigation is required to confirm this supposition and to define the influence of disturbances in specific visual qualities, e.g. visual acuity, visual field, binocular vision, anisometropia, multifocal correction, higher order aberrations and metamorphopsia.

[Vertigo and dizziness. Ophthalmological addendum]. / Schwindel. Ophthalmologisches Addendum.

The ophthalmologist's main task in the interdisciplinary approach to vertigo is the examination of ocular motility to rule out central ocular motility disorders. Further neuro-ophthalmological examinations (e.g. pupil reactions and optic disc) may provide unspecific findings that can be helpful. The ophthalmologist may be able to deliver puzzle-solving key findings in some multidisciplinary diseases (e.g. Cogan I, Vogt-Koyanagi-Harada disease and Behcet's disease). Ocular alterations do not cause vertigo but a variety of more diffuse complaints that some patients refer to as vertigo.

[Translation errors in ophthalmology]. / Übersetzungsfehler in der augenheilkunde.

As global networks are built up, interlingual communication in ophthalmology becomes more and more important. Similar to any other specialised discipline, this raises the dilemma that on one hand precision is mandatory for an exact translation, but on the other hand translators often do not have the scientific and physicians the linguistic knowledge to fulfill this need. Furthermore, even within one language ophthalmological terminology is partially ill defined, and this problem multiplies when translating it into various other languages. However, translation errors can have serious consequences, particularly in medical disciplines. This case study casuistically demonstrates the most common basic mechanisms for translation errors in ophthalmology and shows a potential approach for solution.

[Diagnosis of vertigo: keep an eye on central eye movement disorders]. / Diagnose von Schwindel mit besonderem Blick auf Augenbewegungsstörungen.

With specialist knowledge ophthalmologists can make a valuable contribution to the interdisciplinary work-up of patients with vertigo as the leading symptom. The neuro-ophthalmological examination of eye movements by an ophthalmologist and/or orthoptist is an important contribution because the various vertigo syndromes can only be correctly evaluated by a combined examination of the vestibular and ocular motor systems. If the ophthalmologist is the first doctor to examine a patient suspected disorders from other specialist fields can be indicated, in particular neurology and otorhinolaryngology. When taking the patient history the ophthalmologist should inquire about the type and duration of the vertigo, triggering or modifying factors and accompanying symptoms. This is followed by a systematic examination of the eye position and the different types of eye movements, the head-impulse test and a special examination to check for the presence of nystagmus.

[Influence of corneal transparency on the quality of topographies]. / Einfluss der hornhauttransparenz auf die qualität von topografien.

Corneal topographs that measure the anterior and posterior corneal surface with optical methods need a clear cornea for precise measurements. Opacities cause artifacts in the corneal thickness (with measurements usually being too thin) and corneal curvatures. This is important to know as certain pathologies may repeatedly cause similar artifacts. This is highly relevant after a corneal cross-linking, Lasek or PRK, as these procedures cause typical artifacts that can easily be misinterpreted.

[Ocular pain. Case example from the neuroophthalmological practice]. / Augenschmerzen. Fallbeispiele aus der neuroophthalmologischen Praxis.

This article presents neuroophthalmological conditions that may typically cause ocular pain. Particular attention is paid to the description of two cases of headache and facial pain where after a long diagnostic history the correct reason for the pain was only discovered via subtle diagnostic findings. This is exceptionally important as primary headaches are a main reason for ocular pain on the one hand but on the other hand they do not show unambiguous findings, therefore a definite exclusion of primary sources causing the pain is required before making this diagnosis.

[Ocular pain. Differential diagnostic aspects]. / Augenschmerzen. Differenzialdiagnostische Aspekte.

Clinical ophthalmologists are often confronted with ocular pain, a symptom that can cause severe difficulties in the diagnostic assessment. The most common etiology is constituted by neurological disorders. Besides possible ophthalmologic causes for such disorders, otorhinolaryngological and oral and maxillofacial origins have to be considered. The ophthalmologist plays an important role as the first examiner, who has to rule out acute life-threatening conditions and also direct further steps in the differential diagnosis. This article clarifies such a diagnostic approach and discusses how a rudimentary knowledge of the characteristics of primary headaches is crucial as even though they do not induce ophthalmologic changes they constitute the main reason for the occurrence of ocular pain.

Embracing a family-centred response to the HIV/AIDS epidemic for the elimination of pediatric AIDS.

There are 2.1 million children under the age of 15 living with HIV/AIDS, and 290,000 children died of AIDS in 2007. Despite recent increases in the number of adults on antiretroviral therapy (ART), the number of children receiving treatment remains inappropriately small, and prevention of mother to child transmission (PMTCT) efforts have been grossly inadequate. In sub-Saharan Africa, 14% of those in need of treatment are children, but only 6% of those are receiving treatment. Globally, only 23% of HIV-positive pregnant women have access to PMTCT programmes, which led to 420,000 new pediatric infections last year. Countries with comprehensive, integrated family-centred care programmes are better equipped to prevent and treat pediatric HIV/AIDS. True family-centred care offers prompt maternal and pediatric HIV diagnosis, antiretroviral prophylaxis, cotrimoxazole prophylaxis, and long-term ART for the entire family, as appropriate. Simple child health interventions, prompt treatment of opportunistic infections, nutritional supplementation and infant replacement feeding, as well as malaria treatment and prevention have been proven to synergistically improve pediatric HIV care and increase service uptake. To eliminate pediatric HIV/AIDS, national governments must embrace family-centred care, implement pediatric-friendly infrastructure, and train healthcare workers to treat children.

Assessing exposure to disinfection by-products in women of reproductive age living in Corpus Christi, Texas, and Cobb county, Georgia: descriptive results and methods.

We conducted a field study in Corpus Christi, Texas, and Cobb County, Georgia, to evaluate exposure measures for disinfection by-products, with special emphasis on trihalomethanes (THMs). Participants were mothers living in either geographic area who had given birth to healthy infants from June 1998 through May 1999. We assessed exposure by sampling blood and water and obtaining information about water use habits and tap water characteristics. Two 10-mL whole blood samples were collected from each participant before and immediately after her shower. Levels of individual THM species (chloroform, bromodichloromethane, dibromochloromethane, and bromoform) were measured in whole blood [parts per trillion (pptr)] and in water samples (parts per billion). In the Corpus Christi water samples, brominated compounds accounted for 71% of the total THM concentration by weight; in Cobb County, chloroform accounted for 88%. Significant differences in blood THM levels were observed between study locations. For example, the median baseline blood level of bromoform was 0.3 pptr and 3.5 pptr for participants in Cobb County and Corpus Christi, respectively (p = 0.0001). Differences were most striking in blood obtained after showering. For bromoform, the median blood levels were 0.5 pptr and 17 pptr for participants in Cobb County and Corpus Christi, respectively (p = 0.0001). These results suggest that blood levels of THM species vary substantially across populations, depending on both water quality characteristics and water use activities. Such variation has important implications for epidemiologic studies of the potential health effects of disinfection by-products.

Public health risks of railroad hazardous substance emergency events.

The number of railroad events reported to the Agency for Toxic Substances and Disease Registry's Hazardous Substances Emergency Events Surveillance system increased from 84 in 1993 to 177 in 1998. Comparisons of data on railroad and non-railroad events were made. The results overall indicated a greater potential impact of railroad events on public health. A median number of 2039 persons were living within a 1-mile radius of railroad events versus 982 for non-railroad events. The percentage of events during times when people are more likely to be home was also greater for railroad events. Railroad event victims were more likely to need hospital treatment than non-railroad event victims, which suggested the need for better community planning, reevaluation of current federal regulations and priorities for railroad hazardous material transport, and enhanced railroad industry commitment to safety.

Frequency and type of injuries in responders of hazardous substances emergency events, 1996 to 1998.

This analysis describes the frequency and type of injuries among responders to hazardous materials releases. Data were analyzed from states that participated in the Hazardous Substances Emergency Events Surveillance system maintained by the Agency for Toxic Substances and Disease Registry from 1996 through 1998. A total of 348 responders were injured in 126 (0.7%) of 16,986 reported events. Firefighters and police officers were most often injured. Respiratory irritation and nausea were the most commonly reported injuries, and no injuries resulted in death. Almost half of the responder victims wore firefighter turn-out gear, and about a third had received hazardous materials training. Chemicals frequently released during these events were in the category "other substances not otherwise specified" and "acids." Training, education, planning, and coordination are needed to effectively respond to hazardous substances emergency events.