Mathematical modelling of epidemics under specific regard of adenoviral keratoconjunctivitis.

At first ADV is presented as a typical pandemic. The contagiosity of adenovirus is high because of the viability of the virus on inorganic surfaces in medical offices up to 35 days. Outbreaks and epidemics occur 3-30 days after infection, which is mainly contracted from medical facilities. EKC is considered a notifiable condition in most countries, and outbreaks, suspects and infections must be reported. Symptoms like "pink eye", foreign body sensations, photophobia, pain, signs such as follicles, hemorrhages and corneal infiltrates, and vision decrease associated with malaise are frequently observed first in one eye, later involving the fellow eye. Unilateral disease has a high rate of misdiagnosis. Currently no vaccine or virustatic is available, which is effective, cost-efficient and tolerable. Treatment is symptomatic and antiinflammatory. Late scarring may be amenable to phototherapeutic keratectomy. Infection control measures focus on the disinfection of equipment and hands of staff, the handling of infected patients with gloves, spatial separation of infected individuals resp. cohorting of infected patients, use of unit-dose eye solutions, and the chlorination of pools by approved and registered disinfectants and germicides. In connection with this it is shown how to handle the dynamics of infections by mathematical models like cellular automation, systems of differential equations and to visualize periodic effects by Fourier Analysis and to calculate costs by mathematical programming. Using mathematical analysis the percentage of a population needing vaccination to prevent spreading of pandemic can be calculated. It is shown here that especially the method of cellular automation is a simple way to simulate complex epidemiological situations without completely knowing the mathematical details.

[Post-traumatic inflammation with an intraocular foreign body]. / Posttraumatische "Endophthalmitis" mit intraokularem Fremdkörper.

BACKGROUND: To report on the diagnosis and management of a"firecracker" injury presenting with a post-traumatic intraocular inflammation. CASE REPORT: A 10-year-old boy sustained a penetrating 16-mm cornea-sclera blast injury to his left eye with uveal prolapse and hemophthalmus and doubtful light perception. The cranial computed tomography revealed a metallic intraocular foreign body (IOFB), retinal detachment, and subretinal and subchoroidal hemorrhage. After primary wound closure and antibiotic treatment for 1 week, increasing cell infiltration and amaurosis developed, and a lensectomy, pars plana vitrectomy, and extraction of the 17x7x7-mm encapsulated IOFB via a scleral tunnel was indicated. RESULTS: A vitreous specimen did not reveal microbial growth; however, plenty of polymorphonuclear cells, macrophages, and lymphocytes were observed. Spectroscopy of the IOFB showed copper, zinc, silicon, lead, and other metals. A diagnosis of noninfectious inflammation due to heavy metals, primarily copper (=chalcosis), was made. The postoperative course was unremarkable, the intraocular lens in place, fundus CDR 0.2, retina and macula attached, intraocular pressure 9 mmHg. Three weeks after surgery, the flash VEP showed absent potentials. CONCLUSIONS: Large projectiles or parts should be removed from the eye immediately in order to prevent complications from toxic metallosis and early fibrotic reactions.

[Diseases of the adnexa in the tropics: amnion membrane transplantation for noninfectious trachoma-associated corneal ulcers]. / Erkrankungen der Adnexe in den Tropen: Amniontransplantation bei nichtinfektiösen Trachom-assoziierten Hornhautulzera.

BACKGROUND: Corneal ulcers with fornix shortening associated with late stages of cicatrizing trachoma contribute significantly to blindness in many developing countries. We report on the outcome of ocular surface and fornix reconstruction using amnion membrane transplantation. PATIENTS AND METHODS: From 2001 to 2005, cryopreserved human amnion membrane without mitomycin C was grafted to 25 eyes of 17 patients with trophic corneal ulcers and symblepharon (cicatrizing trachoma: 19 eyes of 14 patients, Stevens-Johnson syndrome: 4 eyes of 2 patients, alkali burns: 2 eyes of 1 patient) in a controlled case series. Follow-up was done up to 6 months. STATISTICS: Fischer's exact probability test. RESULTS: Of 25 eyes, 9 of 19 eyes with trachoma, 3 of 4 eyes with Stevens-Johnson syndrome, and 2 of 2 eyes with chemical burns showed complete reepithelialization and stromal recovery after 28-35 days (mean: 31+/-2.3 days). The primary success rate of trachoma eyes was not significantly different from the other indications (p=0.256). At 6 months post-op, 15 of 19 trachoma eyes (79%) compared to 2 of 6 non-trachoma eyes (33.3%) had developed a recurrence of symblephara (p=0.0592), and 13 of 15 eyes (86.6%) with a cicatricial trachoma compared to 1 of 6 with non-trachoma diagnosis experienced a recurrence of corneal vascularization (difference nonsignificant: p=0.1752). Persistent long-term reepithelialization was observed only in 1 of 19 trachoma eyes (5.3%) versus 4 of 6 non-trachoma eyes (66.7%, p=0.005); 3 of 19 trachoma eyes with a recurrence of ulcers had perforated after 6 months. CONCLUSIONS: Human amnion membrane without mitomycin C can be used for ocular surface reconstruction in selected patients with cicatrizing trachoma. Its efficacy in the long-term rehabilitation of cicatrizing trachoma seems to be limited due to the progressive scarring.

[Microbial keratitis: a 4 year study of risk factors and traditional/complementary medicine in Oman]. / Mikrobielle Keratitis: Vierjahresstudie zu Risikofaktoren und traditioneller/komplementärer Medizin in Oman.

PURPOSE: To determine the risk factors and the influence of complementary/alternative medicines (CAM) for infectious keratitis in a monsoon-free region of the Sultanate of Oman. STUDY DESIGN: Retrospective single center cohort study. OUTCOME MEASURES: Demographic data, risk factors, and pathogens. METHODS: Patients with purulent stromal keratitis admitted from 2001-2004 were evaluated for clinical and microbiological data, CAM use, duration of hospitalization, and outcome of treatment. STATISTICS: chi(2)-test, Z-test. RESULTS: A total of 320 patients (326 eyes) out of 7,524 admissions had severe infectious stromal keratitis requiring inpatient treatment. The average age was 35.1+/-2.5 years (range 1.5-63 years), the male:female ratio was 2:3 in the age group >or=13 years and 2:1 in the age group

[Conceiving and implementing an ISO 9001:2000 quality management system: quality improvement and efficiency increase over 3 years at the Dept. of Ophthalmology, Sultan Qaboos University in Oman]. / Konzeption und Implementierung eines Qualitätsmanagementsystems nach ISO 9001:2000: Qualitäts- und Effizienzsteigerung über 3 Jahre an der Augenklinik der Sultan Qabbos Universität in Oman.

BACKGROUND: Oman is a developing country of the Middle East with a University Hospital in a national health system. Problems related to documentation, structure, and procedure prevailing in a multicultural environment result in a lack of productivity. The aim of this study was to test the feasibility of introducing a quality management system according to ISO 9001:2000 into a university department of ophthalmology with special reference to quality and efficiency data over 3 years. MATERIALS AND METHODS: Standardized types of documentation (35 documents, 183 forms and formats, and 453 registers) under a formal roof (booklets for work instructions, quality management, procedures) were conceived in 2001 and implemented, and were evaluated by descriptive statistics over the years 2002-2005 with respect to quality and efficiency. In 2005, the departmental QMS was merged into the QMS of the whole hospital. RESULTS: Establishment of "responsibility clusters" with structured surveillance tasks, procedural improvements, and continuous audits resulted in a significant quality improvement already during the implementation until ISO 9001:2000 certification in 2002, and over the following 3 years. The data were assessed by non-conformities documented monthly (total inpatients: -50%, outpatients: -20%, operating theater: -100%, teaching: -10%; p <0.05) and increased efficiency assessed by the most important performance indicators (before QMS vs a median of 3 years with QMS): major surgery: +459%, inpatient stay: -49.7%, occupancy rate: +63.9%, technical diagnostics: +292.9%, postgraduate teaching total: +740%, research output total: +330% (p <0.05). CONCLUSIONS: It is feasible to introduce the quality management system according to ISO 9001:2000 into a developing country in the Middle East. It has an immediate effect on the increase of efficiency (measured by performance indicators) and quality in all systems providing the possibility for regional benchmarking.

Binding of bovine parathyroid hormone to surface receptors of cultured B-lymphocytes.

Binding of parathyroid hormone onto B-lymphocytes is detected by the utilization of the labelled antibody membrane assay. The amount of parathyroid hormone bound to the receptor sites was depending on the quantity of cells in the incubation milieu. Each cell line showed typical characteristics in time course of parathyroid hormone binding and maximal receptor capacity. Fragmentation of intact parathyroid hormone, also varying with the cell line tested, was very rapid, even at 24 degrees C. Within 20 min most of the cell lines destroyed 20% of the native hormone in the incubation mixture, indicating a fragmentation rate of up to 2.25 ng/min at 37 degrees C. Bmax and KD for the different lymphocytes was 5.3--19 . 10(11) M and 1.8--18,5 . 10(11) M, respectively. These values are in the range of reported plasma concentrations and may therefore represent more physiological values for the capacity and affinity of membrane receptors.

[Cataract patients with pseudoexfoliation (PEX) syndrome among a population with high prevalence of PEX. Clinical findings and morphological and surgical characteristics]. / Kataraktpatienten mit Pseudoexfoliations- (PEX-)Syndrom in einer Bevölkerung mit hoher PEX-Prävalenz. Klinische Befunde, morphologische und operative Besonderheiten.

BACKGROUND: Cataracts are the most frequent treatable cause of noninfectious blindness in Oman. Therefore, in 2002 a study was performed at our department of ophthalmology to evaluate cataract patients for pseudoexfoliation. METHODS: In a prospective comparative cohort study, 370 age-related cataract eyes out of an evaluable population of 498 cataracts were evaluated by biomicroscopy, confocal corneal analysis, and electron microscopy and followed up after 6 months. RESULTS: Of 370 age-related cataracts without glaucomas 171 had PEX. Preoperative manifestations were 89 subluxations, 15 vitreous prolapses, 6 ciliolenticular blocks, and 7 intravitreal dislocations. In 40 Omani cataract eyes without PEX the endothelial cell count was normal compared to the age-matched US norm and corneal thickness was less than Caucasians, but more than Afro-Americans. CONCLUSIONS: This study reports on a high incidence and frequent preoperative complications (68%) of the surgical cataract cases in an Arabic population. The development of serious complications and blindness is related to the duration of the disease and the lack of timely surgery.

[Patients with secondary open-angle glaucoma in pseudoexfoliation (PEX) syndrome among a population with high prevalence of PEX. Clinical findings and morphological and surgical characteristics]. / Patienten mit sekundärem Offenwinkelglaukom bei Pseudoexfoliations- (PEX-)Syndrom in einer Bevölkerung mit hoher PEX-Prävalenz. Klinische Befunde, morphologische und operative Besonderheiten.

BACKGROUND: The second most frequent treatable cause of noninfectious blindness in Oman is high-pressure glaucoma. Therefore, in 2002 a study was performed at our department of ophthalmology to evaluate pseudoexfoliation (PEX) in glaucoma patients. METHODS: In a prospective comparative cohort study, of 204 glaucoma eyes, 135 open-angle glaucomas were evaluated by biomicroscopy, papillometry, and electron microscopy and followed up after 6 months. RESULTS: The incidence of PEX glaucomas relative to all glaucomas was 50.9% and to open-angle glaucomas 77%. The IOP level in PEX was higher than in POAG; the CDR, neuroretinal rim zone, and the visual field loss were not significantly different. In 38 of 104 operated PEX glaucoma eyes, the postoperative visual acuity deteriorated although the IOP was controlled. CONCLUSIONS: PEX high-pressure glaucomas account for half of all glaucomas in the eastern region of the Arabian peninsula. Surgical outcomes feature a high percentage of postoperative reduction of vision in the late PEX stage.

Optical coherence tomography in uveitis patients.

PURPOSE: To evaluate optical coherence tomography in allergy-prone uveitis patients. METHODS: Thirty-four patients (43 eyes) with posterior uveitis (31 eyes) and intermediate uveitis (12 eyes) were evaluated by fluorescein angiography, indocyanine green angiography, and optical coherence tomography. Follow-up examinations used optical coherence tomography in allergy-prone patients. RESULTS: Optical coherence tomography identified epiretinal membranes, which were removed surgically (three eyes); persistent cystoid macular edema, which resolved with cytotoxic treatment (12 eyes); and juxtafoveolar membranes, which were treated by diode laser (six eyes) and excision (two eyes). CONCLUSION: Optical coherence tomography may provide useful information on complications developing in uveitis patients.

Detection of HPV-20, HPV-23, and HPV-DL332 in a solitary eyelid syringoma.

PURPOSE: To report evidence of many human papillomavirus types occurring in a solitary syringoma clinically appearing as a papilloma. METHODS: A 57-year-old man presented with a 10-year history of an upper eyelid tumor. Histopathology, human papillomavirus-nested polymerase chain reaction, human papillomavirus-DNA cloning into vector pCR2.1, sequencing, and computer-assisted evaluation were performed. RESULTS: Histopathology demonstrated a solitary benign syringoma. HPV-20 and HPV-23 were present in one clone each, and HPV-5-related HPV-DL332 was present in 9 clones. CONCLUSION: Many human papillomavirus types may be detected in an ocular syringoma.

Coxsackievirus B3-associated panuveitis.

A 29-year-old woman suffered from headaches, diarrhoea, and high grade fever followed by a unilateral retinal vasculitis, papillitis, and chorioretinitis. Abnormal electrocardiographic findings and antibody titre dynamics strongly suggested a coxsackievirus B3 infection. With respect to prior observations on coxsackievirus B group associated uveitis this viral infection may be considered in patients with well defined extraocular manifestations and uveitis.

Alpha/beta- and gamma/delta TCR(+) lymphocyte infiltration in necrotising choroidal melanomas.

AIM: To detect specific tumour infiltrating T cells (TIL) carrying antigen specific MHC-I restricted receptor genes on necrotising and non-necrotising malignant melanomas and to correlate the findings with clinical data. METHODS: alpha/beta- and gamma/delta- TIL were determined by immunohistochemical staining in melanomas of patients with known follow up of more than 10 years. An antigen retrieval method was used to determine variable genes delta1 and gamma1 on TCR(+) cells by an anti-TCR Vdelta1 and anti-CrgammaM1, and of Valpha and Vbeta TCR(+) by an anti-pan-TCR(+) alpha/beta antibody. RESULTS: Intratumoral TIL were present in 86 of 113 (76.1%) necrotising melanomas (NMM) v 21 of 100 (21%) in non-necrotising melanomas (MM); of these, Valpha/beta- TCR(+) cells were present in 52 of 74 (70.3%) TIL harbouring NMM v four of 21 (19%) MM; Vgamma1 in 29 of 74 (39.2%) NMM v two of 21 (10%) MM; and Vdelta1 in 39 of 74 (52.7%) NMM v three of 21 (14%) MM. Extratumoral lymphocytic infiltration was seen in 86 (76.1%) NMM including Valpha/beta TCR(+) cells in 10 (11.6%) cases, v five (5%) MM cases with no Valpha/beta TCR(+) cells detected. Vgamma1 and Vdelta1 TCR(+) cells were not found in extratumoral infiltrates. CONCLUSIONS: In NMM, the median survival was 69.3 (range 6-237) months, 19 of 74 patients (25.7%) survived 5 years, and mortality was associated with advanced stage (p<0.001), patient age (p<0.023), and extent of necrosis (p<0.048). Survival was increased with evidence of Vgamma1 and Vdelta1 TCR(+) cells (p<0.026).

Immunological features of psoriasis. Effects of Ro-109359, concanavalin A, pokeweed mitogen, and methotrexate on cultivated lymphocytes.

Isolated peripheral mononuclear cells of psoriasis patients with different disease characteristics, e. g. head-localised, quiescent guttata, confluent active widespread and erythrodermic, were cultured in a modified Mishell-Dutton system. Using the plaque-forming cell (PFC) assay, single cell antibody formation was studied, and class distribution monitored, adding pokeweed mitogen (PWM), concanavalin A (ConA), methotrexate (MTX) or Ro-109359/31, as well as autologous sera to the culture. PFC-estimation vs. sheep red blood cells (SRBC) and burro red blood cells (BRBC) revealed a distinct suppression of primarily IgG-PFC in some of the PWM-treated patients' cultures; ConA maximally reduced PFC by only 50%, compared to 100% for normal immune cells. Ro-109359/31 reduced mainly IgG-PFC in the co-cultures with PWM or autologous sera. MTX resulted in a reduction of IgG-PFC and IgM-PFC equally. The results were compared with cultured immune cells from normal individuals. The two antigenically different indicators, the partial abolition of ConA induced suppression, broad-based immunoglobulin elevation in the sera, and the mainly IgG-formation hint at the role of polyclonal B-cell activation in the perpetuation of psoriasis, which can be specifically reduced by Ro-109359/31. Suppressor cell dysfunctions remain to be discussed.

Parathyroid hormone binding to epithelium of the human lens.

Cell homogenates from human lens epithelium express in binding site for Parathyroid hormone. Kinetic data reveal an affinity/dissociation constant to Kd 17.5 x 10(-11) M and a maximal binding of Bmax 15 x 10(11) M. These data are comparable to previously tested tissues as lymphocytes or renal plasma membranes. No differences can be observed for the association characteristics between senile and juvenile lenticular epithelial cells.

Immunoreactive parathyroid hormone is present in subretinal fluids of the human eye.

(44-68) human Parathyroid hormone (hPTH) was studied in subretinal fluids (SRF) of 20 human eyes with rhegmatogenous retinal detachments. A (44-68) hPTH carboxyl mid-regional radioimmunoassay was used. Depending on the extent and the duration of the retinal detachments, (44-68) hPTH ranged between normal serum levels (ca. 100-300 pg/ml) up to excessive amounts of 4000 pg/ml with longstanding disease and proliferative vitreoretinopathy. Aqueous humors (AH) of one patient with bilateral iridocyclitis and complicated cataract ranged at 90-132 pg/ml (44-68) hPTH, whereas a control population undergoing surgery for senile cataracts had no detectable (44-68) hPTH in AH. The AH of one diseased eye of heterochromia complicata Fuchs showed excessive amounts of more than 4000 pg/ml (44-68) hPTH.

[Ocular manifestation in dengue fever]. / Okuläre Manifestation bei Dengue-Fieber.

UNLABELLED: Dengue-Fever is a mosquito transmitted viral disease. It is endemic mainly in South-East Asia and Africa. The clinical manifestation is divided into different stages. Ocular manifestations in travellers have been rarely reported. PATIENTS: We present the cases of two patients, having just returned from a trip to Thailand. During their trip they had fallen ill with symptoms of classic dengue-fever. FINDINGS: On examination visual acuity had decreased in both patients. In one patient we detected a relative central scotoma in perimetry and reduced amplitudes in VEP. In indirect ophthalmoscopy we found intraretinal haemorrhages, foveal lesions in the pigment epithelium, cotton-wool spots and a maculopathy. The fluorescein angiographic findings included extravasation in the macular region and block fluorescence. The diagnosis was confirmed by a rise in Dengue-fever antibody titre and the detection of flavivirus IgM antibodies. CONCLUSION: Dengue-fever and its ocular manifestation in Europeans is a rare condition. Expanding tourism to tropical countries may lead to an increasing number of cases.

[Prolonged wound healing after perforating keratoplasty. CPAP hyperbaric ventilators for sleep apnea as a risk factor]. / Verlängerte Wundheilung nach perforierender Keratoplastik. Risikofaktor CPAP-Uberdruckbeatmungsgeräte gegen Schlafapnoe.

Nasal hyperbaric respiration devices used at night to counteract sleep apnea may represent a concealed cause of delayed superficial wound healing following perforating keratoplasty. We report the cases of two patients whose respirators produced a continuous flow of pressurized air (nCPAP) onto the operated eyes, leading to conjunctival hyperemia, recurrent corneal erosion, infiltration of the puncture track and the cornea, and superficial punctate keratopathy. Microbiological investigation revealed no clearly identifiable pathogens. Healing improved consistently only after the pressurized air system had been modified so that no air escaped from the nostrils and the patients had been instructed in disinfection of the moisturizing system.

[Ocular chlamydia infections in Munsterland. A clinical study of 409 patients]. / Okuläre Chlamydieninfektionen im Münsterland. Eine klinische Studie an 409 Patienten.

We evaluated demographic data, McCoy cell cultures from conjunctival smears and chlamydia-specific IgG and IgA serum antibody titers in 409 patients (194 men and 212 women) suffering from (kerato)conjunctivitis of presumed bacterial etiology in 1988-1992. Overall, 105 patients were positive in culture and/or serology tests (78 in McCoy cell cultures, 45 in serology tests). In 33 patients (31%) corneal involvement was epithelial (5), subepithelial (13), phlyctenular (7) and/or took the form of pannus vasculosus (12). The incidence and severity of corneal signs correlated with the duration of the (kerato)conjunctivitis. Nasolacrimal duct complications were documented in 16 patients with a duration of illness exceeding 6 months. Some 33% of cases were recorded in May and June, a further 26% from November to January. The age groups primarily affected were: females 20-30 years (25%), males 30-40 years (25%). The highest number of new cases was registered in 1990.

[Therapy refractory unilateral chronic blepharokeratoconjunctivitis as the chief manifestation of auto-aggression syndrome. Clinico-histopathologic findings]. / Therapieresistente einseitige chronische Blepharokeratokonjunktivitis als Leitbefund für Autoaggressionssyndrome. Klinisch-histopathologische Befunde.

UNLABELLED: Autoaggressive syndromes as causes of diseases underlying chronic blepharitis and keratoconjunctivitis that are refractory to treatment are often difficult to recognize. PATIENTS: Three female patients (age 21, 25, 41 years) and one male patient (age 42 years) had suffered from a right-(4x) or left-(1x) handed treatment-refractory blepharokeratoconjunctivitis for 1, 2, 11 and 30 months prior to admission. In each case more than 5 ophthalmologists and 2-6 eye hospitals had been consulted, and extraocular surgery had been performed 1-4 times. RESULTS: Patients presented with a visual acuity of 0.3 p (1x), 0.1 (1x), FC (1x), HM (1x). In three patients contact eczema of the facial skin and lids and a corneal pannus were observed; in two patients we saw purulent pseudomembranous and in two patients chronic cicatrizing keratoconjunctivitis. Conjunctival smears grew P. aeruginosa, and S. aureus; impression cytology showed infiltration with neutrophils and epithelial keratinization; histopathology indicated chronic inflammatory, partly purulent subepithelial and stromal conjunctival infiltrate with hyper- and parakeratosis fibrous strands and epithelial cell loss; the lower lids showed parakeratosis, focal necrosis, intercellular edema and a lymphohistiocytic round-cell infiltrate. Furthermore, multiple allergies to antibiotics and preservatives (4x), lacerations of the arms and legs (2x) and an irritative-toxic dermatitis (1x) were substantiated. In the patients who agreed to a psychiatric consultation, somatized-agitated longing for care combined with a dependent and infantile personality (1x) and reactive depression (2x) were verified. CONCLUSIONS: In patients suffering from treatment-refractory unilateral chronic blepharokeratoconjunctivitis correlated with the hand, one must take into consideration the fact that other factors may be involved: possible exacerbation prior to examinations; multiple inpatient diagnostic and surgical procedures in different locations; histopathological mixed inflammatory patterns; and psychiatric syndromes.