Search

Hintergrund Infektionen mit Leishmanien sind vorwiegend in (sub)tropischen Regionen verbreitet, Berichte uber humane Leishmaniosen in Europa nehmen jedoch kontinuierlich zu. Die systemische, viszerale Form wird durch den Leishmania-donovani/infantum-Komplex verursacht und kann unbehandelt einen letalen Ausgang nehmen.

BACKGROUND: An increase in corneal infiltrates and ulcers, especially among young contact lens users was noticed in our out-patient service over the last years. This prompted us to examine contact lens related corneal infiltrates and ulcers. PATIENTS AND METHODS: Retrospective study of 119 consecutive patients (134 eyes) who did wear contact lenses. 15 had problems in both eyes. We evaluated age of the patients, proportion of soft and hard contact lenses, number and location of infiltrates, the type of bacteria and the permanent corneal damage caused by scarring. RESULTS: Out of the 134 eyes evaluated 127 (94.8%) used soft contact lenses and 7 (5.2%) had used hard contact lenses for refractive correction. Mean age of patients was 28.4 years ± 12.9a. 80.6% (108 eyes) had central solitary infiltrates, 14.9% (20 eyes) had multiple peripheral infiltrates, and 4.5% (6 eyes) developed corneal ulcers. In 25.4% (34 eyes) we were able to isolate bacteria. Most of the bacteria were found in eyes with soft lenses (33 out of 34 eyes, 97%), in only one (3%) case a hard contact lens was used. Gram-negative bacteria such as serratia spp. (7 eyes), pseudomonas spp. (6 eyes), stenotrophomonas maltophilia (6 eyes) and klebsiella oxytoca (5 eyes) were predominantly isolated. 26 of 127 eyes (20.5%) with soft contact lens related keratitis healed with a corneal scar, resulting in permanent visual damage. CONCLUSION: The majority of keratitis was caused by wearing soft contact lenses. One fifth of these comparatively young patients retained a corneal scar. These findings should influence the information given to a patient concerning the choice of refractive correction.

Poor compliance or drug malabsorption are the most common reasons why an adequate TSH suppression is not achieved with oral levothyroxin in patients with hypothyroidism or thyroid carcinoma. When these conditions are excluded rare causes have to be considered. We report a female patient with follicular thyroid carcinoma in whom, under intended levothyroxin suppression therapy, a TSH-PRL-producing pituitary adenoma manifested by failure to achieve adequate TSH suppression, subtle signs of hyperthyroidism,and finally symptoms of elevated PRL.

Background Extralobar pulmonary sequestration is an uncommon congenital abnormality that is rarely diagnosed after the age of 40 years. We describe a 64‐year‐old woman with an intra‐abdominal sequestration of the lung and elevated carbohydrate antigen (CA) 19‐9 serum levels. Case outline On abdominal ultrasound a semi‐solid cystic tumour was demonstrated that showed tight connection to the tail of the pancreas according to computed tomography. Cytological examination of the percutaneous biopsy did not lead to a definitive diagnosis. CA 19‐9 serum levels were repeatedly elevated >250 IU/ml. With a tentative diagnosis of a tumour of the tail of pancreas the semi‐solid cystic mass was resected. Frozen section histology suggested the diagnosis of pulmonary sequestration, which was confirmed by definitive histological examination. Immunohistochemical staining of the specimen with a specific monoclonal antibody against CA 19‐9 showed strong immunoreactivity. Three months later the elevated CA 19‐9 serum levels returned to normal. Discussion Elevated CA 19‐9 serum levels have been described in benign pulmonary and mediastinal cystic lesions and in one case of extralobar intrathoracic lung sequestration. Although there is evidence that malignancies may arise in congenital lung cysts, CA 19‐9 serum levels have not been investigated in such cases. Based on our results elevated serum values of CA 19‐9 in combination with a cystic semi‐solid mass in the left subphrenic space should include the differential diagnosis of extralobar pulmonary sequestration.

OBJECTIVE To investigate the retropubic space and attachments of the prostate and urethra, with special reference to radical perineal prostatectomy. MATERIALS AND METHODS Anatomical relationships were assessed intraoperatively in 60 patients, and in five cadavers after preparing the dorsal vein complex with coloured latex. Cross-sections of the area of interest were evaluated by microscopy. RESULTS The puboprostatic (pubovesical) ligaments could be clearly distinguished from the median part of the puboprostatic complex continuous with the urethral suspensory mechanism. The dorsal vein complex is integrated into this fibromuscular attachment of the prostate and male urethra. During the perineal approach, dissection in this region follows the so-called avascular plane. CONCLUSION With this new insight into the anatomical relationships the nomenclature derived from radical retropubic prostatectomy could be mirrored. In radical perineal prostatectomy, both the urethral suspensory mechanism and the dorsal vein complex can be preserved.

Hintergrund Die autologe Transplantation retinal er Pigmentepithelzellen (RPE) nach der Entfernung der choroidalen Neovaskularisationsmembran (CNV) im Rahmen der subretinalen Chirurgie ist eine zukunftsorientierte Behandlungsmethode der AMD. Ziel der vorliegenden Studie war die Untersuchung moglicher Zusammenhange zwischen den Eigenschaften der entfernten Membranen und der postoperativen Entwicklung der Sehscharfe bei den behandelten Patienten.

PURPOSE: To describe the indications, surgical technique, and clinical results of 14 eyes in 13 patients with age-related macular degeneration and foveal choroidal neovascularization, in which subretinal surgery was combined with simultaneous transplantation of autologous retinal pigment epithelial cells. METHODS: Between March 1999 and February 2000, in a prospective study, 14 eyes (13 patients) with age-related macular degeneration underwent subretinal surgery because of foveal choroidal neovascularization with simultaneous transplantation of retinal pigment epithelium harvested from the nasal subretinal area of the same eye. Preoperatively, 1 month postoperatively, 3 months postoperatively and at 3-month intervals thereafter, examinations were performed including best-corrected visual acuity, visual field, biomicroscopy of anterior and posterior segment, tonometry, fluorescein and indocyanine angiographies, autofluorescence, scotometry, and fixation tests. RESULTS: Postoperatively, after median observation of 17 months (range, 12 to 24 months) best-corrected visual acuity was improved 2 or more lines in eight eyes (57.1%), remained the same (± 1 line) in five eyes (35%), and decreased by more than 2 lines in one eye (7.1%). Pairwise t test showed significant improvement after 1 month ( P = .0031, P = .0062) as well as 1 year ( P = .0066, P = .0105). Satisfactory reading vision between Jaeger 1 and 4 was achieved in three eyes (21.2%). No significant intraoperative or postoperative complications occurred in any eye. No recurrence of choroidal neovascularization was observed during the observation period. CONCLUSIONS: In eyes with age-related macular degeneration and foveal choroidal neovascularization, autotransplantation of retinal pigment epithelium was performed in addition to conventional removal of the choroidal neovascularization without significant intraoperative or postoperative complications. Visual acuity improvement of 2 or more lines in 57% of the eyes was achieved. No recurrent choroidal neovascularization formation was observed during the observation period. The results of this pilot study suggest that autologous transplantation of retinal pigment epithelium combined with submacular surgery might be a reasonable treatment option for patients with foveal choroidal neovascularization secondary to age-related macular degeneration.

Es wird uber den experimentellen Stand der retinalen Transplantation, den Hintergrund, Problematik der Abstosungsreaktion und die Entwicklung einer eigenen Technik der autologen RPR-Transplantation berichtet.

Summary Background 138 infants and young children died from an endemic infantile liver cirrhosis in a circumscribed rural area of western Austria between 1900 and 1974. Frequency of the disease peaked between 1930 and 1960. It has disappeared from this area since 1974. Methods Clinical and genetic data on the patients was gathered; pedigrees analysed and ethnographic studies and interviews were undertaken. Findings The disease, which was clinically and pathologically indistinguishable from Indian childhood cirrhosis and hepatic copper toxicosis, was transmitted by autosomal recessive inheritance. Cow's milk, contaminated with copper from untinned copper or brass vessels, may have contributed to the development of copper toxicosis. Replacement of untinned copper cooking utensils by modern industrial vessels has eradicated the disease. Interpretation Our findings strongly suggest that the endemic Tyrolean childhood cirrhosis—and by analogy non-Wilsonian hepatic copper toxicosis occurring elsewhere—is an ecogenetic disorder requiring the involvement of both genetic and environmental factors for the disease to become manifest.

Zellzahl und Vitalitat der Zellen im zur Transplantation vorgesehenen RPE-Isolat sind kritische Faktoren bei der autologen RPE-Transplantation. Wir uberpruften diese beiden Parameter in RPE-Aspiraten unter Anwendung einer von uns beschriebenen Technik der lokalisierten Mobilisierung und Entnahme von RPE-Zellen vom nasalen Bereich der Netzhaut. Die Studie wurde an 14 Bulbi, die post mortem entnommen wurden, durchgefuhrt. Die Gewinnung der Zellen erfolgte nach Retinotomie und lokaler Abhebung der Netzhaut durch die subretinale Injektion von Ringer-Losung in einem umschriebenen Areal nasal des Sehnerveneintritts. Die RPE-Zellen wurden dabei von einer Flache, die in etwa 2 bis 4 Durchmessern des Discus n. optici entspricht, schonend mobilisiert, aspiriert und unmittelbar danach mit Trypanblau gefarbt und in der Zahlkammer ausgewertet. Die Evaluation der einzelnen Proben erfolgte nach Zellzahl pro Aspirat, Isolationseffizienz, i.e. Zellzahl pro Diskusoberflache, und Vitalitat. Die Gesamtzellzahl in den Aspiraten variierte zwischen 11.000 und 29.200 (19.976 ± 6.016) Zellen. Die Isolationseffizienz war mit 6.165 ± 746 RPE-Zellen bemerkenswert konstant. Die Vitalitatsrate lag zwischen 67 und 89%. Die beschriebene mikrochirurgische Technik erlaubt eine effiziente Gewinnung einer reproduzierbaren Menge vitaler RPE-Zellen zur weiteren, unmittelbaren Verwendung fur eine autologe Transplantation. A reproducible cell amount in the inoculate and its high viability are critical factors for autologous RPE transplantation. We therefore applied a technique of gentle mobilization and aspiration of RPE’s from the nasal area of the retina to 14 cadaver human eyes. The outcome was systematically evaluated for RPE cell counts and their viability. Briefly, after retinotomy the retina was locally detached nasally of the optic disc with a subretinal injection of Ringer’s solution. RPE cells were then gently mobilized over an area of 2–4 disc diameters, aspirated, stained with Trypan blue, and the dye exclusion immediately assessed. Total cell numbers ranged from 11.000 to 29.200 (19.976 ± 6.016), however, the harvesting efficacy (nr. of cells/disc area) was remarkably constant (6.165 ± 746). Cell viability was high (82.0 ± 6.9%). We conclude that reasonable cell numbers of high viability suitable for autologous RPE transplantation can be efficiently harvested even from small retinal areas.

Great progress has been made in developing thermodynamic equations for high-nitrogen steels. Much of this work has centered on the effects of alloy composition on nitrogen concentration. Most of the currently produced high-nitrogen steels are formed by high-pressure melting. This joint U.S. Bureau of Mines, SRIM, and SIM study presents recent attempts to include the effects of pressure on the thermodynamic expressions used to determine the nitrogen concentration in Fe-Cr-Mn-Ni alloys.

We report two cases of cryptosporidiosis after CD34-selected PBSCT for lymphoma. While the first patient died of pulmonary cryptosporidiosis, treatment with paromomycin, azithromycin and subcutaneous low-dose rhIL-2 to improve numerical and functional T lymphocyte defects completely eliminated infection in the second patient. We conclude, that the removal of mature T lymphocytes by positive selection of CD34+ cells bears the risk of a delayed immune reconstitution resulting in an increased incidence of severe and sometimes fatal opportunistic infections. IL-2 might be useful in this situation by accelerating immune reconstitution and reducing the danger of opportunistic infections.

In 1988, a 27-year-old male patient received an allogeneic BMT for leukemic relapse 8 months after ABMT for AML (M2) in first complete remission. Because of chronic GVHD of the liver CsA was administered until 1994. Nine months after discontinuation of CsA, locally advanced gastric granulocytic sarcoma (GS) was diagnosed without evidence of systemic relapse. The patient was treated with two courses of polychemotherapy (ICE, NOVIA). Granulocyte colony-stimulating factor (G-CSF)-mobilized donor buffy coat cells were reinfused after each chemotherapy cycle in an attempt to accelerate hematopoietic regeneration and to induce a graft-versus-leukemia (GVL) effect. Local irradiation and surgical resection of residual leukemic cells resulted in complete remission. Seventeen months from diagnosis of GS the patient relapsed again with multiple lesions and died of generalized bleeding during aplasia after a third course of polychemotherapy (ICE). In our patient donor peripheral blood stem cell support did not accelerate hematopoietic regeneration (time to neutrophil recovery > 0.5 x 10(9) g/l from the start of chemotherapy was 27 days after ICE and 36 days after NOVIA) and did not result in long-term disease-free survival.

PURPOSE. To present the outcome of a consecutive series of patients who had foveal choroidal neovascularization (fCNV) in age-related macular degeneration (AMD) and were treated with subretinal surgery combined with simultaneous transplantation of autologous retinal pigment epithelial (RPE) cells. METHODS. Patients with fCNV who were not eligible for laser or photodynamic therapy were included in the study. They underwent subretinal membrane excision with simultaneous transplantation of autologous RPE cells. Eyes with membrane excision alone served as the control. Tests included best corrected visual acuity for far and near with Early Treatment Diabetic Retinopathy Study (ETDRS) and Jaeger charts, multifocal (mf)ERG, central visual field analysis, optical coherence tomography (OCT), and angiography, before surgery, and 1 month and 3 months after treatment, and at 3-month intervals thereafter. RESULTS. The results of final examinations of 53 eyes are presented. In 39 eyes, RPE transplantation was performed (group 1); 14 eyes had membrane excision alone (group 2). In group 1, visual acuity improved significantly, two or more lines in 21 (53.8%) patients; remained stable in 12 patients (30.8%); and decreased two or more lines in 6 patients (15.4%; P 0.0062). In group 2, the corresponding values were 21.1%, 57.8%, and 21.1% (P 0.5377 NS). Statistical analysis of results in the two groups showed a trend in favor of group 1 (P 0.9714). The difference in reading acuity was significant between the two groups (mean change in group 1: 1.85 0.42 vs. 0.43 0.47 in group 2; P 0.0001). mfERG response density changes were significantly different between groups 1 and 2 (P 0.0094). No significant decreases in central visual field defects were detected. OCT showed the postoperative median retinal thickness in the lesion area in group 1 to be higher (242.31 12.30 m) than in group 2 (202.07 10.68 m), showing a trend (P 0.0682). CONCLUSIONS. Patients undergoing fCNV removal with autologous transplantation of RPE reached significantly better reading acuity and higher mfERG-response density than control subjects. The results provide evidence that autologous transplantation of RPE is a beneficial supplement to membrane excision alone in patients with fCNV in AMD and may be regarded as a reasonable treatment option. (Invest Ophthalmol Vis Sci. 2004;45:4151‐4160) DOI:10.1167/iovs.04-0118

A reproducible cell amount in the inoculate and its high viability are critical factors in autologous RPE transplantation. We therefore applied a technique of gentle mobilization and aspiration of RPE-s from the nasal area of the retina to 14 cadaver human eyes. The outcome was systematically evaluated for RPE cell amounts and their viability. Briefly, after retinotomy the retina was locally detached nasally of the optic disc with a subretinal injection of Ringer’s solution. RPE cells were then gently mobilized over an area of 2–4 disc diameters, aspirated, stained with Trypan blue, and the dye exclusion immediately assessed. Total cell numbers ranged from 11.000 to 29.200 (19.976 ± 6.016), however, the harvesting efficacy (nr. of cells/disc area) was remarkably constant (6.165 ± 746). Cell viability was high (82,0 ± 6,9%). We conclude that reasonable cell numbers of high viability suitable for autologous RPE transplantation can be efficiently harvested even from small retinal areas.

Because of the higher life expectancy in the industrial world and increasing demands on life quality age related macular degeneration (AMD) has become one of the most important diseases in ophthalmologic research. While about 85% of patients are diagnosed with the “dry” atrophic form of AMD, 15% suffer from the “wet” form, which is responsible for the highest percentage of visual loss in these patients and mainly characterised by the development of choroidal neovascularisation [1]. Treatment modalities usually used f.e. laser photocoagulation, photodynamic therapy (PDT), or transpupillary therapy (TTT) are vasodestructive methods and have therefore a very limited potential to improve the retinal situation [2, 3, 4]. These methods also do not allow any visionary aspect for the treatment of the large group of patients with dry AMD.

Purpose: We have recently described combined subretinal surgery and simultaneous autologous transplantation of RPE as a therapeutic option for the treatment of CNV in patients with advanced AMD. The purpose of the present study was to determine whether the size and morphology of the membranes were correlated with patient outcome.

Liver diseases of infancy and childhood are generally rare and within the spectrum of these disorders, only a few subtypes are related to abnormal hepatic copper accumulation. Idiopathic copper toxicosis has been defined as such a subtype; although this disease is characterized by distinct clinical and pathologic features, its exact etiology is still controversial. On the basis of a review of the literature, supplemented by our own observations of 138 cases endemic to western Austria, we hypothesize that idiopathic copper toxicosis is caused by a synergy of an autosomal-recessive inherited defect in copper metabolism and excess dietary copper. Increased awareness of the disease should enable early diagnosis and lead to successful treatment, thereby improving the overall poor prognosis of affected patients.

Twenty-eight histologically proven severe acute vascular rejection episodes in renal grafts were reversed in 22/28 (78%) cases by extensive plasma exchange, which was well-tolerated by all but one patient. CMV infection was the most frequent complication. As 1-year survival of 93% (patient) and 71% (graft) is considered a good result in this severe immunological complication, the extensive plasma exchange can be recommended for the treatment of acute vascular rejection.

e21076 Background: Mutation of the K-ras oncogene was identified as predictive and potentially prognostic in colorectal and pancreatic cancer. Less is known about the influence of the K-ras status ...

According to the literature synchronous adenocarcinomas of both, the colon and the gallbladder or the colon and the appendix are extremely unusual. To our knowledge the simultaneous occurrence of all three tumors has never been published before. Preoperative diagnosis of early stage tumors of the gallbladder and the vermiform appendix is also made very seldom. The following case report records an instance of synchronous adenocarcinomas of the gallbladder, the transverse colon, in a colonic polyp and the appendix. Owing to the patient's advanced age simultane cancer occurrence may be mere coincidence. Nevertheless, this extremely rare entity could also be ascribed to a genetic defect or an unknown carcinogenic agent.