Mitomycin-C in congenital glaucoma

BACKGROUND AND OBJECTIVE: To evaluate the adjunctive use of mitomycin-C (MMC) during trabeculotomy and trabeculectomy for eyes with high-risk congenital glaucoma. PATIENTS AND METHODS: A prospective, randomized, double-blind study was performed to compare the effect of a single, 4-minute intraoperative exposure to 0.2 mg/ml (group 1) or 0.4 mg/ml (group 2) of MMC on trabeculotomy with trabeculectomy in 16 high-risk cases (30 eyes) of congenital glaucoma. RESULTS: The preoperative and final postoperative intraocular pressures (IOPs) of the two groups did not differ significantly. At the final follow-up, IOP control (< 21 mm Hg) without medications was achieved in 60% of the eyes in group 1 and in 86.67% of the eyes in group 2 (P = 21). With medication, IOP control was achieved in 86.7% of the eyes of each group. In both groups, the rate of surgical failure was 13.3%. Avascular, thin, sharply demarcated blebs were noted in 33.3% of the eyes from group 1 and in 66.67% of those from group 2 (P = .14). Intraoperative and postoperative hyphema and postoperative hypotony were the complications encountered in both groups, whereas serous choroidal detachment and wound leakage were seen only in group 2. CONCLUSIONS: Intraoperative MMC applied at a concentration of 0.2 mg/ml controlled postoperative IOP as effectively as a 0.4-mg/ml concentration in high-risk cases of congenital glaucoma, but with a lower incidence of complications and thin-walled blebs.     

Surgical measures in congenital glaucoma

An overview about the classification, diagnostic and therapy of congenital glaucomas is given. Tonometry, gonioscopy, corneal diameter measurements, oculometry and the evaluation of the optic disc are the main diagnostic criteria. Goniotomy is the operation of choice. The technique of goniotomy and their modifications leading to cyclodialysis ab interno are described. Own long-term results of goniotomy are finally demonstrated.     

Topical therapy for psoriasis

The role of collateral flow was evaluated in a pharmacological stress test [a combination of low-dose dobutamine (DOB) and a vasodilator] as a predictor of wall motion reversibility at rest after percutaneous transluminal coronary angioplasty (PTCA) using ultrafast computed tomography (UFCT). Segments with wall motion abnormalities before PTCA were divided into two groups; ie, either with or without collateral flow. Patients were scanned at rest for baseline and again after 5 min of intravenous administration of 4 micrograms/kg per min of DOB after nitroglycerin (0.3 mg sublingually) or isosorbide dinitrate (2.5 mg bolus intravenous injection). Three months after PTCA, patients were scanned again and wall motion was compared with the previous findings. In collateral-dependent segments, the sensitivity of the pharmacological stress test as a predictor of wall motion reversibility was 87.5% and the specificity was 83.3%. In collateral-independent segments, the sensitivity was only 41.7%, while the specificity was 95.2%. Our findings demonstrate that the pharmacological stress test we used satisfactorily predicted wall motion reversibility in collateral-dependent segments, but tended to underestimate wall motion reversibility in collateral-independent segments. Therefore, collateral flow may be an important factor in accurately predicting wall motion reversibility by this pharmacological stress test.     

Psychiatric complications of corticosteroid therapy

Despite limited evidence, the general consensus is that corticosteroids can cause psychiatric complications, mainly depression. This is most noticeable in high doses or in medical conditions with neuropsychiatric sequelae. The prognosis is usually good if corticosteroids are discontinued, but further study of the prevalence of psychiatric reactions, their mechanism of action and appropriate treatment is necessary.     

Pneumoperitoneum complicating mechanical ventilation in congenital myotonic dystrophy

We have studied the train-of-four (TOF) response mechanomyographically during onset of neuromuscular block produced by subclinical doses of suxamethonium in order to follow the augmentation of the first twitch of the TOF (T1) and TOF fade compared with control TOF responses before the drug was given. In the groups given suxamethonium 0.05, 0.1, 0.2 and 0.3 mg kg-1, the increments in T1 after administration of the drug were observed before twitch depression occurred; these were mean 22.3 (SEM 8.1)%, 19.2 (3.3)%, 10.8 (2.0)% and 4.2 (2.2)%, respectively. This effect was more marked with the lower doses (P < 0.05). The degree of TOF fade was moderate during onset of neuromuscular block and depended on the dose of drug. The results of this study suggest that low doses of suxamethonium produced transient increase in muscle tension and twitch depression with significant TOF fade. We conclude that suxamethonium was associated with presynaptic effects as a consequence of brief stimulation of acetylcholine release followed by progressive diminution at the neuromuscular junction.     

Femoral neuropathy complicating anticoagulant therapy

Recoveries of Streptococcus mutans from human dental plaque were lower when plated on mitis-salivarius agar obtained from Baltimore Biological Laboratories as compared with mitis-salivarius agar obtained from Difco Laboratories. However, no difference in recoveries of established laboratory strains of S. mutans was observed between these two agar preparations.     

Role of corticosteroid therapy in non-malignant diseases

The study assessed immunohistochemically the location and distribution of various non-collagenous matrix proteins (fibronectin, laminin, tenascin-C, osteocalcin, thrombospondin-1, vitronectin and undulin) in musculoskeletal tissues of rat. Fibronectin and thrombospondin-1 were found to be ubiquitous in the studied tissues. High immunoreactivity of these proteins was found in the extracellular matrix of the anatomical sites where firm bindings are needed, i.e. between muscle fibres and fibre bundles, between the collagen fibres of a tendon and at myotendinous junctions, osteotendinous junctions and articular cartilage. Tenascin-C was found in the extracellular matrix of regions where especially high forces are transmitted from one tissue component to the other, such as myotendinous junctions and osteotendinous junctions. Laminin was demonstrated in the basement membranes of the muscle cells and capillaries of the muscle-tendon units. Osteocalcin immunoreactivity concentrated in the extracellular matrix of areas of newly formed bone tissue, i.e. in the subperiosteal and subchondral regions, osteoid tissue and mineralized fibrocartilage zone of the osteotendinous junction. Mild vitronectin activity could be seen in the extracellular matrix of the osteotendinous and myotendinous junctions, and high activity around the bone marrow cells. Undulin could be demonstrated in the extracellular matrix (i.e. on the collagen fibres) of the tendon and epimysium only. However, it was co-distributed with fibronectin and tenascin-C. Together, these findings on the normal location and distribution of these non-collagenous proteins in the musculoskeletal tissues help to form the basis of knowledge against which the location and distribution of the these proteins in various pathological processes could be compared.     

Analysis of the systemic corticosteroid sensitivity of patients with primary open-angle glaucoma

Patients with primary open-angle glaucoma have an ocular and systemic sensitivity to corticosteroids. We adapted a cellular assay that used peripheral blood lymphocytes to detect this corticosteroid sensitivity in vitro in a microtiter assay. It reduced the time, cost, and amount of blood required to examine a patient. We examined ten subjects on three separate days and demonstrated that the reliability of one 50% inhibitory concentration was about 76%. We then studied 25 patients with primary open-angle glaucoma and 25 control subjects using this in vitro assay. The patients with primary open-angle glaucoma were significantly more sensitive to corticosteroids than the control subjects (P less than .001).     

Laser therapy and angle-closure glaucoma

All forms of primary and secondary pupillary block angle-closure glaucoma result in an increased resistance to aqueous flow at the pupil margin. As the pressure in the posterior chamber increases, the iris bows forward until the trabecular meshwork is occluded and aqueous outflow is interrupted. Most pupillary block glaucomas are ocular urgencies and require immediate medical therapy to lower intraocular pressure. The definitive treatment for pupillary block is laser therapy. By creating a hole in the iris, the pressure in the anterior and posterior chambers is equalized, allowing the angle to remain open. This discussion reviews the indications, contraindications, and techniques involved in the laser management of angle-closure glaucomas.     

Topical felbinac in therapy of athletic injuries

In the treatment of acute soft tissue injuries, topical nonsteroidal anti-inflammatory drugs are both highly effective and well tolerated. Target is a monopreparation that meets the demands made on a modern topical agent. The active substance, felbinac, readily, penetrates into the tissue affected and accumulates locally, selectively inhibiting inflammation and alleviating pain. This synoptic report on the clinical trials confirm the significant clinical superiority of felbinac over placebo. As compared with piroxicam, felbinac, is more successful in eliminating symptoms. The rapid alleviation of pain by the topical felbinac results in an improvement in the restriction of mobility and rapid restitution of function. The cooling, nongreasy gel base further favors the high level of acceptance of this well-tolerated preparation.     

Some aspects of congenital glaucoma (author's transl)

The following paper on certain aspects of congenital glaucoma was read at a meeting for advanced medical education. Particular emphasis was placed on a review of the theories and concepts dealing with pathogenetic factors of congenital glaucoma. Two main concepts appeared to be most prominent in past and current literature: 1. The concept of a membrane obstructing the chamber angle, 2. underdevelopment or malformation of all or some structure of the chamber angle region. In order to clarify the above mentioned concepts, three stages of development of normal human chamber angles were demonstrated by light and electronmicroscopy. Aspects of surgical treatment of congenital glaucoma were discussed. Light and electronmicroscopic findings in some trabeculectomy specimens were shown. In eyes which underwent repeated surgery, marked scar tissue was seen in the area of trabecular meshwork, thus obliterating aqueous pathways. In those cases, an excision of trabecular tissue (trabeculectomy) was recommended rather than destruction of remaining trabecular tissue (trabeculotomy).