Cochlear implantation in a population of multihandicapped children.
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Abnormalities, Multiple↗
Biomedical subjects
B Bertram
Publications and source records attributed to B Bertram.
Importance of auditory-verbal education and parents' participation after cochlear implantation of very young children.
Congenitally deaf children who receive a cochlear implant at a young age have the potential to achieve nearly normal language development. However, parents and rehabilitation therapists must realize that intensive and long-duration auditory-verbal education is required postoperatively to achieve this goal. Furthermore, the success of the therapeutic treatment is best realized if the parents themselves are trained to engage in linguistic interactions with the child within the natural context of the family. This is especially true if the parents are able to creatively guide auditory-verbal training on a daily basis. At the Cochlear Implant Center in Hannover, parents receive training and guidance on the following aspects of postimplant rehabilitation: basic components of auditory-verbal education; significance of collaborative efforts between parents and therapists; importance of exercising linguistic interactions on a daily basis; importance of the parents as communication partners; milestones and developmental stages of listening, speech, and language; interpretation of the child's first auditory and communication efforts after implantation; and future integration of the child into school and society.
Child↗
Quantification of cystoid changes in diabetic maculopathy.
PURPOSE: In patients with diabetic macular edema and cysts, quantification of the extent of the cystoid formation has been difficult. This study was performed to introduce reliable measurements of cysts, the quantification of the extent, and its relation to visual acuity. METHODS: Fluorescein angiography generated with a scanning laser ophthalmoscope provided detailed recognition not only of the foveal microvasculature, but also of well-demarcated cystoid formations in the early phases. The sampling area included the central 2.5 degrees of the fovea. Using digital image analysis, two independent observers estimated the area covered by cysts, the number of cysts, and the foveal avascular zone (FAZ). RESULTS: Twenty-three subjects with diabetes and macular cysts were enrolled in the current study. The mean area of the cysts was 0.315 +/- 0.241 mm2 (0.05 mm2 to 0.9 mm2), and the number of cysts ranged from 1 to 7. Both parameters, area of cysts (r2 = 0.61), and number of cysts (r2 = 0.48) showed a significant correlation with visual acuity (P < 0.01), whereas FAZ (0.08 to 0.58 mm2) showed no significant correlation with visual acuity. CONCLUSIONS: Fluorescein angiography allows a reproducible quantification of the extent of macular cysts. The relation of visual acuity to the number of cysts and to the area covered by the cystoid formation is highly significant. Thus, both these measures can provide an objective criterion for the estimation of visual prognosis and an outcome for evaluation therapy techniques.
Adult↗
Fate and distribution of [14C]S-(N,N-diethyldithiocarbamoyl)-N-acetyl-L-cysteine, an antimutagenic mixed disulfide from disulfiram, in rats.
S-(N,N-Diethyldithiocarbamoyl)-N-acetyl-L-cysteine (AC-DDTC) is a mixed disulfide from disulfiram and N-acetyl-L-cysteine, which possesses putative anticarcinogenic and antimutagenic properties. The present study describes the absorption, distribution, metabolism and excretion of 14C-labeled AC-DDTC in rats. AC-DDTC was well absorbed after oral administration. Based on the excretion of radioactivity in urine, the minimum absorption was about 73%. The rate of absorption was very rapid, with the peak level of radioactivity in plasma after 15 min of administration. Mean Cmax value for N,N-diethyldithiocarbamate (DDTC) after oral dose of AC-DDTC (20 mg/kg) was 3.8 +/- 0.2 nmol/ml at 15 min and the mean residence time was 47.1 +/- 2.8 min. After oral administration of [14C]AC-DDTC, radioactivity was distributed relatively rapidly. Maximum concentrations were observed in the liver (0.443% dose/g), kidneys (0.496% dose/g), oesophagus (0.313% dose/g) and in the adrenals (0.364% dose/g) at 30 min to 1 h after dosing. Liver was the only organ which contains a considerable amount of radioactivity (0.091% dose/g) 24 h after dosing. Two metabolites of AC-DDTC following oral administration were identified in the plasma and liver by GC and HPLC using extractive alkylation technique, namely DDTC and its methyl ester. Urinary excretion was a major route of elimination of radioactivity derived from [14C]AC-DDTC, in that about 73% of the dose was recovered in urine whereas only 14% was found in feces over 7 days.
Acetylcysteine↗
Protein C, protein S, and antithrombin III in acute ocular occlusive diseases.
Hereditary and acquired deficiencies of protein C, protein S, and antithrombin III are important risk factors of thrombosis, especially in peripheral veins. In a prospective study, concentrations of these factors were measured to determine the prevalence of deficiencies of these proteins in ocular vascular occlusive disease. A total of 167 patients with acute retinal arterial (28%) or venous occlusion (55%) or ischemic optic neuropathy (17%) were included. Exclusion criteria were anticoagulant therapy, renal insufficiency, and hepatic disease. The mean values obtained for all patients were in normal range (protein C, 102 +/- 25%; protein S, 109 +/- 22%; antithrombin III, 23.6 +/- 3.1 IU/ml). Antithrombin III was pathologically reduced in one patient with branch venous occlusion. Proteins C and S were severely altered in two patients with central venous occlusion, in one individual with ischemic optic neuropathy, and in one patient with branch arterial occlusion. Subnormal values were found in 21 patients for antithrombin III (16.1-19.9 IU/ml), in 7 patients for protein C (55-65%). Two of these five patients with pathologic findings showed severe vascular manifestations in the form of current deep-vein thrombosis and multiple retinal occlusions. Their age was 30 and 53 years, respectively, and differed considerably from the mean age of the entire group (65 +/- 12 years). This study suggests that these proteins were important factors for the development of ocular vascular occlusive diseases in single patients. Although the prevalence is low, measurement of these parameters in young patients may be useful in preventing other vascular complications.
Acute Disease↗
Sugar-linked dithiocarbamates as modulators of metabolic and genotoxic properties of N-nitroso compounds.
A series of putative anticarcinogenic and antimutagenic compounds was synthesized on the basis of tetraethylthiuram disulfide (disulfiram) and its metabolite, diethyldithiocarbamate (DDTC). Diallyldithiocarbamate was synthesized in order to combine the anticarcinogenic properties of diallyl sulfide, a known inhibitor of chemical carcinogenesis from Allium species, and those of DDTC. Several sugar-linked dithiocarbamates (SDTCs) were prepared using glucose, cellobiose, and lactose as glycosyl donors and DDTC and diallyldithiocarbamate as acceptors. All the S--glycoside bonds of SDTCs were very stable under physiological conditions in vitro. At low nitrosamine concentrations, glucose-DDTC inhibited microsomal nitrosamine dealkylases in vitro. In vivo these enzymes were also inhibited 4 h after i.p. administration of glucose-DDTC or lactose-DDTC to rats (1.7 mmol/kg); after 24 h, the values had returned to control levels. Glucose-DDTC induced the activity of glutathione-related enzymes. Concomitant treatment of rats with glucose-DDTC and N-nitrosodiethylamine (NDEA) led to a depression of the oxidative metabolism of [14C]NDEA to 14CO2 but increased the elimination of unchanged [14C]NDEA in the urine. Furthermore, glucose-DDTC totally inhibited the formation of DNA single-strand breaks induced by NDEA. All these effects may contribute to possible antimutagenic and anticarcinogenic actions of the dithiocarbamates investigated.
Animals↗
Hemodilution therapy in central retinal vein occlusion. One-year results of a prospective randomized study.
Systemic hemorheologic abnormalities may play a part in the pathogenesis of central retinal vein occlusions. A statistically significant elevation of plasma viscosity was found in patients with acute central retinal vein occlusion compared with control patients. Local retinal blood flow parameters including arteriovenous passage time and mean arterial dye bolus velocity were significantly altered in the central retinal vein occlusion patients compared with age-matched controls at baseline examination. We performed a randomized, prospective, single-blind clinical investigation to determine the effect of hemorheological manipulation on the clinical course and retinal blood flow of eyes with central vein occlusion. Hemodilution included plasma expansion with hydroxyethyl-starch, withdrawal of whole blood if the hematocrit was above 42%, and rheologic manipulation with parenteral pentoxifylline. We found a statistically significant improvement in visual acuity at 1 year post-treatment for the treated group compared with the control group (increase of visual acuity of 1.5 lines vs decrease of 1.5 lines). The retinal blood flow parameters were markedly improved soon after the institution of therapy, and this may have contributed to the improvement in visual acuity in the treated group. There was no statistically significant difference between the two groups in the progression to ischemic central vein occlusion.
Aged↗
Perifoveal microcirculation with non-insulin-dependent diabetes mellitus.
Fluorescein angiograms were performed to evaluate perifoveal capillary blood velocities (v), capillary density (perifoveal intercapillary areas: PIA) and the foveal avascular zone (FAZ) by means of the scanning laser technique (SLO-101 Rodenstock). The angiograms were digitally stored and the data quantified off-line with an image analyzing system (IBAS). In the present study 46 patients with non-insulin-dependent diabetes mellitus (NIDDM) were examined and their data compared with that of 31 healthy volunteers. The perifoveal capillary flow velocity of the NIDDM subjects (v = 2.33 +/- 0.36 mm/s) was significantly (P < 0.01) decreased as compared to healthy subjects (v = 2.86 +/- 0.41 mm/s). The perifoveal intercapillary areas in the foveal avascular zone were significantly increased in patients with NIDDM (PIA = 10029 +/- 3402 microns2; FAZ = 0.415 +/- 0.272 mm2) as compared with healthy subjects (PIA = 3965 +/- 467 microns2; FAZ = 0.221 +/- 0.071 mm2). These data suggest the possibility that a decrease in perifoveal capillary blood velocities in combination with decreased capillary density (enlarged PIA) and an enlargement of the foveal avascular zone may occur in patients with NIDDM. The determination of these parameters could help in monitoring the progress of diabetic retinopathy and diabetic maculopathy.
Adult↗
[Effect of hemodilution on retinal hemodynamics in retinal branch vein occlusion].
The aim of hemodilution therapy in branch retinal vein occlusion is to lower the hematocrit (HCT) and plasma viscosity and thus to ameliorate perfusion of the affected areas. In this study we compared the influence of hemodilution therapy on the retinal hemodynamics of affected areas with unaffected areas. Thirty patients with branch vein occlusion (duration of symptoms less than 14 days) aged 40-84 years (mean 63 +/- 11 years) were examined. All patients received iso- (HCT > or = 42%) or hypervolemic (HCT < 42%) hemodilution with hydroxyethyl-starch (MW 200,000/0.5 10%, HAES-steril) for 10 days. Retinal hemodynamics were quantified by means of video fluorescein angiography assessing arteriovenous passage time (AVP) of the affected and unaffected branches. Hemodilution resulted in a significant decrease in hematocrit, plasma viscosity and erythrocyte aggregation. The arteriovenous passage time of the affected area improved significantly (before therapy 4.91 +/- 2.2 s, after therapy 3.9 +/- 1.6 s). The unaffected branch showed no significant change in the arteriovenous passage time (1.85 +/- 0.7 s before and 1.79 +/- 0.7 s after therapy). The decrease in AVP in the affected branch indicates ameliorated perfusion in the affected branch area without changing the retinal hemodynamics in unaffected areas.
Adult↗
[Anticardiolipin antibodies in vascular occlusions of the eye].
Elevated levels of anticardiolipin antibodies (ACA) have recently been found to be associated with occlusive diseases such as myocardial or cerebral infarction or venous thrombosis. In a prospective study anticardiolipin antibodies (both IgG and IgM) were measured by ELISA in 140 patients with acute vascular occlusions of the eye. Patients with clinical evidence for lupus erythematodes, HIV infection or elevated concentrations of antinuclear antibodies (IIFT with HEp-2 as antigen, LD Diagnostika, Heiden, FRG) were excluded. Elevated concentrations of IgG-ACA and IgM-ACA were found in 9% of the cases, with no correlation with the type of ocular vascular occlusion (retinal artery occlusion, retinal vein occlusion, anterior ischemic optic neuropathy). These results indicate that the anticardiolipin syndrome with elevated concentration of anticardiolipin antibodies may also have a causal role in some patients with occlusive eye diseases, whereas in most patients the concentrations were within normal ranges.
Adult↗
[Follow-up of arteriosclerosis-induced anterior ischemic optic neuropathy].
In 22 patients with acute arteriosclerotic anterior ischemic optic neuropathy (AION), examinations were conducted before the start of therapy and between 1 and 3 years later. In the acute stage of the disease the patients were treated with hemodilution for 10 days. The visual acuity improved from 0.2 to 0.4 (median). Compared with the visual acuity before therapy, at the follow-up 1-3 years later visual acuity had improved by 3 lines or more in 11 patients, remained stationary in 9 patients (+/- 1 line), and worsened in 2 patients by 3 lines or more. The visual fields (Goldmann) improved in 8 patients, did not change in 10 patients and worsened in 4 patients. After 1-3 years, 14 patients (64%) showed a sectorial pallor and 8 patients (36%) a diffuse pallor of the optic disc. Videofluorescein angiography revealed hypofluorescent discs in all patients. No difference in arm-retina time (ART) was found between the acute phase (13.0 +/- 3.3 s) and the examination 1-3 years later (13.1 +/- 2.2 s). ART was within normal limits in all patients. The arteriovenous passage time (AVP) dropped significantly, from 2.36 (+/- 0.81) s in the acute phase to 1.91 (+/- 0.56) s 1-3 years later. However, the AVP still did not fall to normal levels (1.45 +/- 0.40 s). Slowed retinal hemodynamics (AVP) with normal ART at the same time suggests a disturbance in microcirculation still present 1-3 years after the acute phase of AION. The rheological parameters (hematocrit, plasma viscosity, erythrocyte aggregation index) did not show any change between examinations.(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗
[Pedagogic aspects of rehabilitation of children with a cochlear implant. Report from the Hannover Cochlear Implant Center].
As we see it cochlear implant for deaf born and for children who became deaf is only justified if the cochlear implant center can belay an interdisciplinary teamwork preoperatively and the securing of habilitation respectively rehabilitation. The cooperation between parents and teachers of the children is absolutely necessary. As the neurophysiologists see it the cochlear implant is a good chance for young deaf born children to use sensitive phases for development of hearing and speech abilities. In these phases the children needs adequate stimuli for development. The changes for developing open speech abilities are slight, if the children are older.
Child↗
Antigenotoxic properties of lactic acid bacteria in vivo in the gastrointestinal tract of rats.
In view of the high incidence of dietary-related tumors, one important research goal is to identify the participating genotoxic carcinogens and the nutritional factors that may counteract their activities. We therefore have further developed a method to assess DNA damage in tumor target tissues of the gastrointestinal tract. Subsequently the prevention of this inducible DNA damage by lactic acid bacteria and by milk products fermented with probiotics was studied as well. The microgel electrophoresis technique was applied to cells of the esophageal, gastric, duodenal, and colonic mucosa. Cells were grouped according to their degree of DNA damage, the simplest measure of which is to discriminate between those with damage (comets) and those without damage. When these cells were isolated from animals treated with a genotoxic carcinogen, N-methyl-N'-nitro-N-nitrosoguanidine (MNNG), and exposed to MNNG for 1-24 hours, it was possible to follow the course of genotoxicity throughout the gastrointestinal tract. After the animals were treated with the lactic acid bacteria under study, it was possible to detect antigenotoxic properties as well. The gavage of 10(10) viable Lactobacillus casei cells in 10 ml of 0.9% NaCl per kilogram body weight immediately before the oral administration of MNNG (5 mg/kg body wt) resulted in a reduction of induced DNA damage in gastric and colonic mucosa cells. A sequential treatment schedule was even more effective: when the animals were treated orally with lactic acid bacteria or yogurt (10 ml/kg body wt) in the morning followed by MNNG (7.5 mg/kg body wt) eight hours later and the colon cells were isolated 16 hours later, the percentages of cells remaining intact were distinctly higher in the combination groups (68 +/- 10 and 68 +/- 19 for L. casei and a "Bio" yogurt, respectively) than in the group receiving only MNNG (45 +/- 17). The effect of heating L. casei was studied and was found to yield less clear-cut effects in preventing genotoxicity. The method is an efficient tool to elucidate antigenotoxic properties of food components in vivo in those target tissues actually afflicted by dietary-related tumors.
Animals↗
[Hemodilution therapy in patients with acute anterior ischemic optic neuropathy].
A prospective study was performed in 22 patients with an anterior ischaemic optic neuropathy (AION). All patients underwent iso- (Hct > or = 42%) or hypervolemic (Hct < 42%) haemodilution for 10 days with daily infusion of 250 ml hydroxyethyl starch (MW 200,000/0.5, 10% HAES-sterile) in combination with pentoxifylline (p.o.: 1200 mg/day; i.v.: 300 mg/day; Trental). Only patients with recent AION (less than 2 weeks' duration of symptoms) were considered for the prospective trial. Clinical, haemodynamic (arterio-venous passage time) and rheological (haematocrit, plasma viscosity, erythrocyte aggregation) data of all patients were recorded before therapy and after 10 days. An improvement of central vision by 2 or more lines was seen in 7 patients after 10 days. Initially the arterio-venous passage time was significantly prolonged in patients (2.42 +/- 0.7 s) with AION compared with healthy volunteers (1.45 +/- 0.4 s). After the 10-day trial arterio-venous passage time was significantly shorter than baseline values. In addition, the initially elevated plasma viscosity (1.33 +/- 0.1 mPa) was significantly lowered by haemodilution therapy.
Aged↗
[Retinal circulation and current blood glucose value in diabetic retinopathy].
In 42 type II diabetic patients with nonproliferative diabetic retinopathy the arm-retina time (ART) and arteriovenous passage time (AVP) were measured by means of videofluorescein angiography. Glycosylated hemoglobin (HbAlc) as a parameter of longterm diabetic control and the blood glucose level were determined. The ART in the diabetics was similar to the ART of normals and the AVP was significantly prolonged. HbAlc level ranged between 5.6 and 12.2% (8.6 +/- 1.7%) and the blood glucose level between 4.5 and 22.9 mmol/l (11.4 +/- 4.5 mmol/l). Significant correlations were found between AVP and blood glucose (r = 0.37) and between AVP and HbAlc (r = 0.49). No correlation was found neither between ART and blood glucose nor between ART and HbAlc. A multiple stepwise regression analysis shows that of both investigated parameters HbAlc is the predicting variable for AVP. These results show that in diabetic patients the retinal blood flow is more influenced by the longterm diabetic control than by the blood glucose level at the time of examination.
Aged↗
[The microvasculature and microcirculation of the peri-macular capillary network. New diagnostic possibilities with the scanning laser ophthalmoscope].
The scanning laser technique makes it possible for the first time to perform objective measurements of blood flow velocities in retinal capillaries. This new technique allows for continuous recording of retinal pictures at high resolution. Only the quality of the optical media of the eye limits the resolution of the retinal image. Sequences with a sample frequency of up to 50 images/s can be stored using a digital recorder. In these digital sequences the moving blood stream in retinal capillaries is visible. Segments of high and low fluorescence can be observed moving through the capillary network of the perifoveal capillaries. The flow velocities of these segments can be measured objectively using image analysis. In addition, morphologic information about the perifoveal capillary bed can be obtained by this new technique. Determination of flow velocities and morphological parameters give an objective means of assessing oxygen supply to the macular tissue. Furthermore, the degree of changes in the perifoveal microcirculation may provide objective data for estimating the prognosis of diabetic or senile maculopathy. Further investigation is needed to examine the relationship between changes in perifoveal microcirculation and the development of macular edema in various diseases.
Adult↗
Modulation of N-methyl-N'-nitro-N-nitrosoguanidine induced inhibition of cell-free protein synthesis by sulfur compounds.
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Animals↗
[A visual disorder as the initial symptom of hairy cell leukemia].
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Adult↗