[Partial financing of public health services by federal insurance--conceptional restriction or future model?]. / Teilfinanzierung von OGD-Versorgungsleistungen durch Krankenkassen--konzeptionelle Einengung oder zukünftiges Modell?

The growing deficits of community budgets force the Public Health Service to streamline its duties and activities and to develop strategies which allow reimbursement by other resources. The possibilities for part financing of tasks of the Bremen Public Health Office by local statutory health insurance funds are considered and discussed.

[Behavior of the intraocular pressure after blunt eye injuries]. / Augeninnendruckverhalten nach Bulbusprellungen.

Elevation of intraocular pressure is often seen immediately after blunt trauma of the eye, but it can occur even years after the primary impact. A retrospective study was performed in 144 patients with contusion to the eye. After a mean observation period of 6.1 years, a significant rise in intraocular pressure was found in the engaged eye (P < 0.05). In more than 8% of the patients the level of intraocular pressure exceeded 22 mmHg, but only 3 cases developed a glaucomatous visual field and optic nerve head changes. Thus, the risk of secondary glaucoma after contusion of the eye is low.

Local measures for the reduction of drug emergency risks and drug mortality risks.

The alarming increase of drug mortality rates in Germany was followed by research projects to enlighten the causes of this increase. The results of the Bremen, Hamburg and Berlin studies 1991-92, led to the conclusion that specific risk constellations have to be considered in the process of improving the drug counselling and health care system in the community. Primary prevention measures in kindergartens and schools, special services for families with addiction problems, decriminisation of drug abuse, the strengthening and specialisation of the counselling system and health services and new intervention strategies including methadone substitution should be integrated into local drug plans.

The pattern ERG in glaucoma: effect of pattern reversal time.

Pattern reversals with a ramp-like temporal course evoke transient pattern electroretinograms (PERG) that are delayed and attenuated in comparison with responses evoked by a step-like course (abrupt pattern reversals). This delay depends on the reversal time and probably represents a measure for temporal characteristics of the activated retinal structures. A pattern reversal stimulator with adjustable reversal periods (matrix of 8 x 14 rectangular red light emitting diodes, element size 2 degrees x 1 degree, stimulus area 16 degrees x 14 degrees) was used to record transient PERGs from 20 glaucomatous eyes with early or moderate visual field damages (measured with computer perimetry). The q-wave (P1) amplitude difference between the glaucoma group and normal subjects with step-like reversal stimulation was not significant (P = 0.23). On the other hand, a highly significant separation (P < 0.0001) between both groups was possible using the P1 latency at ramp-like stimulation or the response latency shift between step and ramp-like stimulation (Pattern reversal time, 30 ms).

Cortical potentials to pattern reversal and luminance onset under ramp stimulation conditions in glaucoma.

Stimulus quantities with a ramp-like temporal course evoke cortical potentials that are delayed and attenuated in comparison with responses evoked by a step-like course. This delay probably depends on temporal transfer characteristics of the activated precortical visual system. In a pilot study, luminance onset and pattern-reversal stimulation using this technique (light-emitting diode stimulator; transition time, 50 ms) were applied to 18 glaucomatous eyes with early visual field damage. The visual evoked cortical potential latency shifts between ramp and step mode were compared with visual field indices (mean defect, corrected loss variance). The pattern-reversal stimulation in ramp mode yielded a significant difference between the glaucoma group and normal subjects (p less than 0.004). The difference between groups with pattern-reversal stimulation in step mode was not significant (p = 0.15). From the determined visual field indices, only the mean defect showed a significant correlation to the measured visual evoked cortical potential latency shift, with both luminance-onset and pattern-reversal stimulation. In glaucoma with early malfunction, the precortical transmission and processing of lower and middle temporal frequencies, which are predominant in ramp-like temporal stimulus courses, are obviously more affected than the transmission of higher frequencies. The ramp stimulation technique for visual evoked cortical potentials might be of interest as a tool to detect early and specific functional defects in glaucoma.

[Early changes of the vascular system of the eye in hyperlipoproteinemia]. / Frühe Veränderungen am Gefässsystem des Auges bei Hyperlipoproteinämie.

A complete ophthalmological examination including fluorescein angiography of the retina, iris, and limbus corneae was performed in 77 patients suffering from hyperlipoproteinemia. An abnormal angiogram of the retina was observed in one-third of the cases and in 50% of the irises, respectively. The common angiographic findings were hyperpermeabilities of vessels. The results of the study identify hyperlipoproteinemia as a vascular risk factor. Its relationship to atherosclerosis is discussed.

[Value of iris fluorescence angiography in the early diagnosis of vascular lesions]. / Zum Stellenwert der Irisfluoreszenzangiographie bei der Frühdiagnostik von Gefässläsionen.

Fluorescein angiographies of the iris and retina were performed both in normal individuals (104) and in patients suffering from hyperlipoproteinemia (48), maturity-onset diabetes (184), systemic hypertension (12) and atherosclerosis (12). While hyperpermeation of dye located at the pupillary border was seen in 7.7% of the normals, leakages occurred in 66.6% of the hyperlipoproteinemics and in 79% of the recent maturity-onset diabetics. Paraclinical examination of the normal subjects with pathologic dye transit revealed vascular risk factors in each case. Thus, fluorescein iris angiography is a suitable method of detecting vascular damage in cases of metabolic disorder as early as possible.

Fluorescein angiography in inflammation of the peripheral fundus: involvement of the pars plana corporis ciliaris. III.

Two types of cyclitis posterior had to be differentiated owing to the fluorescein angiographic pattern observed. At first, a diffuse, belt-shaped staining of the whole pars plana, and secondly, a circumscribed staining of the inflammatory foci. Both types were combined with the permeation of dye into the cystoid spaces as well as with a high incidence of macular and papillary edema.

Fluorescein angiography in inflammation of the peripheral fundus: the normal fluorescein angiographic pattern. I.

The normal angiographic pattern of the peripheral vasculature was studied in 25 healthy individuals. There was no pathologic leakage of dye from the choroid or retina. However, small areas of choroidal nonperfusion occurred even in young persons. Vessels which never filled with fluorescein represented a common feature of the peripheral retinal vasculature. As a rule, pars plana corporis ciliaris did not stain with dye during the whole angiogram.

Fluorescein angiography in inflammation of the peripheral fundus: involvement of the choroid and retina. II.

Fluorescein angiographies were performed in 65 patients with peripheral uveitis. 34 subjects (52%) showed pathologic dye transit of the peripheral choroid. Fluorographic evidence of retinal involvement was high (91%), preferentially consisting in leakages from capillaries and venules. Fluorescein angiography was able to detect minute lesions and corresponded with the activity of the inflammation.

[Results of direct coagulation of the ciliary body and cyclodialysis in hemorrhagic glaucoma]. / Ergebnisse der direkten Ziliarkörperkoagulation mit Zyklodialyse beim hämorrhagischen Glaukom.

This paper discusses direct coagulation of the ciliary body as a microsurgical method for treatment of hemorrhagic glaucoma. During a follow-up period of 6-12 months intraocular pressure was lowered in all cases from an average of 42.8 mm Hg. Of the 26 patients operated on, 25 were subsequently free of pain. Stabilization of visual acuity was achieved in two-thirds of the cases. The surgical procedure is simple and involves little risk.

Quantitative evaluation of pallor-disc ratio and colour of the optic disc by a photographic method.

A photographic technique is described, which is based on simultaneous photography of the papilla with green and red filters by means of a stereoscopic fundus camera. Using black and white film, the negatives are photometrically measured and the pallor-disc ratio and colour of the papilla are calculated from the densitometric tracings. The latter parameter is quantitatively expressed by a numerical index. The method is demonstrated in a practical example.