[Costs and cost coverage of the neonatology department, University Women's Hospital and canton Women's Hospital, Bern].
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Female↗
Biomedical subjects
H Wilhelm
Publications and source records attributed to H Wilhelm.
[Atypical optic neuritis in systemic lupus erythematosus (SLE)].
HISTORY AND CLINICAL DATA: A 67-year-old woman experienced acute unilateral visual loss accompanied by pain with eye movements. There was a marked relative afferent pupillary defect and a nerve fiber bundle defect in the upper half of the visual field. Optic discs were normal. After 4 days vision worsened to motion detection and only a temporal island was left in the visual field. The optic disc margin was blurred. Since thirty years she had been suffering from renal insufficiency. Immunoserologic examination revealed elevated ANA and DS-DNA antibody titers. An optic neuritis in systemic lupus erythematosus was diagnosed, which is called atopic, because of its association to a systemic disease and the old age of the patient. TREATMENT AND FOLLOW UP: The patient was treated with 100 mg prednisolone/day, slowly tapered. Within 6 weeks visual acuity improved to 0.6 and visual field normalized except for a small nerve fiber bundle defect. CONCLUSION: Autoimmune optic neuritis often responds to treatment with corticosteroids. Early onset of treatment is important. Immunopathologic examinations are an important diagnostic tool in atopic optic neuritis. Their results may even have consequences for the treatment of the underlying disease.
Aged↗
[Visual field compendium. Interpretation of perimetry findings. Comprehensive diagnostic measures].
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Brain Diseases↗
Influence of vascular risk factors for atherosclerotic carotid artery plaque progression.
BACKGROUND AND PURPOSE: Investigations regarding arteriosclerosis of carotid arteries showed an association between increased intima-media thickness and vascular risk factors. A newly developed three-dimensional ultrasound method increases the reproducibility of plaque volume measurements because more exact volume measurements can be performed with a reduction of the disadvantages of two-dimensional measurements. In a pilot study the influence of vascular risk factors on carotid artery plaque progression was examined. METHODS: Volumes of atherosclerotic plaques in carotid arteries in 54 patients were measured with a three-dimensional ultrasound system during a 12-month period to determine the relationship between progression or regression of plaque volume, vascular risk factors, dose of aspirin, and flow turbulence in the plaque region. RESULTS: A progression of plaque volume occurred in 67% (36/54) of all plaques. In no plaque was a regression of plaque volume seen. The optimal adjustment of all risk factors showed a significant influence on plaque progression (r = .31). Diastolic blood pressure was the strongest predictor of plaque progression (P < .01), followed by diabetes (P < .03). Turbulence in the plaque region was found in 78% of the patients in the progression group (n = 36) versus 61% in the nonprogression group (n = 18) but was not significant. Dose of aspirin (100 mg versus 250/300 mg) had no influence on plaque volume after 1 year. CONCLUSIONS: Treatment of vascular risk factors reduces the progression of carotid artery plaque volume in three-dimensional ultrasound. The most important factor for plaque progression is a high diastolic blood pressure. Turbulence in the flow pattern and the examined doses of aspirin showed no significant influence.
Aged↗
[A new miniaturized flicker test for detection of florid retrobulbar neuritis].
A new transportable miniaturized flicker test equipped with green LEDs is contrasted with the conventional Tübingen flicker test, based on brightness perception of intermittent white light. The results are compared with those of former studies. In this study we examined 45 eyes suffering from florid optic neuritis. Another group of 114 eyes were either normal (except minimal ametropia) or suffered from a non-inflammatory or non-refractive impairment of central visual function. In all groups only one eye of each subject was examined. Using the criteria of Trauzettel-Klosinski, the new miniaturized "green" flicker test for the detection of a florid optic neuritis showed a specificity of only 50.9% (83.3%) and a sensitivity of 91.1% (64.4%). (The corresponding results of the conventional Tübingen flicker test are shown in parentheses.) Alternatively, analyzing the data with the help of a logistic regression, the "green" flicker test turned out to have a specificity of 92.9% (93.8%) and a sensitivity of 60.5% (44.2%). For further examinations using the flicker test it is useful to consider the duration and reproducibility of each brightness match by repeating the test several times.
Adolescent↗
[Sensitivity and specificity of masked field campimetry].
Patients with circumscribed visual field defects are able to perceive the scotomata immediately while looking at randomly distributed black and white squares (12' x 12') flickering on a VDU with a high frequency (approximately 30 Hz), resulting in a stimulus field comparable to the white-noise field on a TV screen without reception. In 368 eyes of 368 patients with varying lesions of the visual pathway the results of white-noise field campimetry were compared with those of conventional threshold-related, slightly suprathreshold automated grid perimetry. Rate of detection (sensitivity) was 84.2% in conventional perimetry and 80.7% in white-noise field campimetry, respectively. The results are not significantly different (p > 0.1; McNemar test). Examinations in 198 eyes of 198 persons without any indication of a visual pathway defect allowed a definition of the normal range of white-noise field campimetry to be made. The specificity of this new method was 82.3%. The outcome of this most extensive study on sensitivity and specificity of noise field campimetry is compared with other publications. The results presented emphasize the capabilities of this new method as a screening test. They encourage the initiation of a field study using the noise field stimulus broadcasted to home TV sets.
Adolescent↗
Vascular risk factors for atherosclerotic plaque progression in carotid artery.
Two-dimensional ultrasound is a widely used technique for the clinical assessment of carotid atherosclerosis. We measured volumes of atherosclerotic plaques in carotid arteries in 70 patients with a newly developed and tested three-dimensional ultrasound method over a period of twelve months to determine the relation between progression or regression of plaque volume and vascular risk factors. In multiple regression analysis of age, size, smoking, total cholesterol, HDL-cholesterol, HDL/total cholesterol ratio, LDL-cholesterol, triglycerides, HbA1, diastolic and systolic blood pressure, the strongest predictor of plaque progression (p < 0.01) was diastolic blood pressure, diabetes came next (p < 0.05). The optimal adjustment of all risk factors showed a significant influence on plaque progression (r: 0.76).
Aged↗
Influence of suction cup oculopression on corneal astigmatism.
In 11 (right) eyes of 11 ocularly healthy subjects an artificial stepwise intraocular pressure (IOP) elevation was applied by suction cup oculopression. The initial negative pressure in the suction cup was 80 mmHg; it was raised in steps of 40 mmHg. The median of the corneal astigmatism, measured with a Zeiss ophthalmometer, was 0.50 D before oculopression (the values of the 10th and 90th percentiles were 0.30 and 1.10 D, respectively). Corneal astigmatism increased to 2.00 (0.00-5.10) D, 2.25 (1.00-5.55) D, 2.63 (0.63-7.00) D, 3.38 (1.88-6.88) D, 3.38 (2.83-7.25) D, and 4.38 (2.85-5.63) D with 80, 120, 160, 200, 240, and 280 mmHg oculopression, respectively. The astigmatism dropped to 0.75 (0.00-2.30) D immediately after removal of the suction cup. Thus, suction cup oculopression not only influenced IOP but also ocular refraction. This is of particular importance since visual evoked potential (VEP) amplitude is to a high degree dependent on refractive changes. This fact has to be considered if changes in VEP amplitude during suction cup oculopression are used as a tolerance test in glaucoma diagnosis.
Adult↗
[Pholedrine for determining the site of Horner syndrome].
BACKGROUND: Pharmacologic testing by indirect acting sympathomimetics like hydroxyamphetamine may determine the site of the lesion in Horner's syndrome. Pholedrine is chemically similar to hydroxyamphetamine. Therefore we examined if it shows the same effects in normal subjects and in patients with Horner's syndrome. METHODS: Pupil diameter was measured by means of standardized photography before and after single and with different intervals repeated administration of pholedrine eye drops in normal subjects. In 18 patients with Horner's syndrome and known hydroxyamphetamine test results, a pholedrine test was carried out analogous to the hydroxyamphetamine test. RESULTS: Pholedrine dilates the normal pupil by 2.2 mm (mean). It acts at the longest 8-10 hours with maximal effect between 20 and 90 minutes. After this period its effect decreases rapidly. It acts independently from age and from baseline pupil diameter. Given repeatedly the second administration reaches the same mydriatic effect as the first only if the interval between both applications is 72 hours or more. This is because it needs some time to refill the noradrenaline stores in the sympathetic neuron innervating the dilator muscle of the pupil. In Horner's syndrome pholedrine dilates the involved pupil only minimally in case of a postganglionic lesion, and in case of a preganglionic lesion it dilates the pupil even slightly more than the normal fellow pupil. It shows the same effect as hydroxyamphetamine. There are only few side effects. CONCLUSION: Pholedrine is a substitute for hydroxyamphetamine to localize the site of the lesion in patients with Horner's syndrome.
Adolescent↗
[Comments on the editorial by G. Kommerell "Treatment of optic neuritis with corticosteroids"].
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Adrenal Cortex Hormones↗
GTP binding and hydrolysis by the signal recognition particle during initiation of protein translocation.
The signal recognition particle (SRP) consists of one RNA and six protein subunits. The N-terminal domain of the 54K subunit contains a putative GTP-binding site, whereas the C-terminal domain binds signal sequences and SRP RNA. Binding of SRP to the signal sequence as it emerges from the ribosome creates a cytosolic targeting complex containing the nascent polypeptide chain, the translating ribosome, and SRP. This complex is directed to the endoplasmic reticulum membrane as a result of its interaction with the SRP receptor, a membrane protein composed of two subunits, SR alpha and SR beta, each of which also contains a GTP-binding domain. In the presence of GTP, SRP receptor binding to SRP causes the latter to dissociate from both the signal sequence and the ribosome. GTP is then hydrolysed so that SRP can be released from the SRP receptor and returned to the cytosol. Here we show that the 54K subunit (M(r) 54,000) of SRP (SRP54) is a GTP-binding protein stabilized in a nucleotide-free state by signal sequences, and that the SRP receptor both increases the affinity of SRP54 for GTP and activates its GTPase. We propose that nucleotide-mediated conformational changes in SRP54 regulate the release of signal sequences and the docking of ribosomes at the endoplasmic reticulum.
Amino Acid Sequence↗
[Age dependence of pupillary near reflex].
BACKGROUND: This study was performed to gain age correlated normal values for the pupillary near reflex. METHODS: Accommodation and pupillary near reaction were measured by means of simultaneous infrared video retinoscopy and pupillography in 64 healthy volunteers aged between 5 and 55 years. Measurements were done at a reduced, near mesopic, light condition with accommodation to 10, 14, 20 and 33 cm. RESULTS: The pupillary near response varied highly with age: persons younger than 20 years of age showed a significantly smaller pupillary near response as compared to those older than 20 years. In most of the children younger than 10 years the pupil near response was very small (less than 10% constriction) at accommodation distances longer than 10 cm. There was a significant difference between the age groups younger and older than 20 but no statistically significant differences within these age groups. CONCLUSION: A change of the pupillary near reaction takes place around the age of 20. We conclude that this change does not only reflect the aging of the cristalline lens but is due to an age related change of the supranuclear control.
Accommodation, Ocular↗
[Meningioma of the optic nerve sheath with extensive intraocular growth].
PATIENT: We report on an elderly female patient with a diagnosis of an optic nerve sheath meningioma 11 years after onset of ophthalmological symptoms. 8 years after diagnosis and consecutive tumour-resection near the orbital apex the eye had to be enucleated because of a painful secondary glaucoma. Prior to enucleation computed tomography had revealed extra- and intraocular tumour. MORPHOLOGY: Morphological investigations showed a neoplasia which had entered the eye via the optic nerve head. Besides severe secondary changes there was a diffuse tumour spread within the choroid and a "mushroom-like" growth towards the vitreous cavity. No differences between extra- and intraocular meningioma were found light- and electronmicroscopically.
Aged↗
Inter-individual variability in the dynamics of natural accommodation in humans: relation to age and refractive errors.
1. To study the relationship between accommodation under natural viewing conditions, age and refractive errors, we have measured time courses of accommodation in thirty-nine human subjects aged 5-49 years using a newly developed technique. The technique is based on infrared photoretinoscopy and involves fully automated on-line image processing of digitized video images of the eyes with a sampling rate of 5.3 Hz. 2. The distance between the subject and the video camera was about 1.3 m. Head movements of the subject required little restriction because the eyes were automatically tracked in the video image by the computer program. All subjects were tested under binocular viewing conditions. 3. Both refraction of the right eye and pupil diameter were measured with a precision of 0.2-0.4 dioptres (D) and 0.1 mm, respectively, and were plotted on-line. The data were subsequently automatically analysed. 4. Automated infrared photoretinoscopy proved to be very convenient and easy to handle in both children and adults. 5. The maximal speed of accommodation for a target at a distance of 5 D declined in the subjects with age (from up to 21.7 D s-1 for accommodation and 32.7 D s-1 for subsequent accommodation to a distant target ('near to far accommodation') in children down to 2-18 D s-1 in adults). There was a striking inter-individual variability in the maximum possible speed of accommodation and near to far accommodation. 6. Speed of accommodation and of near to far accommodation was correlated for each subject. However, in most of the subjects, the process of near to far accommodation was faster than accommodation (P < 0.005, if averaged over all subjects). This correlation was independent of age. 7. The accommodation-induced pupillary constriction (pupillary near response) was absent in children for a 4 D target; even at 10 D, there was no reliable pupillary response. The pupillary near response increased to about 1.6 mm D-1 of accommodation at the age of 47. Since a pupillary near response could still be elicited in presbyopic subjects unable to accommodate, the ratio of pupillary constriction per dioptre of accommodation approached infinity. 8. The magnitude of the pupillary near response was highly variable even among subjects of the same age but was typical for each subject. There was a correlation (P < 0.01) to refractive error: corrected myopes had weaker pupillary near responses than emmetropes or hyperopes.(ABSTRACT TRUNCATED AT 400 WORDS)
Accommodation, Ocular↗
Uncommon chiasmal lesions: demyelinating disease, vasculitis, and cobalamin deficiency.
We report on eight patients who presented for evaluation of unexplained visual loss. They all showed a typical chiasmal visual field defect (bitemporal hemianopia, junction scotoma). In all patients, high-resolution computer-assisted tomographic (CT) scans of the sellar region were normal, and neither the medical history nor additional ophthalmological findings pointed to any explanation for the underlying disease. Six patients seemed to have suffered from chiasmal optic neuritis. Magnetic resonance imaging (MRI) scans could elucidate the diagnosis in five cases: white-matter lesions typical of multiple sclerosis (MS) were found and, additionally, in four cases an enlargement of the chiasm or barrier defect was revealed in post-gadolinium MRI. In one patient, MRI was normal. He recovered completely after megadose steroid therapy. One patient developed motoric symptoms of MS during the following year, another patient had mild sensory symptoms and recurrence of severe optic neuritis. An MR-proven chiasmal lesion due to a leukocytoclastic immunovasculitis combined with small subcortical white-matter lesions was diagnosed in another patient. The field defects disappeared spontaneously. In a 28-year-old woman a low vitamin B12 level was found in routine blood samples. Parenteral vitamin B12 substitution led to an almost complete recovery of the visual field defects. Chiasmal optic neuritis may occur isolated or during the course of MS. Megadose steroids may be of value if contraindications have been ruled out. A chiasmal visual field defect caused by vitamin B12 deficiency is very uncommon. A similar case was reported in 1961.
Adult↗
[Differential diagnostic strategies in uncertain vision disorders].
The differential diagnosis of visual disturbances of unclear origin can cause major problems in ophthalmology, especially if there are no functional defects or if functional defects cannot be explained by morphological findings after an extensive regular ophthalmological investigation. The aim of this paper is to present strategies that allow subtle visual disturbances to be related to certain groups of functional defects. Especially simple investigations are emphasized that lead quickly to a well-founded possible diagnosis that helps both the ophthalmologist and patient save time and cost-consuming deviations. The key investigations are: (1) a symptom-oriented case history; (2) exclusion of refractive problems by pin-hole test, retinoscopy and ophthalmometry; (3) the swinging flashlight test; (4) ophthalmoscopy of the macula and optic disc; (5) visual field. A flow chart is presented that explains the strategy of additional special investigations based on the results of the key findings in order to approach quickly the cause of a visual disturbance. Some of the more common causes of visual disturbances of unclear origin are discussed, including some major therapeutic principles.
Humans↗
Tonic pupil, areflexia, and segmental anhidrosis: two additional cases of Ross syndrome and review of the literature.
Two patients are described with the triad of tonic pupil, hyporeflexia and segmental anhidrosis (Ross syndrome). Only 18 cases of this syndrome have been reported in the literature so far. While tonic pupil and reduced sweating can be attributed to the affection of postganglionic cholinergic parasympathetic and sympathetic fibres projecting to the iris and sweat glands, respectively, the pathogenesis of diminished or lost tendon jerks remains obscure. To identify the characteristic clinical features, the previous cases of Ross syndrome are reviewed. Recent evidence of subclinical disturbances of sweating in most patients with Adie's syndrome, i.e. tonic pupil and areflexia, casts doubt on the nosological concept of Ross syndrome as a distinct clinical entity.
Adult↗