Toric intraocular lenses. Clinical results and rotational stability

Background. Correction of an astigmatism at the time of cataract surgery can be achieved in two different ways, by alteration of the corneal curvature or by implantation of a toric intraocular lens (toric IOL). In the latter, in addition to the wound architecture and IOL calculation, the influence of rotational stability in the capsular bag is most important for the refractive result. Patients and methods. This retrospective study included 26 eyes from24 patients with a corneal astigmatism of 2.5–11 D before cataract surgery of which 24 eyes showed a congenital astigmatism and 2 eyes an astigmatism after keratoplasty. After phakoemulsification a three-piece toric PMMA customised IOL (6.5/13.75 mm) was implanted into the capsular bag. Subjective and objective refraction as well as keratometry and corneal topography were performed pre- and postoperatively. The axis of the toric IOL cylinder was marked and could be measured precisely in the postoperative period. The surgically induced astigmatism (SIA) was calculated. Results. At a mean follow-up time of 12 months after the implantation of a toric IOL, all eyes showed a reduction of total astigmatism. The mean total refractive astigmatism could be reduced from 4.16 D±1.58 D preoperatively to 1.64 D±1.21 D postoperatively. In 6 out of the 26 eyes (23%) the toric IOL rotated more than 10° in the capsular bag and in all 6 cases the IOL rotation happened in the first 3 weeks postoperation. The IOL position was surgically corrected within 3–6 weeks after initial surgery and remained stable during the follow-up period. Conclusions. The implantation of a PMMA toric IOL is a promising procedure to correct higher levels of corneal astigmatism in cataract surgery. The initial rotational stability of the haptics in the capsular bag still has to be improved and the corneal SIA has to be reduced by smaller incisions. Therefore, three-piece foldable IOLs with a new haptic design are under development.     

Establishing a new technique of laparoscopic pelvic and para-aortic lymphadenectomy

OBJECTIVE: To assess the number of operations necessary to develop and standardize a laparoscopic approach to pelvic and para-aortic lymphadenectomy, with radicality and number of complications as quality markers. METHODS: Over 4 years, 108 women had complete laparoscopic pelvic and para-aortic lymphadenectomies combined with laparoscopy-assisted radical vaginal hysterectomies for primary therapy of cervical cancer. Complete data and videotapes were available for 99 women. Operating time and radicality for specific anatomic subareas were measured by review of video documentation and histologic lymph node counts. Intra- and postoperative complications were recorded prospectively. To analyze the progress of surgery, we compared two groups of women, one operated on at the beginning of our study (early group, subjects 6-35) and one operated on in the final period of the study (late group, subjects 79-108). RESULTS: The operating time for pelvic and para-aortic lymphadenectomy increased constantly. Comparing the early and late groups for para-aortic lymphadenectomy, there was an increase in mean operating time (34.8 versus 73.2 minutes; P < .001) and mean histologic lymph node yield (5.1 versus 10.6; P < .001). For pelvic lymphadenectomy, mean operating time increased slightly (60.7 versus 69.7 minutes; not significant) but mean histologic lymph node count decreased over time (24.3 versus 21.0; not significant). Retrospective evaluation of videotapes showed that the radicality of lymphadenectomy improved continuously in all evaluated subareas. CONCLUSION: Establishment of a protocol for para-aortic and pelvic lymphadenectomy took 100 operations. Video documentation was a more reliable indicator of progress in technical performance than were histologic lymph node counts.     

Genetics of familial dilated cardiomyopathy

Dilated cardiomyopathy (DCM) is a primary heart muscle disease characterized by ventricular dilatation and impaired systolic function. DCM is the most common form of cardiomyopathy, and is also the commonest cause for heart failure and cardiac transplantation in adults and children. The frequency of familial occurrence of DCM had been significantly underestimated in the past, but extensive family studies showed that 35–45% of cases are familial. This recognition led to molecular genetic investigations that have further enhanced the understanding of the molecular pathogenesis of DCM. In this review, we discuss these new insights into the genetics of DCM which will have important implications for the diagnosis, risk stratification and treatment of DCM.     

Comparison of written reports of mammography, sonography and magnetic resonance mammography for preoperative evaluation of breast lesions, with special emphasis on magnetic resonance mammography

Patients with abnormal breast findings (n = 413) were examined by mammography, sonography and magnetic resonance (MR) mammography; 185 invasive cancers, 38 carcinoma in situ and 254 benign tumours were confirmed histologically. Sensitivity for mammography was 83.7%, for sonography it was 89.1% and for MR mammography it was 94.6% for invasive cancers. In 42 patients with multifocal invasive cancers, multifocality had been detected by mammography and sonography in 26.2%, and by MR mammography in 66.7%. In nine patients with multicentric cancers, detection rates were 55.5, 55.5 and 88.8%, respectively. Carcinoma in situ was diagnosed by mammography in 78.9% and by MR mammography in 68.4% of patients. Combination of all three diagnostic methods lead to the best results for detection of invasive cancer and multifocal disease. However, sensitivity of mammography and sonography combined was identical to that of MR mammography (i.e., 94.6%).     

No relationship between cerebral blood flow velocity and cerebrovascular reserve capacity and contemporaneously measured glucose and insulin concentrations in diabetes mellitus

Blood glucose and insulin concentrations have been reported to influence cerebral hemodynamics. We studied the relationship between actual blood glucose and insulin concentrations and resting cerebral blood flow velocity in the middle cerebral artery and cerebrovascular reserve capacity after acetazolamide stimulation. Thirty-six insulin-dependent diabetic patients in a state of good glycemic control were studied. Blood samples were taken for determination of glucose and insulin concentrations. Subsequently we measured resting cerebral blood flow velocities in supine position using transcranial Doppler, administered 1 g acetazolamide intravenously, and repeated the measurements after 5, 10, 15 and 20 minutes. Cerebrovascular reserve was calculated as the maximal percent increase after acetazolamide stimulation. Multiple regression was used for statistical analysis. Blood glucose levels were not correlated with resting blood flow velocity (R = 0.21, p = 0.22) nor cerebrovascular reserve capacity (R = 0.17, p = 0.32). Similarly, no correlation was found between insulin concentrations, resting cerebral blood flow velocity (R = 0.24, p = 0.22) and cerebrovascular reserve (R = 0.26, p = 0.24). Studying patients with long-term (> 10 years) and short-term (≤ 10 years) disease duration yielded the same lack of correlation. We conclude that there is no significant correlation between contemporaneously measured glucose and insulin concentrations and either cerebral blood flow velocity or cerebrovascular reserve capacity in the middle cerebral artery in type 1 diabetic patients with good control. Received: 13 November 1998 / Accepted in revised form: 17 December 1999     

Coping Strategies of Alcoholic Women

Recent efforts have increased research on alcoholic women. Few studies have examined the coping mechanisms characteristic of alcoholic women relative to their nonalcoholic controls. Conforming to DSM-IV criteria for alcohol dependence, 159 alcoholic women stratified by race (black and white) and age (20–29, 30–39, and 40–49 years) were compared to 150 nonalcoholic women from a variety of public and private inpatient and outpatient treatment facilities regarding the types of coping strategies used. Alcoholic women were significantly more likely to favor maladaptive styles of coping, while nonalcoholic women employed significantly more problem-solving and emotion-based coping strategies. Neither race nor age differences significantly influenced the types of coping utilized by these women. The profile of coping strategies utilized by the alcoholic group is consistent with a poor quality of life and compounding of problems.     

Isolation of DICE1: a gene frequently affected by LOH and downregulated in lung carcinomas.

In the development and progression of sporadic tumors multiple tumor suppressor genes are inactivated that may be distinct from predisposing cancer genes. Previously, a tumor suppressor locus on human chromosome 13q14 that is distinct from the retinoblastoma predisposing gene 1 (RB1) has been identified in lung, head and neck, breast, ovarian and prostate tumors. By an approach that combines genomic difference cloning and positional cloning we isolated the cDNA of a novel gene (DICE1) located at 13q14.12-14.2. The DICE1 gene is highly conserved in evolution and its mRNA is expressed in a wide variety of fetal and adult tissues. The DICE1 cDNA encodes a predicted protein of 887 amino acids corresponding to an 100 kD protein that shows 92.9% identity to the carboxy-terminal half of the mouse EGF repeat transmembrane protein DBI-1. The DBI-1 protein interferes with the mitogenic response to insulin-like growth factor 1 (IGF-I) and is presumably involved in anchorage-dependent growth. When compared to normal lung tissue expression of the DICE1 mRNA was reduced or undetectable in the majority of non-small cell lung carcinomas analysed. The location of the DICE1 gene in the region of allelic loss, its high evolutionary conservation and the downregulation of expression in carcinoma cells suggests that DICE1 is a candidate tumor suppressor gene in non-small cell lung carcinomas and possibly in other sporadic carcinomas.     

Influence of na-salicylate on uterine motility in labour (author's transl)]

A dosage of 10 mg/kg body weight Na-salicylate has no depressive effect on uterine motility. The examination carried out intra partum in the condition of normal uterine activity support our opinion that relatively high doses of 3--5 g per day or the simultaneous administration of beta-adrenergical substances are necessary to obtain an effective tocolysis.