[Functional eye muscle changes in endocrine orbitopathy]. / Funktionelle Augenmuskelveränderungen bei endokriner Orbitopathie.

BACKGROUND: To determine the functional changes in the extraocular muscles in patients with thyroid-associated ophthalmopathy (TAO). PATIENTS AND METHODS: Horizontal saccades with an amplitude of 20 degrees were carried out over a period of 2 min. Eight patients with acute TAO and five patients with chronic TAO were compared with ten age-matched healthy individuals. Ocular movements were recorded using the "Ober 2" system based on infrared technology. For evaluation of fatigue effects, the parameters of the first five and the last five saccades were analysed. RESULTS: A significant difference of four and five, respectively, out of nine tested saccadic variables including maximum velocity (Vmax) was found both before and after fatigue. In comparison to normal subjects, patients with chronic TAO revealed mildly increased reduction of Vmax after fatigue. Results in patients with acute TAO were related to the action of the most severely affected muscle. On active contraction of the medial rectus muscle (adducting saccades), Vmax was not significantly decreased after fatigue. On passive elongation of the medial rectus muscle (abducting saccades), however, Vmax was initially markedly decreased and increased significantly after fatigue. CONCLUSIONS: Functional changes of extraocular muscles in patients with TAO can be demonstrated by saccadic analysis. The inverse change in velocity after fatigue in acute disease indicates an improvement of muscle elasticity during exertion and strongly supports the concept that early impairment of bulbar motility in active TAO results from contracture of myofilaments. Thus, analysis of the fatigue effect may help to differentiate between acute and chronic disease.

[Measuring saccades in endocrine orbitopathy]. / Sakkadenmessung bei endokriner Orbitopathie.

Thyroid-associated ophthalmopathy (TAO) is evaluated mainly by orthoptic examination and morphometric parameters such as ultrasound, CT scanning or magnetic resonance imaging. Inflammatory changes of the extraocular muscles lead to an impairment of eye movement. Recent evidence suggests that saccades are altered by changes to the extraocular muscles. Although of potential interest, this phenomenon has so far received little attention. To determine the role of saccades as a potential diagnostic tool for assessing the function of the affected muscles, we have begun to analyze saccadic parameters in patients with TAO. Preliminary results of this study are reported in the present paper. For registration of both horizontal and vertical eye movements, we used the "Ober-2-Apparatus," which uses the infrared technique. Horizontal and vertical saccades with an amplitude of 10 degrees were analyzed in 20 healthy persons and 30 patients suffering from TAO. Patients showed changes in the quality of saccades, such as the appearance of glissades and additional correctional saccades as well as quantitative changes, such as an increase in the maximum speed and latency. Our current data suggest the presence of saccadic alterations in TAO. Our ongoing studies are designed to evaluate whether characteristic changes can be assigned to certain stages of the disease and whether assessment of saccadic changes in a promising tool for early detection and functional follow-up in patients with TAO.

Transcutaneous electrical nerve stimulation (TENS) for treatment of severe angina pectoris refractory to maximal medical and surgical management--a case report.

This report describes the use of a transcutaneous nerve stimulator for the treatment of severe angina pectoris in a young man refractory to maximal medical management after coronary angioplasty and coronary bypass surgery. Its successful use resulted in a marked clinical improvement and an impressive reduction in hospitalizations and other utilization of health care resources. Consideration for use of a transcutaneous nerve stimulator should be given in similar patients when all other accepted medical and surgical treatment modalities fail to provide adequate pain control.