[Postoperative MRI of the ankle]. / Postoperative Magnetresonanztomographie des Sprunggelenks.

CLINICAL/METHODICAL ISSUE: Postoperative imaging of the ankle can be challenging, even for the experienced radiologist. Pathological and postoperative changes to the primarily complex anatomy of the ankle with its great variety of bone structures, tendons, ligaments, and soft tissue in a very limited space may cause great difficulty in differentiating underlying pathology from expected postoperative changes and artifacts, especially in magnetic resonance imaging (MRI). STANDARD RADIOLOGICAL METHODS: Selecting the appropriate radiological modality is key to making the correct diagnosis. Therefore, knowledge of the initial and current symptoms is just as important as familiarity with the most frequently performed operations in the ankle. PRACTICAL RECOMMENDATIONS: This article aims to give its reader a summary of the most important and frequently performed operation techniques of the ankle and discusses the expected appearance and possible complications in postoperative imaging.

Stereoelectronic Substituent Effects in Saturated Main Group Molecules: Severe Problems of Current Kohn-Sham Density Functional Theory.

The Hartree-Fock method, two common density functionals (PBE and B3LYP), and two new functionals (B97-D and B2PLYP) together with very large AO basis sets are used to compute the isomerization energies for substituted (R [Formula: see text] H, F, Cl) branched to linear alkanes and silanes. The results of accurate SCS-MP2 computations are taken as reference. These reactions are an important test of how nonlocal electron correlation effects on medium-range lengths scales in saturated molecules are treated by approximate quantum chemical methods. It is found that the unacceptably large errors observed previously for hydrocarbons persist also for the here considered more polar systems. Although the B97-D and B2PLYP functionals provide improved energetics, the problem is not fully solved, and thus these systems are suggested as mandatory benchmarks for future density functionals.

Cerebellar ataxia and Purkinje cell dysfunction caused by Ca2+-activated K+ channel deficiency.

Malfunctions of potassium channels are increasingly implicated as causes of neurological disorders. However, the functional roles of the large-conductance voltage- and Ca(2+)-activated K(+) channel (BK channel), a unique calcium, and voltage-activated potassium channel type have remained elusive. Here we report that mice lacking BK channels (BK(-/-)) show cerebellar dysfunction in the form of abnormal conditioned eye-blink reflex, abnormal locomotion and pronounced deficiency in motor coordination, which are likely consequences of cerebellar learning deficiency. At the cellular level, the BK(-/-) mice showed a dramatic reduction in spontaneous activity of the BK(-/-) cerebellar Purkinje neurons, which generate the sole output of the cerebellar cortex and, in addition, enhanced short-term depression at the only output synapses of the cerebellar cortex, in the deep cerebellar nuclei. The impairing cellular effects caused by the lack of postsynaptic BK channels were found to be due to depolarization-induced inactivation of the action potential mechanism. These results identify previously unknown roles of potassium channels in mammalian cerebellar function and motor control. In addition, they provide a previously undescribed animal model of cerebellar ataxia.

A picture of amputees and the prosthetic situation in Haiti.

PURPOSE: The purpose of this study is to present the situation of Haitian amputees and to outline some of the major barriers in Haiti that prevent people from receiving prosthetic treatment. METHOD: Interviews were conducted with amputees throughout Haiti using a 42-question questionnaire. Additionally, interviews were conducted with traditional healers, health care workers, and leaders of handicap associations. Each interview was manuscripted and the data were subsequently coded and analysed in the USA. RESULTS: There are three full-time prosthetic shops and two part-time prosthetic shops in Haiti, all of which are severely limited in the scope of services they are able to provide amputees due to insufficient supplies and inadequately trained personnel. Only 25% of the 164 amputees interviewed had ever had a prosthetic limb. Typically prosthetic treatment is inaccessible and unaffordable for amputees, which prevents many from seeking treatment. The most common cause of amputation in Haiti is infection, followed by motor vehicle accidents. CONCLUSION: There must be additional cooperation between Haitian patients, doctors, traditional healers, prosthetists, and government officials in order to provide more adequate prosthetic care. Prosthetic treatment in Haiti can be successful with cooperation of different entities, proper rehabilitation therapy, adequately trained personnel, and development of culturally appropriate limbs.

[Multifocal steady-state pattern-reversal electroretinography in glaucoma patients]. / Multifokales Steadystate-Musterwechsel-ERG bei Glaukom-Patienten.

AIM: This study was designed to answer the question of whether multifocal steady-state pattern-reversal electroretinography (ERG) is capable of detecting glaucomatous visual field defects. METHOD: Sixteen patients (28 eyes) and ten normal subjects (20 eyes) were examined. Multifocal pattern ERGs were recorded with the RETIscan system and DTL electrodes. We stimulated with a steady-state checkerboard pattern reversal (three reversals during 171 ms sweep length, congruent with 17.5 reversals/s). The multifocal pattern ERG amplitudes were evaluated using discrete Fourier transformation (DFT) across three reversals. In cases of advanced glaucoma, the DFT-calculated amplitudes were combined in hemispheres and checked for correlations with corresponding visual field defects. In all binocularly examined persons, side comparisons ("worse" eye vs "better" eye), and interindividual comparisons (glaucoma vs normal) were carried out. RESULTS: In interindividual comparisons and interocular side comparisons, significant amplitude reductions of the "worse" eyes were seen in the foveal records. No topographical correlation between multifocal pattern ERG amplitudes and visual field defects could be found. CONCLUSIONS: In glaucomatous visual field defects, multifocal steady-state pattern-reversal ERG using the present stimulation was significantly reduced in its foveal records but seems to be incapable of detecting them topographically.

[Acquired hemophilia A as a cause of postoperative bleeding]. / Erworbene Hämophilie A als postoperative Blutungskomplikation.

Acquired spontaneous hemophilia is a rare but potentially life-threatening disease, which poses a major challenge to intensive care medicine. We report a case in which the disease occurred postoperatively in a patient following uncomplicated lumbal discectomy. The clinical sequelae involved hemorrhagic shock (cHb 4.1 g/dl; hct 17 %; systolic BP 60 mmHg; HR 130/min; saO2 73 %) due to retroperitoneal hematoma eight days after neurosurgical intervention. While lesions of the retroperitoneal vessels were not found during emergent angiography and laparotomy, the laboratory results showed a slightly prolonged activated prothrombin time (aPTT; 47 s). However, application of fresh frozen plasma (FFP) even prolonged the aPTT (53 s). Analysis of clotting factors proved a deficiency of factor VIII with a reduced activity of about 20 %, which was resistant against therapy with desmopressin (DDAVP) and substitution of factor VIII. Thus, the plasma-mix-test was performed, showing complete inactivation of the factor VIII-activity of the pooled plasma. This evidenced the presence of acquired inhibitors against factor VIII. Hemostasis was successfully and immediately restored with the application of recombinant factor VIIa (rFVIIa), including boluses of 60 - 80 microg/kg every 6th - 8th hour (supplemented with tranexamic acid, 3 x 1 g/d), leading to a continuous infusion of 12 microg/kg per hour. With prednisolone (1 mg/kgBW/d) over the ensuing 8 weeks, the antibodies were sufficiently suppressed and no additional substitution of factor VIII was necessary to maintain normal hemostasis.

[Multifocal ERG with 30 Hz flicker stimulation in glaucoma patients and normal probands]. / Multifokales ERG mit 30-Hz-Flimmerstimulation bei Glaukompatienten und Normalprobanden.

BACKGROUND: It was the aim of the present study to investigate the value of multifocal ERG with 30 Hz flicker stimulation for glaucoma diagnosis. METHODS: Multifocal ERGs with 30 Hz flicker stimulation were recorded with a mean luminance of 50 cd/m2 and a contrast of 99% from the central 60 degrees of the retina which were stimulated by 61 hexagons. From 30 patients with primary and secondary open-angle and low-tension glaucomas with reproducible visual field losses and glaucomatous optic disc atrophy and 21 normal subjects, one eye was included in the study. The first harmonic wave, the basewave and the ratio of these two parameters were ana-lysed. The responses of seven neighbouring hexagons were averaged for the intraocular comparison between areas with and without perimetric defects and for the comparison between glaucomas and normal subjects. RESULTS: In the glaucoma group, the ratio of the first harmonic wave and the basewave was significantly lower in an area within a perimetric defect than outside the defect (p < 0.001) when compared intraocularly. The extent of ERG changes however did not correlate with the extent of perimetric defects. Comparing the glaucoma with the normal group, the ratio of the first harmonic and the basewave was significantly lower in an area within the perimetric defect in the glaucoma group than in corresponding areas of the normal group (p = 0.002). The first harmonic and the basewave did not differ significantly. DISCUSSION: These results show that the method is not appropriate to objectively indicate visual field losses although it statistically separates glaucomas from normal subjects.

Two methods of lens opacity measurements in glaucomas.

PURPOSE: Determination of lens opacity is important in aging glaucoma patients, because sensory testing may be influenced by increasing lens opacity. Purpose of this study was to measure lens opacity in normals and glaucoma patients using two different techniques, to compare both methods, and to correlate the results with contrast sensitivity testing. METHODS: 94 glaucomatous eyes, 47 ocular hypertensive eyes, and 79 control eyes were studied using the following devices: opacity lens meter (OLM, objective back scatter method), stray light meter (SLM, subjective forward scatter using flicker light), and temporal contrast sensitivity (full-field flicker test). SLM results were separately analyzed at the lower and upper flicker disappearance. All subjects were younger than 66 years and had no significant cataracts. RESULTS: In patients and in normal subjects OLM readings and SLM findings elicited at the upper disappearance point are significantly correlated with age and with each other (R >0.45, P<0.001), while SLM at the lower disappearance point shows no such correlation. In normals, but not in patients, SLM at the lower disappearance point is significantly correlated with temporal contrast sensitivity. CONCLUSIONS: Both devices can be used for quantifying lens opacity in glaucoma. SLM readings with increasing light intensity at the lower disappearance point seems to be more influenced by the individual flicker sensitivity than determination of the upper flicker disappearance. Therefore, using the SLM in glaucoma patients, the threshold measurements based on the upper disappearance of the flicker should be used instead of the suggested mean threshold measurements.

The negative response of the flash electroretinogram in glaucoma.

The existence of a negative ERG component following the b-wave has been known for a long time. Recently, in unilateral macaque experimental glaucoma, a negative response in flash electroretinograms under scotopic as well as photopic conditions has been shown to be greatly reduced or absent compared to the healthy fellow eye. The aim of this pilot study was to test whether a late negative electroretinogram component is reduced also in human glaucoma patients under different stimulus conditions. Dark-adapted ganzfeld flash electroretinograms were recorded after 30 min of dark using two test conditions, obtained as optimal in pilot studies on controls. Under the scotopic condition I white Xenon-flashes of intensity 0.53 Log photopic Td s were presented on a low white background of 1.38 Log scotopic Td. Under the more photopic condition II orange flashes of intensity -0.37 Log photopic Td s were presented on a blue-adapting background of 2.5 Log scotopic Td. Nine controls and 18 patients with advanced glaucoma were analyzed. The amplitude of the negative response was not significantly reduced in glaucoma patients (condition I: -28.5+/-23.7 microV; condition II: -25.2+/-19.7 microV) compared to controls (condition I: -41.4+/-36.6 microV; condition II: -31.3+/-26.2 microV). The peak latency of the responses under condition I and II did not differ significantly between patients and controls. Thus, the late negative electroretinogram component in ganzfeld flash electroretinograms obtained under scotopic and more photopic conditions does not seem to distinguish as easy between human controls and glaucoma patients as animal experiments suggest.

A molecular switch for specific stimulation of the BKCa channel by cGMP and cAMP kinase.

The cGMP and the cAMP pathways control smooth muscle tone by regulation of BK(Ca) (BK) channel activity. BK channels show considerable diversity and plasticity in their regulation by cyclic nucleotide-dependent protein kinases. The underlying molecular mechanisms are unclear but may involve expression of splice variants of the BK channel alpha subunit. Three isoforms, BK(A), BK(B), and BK(C), which were cloned from tracheal smooth muscle, differed only in their C terminus. When expressed in HEK293 cells, cGMP kinase (cGK) but not cAMP kinase (cAK) stimulated the activity of BK(A) and BK(B) by shifting the voltage dependence of the channel to more negative potentials. In contrast, BK(C) was exclusively stimulated by cAK. BK(C) lacks a C-terminal tandem phosphorylation motif for protein kinase C (PKC) with Ser(1151) and Ser(1154). Mutation of this motif in BK(A) switched channel regulation from cGK to cAK. Furthermore, inhibition of PKC in excised patches from cells expressing BK(A) abolished the stimulatory effect of cGK but allowed channel stimulation by cAK. cAK and cGK phosphorylated the channel at different sites. Thus, phosphorylation/dephosphorylation by PKC determines whether the BK channel is stimulated by cGK or cAK. The molecular mechanisms may be relevant for smooth muscle relaxation by cAMP and cGMP.

Effects of doxorubicinol on excitation--contraction coupling in guinea pig ventricular myocytes.

The cardiotoxicity of the anticancer drug doxorubicin may be related to its main metabolite doxorubicinol. In this study, the acute effects of doxorubicinol on excitation-contraction coupling in isolated guinea pig ventricular myocytes were investigated and compared with doxorubicin using the whole-cell patch-clamp-, fura-2 fluorescence- and cell-edge tracking techniques. Both drugs were applied intracellularly by diffusion from the patch electrode for 15--20 min. Doxorubicin (100 microM) prolonged the action potential duration (APD) by 31% and enhanced cell shortening by 26%. Contrary to doxorubicin, doxorubicinol (10 microM) shortened APD by 25% and decreased cell shortening by 31%. APD shortening by doxorubicinol was due to an increase of the delayed rectifier K(+) current. Neither the inward rectifier K(+) current nor the L-type Ca(2+) current was influenced by doxorubicinol. The decline in cell shortening induced by doxorubicinol was not exclusively due to APD shortening because doxorubicinol reduced the peak Ca(2+) transient by 23% in cells clamped with an action potential of constant duration. Despite opposite effects on APD and contractility, both doxorubicin and doxorubicinol produced a considerable delay in the activation and inactivation of contraction and Ca(2+) transient, compatible with an impaired function of the sarcoplasmic reticulum. It is suggested that doxorubicinol-induced APD shortening may amplify the detrimental effects of both doxorubicin and doxorubicinol on sarcoplasmic reticulum Ca(2+) load and hence on contractile function. The accumulation of doxorubicinol in the cardiac myocytes may play an important role in the time-dependent development of doxorubicin-induced ventricular dysfunction.

The a-wave of the dark adapted electroretinogram in glaucomas: are photoreceptors affected?

AIMS: To evaluate whether the a-wave of the dark adapted flash electroretinogram (ERG) is affected by glaucomatous damage. METHODS: ERGs were recorded in 20 patients (age 33-65 years) with advanced glaucomas (primary and secondary open angle and low tension glaucomas) and 20 normals using a ganzfeld stimulus. After 30 minutes of dark adaptation and pupil dilatation to at least 7.5 mm in diameter, luminance response functions were obtained presenting white flashes of increasing scotopic luminance (the highest flash intensity being 9.4 cd/s/m2, the lowest being 5.75 log units below it) with an interflash interval of 5 seconds. For each scotopic luminance, the responses of four flashes were averaged. The a-wave's amplitude was measured at 10, 11, and 12 ms. Within the glaucoma group, correlations between the interocular differences of the a-wave's amplitude and the mean deviation of a static perimetry (Octopus 500 perimeter, program G1) were computed for all flash intensities. Between normals and glaucomas, the a-wave's amplitude was compared for all flash intensities (paired t test). RESULTS: Within the glaucoma group, the interocular differences of the a-wave's amplitudes correlated significantly with the differences of the MD for flash intensities of 9.4, 5.3, 1.7, and 0.5 cd/s/m2. The a-wave's amplitude was significantly lower in the glaucoma compared with the normal group (p <0.005) for flash intensities of 9.4 and 5.3 cd/s/m2. CONCLUSION: These electrophysiological results imply that also the outer retinal structures, especially the photoreceptors, may be affected by glaucomatous damage.

The b-wave of the dark adapted flash electroretinogram in patients with advanced asymmetrical glaucoma and normal subjects.

AIMS: To evaluate whether the b-wave of the dark adapted flash electroretinogram (ERG) is affected by glaucomatous damage. METHODS: ERGs were recorded in 35 patients aged 33-65 years with advanced asymmetrical glaucomas (interocular difference of perimetric defects (mean deviation) >2 dB between the two fellow eyes of the glaucoma patients, primary and secondary open angle and low tension glaucomas) and 17 normal subjects matched for age and sex using white flashes of a xenon discharge tube in a Ganzfeld stimulator. After 30 minutes of dark adaptation luminance response functions were obtained using flashes of increasing scotopic luminance (highest 9.4 cd/s/m2, lowest 5.5 log units below it). The parameters Vmax, n, and K of the Naka-Rushton equation were computed from the measurement values based on the usual fitting procedure. These parameters, together with b-wave amplitudes and implicit times for all flash intensities, were compared interocularly and between the normal subjects and those with glaucoma. Correlations were computed between interocular differences of the mean deviation and interocular differences of Vmax, n, K, b-wave amplitudes, and implicit times between the two fellow eyes of the patients with asymmetrical glaucomatous damage. RESULTS: Implicit times were significantly longer (p<0.005) in the glaucoma patients than in the normal group for flash intensities of 9.4, 5.3, 1.7, 0.53, and 0.17 cd/s/m2. b-Wave amplitudes did not differ significantly between the two study groups. Comparing the two fellow eyes of each patient with glaucoma, Vmax was significantly higher in the less damaged eye than in the more damaged eye. The interocular differences in the mean deviation correlated significantly with the interocular differences in the b-wave amplitudes, implicit times, and Vmax. CONCLUSIONS: These results suggest that glaucomas can lead to electrophysiologically measurable damage of the inner nuclear layer.

[Central corneal thickness in normal eyes, patients with ocular hypertension, normal-pressure and open-angle glaucomas--a clinical study]. / Zentrale Hornhautdicke bei Normalen, Patienten mit okulärer Hypertension, Normaldruck- und Offenwinkelglaukomen--eine klinische Studie.

BACKGROUND: The relation between Goldmann applanation tonometry and central corneal thickness (CCT) was investigated in several studies during the last thirty years. It was the aim of the present study to evaluate CCT in normals, patients with ocular hypertension, low-tension, and open-angle glaucomas. PATIENTS AND METHODS: CCT was measured in 135 normal eyes, 137 with ocular hypertension, 65 with low-tension, and 94 with primary and secondary open-angle glaucomas using the AL-11000-pachymeter (Tomey). The results were compared using the unpaired t-test. RESULTS: CCT was significantly higher in the patients with ocular hypertension (586 +/- 43 microns) than in the normal group (566 +/- 37 microns, p < 0.0001), in low-tension glaucomas (555 +/- 46 microns, p < 0.0001), and in open-angle glaucomas (558 +/- 31 microns, p < 0.0001). The latter three groups did not differ significantly. There was no significant correlation between CCT and age, the actually measured IOP, the highest IOP in the patient's history, or the spherical equivalent. CONCLUSIONS: Only patients with ocular hypertension showed a significant difference in CCT compared with normals. Pachymetry thus should be conducted in those patients to avoid overestimation of the IOP by applanation tonometry. In most of the patients with low-tension and open-angle glaucomas however, CCT regarded without other parameters (e.g. corneal or scleral rigidity) plays a minor role in detection of elevated IOP according to the results of this study.

Visual evoked potentials under luminance contrast and color contrast stimulation in glaucoma diagnosis.

PURPOSE: To evaluate the diagnostic value of visual evoked potential (VEP) assessment with luminance-contrast and color-contrast stimulation in the detection of glaucoma. PATIENTS AND METHODS: The study included 59 patients (96 eyes) with glaucomatous changes of the optic disc and visual field defects and 58 control eyes of 29 healthy patients. Four types of pattern VEP stimulation (0.9 cycle/degree) were performed in all patients: achromatic, alternating sine-wave stripe pattern: 6 reversals per second, contrast of 10% (activation of predominantly the magnocellular pathway); isoluminant, red-green stripe pattern: 83.3 milliseconds onset, 83.3 milliseconds offset, contrast of 30% and 80% (activation of predominantly the parvocellular pathway); and blue grating with yellow background adaptation: 200 milliseconds onset, 500 milliseconds offset (activation of the blue-sensitive pathway). RESULTS: The glaucoma group and the control group differed significantly (P < 0.01) in the peak times of all chromatic VEP responses and to a lesser degree in the achromatic VEP. Considering the amplitudes, only the low-contrast red-green stimulus showed a statistically significant reduction in glaucoma. At a predefined specificity of 90%, in separating patients with glaucoma from healthy control subjects, the peak time of the blue-yellow VEP had a high sensitivity (90%), whereas the sensitivity of the achromatic VEP was low (31%). The red-green VEP showed a sensitivity of 73% using low contrast and 71% using high contrast. In a paired correlation analysis with visual field defects, all stimulations showed significant (P < 0.05) results. Correlation coefficients were highest (R = 0.79, P < 0.01) for the peak time of the blue-yellow VEP. CONCLUSIONS: VEP measurements with presumable stimulation of single neuronal pathways can detect glaucomatous optic nerve damage in a considerable fraction of patients with visual field loss. Occipital responses to chromatic stimulation seem to be more sensitive to glaucoma damages than do responses to achromatic pattern reversal stimulation.

BK(Ca) channel activation by membrane-associated cGMP kinase may contribute to uterine quiescence in pregnancy.

We investigated the influence of pregnancy on large-conductance calcium-activated potassium channel (BK(Ca)) activity (NP(o)) and on channel expression in membranes of isolated human myometrial smooth muscle cells. NP(o) in inside-out patches was higher in pregnant myometria (PM) compared with nonpregnant myometria (NPM), and the half-maximal activation potential was shifted by 39 mV to more negative potentials. This effect was not due to an enhanced BK(Ca) channel expression. In the presence of cAMP kinase (PKA) or cGMP kinase (PKG), NP(o) increased in patches from PM but decreased in those from NPM. Western blot analysis and use of a specific PKG inhibitor (1 microM KT-5823) verified the existence of a partially active membrane-associated PKG. Inhibition of PKA by 100 nM PKI, the inhibitory peptide of PKA, had no effect on NP(o). 8-p-Chlorophenylthio-cGMP (8-pCPT-cGMP) hyperpolarized cells from PM. This effect was abolished by iberiotoxin, a specific blocker of BK(Ca) channels. It is concluded that an endogenous, membrane-bound PKG in myometrial cells specifically enhances BK(Ca) channel activity during pregnancy and thus may contribute to uterine quiescence during pregnancy.

Mechanisms of NO/cGMP-dependent vasorelaxation.

Both cGMP-dependent and -independent mechanisms have been implicated in the regulation of vascular tone by NO. We analyzed acetylcholine (ACh)- and NO-induced relaxation in pressurized small arteries and aortic rings from wild-type (wt) and cGMP kinase I-deficient (cGKI(-/-)) mice. Low concentrations of NO and ACh decreased the spontaneous myogenic tone in wt but not in cGKI(-/-) arteries. However, contractions of cGKI(-/-) arteries and aortic rings were reduced by high concentrations (10 micromol/L) of 2-(N:, N-diethylamino)-diazenolate-2-oxide (DEA-NO). Iberiotoxin, a specific blocker of Ca(2+)-activated K(+) (BK(Ca)) channels, only partially prevented the relaxation induced by DEA-NO or ACh in pressurized vessels and aortic rings. DEA-NO increased the activity of BK(Ca) channels only in vascular smooth muscle cells isolated from wt cGKI(+/+) mice. These results suggest that low physiological concentrations of NO decrease vascular tone through activation of cGKI, whereas high concentrations of DEA-NO relax vascular smooth muscle independent of cGKI and BK(Ca). NO-stimulated, cGKI-independent relaxation was antagonized by the inhibition of soluble guanylyl cyclase or cAMP kinase (cAK). DEA-NO increased cGMP to levels that are sufficient to activate cAK. cAMP-dependent relaxation was unperturbed in cGKI(-/-) vessels. In conclusion, low concentrations of NO relax vessels by activation of cGKI, whereas in the absence of cGKI, NO can relax small and large vessels by cGMP-dependent activation of cAK.

The sequential processing of visual motion in the human electroretinogram and visual evoked potential.

Mechanisms of motion vision in the human have been studied extensively by psychophysical methods but less frequently by electrophysiological techniques. It is the purpose of the present investigation to study electrical potentials of the eye (electroretinogram, ERG) and of the brain (visual evoked potential, VEP) in response to moving regular square-wave stripe patterns spanning a wide range of contrasts, spatial frequencies, and speeds. The results show that ERG amplitudes increase linearly with contrast while VEPs, in agreement with the literature, show an amplitude saturation at low contrast. Furthermore, retinal responses oscillate with the fundamental temporal stimulus frequency of the moving pattern while brain responses do not. In both the retina and the brain, the response amplitudes are tuned to certain speeds which is in agreement with the nonlinear correlation-type motion detector. Along the ascending slopes (which means increasing amplitudes) of the tuning functions, the ERG curves overlap at all spatial frequencies if plotted as a function of temporal stimulation frequency. The ascending slopes of the tuning functions of the VEP overlap if plotted as a function of speed. The descending slopes (which means decreasing amplitudes) of the tuning functions show little (ERG) or no (VEP) overlap and the waveforms at high speeds approach pattern-offset-onset responses. These observations suggest that in the retina motion processing along the ascending slopes of the tuning curves takes place by coding the temporal stimulation frequency which depends on the spatial frequency of the moving pattern. In the brain, however, motion processing is by speed independent of spatial frequency. Simple calculations show that the VEP information is decoded from the ERG signal into a speed signal.

Motion-Evoked pattern visual evoked potentials in glaucoma.

PURPOSE: To evaluate motion-evoked brain potentials for glaucoma diagnosis. PATIENTS AND METHODS: Stripe patterns were presented in Maxwellian view under different stimulus conditions not combined in a factorial design. Spatial frequencies of 0.33 and 0.88 cycles/degree, with speeds of 10 and 5.9 degrees/second and contrasts of 0.04 and 0.93 were used. A 32 degrees whole field and a peripheral 32 degrees-27 degrees annular stimulus were used. Duration of motion was 200 milliseconds, and the interstimulus interval was 1,800 milliseconds. Recordings were obtained from Oz and P3. Thirty-four healthy patients, 12 glaucoma suspects, and 26 patients with open-angle glaucoma were tested. RESULTS: Normal response amplitudes decrease with age only under low contrast conditions, whereas response peak times increase under most conditions. Normal responses are much larger at P3 than at Oz, whereas in open-angle glaucoma, much less difference is seen. In these patients, the response amplitude at P3 is significantly reduced under all conditions, whereas a delay in peak time is less pronounced. A small but significant negative correlation (r = -0.44, P < 0.05) between response amplitude and mean perimetric defect was observed only with the annular stimulation. At a specificity of 90%, a sensitivity of approximately 76.7% for the low contrast and low spatial frequency condition was observed. CONCLUSIONS: Motion-evoked responses recorded at P3 are altered in open-angle glaucoma and thus can be useful as an additional test in glaucoma diagnosis.

[Synopsis of various electrophysiological tests in early glaucoma diagnosis--temporal and spatiotemporal contrast sensitivity, light- and color-contrast pattern-reversal electroretinogram, blue-yellow VEP]. / Synopsis verschiedener sinnesphysiologischer Untersuchungen in der Glaukom-Frühdiagnose--Zeitliche und örtlich-zeitliche Kontrastempfindlichkeit, Helligkeits- und Farbkontrast-Muster-ERG, Blau-auf-gelb-VEP.

BACKGROUND: Of the three glaucoma-defining criteria intraocular pressure, optic-nerve damage, and visual field damage, the latter is a late symptom. Therefore, in order to improve an early sensory diagnosis, new tests are necessary. It is the aim of the present paper to test new sensory methods, to rank them in an order of sensitivity, and to base them on possible pathophysiological mechanisms. PATIENTS AND METHODS: The tests were carried out in subjects of the Erlangen Glaucoma registry: Normals, patients with ocular hypertension, and patients with open-angle glaucoma without or with field defects. The tests are designed to preferentially probe the function of different groups of ganglion cells. Psychophysical methods: Temporal contrast sensitivity in a ganzfeld as "Erlangen flicker test" and spatio-temporal contrast sensitivity to test Magno-cell function. Electrophysiological methods: Pattern-reversal electroretinogram with a luminance-contrast pattern to test Magno-cell function, color-contrast pattern electroretinogram for Parvo-cell function, and blue-on-yellow visual evoked potential to test the "blue-sensitive" pathway. RESULTS: The most sensitive test is the temp.CS, it is significantly reduced in OHT (p < 0.01). The spatio-temp.CS is reduced in perimetric stages (p < 0.01). The BY-VEP is altered in the preperimetric stage (p < 0.01), the PR-ERG in perimetric stages (p < 0.01). The CC-ERG is reduced in even later stages. These results are in agreement with the hypothesis that tests selective for non-redundant neurons are of early diagnostic value. Multivariate analyses increase the early diagnostic value when different functions are tested in combination. CONCLUSIONS: When a particular test is taylored to the the special needs of certain groups of ganglion cells sensory defects can be observed before the occurrence of optic-nerve damage (OHT). The most sensitive psychophysical test is the "Erlangen flicker test" which is a screening test selective for M cells. The most sensitive electrophysiological test is the BY-VEP testing the blue-sensitive ganglion cells.