Quantitative assessment of the intensity of palmar and plantar sweating in patients with primary palmoplantar hyperhidrosis

Objective: To compare individuals with and without hyperhidrosis in terms of the intensity of palmar and plantar sweating. Methods: We selected 50 patients clinically diagnosed with palmoplantar hyperhidrosis and 25 normal individuals as controls. We quantified sweating using a portable noninvasive electronic device that has relative humidity and temperature sensors to measure transepidermal water loss. All of the individuals had a body mass index of 20-25 kg/cm(2). Subjects remained at rest for 20-30 min before the measurements in order to reduce external interference. The measurements were carried out in a climate-controlled environment (21-24 degrees C). Measurements were carried out on the hypothenar region on both hands and on the medial plantar region on both feet. Results: In the palmoplantar hyperhidrosis group, the mean transepidermal water loss on the hands and feet was 133.6 +/- 51.0 g/m(2)/h and 71.8 +/- 40.3 g/m(2)/h, respectively, compared with 37.9 +/- 18.4 g/m(2)/h and 27.6 +/- 14.3 g/m(2)/h, respectively, in the control group. The differences between the groups were statistically significant (p < 0.001 for hands and feet). Conclusions: This method proved to be an accurate and reliable tool to quantify palmar and plantar sweating when performed by a trained and qualified professional.

Artificial and natural radioactivity in edible mushrooms from Sao Paulo, Brazil

Environmental biomonitoring has demonstrated that organisms such as crustaceans, fish and mushrooms are useful to evaluate and monitor both ecosystem contamination and quality. Particularly, some mushroom species have a high capacity to retain radionuclides and some toxic elements from the soil and the air. The potential of mushrooms to accumulate radionuclides in their fruit-bodies has been well documented. However, there are no studies that determine natural and artificial radionuclide composition in edible mushrooms, in Brazil. Artificial (Cs-137) and natural radioactivity (K-40. Ra-226. Ra-228) were determined in 17 mushroom samples from 3 commercialized edible mushroom species. The edible mushrooms collected were Agaricus sp., Pleurotus sp. and Lentinula sp. species. The activity measurements were carried out by gamma spectrometry. The levels of Cs-137 varied from 1.45 +/- 0.04 to 10.6 +/- 0.3 Bq kg(-1), K-40 levels varied from 461 +/- 2 to 1535 +/- 10 Bq kg(-1), Ra-226 levels varied from 14 +/- 3 to 66 +/- 12 Bq kg(-1) and Ra-228 levels varied from 6.2 +/- 0.2 to 54.2 +/- 1.7 Bq kg(-1). Cs-137 levels in Brazilian mushrooms are in accordance with the radioactive fallout in the Southern Hemisphere. The artificial and natural activities determined in this study were found to be below the maximum permissible levels as established by national legislation. Thus, these mushroom species can be normally consumed by the population without any apparent risks to human health.

Characterization of Staphylococcus aureus isolates in milk and the milking environment from small-scale dairy farms of Sao Paulo, Brazil, using pulsed-field gel electrophoresis

This research aimed to evaluate the occurrence of Staphylococcus aureus isolates in milk and in the milking environment of 10 small-scale farms (<400 L/d) located in the regions of Franca and Ribeirao Preto, state of Sao Paulo, Brazil. Two-hundred twenty samples of milk were collected from individual cows, along with 120 samples from bulk tank milk, 389 samples from milking equipment and utensils (teat cups, buckets, and sieves), and 120 samples from milkers' hands. Fifty-six Staph. aureus strains were isolated from 849 analyzed samples (6.6%): 12 (5.5%) from milk samples of individual cows, 26 (21.7%) from samples of bulk tank milk, 14 (3.6%) from samples collected from equipment and utensils, and 4 (3.3%) from samples from milkers' hands. Pulsed-field gel electrophoresis typing of the 56 Staph. aureus isolates by SmaI restriction enzyme resulted in 31 profiles (pulsotypes) arranged in 12 major clusters. Results of this study indicate a low incidence, but wide distribution of Staph. aureus strains isolated from raw milk collected from individual cows and surfaces of milkers' hands and milking equipment in the small-scale dairy farms evaluated. However, the high percentage of bulk milk samples found with Staph. aureus is of public health concern because raw, unprocessed milk is regularly consumed by the Brazilian population.

Mechanical thrombectomy with solitaire stent retrieval for acute ischemic stroke in a Brazilian population

OBJECTIVE: Large vessel occlusion in acute ischemic stroke is associated with low recanalization rates under intravenous thrombolysis. We evaluated the safety and efficacy of the Solitaire AB stent in treating acute ischemic stroke. METHODS: Patients presenting with acute ischemic stroke were prospectively evaluated. The neurological outcomes were assessed using the National Institutes of Health Stroke Scale and the modified Rankin Scale. Time was recorded from the symptom onset to the recanalization and procedure time. Recanalization was assessed using the thrombolysis in cerebral infarction score. RESULTS: Twenty-one patients were evaluated. The mean patient age was 65, and the National Institutes of Health Stroke Scale scores ranged from 7 to 28 (average 17+/-6.36) at presentation. The vessel occlusions occurred in the middle cerebral artery (61.9%), distal internal carotid artery (14.3%), tandem carotid occlusion (14.3%), and basilar artery (9.5%). Primary thrombectomy, rescue treatment and a bridging approach represented 66.6%, 28.6%, and 4.8% of the performed procedures, respectively. The mean time from symptom onset to recanalization was 356.5+/-107.8 minutes (range, 80-586 minutes). The mean procedure time was 60.4+/-58.8 minutes (range, 14-240 minutes). The overall recanalization rate (thrombolysis in cerebral infarction scores of 3 or 2b) was 90.4%, and the symptomatic intracranial hemorrhage rate was 14.2%. The National Institutes of Health Stroke Scale scores at discharge ranged from 0 to 25 (average 6.9+/-7). At three months, 61.9% of the patients had a modified Rankin Scale score of 0 to 2, with an overall mortality rate of 9.5%. CONCLUSIONS: Intra-arterial thrombectomy with the Solitaire AB device appears to be safe and effective. Large randomized trials are necessary to confirm the benefits of this approach in acute ischemic stroke.

Evaluation of quality of life over time among 453 patients with hyperhidrosis submitted to endoscopic thoracic sympathectomy

Objectives: Current data do not provide enough information on how quality of life (QoL) evolves over time in cases of endoscopic thoracic sympathectomy (ETS). The purpose of this study was to ascertain whether the immediate improvement in QoL after the surgery was sustained until the fifth postoperative year. Methods: This was a prospective, nonrandomized and uncontrolled study. From March 2001 to December 2003, 475 consecutive patients with hyperhidrosis submitted to ETS were included. A QoL questionnaire was applied at the preoperative day, around the 30th postoperative day, and after the fifth year. Results: After excluding 22 patients who did not answer all the questions, we analyzed 453 patients. Their ages ranged from 11 to 57 years old, with a mean of 25.3 + 7.9 years, including 297 female patients (65.6%). All patients were assessed on three occasions: before surgery, around the 30th postoperative day, and after the fifth postoperative year. The QoL before surgery was considered to be poor or very poor for all patients. The QoL around 30 days after surgery was better in 412 patients (90.9%), the same in 27 patients (6.0%), and worse in 14 patients (3.1%). After 5 years, 409 patients (90.3%) were better, 27 (6.0%) were the same, and 14 (3.1%) were worse. There were no differences between these postoperative times according to the McNemar statistical test. Conclusion:The patients had an immediate improvement in QoL after ETS, and this improvement was sustained until the fifth postoperative year. (J Vase Surg 2012;55:154-6.)

A quantitative view of the transcriptome of Schistosoma mansoni adult-worms using SAGE

Abstract Background Five species of the genus Schistosoma, a parasitic trematode flatworm, are causative agents of Schistosomiasis, a disease that is endemic in a large number of developing countries, affecting millions of patients around the world. By using SAGE (Serial Analysis of Gene Expression) we describe here the first large-scale quantitative analysis of the Schistosoma mansoni transcriptome, one of the most epidemiologically relevant species of this genus. Results After extracting mRNA from pooled male and female adult-worms, a SAGE library was constructed and sequenced, generating 68,238 tags that covered more than 6,000 genes expressed in this developmental stage. An analysis of the ordered tag-list shows the genes of F10 eggshell protein, pol-polyprotein, HSP86, 14-3-3 and a transcript yet to be identified to be the five top most abundant genes in pooled adult worms. Whereas only 8% of the 100 most abundant tags found in adult worms of S. mansoni could not be assigned to transcripts of this parasite, 46.9% of the total ditags could not be mapped, demonstrating that the 3 sequence of most of the rarest transcripts are still to be identified. Mapping of our SAGE tags to S. mansoni genes suggested the occurrence of alternative-polyadenylation in at least 13 gene transcripts. Most of these events seem to shorten the 3 UTR of the mRNAs, which may have consequences over their stability and regulation. Conclusion SAGE revealed the frequency of expression of the majority of the S. mansoni genes. Transcriptome data suggests that alternative polyadenylation is likely to be used in the control of mRNA stability in this organism. When transcriptome was compared with the proteomic data available, we observed a correlation of about 50%, suggesting that both transcriptional and post-transcriptional regulation are important for determining protein abundance in S. mansoni. The generation of SAGE tags from other life-cycle stages should contribute to reveal the dynamics of gene expression in this important parasite.

HPV type infection in different anogenital sites among HIV-positive Brazilian women

Abstract Objectives To evaluate the prevalence of human papillomavirus (HPV) types, and risk factors for HPV positivity across cervix, vagina and anus, we conducted a study among 138 women with human immunodeficiency virus (HIV). Goal Compare the prevalence of different HPV types and the risk factors for HPV positivity in three sites. Results The most frequently detected HPV types in all sites were, in decreasing order, HPV16, 53, 18, 61 and 81. Agreement between the cervix and vagina was good (kappa 0.60 – 0.80) for HPV16 and 53 and excellent (Kappa > 0.80) for HPV18 and 61. HPV positivity was inversely associated with age for all combinations including the anal site. Conclusion In HIV positive women, HPV18 is the most spread HPV type found in combinations of anal and genital sites. The relationship of anal to genital infection has implications for the development of anal malignancies. Thus, the efficacy of the current HPV vaccine may be considered not only for the cervix, but also for prevention of HPV18 anal infection among immunossuppressed individuals.

Maxillary sinus and posterior teeth: accessing close relationship by cone-beam computed tomographic scanning in a brazilian population

Introduction: This study aimed to evaluate the close proximity established between the maxillary sinus floor and posterior teeth roots apices by using cone-beam computed tomographic scanning. Methods: The relationship of maxillary sinuses and posterior teeth roots, which were divided into 2 groups, was analyzed using i-CAT Vision software (Imaging Sciences, Hatfield, PA). Group 1 included all root apices found in close contact with the maxillary sinus floor without sinus floor elevation, whereas group 2 included all root apices that were protruded within the sinus producing an elevation of the bony cortical. Results: A total of 100 maxillary sinuses and 601 roots apices were evaluated. Group 1 presented 130 of 601 (21.6%) roots and group 2 presented 86 of 601 (14.3%) roots. Conclusions: The second molar mesiobuccal root apex is frequently found in close proximity with the sinus floor, and the relation between these anatomic structures should be considered in order to prevent an iatrogenic procedure and minimize the risks from an infectious disease within the sinus

Prevalência de asma e fatores associados: estudo de base populacional em São Paulo, SP, 2008-2009

OBJETIVO: Estimar a prevalência de asma em crianças e adolescentes e identificar fatores associados. MÉTODOS: Estudo transversal de base populacional com 1.185 crianças e adolescentes de ambos os sexos de São Paulo, SP, de 2008 a 2009. As informações foram coletadas por meio de entrevistas domiciliares e os participantes foram selecionados a partir de amostragem probabilística, estratificada por sexo e idade, e por conglomerados em dois estágios (setores censitários e domicílios). Foi realizada regressão múltipla de Poisson na análise ajustada entre o desfecho e variáveis sociodemográficas, econômicas, estilo de vida e condições de saúde. RESULTADOS: Dos entrevistados, 9,1% (IC95% 7,0;11,7) referiram asma. Após análise ajustada, identificaram-se os seguintes fatores independentemente associados ao agravo: idade (zero a quatro anos/15 a 19) RP = 3,18 (IC95% 1,20;8,42), idade (cinco a nove anos/15 a 19) RP = 6,37 (IC95% 2,64;15,39), idade (10 a 14 anos/15 a 19) RP = 4,51 (IC95% 1,95;10,40), alergia (sim/não) RP = 2,22 (IC95% 1,24;4,00), rinite (sim/não) RP = 2,13 (IC95% 1,22;3,73), problemas de saúde nos 15 dias prévios à entrevista (sim/não) RP = 1,96 (IC95% 1,23;3,11), número de cômodos no domicílio (1 a 3/4 e mais) RP = 1,67 (IC95% 1,05;2,66), e cor da pele (preta e parda/branca) RP = 2,00 (IC95% 1,14;3,49). CONCLUSÕES: Os achados do presente estudo apontam a importância da asma associada à presença de rinite e alergia, idade entre cinco e nove anos, cor da pele preta e parda e moradia com menor número de cômodos. Os frequentes problemas de saúde podem ser considerados consequência dessa doença.

The re-establishment of the normal blood lactate response to exercise in humans after prolonged acclimatization to altitude

[EN] 1. One to five weeks of chronic exposure to hypoxia has been shown to reduce peak blood lactate concentration compared to acute exposure to hypoxia during exercise, the high altitude 'lactate paradox'. However, we hypothesize that a sufficiently long exposure to hypoxia would result in a blood lactate and net lactate release from the active leg to an extent similar to that observed in acute hypoxia, independent of work intensity. 2. Six Danish lowlanders (25-26 years) were studied during graded incremental bicycle exercise under four conditions: at sea level breathing either ambient air (0 m normoxia) or a low-oxygen gas mixture (10 % O(2) in N(2), 0 m acute hypoxia) and after 9 weeks of acclimatization to 5260 m breathing either ambient air (5260 m chronic hypoxia) or a normoxic gas mixture (47 % O(2) in N(2), 5260 m acute normoxia). In addition, one-leg knee-extensor exercise was performed during 5260 m chronic hypoxia and 5260 m acute normoxia. 3. During incremental bicycle exercise, the arterial lactate concentrations were similar at sub-maximal work at 0 m acute hypoxia and 5260 m chronic hypoxia but higher compared to both 0 m normoxia and 5260 m acute normoxia. However, peak lactate concentration was similar under all conditions (10.0 +/- 1.3, 10.7 +/- 2.0, 10.9 +/- 2.3 and 11.0 +/- 1.0 mmol l(-1)) at 0 m normoxia, 0 m acute hypoxia, 5260 m chronic hypoxia and 5260 m acute normoxia, respectively. Despite a similar lactate concentration at sub-maximal and maximal workload, the net lactate release from the leg was lower during 0 m acute hypoxia (peak 8.4 +/- 1.6 mmol min(-1)) than at 5260 m chronic hypoxia (peak 12.8 +/- 2.2 mmol min(-1)). The same was observed for 0 m normoxia (peak 8.9 +/- 2.0 mmol min(-1)) compared to 5260 m acute normoxia (peak 12.6 +/- 3.6 mmol min(-1)). Exercise after acclimatization with a small muscle mass (one-leg knee-extensor) elicited similar lactate concentrations (peak 4.4 +/- 0.2 vs. 3.9 +/- 0.3 mmol l(-1)) and net lactate release (peak 16.4 +/- 1.8 vs. 14.3 mmol l(-1)) from the active leg at 5260 m chronic hypoxia and 5260 m acute normoxia. 4. In conclusion, in lowlanders acclimatized for 9 weeks to an altitude of 5260 m, the arterial lactate concentration was similar at 0 m acute hypoxia and 5260 m chronic hypoxia. The net lactate release from the active leg was higher at 5260 m chronic hypoxia compared to 0 m acute hypoxia, implying an enhanced lactate utilization with prolonged acclimatization to altitude. The present study clearly shows the absence of a lactate paradox in lowlanders sufficiently acclimatized to altitude.

Forecasting the need for medical specialists in Spain: application of a system dynamics model

[EN] Background: Spain has gone from a surplus to a shortage of medical doctors in very few years. Medium and long-term planning for health professionals has become a high priority for health authorities. Methods: We created a supply and demand/need simulation model for 43 medical specialties using system dynamics. The model includes demographic, education and labour market variables. Several scenarios were defined. Variables controllable by health planners can be set as parameters to simulate different scenarios. The model calculates the supply and the deficit or surplus. Experts set the ratio of specialists needed per 1000 inhabitants with a Delphi method. Results: In the scenario of the baseline model with moderate population growth, the deficit of medical specialists will grow from 2% at present (2800 specialists) to 14.3% in 2025 (almost 21 000). The specialties with the greatest medium-term shortages are Anesthesiology, Orthopedic and Traumatic Surgery, Pediatric Surgery, Plastic Aesthetic and Reparatory Surgery, Family and Community Medicine, Pediatrics, Radiology, and Urology. Conclusions: The model suggests the need to increase the number of students admitted to medical school. Training itineraries should be redesigned to facilitate mobility among specialties. In the meantime, the need to make more flexible the supply in the short term is being filled by the immigration of physicians from new members of the European Union and from Latin America.

Vorkommen und Charakterisierung von Ecdysiotropinen bei männlichen Imagines der Mittelmeerfeldgrille Gryllus bimaculatus de Geer

Das Vorkommen von Häutungshormonen in adulten Insekten, insbesondere solcher, die eine lange Imaginalphase durchlaufen, wirft die Frage nach der Regulation der Ecdysteroidsynthese außerhalb der Prothorakaldrüse auf. Unter diesem Gesichtspunkt kann Gryllus bimaculatus mit einem ausgesprochen langen Adultstadium und rapiden zeitlichen Veränderungen des Ecdysontiters als ein geeignetes Versuchsobjekt angesehen werden.Der vorliegenden Dissertation liegt die Arbeitshypothese zugrunde, daß die Ecdysteroid-Synthese bzw. Sekretion von Adultgeweben in männlichen Imagines der Mittelmeerfeldgrille durch Neuropeptide hormonell reguliert wird. Als Quelle für die Ecdysteroidsynthese wurde auf Grund immunohistochemischer Befunde sowie der Ergebnisse von Sekretionsprofil-Analysen unter anderem die Oenocyten in Betracht gezogen.Zur Überprüfung dieser Hypothese wurde ein in vitro Bioassay entwickelt, der es ermöglichte, die Wirkung von extrahierten Substanzen auf die Hormonsynthese mittels RIA/HPLC zu bestimmen. Aus Köpfen adulter G. bimaculatus ließen sich durch HP-SEC Faktoren isolieren, die die Ecdysteroidsekretion in Oenocyten und Tergiten stimulierten, die aber keinen Einfluß auf die Hormonsekretion von Fettgewebe sowie der Prothorakaldrüsen hatten. Die Wirkung des aufgereinigten Extraktes in Oenocyten war zeit- und dosis-abhängig. Die ecdysiotropen Faktoren besaßen ein Molekulargewicht zwischen 26,5 und 30 kDa. Die Größe der Molmasse der ecdysiotropen Faktoren entsprach somit bei adulten männlichen Grillen etwa dem des Neurohormons PTTH bei Lepidopteren. Dennoch zeigten Antikörper, die gegen PTTH von Bombyx mori gerichtet waren im Western-Blot keine Bindung an Gryllus bimaculatus Kopfextrakte. Die Sekretionsprodukte von Oenocyten, die mit Ecdysiotropinen behandelt waren, wurden durch RP- und NP-HPLC identifiziert. Es konnten zwei zusätzliche Peaks neben einem deutlichen Anstieg von 20-Hydroxyecdyson nachgewiesen werden. Auf Grund identischer Retentionszeiten mit Referenzsubstanzen handelt es sich bei einem Peak vermutlich um Makisteron A.Obwohl die Applikation von Azadirachtin in G. bimaculatus zu einer Senkung des Hämolymph-Ecdysteroidgehalts führte, konnte keine Anreicherung von Ecdysiotropinen erzielt werden.Die die Ecdysteroidsekretion-beeinflussenden Faktoren waren resistent gegen Kochen und Alkylierung aber nicht stabil gegen Reduzierung durch DTT und Behandlung mit Neuramidase. Damit konnte gezeigt werden, daß das Vorhandensein von Disulfidbrücken und Oligosaccharidketten für die biologische Aktivität notwendig ist.Die Aminosäuresequenz-Analyse und der enzymatische Verdau der stimulierenden Faktoren durch Exopeptidasen wiesen auf geschützte N- und C-Termini hin. Ferner wurden einige interne Peptidfragmente von fünf Proteinbanden sequenziert, die keine Homologie zu bereits bekannten regulatorischen Neuropeptiden zeigten. Als einziges bekanntes Protein aus diesem Bereich konnte das „14-3-3-like Protein“ mit Hilfe MALDI-MS identifiziert werden.Die Stimulierung der Ecdysteroidsekretion in Oenocyten von G. bimaculatus durch Oenocyten-stimulierende Faktoren (OSF) aus Kopfextrakten konnte mittels Signalstoff-Effektoren in vitro nachgeahmt werden. Außerdem wurde mit Hilfe eines RRA nachgewiesen, daß der intrazelluläre cAMP-Spiegel von Oenocyten durch OSF erhöht wird. Daraus kann geschlossen werden, daß cAMP als „Second Messenger“ an der Wirkung der OSF beteiligt ist. Calcium-Ionen schienen für die Ecdysteroidsekretion notwendig zu sein. Allerdings führte eine artifizielle Erhöhung der intrazellulären Calcium-Konzentration durch das Ionophor Ionomycin zu einer Hemmung der Sekretion. Schließlich wird ein Modell zur Erklärung des Wirkmechanismus von OSF in Gryllus bimaculatus postuliert und diskutiert.

Langzeitergebnisse nach Trabekulektomie bei Glaukompatienten

Hintergrund: Die antimetabolitgestützte Trabekulektomie stellt seit längeren denrnGoldstandard bei medikamentös nicht ausreichend therapierbaren Glaukomen dar. Kurz- und mittelfristige Erfolge wurden durch viele Studien bestätigt. Allerdings unterliegen diese sehr unterschiedlichen Erfolgsdefinitionen. Eine strikte Druckkontrolle ≤ 15 mm Hg ohne zusätzliche medikamentöse Therapie erscheint sinnvoll einen risikofreien Therapieerfolg zu bewerten. Es existieren nur wenige Langzeitstudien mit diesem Erfolgskriterium. Die durchgeführte Studie soll einen Eindruck der ophthalmologischen Versorgung trabekulektomierter Patienten an der Universitätsaugenklinik Mainz über einen bewusst langen Zeitraum bieten. Patienten und Methoden: In diese retrospektiven Studie wurden alle Patienten, die aufgrund einer fortgeschrittenen Glaukomerkrankung in den Jahren 1996, 2001 oder 2006 eine Trabekulektomie erhielten, aufgenommen. Von den 723 Augen der 664 Patienten dieser Jahrgänge konnten 447 (61,8%) nachverfolgt werden. Die Zusammensetzung der Patienten war mit anderen Studien vergleichbar. 28% konnten mindestens 7 Jahre, 10% sogar 10 Jahre nachverfolgt werden. Esrnwurde untersucht, ob ein signifikanter Zusammenhang zwischen dem ophthalomologisch-internistischem Entlassstatus (Visus, Tensio, Gesichtsfeld,rnGlaukomtyp, Voroperationen, Medikation, Vorerkrankungen, Art der Operation) undrnder erstrebten Kontrolle des Intraokulardruckes besteht. Ergebnisse: Die mittlere Nachbeobachtungszeit betrug 4,3 ± 3,4 Jahre. Nach 1, 3,rn5, 7 und 10 Jahren wiesen 217 (82,1%) (p < 0,001), 133 (67,7%) (p < 0,001), 70rn(50%) (p < 0,001), 59 (47,7%) (p = 0,056) und 16 (38,1%) (p = 0,06) Augen Intraokulardrücke ≤ 15 mm Hg ohne zusätzliche Antiglaukomatosa auf. Nichtrnstatistisch signifikant waren die 7- und 10-Jahresergebnisse. Mit Hilfe von Antiglaukomatosa waren es insgesamt, 225 (85,1%), 156 (79,7%), 87 (62,5%), 93 (75%) und 23 (54,7%) (alle p < 0,001). Die mediane Überlebenszeit für IOD ≤ 15 mm Hg ohne Medikation betrug 7,4 Jahre ± 5 Monate. Druckobergrenzen von ≤ 18 bzw. 21 mm Hg erfüllten bis zu 20% mehr Patienten. Der mittlere Visus von 0,32 ± 6 Stufen blieb nach einem mittleren postoperativen Abfall auf 0,25 ± 5 Stufen in den Folgeuntersuchungen stabil. Er zeigte ab dem 3-Jahresintervall keine statistisch signifikante Verschlechterung zum präoperativen Visus. 5,8 Jahre ± 80 Tage betrug die mediane Überlebenszeit für ein stabiles Gesichtsfeld. Gesichtsfelddaten, MD und PSD zeigten keine statistisch signifikante Verschlechterung (p > 0,05). Risikofaktoren für ein Scheitern der Operation waren Patientenalter (RR = 1,01, KI: 0,95 - 1,34, p = 0,043), arterielle Hypertonie (RR = 1,87, KI: 1,21-2,9, p = 0,005) und männliches Geschlecht (RR = 1,24; KI: 1,07 – 1,43; p = 0,004). Komplikationen waren passagere okuläre Hypotonien an 85 (19%), Fistulation an 46(10,2%), Aderhautschwellung an 29 (6,4%) –abhebung an 14 (3,1%), retinale Amotio an 9 (2%), hypotone Makulopathie an 5 (1,1%) und Hypertonien an 70 (15,6%) Augen. 150 (33,5%) Augen erhielten einen Folgeeingriff, 117 (26%) eine Phakoemulsifikation, 149 (33%) eine Fadenlockerung, 122 (27%) 5-FU-Injektionen, 42 (9,4%) eine Fadennachlegung, 33 (7,4%) ein Needling, 26 (5,8%) eine Zyklophotokoagulation, 19 (4,3%) eine Re-TE und 9 (2%) sonstige chirurgische Revisionen. Schlussfolgerung: Die Kontrolle des Augeninnendruckes ≤ 15 mm Hg ohne zusätzliche Medikation erreichten viele Patienten über einen langen Nachbeobachtungszeitraum. Die Häufigkeit der Komplikationen oder nötiger Folgeeingriffe war meist niedriger als in vergleichbaren Studien. Selbst Patienten mit hohem Risikoprofil hatten gute Ergebnisse. Aufgrund mangelnder Gesichtsfelddaten fanden sich keine Hinweise auf statistisch relevantes Fortschreiten des Glaukoms zur angestrebten medikationsfreien Druckkontrolle. Weitere Studien für einen Untersuchungszeitraum von 10 Jahren mit gleichen Erfolgskriterien wie in der vorliegenden Arbeit mit genauer Analyse der Gesichtsfelddaten wären wünschenswert, um zu belegen, dass die guten Langzeitergebnisse nach Trabekulektomie an der Universitätsaugenklinik Mainz auch eine Glaukomprogredienz dauerhaft verhindern. Damit stellt die an der Universitätsaugenklinik Mainz durchgeführte antimetabolitgestützte Trabekulektomie und deren postoperative Nachbetreuung an einer repräsentativen Population eine sichere und komplikationsarme Methode dar.

Thickness of softened human enamel removed by toothbrush abrasion: an in vitro study

The aim of the study was to assess the thickness of softened enamel removed by toothbrushing. Human enamel specimens were indented with a Knoop diamond. Softening was performed with citric acid or orange juice. The specimens were brushed in a brushing machine with a manual soft toothbrush in toothpaste slurry or in artificial saliva. Enamel loss was calculated from the change in indentation depth of the same indent before and after abrasion. Mean surface losses (95% confidence interval) were recorded in treatment groups (in nanometers): (1) citric acid, abrasion with slurry = 339 (280-398); (2) citric acid, abrasion with artificial saliva = 16 (5-27); (3) orange juice, abrasion with slurry = 268 (233-303); (4) orange juice, abrasion with artificial saliva = 14 (5-23); (5) no softening, abrasion with slurry = 28 (10-46). The calculated thickness of the softened enamel varied between 254 and 323 nm, depending on the acid used.

Remineralization of initial carious lesions in deciduous enamel after application of dentifrices of different fluoride concentrations

The aim of the present study was to evaluate the remineralization potential of five dentifrices with different fluoride concentrations. Initial caries lesions were created in 72 cylindrical enamel blocks from deciduous teeth. The specimens were randomly distributed among six experimental groups corresponding to six experimental periods. Each of the six volunteers carried two deciduous enamel specimens fixed in an intraoral appliance for a period of 4 weeks. They brushed their teeth and the enamel blocks at least two times a day with dentifrices containing 0 ppm (period 1), 250 ppm (period 2), and 500 ppm fluoride (period 3), respectively. A second group of volunteers (n = 6) used dentifrices with a fluoride content of 0 ppm (period 4), 1,000 ppm (period 5), or 1,500 ppm (period 6). At the end of the respective period, the mineral content was determined by transversal microradiography (TMR). The use of dentifrices containing 500 ppm fluoride (38% MR), 1,000 ppm fluoride (42% MR), and 1,500 ppm fluoride (42% MR) resulted in a statistically significant higher mineral recovery compared to the control group (0 ppm fluoride). Mineral recovery was similar after use of dentifrices containing 0 and 250 ppm fluoride (24%; 25%). It is concluded that it is possible to remineralize initial carious lesions in deciduous enamel in a similar way as it has been described for enamel of permanent teeth.