[Implementation of cross-compliance in the area of animal welfare]. / Umsetzung von Cross Compliance im Bereich Tierschutz.

From 1 January 2007, requirements concerning animal welfare were introduced with effect to cross-compliance. Farmers receiving single payment as well as agri-environmental payments (payments of second pillar) shall respect the statutory management requirements of the following 3 directives in the area of animal welfare: Council Directive 91/629/EEC laying down minimum standards for the protection of calves; Council Directive 91/630/EEC laying down minimum standards for the protection of pigs; Council Directive 98/58/EC concerning the protection of animals kept for farming purposes. The competent authority shall carry out annual systematic inspections on at least 1% of all farmers submitting payments on the basis of a risk analysis and partly at random. In case of non-compliance with the conditions due to specific rules, there will be a reduction or cancellation of the payments to be granted in the calendar year in which non-compliance occurs. Cross-compliance controls should take place on the basis of documented procedures so as to ensure that these controls are carried out uniformly and are of a consistently high quality. For this purpose, a working group composed of representatives from the Federal Ministry of Food, Agriculture and Consumer Protection and from the Lander developed uniform control reports in order to monitor compliance and a guidance booklet for control execution of animal welfare requirements. In the control report (Level 1), the outcomes of inspections of all systematic testable animal welfare requirements are summarized in 6 items. Furthermore, the non-systematically testable requirements are integrated in the control report as a independent item. The guidance booklet (Level 2) with a matrix of validation serves as a specification for on-the-spot checks. Where appropriate, on-the-spot checks provided for cross-compliance and any other checks in animal welfare rules as well as requirements to animal identification and registration shall be carried out at the same time in Baden-Württemberg (integrated control system). Farmers subjected to on-the-spot checks shall be selected on the basis of a centralized common risk analysis and partly at random. This is the best way of safeguarding that the control rate will not be much higher than the established 1% with a minimum administrative burden and costs for farmers and competent control authorities. Integrated check lists for on-the-spot checks were established which take into account systematic cross compliance inspections to improve compliance with 3 existing standards in the area of animal welfare and official controls as proved in Council Directives concerning animal welfare and Regulation (EC) No 882/2004. All staff of the competent authorities performing controls received, for their area of competence, appropriate training enabling them to make their duties competently and to carry out controls in a consistent manner. Integrated systematic controls are very time-consuming and a burden for farmers and the competent authorities. For the beginning of this year, we will expect a discharge by Decision (EC) 2006/778. A controlling system was installed to ensure that cross compliance rules are applied consistently, for example by making subsequent controls by controlling institutions.

Ultrasound biomicroscopic imaging in intermediate uveitis.

BACKGROUND: Clinical examination of the region of the eye mainly affected in patients with intermediate uveitis is difficult and often hampered by media opacities. In that perspective ultrasound biomicroscopy (UBM) promises to be a valuable additional diagnostic tool. METHODS: UBM was performed at a sound frequency of 50 MHz on 26 eyes of 13 patients with intermediate uveitis in order to determine configuration of pars plana, peripheral retina, and vitreous. Findings of ophthalmoscopy with scleral indentation and UBM were compared. RESULTS: In 18 of 26 eyes pathological structures such as membraneous or fluffy vitreous condensations were identified by UBM. Among these UBM revealed pathological findings which were not visible on funduscopy in nine eyes. Most importantly, vitreoretinal adhesions with traction on the retina were imaged in four eyes. However, in three eyes vitreous opacities being visible on funduscopy were not identified by UBM. CONCLUSION: UBM seems to be a valuable diagnostic technique for the evaluation of patients with intermediate uveitis. Longitudinal studies will have to determine the relevance of UBM findings for the individual clinical course and their influence on therapeutic decisions.

Effect of folding on the multifocal silicone intraocular lens: scanning electron microscopic study.

PURPOSE: To evaluate whether the surface of the refractive zonal multifocal silicone intraocular lens (IOL) is altered by different folding and implantation instruments and is more sensitive to manipulation during folding than the surface of a monofocal IOL. SETTING: Department of Ophthalmology, University Hospital, Kiel, Germany. METHODS: Evaluated were the refractive multifocal silicone IOL (SA-40N, Array) and an otherwise identical monofocal IOL (SI-40NB) from the same manufacturer (Allergan Inc.). Different folding devices (folding blocks, folding and implantation forceps, and an injector system) were used. The IOLs were kept folded for 60 seconds; 24 hours later, scanning electron microscopy (SEM) was performed. In addition, the cartridges of the injector system were examined by SEM. RESULTS: Overall, regardless of the folding and implantation instruments used, both the multifocal and monofocal IOLs had discrete surface alterations. The cartridges of the injector system had a rough surface at the tip, while the proximal portion appeared smooth. CONCLUSION: There were no signs of lesions particularly affecting the surface of multifocal IOLs.

Subjective photic phenomena with refractive multifocal and monofocal intraocular lenses. results of a multicenter questionnaire.

PURPOSE: To compare the incidence and severity of photic phenomena after the implantation of the Array(R) (Allergan) refractive multifocal intraocular lens (MIOL) and a monofocal IOL. SETTING: Multicenter study at Kiel, Mainz, Karlsruhe, and Bremerhaven, Germany. METHODS: The study comprised 231 randomly selected patients from 4 study centers. The patients had had uneventful phacoemulsification with implantation of a refractive MIOL (n = 138) or a monofocal IOL (n = 93). By questionnaire, patients were asked whether they experienced light sensations postoperatively (light streaks, halos, flare, flashes, or glare) that had not been noticed preoperatively. Additional questions evaluated whether these phenomena had changed over time and how much they affected the patients' quality of life. RESULTS: Overall, 9% of patients with a monofocal IOL and 41% of those with an MIOL reported photic phenomena that had not been noticed before cataract surgery. Halos and flare were mentioned significantly more often by patients with MIOLs than by those with monofocal IOLs. There was no significant between-group difference in the mention of flashes. Eighteen percent of patients with MIOLs and 4% with monofocal IOLs were slightly or moderately bothered by the photic phenomena, whereas 5% of patients with MIOLs and none in the monofocal group were severely disturbed by the light sensations. CONCLUSION: Subjective photic phenomena were experienced significantly more often by patients who had refractive MIOLs than by those who had monofocal IOLs. The differences in the results of the 4 study centers were probably influenced by different patient selection criteria for the implantation of MIOLs.

Stereoacuity and aniseikonia after unilateral and bilateral implantation of the Array refractive multifocal intraocular lens.

PURPOSE: To evaluate stereoacuity and aniseikonia in eyes with unilateral and bilateral implantation of the Allergan Array refractive multifocal intraocular lens (MIOL). SETTING: Department of Ophthalmology, University Hospital, Kiel, Germany. METHODS: This study comprised 31 patients with a unilateral MIOL and a phakic fellow eye and 29 patients with bilateral MIOLs. In all pseudophakic eyes, an Array MIOL had been implanted between 1991 and 1994 during a prospective clinical trial. In the present study, patients were re-examined. Near and distance visual acuity were tested; binocular functions were assessed using Bagolini lenses, the Worth 4-dot test, the Lang random-dot test, and the Titmus fly chart. Aniseikonia was evaluated using Aulhorn's phase-difference haploscope. Mean follow-up was 43 months in both groups. RESULTS: After unilateral implantation 87.1% of patients and after bilateral implantation 93.1% of patients correctly perceived the stereograms of the Lang random-dot test. The mean subjective height of the measured Titmus fly was 4.2 cm after unilateral and 4.3 cm after bilateral implantation. The stereoacuity tests revealed no statistically significant differences between the groups. Distance and near aniseikonia were significantly less after bilateral than after unilateral implantation. CONCLUSION: Despite the simultaneous formation of multiple retinal images, the Array MIOL allowed good binocular vision including random-dot stereopsis. Functional aniseikonia developed but did not interfere with normal binocular vision.

[Effect of phacoemulsification and posterior chamber lens implantation on intraocular pressure in patients with and without open-angle glaucoma]. / Einfluss der Phakoemulsifikation und HKL-Implantation auf den Intraokulardruck bei Patienten mit und ohne Offenwinkelglaukom.

BACKGROUND: Many of the previous studies which dealt with the influence of cataract surgery on intraocular pressure, were performed retrospectively and based on heterogeneous groups of patients. Therefore, the purpose of our study was to prospectively assess the effect of phacoemulsification and posterior chamber intraocular-lens (IOL)-implantation on intraocular pressure (IOP) under standardized conditions in patients with and without open-angle-glaucoma. PATIENTS AND METHODS: Overall 52 patients were recruited for the study. 34 eyes with normal IOP and 16 eyes with open-angle-glaucoma were operated with the same technique. RESULTS: Mean IOP in patients with cataract and without glaucoma was preoperatively 15.1 mmHg. 6 months postoperatively these patients showed a mean decrease of IOP of 11.9% (1.8 mmHg +/- 3.8; p = 0.027); after 12 months IOP showed a decrease of 18.5% (2.8 mmHg +/- 3.5; p = 0.0001). In patients with glaucoma mean IOP was preoperatively 17.3 mmHg. IOP was reduced by 23.7% (4.1 mmHg +/- 6.0; p = 0.017) 6 months after cataract surgery and 22.6% (3.9 mmHg +/- 4.5; p = 0.005) 12 months after the operation. In 6 of 16 eyes the antiglaucoma medication could be suspended. CONCLUSION: Reduction of IOP is a positive side effect of phacoemulsification and posterior chamber IOL implantation and should be considered when indicating cataract surgery in patients with glaucoma and only slight elevation of IOP.

[Functional results after implantation of Array type refractive multifocal intraocular lenses]. / Funktionelle Ergebnisse nach Implantation von refraktiven multifokalen Intraokularlinsen vom Typ ARRAY.

A prospective study is under way to assess the performance of refractive multifocal intraocular lenses (IOL) of the "Array" type. The results obtained in 35 patients who have been followed up for at least 3 months are reported. In the course of the study it is planned that 100 IOL of this type be implanted. The following parameters were evaluated: distance visual acuity, near visual acuity (Nieden, Jaeger), contrast sensitivity (Regan charts 96%, 50%, 25%, 11%), glare (Brightness Acuity Tester, BAT) for distance and near visual acuity, and other Regan charts. In 28% of the patients the best distance visual acuity was achieved without any correction, while 13% (Nieden 1-3) and 47% (Jaeger 1-3) did not need any correction for their best close visual acuity. Overall, an average correction of +2.6 D was necessary for best near-visual acuity. The average uncorrected distance visual acuity was 0.7, and the average best corrected distance visual acuity was 1.0. In contrast sensitivity testing with the 50% Regan chart, visual acuity decreased by an average of 16% compared with the 96% chart. Even lower contrast reduced visual acuity by 33% (25% chart) and 81% (11% chart) compared with the 96% chart. When glare was tested with BAT at the "high" position the average visual acuity against that without BAT decreased by 19% for the 96% chart, by 25% for the 50% chart, by 45% for the 25% chart and by 82% for the 11% chart. The Array-type IOL allows good distance and near visual acuity.(ABSTRACT TRUNCATED AT 250 WORDS)

[Severe intra- and postoperative supra-choroid hemorrhage. Risk factors, therapy, results]. / Schwere intra- und postoperative suprachorioidale Blutungen. Risikofaktoren, Therapie, Ergebnisse.

BACKGROUND: The aim of this study was to analyze risk factors, therapeutic strategies, and functional and anatomic results of eyes with severe suprachoroidal hemorrhage. PATIENTS: Eight of 11 bleeding episodes occurred intraoperatively and 3/11 postoperatively. Bleeding was associated with the following surgical procedures: perforating keratoplasty (5x), extracapsular cataract extraction (3x), pars plana vitrectomy (2x), intracapsular cataract extraction (1x). RESULTS: Nine operations were performed with general anesthesia, two after retrobulbar injection. Ocular risk factors (e.g., prior operations, ocular diseases) and general risk factors (e.g., cardiovascular diseases, diabetes) were analyzed. At the end of the follow-up time visual acuity had improved in three eyes, and it was unchanged in one eye and worse in seven eyes. Four eyes were amaurotic; two of them had to be enucleated. CONCLUSIONS: In spite of using state-of-the-art surgical techniques the prognosis of suprachoroidal bleeding remains serious. Patients who have a combination of several ocular and general risk factors almost exclusively are the ones who afflicted by this complication.

[Bilateral simultaneous acute amaurosis in neuritis nervi optici. Initial manifestation of encephalomyelitis disseminata]. / Bilaterale simultane akute Amaurose bei Neuritis nervi optici. Erstmanifestation einer Encephalomyelitis disseminata.

BACKGROUND: Bilateral simultaneous acute amaurosis as a primary manifestation of demyelinating disease is extremely rare. PATIENT: The clinical course of a 24-year-old patient who initially presented with a bilateral complete loss of vision is demonstrated. Morphologically both optic discs appeared slightly blurred and prominent. Otherwise there were no anterior and posterior segment abnormalities. Examination of the cerebrospinal fluid revealed an increased number of cells and protein without oligoclonal bands. On MRI multiple white matter lesions were visible. Laboratory tests showed no specific abnormalities, especially with respect to infectious or vasculitic diseases. Under intensive steroid therapy (initially 1000 mg prednisolone/day), visual acuity recovered almost completely. Nine months after onset of the disease visual acuity was 1.0 in both eyes. CONCLUSIONS: Even in patients with a fulminant onset of the disease almost complete visual recovery is possible. Differential diagnosis should rule out vasculitic autoimmune optic neuritis, infections, tumors, processes of the paranasal sinuses, toxic, and hereditary causes.

[Progress in laser sclerotomy ab externo] Enlarging the sclerostomy channel and local mitomycin administration]. / Fortschritte bei der Lasersklerostomie ab externo. Erweiterung des Skerostomiekanals und lokale Mitomycingabe.

In a previous study we presented our first results after sclerostomy using a pulsed erbium/holmium: YAG laser. At a fiber diameter of 300 microns a success rate of 20-30% was found after a 1-year follow-up. This study concentrates on the improvement of the parameters for filter survival. METHODS. The fiber diameter and thus the size of the fistula increased to 400 microns. Patients who had undergone fibrosis for a previous fistula were treated intraoperatively with topical mitomycin administration. RESULTS. After a follow-up of 6 months, filter function in the 300 microns group was maintained in 26% of the treated eyes (n = 23), while 400 microns fistulas were successful in 48% (n = 26). In the mitomycin-treated group (n = 6), sclerostomy achieved an IOP regulation in four patients. Postoperative hypotony was more frequent, but did not exceed 2 weeks. CONCLUSION. An increase in fistula diameter improves the long-term results of laser sclerostomy. Mitomycin is useful in maintaining filter function in patients with an unfavorable prognosis.

Influence of muscle relaxation on neuromonitoring of the recurrent laryngeal nerve during thyroid surgery.

BACKGROUND: The influence of muscle relaxation on the intra-operative neuromonitoring of the recurrent laryngeal nerve during thyroid surgery is unclear. METHODS: In a prospective study involving 200 patients undergoing elective thyroid surgery, the influence of muscle relaxation on neuromonitoring of the recurrent laryngeal nerve was investigated. The patients received balanced anaesthesia with oxygen-nitrous oxide-isoflurane, and rocuronium bromide was used as the non-depolarizing neuromuscular blocking agent. The degree of relaxation was monitored continuously by accelerometry [twitch (% TW)]. Summed action potentials (SAcP) obtained from the vocalis muscle were characterized by the area under the electromyographic curve expressed in millivolt seconds. RESULTS: Evoked potentials were obtainable in all patients and at all time points. With decreasing neuromuscular blockade a significant increase in the potentials evoked at the vocalis muscle was observed. At 0% TW SAcP was 1.27 (SD 1.02) mV s. An increase in TW to 10% was accompanied by an increase in SAcP to 2.68 (2.01) mV s (P<0.01). At a TW of 25%, mean SAcPs of 5.08 mV s were recorded. CONCLUSIONS: There was a significant difference in the degree of relaxation of the adductor pollicis muscle and the vocalis muscle. The laryngeal muscles exhibited a shorter response time than the adductor pollicis and recovered more quickly. These results confirm the feasibility of intra-operative neuromonitoring of the recurrent laryngeal nerve during neuromuscular blockade.

Long-term results after scleral buckling surgery in uncomplicated juvenile retinal detachment without proliferative vitreoretinopathy.

PURPOSE: To evaluate long-term anatomic and functional results of scleral buckling surgery in retinal detachment without proliferative vitreoretinopathy in juvenile patients. METHODS: A total of 33 eyes of 31 patients were operated on. Surgical techniques included segmental buckle (23 eyes), radial buckle (5 eyes), encircling band (4 eyes), and temporary balloon buckle (1 eye). The average age at time of surgery was 15.3 years and the average follow-up time was 8.9 years. Retinal detachment was associated with the following risk factors: myopia (14 eyes), blunt trauma (8 eyes), and aphakia (3 eyes). In 9 eyes, no risk factors were present. Fifteen eyes had a detached macula. In addition to anterior and posterior segment examination, binocular functions and ocular motility were evaluated. RESULTS: Retinal reattachment required one operation in 29 eyes, two operations in three eyes, and three operations in one eye. In one eye, pars plana vitrectomy had to be performed to reattach the retina. At the end of follow-up, retinal reattachment was achieved in all eyes. Visual acuity of 20/40 or better was achieved by 39.4% preoperatively and 60.6% postoperatively; in 52.4%, binocular functions were normal. CONCLUSION: Scleral buckling procedures allow favorable anatomic and functional results in juvenile retinal detachment without proliferative vitreoretinopathy.

Evaluation of laser sclerostomy fistulas using ultrasound biomicroscopy.

BACKGROUND: Laser sclerostomy is a relatively new technique in glaucoma surgery. Clinical examination, particularly of the intrascleral part of laser sclerostomy fistulas, is difficult. We performed ultrasound biomicroscopy (UBM) in order to determine, if it were possible to visualize fistulas. Moreover, it was the aim to investigate whether this imaging technique could provide additional information on fistula morphology. PATIENTS AND METHODS: Ten eyes of eight patients with chronic open angle glaucoma who had undergone erbium-YAG laser sclerostomy ab externo were examined using a UBM-probe with a 20 MHz transducer providing spatial resolution of approximately 80 microm. RESULTS: Radial scanning allowed visualization of the sclerostomy fistula in nine of ten eyes. The different functional state of sclerostomy fistulas correlated well to UBM findings. It was possible to image differences in the morphology of occluded and patent fistulas and to visualize the filtering pathway in functioning blebs. CONCLUSIONS: Ultrasound biomicroscopy allows imaging of laser sclerostomy fistulas. UBM and clinical findings correlated well in the majority of the patients we examined. The technique supplements clinical examination and in some cases may provide additional information.

[Progressive disseminated essential telangiectasia with conjunctival involvement]. / Progressive disseminierte essentielle Teleangiektasien mit konjunktivaler Beteiligung.

BACKGROUND: Widespread idiopathic telangiectasia (generalized essential telangiectasia) is a rare skin disorder characterized by the development and gradual spreading of telangiectases. The condition tends to affect women in their midthirties. For no apparent reason telangiectases start to appear to the lower extremities and progress steadily to involve the skin of the trunk, the arms, and the face. General health is not affected by the condition and standard laboratory tests consistently yield normal results. CASE REPORT: In February 1997 a 78-year-old lady was admitted for treatment of cataracta corticonuclearis of her left eye. Complete ophthalmological and dermatological examinations were performed. She presented marked conjunctival telangiectases of both eyes and widespread cutaneous telangiectases involving her face, trunk, arms, and legs. Complete blanching of lesional skin was observed on diascopy. The Rumpel-Leede-test was normal. Cutaneous and conjunctival changes appeared not to be associated with internal disease or bleeding abnormalities. DISCUSSION: The patient presented here shows widespread idiopathic telangiectasia with marked conjunctival involvement. Ocular changes rarely have been reported in patients with generalized essential telangiectasia to date. Concomittant conjunctival and cutaneous telangiectases may be seen in other conditions such as hereditary hemorrhagic telangiectasia (Rendu-Osler-Weber disease) and ataxia telangiectasia (Louis-Bar syndrome). The former shows an associated bleeding abnormality and is transmitted autosomal dominantly. The latter presents associated neurological signs such as cerebellar ataxia, strabism, nystagmus, apraxia, and mental retardation.

Solubilization of bacterial cells in organic solvents via reverse micelles.

A reverse micellar system containing Tween 85 and water in isopropylpalmitate was developed which permitted the solubilization of bacteria in the form of homogenous organic solutions. The presence of the bacteria in solution was demonstrated by light microscopy. Immediately after solubilization, isolated bacterial cells were observed, which by aging tend to form larger aggregates. Cells of Escherichia coli remained viable in this system for at least one day and retained beta-galactosidase activity for an even longer period as indicated by the hydrolysis of x-gal. Cells of an alkane-degrading strain of Acinetobacter calcoaceticus remained viable in the system for several days.

[Acute appendicitis in pregnancy]. / Akute Appendizitis in der Schwangerschaft.

Appendectomy was performed on 34 pregnant women between 1977 and 1984. These accounted for 1.1 per cent of appendectomies and 1.8% of all deliveries in the above period under review. The incidence of appendicitis during pregnancy did not appear to be very much below that outside gravidity. The foetus is endangered by hypoxaemico-toxic conditions in all phases but primarily during the last three months. Caesarean section should be precedent to appendectomy, at least in cases of advanced appendicitis and when the foetus is viable. With non-viable foetus, appendectomy should be performed alone.

[Chronic granulomatous chorioretinitis in tuberculosis]. / Chronische granulomatöse Chorioretinitis bei Tuberkulose.

BACKGROUND: Though the incidence of tuberculosis decreased substantially during the second half of the century, a steady increase of new cases has been observed within the last decade. Among other reasons, the growing number of immunodeficient patients (e.g. HIV, therapy with immunosuppressive agents) and migration from underdeveloped to industrial countries contribute to this finding. PATIENT: A 57-year-old male patient presented with a history of chronic bilateral chorioretinitis of unknown origin. During the last months a marked decrease in visual acuity of the left eye was noted. Prior diagnostic attempts had not led to a specific diagnosis. Notable was the history of long-term systemic corticosteroid therapy for chronic obstructive lung disease. Funduscopy of the right eye revealed a choroidal granuloma with adjacent serous retinal detachment. Both eyes showed multiple dot-like lesions in the retinal pigment epithelium of the posterior pole. Finally the diagnosis could be made by isolating Mycobacterium tuberculosis from sputum samples and gastric aspirate. Within a few weeks after starting tuberculostatic therapy the ocular symptoms regressed and the visual acuity improved significantly. DISCUSSION: Securing the diagnosis of tuberculous uveitis is often difficult. The differential diagnosis includes other granulomatous ocular inflammations. The detection of Mycobacterium tuberculosis and the clinical course make the diagnosis most likely. CONCLUSION: Tuberculosis should always be included in the differential diagnosis as a possible etiology for uveitis, particularly in those cases taking a chronic course. Despite the recent emergence of drug-resistant strains in most cases tuberculosis is a well curable disease.

Laser sclerostomy ab externo using the erbium: YAG laser. First results of a clinical study.

A new approach to fistulating glaucoma surgery, laser sclerostomy ab externo, was investigated in a clinical study. A pulsed (200 microseconds) erbium-YAG laser was used, as its wavelength (2940 nm) is very well absorbed by tissue water. The laser energy was transmitted via a fiber to an application probe with a cannula particularly designed to guide another fiber into the subconjunctival space. Nine patients with advanced open-angle or neovascular glaucoma were treated. In all cases a functioning fistula with a prominent filtering bleb and a reduction of the intraocular pressure (from up to 50 mmHg to 8-18 mmHg) could be achieved. The total energy was 60 mJ on average. No complication occurred intraoperatively. Postoperatively, all fistulas in patients with neovascular glaucoma (n = 6) were impatent after approx. 7 days due to iris adherence to the internal ostium and episcleral scarring. In cases of open-angle glaucoma (n = 3) a patent fistula persisted for several months. Variation of the exposure parameters, the use of antiproliferative drugs, and a less restrictive selection of patients could further improve the success rate.