[Subretinal co-application of rtPA and bevacizumab for exudative AMD with submacular hemorrhage. Compatibility and clinical long-term results]. / Subretinale Koapplikation von rtPA und Bevacizumab bei exsudativer altersbedingter Makuladegeneration mit submakulärer Blutung. Kompatibilität der Wirkstoffe und klinische Langzeitergebnisse.

Exudative age-related macular degeneration (AMD) is the most frequent cause of acute submacular hemorrhage (SMH). Without treatment the formation of a macular scar with poor visual function is the usual outcome. While several surgical treatment approaches have been proposed to date, there is no general consensus regarding optimal treatment of acute SMH. Vitrectomy with subretinal co-application of recombinant tissue plasminogen activator (rtPA) and bevacizumab followed by a gas tamponade is a new approach which has shown promising functional results in clinical studies. The aim of the co-application of rtPA and bevacizumab is to simultaneously displace the submacular hemorrhage from the fovea and to effectively reduce choroidal new vessel activity. Experimental studies have shown that rtPA and bevacizumab are compatible in a co-application.

The incidence and mechanism of transphyseal spread of osteosarcoma of long bones.

Although the physeal cartilage is considered resistant to invasion by metaphyseal osteosarcoma, no objective clinical proof exists to support this view. Fourteen cases of osteosarcoma of long bones in patients ranging in age from ten to 19 years with open physes were reviewed to determine the incidence of transphyseal spread. The physeal cartilage was not crossed in only two cases. In the remaining 12 cases the tumor crossed the cartilaginous plate partially or completely, remaining in the epiphysis in seven and crossing the articular cartilage and involving the joint in five. Histologic sections showed that increased vascularity occurs initially, followed by osteoclastic and chondroclastic activity at the physeal plate with subsequent tumor tissue invasion. The incidence of transphyseal spread in the three published series (total of 64 cases, including the present 14 cases) is 81.2%. This is contrary to the often published unsupported statements of others. Transphyseal spread of osteosarcoma is the rule rather than the exception.