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Biomedical subjects

H Witschel

Publications and source records attributed to H Witschel.

At least 19 recordsLinked to original sources
PubMed1996

Immunoscintigraphy for ocular melanoma: a reliable diagnostic technique?

BACKGROUND: Immunoscintigraphy (IS) has recently been used as a diagnostic tool for ocular melanoma. We wanted to reevaluate published data in our own patients and to correlate immunoscintigraphic results with histologic findings and immunohistochemical characteristics of the tumour tissue. METHODS: During a 4-year period, IS was performed on 35 patients (average age 64 years) with suspected ocular melanoma by i.v. injection of 225.28S, a monoclonal antibody against high-molecular-weight melanoma-associated antigen. Histology was available in 22 cases. Tumour tissue was evaluated for cell type, vascularization, necrosis, pigmentation, and lymphocytic infiltration, and immunohistochemistry was performed with 225.28S and antibodies against HMB-45, S-100 and vimentin. One hundred and two patients with metastasizing cutaneous melanoma served as controls. In these patients the identical immunoscintigraphic technique was applied. RESULTS: IS yielded a positive result in about 50% of our patients with ocular melanoma, while in patients with cutaneous melanoma sensitivity was 89%. In five patients who turned out not to have melanoma, two false-positive results were obtained (one subretinal hemorrhage and one Wegener's granulomatosis). No correlation was found between any of the histological features or the immunoreactivity pattern and the immunoscintigraphic outcome. However, antigenic differences between ocular and cutaneous melanoma were evident. CONCLUSION: We conclude that IS, using the antibody applied in this study, is of only limited value in patients with ocular melanoma. Our results suggest that antigenic differences, rather than histological characteristics or technical problems, are responsible for the low sensitivity in ocular melanoma compared to cutaneous melanoma.

Antibodies, Monoclonal↗
PubMed1996

Malignant tumor of the retinal pigment epithelium with extraocular extension in a phthisical eye.

BACKGROUND: Malignant tumors of the retinal pigment epithelium (RPE) are exceedingly rare. We describe the histopathologic and immunohistochemical features of a RPE neoplasm that was found accidentally in a blind and painful phthisical eye. METHODS: The enucleated eye was investigated by light microscopy, and tumor tissue was also studied by electron microscopy. Immunohistochemistry was performed using antibodies against HMB-45, S-100 protein, NSE, cytokeratins, vimentin, desmin, GFAP, the HNK-1 carbohydrate epitope and alpha-smooth muscle actin. RESULTS: The tumor was located mainly in the vitreous cavity with practically complete destruction of the retina, but foci of choroidal infiltration and extraocular extension along vascular channels were identified. The mitotic rate was high, and large areas of necrosis were present. No features of differentiation were seen, apart from occasional desmosome-like junctions and deposition of basal lamina at the ultrastructural level. Adjacent to the tumor, reactive hyperplasia and metaplasia of RPE cells was prominent. By immunohistochemistry, tumor cells revealed intense immunoreactivity with anti-vimentin and weak staining with anti-S-100 protein. The hyperplastic RPE cells also reacted for cytokeratins 8, 18 and 19 and for alpha-smooth muscle actin. At more than 1 year post enucleation the patient is well and shows no signs of recurrence or metastatic disease. CONCLUSION: We present the features of a malignant tumor of the RPE with unequivocal extraocular extension. These findings raise the possibility that RPE hyperplasia may transform into a malignant tumor.

Aged↗
PubMed1996

Vimentin and cytokeratin pattern in granular corneal dystrophy.

BACKGROUND: Corneal granular dystrophy is usually classified as a hereditary stromal disease of the cornea. Some investigations, however, have indicated an epithelial rather than a stromal origin of the granular deposits. In early stages and in recurrences of granular dystrophy after keratoplasty, the deposits are most often found in the upper microlayers of the cornea and even intraepithelially. METHODS: In this study we tried to identify immunohistochemical epithelial markers in the corneal granular deposits. RESULTS: A positive reaction with anti-cytokeratin 18 and polyclonal anti-vimentin were found both in the corneal epithelium and in the granular deposits. CONCLUSION: The immunohistochemical findings support the hypothesis of an epithelial origin of the corneal deposits in granular dystrophy.

Adult↗
PubMed1996

Signet ring cell carcinoma of the eccrine sweat glands in the eyelid.

BACKGROUND: Signet ring cell carcinoma of the eyelid is a rare variant of eccrine sweat gland carcinoma and has been reported previously in only five patients. METHODS: The authors report the clinical findings of a 55-year-old man with a signet ring cell carcinoma in the left eyelid as well as a clinical follow-up of 4.5 years. Several biopsies and the exenteration specimen were analyzed by routine light microscopy, electron microscopy, and comprehensive immunohistochemical stains on paraffin sections. RESULTS: Histologically, the tumor was shown to be a rare type of eccrine sweat gland carcinoma with signet ring cells and Indian file growth pattern reminiscent of invasive lobular carcinoma of the breast. Estrogen and progesterone receptors were identified immunohistochemically. On electron microscopy, intracytoplasmic pseudolumina with microvilli were positive for anti-human milk fat globulin and the lectin peanut agglutinin. Clinically, the tumor followed a malignant course with orbital invasion and lymph node metastases. CONCLUSIONS: Histologic recognition of this variant of eccrine sweat gland carcinoma is important because of its aggressive and malignant behavior and the wide range of differential diagnoses. Primarily, metastatic mammary carcinoma must be excluded. The treatment is primary excision with histologic control of the excision margins. In more advanced stages, radiation therapy, neck dissection, and anti-estrogen therapy should be considered.

Biomarkers, Tumor↗
PubMed1996

Sympathetic ophthalmia: an immunohistochemistry study of four cases.

We present histological and immunohistochemical data on four cases of sympathetic ophthalmia, a disease that is believed to occur predominantly after perforating injury to the eye. Only a few cases without previous perforation have been reported. Nevertheless, sympathetic ophthalmia should be taken into consideration if there is a bilateral intraocular inflammation, even without trauma, as in two of our cases (cases 1 and 2). An unusual case after uneventful intracapsular cataract extraction and a posttraumatic "classic" case are also presented (cases 3 and 4). We found a granulomatous infiltration of the uveal tract by lymphocytes, plasma cells, and epithelioid cells, particularly of the choroid. Dalen-Fuchs nodules were found in all cases, the second case also being associated with phacoanaphylaxis. Case 1 and 4 showed immunohistochemically a predominance of CD3-positive cells (T-lymphocytes), whereas in cases 2 and 3, many cells surprisingly stained positively for L26 (B-lymphocytes). In case 2 the immune response may have been altered by the additional phacoanaphylaxis. In all four cases, scattered epithelioid cells stained positively for CD 68. We conclude that in cases of bilateral uveitis, even without previous penetrating injury or after common intraocular surgery, sympathetic ophthalmia as a possible cause should be taken into consideration because an early diagnosis with subsequent enucleation of the exciting eye is of decisive influence on the course of the disease.

Adult↗
PubMed1996

Characteristic distribution of deposits in recurrent granular corneal dystrophy.

Granular corneal dystrophy can recur after penetrating keratoplasty. In those cases as in the early primary manifestation of the disease, deposits are found predominantly in the superficial corneal layers. At a later stage, stromal deposits can also be seen. We describe an additional particular location of deposits and correlate clinical with histological findings in three corneas from two patients. Deposits were found mainly superficially within the graft and around the edge of the transplant along the scar between host and donor cornea. We suggest that the deposits are of epithelial origin, though their production by stromal cells cannot be excluded. Chemical interactions are discussed as an explanation for the characteristic distribution of the deposits.

Adult↗
PubMed1995

Transscleral suture fixation of posterior-chamber lenses after cataract extraction associated with vitreous loss.

From 1987 to 1993, 21 patients who had undergone complicated cataract extraction that was associated with vitreous loss and transscleral suture fixation of the posterior-chamber lens (PC-IOL) in one eye (group A) and uncomplicated in-the-bag implantation of the PC-IOL in the fellow eye (group B) were followed prospectively. The follow-up period was 29.5 months (SD, +/- 17.0 months) in group A and 36.6 months (+/- 24.0 months) in group B. Visual acuity did not differ significantly between the two groups (P = 0.60, Wilcoxon test). In all, 17/21 patients in group A and 16/21 patients in group B achieved a visual acuity of > or = 20/40. Postoperative refractions measured in group A were +0.68 D more hyperopic than those measured in group B (P < 0.04). This result was consistent with the postoperative finding of a significantly deeper anterior chamber in group A (mean, 0.44 mm; P < 0.03). The accuracy of the desired postoperative refraction was poorer in group A. The risk for retinal detachment, cystoid macular edema, and intraocular pressure elevation was increased in patients who had had capsular defects and vitreous loss during cataract extraction. Nevertheless, transscleral suture fixation of PC-IOLs in patients with complicated cataract extractions associated with vitreous loss can give acceptable visual results. We recommend that +0.5 D be added to the calculated IOL power when severe complications require transscleral suture fixation of the PC-IOL during cataract extraction.

Aged↗
PubMed1995

[Antigen pattern in choroid melanoma in correlation with immunoscintigraphy].

We have reported that the sensitivity of immunoscintigraphy in ocular melanoma is fairly low in comparison with (metastasizing) cutaneous melanoma. No significant correlation was found between the histological data for ocular melanoma and the immunoscintigraphic results. We therefore wanted to see whether we could demonstrate an antigen pattern that was different from that of cutaneous melanoma, which might explain our previous results. Our study comprised tumor tissue from 20 patients with ocular melanoma who had undergone previous immunoscintigraphic examination. Using immunohistochemical techniques, tumor immunoreactivity was investigated against 225.28S, the antibody used for immunoscintigraphy, on cryosections in 12 cases, and against anti-HMB-45, and anti-S-100 and anti-vimentin on paraffin sections in all 20 patients. In summary, there was marked immunohistochemical heterogeneity, and none of the antibodies examined showed a significant correlation with immunoscintigraphy. Even 225.28S that was used for the immunoscintigraphic examination did not retrospectively allow a predictable immunoscintigraphic outcome. When comparing our results with the literature on cutaneous melanoma we were also able to confirm differences in immunoreactivity with regard to the other antibodies. We conclude that the comparatively poor results in ocular immunoscintigraphy obtained with 225.28S are due to antigenic differences between ocular and cutaneous melanoma.

Antigens, Neoplasm↗
PubMed1994

Paraffin induced sclerosing lipogranuloma of eyelids and anterior orbit following endonasal sinus surgery.

During the past 5 years we have seen 10 patients who had developed sclerosing lipogranuloma of the lid and orbit after endonasal sinus surgery with subsequent ipsilateral monocular haematoma. The histopathological examination of all and the additional nuclear magnetic resonance spectroscopic examination of four surgical specimens in combination with the typical clinical course led to the conclusion that the granulomas were caused by small paraffin droplets. These in turn stemmed from the ointment plugs applied to the sinuses at the end of the operation, and were washed out into the surrounding tissues by the postoperative haemorrhage. As the chronic and recurring granulomas can lead to considerable cosmetic and functional impairment, the application of ointment plugs at the end of sinus surgery should be abandoned, especially when peri- or postoperative bleeding occurs.

Adult↗
PubMed1994

[Late complications and functional results at least 5 years following pars plana lentectomy for congenital cataract].

Pars plana or pars plicata lentectomy was introduced for congenital cataract at the University Eye Clinic of Freiburg 12 years ago. Records of 32 patients (48 eyes) who were operated on during a period of 7 years were retrospectively analyzed to determine the anatomical and functional results in comparison to previous methods of treatment for congenital cataract. The documented follow-up was at least 5 years long (maximum 11 years, mean 7.3 years). Seventeen patients had bilateral, 15 patients monolateral cataract operations. Thirteen eyes were operated on during the first 2 months of life, and 31 of the 48 eyes during the first year. Sixteen of the 48 eyes had additional malformations, like microphthalmus, different stages of persistent hyperplastic primary vitreous, or anterior chamber malformation. Visual acuity was at least 20/50 at the last visit in 3 of 15 eyes after monolateral lentectomy and in 19/33 eyes after bilateral lentectomy. Twenty-four children are now able to attend a regular school; only one child is attending a school for the visual handicapped; another child attends a school for deaf children. Postoperatively, secondary cataract or a retropupillary membrane was found in two eyes. Glaucoma developed in two eyes, requiring additional surgery. Postoperative retinal detachment caused by a giant tear complicated the postoperative course in one case. The anatomic results turned out to be better than after discission and aspiration with fewer postoperative complications like secondary cataract, glaucoma, or retinal detachment. The functional outcome is mainly dependent on good postoperative orthoptic and pleoptic management of the children.

Adolescent↗
PubMed1994

[Immunoscintigraphy results in the comparison of ocular with cutaneous melanoma].

For several years, immunoscintigraphy (IS) using a 99mTc-labeled monoclonal antibody for tumor localization has been used as an additional tool in the diagnosis of malignant melanoma. The aim of our study was to verify previously published data with respect to our own patients and to correlate immunoscintigraphic results with histological findings. In particular, we wanted to compare the outcome of IS in ocular melanoma with that in cutaneous melanoma. We examined 28 patients (15 females, 13 males, average age 64 years) with clinically suspected ocular melanoma. IS was performed using the monoclonal antibody 225.28S (Tecnemab-K-1, Fa. Sorin/Solco), and images were obtained in a standard fashion (planar) as well as with the SPECT technique. In 16 patients, the tumor was examined afterwards histologically. The control group consisted of 102 patients with histologically proven metastasizing cutaneous melanoma who were investigated by IS in an identical fashion. In contrast to the literature published so far, we demonstrated a positive IS reaction in only 42% (and 56% in histologically proven cases, respectively) in our patients with ocular melanoma, while in patients with cutaneous melanoma, we found a sensitivity of more than 80%. In the 3 patients who turned out not to have ocular melanoma, we found one false-positive reaction (subretinal hemorrhage). No correlation was found between the various histological features of ocular melanoma and the immunoscintigraphic results. We conclude that IS using the antibody 25.28S is of limited value in patients with ocular melanoma and should only be recommended in selected cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Choroid Neoplasms↗
PubMed1993

[Chronic lipogranuloma (paraffin granuloma) of the eyelids and orbits after endonasal paranasal sinus operation].

During the last five years 10 patients received surgical treatment in our eye clinic for tumours of the eyelids and the orbit that had developed after endonasal sinus surgery. In most patients the first signs of lid or orbital involvement had occurred 4 weeks after ENT surgery and after a unilateral or bilateral postoperative haematoma had subsided. The histological examination of the surgical specimens showed chronic sclerosing lipogranuloma containing large vacuoles surrounded by epithelioid and giant cells, typical of a so-called paraffin granuloma. MR-spectroscopy detected high concentrations of paraffin in the specimens of 3 patients. Since paraffin is a constituent of many ointments, we assume that the granulomatous reaction was elicited by the ointment tampons routinely applied to the wound area following sinus surgery. The bleeding acted as a vehicle to distribute the paraffin into the surrounding tissues.

Adult↗
PubMed1993

[Isovolemic hemodilution in central retinal vein occlusion in patients less than 50 years of age].

AIM--Aim of the study was investigation of the effect of isovolemic hemodilution in patients younger than 50 years on the course of central retinal vein occlusion (CRVO) and to compare these results with those of older patients with CRVO. PATIENTS AND METHODS--We performed a prospective study on 35 patients younger than 50 years who were suffering from a central retinal vein occlusion. These patients were all treated by isovolemic hemodilution and compared to a group of older patients with CRVO with the same treatment. RESULTS--About 66% of the younger patients were men compared to only 46% in older patients. At least two cardiovascular risk factors were present in 8.5% of the younger and 54% of the older patients. 16 eyes showed the ischemic, 19 the nonischemic type of CRVO, a similar distribution as in older patients. The course of the disease was more favourable in younger patients, although ocular complications may occur in ischemic CRVO. Isovolemic hemodilution did not change the initial visual acuity of eyes with nonischemic CRVO, but led to an improvement in 56% of the eyes with ischemic CRVO. This means only a minor difference to the course of CRVO in hemodiluted older patients. CONCLUSION--In general, there is no principal difference between the CRVO in younger and older patients, but the course is more favourable in younger patients. On the basis of these findings we recommend isovolemic hemodilution in younger patients with ischemic CRVO.

Combined Modality Therapy↗
PubMed1993

[Effect of pterygium operation on preoperative astigmatism. Prospective study].

High-grade corneal astigmatism is considered to be an indication for pterygium surgery. However, no prospective studies have been carried out to determine whether a pterygium operation really reduces preoperative astigmatism. Therefore, we prospectively examined 23 patients who were operated on for pterygia at the University Eye Clinic in Freiburg in 1991. Pre- and postoperative corneal astigmatism was measured by ophthalmometry or retinoscopy. Preoperative astigmatism after pterygium surgery was reduced or unaltered in 19 patients. In 4 patients, the postoperative astigmatism was increased. The mean preoperative astigmatism was 2.41 D in the horizontal meridian, the postoperative astigmatism 1.29 D. The reduction was statistically significant (P < 0.0001, Wilcoxon test). The higher the preoperative astigmatism, the higher the difference between pre- and postoperative astigmatism (r2 = 0.88, P = 0.0001). Our technique of pterygium surgery (free conjunctival transplant after polishing the cornea, limbus, and sclera) reduces preoperative astigmatism. Thus, high-grade astigmatism can be regarded as an indication for pterygium surgery.

Astigmatism↗