[Localization of scotomas in AMD by reading test : Random series of words in standardized format]. / Lokalisation von Skotomen mittels Lesetest bei AMD : Willkürliche Wortserien in standardisiertem Format.

BACKGROUND: Reading performance that can be measured by reading tests depends on whether reading material with or without contextual continuity is used. OBJECTIVE: The goal of this study was to create a German version of the SKread test and to evaluate it in a clinical setting. MATERIAL AND METHODS: The evaluation of the SKread test was first performed on two groups of visually healthy subjects of different ages: a junior group of 25 persons with ages between 20 and 30 years (mean = 25.84 years, SD ± 2.41 years) and a senior group of 25 persons with ages between 51 and 84 years (mean = 62.40 ± 8.46 years). The same measurements were also performed on a group of 18 patients with age-related macular degeneration (AMD) with ages between 75 and 95 years (mean = 81.89 ± 5.48 years). The reading performance was also measured using Radner charts. RESULTS: Using reading material without syntactic continuity considerably slowed down the reading speed and increased the error rate. Median reading rates of 11.53 characters/s (CPS) for the junior group and 8.96 CPS for the senior group were clearly lower than those for the Radner charts (22.02 CPS and 18.48 CPS, respectively). In the AMD patients, a statistical analysis of the error rates showed a highly significant difference between the Radner charts and the SKread test (p = 0.00014). Furthermore, by analyzing the errors made in the SKread test information could be obtained about the position of central scotomas. The test-retest reliability of the SKread was very good. CONCLUSION: Information about the position of a central scotoma can be acquired by using the SKread test and an analysis of reading errors, which can augment effective clinical monitoring in AMD and subsequent visual rehabilitation.

[3-D ultrasound. Initial experiences in various eye diseases]. / 3D-Ultraschall. Erste Erfahrungen bei verschiedenen Augenerkrankungen.

BACKGROUND: Studies have confirmed three-dimensional (3-D) ultrasound as a practical diagnostic tool in examining the eye and orbit and suggest its routine clinical use. MATERIALS AND METHODS: 3-D ultrasound was prospectively performed in 46 patients (46 eyes) with various ocular diseases. In six large choroidal melanomas the tumor volume were measured by 3-D ultrasound and compared to that measured by MRI and to that calculated by a theoretical formula. To assess the reproducibility of volumetry by 3-D ultrasound the volumes of such three intraocular tumors were measured ten times using ten different virtual sectioning planes and a section thickness of 0.5 mm and/or 1.0 mm. RESULTS: 3-D ultrasound allows the precise assessment of complex three-dimensional structures. Choroidal melanoma volumes measured by 3-D ultrasound, MRI, and theoretical calculation were in the same range. CONCLUSION: Intraocular tumor volume can be measured well by 3-D ultrasound,which may be of clinical importance in follow-up examinations.

[Stereotaxic precision irradiation of large uveal melanomas with the gamma knife]. / Die stereotaktische Präzisionsbestrahlung grosser uvealer Melanome mit dem Gamma-Knife.

BACKGROUND: We report our experience with stereotactic radiosurgery using the Gamma-knife in large uveal melanoma unsuitable for brachytherapy (Ru106). PATIENTS AND METHODS: We treated 35 patients (16 male, 19 female; age: median 59 years (95% Confidence interval (CI): 31-84 years; 18 right eyes, 17 left eyes). 7 tumors were located juxtapapillary, 16 tumors were located in the mid-periphery and 12 tumors were located in the ciliary body, The localization and/or the dimension of the tumors did not allow for radiation brachytherapy (Ru106). All patients underwent regular clinical, echographical and neuroradiological follow-up examinations. RESULTS: The follow-up time was median 12 months (95% CI: 4-20 months). A local tumor control defined as either continuous tumor regression or stopping of tumor progression was achieved in 34 (97%) of the 35 treated patients within the observation period. The eye of one patient was enucleated due to tumor regrowth. Maximum apical tumor height according to standardized A-scan before treatment was median 9.1 mm (95% CI: 3.2-13.9 mm) and after treatment median 6.4 mm (95% CI: 2.1 bis 11.9 mm). The difference was statistically highly significant (p < 0.001, one-tailed paired t-test). CONCLUSIONS: Our results in 35 patients indicate that radiosurgery using the Gamma-knife is beneficial in retaining the eyes of patients with large uveal melanomas that are not suitable for brachytherapy (Ru106).

[Minimally invasive therapy for clinically complete central retinal artery occlusion--results and meta-analysis of literature]. / Minimal invasive Therapie bei klinisch komplettem Zentralarterienverschluss--eigene Ergebnisse und Literaturvergleich.

BACKGROUND: Goal of our study was the comparison of the efficacy of various minimal invasive therapeutic regimens for clinically complete central retinal artery occlusion (CRAO) and the comparison with the literature. PATIENTS AND METHODS: In a retrospective study 93 patients treated for CRAO during the period 1994-1998 were identified. 65 of these patients with clinically complete occlusion without a cilioretinal artery were included in the study. Analysis focused on the results of different therapies and the duration of visual impairment till starting treatment. RESULTS: The following therapies were used: acetazolamide (65%), aspirin (60%), bulbus massage (45%), hemodilution (34%), oral pentoxifylline (28%), topical beta blockers (9%), paracentesis (8%), heparin (6%). In 15% of all cases an improvement of at least 3 visual acuity gradations was achieved. No significant positive influence of any treatment method could be identified. Also, a correlation between duration of visual impairment and final visual acuity could not be shown. In the literature very different criteria for inclusion of patients to the studies and for visual acuity improvement are found. When applying comparable criteria to ours most studies show similar results for the therapies listed above as well as for paracentesis and the use of carbogen (95% O2 and 5% CO2). CONCLUSION: The minimal invasive treatments given above do only improve natural course of CRAO in occasional cases. Thus a therapy (-combination) should be chosen, which is adapted to the individual risk factors and is exposing the patient to a low risk by therapy itself.

[Enlargement of an extraocular eye muscle: a symptom of cysticercosis]. / Raumforderung in einem äusseren Augenmuskel: Manifestation einer Zystizerkose.

BACKGROUND: Cysticercosis is one of the two infections caused by Taenia solium. It is endemic in areas with poor hygienic standards. In western countries the patients history of previous living or travelling in endemic areas is important. Neurocysticercosis is a manifestation with single or multiple ocular, orbital or cerebral lesions. PATIENT: Two patients presented with severe headache and pain in the ocular region. Both patients were diagnosed to have a cystic lesion in an extraocular muscle. RESULTS: Both patients had a manifestation of cysticercosis. Additionally patient no. 1 had a myositis of this muscle, patient no. 2 had a posterior scleritis. CONCLUSION: Without evidence of an eosinophilia and stool ova and cysts and without a positive ELISA-test for cysticercosis the pathognomonic appearance of the thickened muscle, the cyst and the scolex inside should lead to the diagnosis cysticercosis.

Visual field constriction is not limited to children treated with vigabatrin.

Vigabatrin (GVG) is widely used in the treatment of complex partial seizures and infantile spasms. Persistent visual field constriction associated with GVG therapy in adults was reported as a rare but serious side-effect. Visual field examination in children is more difficult because of a lack of cooperation among very young or mentally handicapped patients. We performed Goldmann perimetry in 12 of 153 patients treated with GVG as mono- or as add-on therapy. The others would not cooperate, and two adolescents refused the examination. For comparison, we examined 12 age-matched patients with complex partial or generalized epilepsy who had never taken GVG. In five of 12 GVG-treated patients, and in one of the control group, we found a concentric visual field constriction. All patients were subjectively asymptomatic. The GVG-treated patients had taken the drug in combination with valproic acid (VPA) or oxcarbazepine (OCB). In four patients, GVG treatment was already stopped at the time of the ophthalmologic examination. Three patients had intracerebral lesions that could not account for the pathologic perimetric findings. The single patient from the control group with concentric visual field constriction had an absence epilepsy, treatment being performed with VPA and lamotrigine (LTG). In conclusion, GVG has a causal but not unique connection with visual field constriction in pediatric patients.

Cerebroretinal vasculopathy mimicking a brain tumor: a case of a rare hereditary syndrome.

We report a 35-year-old man with hereditary cerebroretinal vasculopathy (CRV) characterized by retinal microvascular changes and a right frontal intracerebral mass lesion that suggested a brain tumor. Histopathologic analysis of the patient's brain lesion as well as reviewed specimens of the patient's mother, who had reportedly died of a brain tumor, showed no neoplasia but did show cerebral microvasculopathy. CRV should be considered as a differential diagnosis for patients with intracerebral mass lesions, retinal vascular changes, and a positive family history of "brain tumors."

[Dural carotid-cavernous sinus fistulas: clinical aspects, diagnosis and therapeutic intervention]. / Durale Carotis-Sinus-cavernosus-Fisteln: Klinik, Diagnostik und therapeutische Intervention.

BACKGROUND: Carotid cavernous fistulas are cerebral artenovenous shunts which may present with ocular or orbital signs. Direct fistulas are distinguished from dural shunts with respect to the anatomical situation. PATIENTS: We report on two patients with spontaneous dural carotid cavernous fistulas with multiple feeding vessels. Both patients required endovascular embolization. RESULTS: Therapy was successful in both patients. We present an overview of the clinical picture, the diagnostic procedure, the differential diagnosis and the therapeutic possibilities in this clinical entity. CONCLUSION: Both patients prove the importance of an immediate differential diagnostical classification so that a specific neuroradiological diagnostic can be ensured. Today's advanced endovascular technology offers therapeutic options with less risk for the patient than in recent years.

[Ophthalmia neonatorum caused by Chlamydia trachomatis. Rapid diagnosis and therapy]. / Ophthalmia neonatorum durch Chlamydia trachomatis. Schnelldiagnostik und Therapie.

BACKGROUND: In up to 73% of ophthalmia neonatorum, Chlamydia trachomatis is the causative agents. Untreated sequelae to the eyes and organs may be the result. The aim of this study was to determine the bacterial spectrum of ophthalmia neonatorum with special regard to chlamydia and their diagnostic tests. MATERIALS AND METHODS: We compared the results of 15 newborn with ophthalmia neonatorum. For the diagnosis we used a rapid diagnostic test, Immunofluorescent Antibody Staining and Culture on McCoy cells. Bacteria that were cultured on culture media were also identified. RESULTS: In 66% the newborn showed a positive rapid diagnostic test result that was confirmed by Immunofluorescent Antibody Staining. In 5 patients all tests were negative. CONCLUSIONS: In this study C. trachomatis was the most frequent pathogen. In the culture media we isolated mostly gram-positive cocci but not Neisseria gonorrhoeae. We point out the value of an exact rapid diagnosis and specific treatment to avoid sequelae to the eye and organs.

Respiratory muscle activity during vocalization in the squirrel monkey.

In order to find out which muscles are involved in the respiratory component of primate phonation, the activity of 17 abdominal and thoracic muscles was recorded during vocalization in the squirrel monkey. Vocalization-correlated activity was found in the musculi obliquus externus et internus, rectus et transversus abdominis, intercostalis externus et internus and intercartilagineus. It was lacking in the mm. iliocostalis, latissimus dorsi, longissimus dorsi rhomboideus, serratus posterior superior, trapezius, splenius capitis, sternocleidomastoideus, scalenus medius and pectoralis major. There was simultaneous activation of the rib-raising external and rib-lowering internal intercostal muscles during most vocalizations. It is hence concluded that the intercostals, rather than supporting expiratory efforts, serve to stabilize the thorax, thus providing an anchorage against which the abdominal muscles can act.

Comparison of beliefs and practices of ethnic Viet and Lao Hmong concerning illness, healing, death and mourning: implications for hospice care with refugees in Canada.

This research paper examines the background, cosmology, and health, illness, healing, death, and mourning-related beliefs and practices of two groups of refugees in Canada, the ethnic Viet and the Lao Hmong. Emphasis is placed on the syndrome of uprootedness among refugees which exacerbates the patient's sense of loss in the palliative care setting. Practical recommendations to improve care of these patients and their families are made.

Location of respiratory motoneurons involved in phonation. An HRP study in the squirrel monkey.

In 11 squirrel monkeys (Saimiri sciureus) the motoneuronal distribution of those muscles being involved in the respiratory component of phonation, that is the Mm. obliquus externus and internus, rectus and transversus abdominis, intercostalis externus and internus, and intercartilagineus, were studied with the horseradish peroxidase retrograde tracing technique. It was found that the spinal representations of the abdominal muscles overlap to a large extent. Motoneurons of all four abdominal muscles were found in the lateral, central, medial, ventral as well as dorsal part of the ventral horn, with a clear dominance of the lateral and central positions, however. Marked differences occurred with respect to the rostro-caudal distribution. While rectus motoneurons occupied up to 16 spinal segments, obliquus internus and transversus motoneurons occupied only 9, obliquus externus 14. Furthermore, the density of motoneurons in the different segments showed quite dramatic changes in the case of the obliquus externus and transversus, was relatively constant in the rectus, and formed a single sharp peak in the obliquus internus. The motoneuronal distribution of the intercostal and intercartilaginous muscles showed less overlap than that of the abdominal muscles. Intercostalis internus motoneurons were mainly found laterally in the ventral horn, intercartilagineus motoneurons laterally and centrally, intercostalis externus motoneurons laterally and medially. The intercartilagineus muscle of a specific inter costal space was found to be innervated from 1 to 2 spinal segments, the intercostalis internus from 2, the intercostalis externus from 2 to 3. As all muscles participating in the respiratory component of phonation have a spinal representation in the lateral ventral horn of the lower thoracic cord, this area is proposed to play a crucial role in vocal production.