Outcomes of Primary Transconjunctival 23-Gauge Vitrectomy in the Diagnosis and Treatment of Presumed Endogenous Fungal Endophthalmitis

Purpose: To report the outcomes of primary transconjunctival 23-gauge (23-G) vitrectomy in the diagnosis and treatment of presumed endogenous fungal endophthalmitis (EFE).

Methods: Retrospective analysis of patients with EFE who underwent diagnostic transconjunctival 23-G vitrectomy at a tertiary referral center.

Results: Nineteen eyes of 15 patients with EFE were included in the study. Four patients had bilateral and 11 patients unilateral disease. Sixteen eyes of 15 patients underwent 23-G vitrectomy to confirm the diagnosis using vitreous culture, polymerase chain reaction, and histopathologic examinations. All affected eyes were treated with intravitreal amphotericin B 5 µg/0.1 mL. Fourteen patients received additional systemic antifungal therapy. Diagnostic 23-G vitrectomy confirmed the diagnosis of EFE in 75% of the eyes (12/16). Candida was found to be a causative agent in 62.5% and Aspergillus in 12.5% of the eyes. Retinal detachment was the most common complication (42% of eyes).

Conclusions: EFE can be easily confirmed using primary 23-G vitrectomy.     

Beitrag zur Lymphogranulomatosis intestinalis

Ohne Zusammenfassung     

Telomeraseaktivit?t in uvealen Melanomen

Hintergrund: Nach einer für jede Zellpopulation genetisch fixierten Zahl von Teilungen treten Zellen als Ausdruck der Alterung in ein Stadium der Teilungsunf?higkeit (Seneszenz) ein. Die als “Hayflick-Grenze” bezeichnete replikative Lebensspanne ist wahrscheinlich dann erreicht, wenn die Telomeren – hierbei handelt es sich um spezielle DNS-Abschnitte an den 4 Chromosomenenden, die bei jeder Zellteilung verkürzt werden – eine “kritische” L?nge unterschreiten. Zellen der meisten, wenngleich nicht aller maligner Tumoren reaktivieren das Enzym Telomerase. Sie k?nnen damit die Telomeren neu aufbauen, die “Hayflick-Grenze”überwinden und unbegrenzte Teilungsf?higkeit herstellen. Mit den vorliegenden Untersuchungen sollte überprüft werden, ob Telomerase- Aktivierung auch für das Wachstum uvealer Melanome eine Rolle spielt.     

Influence of anticoagulant substances on phosphoserine and taurine of human blood.

The influence of heparine (Liquemin) and sodium-EDTA on phosphoserine and taurine of human blood was investigated. Phosphoserine which was not or nearly not present in serum increased after addition of both the anticoagulant substances. The heparine used contained phosphoserine as the only ninhydrinic substance in low concentrations. After addition of heparine phosphoserine in human plasma does not increase proportionally to that change. A mechanism is assumed which leads to the release from cells or which stimulates the synthesis of the substance. A similar effect was found with sodium-EDTA but not with sodium citrate. An opposite effect was detected with taurine in human blood. In serum the highest concentration was measured which decreased slowly under heparine as well as under sodium-EDTA addition.     

Congenital adrenal hyperplasia - how to improve the transition from adolescence to adult life.

Congenital adrenal hyperplasia (CAH) is caused by a defect in the biosynthesis of cortisol that results in maximal activity of the hypothalamic-pituitary adrenal axis with hyperplasia of the adrenals and hyperandrogenism due to the accumulation of androgen precursors. In the salt-wasting subtype of the disorder, which accounts for appr. 75 % of patients with classical CAH, patients are unable to synthesise sufficient amounts of aldosterone and are prone to life-threatening salt-losing crises, whereas the simple virilising form is predominantly characterized by clitoris hypertrophy and posterior labial fusion. In addition, a non-classical variant can be discerned which in most cases is diagnosed at the time of puberty or early adolescence when hirsutism and menstrual irregularities may occur. The vast majority of CAH patients have 21-hydroxylase deficiency (90 - 95 %). Less common forms, such as 11beta-hydroxylase deficiency, will not be discussed in this review. Unfortunately, a considerable number of CAH patients is lost to regular and competent follow-up once they move out of paediatric care. This is most probably the result of insufficient co-operation between paediatric and adult endocrinologists at the time of transition from adolescence to adulthood. Furthermore, there is a lack of clinical guidance regarding psychosexual development in these patients. In this overview we will focus on special aspects of CAH treatment in adolescence and adulthood, and report on our 10-year experience with a transfer system for endocrine patients from paediatric to internal medical care, known as the "Kieler Modell". For practical purposes, we here provide charts for follow-up of CAH patients that can be adapted for use in any endocrine outpatient clinic.