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Biomedical subjects

H Wilhelm

Publications and source records attributed to H Wilhelm.

At least 91 records · Page 5Linked to original sources
PubMed1992

[Bilateral optic neuropathy with papilledema].

The findings in nine patients are presented who suffered from acute bilateral visual loss occurring within less than one week, and all showed optic disc edema. CT scans revealed no abnormalities and the CSF-pressure measured in 6 patients was normal. Four of the patients (22 to 53 years old) recovered completely under orally given prednisolone (about 100 mg/day). The recent history of three patients suggested that the optic neuropathy was associated with an infection. This parainfectious process may be identical to the bilateral optic neuritis described in children. Four older patients (55 to 63 years) did not respond to steroid therapy. Their vision did not significantly improve. They showed attenuated retinal arteries; therefore it can be assumed that ischemia plays a role in the pathogenesis of this second type of optic neuropathy. In none of the cases a toxic optic neuropathy could be confirmed. One patient who experienced a visual loss down to finger counting after throat-surgery without marked blood loss recovered partially after steroid treatment.

Adult↗
PubMed1992

[Narrowing of the palpebral fissure as the first symptom of extensive osteoma with orbital involvement].

Unilateral narrowing of palpebral fissure and moderately impaired visual acuity induced a 14 years old woman to consult an ophthalmologist. Neuroradiological examination revealed a large osteoma starting from the ethmoid cells and invading both the orbit and the cranial cavity. This case illustrates that proptosis may be absent even in cases of extensive and compact orbital tumors. Therefore, exophthalmos is a common but not an indispensable sign of an orbital tumor. In Gardner's syndrome osteomas are associated with soft tissue tumors, intestinal polyposis and colonic adenomatosis that ultimately progresses to colorectal cancer. This association is frequent enough that a colon examination should be suggested to all patients with osteoma.

Adolescent↗
PubMed1992

Horner's syndrome: a retrospective analysis of 90 cases and recommendations for clinical handling.

The records of 90 cases of oculosympathetic paresis (1982-1991), 39 women and 51 men aged between 3 months and 82 years, were evaluated. The mean baseline anisocoria was 0.92 mm but did not exceed 2.4 mm. The mean difference in the position of the upper eyelid was 2.3 mm. Enophthalmus of 1 mm or more was found in only 25% and exophthalmus of 1 mm or more, in 18%. Exophthalmus or enophthalmus of more than 2 mm was not encountered. The cocaine test (5% solution in most cases) was performed in 85 cases and could be quantified in 65 cases. The average dilation of the involved pupil was 0.52 mm, whereas the normal pupil dilated 2.14 mm. The average postcocaine anisocoria was 2.54 mm. Hydroxyamphetamine 1% dilated the involved pupil in cases with presumed preganglionic lesions slightly more than the normal fellow pupil (2.39 mm and 2.09 mm respectively). The difference was significant (P < 0.05). In postganglionic lesions, the hydroxyamphetamine dilation was 0.57 mm. The hydroxyamphetamine test had a specificity of 90% for postganglionic lesions and 88% for preganglionic. An underlying acquired disease could be identified in 53 cases; 6 cases were congenital. In 37 cases (including the congenital ones), no cause was found. Among the 33 preganglionic lesions, only one malignant tumor was found, whereas 6 malignant tumors were encountered among the 20 postganglionic cases. Additional ocular motor palsies or other local signs were present in these 6 cases. Goiter was frequently associated with preganglionic Horner's syndrome.

Adolescent↗
PubMed1992

[White-noise field campimetry before and after artificial increase of intraocular pressure. Possible applications in diagnosis and evaluation of glaucoma].

A total of 173 eyes (visual field defect stages O-V) of 99 glaucoma patients were investigated by means of conventional threshold-oriented suprathreshold automated test point perimetry using the Tübingen Automatic Perimeter (TAP) and by means of white-noise-field campimetry (flickering random dot pattern) using the Tübingen Electronic Campimeter (TEC). Most eyes were affected by primary open-angle glaucoma (119) or low tension glaucoma (35). The concordance between the two methods was good in 65 eyes (37.6%). Sufficient in 32 (18.5%) eyes, poor in 32 cases (18.5%) and inadequate in 44 eyes (25.4%). Among the last group of 44 eyes, 32 perceived a scotoma in the noise field (NF) but did not show any pathologic defect in conventional automated test point perimetry: the opposite constellation was found in only 12 eyes. In most cases, scotoma in the NF showed a change in both brightness and motion (noise) perception. No clear relationship between the type of glaucoma and a certain constellation of the aforementioned NF specifications could be found. Complete lack of noise perception in the scotoma occurred more frequently in advanced glaucoma (stage > or = IV). In 110 eyes of 63 of the glaucoma patients, white-noise-field campimetry was carried out during artificial IOP elevation achieved by suction-cup oculopression: during steplike increases of the negative pressure in the suction-cup up to maximum of 375 mmHg the following stages could be seen (the percentage of eyes that perceived each phenomena over the negative pressure range is shown in brackets): change in NF perception compared with initial findings (96.4%); impairment of central noise-field perception (78.2%); concentric constriction of NF (61.8%); complete breakdown of noise (field) perception (42.7%). A further, quantitative classification of these eyes was possible by evaluation of the negative pressure in the suction-cup that led to any one of these NF phenomena. The results demonstrate the usefulness of white-noise-field campimetry as a very fast screening method for detecting glaucomatous visual field defects. It can also be performed as a pressure tolerance test and thus be used to classify glaucomatous risk stages.

Adolescent↗
PubMed1992

[Prospective follow-up of neuropsychological deficits after cervicocephalic acceleration trauma].

30 patients with acute cervico-cephalic syndrome following whiplash injury (neck and head pain, vegetative symptoms and subjective complaints of impaired mental functions) without neurological deficits were investigated in a prospective follow-up of 3 months with neuropsychological examination in the acute phase (x = 5.7 days) and again 6 and 12 weeks after the accident. Attention, concentration, cognition and verbal and visual memory functions were quantified by neuropsychological tests, and changes over the observation period were analysed. In the acute phase all neuropsychological functions were below the individual's normal level. Deficits in attention and concentration recovered within the first 6 weeks. Further recovery within the following 6 weeks were observed in visual memory, imagination and analytic capacity. The capability of verbal memory and abstraction, cognitive selectivity and information processing speed was impaired for a longer time and first recovered after 12 weeks. In conclusion, intraindividual neuropsychological deficits following whiplash injury can be quantified and monitored to show the time course of recovery. Thus in clinical and forensic practice the diagnosis of a pseudoneurasthenic or even "neurotic" syndrome in acute whiplash injury should be made with caution.

Accidents, Traffic↗
PubMed1991

[Modification of refraction and visual noise perception by suction cup oculocompression].

In 17 ocularly healthy persons the IOP was artificially raised by suction cup oculopression (negative pressure: 65 mmHg [8.67 kPa]) from initially 15.5 +/- 2.2 mmHg (2.07 +/- 0.29 kPa) to 25.2 +/- 4.0 mm Hg (3.36 +/- 0.53 kPa) (mean +/- SD). Continuing the initial refractive correction, visual acuity (Landolt's rings) decreased from initially 1.06 +/- 0.13 to 0.39 +/- 0.22 (P less than 0.001* [*t-test, paired ties each]). A new optical refraction with suction cup in position significantly raised the visual acuity to 0.64 +/- 0.24 (P less than 0.002*). The suction cup itself induced astigmatism of 2.15 +/- 1.46 dpt (Canon Auto-Refractometer RK-1), which significantly differed from the initial astigmatism (0.32 +/- 0.23 dpt) (P less than 0.001*). The minus cylinder axis initially showed no preferential position. During artificial IOP elevation it shifted to 90 degrees...125 degrees (referred to the right eye) and thus ran about perpendicular to the meridian the suction cup was positioned on the eyeball. Effects of such refractive changes on differential light threshold and VEP amplitude are demonstrated. The results presented allow critical interpretation of previous IOP tolerance tests. The influence of suction cup oculopression on the perception of the white-noise field is shown in some glaucoma patients: the speed of the white-noise campimetry allows the increase in field defects during artificial IOP elevation to be followed up directly.

Adult↗
PubMed1991

[Mydriasis caused by plant contact].

Uni- or bilateral dilatation of pupils that are not reactive to light and lack miosis in response to 1% pilocarpine may be caused by contact with plants containing alkaloids such as scopolamine and atropine. Other causes of a non-light-reactive dilated pupil, such as Adie's tonic pupil, third nerve palsy and lesion of the mesencephalic pretectal region, must be excluded before testing the iris sphincter reaction to 1% pilocarpine. Among the naturally growing flowers in Germany, deadly nightshade (Atropa belladonna), jimson weed (thornapple, Datura stramonium) and black henbane (Hyoscyamus niger) contain enough alkaloids to cause mydriasis by direct contact. However, in most cases an accidental mydriasis by plants in Germany is caused by Datura arborea taxa, e.g. Datura suaveolens, D. candida, D. aurea and D. sanguinea. They contain up to 0.6% dry weight scopolamine. These plants can grow very large and are often planted in tubs. They have to be cut back each year before the winter. This is typically how the eye is contaminated by parts of the plants, which can cause dilatation of the pupil mimicing a neuroophthalmological disorder.

Diagnosis, Differential↗
PubMed1990

An E. coli ribonucleoprotein containing 4.5S RNA resembles mammalian signal recognition particle.

The signal recognition particle (SRP) plays a central role in directing the export of nascent proteins from the cytoplasm of mammalian cells. An SRP-dependent translocation machinery in bacteria has not been demonstrated in previous genetic and biochemical studies. Sequence comparisons, however, have identified (i) a gene in Escherichia coli (ffh) whose product is homologous to the 54-kilodalton subunit (SRP54) of SRP, and (ii) an RNA encoded by the ffs gene (4.5S RNA) that shares a conserved domain with the 7SL RNA of SRP. An antiserum to Ffh precipitated 4.5S RNA from E. coli extracts, implying that the two molecules reside in a complex. The 4.5S RNA can also bind to SRP54 and can replace 7SL RNA in an enzymatic assay. The product of a dominant mutation in the ffs gene (4.5S RNAdl1) is also coprecipitated by the antiserum to Ffh protein and is lethal when expressed from an inducible promoter. After induction of 4.5S RNAdl1, the earliest observed phenotype was a permanent induction of the heat shock response, suggesting that there was an accumulation of aberrant proteins in the cytoplasm. Late after induction, translocation of beta-lactamase was impaired; this may be an indirect effect of heat shock, however, because translocation of ribose binding protein or of the porin, OmpA, was unaffected. An unusual separation of the inner and outer membranes, suggestive of a defect in cell envelope, was also observed. Protein synthesis did not cease until very late, an indication that 4.5S RNA probably does not have a direct role in this process.

Bacterial Proteins↗
PubMed1990

[Ophthalmologic complications in mitral valve prolapse].

Usually, mitral valve prolapse is a benign condition, but there are some reports about ischemic cerebral or ocular insults. Among our patients with ischemic ophthalmic diseases we found seven with no risk factors other than mitral valve prolapse. The ages ranged from 18 to 61 years. Three patients suffered from monocular amaurosis fugax. Two patients showed a transient homonymous visual field defect. One patient had a vascular brain-stem lesion in the lower pons, causing a skew deviation. One patient showed typical anterior ischemic optic neuropathy. All but one patient (ischemic optic neuropathy) recovered completely. We recommend secondary prophylaxis with low-dose aspirin in cases where the symptoms persist longer than 24 h.

Adolescent↗
PubMed1989

Cavernous angiomas of the anterior visual pathways.

Three patients with cavernomas of the optic nerve, chiasm, or optic tract are presented. All suffered progressive visual loss due to local hemorrhage and the space-occupying effects of the vascular malformation. Computed tomography scans revealed small lesions with mild contrast enhancement in the suprasellar and parasellar cisterns, whereas angiography was unremarkable. Magnetic resonance imaging was helpful in our cases both for diagnosis and for planning surgical approach, showing typical signs of cavernomas as confirmed by subsequent surgery and histological examination. The clinical and intraoperative findings are presented.

Adolescent↗
PubMed1989

[Age dependence of kidney function].

Although kidney function is immature in infants and decreases with increasing age in adults, when assessing the kidney clearance, it is not common to make an adjustment for age. On the other hand, correction for the standard body surface is generally accepted. Previous studies have yielded contradictory results, probably due to the small numbers of patients studied. To obtain the statistically significant relationship between age and kidney clearance, we compiled more than 1000 studies. These studies were divided into three groups: (1) children under 2 years of age (n = 71); (2) children and adolescents from 2 to 15 years (n = 64 male/58 female); (3) adults (n = 474 male/424 female; age: 16-80 years). Total clearance determinations were only considered if there were no differences between the two kidneys and if there was no obstruction of micturition or other pathological findings. Surprisingly, the statistical analysis showed no differences in clearance values between sexes. The maximal clearance values were found in the groups with children about 8 years old and the greatest scatter of values was seen in children under 2 years of age (a discrepancy between maturation age and calendar age). The complete set of data was based on the presumption that continuous function consisting of three trunks describes the course of normal kidney clearance in relation to patient age. If one determines an arbitrary reference value (e.g., 25 years), correction factors can easily be derived from the function described in order to compare individual clearance with a normal value.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

[Tonic pupil caused by ischemia].

Tonic pupil is usually an idiopathic condition. In some cases, the cause of the ciliary ganglion lesion leading to tonic pupils is obvious. Rarely ischemia causes a lesion of the ciliary ganglion or the short ciliary nerves due to the good blood supply of the ciliary ganglion. Only two cases of tonic pupils in the course of giant cell arteritis are mentioned in the literature, but tonic pupils are probably much more common with this disease. Five cases are demonstrated here. All had associated ischemic optic neuropathy, and stagnation of the blood flow in the supratrochlear artery could be demonstrated in two cases by Doppler sonography. Tonic pupils may also occur when an oclusion of the internal carotid artery resolves, probably because of transient stasis of the orbital blood flow. In another case, tonic pupils were associated with choroidal ischemia (proved by video fluorescent angiography) of unknown origin. The diagnosis of tonic pupils was made by pharmacological testing for cholinergic hypersensitivity with 0.1% pilocarpine.

Adult↗
PubMed1988

Chronic borrelia encephalomyeloradiculitis with severe mental disturbance: immunosuppressive versus antibiotic therapy.

A 57-year-old male was repeatedly admitted to hospital because of complex neurological symptoms, including radicular pain, disturbance of micturition, seizures, and severely impaired mental state. The diagnosis was encephalomyeloradiculitis possibly of viral origin, and treatment with immunosuppressants was initiated. An alternating course with a tendency towards improvement ensued. Two and a half years after the occurrence of the initial symptoms, identification of specific antibodies in the blood and CSF led to the diagnosis of borreliosis with CNS involvement. High-dose therapy with penicillin rapidly reduced the symptoms, beginning with those of radicular pain and followed by an improvement of the mental state. Attention is directed to the wide spectrum of clinical symptoms of chronic borreliosis with CNS involvement. Previous reports that immunosuppression may result in some improvement but with a tendency towards relapse are confirmed. Our encouraging treatment results support those of other reports that penicillin therapy may lead to improvement even at late chronic stages in patients with severe CNS deficits.

Chronic Disease↗
PubMed1986

The involvement of the major surface glycoprotein (gp63) of Leishmania promastigotes in attachment to macrophages.

The interaction between the macrophage and the parasite plays a central role in the continued success of Leishmania infection. The promastigote surface ligand, and its complementary macrophage membrane receptor, involved in attachment and phagocytosis are likely to exert considerable influence over the outcome of a new infection. In this study, we report experiments pertaining to one such parasite membrane protein. Initial examination of promastigote surface proteins by radiolabeling and two-dimensional-polyacrylamide gel electrophoresis revealed an abundant polypeptide with an apparent m.w. of 63,000. Lectin-binding studies indicated that it was a glycoprotein containing mannose, N-acetyl glucosamine, and N-acetyl galactosamine residues. Monospecific antiserum raised against this glycoprotein, gp63, decorated the entire promastigote plasmalemma. Univalent antibody fragments from this antiserum blocked the interaction between promastigotes and macrophages by inhibiting attachment. Anti-gp63-inhibition reduced parasite/macrophage binding to 30 to 35% of the control binding level. Additional evidence of the involvement of gp63 in attachment to macrophages was provided by studies that made use of gp63-containing proteoliposomes. These vesicles were avidly phagocytosed by macrophages. Uptake of the gp63-containing liposomes was suppressed by greater than 90% by both anti-gp63 F(ab) fragments and the oligosaccharide mannan, indicating that their phagocytosis was receptor dependent. These results demonstrate that the abundant glycoprotein gp63 plays an important role in attachment of promastigotes to macrophages, and attachment via this parasite ligand is sufficient to trigger phagocytosis.

Adhesiveness↗
PubMed1984

Palliative therapy of tumor-induced pleural effusions with 90Yttrium-silicate.

In 20 patients with rapidly recurring malignant pleural effusion, 90Yttrium-silicate was intrapleurally instilled after the puncture. In all patients this treatment resulted in marked reduction, or even interruption, of exudate formation. Eleven patients died with an average survival of 166 days. Nine patients are still alive and have been followed up for a mean of 140 days without the pleural effusion recurring. Side effects were not observed, either subjectively or in relation to hematological and other laboratory findings.

Adult↗