[Postoperative intestinal paralysis caused by the muscarinic receptor blocker tiotropium bromide]. / Postoperative Darmparalyse durch den Muscarinrezeptorenblocker Tiotropiumbromid.

Drug-induced manipulation of the different muscarinic receptors is gaining increasing interest in the treatment of various diseases. Despite enhanced specific chemical design of these substances, side effects in other organ systems cannot be avoided completely. The observations presented led to the conclusion that under certain circumstances the bronchodilator tiotropium bromide can cause paralytic ileus.

Vascular occlusion of the retina: an experimental model. I. Leukocyte aggregates.

A new technique was developed to study the pathogenesis of retinal arteriolar occlusion in the pig. Using a catheter with its tip in front of the exit of the ophthalmic artery, autologous microparticles could be injected directly into the retinal arterial system. These microparticles were C5a-des-Arg stimulated leukocytes, which were aggregated to pellets of different sizes ranging from 0.26 to 1.0 mm. For better adhesion of the aggregates to the endothelium, endothelial damage was induced by the injection of additional substances, including methomidate and endothelial antibodies. In a further series of experiments systemic hypoxemic conditions were created over several hours prior to injection of the leukocyte aggregates. This resulted in cotton-wool spots and arterial branch occlusions with retinal edema. Furthermore, retinal hemorrhages occurred. This experimental model seems to be appropriate for mimicking retinal arteriolar occlusion syndromes.

Intraocular foreign bodies. 297 consecutive cases.

The records of 297 patients with intraocular foreign body (IOFB) injuries were analyzed in a retrospective study ranging from 1956 to 1985, and the data of the three decades were compared. 62% of the IOFB were located in the vitreous, 13.5% in the posterior sclera. There was no significant difference between Haab's and Hirschberg's methods in removing the IOFB. In 6.7% an enucleation followed the primary operation, half of these due to postoperative infection. The number of injuries with IOFB has declined. The postoperative improvement of visual acuity has doubled in the last decade compared to the first. The importance of removing the IOFB is stressed, as an unsuccessful attempt considerably worsens the prognosis. 5 of the 297 cases were female, which emphasizes the causative occupational factor. Hammering was the commonest cause of IOFB (80%). None were wearing protective goggles. The importance of wearing protective goggles should be stressed in health education programs.

[Significance of the thrombin-antithrombin III complex in the diagnosis of pulmonary embolism and deep venous thrombosis--comparison with fibrinopeptide A, platelet factor 4 and beta-thromboglobulin]. / Die Bedeutung des Thrombin-Antithrombin III-Komplexes in der Diagnostik der Lungenembolie und der tiefen Venenthrombose--Vergleich mit Fibrinopeptid A, Plättchenfaktor 4 und beta-Thromboglobulin.

In 22 patients with suspected pulmonary embolism and 19 patients with suspected deep vein thrombosis, thrombin-antithrombin III complex (TAT) as an indicator of thrombin activation was measured using a newly developed ELISA. For comparison fibrinopeptide A (FPA), as a marker of an activated coagulation, as well as platelet factor 4 (PF4), and beta-thromboglobulin (beta-TG), as markers of platelet activation, were determined. In all patients in whom pulmonary embolism was confirmed by perfusion lung scan and in 15 of 16 patients in whom deep vein thrombosis was confirmed by phlebography, TAT exceeded the upper limit of normal (3.0 ng/ml). FPA was increased in 71% of the pulmonary embolism patients, PF4 in 53%, and beta-TG in 59%. The data for the patients with deep vein thrombosis were comparable. PF4 and beta-TG were increased in more than 25% of the normal controls, FPA in 17%, and TAT in 9%. TAT is very sensitive in detecting an activation of the coagulation system in patients with suspected thromboembolic events. The test, however, is not specific for thromboembolism; it only indicates an activation of the coagulation system. Acute pulmonary embolism or deep vein thrombosis would appear to be unlikely if TAT is normal. The measurement of TAT is easier and less susceptible to disturbances than that of FPA, PF4, and beta-TG.