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Relato de complicação relacionada ao uso do azul de tripano 0,1% ocorrida ao corar a cápsula anterior do cristalino em facectomia extracapsular com implante de lente intra-ocular. O corante foi injetado sob alta pressão utilizando a técnica de bolha de ar ocasionando a migração deste através da zônula e conseqüente perda do reflexo vermelho no peroperatório dificultando os passos subseqüentes à extração da catarata e comprometendo temporariamente a acuidade visual no pós-operatório. Tendo como objetivo evitar esta complicação, os autores descrevem ainda, o uso da "Técnica de bolha de ar modificada" no qual o viscoelástico dispersivo é injetado no espaço iridolenticular 360° para compor uma barreira de proteção.Report of a complication related to the use of 0.1% trypan blue during capsular staining of the anterior crystalline lens capsule in an extracapsular cataract extraction with intraocular lens implantation. The capsular dye was injected using an air-bubble technique, inadvertently, it was done using high pressure dispersing the dye through the zonules leading to a complete losts of red reflex, the following steps of the procedure becoming more difficult after the cataract extraction and causing a temporary disturbance of visual acuity in the postoperative period. In order to avoid this complication, the authors also describe the use of "Modified air-bubble technique" where dispersive viscoelastic is placed into the iridolenticular space 360° to create a protection barrier.

Report of a complication related to the use of 0.1% trypan blue during capsular staining of the anterior crystalline lens capsule in an extracapsular cataract extraction with intraocular lens implantation. The capsular dye was injected using an air-bubble technique, inadvertently, it was done using high pressure dispersing the dye through the zonules leading to a complete lost of red reflex, the following steps of the procedure becoming more difficult after the cataract extraction and causing a temporary disturbance of visual acuity in the postoperative period. In order to avoid this complication, the authors also describe the use of "Modified air-bubble technique" where dispersive viscoelastic is placed into the iridolenticular space 360 degrees to create a protection barrier.

RESUMO Foram estudados 71 pacientes com glaucoma do desenvolvimento, divididos em 2 grupos (I e II). 42% dos pacientes foram tratados com oclusão, enquanto que 58% não eram amblíopes. Comparou-se a acuidade visual dos dois grupos, podendo-se deduzir que os pacientes com glaucoma congênito (grupo I) apresentam um pior prognóstico visual que os pacientes com glaucoma infantil (grupo II). SUMMARY 71 patients with developmental glaucoma were studied and divided in two group. Group I formed by patients with congenital glaucoma and group II having patients with infantile glaucoma. 42% were treated by patching and 50% were not treated at all, because they do not have amblyopic eyes. The final visual acuity was determined and it must be pointed out that the visual prognosis was worse in congenital glaucoma patients than in infantile glaucoma ones. The time between the diagnosis and intra-ocular pressure (IOP) normalization was bigger in group I, probably because they were more resistent to the surgical treatment due to more intense developmental alterations as it is shown in the literature.

The pharmaceutical industry offers the pharmacist a unique practice alternative in the area of health economics research (HER). This article will briefly describe why HER is important, the key elements involved, and a description of how the pharmacist can play a role in developing HER. HER is a form of technology assessment and has been developed due to needs brought about by changes in the financial aspect of health care. It involves several points of concentration including the identification of the economic impact of therapeutic interventions, the separation of costs of a disease from the costs of therapy, determination of the economic impact of side effects, assessment of therapy's impact on patients' quality of life, and differentiation of costs from charges. The most often used economic tools in HER are cost effectiveness (CEA), cost benefit (CBA), and cost utility (CUA) analyses. Quality of life (QofL) considerations are a component of HER. They are important from the perspectives of the clinician as well as the patient's and often the insurance carrier, the managed health care organization, or the patient's employer. QofL measurements are made with several types of instruments including general health rating scales or batteries of tests or through health state utilities. HER data may be collected either prospectively or observationally. Quality-of-life research data may only be collected prospectively. HER crosses the boundaries of several sciences resulting in a multidisciplinary approach to technology assessment using principles from therapeutics, epidemiology, accounting, finance, the decision sciences, and the economic impact of new and existing technology. The concerns of drug decision makers with the issues of therapeutic outcomes, quality of care, impact on the pharmacy budget, the possibility of reducing or increasing other costs within the institution and the manufacturers' contractual terms, will increase. As a result, the necessity for HER is obvious. HER, as it relates to therapeutics, is in its developmental stages; it will, however, continue to evolve. The pharmacist can play a role and make significant contributions in the development of HER to determine the mechanics, assumptions and techniques of this research area. The pharmacist's background easily creates a contributing role within HER as a result of the diverse application of specialized training.

Vom 25. bis 29. Marz hielten die DPG-Fachausschusse bzw. Arbeitsgemeinschaften Quantenoptik, Plasmaphysik, Molekulphysik, Kurzzeitphysik, Oberflachenphysik, Massenspektrometrie ihre Fruhjahrstagung in der Universitat Bayreuth ab. 1030 Teilnehmer, darunter viele aus dem Ausland, waren in die Wagner-Stadt gekommen, und sie haben sich ohne Zweifel wohlgefuhlt in den ansprechenden Raumen der „NW I und II” (Naturwissenschaftliche Fakultat I und II) und im Stadtchen. Unauffallig und souveran organisiert von J. Friedrich, D. Haarer, A. Laubereau, Frau R. Muller und M. Schwoerer gingen 11 Plenar-, 11 Haupt- und 43 Fachvortrage sowie 453 Kurzberichte, 78 Posterbeitrage, 3 Fortbildungsvortrage und ein offentlicher Abendvortrag uber die diversen Buhnen. Auch die fast 40 Gerate-und Buchaussteller konnten zufrieden sein: Zumindest im zentralen Foyer der NW I waren ihre Stande nahezu ohne Pause gut besucht. Eines regen Interesses erfreuten sich auch die drei Fortbildungsvortrage von F. Frungel (Hamburg) uber Einsatzmoglichkeiten der photographischen Bewegungs-analyse in sehr kurzen Zeiten, von H. J. Pfeifer (Saint Louis) uber Laser-Doppler-Anemometrie in der Stromungsforschung und von A. Laubereau (Bayreuth) uber Erzeugung und Anwendung von ultrakurzen Laserimpulsen. In dieser Form — mit Referenten, die gut vorbereitet sind und glanzend vortragen, in einem zentral gelegenen Horsaal und zu gunstiger Zeit — sind Fortbildungsveranstaltungen ein wirklicher Gewinn fur die Zuhorer und eine Werbung fur die Physik. Beim offentlichen Abendvortrag von G. Wegner aus dem MPI fur Polymerforschung in Mainz mit dem Titel „Molekulare Architektur — Konzepte der Polymerforschung” waren im Emil-Warburg-Horsaal noch einige Platze frei geblieben. Mit ihrer Einladung an die Bayreuther Offentlichkeit, in den „Emil-Werbung-Horsaal” zu kommen, hatte dazu vermutlich auch die ortliche Tageszeitung beigetragen. Wegner wies in seinem sehr anschaulichen Vortrag eindringlich darauf hin, wie wichtig die Intensivierung einer fruchtbaren Zusammenarbeit von Chemikern und Physikern bei der Erforschung der unkonventionellen, vor allem der elektronischen Eigenschaften der Polymere ist. Einer moglichen Langeweile am Abend hatten die Organisatoren mit einem sehr ansprechenden Rahmenprogramm vorgebeugt. Neben Zunftigem (Besuch der Grosbrauerei Maisel mit ihrem hervorragenden Brauereimuseum und anschliesendem frankischen Abendessen) stand Erlesenes zur Wahl: ein Konzert der Capella Antiqua Bambergensis mit heiterer Musik aus Mittelalter, Renaissance und Barockzeit im Markgraflichen Opernhaus unter der Leitung von Prof. Dr. W. Spindler. Gespielt wurde auf historischen Instrumenten wie Krummhornern, Gemshornern, Blockfloten, pommern, Rauschpfeifen, Dulciane, Gamben, Schlagwerk. Fur Wagner-Freunde war die Wallfahrt zum Haus Wahnfried (Wagner-Museum) und zum Festspielhaus unter der kompetenten und charmanten Fuhrung der Wagner-Kennerin Irmgard Pflaum eine bare Selbstverstandlichkeit. Die restliche Musik war durch Werke von Mayuziumi, Tschaikovsky und Dvořak reprasentiert, und zwar in einem Konzert der Bamberger Symphoniker.

A panel discussed ways to improve patient-oriented pharmacy services, drawing on the proceedings of a recent conference on directions for clinical practice in pharmacy. Clinical pharmacy should be defined in terms of responsibility rather than by a list of specific functions. Pharmacists are responsible for drug use, not just for dispensing; this implies responsibility for educating physicians and nurses to ensure optimal patient outcomes. Clinical practice cannot be separated from pharmacy practice; although pharmacy practice requires different kinds of tasks, all have the goal of patient care. Pharmacists can exercise their responsibility for control of drug use without prescriptive authority or mandated review of physician prescribing. Pharmacists can increase their influence on drug therapy through the formulary system and through their physical presence on patient-care units. A mission statement that recognizes responsibility for patient outcomes can serve as the basis for a management system that supports clinical practice. The panel members believed that pharmacy leaders at the conference were unified by a commitment to increase the profession's clinical orientation.

Pneumocystis carinii pneumonia is a devastating disease state that is almost always fatal without appropriate therapy. The offending organism is difficult to culture, and the diagnosis is best confirmed by performing an open-lung biopsy. Drug therapy includes pentamidine in doses of 4 mg/kg/d im and/or trimethoprim/sulfamethoxazole (TMP/SMX) in doses of 20 mg/kg/d of the former and 100 mg/kg/d of the latter in four divided doses. Of these two agents, TMP/SMX appears to be most effective, although pentamidine may be of benefit if the combination product fails. Adverse effects associated with pentamidine are greater in number and more severe than those associated with TMP/SMX. A case report is presented to demonstrate drug therapy and the severity of the disease.

The importance of the effect of gentamicin on heparin activity was investigated. Heparin activity was assessed using the activated partial thromboplastin time (APTT), thrombin clotting time (TCT), and Factor X heparin assay. Drug concentrations used were 0.1, 0.2, 0.3, and 0.4 units/ml heparin with 40, 80, and 400 microgram/ml gentamicin, in vitro in human plasma. The drugs were precipitated at concentrations of 10, 20, 30, and 40 units/ml heparin with 4 and 40 mg/ml gentamicin. After centrifuging, the supernate was diluted to 0.1-0.4 units/ml heparin for assay. There was no change in heparin activity in the presence of gentamicin (in the unprecipitated solutions) as measured by the TCT, Factor X assay, and the APTT; however, APTT was prolonged by gentamicin. In the precipitated samples, heparin activity was lost in the precipitate. No significant clinical interaction that would affect the therapeutic efficacy of heparin was demonstrated except for a pharmaceutical incompatibility between gentamicin and heparin. The APTT, performed with ellagic acid as an activator, is prolonged by gentamicin.

Two case reports describing the treatment of digitoxin toxicity with cholestyramine resin are presented. Both female patients were receiving 100 microgram/day of digitoxin when toxicity occurred. In both patients, digitoxin was discontinued and hypokalemia was corrected. In patient 1, lidocaine hydrochloride and phenytoin sodium also were administered. Serum digitoxin levels were decreased from 43 ng/ml to 21.8 ng/ml and from 42 ng/ml to 29 ng/ml in patients 1 and 2, respectively, following administration of three 4-g doses of cholestyramine resin over a one-day period. Previous studies on the treatment of digitoxin intoxication with potassium chloride, phenytoin sodium, lidocaine hydrochloride, digitoxin-specific antibodies, colestipol hydrochloride and cholestyramine resin are discussed. Ion-exchange resins may be valuable adjuncts in the treatment of digitoxin intoxication but further studies of their utility are needed.

Durch photoelektrische Intensitätsmessungen an einem durch eine Membranstoßwelle aufgeheizten Plasma werden die kontinuierlichen Absorptionskoeffizienten und damit die ξ-Faktoren der Neutralatome von Argon, Krypton und Xenon im sichtbaren Spektralgebiet absolut bestimmt. Die Zustandsgrößen des Plasmas werden aus den gemessenen Stoßwellengeschwindigkeiten und den Zustandsgrößen vor der Front berechnet.

Durch photoelektrische Intensitätsmessungen an einem durch eine Membranstoßwelle erzeugten Krypton-Wasserstoff-Plasma wird der kontinuierliche Absorptionskoeffizient negativer Wasserstoffionen im sichtbaren Spektralgebiet absolut bestimmt. Die Zustandsgrößen des Plasmas werden aus den gemessenen Stoßwellengeschwindigkeiten und den Zustandsgrößen vor der Front berechnet.

How individual pharmacists can improve patient-oriented services is described. Pharmacists practicing on patient-care units should assess how they can, by meeting the needs of other health-care providers, contribute to better drug therapy. They should examine how changes in the drug distribution system can allow more flexibility for providing services on the patient-care unit. They should promote appropriate drug use by identifying problems and bringing these to the attention of the providers involved. Individual pharmacists can be assigned to patient-care units to coordinate drug therapy and patient education. They should document their activities. Individual pharmacists can take responsibility not only for their own actions but also for the actions of other health-care professionals associated with drug therapy.

Use of workload and work-flow documentation in two pharmacy satellites to evaluate pharmacists' productivity is described. Workload was evaluated during 14 consecutive days in May 1983 and 7 consecutive days in May 1984. All pharmacists and technicians working in the satellites recorded times for their activities on a form that listed every possible activity; interruptions such as answering the telephone, responding to walking requests, replacing stock, and lunches and break times were also recorded. Concurrently, the clinical coordinator observed and evaluated work performed for four-hour time blocks at least once each day. Analysis of workload and work-flow information identified problems with scheduling, priorities, interruptions, and pharmacists' knowledge of clinical pharmacy practice. Based on these observations, the following changes were implemented: pharmacists were scheduled to work either inside or outside the satellites for two-week or one-month time periods, priorities were assigned to certain tasks performed inside or outside the satellites, job assignments were made based on the pharmacist's capabilities and the needs of the patient-care areas, a form for documenting potential problem orders was created, and pharmacists were evaluated monthly and given one-on-one instruction by the clinical coordinator. Documentation of time use identified problems and led to changes in assignments that better integrated clinical, educational, and distributive responsibilities for the purpose of providing more efficient and effective services.

How individual pharmacists can improve patient-oriented services is described. Pharmacists practicing on patient-care units should assess how they can, by meeting the needs of other health-care providers, contribute to better drug therapy. They should examine how changes in the drug distribution system can allow more flexibility for providing services on the patient-care unit. They should promote appropriate drug use by identifying problems and bringing these to the attention of the providers involved. Individual pharmacists can be assigned to patient-care units to coordinate drug therapy and patient education. They should document their activities. Individual pharmacists can take responsibility not only for their own actions but also for the actions of other health-care professionals associated with drug therapy.

A panel discussed ways to improve patient-oriented pharmacy services, drawing on the proceedings of a recent conference on directions for clinical practice in pharmacy. Clinical pharmacy should be defined in terms of responsibility rather than by a list of specific functions. Pharmacists are responsible for drug use, not just for dispensing; this implies responsibility for educating physicians and nurses to ensure optimal patient outcomes. Clinical practice cannot be separated from pharmacy practice; although pharmacy practice requires different kinds of tasks, all have the goal of patient care. Pharmacists can exercise their responsibility for control of drug use without prescriptive authority or mandated review of physician prescribing. Pharmacists can increase their influence on drug therapy through the formulary system and through their physical presence on patient-care units. A mission statement that recognizes responsibility for patient outcomes can serve as the basis for a management system that supports clinical practice. The panel members believed that pharmacy leaders at the conference were unified by a commitment to increase the profession's clinical orientation.

Two case reports describing the treatment of digitoxin toxicity with cholestyramine resin are presented. Both female patients were receiving 100 microgram/day of digitoxin when toxicity occurred. In both patients, digitoxin was discontinued and hypokalemia was corrected. In patient 1, lidocaine hydrochloride and phenytoin sodium also were administered. Serum digitoxin levels were decreased from 43 ng/ml to 21.8 ng/ml and from 42 ng/ml to 29 ng/ml in patients 1 and 2, respectively, following administration of three 4-g doses of cholestyramine resin over a one-day period. Previous studies on the treatment of digitoxin intoxication with potassium chloride, phenytoin sodium, lidocaine hydrochloride, digitoxin-specific antibodies, colestipol hydrochloride and cholestyramine resin are discussed. Ion-exchange resins may be valuable adjuncts in the treatment of digitoxin intoxication but further studies of their utility are needed.

The importance of the effect of gentamicin on heparin activity was investigated. Heparin activity was assessed using the activated partial thromboplastin time (APTT), thrombin clotting time (TCT), and Factor X heparin assay. Drug concentrations used were 0.1, 0.2, 0.3, and 0.4 units/ml heparin with 40, 80, and 400 microgram/ml gentamicin, in vitro in human plasma. The drugs were precipitated at concentrations of 10, 20, 30, and 40 units/ml heparin with 4 and 40 mg/ml gentamicin. After centrifuging, the supernate was diluted to 0.1-0.4 units/ml heparin for assay. There was no change in heparin activity in the presence of gentamicin (in the unprecipitated solutions) as measured by the TCT, Factor X assay, and the APTT; however, APTT was prolonged by gentamicin. In the precipitated samples, heparin activity was lost in the precipitate. No significant clinical interaction that would affect the therapeutic efficacy of heparin was demonstrated except for a pharmaceutical incompatibility between gentamicin and heparin. The APTT, performed with ellagic acid as an activator, is prolonged by gentamicin.

To the Editor.— The recent article by Mazzullo et al (227:929, 1974) on the need for improved prescribing habits deserves comment. One of the most important aspects was overlooked, namely the role of the practicing pharmacist. The authors state that today's prescriptions require "only that the physician order and that the pharmacist fill from shelves stocked with manufactured drugs." With regard to the pharmacist, this is not altogether true. Recently, the Washington state legislature ruled that all Rx legend drugs dispensed from a pharmacy be personally handed to the patient by a registered pharmacist, and that in addition to the usual labeled directions, the pharmacist must verbally explain to the patient what the directions mean and provide any necessary information that the patient should be aware of. In May of last year, a Superior Court in New Jersey upheld a decision requiring pharmacists in that state to initiate and utilize

Strong shocks at Mach numbers from 10 to 15 and at initial pressures between 1 and 10 Torr are produced in a conventional diaphragm shock tube. The effect of radiative energy loss from the plasma behind the shock is studied by quantitative measurement of the decay of continuous emission at λ = 4000 A. It is shown that for high electron densities the maximum emissivity deviates remarkably from Unsold's theory. The variation of flow parameters with increasing distance from the shock front is calculated using an iterative method developed by Pomerantz. The results indicate that the observed luminosity decay cannot be explained by losses of continuous radiation alone. The influence of resonance radiation and line emission on the plasma cooling rate is briefly discussed.