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Biomedical subjects

H J Kaiser

Publications and source records attributed to H J Kaiser.

At least 55 records · Page 3Linked to original sources
PubMed1996

[Assessment of myocardial viability using 201TL SPECT at rest to predict the reversibility of left ventricular wall motion abnormalities].

AIM: The aim of the present study was to predict preoperatively the reversibility of left ventricular wall motion abnormalities using TI-201 SPECT at rest. METHODS: 19 patients with advanced coronary artery disease and regional wall motion abnormalities were examined at rest with TI 201 SPECT (acquisition 15 minutes and 3 hours post injection). Successfully revascularized, proven by a second coronary angiography three month after revascularisation. Wall motion was again evaluated by cineventriculography. RESULTS: The preoperative a- or dyskinetic segments were best separated by the minimal relative TI-201 uptake in the defect 3 hrs p.i. in (i) postinterventionally improved wall motion (TI-201 uptake 67 +/- 14%, viable) and in (ii) without recovery (TI-201 uptake 46 +/- 12%, p < 0.001, non viable). A threshold at a TI-201 uptake of more than 50% yielded a positive predictive value of 0.73 and a negative predictive value of 0.86. If the segments with wall motion abnormalities (hypokinetic included) were evaluated as one group, no such threshold was obtained all segments which occurred a TI-201 uptake of more than 80% showed a functional recovery, wall motion did not improve in any segment with a TI-201 uptake of less than 40%. In the present study a considerable influence of the defect localisation with regard to the posterior wall was not observed. The values of TI-201 redistribution under resting condition were not useful to predict functional recovery. CONCLUSION: TI-201 SPECT in rest predicts preoperatively the reversibility in regions with severe wall motion abnormalities only and indicates myocardial viability in these cases. Thus, the method is basically useful to determine myocardial viability. In hypokinetic segments, however, a wide range of TL-201 uptake values exists without definite evidence to functional recovery.

Aged↗
PubMed1996

Reproducibility of color Doppler imaging in orbital vessels.

The purpose of this study was to evaluate the short-term reproducibility, the long-term reproducibility, and the reproducibility of the measurements made between two different examiners of blood-flow velocity in extraocular vessels using color Doppler imaging (CDI). In a group of 10 healthy volunteers, measurements of the peak-systolic velocity (PSV), end-diastolic velocity (EDV), and resistivity index (RI) in the ophthalmic artery and the central retinal artery as well as one lateral and one medial short posterior ciliary artery were performed. The best intraindividual reproducibility, expressed as the relative error, was found for the PSV and RI measured in the ophthalmic artery (OA; PSV 5.9%, RI 3.1%) and the central retinal artery (CRA; PSV 7.7%, RI 4.7%). The PSV and RI determined in the posterior ciliary arteries were less reproducible but as much so as the EDV measured in the OA (11.8%) and CRA (19.9%). No systematic trend could be found between the first and second measurements. However, the long-term fluctuation was considerable high. Measurements of PSVs showed good concurrence between the two observers in all four vessels measured. The EDVs and RIs differed statistically significantly between the two observers. This difference was most pronounced in the posterior ciliary arteries.

Adult↗
PubMed1995

Endothelin-1 plasma levels in normal-tension glaucoma: abnormal response to postural changes.

BACKGROUND: Endothelin-1 (ET-1) is a potent vasoconstrictor peptide produced by vascular endothelial cells. ET-1 may have a role in the pathogenesis of various vascular diseases. There are reports in the literature that ET-1 plasma levels are raised in normal-tension glaucoma (NTG) patients. METHODS: ET-1 concentration, plasma renin activity, and 24-h blood pressure were measured in 21 high-tension glaucoma (HTG) patients, 19 NTG patients, and 20 non-glaucomatous controls in supine and upright positions. RESULTS: ET-1 plasma levels tended to be higher in NTG patients (3.2 +/- 2.2 pg/ml) than in HTG patients (2.2 +/- 0.6 pg/ml) and controls (2.6 +/- 0.7 pg/ml). The differences, however, were not statistically significant. The individual scatter was significantly greater in the NTG group, indicating that our NTG patients are a heterogeneous population. The physiological increase in ET-1 plasma level after changing from the supine to the upright position was absent in NTG patients. Plasma renin activities tended to be lower in NTG patients (1.2 +/- 1.2 ng/ml/h) than in HTG patients (1.3 +/- 0.8 ng/ml/h) and controls (2.0 +/- 1.7 ng/ml/h). This may explain why NTG patients had relatively low blood pressure despite high ET-1 levels. CONCLUSIONS: Our data support the hypothesis that vascular dysfunction may be involved in the pathogenesis of optic nerve damage in normal-tension glaucoma.

Blood Pressure↗
PubMed1995

[Automated perimetry in ptosis and blepharochalasis].

BACKGROUND: First, we were looking if a correlation between the extent of ptosis and superior visual field defect exists. In a second step visual fields in blepharochalasis were compared with those in ptosis. PATIENTS AND METHODS: Pre- and postoperative visual fields in 20 patients with blepharochalasis, 6 patients with congenital and 9 with acquired ptosis were tested using program 7 of Octopus 500 automated perimeter. The degree of ptosis was separated in mild, medium and severe. According to the extent of visual field defect the same parameters as in ptosis were used also grading blepharochalasis in mild, medium and severe. RESULTS: We found that the amount of upper visual field defect clearly correlated with the extent of ptosis. In addition, patients with congenital ptosis showed less visual field defect compared to those with acquired ptosis. Comparable to ptosis surgery blepharoplasty also lead in severe and medium cases to a clear gain of upper visual field. CONCLUSION: Using perimetry and the same grading system as for ptosis makes it possible to study the functional defect occurring to the blepharochalasis patient.

Adolescent↗
PubMed1995

Influence of posture on the visual field in glaucoma patients and controls.

The intra-ocular pressure rises when body position is changed from sitting to supine. This phenomenon occurs to the same extent in healthy people and glaucoma patients. The purpose of this preliminary study was to determine the effect of posture on the visual field. Visual fields of 15 eyes of 12 normal-tension glaucoma (NTG) patients, 16 eyes of 11 high-tension glaucoma (HTG) patients and 30 eyes of 26 healthy controls were measured in the upright and supine positions with program G1X on an Octopus swivel-arm perimeter. The delta mean defect (delta MD), that is MDupright-MDsupine, was calculated for each patient and compared among study groups. Whereas visual fields improved in healthy controls (delta MD = +0.45 dB), glaucoma patients showed a slight deterioration of the visual field after changing position from supine to upright (HTG: delta MD = -0.25 dB, NTG: delta MD = -0.24 dB). The difference between HTG and controls, as well as between NTG and controls, was statistically significant (p < 0.002, Student's t test). These findings indicate that in some glaucoma patients the regulatory mechanisms for blood supply in the optic nerve head are insufficient.

Adult↗
PubMed1995

Visaline in the treatment of age-related macular degeneration: a pilot study.

Age-related macular degeneration (AMD) is the main cause of a reduction in visual acuity in patients over the age of 65 years. A positive influence of medical treatment (i.e. with vitamins and trace minerals) has been suggested but remains unproven. In this randomized, double-blind study, 20 patients in an early stage of AMD were included. Over a period of 6 months, 9 patients were treated with Visaline and 11 with a placebo. The effect of the treatment was not statistically different between the two groups, admittedly small in number, in terms of visual and retinal acuity, color vision, and contrast sensitivity. Despite the lack of such measureable differences, the patients' own subjective assessments, however, were much better in the Visaline-treated group. Due to the short duration of the observation time, we can not comment on a possible long-term effect.

Adrenergic beta-Agonists↗
PubMed1995

[Acute glaucoma attack].

An acute angle-closure glaucoma is thought of as a sudden, mostly unilateral marked increase in intraocular pressure. The patient complains of strong, sometimes radiating pain as well as a reduction in visual acuity. The affected eye is severely reddened, the cornea is cloudy, and the ocular globe feels rock-hard under palpation. Immediate therapy is decisive for maintaining visual function. In an acute case, therapy should include local pressure-reducing eye drops and systemic diuretics. Surgical intervention should always be made to prevent repeated occurrence and as a prophylaxis in the partner eye.

Acute Disease↗
PubMed1995

[Effect of morphological changes on perfusion and metabolism in cerebral microangiopathy. A comparison of PET, SPECT, and magnetic resonance imaging findings].

51 patients with cerebral microangiopathy were studied with MRI, 18FDG-PET, and 99mTc-HMPAO-SPECT. Exact morphological correlation of MRI-findings to functional data from PET and SPECT was obtained by a special head holder system applied to the patient's head. Patients with less than four lacunar infarctions (LI) and without or only slight deep white matter lesions (DWML) in MRI showed no significantly changed parameters (rMRGlu, rCBF) compared to patients with four or more LI and severe DWML. Patients with medium to severe outer and inner brain atrophy showed significantly lower rMRGlu and rCBF values in both cortex and white matter than patients with no to only slight atrophy. Thus, in patients with cerebral microangiopathy only atrophy and not the presence of LI and DWML is associated with a significant reduction of rCBF and rMRGlu.

Brain↗
PubMed1995

[Comparison of relative 18FDG uptake with metabolic rate (MRGlucose) in the myocardium in CAD, classified by 99m-Tc-MIBI].

AIM: Are i) typical patterns of perfusion/metabolism (match, mismatch), gained from relative 99mTc-MIBI vs relative 18FDG uptake (normalized to the perfusion maximum) obtainable also vs absolute MRGlu and is ii) rMRGlu in the segment of maximum perfusion (MIBI = 100%) within the normal range for all degrees of coronary artery disease (CAD)? METHODS: In 55 non-diabetic patients with CAD, relative myocardial perfusion (99mTc MIBI SPECT at rest) and relative 18FDG uptake (PET after glucose load) were used to separate for various flow/metabolism constellations. In addition, regional glucose metabolic rate (rMRGlu in mumol/100 g/min; dynamic-graphic analysis from Gambhir/Patlak) was determined in 13 segments of the left ventricle each (i.e., in a total of 715 segments). RESULTS: rMRGlu revealed wide standard deviations (up to 51%). It decreased from normal (52.7 +/- 27.3 mumol/100 g/min), mismatch (45.3 +/- 17.3) and intermediate (35.2 +/- 12.4) to match ("non viable"; 26.7 +/- 13.3) significantly (p < 0.01). In 26% of the perfusion maxima, MRGlu was < 40 mumol/100 g/min. Out of these, only in five patients (of 28) with 3-vessel disease, it was even smaller (< 30 mumol). In three out of the latter, glucose blood levels were below euglycemia. CONCLUSION: rMRGlu in CAD revealed an identical perfusion/metabolism pattern as relative 18FDG uptake. Thus, the higher efforts employed to compute rMRGlu do not yield diagnostic advantage. The segmental perfusion maximum, used for normalization of relative 18FDG uptake (100% MIBI uptake = 100% FDG uptake) was reliable in euglycemic patients even with 3-vessel disease.

Biological Transport↗
PubMed1994

Longterm visual field follow-up of glaucoma patients treated with beta-blockers.

In a prospective, randomized, double-masked study, 44 patients with primary open-angle glaucoma were treated either with 0.5% betaxolol or 0.5% timolol in both eyes twice daily. Twenty-nine patients could be followed up for 48 months. Seventeen of these patients were treated with betaxolol and 12 with timolol. Each examination included visual field measurements with an Octopus automated perimeter 201 (Program G1), intraocular pressure measurement, funduscopy, as well as pulse and arterial blood pressure measurements. Both drugs lowered in the intraocular pressure. This reduction was slightly but not statistically significantly higher in the timolol-treated group. However, the visual fields improved more in the betaxolol group. Patients treated with betaxolol had significantly smaller averaged mean defects (p < 0.05) and higher averaged mean sensitivities (p < 0.05, Wilcoxon rank score text) than did timolol-treated patients at months 3, 6, 12, and 18. Thereafter, the difference between the two groups was not statistically significant in this relatively small sample size. For betaxolol patients the cumulative area-under-the-curve analysis for the worse eye yielded significantly larger mean sensitivities beyond month 12 (exception: month 30; p < 0.05) and significantly smaller mean defects beyond month 6 (p < 0.05).

Aged↗
PubMed1994

High-resolution perimetry of the central visual field.

The Octopus Program M1 was designed for the detection/follow-up of central or paracentral visual field defects in patients with neurological disorders or with macular or perimacular diseases. Within the central 25 degrees visual field, 59 test locations provide a resolution of < or = 1.4 degrees. The differential light sensitivity is measured with 'Octopus normal strategy', i.e. a 4/2/1 staircase procedure. The Program M2X has 81 test locations in the central 10 degrees, giving even higher resolution (< or = 0.7 degrees) of the central visual field. Both programs have 2 phases, the second being a re-test. Program M2X's phases are divided into 4 stages and allow interruption anytime.

Adult↗
PubMed1994

A method of correlating and merging cerebral morphology and function by a special head holder.

A method is introduced which records and correlates topographically identical morphological and functional image data by means of a special head holder system which is adaptable to different modalities (MRI, PET, SPECT). It is based on a commercially available thermoplastic headmask. A thermoplastic form is used to mold an individual headmask (time required: 7 min) for all modalities providing a fixation of the patient during acquisition. This method guarantees an exact repositioning and therefore the same slice orientation of the images. The in-plane correlation is performed by adapting standard offset parameters determined with a homogeneous head phantom. By fusion (merging) of the brain outline contours or images themselves the accuracy was tested in MRI vs. PET resp. SPECT (transaxial accuracy: < or = 2.0 mm, axial: < or = 3.0 mm in patients with MRI-slice thickness of 6.0 mm).

Brain↗
PubMed1993

Systemic blood pressure in glaucoma patients.

Blood pressure was monitored for 24 h in 32 control patients, 38 open-angle glaucoma patients referred because of decompensated IOP despite maximum treatment, 40 patients with open-angle glaucoma referred because of progressive damage despite controlled IOP, and 39 normal-tension glaucoma patients. In the control group a physiological drop in blood pressure during the night was observed. The patients referred with uncontrolled IOP had blood pressure very similar to that of the control group during both day and night. However, the open-angle glaucoma patients with progression despite well-controlled IOP and also the patients with normal-tension glaucoma had markedly, and statistically significantly, lower systolic blood pressure during both day and night. The difference in diastolic blood pressure was smaller. Thus, blood pressure should be considered in diagnosis.

Aged↗
PubMed1993

Silent myocardial ischemia in glaucoma patients.

The pathophysiological mechanism involved in normal-tension glaucoma is still not fully understood. Besides intraocular pressure, vascular and rheological factors have been described. In the present study, the prevalence of silent myocardial ischemia in patients of the same age with normal-tension glaucoma, primary open-angle glaucoma and cataract was compared. Our findings indicate that in all three groups ischemic episodes occurred more frequently than described in normal people. The most striking observation, however, was the fact that in normal-tension glaucoma the frequency was twice that of the other two groups.

Electrocardiography↗
PubMed1992

Fluorine-18 deoxyglucose PET for assessment of viable myocardium in perfusion defects in 99mTc-MIBI SPET: a comparative study in patients with coronary artery disease.

Extent and frequency of viable tissue in myocardial segments yielding a perfusion defect on technetium-99m methoxyisobutylisonitrile (99mTc-MIBI), single photon emission tomography (SPET) at rest was prospectively investigated with 2-18F-2-deoxyglucose (18FDG) positron emission tomography (PET) in 46 patients with chronic coronary artery disease (CAD). Of these, 43 had a history of old myocardial infarction. For comparative visual and quantitative evaluation of identical anatomical slices, PET image files were converted into the SPET file structure and into the same matrix size. SPET and PET images were documented and visually (9 segments/patient) or semiquantitatively evaluated by a target-like polar map. Relative perfusion was expressed in percentage of peak 99mTc-MIBI uptake. Sample 18FDG uptake was related to the 18FDG uptake in the area of such maximal perfusion (18FDG uptake was 100% at the 100% 99mTc-MIBI uptake area). Of 414 segments, 167 (40%) revealed a resting perfusion defect. 18FDG uptake was present in 38 (23%) of the defects, while another 40 (24%) segments yielded 18FDG uptake in the periphery of the defect. When grouped according to the degree of 99mTc-MIBI uptake-reduction (in percentage of peak activity), 80% of severe defects (less than or equal to 30% of peak uptake), 48% of moderate (31%-50% of peak uptake) and 31% of mild (greater than 50% of peak uptake) defects were considered as non-viable on the basis of 18FDG uptake. Complete viability was found in none of the severe defects in contrast to 29% of moderate and 35% of mild perfusion defects.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary Disease↗
PubMed1992

Bromocriptine lessens the incidence of mortality in L-dopa-treated parkinsonian patients: prado-study discontinued.

L-Dopa supplemented by a peripheral decarboxylase inhibitor is considered the most potent therapeutic regimen prolonging active life in Parkinsonian patients. The long-term benefit of therapy is limited by adverse effects, such as dyskinesia and on-off phenomena, which can be mitigated by the concomitant administration of dopamine agonists, such as bromocriptine. In order to quantify the beneficial impact of early combination therapy, a controlled clinical trial (PRADO: PRA videl1 + DO pa) in patients with early Parkinson's disease was carried out, whereby L-Dopa monotherapy (in a fixed combination with benserazide (DoBe) was being compared with the same combination plus bromocriptine (DoBeBro). Patients were recruited and treated by 101 practising neurologists in the Federal Republic of Germany and in Hungary. Twenty seven clinical university centers cross-checked the patients at regular intervals. The trial started with 3 months of DoBe monotherapy (median dose of 375 mg L-Dopa for both randomized groups) followed by gradual substitution of DoBe by bromocriptine over 3 months in one of the groups (250 mg L-Dopa/10 mg bromocriptine). The target medication was maintained from study months 6 to 54. Parkinsonian symptoms were classified according to the Webster rating scale, the Hoehn and Yahr scale and the Zung Self-Rating Depression Scale. Adverse events and life status were checked at regular intervals. Special emphasis was given to motor performance tests. 587 patients (302 in the DoBe group and 285 in the DoBeBro group) were available for intention-to-treat analysis. Both groups were homogeneous at baseline in all observed parameters.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

[Significance of the peripheral visual field for diagnosis of glaucoma].

Investigated was the significance of semiquantitative tests of the peripheral visual field in glaucoma. For that purpose 793 visual fields of 793 glaucoma patients or glaucoma suspects and 338 visual fields of 338 normal controls (normal central 26 degrees--area) were analysed. Perimetry was performed with an Octopus 201 with the help of program G1, which tests 14 peripheral test locations. In the majority of the 455 glaucoma patients (pathological findings in the central visual field) the periphery was also disturbed. Much to our surprise however, the 338 glaucoma suspects (having normal central visual fields) showed the same frequency of peripheral visual field disturbance as the normals. This holds true for the total peripheral visual field, as well as for the individual test locations. Therefore it makes sense to limit perimetry in glaucoma patients to the central area, provided that the central area is quantitatively measured with an adequate testgrid.

Diagnosis, Differential↗