Klinische Monatsblätter für Augenheilkunde
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In Germany, a vaccine (Zostavax) to prevent herpes zoster and postherpetic neuralgia (PHN) in adults aged 50 years and older has been available since October 2009. The efficacy of this attenuated high-dose live vaccine was evaluated in a double-blind randomised, placebo-controlled trial involving more than 38,000 immunocompetent adults aged >or= 60 years. Compared to placebo the vaccine reduced the frequency of herpes zoster by 51 % and the incidence of PHN by 67 %. ⋯ Zostavax has been well tolerated. It can be concomitantly administered with inactivated influenza vaccine at separate sites. Zoster and pneumococcal vaccines should not be given concomitantly.
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Klin Monbl Augenheilkd · Nov 2009
Review[Ocular neuromyotonia--clinical appearance and thoughts on pathogenesis].
Ocular neuromyotonia (ONM) is a rare neurogenic disorder of ocular motility. The affected patients complain of recurrent transient diplopia secondary to a sudden, painless deviation of one eye. This deviation occurs in the direction of action of an extraocular muscle, which is being stimulated at high frequency. ⋯ The diagnosis of ONM is made based on clinical findings and can be supported by electrophysiological characteristics. Neuroimaging with attention to the affected cranial nerve should be obtained in order to exclude a compressive cause. Therapy of ONM with carbamazepine is usually effective.
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Hospital quality management (QM) is a legal obligation in Germany. This article reviews the regulations of quality control, the basic principles of QM, specific quality techniques, the process of QM implementation in the hospital and the possibilities of external QM certifications. Due to the increasing and effective privatisation of hospitals in Germany, careful attention to specially designed QM systems for private hospitals seems to be reasonable.
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Ocular neuromyotonia is a rare ocular motility disorder characterized by involuntary contractions of one or several ocular motor muscles. In this report a typical case is presented. ⋯ These typical findings permit the diagnosis of ocular neuromyotonia. The characteristic symptoms of ocular neuromyotonia and the typical history of a previous intracranial tumor, treated neurosurgically with adjuvant radiotherapy, lead to the hypothesis that ephaptic transmission in the cranial nerve is the underlying pathophysiological mechanism in the development of ocular neuromyotonia. Hereby, efferent impulses from non-twitch motoneurons could activate neighbouring axons, and spread both peripherally and centrally. Beside other mechanisms discussed, an involvement of proprioceptive elements and their reafference is also a possible cause for the prolonged muscle contraction.