Biomedical subjects
Publications and source records attributed to K Hruby.
Five cases (six eyes) of retinal detachment due to fisticuffs are recorded; at least four eyes went blind. Similar observations have been reported by other authors. In boxing, traumatic lesions of the head are inevitable since punches upon the head are crucial in this sport. Because of the risk of severe injuries including blindness and even death, at least brutal boxing must be rejected.
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The biomicroscopic image of cystoid macular oedema was fully described by A. Bangerter in 1945. By means of fluorescein angiography additional cases may be revealed, but such cases are transitory and asymptomatic. Cystoid macular oedema seems to be caused by vascular disorders of inflammatory-toxic aetiology, the vitreous body being involved as a carrier of toxins. For treatment of cystoid macular oedema retrobulbar injections of vasodilators have been recommended by Bangerter. This therapy is definitely effective in cases of Irvine-syndrome, and in cases of cystoid macular oedema due to chronic iridocylitis, provided that application is starded early enough. Bangerter's treatment fails in other types of cystoid macular oedema. Corticosteroids are useful adjuvants, but they don't fully substitute Bangerter's treatment.
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The actual economical problems of hospital management demand critical considerations on the possibilities of rationalisation. Regarding the activities on an university eye-clinic in a big city the realisation of certain facilities could be well obtained: a decrease of the number of in-patients by treating of suitable cases as out-patients; shortening of the time of hospitalisation according to the progress of modern surgical and medical treatment; arrangment of departments for treating patients during the day in cases requiring intensive treatment and follow-up after full hospitalisation.
The pharmakokinetic data (elimination half-life, apparent distribution volume, total and renal clearance and cumulative urine excretion) were determined after intravenous administration of 1 mg digoxin in 9 female patients with an average age of 52 +/- 15 years with manifest hyperthyroidism. The study protocol was repeated after normalization of thyroid function by means of conventional thyrostatic therapy. Digoxin was determined by radioimmunoassay.
A survey is given on the evolution of retinal detachment surgery during the past four decades. Contributions of the ophthalmological school of Vienna are particularly considered. The review includes simple diathermy-coagulation with subretinal drainage, the undermining operation of Lindner and his eye ball shortening procedure, the combined operation (sealing of retinal breaks by diathermy plus scleral resection), and vitreous tamponade using sodium hyaluronate. All these methodes have been widely replaced during the past years by cryopexy with plombage, and by encircling procedures. Though the rate of success could not be definitely increased, the introduction of the modern methods implies technical facilities for the eye surgeon, and advances for the treated patients. The evolution of retinal detachment surgery is not yet terminated, and further progress can be taken as granted. Retinal detachment surgery with very short hospitalization may become practicable in near future.
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All kinds of treatment attempted so far in cases of senile maculopathies were unsatisfactory. Intramuscular injections of retinal phosphatides were introduced six years ago. In this follow-up study 216 eyes of patients with senile maculopathy treated by Etaretin have been checked. The former experience was confirmed that an improvement in visual acuity can be obtained only in early cases of the dry type. In such cases i.m. injections of Etaretin are actually the treatment of choice. In fairly advanced cases eventually some stabilization of the process may be obtained. In terminal stages no effect can be expected. Experimental observations revealed that the therapeutic effect of a phosphatide compound depends on the content of the polyunsaturated fatty acid C 22:6, but not on the animal organ which serves as the source of the extract. From an economic point of view these findings are of importance for further experimental work, as well as for broad clinical application.
Three cases of self poisoning with tricyclic antidepressants (TAD) are reported, one of them with a potentially lethal dose. All three cases were treated with physostigmine salicylate (PS) and in two cases there was complete reversal of coma within a few minutes. In striking contrast to the reported high incidence of cardiac arrhythmias no cardiac complications were observed in any of the cases. Therefore we think that the use of PS should be considered when treating cases of TAD poisoning.
The results of plombage and encircling procedures in 417 eyes operated on for retinal detachment are compared with the rate of success obtained by lamellar or penetrating scleral resection in the past.
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Vitreous suction is still a useful procedure in cases of severe vitreous opacification. In spite of the technical perfection and good results of vitrectomy, the chances of a vitreous suction should be taken into consideration before a definite decision is made. The surgical technique of vitreous suction is very simple, lensectomy is never required, and the possibility of a subsequent vitrectomy is not impaired of the suction manoeuvre has failed. The frequency of complications, namely retinal detachment and bacterial intraocular infection, is reasonable if the almost hopeless condition of the affected eyes, and the severe general diabetic angiopathy and poor resistance are considered, which in individuals with postoperative endophthalmitis usually are found. Vitreous suction is still acceptable as a minor sort of vitrectomy.
The bio-availability of various galenic preparations of beta-acetyldigoxine was tested in six healthy probands after a single oral dose (1 mg). The availability parameters were calculated from the areas under the plasma concentration curves and from the cumulative urinal excretion. There was no significant difference between the bio-availabilities of Novodigal (beta-acetyledigoxine tablets), Ildamen-Novodigal (beta-acetyldigoxine and oxyfedrine) and an alcoholic solution of beta-acetyldigoxine. Correlation calculations showed that the determination of the plasma concentration courses up to six hours after substance application are most favourite in regard to judging the absorption processes of digoxine preparations. For the assessment of the bio-availability, the methods of comparing the areas under the blood level curves of 0 to 6 hrs and of comparing the cumulative urinal excretion over a period of 24 hrs were of equal validity.
The bio-availability of Novodigal (beta-acetyldigoxine) alone and applied together with Alucol (aluminum hydroxide, magnesium hydroxide) was studied in six healthy probands. Bio-availability parameters were calculated from the areas under the plasma concentration curves and from the comparison of the blood levels after absorption during steady state. There was no significant difference between the bio-availability of beta-acetyldigoxine alone and that of the combination with Alucol. Thus, beta-acetyldigoxine combined with antacids of the aluminum hydroxide and magnesium hydroxide type can be applied in the same dosage as usual since no decrease of effect has to be apprehended.
Purulent exudation into the anterior chamber with a hypopyon on the first or second day after intraocular surgery is the alarming sign of intraocular bacterial infection. The manifestation of an intraocular mycosis takes 4 to 5 weeks, the exudation into the anterior chamber increases slowly; however, a hypopyon may also develop. In cases of early postoperative cloudy exudation in the pupillary area without hypopyon a sterile aqueous humour is found. Consideration of this symptomatology leads to the correct diagnosis of a harmless reaction, which may be related to the protein content of the aqueous humour in a hypotonic eye.
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