[Striking scleral pigmentation].
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Adolescent↗
Biomedical subjects
P Meier
Publications and source records attributed to P Meier.
Massive suprachoroidal hemorrhage: secondary treatment and outcome.
PURPOSE: Massive suprachoroidal expulsive hemorrhage (SCH) is a dramatic and devastating intraocular complication of intraocular surgery and trauma that can result in total loss of vision. The aim of our study was to present the results of secondary surgical treatment of eyes following massive SCH. PATIENTS AND METHODS: We treated 10 patients suffering from massive SCH by combined radial sclerotomies for suprachoroidal drainage and vitrectomy with use of perfluorocarbon and instillation of silicone oil. We analyzed the clinical characteristics, visual acuity and anatomical status before and after secondary treatment. RESULTS: Visual acuity of all eyes suffering from SCH was light perception. Postoperatively five patients with SCH showed either no improvement of function or visual acuity of counting fingers. An increase in visual acuity to maximal 0.1 was seen in four eyes; one patient achieved 0.6. With a minimum of 6 months' follow-up, four eyes developed hypotony, two eyes became phthisical, and in two eyes recurrent traction retinal detachment occurred. CONCLUSIONS: Secondary treatment by combined suprachoroidal drainage by sclerotomies and vitrectomy should be performed to minimize the damaging effect of choroidal hemorrhage.
Aged↗
Direct MR arthrography of the shoulder: is exercise prior to imaging beneficial or detrimental?
PURPOSE: To define the beneficial and detrimental effects of adding exercise to direct magnetic resonance (MR) shoulder arthrography. MATERIALS AND METHODS: Direct, intraarticular, gadolinium arthrography of the shoulder was performed in 41 patients, who underwent 1.5-T MR imaging before and after 1 minute of arm swinging. Fourteen milliliters of dilute gadolinium solution was injected. Two readers blinded to exercise independently graded the randomly distributed images with a five-point scale for capsular contrast material resorption; extraarticular contrast material leakage; rotator cuff, glenoid labrum, and anterior capsule conspicuity; and partial-thickness or full-thickness rotator cuff tear and labral tear detectability. The sign test was performed to evaluate the significance of differences between preexercise and postexercise grading for each reader. A second review was performed, with direct side-by-side comparison of preexercise and postexercise images. RESULTS: There was evidence of increased capsular resorption after exercise but no alteration in the depiction of the rotator cuff tendons or glenoid labrum. There was no significant extraarticular contrast material leakage after exercise and no alteration in depiction of the anterior capsule. There was no difference in the detectability of rotator cuff or labral tears. CONCLUSION: Exercise with direct shoulder MR arthrography has no beneficial or detrimental effect on image quality or on the depiction of rotator cuff or labral tears.
Adolescent↗
One-year immunological evaluation of chronic hemodialysis in end-stage renal disease patients.
BACKGROUND: Much research has been devoted to the determination of acute leukocyte activation as well as acute cytokines production during and after blood hemodialysis membrane interaction. In contrast, few studies deal with chronic immunological evaluation of T-cell activation markers in hemodialysis. METHODS: We evaluated different immune parameters using a modified cellulose low-flux hemophan vs. synthetic high-flux polyamide membrane during 1 year in 35 stable chronic hemodialysis patients. Leukocyte counts, lymphocyte subpopulations, T-cell activation markers (CD69, CD25, HLA-DR, CD54, CD62L, CD45RO, CD11a, CD28), complement-activation products (C3a) and serum elastase were measured at 0, 3, 6 and 12 months in the two patient groups and compared to 13 healthy control subjects. RESULTS: Over dialysis time, all patients showed a significant level elevation of CD69/CD3 (p < 0.005) and CD25/ CD3 (p < 0.005) phenotypes. In contrast, HLA-DR and CD45RO remained unchanged suggesting a truncated pattern of activation. T lymphocyte subset analysis showed in both hemodialyzed groups a significant decrease in the expression of CD54 (ICAM-1) when compared to controls (p < 0.005). C3a and elastase measurements showed a significant upward trend with dialysis time in both hemodialyzed groups. CONCLUSION: Although the immunological changes seen in chronic hemodialyzed patients must be interpreted in conjunction with their basal uremic states and the membrane permeability properties, our study suggests that 1-year immunological evaluation of hemodialysis membranes biocompatibility is associated with changes in the pattern of chronic T-cell activation, which is in part related to the use of a particular membrane type. Moreover, some key molecules (CD54) are affected in patients with end-stage renal disease undergoing hemodialysis.
Aged↗
Long-term efficacy of lipoprotein apheresis in homozygous familial hypercholesterolaemia.
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Adult↗
Long-term efficacy of lipoprotein apheresis in homozygous familial hypercholesterolaemia
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Journal Article↗
The child with congenital toxoplasmosis.
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Child↗
Dormancy of mammary carcinoma after mastectomy.
BACKGROUND: The longest interval between primary treatment of breast cancer and tumor recurrence, i.e., the limit of breast cancer dormancy, defines the appropriate length of follow-up, the effectiveness of treatment, and curability (no excess mortality risk for patients relative to the general population) for the disease. To determine this limit, we analyzed long-term follow-up data from patients who underwent a radical mastectomy during a four-decade period at the University of Chicago Hospitals. METHODS: For 1547 patients operated on during the period from 1945 through mid-1987, the number of recurrences and deaths occurring within each postoperative year were tabulated, and the hazard rate for first recurrence or death from breast cancer was estimated by use of the actuarial method. The excess mortality rate was calculated for successive 5-year intervals, beginning at the time of mastectomy, by use of U.S. life tables and matching on the basis of age, race, and sex. RESULTS: Most recurrences occurred within the first 10 years after mastectomy. Recurrences were rare after 20 years; only one recurrence was reported among 192 patients followed for 26-45 years. Patients who had a recurrence within 5 years following mastectomy had shorter subsequent survival times than those whose recurrence appeared after 5 years (two-sided P = .0001). The excess death rate increased with pathologic stage of the primary tumor. Overall, there was evidence of excess mortality up to 20 years postsurgery (two-sided P = .009). CONCLUSIONS: The limit of breast cancer dormancy in this patient population appears to be between 20 and 25 years. After this time, recurrences were rare, and the mortality rate was no longer statistically significantly different from that of the general population. Patients surviving to this time without evidence of recurrence or contralateral breast cancer are probably cured.
Breast Neoplasms↗
[Vitreoretinal surgery in children].
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Child↗
[Management of submacular hemorrhage by tissue plasminogen activator and SF(6) gas injection].
UNLABELLED: The formation of platelet-fibrin clots causes degeneration of foveolar photoreceptors by subretinal hemorrhage. PATIENTS: Twenty-two patients with submacular hemorrhages were treated by intravitreal injection of 50 microg tpa and 0.5 ml SF(6) gas within 1 h. Biomicroscopy, fundus photography and fluorescein angiography were performed pre- and postoperatively. Further multifocal electroretinograms were recorded. RESULTS: The subfoveolar hemorrhages were dissoluted and displaced out of the macular region. The visual acuity increased in 18 cases and ranged from hand movement and 0.3 to values between 1/10 and 0.5. CONCLUSIONS: Toxic and hypoxic damage of foveolar photoreceptors by subretinal hemorrhage can be prevented by early and minimal invasive fibrinolytic therapy. After localization of choroidal neovascularizations, treatment by focal laser coagulation is possible in some cases.
Aged↗
The REMATCH trial: rationale, design, and end points. Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure.
BACKGROUND: Because left ventricular assist devices have recently been approved by the Food and Drug Administration to support the circulation of patients with end-stage heart failure awaiting cardiac transplantation, these devices are increasingly being considered as a potential alternative to biologic cardiac replacement. The Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure (REMATCH) trial is a multicenter study supported by the National Heart, Lung, and Blood Institute to compare long-term implantation of left ventricular assist devices with optimal medical management for patients with end-stage heart failure who require, but do not qualify to receive cardiac transplantation. METHODS: We discuss the rationale for conducting REMATCH, the obstacles to designing this and other randomized surgical trials, the lessons learned in conducting the multicenter pilot study, and the features of the REMATCH study design (objectives, target population, treatments, end points, analysis, and trial organization). CONCLUSIONS: We consider what will be learned from REMATCH, expectations for expanding the use of left ventricular assist devices, and future directions for assessing clinical procedures.
Heart Failure↗
Clinical application of a new disposable lithotripter: a prospective multicenter study.
BACKGROUND: Mechanical lithotripsy has become a well-accepted method of bile duct stone fragmentation and removal. The Olympus lithotripter (Olympus American, Melville, NY) is the standard reusable lithotripter at the institutions that participated in this study. A disposable device with a preassembled pistol grip may perform equally well and facilitate operation. METHODS: Twenty patients with bile duct stones were evaluated as part of a multicenter prospective study. Data were obtained regarding stone size and number, bile duct diameter, and configuration, ease of cannulation, basket function, stone capture and crushing success, and complications. RESULTS: The maximum stone size averaged 16.5 +/- 1.2 mm (range 10 to 30 mm). Sixteen patients had multiple stones (median 5, range 2 to 12). The mean bile duct diameter was 20.5 +/- 1.5 mm (range 12 to 38 mm). Cannulation was successful in all within 5 attempts. Basket deployment failed in 1 patient because of stone size and the basket was misshapen in 14. Bile duct clearance was complete in 16 subjects (80%), incomplete in 2 patients, and failed in 2 patients. Abnormal duct configuration (sigmoid, stricture) was noted in 2 of 4 patients with failed capture and 7 of 16 patients with successful clearance. No statistically significant difference was observed between the bile duct diameter, maximum stone size, number of stones, and successful clearance. CONCLUSION: The disposable lithotripter is easy to use and, compared with the published results for the reusable lithotripter, performs almost as well.
Adult↗
[Penetrating and perforating eye injuries with foreign bodies during motorized brush-cutting while wearing head protection gear].
BACKGROUND: Protective clothing is prescribed concerning gloves, shoes, protective trousers and a helmet for protection of hearing and the face during brush-cutter work. PATIENTS AND METHODS: Seven patients were observed in a time period from 1994 to 1998. Mostly a nylon head protection had been used. The side of the helmet has no protection shield. The 1- to 4-mm large foreign bodies passed the head protection shield from the side or by entering through the holes of the nylon mesh which may be not small enough to stop the foreign body. A pars plana vitrectomy with foreign body removal was performed after primary wound repair. RESULTS: An endophthalmitis was diagnosed in two patients after primary wound treatment. In these cases, a pars plana vitrectomy and antibiotic instillation was performed. In 5 patients visual acuity increased postoperatively. We measured a postoperative visual acuity from 1/50 to 1.6. The development of proliferative vitreoretinopathy with retinal detachment in 4 patients was the main complication observed after pars plana vitrectomy. CONCLUSIONS: A cosmetically satisfactory appearance of the injured eye was reached by pars plana vitrectomy in all patients. Anatomic and functional success was reached in most of the patients. For prophylaxis, a head-protection seems not safe enough. The additional usage of eye protection glasses may be imperative for the prevention of these eye injuries.
Adult↗
[Hyperplastic persistent pupillary membrane--surgical procedure].
BACKGROUND: Persistent pupillary membranes are a common congenital anomaly seen in 95% of neonates. Extensive persistent pupillary membranes, occluding the visual axis and resulting in reduced visual acuity, are relatively uncommon. CASE REPORT: A 4-year-old male infant was seen in our hospital with reduced visual acuity of his left eye. Slit-lamp examination revealed a dense, extensive, persistent pupillary membrane associated with anterior polar cataract. We performed an excision of the pupillary membrane, lens aspiration of the lens material, posterior capsulorhexis, anterior vitrectomy and placement of a posterior chamber-intraocular lens in the capsular bag. 8 weeks after operation visual acuity improved to 0.25. CONCLUSIONS: Dense pupillary membranes associated with polar cataract require early surgical treatment. Membranectomy, lens aspiration and implantation of an intraocular lens clear the visual axis and optimize the treatment of amblyopia.
Cataract↗
Regulation of Hoxa2 in cranial neural crest cells involves members of the AP-2 family.
Hoxa2 is expressed in cranial neural crest cells that migrate into the second branchial arch and is essential for proper patterning of neural-crest-derived structures in this region. We have used transgenic analysis to begin to address the regulatory mechanisms which underlie neural-crest-specific expression of Hoxa2. By performing a deletion analysis on an enhancer from the Hoxa2 gene that is capable of mediating expression in neural crest cells in a manner similar to the endogenous gene, we demonstrated that multiple cis-acting elements are required for neural-crest-specific activity. One of these elements consists of a sequence that binds to the three transcription factor AP-2 family members. Mutation or deletion of this site in the Hoxa2 enhancer abrogates reporter expression in cranial neural crest cells but not in the hindbrain. In both cell culture co-transfection assays and transgenic embryos AP-2 family members are able to trans-activate reporter expression, showing that this enhancer functions as an AP-2-responsive element in vivo. Reporter expression is not abolished in an AP-2(alpha) null mutant embryos, suggesting redundancy with other AP-2 family members for activation of the Hoxa2 enhancer. Other cis-elements identified in this study critical for neural-crest-specific expression include an element that influences levels of expression and a conserved sequence, which when multimerized directs expression in a broad subset of neural crest cells. These elements work together to co-ordinate and restrict neural crest expression to the second branchial arch and more posterior regions. Our findings have identified the cis-components that allow Hoxa2 to be regulated independently in rhombomeres and cranial neural crest cells.
Animals↗
Primary basal cell carcinoma of the caruncle.
We describe a 24-year-old man with primary basal cell carcinoma of the caruncle. Clinically the lesion was a whitish, slightly prominent nodule surrounded by fine vessels. No associated cutaneous lesion and no connection to the surrounding skin was present. The lesion was subsequently completely excised, and histopathological examination revealed a solid-cystic basal cell carcinoma of the caruncle. Primary basal cell carcinoma of the caruncle is an extremely rare but distinct entity. To our knowledge, review of the literature has not demonstrated a previous photographically documented case of primary basal cell carcinoma of the caruncle.
Adult↗