Photophysical properties of Na+ -indicator dyes suitable for quantitative two-photon fluorescence-lifetime measurements.

Two-photon microscopy (2PM) offers great potential in fluorescence imaging of intracellular Na+ dynamics of live cells. A severe drawback, however, is that quantitative ratioing of fluorescence intensities at different wavelengths [possible in one-photon imaging with the classical Na+ -indicator dye sodium-binding benzofuran isophtalate (SBFI)] is not practical in 2PM. We aimed at establishing 2PM-based time-correlated fluorescence lifetime measurements as an alternative method for quantifying Na+ dynamics. We compared the photophysical properties of the four Na+ -sensitive fluorescent indicator dyes SBFI, CoroNa Green, Sodium Green and Asante NaTRIUM Green-2 (ANG-2) in cuvette calibrations. All four dyes showed Na+ -dependent intensity changes, with ANG-2 having the most favourable properties for 2PM. All dyes but SBFI showed significant changes in their fluorescence lifetime upon Na+ binding, again with ANG-2 being the most promising dye. We found that, unfortunately, the fluorescence lifetime of ANG-2 is not only affected by Na+ but also by protons, K+ and dye impurities, rendering a quantitative description of the individual lifetime components impractical. However, a simplified calibration procedure, based on a published approach for Ca2+ imaging, allowed relating lifetimes to Na+ concentration. Using ANG-2 and the simplified calibration will allow quantitative two-photon Na+ imaging with millimolar sensitivity. LAY DESCRIPTION: Dynamic changes of ion concentrations, which play crucial roles in cellular physiology, can be monitored with appropriate fluorescent indicator dyes. For intracellular sodium ions (Na+ ), certain dyes even allow quantitative measurements with standard microscopic techniques. However, for two-photon microscopy, which allows resolving cells deep in intact tissue, imaging solutions that are fully quantitative are lacking. For the four commercially available Na+ dyes 'SBFI', 'CoroNa Green', 'Sodium Green', and 'Asante NaTRIUM Green-2' (ANG2) we analyzed whether their fluorescent lifetime (LT), i.e., the nanosecond decay of emission of photons after a pulsed excitation, could serve as a quantitative measure of intracellular Na+ . Pulsed excitation in the femtosecond range is an inherent feature of two-photon microscopy and, in combination with fast, single-photon counting microscopes, allows for easy-to-implement LT microscopy. We found that Sodium Green and ANG2 showed strong Na+ -dependent changes in the fluorescence LT, while SBFI showed no, and CoroNa Green only small changes. ANG2, as the brightest dye, was further characterized regarding effects of protons and potassium ions (K+ ), both also present in cells at significant concentrations, on the fluorescence LT. We found that the LT of ANG2 is affected in a predictable manner by Na+ , K+ , and protons. However, our data reveal that the commercial dye must also contain impurities with unexpected Na+ - and K+ -binding characteristics, rendering a quantitative description of the individual lifetime components impractical. We, therefore, adapted a simplified calibration procedure, based on a published approach for Ca2+ imaging, that allows relating the average lifetime to Na+ concentration. With this simplified calibration procedure, ANG2 is well suited for quantitative two-photon Na+ imaging with millimolar sensitivity.

Evaluation of indication-specific genuine stress urinary incontinence procedures in a pelvic floor center.

PURPOSE: The aim of this study was to assess the indication-related safety, feasibility, and efficacy of laparoscopic Burch colposuspension (LBC), open Burch colposuspension (OB), and midurethral sling (MUS), retropubic vaginal tape (TVT) and transobturator vaginal tape (TOT) procedures for surgical treatment of female stress urinary incontinence (SUI). METHODS: Perioperative outcome was assessed in 321 patients treated for SUI by a single surgeon (LBC, n = 120; OB, n = 23; TVT, n = 129; TOT, n = 49) between April 2001 and December 2007 at a single center. Follow-up was available for 115 patients at 30, 40, and 26 months for LBC, OB, and MUS, respectively. The primary outcome was the objective continence measured by a negative cough stress test. The secondary outcome was the subjective continence measured by subjective perception of cure, the King's Health Questionnaire (KHQ), and visual analog score (VAS). RESULTS: The LBC group had one (0.8%) intra-operative complication (bladder injury) and a mean operation time of 56.5 min. The objective and subjective cure rate associated with LBC was 90.3 and 71%, respectively. The OB group had three (13%) intra-operative complications and a mean procedure time of 44.6 min. The objective and subjective cure rate was 69.2 and 61.5%, respectively. MUS had 7 (TVT, n = 2; retropubic I-STOP, n = 5) procedure-related complications (5.4%) and an operation time of 19.8 min. The objective and subjective efficacy rate for MUS was 84.5 and 62%, respectively. CONCLUSIONS: LBC was shown to be safe and feasible with a high objective and subjective success rate. Use of this minimally invasive procedure should be considered in patients with concomitant intra-abdominal pathology.

Different surgical approaches for stress urinary incontinence in women.

Stress urinary incontinence (SUI) constitutes involuntary voiding as a consequence of rising intra-abdominal pressure caused by sphincter weakness. In recent years studies were published according to surgical SUI management evaluating and comparing therapy options and outcomes. Therapy options were evaluated using a Medline search, including only publications in English between 2000-2012. Key words used were: SUI, conservative and surgical treatment, midurethral sling, colposuspension. Surgical treatment options demonstrate significantly better results than conservative treatment. MUS demonstrate better subjective and objective cure rates than colposuspension; it is less invasive and more cost-effective. First line SUI therapy such as RP MUS and TVT seem to be favored when compared to transobturator techniques. Retropubic and transobturator MUS showed equivalent objective and subjective success rates. Open colposuspension is an effective treatment possibility for recurrent SUI after failed MUS. TVT, compared with other MUS, seems to show slightly better cure rates. but perioperative complications appear to be similar. Long-term results (>10 years) of repeated SUI surgery showed that the Burch procedure had the lowest 9-year cumulative incidence of repeat SUI surgery. Mini-sling techniques may be underestimated but long-time results are pending and closer monitoring of the adverse event profile must be carried out. MUS are first choice in the treatment of SUI, of which TVT, has the best cure rate. Colpussupension continues to have its place in recurrent SUI. The new mini-MUS needs a longer follow-up for final evaluation.

[Keratoplasty in children--still a dilemma]. / Die perforierende Keratoplastik im Kindesalter--das ewige Dilemma.

BACKGROUND: Penetrating keratoplasty (PKP) in children is associated with specific age-related problems. In contrast to adults, children can be examined less easily and they are not readily complaining about symptoms. Thus, the rate of intra- and postoperative complications is higher than in adults. In addition, amblyopia is a major issue before the age of seven years potentially resulting in irreversible reduction of visual acuity. PATIENTS AND METHODS: Potential indications for surgery are classified as follows: (i) congenital cloudiness (e.g., congenital hereditary endothelial dystrophy--CHED), (ii) acquired traumatic scars, (iii) acquired non-traumatic scars (e.g., infections, keratoconus) and (iv) irreversible graft failure. Our experience concerning 126 paediatric PKPs between 1980 and 2002 in children under age 16 is reported. Five case reports of PKPs performed in Homburg/Saar from 2006 are added. RESULTS: To minimise the risk of immunological graft rejection and chronic endothelial cell loss, we prefer PTK, lamellar keratoplasty or ipsilateral autologous rotational keratoplasty whenever possible. In cases of sclerocornea we feel that PKP should be avoided in view of the histopathology, in cases of Peters' anomaly an optical sector iridectomy may be considered as a valid alternative to high-risk PKP. In cases of buphthalmos the IOP must be controlled before PKP (e.g., previous trabeculotomy). In cases of central penetrating cornea and lens injuries we advocate simultaneous PKP and IOL implantation in the quiet interval after primary wound closure to achieve quick optical rehabilitation. We prefer smaller grafts and interrupted sutures in children. In addition, early suture removal is attempted, especially in cases of progressive corneal neovascularisation threatening the graft. If in doubt, examinations are performed in general anaesthesia readily. CONCLUSIONS: Corneal grafting in children should be performed as soon as necessary (less amblyopia!), but as late as possible (better cooperation!). In children, critical indication, repeated in-depth counselling of the parents, good cooperation with the anaesthetist and excellent cooperation with the paediatric ophthalmologist are indispensable in order to achieve good morphological and functional results after PKP.

Impact of mode of delivery on levator morphology: a prospective observational study with three-dimensional ultrasound early in the postpartum period.

OBJECTIVE: To evaluate morphology and integrity of the levator ani muscle (LAM) with three-dimensional ultrasound early in the postpartum period. DESIGN: Prospective cross-sectional observational study. SETTING: University hospital in Germany. POPULATION: Women after vaginal delivery and caesarean section with no previous vaginal delivery. METHODS: Three-dimensional perineal ultrasound was performed between 48 and 72 hours postpartum. The axial plane at the level of minimal hiatal dimension and tomographic ultrasound imaging were used to determine LAM biometry and defect. MAIN OUTCOME MEASURES: Primary outcome was to compare hiatal dimensions and levator defect following vaginal delivery or caesarean section. For secondary outcomes, we evaluated the role of caesarean section in protecting levator integrity, and the possible involvement of the first stage of labour in LAM changes. RESULTS: In all, 157 women participated: 81 (51.6%) following vaginal delivery (70 spontaneous and 11 operative deliveries) and 76 (48.4%) following caesarean section (55 elective and 21 emergency caesarean sections). All biometric indices of the levator were higher after vaginal delivery (P<0.001), except for LAM thickness. LAM defects were found to be significantly associated with vaginal delivery, with relative risk 7.5 (P<0.001). Following vaginal delivery, 32 (39.5%) levator defects were found: 27 (38.5%) after spontaneous delivery and five (45.4%) after operative delivery. Four (5.2%) women had a levator defect following emergency caesarean section. CONCLUSION: Vaginal delivery modifies and damages the LAM: the risk of levator defect after vaginal delivery is more than seven times higher than after caesarean section. Despite this, emergency caesarean section seems to have no complete preventive effect on LAM trauma.

[Measurement of the infrapubic angle using 3D perineal ultrasound and its relationship to obstetrical parameters]. / Die Messung des infrapubischen Winkels in der 3-D-Perineal-Sonografie und seine Beziehung zu geburtshilflichen Parametern.

PURPOSE: Ultrasound has achieved an indispensable role in urogynecology. The introduction of 3 D technology has enabled sonographers to visualize structures in the axial plane. The angle of the infrapubic arc may enable us to presume the shape of the pelvis. Our aim was to describe a method for measuring the infrapubic angle and the interpubic space with 3 D perineal ultrasound through 3 D rotation, correlating them with the length of the 2nd stage of labor and the rate of levator defects. MATERIALS AND METHODS: Women after vaginal delivery were recruited and underwent a 3 D perineal ultrasound on 2nd - 3 rd day postpartum. Volume datasets were analyzed to measure the infrapubic angle and the interpubic space independently by 2 urogynecologists. The interobserver reliability and the correlation between infrapubic arc angle and the length of the 2nd stage of labor and the occurrence of levator defects were calculated. RESULTS: 110 women were enrolled. With a correlation coefficient of 0.76, the relationship between the infrapubic angle measurements of the two observers was very good. A moderate to good correlation was found for the assessment of the interpubic gap, with r = 0.69. Between the infrapubic angle and length of the 2nd stage of labor, no statistical correlation for both observer measurements (p = 0.31; p = 0.78, respectively) was found. Also the correlation between the infrapubic arc angle and the occurrence of levator avulsions was not significant (p = 0.59; p = 0.39, respectively). CONCLUSION: 3 D ultrasound technology enables us to identify and evaluate the interpubic gap and the infrapubic arc with a high inter-observer reproducibility. However, from our data, the infrapubic angle does not seem to influence the length of the 2nd stage of labor and the occurrence of levator defects.

The IUGA/ICS classification of complications of prosthesis and graft insertion: a comparative experience in incontinence and prolapse surgery.

INTRODUCTION AND HYPOTHESIS: This is a presentation of case series after the use of alloplasic material in urogynaecology. METHODS: From 2004 to 2010, a total 179 patients with complications have been referred directly after the use of alloplastic material in incontinence and prolapse surgery. Of this total, 125 patients had a previous vaginal sling plasty because of urinary stress incontinence, while 54 patients underwent a prolapse surgery with mesh use. Symptoms and findings are expressed by the recently introduced International Urogynecological Association/International Continence Society (IUGA/ICS) terminology. RESULTS: The most frequent findings after vaginal sling plasty were bladder outlet obstruction, pain and tape exposure. The most frequent findings after prolapse surgery were pain and mesh erosion. The IUGA/ICS classification does not give the possibility to express functional disorders. Most revisions were done more than 2 months after surgery. After incontinence surgery, mostly the vaginal area of suture line was affected; after prolapse surgery, the vagina and the trocar passage were affected. CONCLUSIONS: Mesh complication and affected site after prolapse surgery do differ from those after incontinence surgery. The IUGA/ICS classification of mesh complication facilitates the comparison of mesh complication.

[Accuracy of IOL power prediction in cataract surgery after penetrating keratoplasty--retrospective study of 72 eyes]. / Treffsicherheit der Kunstlinsenberechnung bei Katarakt-Operation nach perforierender Keratoplastik--retrospektive Studie an 72 Augen.

BACKGROUND: In concomitant cataract surgery and penetrating keratoplasty (PKP), the sequential procedure is supposed to have a higher accuracy in calculation of the intraocular lens (IOL) power compared to the triple procedure. The purpose of this study was to evaluate the refractive results of cataract surgery in patients after PKP. MATERIALS AND METHODS: Our retrospective study included 72 operations on 65 patients. In 35 eyes (group 1, G 1), all corneal sutures had been removed before cataract surgery (median time interval after PKP 3.1 years), while in 37 eyes (group 2, G 2) corneal sutures were in place but removed intra- or postoperatively (median time interval after PKP 1.5 years). Mean age of the patients (65 / 67 years), mean target refraction (-1.8 diopters, D), and mean follow-up interval (2.9 / 3.4 years) were comparable in G1 / G2. Pre- and postoperatively refraction, keratometry, and best corrected visual acuity were recorded. Main outcome measures included the deviation of the spherical equivalent of the real refraction from the target refraction after cataract surgery. RESULTS: In G1 / G2 median visual acuity increased from preoperatively 0.2 / 0.15 to 0.6 / 0.5 after a follow-up period of 3 years on average. Mean deviation from target refraction was -0.3 ± 2.2 (-4.95 to + 3.15) D in G 1 and -0.4 ± 3.0 (-7.3 to + 7.25) D in G 2. After cataract surgery, the steepening of the cornea on average was significantly less in G 1 (0.5 ± 1.6 D) than it was in G 2 (3.3 ± 2.1 D; p = 0.003). CONCLUSIONS: Although the mean deviation from target refraction is minimal after cataract surgery following PKP, our results indicate a high level of variability. If corneal sutures have been completely removed before biometry, the accuracy of the IOL power calculation seems to be better.

Soil moisture evaluation over the Argentine Pampas using models, satellite estimations and in-situ measurements.

STUDY REGION: The Pampas region is located in the central-east part of Argentina, and is one of the most productive agricultural regions of the world under rainfed conditions. STUDY FOCUS: This study aims at examining how different Land Surface Models (LSMs) and satellite estimations reproduce daily surface and root zone soil moisture variability over 8 in-situ observation sites. The ability of the LSMs to detect dry and wet events is also evaluated. NEW HYDROLOGICAL INSIGHTS FOR THE REGION: The surface and root zone soil moisture of the LSMs and the surface soil moisture of the ESA CCI (European Space Agency Climate Change Initiative, hereafter ESA-SM) show in general a good performance against the in-situ measurements. In particular, the BHOA (Balance Hidrológico Operativo para el Agro) shows the best representation of the soil moisture dynamic range and variability, and the GLDAS (Global Land Data Assimilation System)-Noah, ERA-Interim TESSEL (Tiled ECMWF's Scheme for Surface Exchanges over Land) and Global Drought Observatory (GDO)-LISFLOOD are able to adequately represent the soil moisture anomalies over the Pampas region. In addition to the LSM results, also the ESA-SM satellite estimated anomalies proved to be valuable. However, the LSMs and the ESA-SM have difficulties in reproducing the soil moisture frequency distributions. Based on this study, it is clear that accurate forcing data and soil parameters are critical to substantially improve the ability of LSMs to detect dry and wet events.

[Management of complications after sling and mesh implantations]. / Komplikationsmanagement nach Band- und Netzimplantationen.

Tension-free alloplastic slings (TFAS) have revolutionized surgery for female stress urinary incontinence for more than 15 years. The procedure is easy to perform, minimally invasive with short operation time in an ambulatory setting, and has proven efficacy comparable to the gold standard procedure of retropubic colposuspension.Possible TFAS complications are potentially underestimated with respect to prevalence and manageability. We report our experience with major complications following TFAS and mesh implantation in patients referred to our interdisciplinary continence center. Patient history, risk factors, and preoperative diagnostics were analyzed for development of individualized treatment strategies. Overcorrections with formation of postvoid residual (PVR) can occur in retropubic TFAS as well as in transobturator TFAS. However, the most prevalent and challenging complication is de novo urgency. Major complications like urethrovaginal fistula, sling arrosions of the urethra, bladder, and vagina as well as infected gangrene and complete urethral loss requiring urinary diversion were seen at a frequency suggesting underrepresentation of these complications in the literature. The large amount of implanted artificial mesh material used for pelvic organ prolapse (POP) correction represents a particular challenge in cases of dyspareunia or persisting pelvic pain.Complication management has to be based on cystoscopic, urodynamic, and physical examination findings to be individualized to each patient and must take potential risks of recurrent incontinence or persisting complaints into account.To prevent TFAS or mesh complications, every patient should have tried all conservative treatment options and should be completely evaluated (including urodynamics) preoperatively. Artificial meshes should only be used in cases of prolapse recurrence or in otherwise inoperable patients. Postoperative urodynamics may help to document treatment success and to identify and quantify complications.

Increased homocysteine levels in tear fluid of patients with primary open-angle glaucoma.

AIMS: We assessed homocysteine (Hcy) levels in tear fluid and plasma of patients with primary open-angle glaucoma (POAG). We determined the association between Hcy levels, dry eye syndrome and B vitamin status. METHODS: This prospective case-control study included 36 patients with POAG and 36 controls. Hcy concentrations were measured by high-performance liquid chromatography. RESULTS: Patients with POAG had significantly higher mean Hcy levels both in tear fluid (205 +/- 84 nmol/l; p < 0.001, t test) and in plasma (13.43 +/- 3.53 micromol/l; p = 0.001, t test) than control subjects (130 +/- 53 nmol/l and 10.50 +/- 3.33 micromol/l, respectively). Hcy in tear fluid was significantly correlated with plasma Hcy in POAG patients (r = 0.459; p = 0.005, Pearson's correlation), but not in controls (r = 0.068; p = 0.695). POAG patients with dry eye disease had significantly higher Hcy levels both in tear fluid and plasma than POAG patients without dry eye disease. There was no association between Hcy levels and B vitamin status in subjects with POAG. CONCLUSIONS: The study suggests increased Hcy levels in tear fluid and plasma of patients with POAG. Elevated Hcy levels might be a risk factor for POAG and dry eye syndrome in subjects with glaucoma.

Cardiac protein expression patterns are associated with distinct inborn exercise capacity in non-selectively bred rats.

In the present study, we successfully demonstrated for the first time the existence of cardiac proteomic differences between non-selectively bred rats with distinct intrinsic exercise capacities. A proteomic approach based on two-dimensional gel electrophoresis coupled to mass spectrometry was used to study the left ventricle (LV) tissue proteome of rats with distinct intrinsic exercise capacity. Low running performance (LRP) and high running performance (HRP) rats were categorized by a treadmill exercise test, according to distance run to exhaustion. The running capacity of HRPs was 3.5-fold greater than LRPs. Protein profiling revealed 29 differences between HRP and LRP rats (15 proteins were identified). We detected alterations in components involved in metabolism, antioxidant and stress response, microfibrillar and cytoskeletal proteins. Contractile proteins were upregulated in the LVs of HRP rats (α-myosin heavy chain-6, myosin light chain-1 and creatine kinase), whereas the LVs of LRP rats exhibited upregulation in proteins associated with stress response (aldehyde dehydrogenase 2, α-crystallin B chain and HSPß-2). In addition, the cytoskeletal proteins desmin and α-actin were upregulated in LRPs. Taken together, our results suggest that the increased contractile protein levels in HRP rats partly accounted for their improved exercise capacity, and that proteins considered risk factors to the development of cardiovascular disease were expressed in higher amounts in LRP animals.

[High-dose 106Ruthenium plaque brachytherapy for posterior uveal melanoma. A clinico-pathologic study]. / Hochdosisbrachytherapie des malignen Aderhaut- und Ziliarkörpermelanoms mit 106Ruthenium. Eine klinisch-pathologische Studie.

BACKGROUND: The purpose of this study was to report the multifactorial results of high-dose (106)Ruthenium plaque brachytherapy for (cilio-)choroidal melanoma and to confirm them by histological examinations. PATIENTS AND METHODS: 100 patients with choroidal or ciliochoroidal melanoma treated by high-dose 106Ruthenium plaque brachytherapy were followed-up for 5 years. 12 secondary enucleated eyes were compared to a non-irradiated matched group by light microscopy. RESULTS: The 5-year local tumour control rate was 93%, the 5-year survival rate 91%. Late radiogenic side effects occured as a retinopathy in 13%, as an optic neuropathy in 5% and as a secondary glaucoma in 3% of the patients. 14% had to be enucleated, 10% developed metastases. The histopathologic examination revealed significantly higher degrees of necrosis (p=0,041), balloon cell degeneration (p=0,025) and fibrosis (p<0,001) in the irradiated melanomas than in the control tumours. CONCLUSION: High-dose 106Ruthenium plaque brachytherapy turned out to be an effective treatment procedure for posterior uveal melanoma (not exceeding a prominence of 5,5 mm) with a high rate of local tumour control and a low rate of side effects.

[The penetrating keratoplasty. A 100-year success story]. / Die perforierende Keratoplastik. Eine 100-jährige Erfolgsgeschichte.

Ten precautions for prophylaxis of astigmatism in penetrating keratoplasty are recommended:1. The attempt should be made to determine donor topography for exclusion of previous refractive surgery, keratoconus/high astigmatism, and to allow for "harmonization" of donor and recipient topography.2. Donor and recipient trephination should be performed from the epithelial side with the same system, which is the prerequisite for congruent cut surfaces and angles in donor and recipient. For this purpose an artificial anterior chamber is used for donor trephination.3. Orientation structures in donor and host facilitate the correct placement of the first four or eight cardinal sutures to avoid horizontal torsion.4.A measurable improvement seems to be possible, using the Krumeich guided trephine system (GTS), the second generation Hanna trephine, and the Erlangen technique of nonmechanical trephination with the excimer laser.5. Horizontal positioning of the head and limbal plane are indispensable for state-of-the-art PKP surgery in order to avoid decentration, vertical tilt, and horizontal torsion.6. Graft size should be adjusted individually ("as large as possible, as small as necessary").7. Limbal centration should be preferred over pupil centration (especially in keratoconus).8. Excessive graft over- or undersize should be avoided to prevent stretching or compression of peripheral donor tissue.9. As long as Bowman's layer is intact a double running cross-stitch suture (according to Hoffmann) is preferred since it results in higher topographic regularity, earlier visual rehabilitation, and less suture loosening requiring only rarely suture replacement.10.Intraoperative keratoscopy should be applied after removal of lid specula and fixation sutures.

[Functional significance of adenosine receptors in the eye and their dysregulation in pseudoexfoliation syndrome]. / Funktionelle Bedeutung der Adenosinrezeptoren im Auge und ihre Dysregulation beim Pseudoexfoliationssyndrom.

BACKGROUND: Adenosine regulates many physiologic processes, such as aqueous humor secretion and intraocular pressure, via activation of its receptors. We investigated the expression of the receptor isoforms in eyes with PEX syndrome, which is associated with anterior chamber hypoxia and elevated intraocular pressure. MATERIALS AND METHODS: The mRNA and protein expression of the adenosine receptor subtypes in anterior segment tissues of patients with PEX syndrome, glaucomas, and normal control eyes were analyzed comparatively. RESULTS: Whereas the receptor subtypes A1, A2a, and A2b displayed no differential expression between PEX and control tissues, expression of the A3 adenosine receptor was consistently enhanced in the nonpigmented ciliary epithelium of all PEX eyes, independent of the presence of glaucoma, compared to normal and glaucomatous control eyes. CONCLUSION: Considering the known role of the A3 adenosine receptor in modulating aqueous humor secretion, its selective upregulation in the ciliary epithelium may confer cytoprotection and be accessible to therapeutic intervention in PEX patients.

[1.5 Years of Bladder Blog: Questions on Incontinence Outside of the Doctor's Office]. / 1,5 Jahre Blasen-Blog: Fragen zur Inkontinenz jenseits der Sprechstunde.

Nowadays to ascertain medical history is not the only way of communication between the person concerned and the physician. Dealing with a complaint or a disease includes gaining information by surfing on the internet too. The internet offers blogs with the possibility to put a question anonymously. One of these blogs is part of the website "die Blase.de" of Dr. R. Pfleger Arzneimittel in Bamberg, Germany. The requests of 20 months have been evaluated. The typical user of this blog is female; thematically - side effects of a current therapy, seeking a solution for complex continence problems or a refractory therapy and capacity building measures were most frequent. The complexity of the particularised continence problems and the extensive searches for a qualified physician support the offer of an internet-based doctor's consultation in due consideration of a taboo topic such as urinary incontinence.

Identification of C-type isolectins in the venom of the scorpionfish Scorpaena plumieri.

Chemical analyses of the hemagglutinating fraction from Scorpaena plumieri venom revealed that it contains five components (Sp-CL 1-5) with similar chromatographic elution profiles (35-38% of acetonitrile), molecular masses (16,800-17,000 Da) and N-terminal sequences, suggesting that they are isoforms of the same protein. The amino acid sequence of Sp-CL4 was determined and shown to have homology with fish C-type lectins. These data demonstrate for the first time the presence of C-type isolectins in a scorpionfish venom.

Parapapillary chorioretinal atrophy in normal and glaucoma eyes. II. Correlations.

The parapapillary chorio-pigment-epithelio-retinal atrophy in glaucomatous eyes is significantly larger than in normal eyes. In a previous study its area and frequency have been measured in 582 eyes of 321 patients with chronic primary open-angle glaucoma and in 390 eyes of 231 normal subjects. In the current study the parapapillary changes were correlated with intrapapillary morphometric data and with perimetric indices. The parapapillary chorioretinal atrophy was significantly correlated with the neuroretinal rim area, the horizontal and vertical cup/disc ratios, the quotient of horizontal to vertical cup/disc ratio, the retinal nerve fiber layer score, and the mean visual field loss. It was larger in the same sector where the neuroretinal rim loss was more marked. The correlation coefficients were generally higher for zone "Beta," characterized by complete chorioretinal atrophy with visible large choroidal vessels and sclera, than for zone "Alpha," which showed irregular hypo- and hyperpigmentation. The parapapillary chorioretinal atrophy was correlated in location and time with the intrapapillary glaucomatous changes. It deserves attention in glaucoma diagnosis and follow-up. Its evaluation is especially valuable in eyes with small optic nerveheads (disc size less than 1.6 mm2) in which the intrapapillary glaucomatous changes occur later than the parapapillary ones.

Parapapillary retinal vessel diameter in normal and glaucoma eyes. II. Correlations.

The juxtapapillary diameters of the superior temporal and inferior temporal retinal artery and vein have been shown to be significantly smaller in glaucomatous eyes than in normal eyes. They had been measured in 473 eyes of 281 patients with chronic primary open-angle glaucoma and in 275 eyes of 173 normal subjects. In the current study the vessel diameters were correlated with intra- and parapapillary morphometric data and visual field indices. Only one eye per patient and subject was taken for statistical analysis. The retinal vessel calibers were significantly (P less than 0.001) correlated with: (1) the area of the neuroretinal rim as a whole and in four different optic disc sectors; (2) the rim width determined every 30 degrees; (3) the optic cup area and diameters; (4) the horizontal and vertical cup/disc ratios and (5) the quotient of them; (6) the retinal nerve fiber layer score; (7) the area of the parapapillary chorioretinal atrophy; and (8) the visual field indices. In the same eye the vessel caliber was smaller in that sector where the neuroretinal rim loss was highest and the retinal fiber layer score lowest. In intraindividual comparison the vessels were smaller in that eye with less neuroretinal rim tissue and lower nerve fiber layer score. No significant correlations were found with the form of the optic disc, the area of the peripapillary scleral ring, side, sex and refraction. The correlation coefficients were not significantly different when the control group was matched for age. The parapapillary retinal vessel diameter decreases with advancing glaucomatous optic nerve damage. It is correlated with morphometric intra- and parapapillary glaucomatous changes and perimetric defects.

Trabecular meshwork in pseudoexfoliation syndrome with and without open-angle glaucoma. A morphometric, ultrastructural study.

PURPOSE: To test the hypothesis that glaucoma in eyes with pseudoexfoliation (PEX) syndrome results from blockage of the outflow channels by PEX material, melanin granules from the iris pigment epithelium, or both, and to determine the origin of intratrabecular PEX material. METHODS: Trabecular meshwork tissue was obtained from five surgically enucleated eyes with PEX glaucoma, ten autopsy eyes with PEX syndrome without evidence of glaucoma, and six age-matched control eyes. Morphometric methods were used to measure the percentage area occupied by open spaces, cells, plaque material, PEX material, and melanin granules on electron micrograph montages of the entire filtration area and the juxtacanalicular tissue (JCT) area. RESULTS: Independent of the presence of glaucoma, most PEX deposits were located in the JCT adjacent to the inner and outer walls of Schlemm's canal, as well as in the uveal meshwork. Although ultrastructural evidence indicates the local production of PEX fibers in the JCT by endothelial and connective tissue cells, PEX material in the uveal meshwork is derived partly from the aqueous humor. A significant correlation could be established between the presence of glaucoma and the amount of PEX material in both the filtration area and the JCT, the average thickness of the JCT, and the mean cross-sectional area of Schlemm's canal. No significant correlation existed, however, between glaucoma status and the concentration of melanin granules or plaque material, and the cellularity. CONCLUSION: In addition to a mechanical obstruction by PEX material of exotrabecular origin, the apparent production of PEX material by trabecular cells may be principally responsible for glaucoma development. Accumulation of locally produced PEX material in the JCT, followed by dysfunction of endothelial cells and disorganization of JCT and Schlemm's canal, appear to be causative factors in the development of a special type of secondary open-angle glaucoma in PEX syndrome.