Corneal injury after carbon dioxide laser skin resurfacing.

PURPOSE: To describe a corneal injury in both eyes of a patient who had undergone carbon dioxide laser skin resurfacing. METHOD: Case report. RESULTS: A 67-year-old woman had severe pain and decreased vision in both eyes after undergoing laser skin resurfacing treatment with a pulsed carbon dioxide laser. Clinical examination disclosed a corneal ulcer, a bullous keratopathy, and intrastromal bleeding. After perforating keratoplasty, the histologic examination of the cornea showed signs of thermal injury. CONCLUSIONS: The results of the histologic examination and the onset of symptoms within 24 hours after therapy suggest that the laser application caused the corneal damage. Safety guidelines for this procedure should be reviewed.

Diffuse epithelial ingrowth after perforating keratoplasty.

Diffuse epithelial ingrowth was observed in 2 patients after perforating keratoplasty. Both cases involved a corneal graft after perforating injury with aphakia. In the first patient, the epithelial invasion was probably stimulated by a spatula synecholysis. In this case, the diagnosis was only made by histological investigation after enucleation. In the second patient the epithelial ingrowth was observed 8 months after keratoplasty. The clinical diagnosis was made on the basis of the typical slitlamp findings. In this case, the epithelial invasion led to hypotension with high resistance of outflow measured by electrotonography. In a very close chronological relation to the probable fall of chamber fluid secretion, development of a band-shaped keratopathy was observed.

Hereditary cancer litigation: a status report.

During the past few decades, cancer patients have sued their physicians for negligence in diagnosing or managing their disease, based on the charge that the clinician failed to consider the patient's genealogy when trying to arrive at a diagnosis. Other suits have charged that the clinician is liable for failing to investigate other members of the cancer patient's family, regardless of whether they were his or her patients. Although these cases have been successful only sporadically, they underscore the importance of obtaining a complete cancer history not only of the patient but also the immediate family. With the advent and more widespread use of gene analysis studies, more such cases are likely in the future.

Medos/HIA-assist system: first experiences with mechanical circulatory assist in infants and children.

The Medos/HIA-System is a new pneumatically driven system for mechanical circulatory assist. The system is characterized by excellent efficiency at high heart rates and is available with three ventricles of 10, 25 and 60ml stroke volume. It can be used as left-, right- or biventricular assist device. Our preliminary experiences with this novel system for support of infants and children are reported.

Dexamethasone bovine pharmacokinetics.

Dexamethasone phosphate (DXM-PHO) is an ester which is quickly hydrolysed by the bovine and the dexamethasone (DXM) plasma half-life was 5.16 h. It has been demonstrated that 54 h after DXM-PHO injection, DXM concentrations were lower than 0.1 mg/ml. Tritiated dexamethasone was also administered twice to an another young bull for metabolite investigation. The elapsed time required to recover, in plasma, half of the radioactivity injected was 8.8 h. Radioactivity recovery in the urine reached 36.4% and 22.6% for the first and the second injections respectively.

[A study of the quantitative dual-parameter flow cytometry analyses of cellular antigens on transitional cells for the diagnosis of bladder cancer].

To establish a quantitative dual-parameter flow cytometry (FCM) analysis of cell surface antigens, possible obstacles caused by contaminated leucocytes in a specimen and staining and measuring conditions were investigated using human bladder cancer cell lines, 5637, T24 and SW1710. The first monoclonal antibody (MoAb) used to select urothelial cells in a specimen was applied with the second MoAb used to discriminate between normal and transformed urothelial cells. MoAbs Due AUT 2 and CD45 appeared to be suitable for the selection of urothelial cells, while Due ABC 3 and Due ABC 5 were applied to detect transformed cells. Tumor cell-leucocyte suspension was simultaneously stained with combinations of these MoAbs. The results demonstrated that Due AUT 2 and CD45 effectively eliminated contaminated leucocytes by means of positive and negative selection of the urothelial cells, respectively. Based on these experiments, dual-parameter FCM analyses of bladder washing from 5 patients with bladder cancer were performed using MoAbs Due AUT 2 and Due ABC 3. The results indicated that by dual-parameter FCM distinct antigenic features of transitional cells could be investigated even if considerable amounts of contaminated leucocytes were present. The clinical impact of this approach is a subject of ongoing trials.

Diethylstilbestrol, teratogenesis, and carcinogenesis: medical/legal implications of its long-term sequelae, including third generation effects.

The spectrum of teratogenic and carcinogenic effects which can be exerted when the unborn child is exposed to diethylstilbestrol (DES) has been shown to be broad. Animal work indicates the need for vigilance as regards genetic susceptibility to DES sequelae. The emergence of third generation sequelae has been demonstrated in mice, and has been postulated to occur in humans. Given the emergent data establishing problems of infertility in men and women and of relatively late onset cancer, and the possibility that in utero exposure to DES may prime a variety of tissues to noxious environmental influences there is an urgent need for measures to provide just coverage for those harmed by the drug. The DES disaster also raises important ethical and reserch questions which demand attention.

[Present status of locating intraocular foreign bodies (author's transl)]. / Heutiger Stand der Lokalisation intraokularer Fremdkörper

The different procedures used today to locate intraocular foreign bodies are discussed. The x-ray procedure is not adequate for splinters near the wall, questionable double perforations and foreign bodies which cannot be demonstrated radiographically. Complementary methods of examination such as transillumination, electroacustic location, ultrasonics and direct radio-optic controls must be used. Advantages and limitations of these individual locating procedures are discussed. Intensive transillumination with glass-fiber diaphanoscope is particularly important for splinters in the anterior section of the eyeball near the wall. Ultrasonics cannot be replaced by other methods for foreign bodies in the posterior section of the eyeball which do not produce shadows, demonstration of the relationship of the foreign body to pathologic intraocular structures and the measurement of the length of the eyeball. At the University Ophthalmic Hospital in Cologne, direct radio-optic controls are conducted with a stereo-x-ray image amplitier, a stereoscopic image that gives.

[Immune reactions following keratoplasty]. / Immunreaktionen nach Keratoplastik.

On the basis of follow-up examinations of 236 penetrating keratoplasties the different forms of immune reaction were analyzed with special regard to their relationship to indication and prognosis. An immune reaction was observed in 42.8% of the cases. An epithelial Khodadoust line occurred in 17 transplants (7.2%). Nine of these were early reactions within the first two months after reoperation. Subepithelial infiltrates occurred in 14 grafts (5.9%), usually as late complications except after reoperation. Special risk factors are anterior synechiae, chronic inflammation and regrafts. The lower risk group differs from the high risk group with regard to a) the epithelial Khodadoust line (2.9% vs. 10.6%), b) the severs forms of endothelial immune reactions (4.8% vs. 32.6%), and c) the irreversible immune reactions (0% vs. 23.5%). Subepithelial infiltrates and mild forms of precipitates occurred about equally in both groups. The different forms of endothelial immune reactions are of prognostic value only in connection with the individual diagnosis and indication. About 50% of the late immune reactions were of iatrogenic origin. Misalignment of the graft can lead to a typical Khodadoust line. In one patient an irreversible immune reaction of the diffuse type was caused by YAG laser treatment of a secondary membrane.

[Eye changes in familial juvenile nephronophthisis (author's transl)]. / Augenveränderungen bei familiärer juveniler Nephronophthise

5 patients from three families with confirmed diagnoses of nephronophthisis and eye changes are described. All patients showed along with relatively slight decreased function changes in the pigment epithelium and the choroid. In three of these patients the ERG was pathologically reduced. Contrary to the known observations from the literature our patients showed no typical signs of congenital retinal Leber's amaurosis. The observed changes in the sclera reflect the gravity of the illness. With dialysis treatment the progress of the disease could in two patients be arrested for 4 years.

[Perforating keratoplasty in the presence of considerable changes of the anterior segment of the eye (author's transl)]. / Perforierende Keratoplastik bei schweren Veränderungen des vorderen Augenabschnittes.

A report is given on 44 patients with penetrating keratoplasty in severe damage of the anterior eye. The first group consisted of 31 patients with acute, deep inflammatory processes of the cornea, threatened by perforation or with perforation and severe iritis. The second group of 13 patients had had perforating injury with corneal scar, broad anterior synechiae and lens remnants. In group 1 55% had visual function between 0.3 and 1.0; 35.5% showed no improvement, 10% got worse. In group 2 only 5 patients had visual improvement from 0.3-1.0. In 3 patients there was a negative outcome. The indication for corneal graft in these groups and the right moment of operation are discussed. We tried to compare our own results with other statistics.

Acquired immunodeficiency syndrome: more than a health-related dilemma.

Many legal issues will affect the health care worker during the AIDS pandemic. These issues are now beginning to be contested in our courts. It is certain that their numbers will continue to grow in the foreseeable future. As local, state, and federal governments design and implement new laws concerning PWA, mechanisms for surveillance, and control of AIDS, new issues are sure to arise. These will undoubtedly involve persons concerned with providing service to those afflicted with this illness. The direction of health care research has already been altered by AIDS. Societal relationships have been affected, as evidenced by the increasing number of legal charges filed when the question of HIV infection involves a patient, student, employee, or other citizen. Inevitably, the health care worker who has contact with PWA will be asked to participate in the mechanisms of the resulting legal contests. If the case reports cited above are an indication of the legal struggles ahead, appearance as a witness to provide scientific information as well as information about the care and treatment afforded PWA will be required of health care workers with increasing frequency.

Genetic susceptibility for specific cancers. Medical liability of the clinician.

The use of genetic profiling techniques to detect individuals with an increased susceptibility to heritable cancers has provoked recent legal interest in the duties of the attending physician and in the rights of patients and their families. In the current study specific prima facie and recently litigated cases are presented and explored to delineate the issues facing physicians and to illustrate the prerogatives of patients who are caught up in a heritable cancer enigma. Various courts have attempted to answer questions involving lawsuits in which incidents of breast/ovarian carcinoma and colon carcinoma have provoked claims of negligence against health care providers. Health care workers involved in the care of these patients have specific duties to these individuals. It would appear that physicians are being forced to assume the additional duty of delving into a patient's family history of cancer through multiple generations. This duty is followed by a responsibility to provide detailed counseling to those patients in whom such activity impacts the diagnosis and management of familial cancer.

[Patients on dialysis--late fundus controls (author's transl)]. / Fundusveränderungen bei Patienten unter Hämodialyse (Langzeitkontrolle).

In 102 patients on dialysis for renal failure late fundus controls have been done to studie the response of retinal vessels to blood pressure reduction. In 52 patients follow up studies were possible. Only 4 patients showed reversible changes of the vessels, in 4 other patients changes increased. In the majority of the patients hypertensive vascular changes (stage I or II) remained unchanged. Young age and deep diastolic pressure seems to be necessary for normalization of the fundus vessels. Vessel changes did not improve if the diastolic pressure was 90--100 mmHg and more.