[Pigmented macules as possible early signs of genetic syndromes]. / Pigmentierte Flecken als mögliche Frühzeichen genetischer Syndrome.

Solitary congenital or early apparent pigmented macules are usually without relevance; however, when multiple, extensive or in a patterned arrangement, they are not uncommonly the first sign of an underlying genetic syndrome. The present article gives an overview on the clinical significance of multiple café-au-lait macules, multiple lentigines and pigmentary mosaicism and discusses the differential diagnosis of associated syndromes. Early diagnosis with the essential contribution of the dermatologist is not only important for genetic counseling but can also contribute to avoidance of sometimes life-threatening complications.

[Microendoscopic minimally invasive techniques in lacrimal surgery]. / Mikroendoskopische, minimalinvasive Techniken in der Tränenwegschirurgie.

BACKGROUND: Lacrimation of the eye is a relatively common problem, the cause of which must be clarified by differential diagnostics. The most important symptom of a dysfunction of lacrimal drainage is epiphora. METHODS: Due to the enhancement and miniaturization of endoscopes, which were originally used in gastroduodenoscopy in the 1990s, it is possible to check the anatomical structure and visualize pathological changes of the lacrimal drainage system, which is only approximately 1 mm in diameter. As shown by the results, mechanical stenoses are often caused by recurrent chronic inflammation. A complete stenosis usually occurs only slowly due to dysregulation of the lacrimal unit. CONCLUSION: In contrast to the assumptions that were valid before the implementation of microendoscopy, complete stenoses are often only punctate and do not stretch over long distances. Shortly after the introduction of microendoscopic diagnostics minimally invasive therapy techniques, such as laser dacryoplasty (LDP) and microdrill dacryoplasty (MDP) were established. These procedures have enabled for the first time preservation of the entire physiology of the lacrimal drainage pump system despite surgical intervention after recanalization.

[Nontuberculous mycobacteria]. / Atypische Mykobakterien.

Dermatologically relevant nontuberculous mycobacteria (NTM) include Mycobacterium marinum and Mycobacterium ulcerans and different rapidly growing mycobacteria (RGM). RGM are widely present in the environment and are facultative pathogenic. Diagnostic detection of nontuberculous mycobacteria is frequently challenging. Immune-competent individuals mostly develop localized infections. Immune-suppressed patients may present with severe and disseminated disease. In these cases, rapid initiation of medical treatment is important. Moreover, infections with the more aggressive Mycobacterium ulcerans should be treated early. Due to the risk for the development of inducible antibiotic resistance, antibiotic regimes for NTM infections typically require at least two drugs. Surgical treatment should also be considered. This article discusses clinical presentation, diagnostic workup, and in particular antibiotic treatment options for dermatologically relevant infections caused by NTM.

[Minimally invasive lacrimal duct surgery with a multimodal concept for functional lacrimal stenosis]. / Minimalinvasive Tränenwegschirurgie mit einem multimodalen Konzept zur Therapie funktioneller Tränenwegsstenosen.

PURPOSE: The aim of this study was to evaluate the long-term success rates of a multimodal concept for treating functional nasolacrimal duct obstruction (FNLDO) consisting of minimally invasive lacrimal duct surgery and additional treatment of the conjunctiva, the puncta or the lids if necessary. METHODS: Clinical outcomes and subjective symptoms of 118 consecutive patients with the main diagnosis FNLDO were studied in a retrospective design. RESULTS: Of the 118 cases 64 % were treated by microendoscopy and microdrill only while 36 % needed additional treatments. In 76 % of all cases (82 % in the group of patients who were treated by microdrill only) the patients reported their symptoms to have "improved" after a median follow-up of 14 months. Up to the age of 70 years more women were affected by FNLDO, while it was more common among male patients above this age. In older patients additional treatment especially tightening of the lids was required more frequently. CONCLUSION: Transcanalicular microendoscopy of the lacrimal duct alone or in combination with additional treatments, if needed, showed satisfactory long-term outcomes in patients suffering from FNLDO and can be considered a valuable and minimally invasive option for these patients.

[Modern, minimally invasive surgery of the lacrimal duct system]. / Moderne, minimalinvasive Tränenwegchirurgie.

Dacryorrhea is a relatively common but often difficult problem from a differential diagnostic aspect. The most important symptom of dysfunction of lacrimal drainage is called epiphora. Due to the enhancements and miniaturization of endoscopes originally used in gastroduodenal surgery, since the 1990s it is possible to check the anatomical structure and the pathological changes of the lacrimal drainage system, which is only 1 mm in diameter. Mechanical stenosis is often caused by recurrent chronic inflammation. Complete stenosis is usually only dot-like and seldom occurs over a long distance. Shortly after the development of tools for microendoscopic diagnosis, therapeutic techniques were established, such as laser dacryoplasty (LDP) for which a laser is used and microdrill dacryoplasty (MDP) for which a drill is used. These procedures allow for the first time the whole physiology of the lacrimal drainage system to be preserved despite surgical intervention.

[Modern, minimally invasive surgery of the lacrimal duct system]. / Moderne, minimal-invasive Tränenwegschirurgie.

Epiphora (tearing) is the main symptom of a dysfunction of the lacrimal drainage. Tearing is a common problem and the cause can not easily be identified. Since development and miniaturisation of gastroduodenal endoscopes in the 1990s, it is possible to check the anatomical structure and the pathological changes of the lacrimal drainage system, which has a diameter of 1 mm. Mechanical stenosis is often caused by recurring chronic inflammation. Complete stenosis is usually only punctual and seldom over a long distance. Shortly after the development of microendoscopic diagnostic tools, therapeutic techniques using a laser for the dacryoplasty (LDP) or a microdrill for the dacryoplasty (MDP) were established. For the first time, these treatments enable preservation of the whole physiology of the lacrimal drainage system in spite of surgical intervention.

[Causes, diagnostics and therapy for paediatric ptosis]. / Ursache, Untersuchungsgang und Behandlung der kindlichen Ptosis.

BACKGROUND: The diagnosis of and therapy for paediatric ptosis present challenges because of difficulties in performing preoperative examinations and the inability of the patient to provide intraoperative cooperation for proper lid placement. The authors provide an overview of the different forms and findings in congenital ptosis patients and point out the difficulties of the surgical procedures. DIAGNOSTICS AND THERAPY: The majority of paediatric ptosis cases is simple unilateral congenital ptosis with dysgenesis of the levator palpebrae superioris muscle. Other different forms exist due to neurological, neuro-myogenic, aponeurotic, sympathic, and mechanical reasons or syndromes. The relevant history is obtained, including birth history and family history, careful observation and full ophthalmological examination are necessary. Amblyopia because of ptosis, strabismus or anisometropia with corneal astigmatism should be recognised and treated early. The preoperative examination is vital for determining the appropriate diagnosis and is useful for selecting the appropriate procedure. Ptosis correction is based on ptosis severity, Bell phenomenon and levator function. The primary goal is symmetry of the upper lids. Most frequently a levator resection is performed between the 3rd and 5th year with a levator function of more than 3 mm. The most common complication is undercorrection, poor lid contour or amblyopia. Overcorrection may be associated with dry eye syndrome and keratopathy. CONCLUSION: Levator resection is a useful procedure for the correction of mild to moderate ptosis. Frontalis suspension surgery is effective for congenital ptosis with poor levator function.

Basal HIF-1α expression levels are not predictive for radiosensitivity of human cancer cell lines.

BACKGROUND AND PURPOSE: High levels of hypoxia inducible factor (HIF)-1α in tumors are reported to be associated with tumor progression and resistance to therapy. To examine the impact of HIF-1α on radioresistance under normoxia, the sensitivity towards irradiation was measured in human tumor cell lines that differ significantly in their basal HIF-1α levels. MATERIAL AND METHODS: HIF-1α levels were quantified in lysates of H1339, EPLC-272H, A549, SAS, XF354, FaDu, BHY, and CX- tumor cell lines by ELISA. Protein levels of HIF-1α, HIF-2α, carbonic anhydrase IX (CA IX), and GAPDH were assessed by Western blot analysis. Knock-down experiments were performed using HIF-1α siRNA. Clonogenic survival after irradiation was determined by the colony forming assay. RESULTS: According to their basal HIF-1α status, the tumor cell lines were divided into low (SAS, XF354, FaDu, A549, CX-), intermediate (EPLC-272H, BHY), and high (H1339) HIF-1α expressors. The functionality of the high basal HIF-1α expression in H1339 cells was proven by reduced CA IX expression after knocking-down HIF-1α. Linear regression analysis revealed no correlation between basal HIF-1α levels and the survival fraction at either 2 or 4 Gy in all tumor cell lines investigated. CONCLUSION: Our data suggest that basal HIF-1α levels in human tumor cell lines do not predict their radiosensitivity under normoxia.

[Transcanalicular microendoscopic laser DCR: technique and results]. / Technik und Ergebnisse der transkanalikulären Laser-DCR.

Transcanalicular microendoscopic diode laser DCR combined with 5-mm balloon dacryoplasty is an innovative procedure in lacrimal surgery. This procedure is minimally invasive and provides the possibility to fill the gap between the first step procedures (LDP, MDP) and external or internal DCR.

[How did lacrimal endoscopy influence lacrimal surgery?]. / Wie hat die Tränenwegendoskopie die Tränenwegchirurgie beeinflusst?

Lacrimal surgery has been characterised by multiple rapid changes within the last 20 years. The understanding of the development and existence of lacrimal stenoses has changed considerably. New morphological (endoscopy of the lacrimal system) and anatomic-functional aspects have been added. In the field of surgery the frequency of DCR has dropped within the last years, but still, with proper indications, this method has its significance, as well as irrigation of the lacrimal system. On the other hand microendoscopic canalicular surgery has been almost fully replaced by microendoscopic transcanalicular laser dacryoplasty and microdrill dacryoplasty. For the surgical treatment of injuries of the lacrimal system no changes have been implemented. As a spin-off effect from gastroduodenoscopy and ERCP superfine endoscopes have been developed, and have opened the possibility to inspect the mucosa and directly evaluate the lumen of the lacrimal system. Following the development of laser dacryoplasty and microdrill dacryoplasty as well as miniaturised drill systems, surgery can be performed less invasively today. Future developments of lacrimal surgery will be strongly influenced by the ongoing developments of microendoscopic transcanalicular techniques and modulation in wound healing.