Augenärztliche Prävention im 1. Lebensjahr

Prospective studies on the evolution of refraction during the first few months of human life are necessary for the early detection of amblyopia and strabismus. In our study, the medical examination of 1,264 neonates showed rapid emmetropisation of primary existing hyperopia – (mean 3.62 D at birth) – especially during the first 6 months of life. The rate of emmetropisation continuously decreased until the end of the present period of observation. However, we did not observe this normal course in all cases. A total of 47 children did not lose their primary hyperopia, and in another 11 cases the rate of hyperopia even increased. We prescribed glasses for those children in whom emmetropisation was insufficient between the third and sixth months of life. We only observed the development of esotropia in the group of children without emmetropisation who did not wear glasses. No child in the group which wore glasses continually developed any form of strabismus. Therefore, we recommend very early examination of the refractive condition of the eyes for all children (from birth until the third month of life). Checkups should follow – if no abnormal results are found – between the 12th and 15th month and at the age of 4 years. If there are any abnormal results, glasses should be prescribed very early. Our study will continue until the end of 2007 in order to estimate the success of early provision for amblyopia.     

Comparison of tumor- and comorbidity-related predictors of mortality after radical prostatectomy

OBJECTIVES: To identify and compare tumor- and non-tumor-related predictors of survival after radical prostatectomy and to incorporate the latter into the tumor node metastasis classification of prostate cancer. MATERIAL AND METHODS: A total of 402 patients who underwent radical prostatectomy (mean follow-up period 6.9 years) were stratified according to postoperative tumor stage, Gleason score, prostate-specific antigen level, age and five comorbidity classifications. Cox proportional hazard models were used to identify independent prognostic factors predicting overall survival. RESULTS: Comorbidity (American Society of Anesthesiologists Physical Status classification), Gleason score and age, but not tumor stage, were independent predictors of overall survival. Based on tumor stage and the identified independent prognostic factors, an easily applicable prognostic score was developed to predict overall mortality. CONCLUSION: A prognostic classification of radical prostatectomy patients based on Gleason score, comorbidity and age and supplementary to a coarsened variant of the tumor node metastasis classification may be of clinical value.     

A meta-analysis of outcomes of external fixation versus plate osteosynthesis for unstable distal radius fractures

PURPOSE: External fixation and open reduction and internal fixation have been the traditional techniques for surgical fixation of unstable distal radius fractures. The existing literature has not identified which is superior, primarily because of the lack of comparative trials. We performed a comprehensive systematic review and meta-analysis of the current literature on external fixation and internal fixation of distal radius fractures to determine the dominant strategy based on available scientific evidence. METHODS: We searched MEDLINE and EMBASE for English-language articles published between 1980 and 2004 that satisfied predetermined inclusion and exclusion criteria. The outcomes of internal and external fixation were compared using continuous measures of grip strength, wrist range of motion, and radiographic alignment and categoric measures of pain, physician-rated outcome scales, and complication rates. Outcomes were pooled by random-effects meta-analysis and meta-regression analysis was used to control for patient age, presence of intra-articular fracture, duration of follow-up period, and date of publication. Sensitivity analyses were used to test the stability of the meta-analysis results under different assumptions. RESULTS: Forty-six articles were included in the review with 28 (917 patients) external fixation studies and 18 (603 patients) internal fixation studies. Meta-analysis did not detect clinically or statistically significant differences in pooled grip strength, wrist range of motion, radiographic alignment, pain, and physician-rated outcomes between the 2 treatment arms. There were higher rates of infection, hardware failure, and neuritis with external fixation and higher rates of tendon complications and early hardware removal with internal fixation. Considerable heterogeneity was present in all studies and adversely affected the precision of the meta-analysis. CONCLUSIONS: The current literature offers no evidence to support the use of internal fixation over external fixation for unstable distal radius fractures. Comparative trials using appropriately sensitive and validated outcome measurements are needed to guide treatment decisions.     

Electrotactile perception of scatterplots on the fingertips and abdomen

A comparison of auditory and visual perception of scatterplots showed similar correlation estimation performance in both modalities. The present study replicated this experiment using electrotactile (electrocutaneous) presentation of scatterplots on the fingertips and abdomen, as well as visual presentation. The correlation estimation task resulted in a slightly poorer performance on electrotactile scatterplots (abdomen r=+0.847; fingertip r=+0.723) compared with the previous Flowers auditory displays (r=+0.91). There were similar levels of performance in the visual (control) condition in both the studies (r for both approx.+0.91). The performance in the correlation estimation task was similar across the two electrotactile displays, with perhaps a slight, but not significant (p=0.077), advantage for the abdominal array. However, a preliminary digit identification task on both displays produced a better performance on the fingertip display (p<0.05), suggesting that the relative performance of the two displays may be task specific. The present results demonstrate electrotactile perception of complex graphs and provide useful information for improving future versions of tactile displays.     

Functional genomic analysis of the response of HIV-1-infected lymphatic tissue to antiretroviral therapy

Highly active antiretroviral therapy (HAART) curtails human immunodeficiency virus type 1 (HIV-1) replication in lymphatic tissues and partially reverses the pathological damage associated with infection, but the genes that mediate these pathological and reparative processes remain largely unknown. To identify these genes, we used microarrays to profile gene expression in serial lymph node biopsy specimens obtained before and after treatment. We discovered approximately 200 treatment-responsive genes, many of them known mediators and moderators of immune activation and defenses, particularly innate defense genes, which, surprisingly, were expressed at all stages of HIV-1 infection. Most of the rest of the treatment-responsive genes we categorized as mediators of trafficking, reformation of active follicles, and tissue repair. We propose a model in which nearly counterbalanced functions of mediators and moderators of immune activation and defenses account for the slow dynamics of HIV-1 infection before treatment. This model suggests that there could be a role for anti-inflammatory agents, alone or in combination with HAART, in treating HIV-1 infection by tipping this balance to mitigate pathology.     

Comparison of EORTC Quality of Life Core Questionnaire (EORTC-QLQ-C30) and Gastrointestinal Quality of Life Index (GIQLI) in patients undergoing elective colorectal cancer resection

Background EORTC-QLQ-C30 questionnaires and GIQLI questionnaires are used to evaluate post-operative quality of life (QoL). It was not clear whether results of both instruments are comparable. Therefore, the level of agreement between both QoL questionnaires was evaluated in patients undergoing elective colorectal cancer resection.Methods Pre-operatively, 7 and 30 days after surgery 116 patients answered the EORTC-QLQ-C-30 and the GIQLI questionnaires in random order. Individual questions with similar content from each questionnaire were compared. Data for global QoL, physical (PF), emotional (EF) and social function (SF) were linearly transformed to fit a scale from 0 to 100. Data from the two instruments were correlated and the level of agreement between them was calculated according to the method of Bland and Altman.Results A total of 308 data sets [(pre-op. n=116; 7th pod n=101; 30th post-operative day (pod) n=91)] were evaluated. Both instruments detected a reversible reduction of QoL after surgery and gave inferior results for patients with conditions known to impair QoL. EORTC-QLQ-C30 was more sensitive than GIQLI. The correlation between the two questionnaires for global QoL, PF and EF was good (r=0.53–0.66, p<0.01), but no correlation for SF was detected (r=–0.44, p=0.44). Linearly transformed scores from the two instruments differed considerably from –13 (95%CI –51 to 24) points (QoL) to 10 (–38 to 58) points (PF).Conclusion Although EORTC-QLQ-C30 scores and GIQLI scores from patients undergoing elective colorectal cancer surgery did correlate well, the level of agreement between the two instruments was quite low. Perioperative QoL data from the two instruments cannot be compared with each other.Presented in part at the 120th annual meeting of the German Surgical Society in Munich, May 2003, and contains part of the dissertation of Mrs. Tanja Strohm     

An expert system for cutaneous blood flow in melanocytic skin lesions

A basic tool in microcirculation research is laser Doppler fluxmetry (LDF). The chaotic behaviour of the measured LDF-time series acquires mathematical tools like, for instance, Wavelets. The notion of contrast is known as useful tool to measure differences between two LDF-time series [K. Br?uer, Chaos, Attraktoren und Fraktale, Logos, Berlin, 2002]. The one time series arises from the blood flow in healthy skin and the other from a pigmented symmetric contra lateral skin lesion. Our approach is based on taking the contrast from all shorter non-overlapping time intervals of approximate length 5 or 10 seconds. This gives a sample or more precisely, a time series of contrast values. Our goal is an expert system to decide between malign and beligne lesions by estimating the probability for a maligne lesion. As a data base we again use the same data set as [H.-M. H?fner, K. Br?uer, M. Eichner, A. Steins, M. M?hrle, A. Blum and M. Jünger, Wavelet analysis of cutaneous blood flow in melanocytic skin lesions, J. Vasc. Res., submitted]. The statistical tool is logistic regression. We can show that 93% of data are correctly classified. If we check the expert system against the independent data base of the Greifswald dermatology department we get 78% correctly classified cases. Further work must be done to find a well distributed data base for an expert release system.     

Effects of religiosity on patients' perceptions of do-not-resuscitate status

Forty-eight oncology inpatients participated in a survey designed to characterize their understanding of and beliefs about do-not-resuscitate (DNR) decisions and to identify dimensions of religiosity associated with moral beliefs about DNR decisions. Seventy-five percent of the patients believed they understood the meaning of "DNR," but only 32% were able to provide an accurate definition. Seventeen percent believed that DNR decisions are morally wrong, and 23% believed that they are equivalent to suicide. Those who lacked an accurate understanding of DNR status were significantly more likely to perceive them as morally wrong. Gender, but not religious denomination, was significantly related to patients' attitudes about the morality of DNR decisions. The belief that DNR decisions are morally wrong was predicted by certain religious practices, including near-daily meditation, near-daily thinking about God, and the current practice of meditation, and by endorsement of the statement, "My faith sometimes restricts my action."