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Ein 34-jähriger männlicher Patient stellte sich zur Abklärung einer seit dem 9. Lebensjahr bestehenden und im letzten Jahr rasch progredienten Visusminderung beider Augen bei uns vor. Er beschrieb eine subjektiv zunehmende, im Spiegel für ihn selbst sichtbare, weißliche Trübung in der Pupille beidseits und eine starke Blendempfindlichkeit. Nebenbefundlich gab er rezidivierende Konjunktivitiden und morgens verklebte Lider an. Eine Allergie auf Gräserpollen und eine Unverträglichkeit auf Alkohol sowie mehrere Lebensmittel seien ebenfalls bekannt.
Zusätzlich leidet der Patient an stark ausgeprägtem atopischem Ekzem. Dieses wurde nie systemisch, sondern nur bei Bedarf mit kortisonhaltiger Salbe therapiert.
Patients after coarctation repair still have an increased risk of cardiovascular or cerebrovascular events. This has been explained by the persisting hypertension and alterations in the peripheral vessels. However, involvement of the central vessels such as the retinal arteries is virtually unknown. A total of 34 patients after coarctation repair (22 men and 12 women; 23 to 58 years old, age range 0 to 32 years at surgical repair) and 34 nonhypertensive controls underwent structural and functional retinal vessel analysis. Using structural analysis, the vessel diameters were measured. Using functional analysis, the endothelium-dependent vessel dilation in response to flicker light stimulation was assessed. In the patients after coarctation repair, the retinal arteriolar diameter was significantly reduced compared to that of the controls (median 182 μm, first to third quartile 171 to 197; vs 197 μm, first to third quartile 193 to 206; p <0.001). These findings were independent of the peripheral blood pressure and age at intervention. No differences were found for venules. The functional analysis findings were not different between the patients and controls (maximum dilation 3.5%, first to third quartile 2.1% to 4.5% vs 3.6%, first to third quartile 2.2% to 4.3%; p = 0.81), indicating preserved autoregulative mechanisms. In conclusion, the retinal artery diameter is reduced in patients after coarctation repair, independent of their current blood pressure level and age at intervention. As a structural marker of chronic vessel damage associated with past, current, or future hypertension, retinal arteriolar narrowing has been linked to stroke incidence. These results indicate an involvement of cerebral microcirculation in aortic coarctation, despite timely repair, and might contribute to explain the increased rate of cerebrovascular events in such patients.
The present article describes a standard instrument for the continuous online determination of retinal vessel diameters, the commercially available retinal vessel analyzer. This report is intended to provide informed guidelines for measuring ocular blood flow with this system. The report describes the principles underlying the method and the instruments currently available, and discusses clinical protocol and the specific parameters measured by the system. Unresolved questions and the possible limitations of the technique are also discussed.
Die Konzernrechnungslegung
(2010)
A novel scheme for precise diagnostics and effective stabilization of currents in a fuel cell stack
(2010)
Bead-on-plate butt joints of 2.5 mm hot rolled DP600/DP600 and 1.2 mm cold rolled TRIP700/TRIP700 steel sheets were performed using 6 kW CO2 laser beam welding. The welding speed ranged from 1.5 to 3.0 and from 2.1 to 3.9 m/min in DP/DP and TRIP/TRIP steel weldments respectively. A top surface helium gas was used as a shielding gas at a flow rate of 20 l/min. Metallographic examinations and transverse tensile testing (DIN EN 895: 1995) were carried out to characterize the weldments. The formability of base metals and weldments were investigated by standard Erichsen test (DIN EN ISO 20482). It was found that the uniaxial plastic behavior of both DP600 and TRIP700 base metals was in agreement with Swift and modified Mecking–Kocks models respectively. In a perpendicular tensile test to the weld line, all specimens were fractured at the base metal however the strengths were somewhat higher than those of base metal. There was a significant reduction in formability caused by welding of both DP/DP and TRIP/TRIP steel weldments and the formability has been improved with the increase of the welding speed.