Clinical and electrophysiologic results after intracameral lidocaine 1% anesthesia: a prospective randomized study.

OBJECTIVE: To evaluate the efficacy and safety of intracameral lidocaine in cataract surgery compared to peribulbar anesthesia. DESIGN: A prospective, randomized, controlled study. PARTICIPANTS: A total of 200 consecutive cataract patients (200 eyes) participated. INTERVENTION: Eyes were randomly assigned to two groups: one group received 0.15 ml intracameral 1% unpreserved lidocaine combined with topical anesthesia (oxybuprocaine); the other group received 6 ml prilocaine peribulbar before phacoemulsification with sclerocorneal tunnel incision. MAIN OUTCOME MEASURES: Duration of surgery was measured; implicit time and amplitudes of the b-waves of the photopic electroretinogram (ERG) potentials (single-flash ERG and the 30-Hz flicker ERG) were recorded; frequencies of intraoperative problems, complications, intraoperative, and postoperative pain were evaluated. RESULTS: After lidocaine anesthesia combined with topical anesthesia, similar complications were found, longer operation time (P < 0.001), and significantly better visual acuity immediately after surgery (P < 0.001). The ERG amplitudes were not significantly reduced after 0.15-ml intracameral lidocaine half an hour after surgery (P > 0.05). CONCLUSION: Intracameral lidocaine 1% combined with topical anesthesia can be recommended as an alternative procedure to peribulbar anesthesia in cataract surgery with corneoscleral tunnel incision.     

Evaluation of polyurethane stent implantation for the treatment of complete obstruction of the nasolacrimal system: 8-month follow-up and complications

Dacryocystorhinostomy is still the standard procedure complete stenosis of the nasolacrimal duct. New methods try to preserve the natural lacrimal pathway. Song implanted in 1995 a nasolacrimal polyurethane stent through the nasolacrimal duct. The results and complications of this new method are described in this prospective study. METHODS: Thirty consecutive patients with complete obstruction of the nasolacrimal duct or lacrimal sac were included in the study. The stenosis was localized by dacryocystography. The ages ranged from 22 to 87 years (mean, 58.9 +/- 16 years). Dacryocystography was performed immediately, 4 weeks and 8 months after the procedure to verify the position and patency of the stent. RESULTS: Twenty-five short (35 mm) and 5 long (45 mm) stents were implanted. Twenty-four of 30 patients after 4 weeks and 9 of 10 patients after 8 months had reduced or no complaints. In 1 patient the stent was obstructed. Forceful irrigation with saline solution permitted recanalization. In 1 patient the stent had moved into the upper canaliculus. Because of irritation of the canaliculus it had to be pulled out after 2 months. CONCLUSION: The follow-up is still too short to recommend stent implantation as a real alternative to dacryocystorhinostomy. The main advantages are that the procedure is faster, no incision is necessary, and the local anesthesia is easier. The disadvantage is the need for X-ray examination.     

Strabismus and diplopia as complications after cataract surgery with IOL implantation

Summary In our Department of Orthoptics we have seen an increasing number of patients suffering from diplopia after cataract surgery with IOL implantation. Between 1993 and 1997 the total number of patients with this problem was 24 (2.7 % of all patients, mean age 71 years, age range 38–88). We addressed the question of whether there is a common pattern of motility dysfunction. Methods: After evaluation of the clinical history and the basic ophthalmological findings the following parameters were examined: binocular function (Bagolini test), squint angles (Maddox cross), ocular motility. Results: The 24 patients could be divided up into three groups. Group 1 consisted of 9 patients (mean age 82 years, range 64–88) who complained about diplopia because of strabismus incomitans with vertical deviation and restricted motility on the first day after surgery. In 8 of the 9 patients strabismus surgery was done. Group II consisted of 10 patients (mean age 66 years, range 38–77) who noticed diplopia and strabismus within 7 days after surgery. We found various kinds of heterotropia. Seven of these patients were operated on and two had a prism correction. Group III consisted of 5 patients (mean age 67 years, range 61–78). Their already known strabismus paralyticus or concomitans deteriorated, leading to diplopia in some cases. All patients in this group were operated on. Discussion: For group I we believe that retro-, para- or peribulbar anesthesia caused the motility dysfunction. In groups II and III it is unlikely that local anesthesia had a causative role. The prolonged disruption of binocular vision and the abrupt change in the sensory situation after the cataract operation with lens implantation may be the leading causes for strabismus or deterioration of a preexisting strabism, respectively. Conclusions: These patients need a subtil meticulous diagnostic work-up and follow-up because of the possibility of early surgical therapy, which has a good prognosis. Evaluation of binocular vision and eye movements prior to cataract surgery appears to be helpful for later strabismic surgery.      

Qualitative and Quantitative Analysis of the Phenolic Constituents from Orthosiphon aristatus

ORTHOSIPHON ARISTATUS (Orthosiphonis folium DAB 9) was studied with regard to its phenolic constituents. Twenty compounds were isolated and identified on the basis of their spectral characteristics. The compounds included nine lipophilic flavones, two flavonol glycosides, and nine caffeic acid derivatives. The presence of the recently reported methylripariochromene A could not be confirmed. All compounds identified were quantified by HPLC. The caffeic acid derivatives including the major compounds rosmarinic acid and 2,3-dicaffeoyltartaric acid (67% of total identified phenolics) predominated over the flavones (33%) in an aqueous MeOH extract. The predominance of the caffeic acid derivatives was even more pronounced in a hot water extract (94.5% of total identified phenolics) that was comparable to a herbal tea.     

Reproductive toxicity and toxicokinetics of 2,3,7,8-tetrachlorodibenzo-p-dioxin

The effects of a single dose of TCDD on the testis were studied in rats. The animals were treated (subcutaneously) once with TCDD doses of 0, 0.5, 1.0, 3.0, 5.0 g/kg body weight. Doses of 3.0 or 5.0 g TCDD/kg reduced the number of spermatids/testis significantly (60% of the controls). Electron microscopic inspection revealed that both doses led to a dissolution on the germinal epithelium. Altered germ cells at all developmental stages occurred in all testes evaluated. Doses of 0.5 or 1.0 g TCDD/kg did not induce any effects in the testis; therefore, under these experimental conditions of single exposure to rats the dose of 1.0 g TCDD/kg can be considered as NOAEL.     

Studies on the development of extra-endothelial and intra-endothelial pigment deposits by means of direct and indirect contact specular microscopy of the cornea

Retro-corneal pigmentation as a result of primary (degenerative) or secondary (inflammatory, traumatic) pigment dispersion represents one of the most frequent findings in specular microscopy. The analysis of the pigment distribution patterns of dense deposits like those inKrukenberg spindle (KS) permits the postulation of ahypothesis concerning the development of such typical corneal pigmentations and the pigmentation of the posterior surface of the cornea in general, such as diffuse pigment dispersion (Vogt 1930), which is seen frequently.In a particular case of double KS with extreme myopia and cataract, endothelial morphological findings were documented over a period of 1 year, both before and after cataract extraction. This was done by means of contact and non-contact specular microscopy in various spindle areas.Themorpho-metric studies (cell density/mm²; cell perimeter; largest, smallest and average cell diameter; specific surface; horizontal and vertical cell orientation) were carried out automatically using a computerised video image analyser. The changes in the area of densest pigmentation in the KS centre confirm the histologically proven capacity of pigment phagocytosis by human corneal endothelium. These findings indicate that in specular microscopy, both endothelial cellular surface modifications andintra-cellular changes are documentable. The extracellular pigment deposits can also be shown by means ofindirect specular microscopy, the optical principle of which is described.

---

Zusammenfassung Feinste Pigmentablagerungen an der Hornhautrückfläche als Folge einer primären (degenerativen) oder sekundären (entzündlichen, traumatischen) Pigmentdispersion stellen einen der häufigsten Befunde bei der endothelmikroskopischen Untersuchung dar.Die Analyse des Pigmentverteilungsmusters bei dichten Ablagerungen, wie z.B. bei derKrukenbergspindel, erlauben die Aufstellung einerHypothese bezüglich der Entwicklung dieser typischen primären Hornhautpigmentierung und von degenerativen Pigmentierungen der Hornhautrückfläche im allgemeinen, wie der klinisch sehr häufigen senilen, diffusen Pigmentbestäubung.Bei einem ausgewählten Fall von beidseitiger Krukenbergspindel bei hoher Myopie und Katarakt, wurden vor und nach Katarakt-Extraktion in einem Zeitraum von über einem Jahr endothelmorphologische Befunde in verschiedenen Zonen der Pigmentspindel mittels Contact-/Noncontact-Endothelmikroskopie dokumentiert. Diemorphometrischen Untersuchungen (Zelldichte/mm², Zellumfang; größter, kleinster und mittlerer Zelldurchmesser; spezifische Oberfläche; Zell-Horizontal- und Vertikal-Orientierung) wurden mittelsautomatisierter Endothelanalyse über ein Video-Computer-Bildanalysesystem durchgeführt.Die Veränderungen im Bereich der dichtesten Pigmentablagerungen im Spindelzentrum bestätigen die histologisch gesicherte Fähigkeit des Hornhaut-Endothels zur Pigment-Phagocytose.Die erhobenen Befunde sprechen dafür, daß bei der Endothelmikroskopie nicht nur die Endothelzelloberfläche, sondern auchintrazelluläre Endothelzellveränderungen dokumentiert werden können. Extrazelluläre Pigmentauflagerungen konnen auch mittels indirekter Endothelmikroskopie dargestellt werden, deren optisches Prinzip erklärt wird.

---

---

Professor Dr. H. Neubauer for his 60th birthday     

Quinolizidine alkaloids from plants and their cell suspension cultures

The alkaloid composition of cell suspension cultures and differentiated plants of LUPINUS POLYPHYLLUS was evaluated using quartz capillary gas-liquid chromatography, GLC-MS and FD-MS. Lupanine (97% of total alkaloids), sparteine, 13-angeloyloxylupanine and 13-tigloyloxylupanine were detected in alkaloid extracts of L. POLYPHYLLUS cell suspension cultures. Lupanine, 13-cis and 13-trans-cinnamoyloxylupanine were found in the spent cell culture medium. No significant difference was found in the alkaloid composition of photomixotrophic and heterotrophic cell strains although the alkaloid content was 5 to 10 times higher in photomixotrophic cell strains. In the respective plants we could identify 18 alkaloids which include the following esters of 13-hydroxylupanine: 13-tigloyloxylupanine, 13-angeloyloxylupanine, 13-cis-cinnamoyloxylupanine, 13-trans-cinnamoyloxylupanine, 13-benzoyloxylupanine, 13-(2-methylbutyryl)-oxylupanine; and 13-vanilloyloxylupanine.     

The psychological effects of dopamine-beta-hydroxylase inhibition in normal subjects.

Acute administration of the dopamine-beta-hydroxylase (DBH) inhibitor, fusaric acid, combined with L-dopa, 500 mg, produced discernible psychological abnormalities in normal subjects. These were not found after L-dopa alone, or after placebo. The changes, lasting a few hours, were manifested by significant increases in "total psychopathology," and in a number of subscales on the Brief Psychiatric Rating Scale. Changes were also found in mood ratings on adjective checklists, and inkblot tests. A variety of effects were found on psychiatric interview. Since DBH does not occur in dopamine neurons, it is likely that the psychological effects were due to changes in dopamine or norepinephrine in norepinephrine neurons.     

Hashimoto-Enzephalopathie Steroid-sensitive Enzephalopathie bei Hashimoto-Thyreoiditis

Hashimoto's encephalopathy is a steroid-responsive, relapsing or progressive encephalopathy associated with Hashimoto's thyroiditis. Characteristic clinical features are confusion, seizures, alteration in conscious level, stroke-like episodes, myoclonus, and tremulousness. High CSF protein levels without pleocytosis and a diffusely abnormal EEG are typical findings. Brain CT and MRI and cerebral angiogram are usually normal. We present two case reports of Hashimoto's encephalopathy in 55- and 77-year-old patients who both responded well to steroid therapy, and review the literature.