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Zusammenfassung Hintergrund In der Neonatologie sind peripher eingeführte zentrale Katheter ein häufiger Zugangsweg zur parenteralen Ernährung und Verabreichung von Medikamenten und Flüssigkeit. Die Vorteile stehen den Risiken wie Infektion, Thrombose und Fehllage gegenüber. Fragestellung Welche Charakteristika und klinischen Zeichen weisen auf das Vorliegen einer katheterassoziierten Thrombose hin? Material und Methoden In einer retrospektiven Betrachung aus dem Zeitraum 2010–2016 wurden alle Fälle von katheterassoziierten Thrombosen untersucht. Identifiziert wurden 10 Frühgeborene, deren Indikation zur Katheteranlage, Zugangsweg, Lage der Katheterspitze, Liegedauer, klinische Symptome und Krankheitsverlauf analysiert wurden. Ergebnisse Bei 10 Frühgeborenen mit einem Gestationsalter von 23 + 4 bis 34 + 5 SSW wurden 11 Thromboseereignisse beobachtet. Zehn der 11 Thromboseereignisse betrafen die V. cava inferior nach Katheteranlage an der unteren Extremität. Die Indikation zur Katheteranlage waren parenterale Ernährung und chirurgische Eingriffe. Bei 9 Patienten traten perinatale Komplikationen auf. Bei allen Patienten bestand während der Liegedauer der Katheter der Verdacht auf eine Infektion. Das Auftreten der Thrombose wurde nach 3 bis 27 Tagen sonographisch dokumentiert. In 8 Thromboseereignissen war eine Thrombozytopenie, in 4 Fällen eine Beinschwellung auffällig. Diskussion Das Patientenkollektiv zeigt Gemeinsamkeiten im klinischen Verlauf und bei den Symptomen, welche auf das Vorliegen einer Thrombose deuten. Auffällig ist außerdem, dass die meisten Thromboseereignisse das Stromgebiet der V. cava inferior betrafen.

Soft tissue tumors are often challenging for pathologists on the basis of morphology alone; therefore, tumor-specific chromosomal aberrations, such as translocations and fusions, amplifications or deletions can be diagnostically useful. Fluorescence in situ hybridization is widely used for the detection of most aberrations in routine diagnostics. Furthermore, reverse transcriptase PCR, sequencing and specific immunohistochemical assays are also applied. Next generation sequencing has already contributed to the identification of hitherto unknown aberrations. Molecular pathology is mainly used in sarcomas to discriminate between different tumor entities. In terms of personalized therapy and targeted treatment, molecular pathology can be utilized to detect predictive markers.

Since July 2010 Ozurdex® is approved in Germany for treatment of macular edema from retinal vein occlusion (RVO). The objective of this observational study was a systemic summary and analysis of clinical experience regarding complications and side effects of intravitreal administration of dexamethasone.In a retrospective, multicenter study conducted at 10 centers, 342 eyes with RVO were treated with intravitreal dexamethasone (Ozurdex®, Allergan). After treatment the patients were followed-up over a period of 8 months and intraoperative, perioperative and postoperative complications, such as elevated intraocular pressure and dislocation of implants were systematically recorded.No infections, endophthalmitis, perioperative hypotension, intraoperative lens injuries or retinal detachment occurred. Elevated intraocular pressure was the most common complication accounting for nearly 20 %. In 9 % of patients the intraocular pressure increased by more than 10 mmHg compared to baseline and in 6 patients to 35 mmHg. In cases of known glaucoma intraocular pressure elevation was not significantly more frequent compared to non-glaucoma patients. In four cases a progression of lens opacity led to phacoemulsification and two implant dislocations in the anterior chamber required surgical repositioning in the vitreous cavity. In two cases a postinterventional macular hole was observed.In the clinical routine Ozurdex treatment has proven to be a therapy method with minimal side effects. In Ozurdex administration intraocular pressure elevation was observed as the most common side effect; however, this generally did not require surgical intervention. Caution is advised in patients with an anterior chamber lens and iridectomy. Macular holes as a rare complication might result from vitreous traction during the administration process. In summary, even in the clinical routine application of Ozurdex the complication rate was not higher than in registration studies.

Die Energieversorgung kann nicht länger als ein isoliertes, technisch-ökonomisches Problem angesehen werden. Eine systemorientierte Betrachtungsweise scheint erforderlich, die ausgeht von der Energieversorgung als ein in eine technisch-ökonomisch-ökologisch-gesellschaftliche Umgebung eingebettetes System, dessen Entwicklung wesentlich von seinen Wechselwirkungen mit eben dieser Umgebung bestimmt wird. Für die Beurteilung und Planung der zukünftigen alternativen Energieversorgungssysteme ist also die Berücksichtigung der Einbettung des Energiesystems in seine Umgebung die generelle Forderung, die sich aus einer solchen systemorientierten Problembetrachtung ableitet. Die Entwicklung mathematischer Modelle scheint ein besonders geeignetes Hilfsmittel für die Erarbeitung von derartigen Entscheidungshilfen zu sein, und zwar von Entscheidungshilfen, die im Prinzip der Vielzahl der zu berücksichtigenden Zusammenhänge und der inneren Verkettung der Probleme gerechter werden als andere Analysemethoden.

Globe injuries frequently are the cause of permanent loss of visual function. Especially ruptures of the globe have a 50 times lower chance of achieving a final visual acuity better than 20/200 as compared to contusions of the globe. Besides injury to the retina and choroids, injury of the iris-lens diaphragm plays an important role for visual rehabilitation (10% iris defects and 1% aniridia after blunt trauma). Against this background the surgical results after implantation of aniridia intraocular lenses were investigated.Eleven patients (41.9+/-19.6 years of age) after globe injury (three ruptures of the globe, eight penetrating injuries with trauma of the iris) were implanted with an aniridia IOL.The implantation of an aniridia IOL was performed on average 1.0+/-0.6 years (range: 0.4-2.3 years) after the primary injury. In ten eyes an aniridia IOL model HMK ANI 2 (Ophtec/Polytech) was implanted and in one eye an aniridia IOL model 67 (Morcher). Most patients were very satisfied with the results achieved (average corrected visual acuity 0.48; 0.05-1.0). Of the operated eyes, 63% reached a visual acuityor = 0.4. All patients noticed a significant reduction in glare disability as compared to the preoperative condition. The incidence of secondary glaucoma remained unchanged after the secondary implantation. One patient demonstrated retinal detachment 3 months after receiving the secondary implant, which was successfully treated with vitrectomy and gas tamponade.The implantation of aniridia IOLs seems to be a beneficial therapeutic option in post-traumatic eyes with partial or complete aniridia and aphakia with good visual recovery. During the postoperative follow-up special attention must be paid to sufficient regulation of intraocular pressure and to the retinal situation.

After simple excision without additional surgical measures, pterygiums demonstrate high recurrence rates. According to the literature, recurrences may occur in up to 83% after simple excision compared to 5-21% after excision combined with conjunctival autografts. An alternative to the free conjunctival graft is the sliding conjunctival graft.The data of 50 patients operated over a period of 8 years were evaluated retrospectively. The long-term results after pterygium excision with free conjunctival graft vs sliding conjunctival flap were compared with data extracted from the literature.The average follow-up was 23 months. During this period, 18.5% of 27 operated eyes with free conjunctival grafts developed a recurrence of pterygium. After excision with sliding conjunctival grafts only 6.9% of 29 operated and examined eyes developed recurrences.In the present study pterygium excision combined with sliding conjunctival graft was a simplified surgical technique with a lower recurrence rate compared to the free conjunctival graft.

The postoperative clinical course after penetrating keratoplasty and trephination in free form using a guided excimer laser beam has been published before. Here the findings of light-microscopy comparing corneal wound healing after experimental penetrating keratoplasty after laser trephination and after conventional mechanical trephination are presented.Homologous penetrating keratoplasty was performed on 12 NZW rabbits (6 animals with mechanical trephination, 6 animals with excimer laser trephination). The cutting edges achieved by both trephination techniques were examined by light microscopy in the remaining donor rings. During the postoperative follow-up animals were sacrificed at 3 and 6 weeks and at 3 months. Corneal specimens were retrieved and corneal healing processes were evaluated by light microscopy.The cutting edges of corneal excisions with the excimer laser demonstrated a high precision with only minimal collateral damage to adjacent tissue structures. At the different intervals both trephination groups demonstrated comparable stages of corneal wound healing regarding epithelial regeneration, stromal fibroblast migration with collagen synthesis and Descemet repair by endothelial synthesis of basement membrane. After 6 months corneal specimens of both groups demonstrated complete healing with nearly parallel orientation of newly synthesised collagen lamellae. Corneal thickness in the wound areas did not differ significantly from normal corneal tissue.Experimental follow-up studies to evaluate the feasibility of the developed technology of laser trephination in the living eye have shown no differences between conventional mechanical and excimer laser trephination with a guided beam. The present histology study also does not demonstrate any significant differences in corneal wound healing between the two trephination groups. Although excimer laser trephination along metal masks has now been established for several years, the here presented technique for trephination with individualised transplant geometries appears to be a valuable addition to the surgical repertoire in the presence of selected corneal pathologies.

The risk of postoperative immune reaction/transplant rejection is increased in the presence of distinct risk factors. In these situations, the use of established immunosuppressive agents (steroids, cyclosporin) is indicated. However, immune reactions can occur despite this therapy. Basiliximab is a monoclonal antibody with a high specific binding affinity to the IL-2 receptor of activated T-cells. After renal transplantation, the combination therapy with basiliximab and cyclosporin reduces the risk of acute rejection by 30% against placebo. The aim of this study was to investigate the effect of complementary immune suppression with the IL-2 synthesis inhibitor cyclosporin and the IL-2 receptor antagonist basiliximab on the incidence of transplant rejection after high-risk keratoplasty.In an open pilot study, seven patients with high-risk keratoplasty were treated with basiliximab perioperatively and cyclosporin postoperatively. All patients had penetrating keratoplasty with a non-HLA-matched corneal graft.Seven patients were operated on from 12/98 through 12/99 with a corneal transplant diameter between 7.1 and 9.5 mm. Risk factors included extensive corneal neovascularization in all patients (indications for surgery: 4 cases with corneal scars after herpetic disease, 2 cases with conditions after alkali burns, 1 case with corneal ulceration after thermal burn). During the follow-up of 14-25 months, no immune reaction has occurred, and all transplants are clear. The mean visual acuity increased from 0.04 to 0.41 postoperatively.The preliminary data on a combination therapy with basiliximab and cyclosporin are promising. For further evaluation a prospective multicenter study is planned.

The internet offers charge-free access to electronic online databases and thus has revolutionized the handling of information. Today's challenge is the rational management of the large amount of attainable data. This overview presents the various databases--particularly databases for online Medline search--and basic knowledge for effective and successful search strategies. There are numerous important advantages of online access to literature databases: availability at any time and any place in the world, easy handling due to the user-friendly surface of the World Wide Web, capability of linking directly to the private database. Clinicians, scientists, and ophthalmologists in private practice can equally profit from the advantages of fast, easy, and charge-free online-search in medical literature databases. Literature search should thus be an important tool to obtain the latest scientific knowledge for every physician.

Central vein pressure depends on intracranial pressure (ICP). Baurmann in 1925 therefore recommended measuring central vein pressure to determine ICP, but the accuracy of this method has not yet been verified. To test the method we measured venous outflow pressure (VOP) by noninvasive ophthalmodynamometry (ODM).We studied 31 patients with suspected increased ICP. ICP was recorded continuously for a minimum of 24 h by intraventricular catheters, and ODM was performed during ICP measurement. The findings were compared with the results of conventional invasive ICP measurement.Pressure in the central retinal vein was highly correlated with ICP.Measuring VOP by ODM seems to be a reliable method for noninvasive recording of ICP. It is a useful screening test in all cases of presumed ICP elevation.

Penetrating keratoplasty in cases of perforated corneal ulcers is a technical challenge. The loss of anterior chamber volume during trephination causes irregularities of surgical margins and carries the risk of trauma to iris and crystalline lens. The highly viscous substance Healon 5 allows a deep anterior chamber to be maintained even in cases of rather large perforations.A 34-year-old man presented with acutely perforated ulcer on the transplant-host interface. Perforating minikeratoplasty (diameter 4.5 mm) including the corneal limbus had been performed 3 years previously because of a perforated ulcer after pterygium surgery. Corneal melting extending to the visual axis required a large-diameter transplant (8.0 mm), partially including the former transplant. Before trephination the anterior chamber was restored with Healon 5. Despite the fairly large perforation site we did not note any anterior chamber shallowing during trephination. Hardly any bleeding occurred perioperatively, although deep and superficial neovascularizations in the former transplant were cut. The postoperative course was uneventful with no rise in intraocular pressure. After 4 weeks, postoperative pinhole visual acuity with the preoperative correction (1.5 dpt. cyl.) was 0.7, with a topographic astigmatism of 6.5 dpt.In the case presented here, a regular recipient wound bed as a prerequisite for a relatively low postoperative astigmatism was created by the use of Healon 5 for anterior chamber stabilization during trephination.

In a retrospective study of the records of 64 patients with AIDS and cytomegalovirus (CMV) retinitis, 47 patients were evaluated regarding the effectiveness of initial virustatic therapy, and 41 patients regarding the anatomical and functional long-term development (maintenance therapy, rate and intervals of recurrences, complications, adverse drug reactions, time of survival, and visual outcome). The average survival time of 45 treated patients was 226 days (31-717 days). More than 90% responded to initial therapy with ganciclovir or foscarnet. Forty-four percent remained free of recurrences until they died (for up to 15 months); 56% had 1 to 4 recurrences, altogether 35 episodes, of which 14 occurred after withdrawal of therapy. Recurrences were treated with high-dose reinduction therapy with good or partial response in more than 80% of cases. Nine patients showed "smouldering retinitis" at a late stage. Two out of 45 patients became blind shortly after diagnosis despite therapy; both showed a course mimicking acute retinal necrosis syndrome with histologically proven CMV disease. None of the 43 patients on maintenance therapy for up to 2 years became blind in both eyes. Only 2 out of 43 patients had a poor visual outcome40/100 in the better eye at a late disease stage. Of 60 affected eyes, 11 showed retinal detachment, 14 eyes developed optic atrophy and 12 eyes became blind. Our retrospective study shows that consistent maintenance therapy of patients with CMV retinitis prevents severe deterioration of visual acuity in most cases even in long disease courses and thus maintains quality of life.

Toxoplasmosis-retinochorioiditis is the second most frequent opportunistic infection of the eye among our series of AIDS patients. Between 1985 and 1990 we diagnosed 7 cases in 261 AIDS patients (Walter Reed classification 6); prevalence = 2.7%). The incidence has been increasing over the years. In four cases, toxoplasmosis was restricted to the eye, in three cases, ocular disease occurred combined with toxoplasmosis of the central nervous system. Since serological findings are not very reliable in AIDS-patients, the most important element in the differential diagnosis against retinitis of different etiology is ophthalmoscopy. There are a number of findings which allow differentiation of toxoplasmosis from other forms of retinitis, especially cytomegalovirus retinitis. Toxoplasmosis-retinitis was stopped in all cases by administering a specific therapy of pyrimethamine combined with clindamycin, a sulfonamide or spiramycin. Stable scar formation was achieved after 2-3 weeks therapy. Subsequent maintenance therapy with Fansidar (pyrimethamine + sulfadoxine) protected 4/4 patients from a relapse, while maintenance therapy with pyrimethamine alone allowed a relapse in 1/2 patients.

In the first part of the paper is reported on differential-therapeutic experiences in the hospital treatment of 307 alcoholics with disulfiram R, Lithium R and Apomorphine R as monotherapy as well as in combined application. Our investigations show that neither lithium R nor apomorphine R have ascertained advantages to the monotherapy with Disulfiram R. An improvement of the still unsatisfactory number of success is to be achieved in the first place by an optimization of the after-care by means of a close sociotherapeutic and if necessary psychotherapeutic care, possibly in special outpatient departments. In the second part of the paper is reported on first experiences.

After local assimilation of NaH(14)CO3 by an old frond of Laminaria hyperborea, radioactive photosynthate is translocated to the growing region of the thallus. The pathway of this long-distance transport was studied by histoautoradiography. Cellular localization of the conducting channels was accomplished by new autoradiographic methods including freeze-substitution and 1 μm-cuttings of epoxy resin embedded tissue. In the autoradiographs, patches of silver grains overlying single trumpet-filaments (=Trompetenzellen) indicated that downward translocation occurs in these cells only. It could be shown that predominantly young trumpetfilaments contain the bulk of labeling. It is concluded that the young filaments rather than the older ones are particularly active in translocation. A lateral movement of labelled material was not observed except in the growing region.

When D-Glucose-6-T is applied to small areas of the leaf blade of Cucumis or Cucurbita, a translocation of labelled material within the veins and the petiole down to the internodes of the axis can be demonstrated by chemical methods and by histoautoradiography. The translocated material was identified by thin layer and paper chromatography as stachyose, raffinose, and sucrose. A dry mounting autoradiographic technique was elaborated which prevented any secondary diffusion of water soluble substances. In autoradiograms of longitudinal and cross sections of veins, petioles and internodes, tritium can be localized within single sieve tubes of exporting bundles. Usually the centre of activity corresponds to the cytoplasmic material or the slime-plugs and to the sieve plates. Since sucrose, stachyose and raffinose are the main labelled translocated substances in these experiments, there is little doubt that with certain precautions such autoradiograms may present a real picture of the long-distance translocation of assimilates.

After application of D-glucose-6-T to small areas of leaf surfaces of Cucurbita, radioactivity - mainly sucrose-T - could exclusively be localized by histoautoradiography ("dry-technique") within single sieve tubes of exporting bundles. The centre of activity corresponded to the "slime"-plugs (in crosssection-autoradiograms) of the sieve tubes and to the sieve plates (in longitudinal sections). It is concluded that only the sieve tubes are the conducting channels for the long-distance transport of those substances which are labeled with tritium in these experiments.