Two-year efficacy after first transscleral controlled cyclophotocoagulation in patients with and without pseudoexfoliation

Purpose

Transscleral controlled cyclophotocoagulation (COCO) is a transscleral 810-nm diode laser cyclophotocoagulation that automatically adjusts the applied laser energy utilizing an optical feedback loop. The present study investigates the influence of pseudoexfoliation (PEX) on the efficacy of COCO in a Caucasian study population.

Methods

Retrospective data from 130 consecutive eyes were analyzed during a 2-year follow-up. Baseline characteristics, intraocular pressure (IOP), number of IOP-lowering medications, visual field, best-corrected visual acuity (BCVA), and secondary surgical interventions (SSI) were analyzed. The primary endpoint was IOP reduction at M24 compared to baseline, and the secondary endpoints were IOP course, reduction of IOP-lowering medications, surgical success, and IOP-lowering SSIs stratified by PEX and baseline IOP.

Results

IOP reductions of −35, −39, −25, −25, −23, −34, and −36% could be achieved from baseline to D1, W1, M1, M3, M6, M12, and M24 (all p < 0.001), respectively, while there was a significant overall reduction over time (p < 0.001) in the number of topical IOP-lowering medications postoperatively. The proportion of eyes requiring additional systemic IOP-lowering medication reduced from 31 to 0% at M24 (p = 0.025). Eyes without PEX and IOP < 30 mmHg at baseline had the lowest risk for IOP-lowering SSIs (p < 0.03). BCVA dropped at M12 (0.25 [95% CI: 0.12–0.38]), and the drop persisted during the following 12 months.

Conclusion

The present study demonstrates a midterm IOP-lowering effect after COCO while reducing the burden for topical and systemic IOP-lowering medications. Patients without PEX and IOP < 30 mmHg have a lower risk of SSI. The procedure per se cannot be excluded as causative for the decreased postoperative BCVA. Further prospective investigations are suggested.

     

Effectiveness and tolerance of amlodipine in treatment of patients with mild to moderate hypertension. Results of a long-term study with a new calcium antagonist]

The efficacy and safety of amlodipine in the long term treatment of outpatients with mild to moderate hypertension were examined in an open, non-comparative study. 87 patients were enrolled in the study, 62 (71%) of whom were observed for 27 months under controlled conditions. Daily doses of 5-10 mg amlodipine led to a statistically significant decrease in systolic and diastolic blood pressure (-30.5/-20.7 mmHg, p less than 0.01) while there was no substantial influence on heart rate or decrease in efficacy. Amlodipine was tolerated very well; only 17% of the patients reported side effects, most of which were either mild or moderate and were tolerated or disappeared with continued treatment. No clinically significant changes were noted in clinical laboratory or ECG examinations. Based on its special pharmacological and pharmacokinetic properties, amlodipine is a novel calcium antagonist from the dihydropyridine class which has proved to be effective in the treatment of hypertension. The antihypertensive effect, which is sustained for more than 24 hours, parallels the circadian variations in blood pressure and thus induces beneficial pharmacodynamic effects. Due to the low incidence of side effects and the once-daily dosage regimen, an improvement in patient compliance can be expected.     

Assessment of the human tumor cloning assay for urologic malignancies with special emphasis on bladder cancer

Specimens of different urologic malignancies such as cancer of the bladder, renal pelvis, prostate, testis and renal cell carcinomas were sent to our laboratory for cultivation with the clonogenic assay. Of the 62 samples--biopsies, bladder barbotages and effusions--48% were considered to be evaluable; the others had to be excluded from evaluation because of negative histologic/cytologic findings, insufficient cell viability, inadequate tumor material, or contamination. All test procedures were done using a slightly modified human tumor cloning assay originally described by Hamburger and Salmon [Science 197: 461-463, 1977]. Overall growth was seen in about one third of all tumors cultivated; the mean colony count being 13 +/- 8, the mean cloning efficiency 0.0026%. About one third of bladder cancer specimens and half of the renal cell carcinomas showed colony growth. No correlation between tumor stage or grade and the overall colony growth rate in vitro was seen. Furthermore, it was impossible to correlate the growth rate in vitro and the overall survival of the patients included in the study.     

Acute cardiac toxicity in patients after doxorubicin treatment and the effect of combined tocopherol and nifedipine pretreatment

In two groups of female patients with metastatic breast cancer who had all been pretreated with doxorubicin (350 mg/m2), acute cardiac effects following i.v. doxorubicin bolus injection (60 mg/m2) were recorded on the basis of systolic time intervals (STI). In six patients who received doxorubicin only the ratio between the heart-beat-corrected preejection period and left ventricular ejection time (PEPI:LVETI) as well as the PEP index were found to be significantly increased with a peak at 6 h following drug infusion (P less than 0.001). Another six patients received an identical chemotherapeutic regimen and, in addition, a combination of tocopherol (200 mg i.m. 6 h before treatment) and nifedipine (60 mg p.o. daily from 2 days before doxorubicin infusion). In the pretreatment group, the PEPI:LVETI ration and PEP index remained unchanged during the posttreatment period. Pharmacokinetic analysis of drug concentrations in the plasma revealed a significantly accelerated distribution and elimination of doxorubicin after combined tocopherol and nifedipine pretreatment, although no statistically significant differences could be found in calculated drug levels in the peripheral compartment between both treatment groups. Our results indicate that acute cardiac reactions reflected by changes in STI values can be prevented by combined tocopherol and nifedipine pretreatment.     

Course and intensive treatment of acute falciparum malaria (author's transl)]

The case of a nineteen-year-old women with the cerebral form of malaria tropica is reported. She showed hyperpyrexia, abdominal manifestations, haemolysis and disseminated intravascular coagulation. Cerebral symptoms amounting to grade IV encephalopathy occurred. The patient responded rapidly to the administration of chloroquine, anticonvulsants, dextran, corticosteroids, antipyretics, blood and antithrombin III and her symptoms had almost completely vanished one week after the onset of therapy.     

Simultaneous and sequential determinations of steroid hormone receptors in human breast cancer. Influence of intervening therapy.

Estrogen (ER), progesterone (PgR), and androgen (AR) receptors were measured in two simultaneous or subsequent specimens taken each from 259 patients with breast cancer. We studied in 182 patients results from receptor assays, either from one tumor or from the primary tumor, and a lymph node metastasis, and in 77 sequential biopsies with or without intervening therapy. All assays were performed in a single laboratory, considering 10 fmol/mg cytosol protein bound ligand as receptor positive. The concordance rate in simultaneous ER assays was 85%; however, we found a considerable high discordance rate for PgR in primary tumor and lymph node metastasis (25%). The overall discordance rate in sequential biopsies for ER was 38% and for PgR 25%. This discordance rate was primarily dependent on the receptor quality of the first assay (ER+: 50%, ER-: 24%, PgR+: 68%, PgR-: 9%). Considering only the ER+ and PgR+ cases, we found the greatest discordance rate in the patients having endocrine treatment following the first biopsy (55% and 84%, respectively). We conclude that the receptor status of one tumor biopsy is highly representative for other tumor or lymph node biopsies. Because of the high discordance rate of primarily receptor + cases in subsequent recurrences, the receptor quality of these lesions should be analyzed whenever possible.     

Pamidronat in der Behandlung der tumorassoziierten Hypercalcämie

Summary After a 48-hour rehydration period 28 of 31 patients with cancer-associated hypercalcemia (serum calcium 2.8 mmol/1) were treated intravenously with the bisphosphonate pamidronate. In three patients fluid repletion with 0.9% saline solution had already normalized serum calcium levels. Pamidronate was given in a single infusion on day 0, the dose of pamidronate adapted to the severity of hypercalcemia. If the serum calcium concentration was 2.8 mmol/1 on day 3, application of pamidronate was repeated. In all patients normocalcemia was restored; mean serum calcium decreased from 3.2±0.35 on day 0 to 2.15±0.32 on day 12. Hypercalcemia recurred in 11 patients, seven of these underwent pamidronate treatment according to the same therapeutical regimen. Normal calcium levels were attained in five cases. Side effects were of minor gravity:brief hyperthermia occurred in four patients and transient, asymptomatic hypocalcemia was noticed in nine cases.

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Abkürzungsverzeichnis PTHrP Parathormon ähnliches Peptid     

Natural killer cell activity in patients with multiple sclerosis: interferon and plasmapheresis

Peripheral blood lymphocytes from patients with multiple sclerosis (MS) were studied for natural killer (NK) cell activity and reactivity to interferon. NK activity determined at the same time in a 4-hr chromium-51 release assay using K562 target cells was significantly lower in MS patients than in controls. In-vitro treatment of MS lymphocytes with interferon resulted in only a slight increase in NK activity, while NK activity of normal individuals was markedly augmented by interferon. Leukopheresis of MS patients gave a rapid decrease in cytotoxic activity, which returned to pretreatment levels by 24 hrs. These results are consistent with the hypothesis of an immune deficit in multiple sclerosis.