The purpose of the study was to validate a recently proposed new grading system for ocular manifestations of chronic graft-versus-host disease (cGVHD). Diagnosis of cGVHD was based on the NIH consensus criteria. In addition, a grading scale was applied, which has been developed by the German-Austrian-Swiss Consensus Conference on Clinical Practice in cGVHD. Sixty-six patients (male n = 46, female n = 20, mean age 48 years) with ocular cGVHD were included. Application of the proposed Consensus Conference grading revealed inflammatory activity in all patients with mild (33 %), moderate (44 %), or severe inflammation (23 %). Clinical scoring by the NIH scoring system showed that 6 % of patients had mild symptoms; 59 % of patients had moderate dry eye symptoms partially affecting activities of daily living, without vision impairment; and 35 % of patients had severe dry eye symptoms significantly affecting daily activities. Clinical characterization and grading by the Consensus Conference grading scale revealed that ocular cGVHD (1) frequently leads to severe ocular surface disease based on impaired function of the lacrimal glands and involvement of cornea, conjunctiva, and lids; (2) is mostly associated with ongoing inflammatory activity; (3) often leads to functional impairment and reduced quality of life; and (4) is associated with an increased risk for severe, sight-threatening complications.
The name of flagellate dermatitis originates from self-flagellating medieval people. This dermatitis is not rare as a drug eruption following bleomycin therapy. An identical skin eruption caused by the mushroom shiitake Lentinus edodes is more common but reported mostly from Japan. We saw a 67-year-old patient who presented with the typical linear scratch marks after a dinner in a Chinese restaurant. The basic mechanism is a toxic epidermal damage. Since it is not clear why the dermatitis does not occur frequently since Shiitake is the second most popular mushroom in the world, we discuss possible cofactors that may trigger the toxic reaction.
Unilateral posterior chamber intraocular lens (IOL) implantation was performed after phacoemulsification or extracapsular cataract extraction in ten of 11 patients with phakodonesis or lens subluxation, which was bilateral in two cases. To facilitate placement of the IOL, the anterior capsule was opened with a YAG laser in nine patients. Intraoperative vitrectomy was performed in two patients, and posterior chamber IOL implantation was accomplished with fixation in the ciliary sulcus. Postoperative follow-up studies failed to demonstrate significant decentration or dislocation of the IOLs. Phakodonesis and lens subluxation are no longer considered absolute contraindications to implantation of posterior chamber IOLs.
SummaryPeriosteal transection and elevation is a standard treatment for angular limb deformities in foals. It is used to correct axis deviations in the limbs at an early age to assure that the foals grow up with straight limbs to improve their chances to reach their full potential as future athletes. Although clinically proven, its mechanisms of action were never elucidated on a more basic scientific level. In this experimental study the molecular response to periosteal stripping was investigated within the growth plate and adjacent perichondrium. The study was based on the hypothesis that a growth restraining feedback loop related to Indian hedgehog (Ihh), parathyroid hormone related protein (PTHrP) and parathyroid hormone receptors (PTHR) was responsible for the corrective effect of periosteal stripping. Twelve 3 months old lambs underwent periosteal stripping of the distal lateral radius and tibia on one side. The contralateral side served as non-operated controls. Two animals each group were sacrificed at 2, 6, 10, 14, 18 and 21 days after surgery and the growth plates with minimal adjacent bone tissue were harvested for histological investigations. After decalcification, paraffin-embedded sections with routine hematoxylin-eosin stains were prepared to assess morphology and length of growth plates, whereas immunohistochemistry of Ihh, PTHrP, PTHR and the two cytokines fibroblast-(FGF) and transforming growth factor (TGF) was performed to study different protein expression between operated limbs and controls. The results indicate that periosteal stripping caused an up-regulation of Ihh in the early pre-and hypertrophic zone of the growth plate, followed by an increase of PTHrP mainly in the perichondrium, while an increase of PTHR was noticed in all zones, although highest in the perichondrium and hypertrophic zones. The growth factors FGF and TGF were upregulated in all zones, but FGF in response to periosteal stripping was more intensely expressed in the proliferative zone and the highest peak of TGF was found in the perichondrium. Length measurements of the various growth zones revealed significant negative correlations between the proliferative and pre-and hypertrophic zones, indicating that indeed a negative feed back loop after periosteal stripping exists coupled by the Ihh/PTHrP/PTHR cascade.The hypothesis that periosteal stripping had an effect on the Ihh/PTHrP/PTHR related feedback loop in epiphyseal growth was confirmed in this experimental study in lambs. Since these mechanisms are very basic and similar in most species, it can be safely assumed that the effects in foals are similar. In fact, the asymmetric mechanical load in animals suffering from axis deviation may even increase the enhancing effect of length correction.Keywords: growth plate, periosteal stripping, molecular signaling, foals, axis deviation Molekulare Signalübertragung in der Wachstumsfuge von Radius und Ulna nach Periost Stripping: eine experimentelle Studie in Lämmern Chirurgisches Durchtrennen und Anheben des Periosts ("Perios...
Self-tonometry using the automatic self-tonometer "Ocuton S" appears to be suitable to record diurnal profiles of intraocular pressure at home.
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