Vitreoretinal dissection instruments.

We developed and evaluated clinically a series of three vitreoretinal dissection instruments with a constant-diameter shaft and various tip designs including a 90-degree hooked tip, a 130-degree hooked tip, and a blunt-tip right-angle spatula. The instruments, manufactured from a titanium alloy, are lightweight and glare resistant. We have used these instruments interchangeably with other vitreous surgery instruments introduced through a 20-gauge sclerotomy. They facilitate delicate manipulations associated with separation of epiretinal membranes from the inner retinal surface.     

Basal cell carcinoma in a patient with intestinal polyposis

A 22-year-old female, with multiple polyposis of the colon and two central nervous system tumors, also suffered from recurrent basal cell carcinoma. The purpose of this report is to alert physicians to the possibility that basal cell carcinoma occurring at an unusually young age may be another manifestation of the familial polyposis syndromes.     

Results and complications of 100 consecutive cases of pars plana vitrectomy.

We employed pars plana vitrectomy for several different indications in 100 eyes. In 51 eyes, the operation was performed for complications of pholiferative diabetic retinopathy. Improved visual acuity was our only criterion of success, and this varied widely depending on the specific indication forsurgery. Vision improved in all eight eyes undergoing anterior segment reconstruction and in none of three eyes with preoperative retinal detachment complicated by massive vitreous retraction. There was a high incidence of retinal tears complicating the operations in the series (37%). These retinal breaks could usually be closed at the time of the initial operation, and retinal detachment that could not be successfully managed developed in only four eyes.     

Medicinal herb use in a population-based survey of adults: prevalence and frequency of use, reasons for use, and use among their children

PURPOSE: There is sparse population-based data on health factors related to medicinal herb use and use of medicinal herbs in children. For a sample of American adults, we estimated the prevalence and frequency of medicinal herb use, factors related to use, reasons for use, patient-physician discussion, and the proportion of respondents who gave herbs to their children. METHODS: The data used in this study was from the 2001 North Carolina Behavioral Risk Factor Surveillance System, a population-based telephone survey of English-speaking adults (n = 2982). RESULTS: Approximately 20% of respondents reported using medicinal herbs in the past year. Of these, 34% reported discussion of herb use with a physician; 69% reported taking herbs to maintain health, 20% to prevent illness, and 11% to treat illness. Of the total sample, 7% reported using herbs everyday and 5% of the respondents reported giving their children herbal medicines in the past year. CONCLUSIONS: Medicinal herb use is common in this population sample. The lack of discussion between users and their physicians highlights the importance of patient-physician communication to avoid possible herb-drug interactions and surgical complications. Herb use appears to be a popular strategy for maintaining health. Children may be vulnerable to herbal toxicity and therefore clinicians need to know about their medicinal herb use and counsel appropriately.     

Low concentrations of flavonoids are protective in rat H4IIE cells whereas high concentrations cause DNA damage and apoptosis

Dietary flavonoids possess a wide spectrum of biochemical and pharmacological actions and are assumed to protect human health. These actions, however, can be antagonistic, and some health claims are mutually exclusive. The antiapoptotic actions of flavonoids may protect against neurodegenerative diseases, whereas their proapoptotic actions could be used for cancer chemotherapy. This study was undertaken to determine whether a cytoprotective dose range of flavonoids could be differentiated from a cytotoxic dose range. Seven structurally related flavonoids were tested for their ability to protect H4IIE rat hepatoma cells against H(2)O(2)-induced damage on the one hand and to induce cellular damage on their own on the other hand. All flavonoids proved to be good antioxidants in a cell-free assay. However, their pharmacologic activity did not correlate with in vitro antioxidant potential but rather with cellular uptake. For quercetin and fisetin, which were readily taken up into the cells, protective effects against H(2)O(2)-induced cytotoxicity, DNA strand breaks, and apoptosis were detected at concentrations as low as 10-25 micromol/L. On the other hand, these flavonoids induced cytotoxicity, DNA strand breaks, oligonucleosomal DNA fragmentation, and caspase activation at concentrations between 50 and 250 micromol/L. Published data on quercetin pharmacokinetics in humans suggest that a dietary supplement of 1-2 g of quercetin may result in plasma concentrations between 10 and 50 micromol/L. Our data suggest that cytoprotective concentrations of some flavonoids are lower by a factor of 5-10 than their DNA-damaging and proapoptotic concentrations.     

Computed tomography of cerebral venous angiomas

Six cases of venous angioma of the brain, a rare vascular malformation, were studied by means of computed tomography (CT), angiography, and other tests. In each case, angiography demonstrated the typical normal arterial phase and the network of abnormal veins that converge on a single large draining vein. In three cases, the CT scans showed rounded areas of high density not unlike neoplasms in appearance. In the other cases, the CT scan demonstrated the enlarged draining vein only. The CT scan findings, although not specific, may alert the radiologist to the possibility of this lesion and may lead to its demonstration through angiography.     

Einflussfaktoren auf die Rehabilitation der Innenohrschwerhörigkeit mit Hörgeräten

BACKGROUND: A large proportion of older as well as younger patients do not use their hearing aids. Of the younger hearing impaired population, this occurs in the majority of those who do not benefit sufficiently from their hearing aids and, consequently, they face difficulties in their working and social life. SCIENTIFIC QUESTION: Our aim was to evaluate whether a classical hearing aid adjustment is of sufficient predictive value to determine whether adequate rehabilitation in everyday and professional life will occur. METHODS AND RESULTS: A questionnaire was returned by 197 adult hearing impaired patients. Only 108 were using their hearing aids all the time; 57 rarely and 32 never. The main reason for this low rehabilitation rate proved to be inadequate amplification. At the workplace, insufficient speech discrimination came into play. Another important factor was dysacusis induced by specific noise signals. There was an intolerable acoustic feedback in 40% which could not be sufficiently alleviated. Taking these results into account, only about a third of patients were sufficiently rehabilitated. CONCLUSIONS: Proof of effectiveness in a typical audiological testing situation is an important but not a fully reliable predictor for effectiveness in everyday life. Even when hearing aids are shown to be effective with such testing, their application in particular everyday or work situations may be insufficient of even impossible.