Search PubMed⌕ Search

Biomedical subjects

V Klauss

Publications and source records attributed to V Klauss.

At least 127 records · Page 7Linked to original sources
PubMed1994

Four-year experience with Palmaz-Schatz stenting in coronary angioplasty complicated by dissection with threatened or present vessel closure.

BACKGROUND: Abrupt vessel closure after percutaneous transluminal coronary angioplasty (PTCA) is associated with major adverse events. Different surgical and nonsurgical approaches have been advocated to treat or prevent this complication. This study summarizes our 4-year experience with Palmaz-Schatz stenting for the management of 339 patients with present or threatened occlusion after PTCA. METHODS AND RESULTS: Stent implantation was attempted in a total of 339 and 4959 patients with PTCA during the study period and was successful in 327 (96.5%). During the follow-up, events like death, myocardial infarction, need for revascularization (bypass surgery and repeat in-stent angioplasty), and major vascular complications were recorded. Angiographic follow-up at 6 months was performed in 89.3% of the eligible patients. As part of an initial policy, stenting was intended as a bridge to nonemergency bypass surgery in 26 patients. In 301 patients for whom stenting was intended as permanent treatment, early clinical course (first 4 weeks) was characterized by a 1.3% cardiac mortality and a 4.0% nonfatal myocardial infarction rate; bypass surgery was necessary in 1%, and 6.3% required early repeat PTCA. Surgical repair for peripheral vascular complications was required in 5.6%, and major bleeding events were encountered in 9%. The incidence of subacute stent closure was 6.9%, with subsequent recanalization successful in 86%; subacute stent closure was predicted by presence of vessel occlusion before stenting and localization of the stent in a vessel other than the right coronary artery. Survival rate at 2 years was 95.4%, survival without myocardial infarction was 91.1%, and event-free survival was 70.7%. Survival at 2 years was lower for patients with stents in bypass vein grafts and with myocardial infarction after stenting. Six-month control angiography revealed a restenosis rate of 29.6%. CONCLUSIONS: Patients with present or threatened occlusion after PTCA may benefit from Palmaz-Schatz stenting. It is associated with a low mortality and myocardial infarction rate and with a long-term event-free rate comparable to that of uncomplicated PTCA.

Adult↗
PubMed1994

[HIV-1 and tears. Results of virus isolation and polymerase chain reaction (PCR)].

Beside the threat of infection via HIV-containing blood, the ophthalmologist is especially interested in the possibility of HIV infection via the tears of HIV-positive persons. In a first step, we tried to isolate HIV-1 from the peripheral blood lymphocytes (PBL) of 50 HIV-1-antibody-positive persons in different stages of disease and to detect reverse transcriptase (RT) and p24 antigen (p24-Ag) in the supernatant. Simultaneously we carried out the same tests on tears of these patients. In 10 persons tears were collected using Schirmer strips, in 40 persons by means of microcapillaries. In a second step 10 sample pairs (PBL and tears) were tested with the polymerase chain reaction to detect proviral sequences of HIV-1 (gag, pol, env). In the first step it was not possible to isolate HIV-1 from tears, nor was it possible to detect RT or p24-Ag from the supernatant. In contrast, this was successful in 32 of the 50 examined cases for the PBL. In the second step, it was possible to detect gag, pol and env in all 10 PBL samples, while gag and pol could be detected only in one tear sample and env not at all. Our results show that the tears of HIV-positive persons contain extremely low quantities of tissue-infectious units of HIV. In addition, proviral sequences seem to occur in much lower frequency in tears than in PBL. Infection with HIV via tears therefore appears very unlikely. These findings make it possible to assign tears a place in a semiquantitative ranking of different body fluids by HIV-1 concentration.

Adolescent↗
PubMed1994

[No detection of mycoplasma in 205 conjunctival swabs].

Mycoplasma is known to cause pulmonary and urogenital infections in humans. A pathogenicity for the human eye never has been assessed, although they have been observed in the peripheral eye in a few cases of acute and non-specific conjunctivitis, in patients with Reiter's disease and in newborns. Due to the absence of cell walls, mycoplasma is only sensitive to a few antibiotics. Therefore, we presume that mycoplasma has a role in non-specific and chronic conjunctivitis. It is conceivable that in HIV-positive patients the risk of opportunistic colonization of the conjunctiva by mycoplasma is increased. PATIENTS AND METHODS. Between January and December 1992, 205 conjunctival swabs of 151 patients were prospectively analyzed for mycoplasma. The group contained 51 HIV-infected patients (94 swabs). A total of 85 swabs were from non-irritated eyes and the remaining (120) from peripherally inflamed eyes, mainly diagnosed as non-specific or chronic conjunctivitis (75 swabs). Specimen were obtained from the inferior fornix conjunctivae by use of a moistened cotton swab, which was directly immersed in culture broth. For subsequent culture, we used a liquid and a solid mycoplasma medium to differentiate Mycoplasma hominis, Mycoplasma fermentans and Ureaplasma urealyticum. In 77 swabs, a second sample was taken, which was investigated at the Institute for Poultry Diseases of the Ludwig Maximilians University, Munich. OUTCOME. None of 205 swabs, including the 77 samples tested in parallel, gave positive results for mycoplasma. Six cases were positive for bacteria and five cases for fungi. CONCLUSION. In adult patients at the Munich University Eye Hospital with either non-irritated eyes or non-specific and chronic conjunctivitis, no mycoplasma could be detected. With regard to HIV infection, there is no indication that mycoplasma plays a role in opportunistic infections of the conjunctiva.

AIDS-Related Opportunistic Infections↗
PubMed1994

Human immunodeficiency virus type 1 and type 2 seroprevalence in cornea donors.

Routine screening of cornea donors for human immunodeficiency virus type 1 (HIV-1) has been established and has reduced the risk of HIV-1 transmission to a minimum. Screening for HIV-2 is less common. We evaluated 100 cornea donors for HIV-2 and 166 cornea donors for HIV-1 according to our routine screening procedure. Enzyme-linked immunosorbent assays (ELISAs) with high sensitivity were used to detect antibodies in donor blood. HIV-2 seroconversion was not found in any of the 100 cases tested, whereas HIV-1 seroconversion was detected in 4 of 166 cases; consecutive Western-blot analysis showed only 1 positive result. Thus, 1 of 166 cases (0.6%) had to be considered infected with HIV-1. Our findings of HIV-1 seroprevalence are comparable with those obtained in studies carried out in Europe and the United States. Data are lacking for comparison with our results concerning HIV-2 seroprevalence. Because of the epidemiologic situation of HIV-2 in Europe, different seroprevalence rates would be expected. Routine screening of potential cornea donors for HIV-2 in Germany may be necessary only if the seroprevalence rises in the population.

Adolescent↗
PubMed1994

Ocular microangiopathic syndrome in patients with acquired immunodeficiency syndrome and its relationship to alterations in cell adhesion and in blood flow.

Ocular microangiopathic syndrome is the most frequent ophthalmic finding in patients with acquired immunodeficiency syndrome (AIDS). Ocular microvascular changes, including cotton-wool spots, are closely associated with neuroretinal and cognitive deficits in patients infected with the human immunodeficiency virus type 1 (HIV-1). Cell adhesion has become an important pathogenetic concept in infectious diseases. We studied 39 patients with AIDS by indirect ophthalmoscopy and by slit-lamp biomicroscopy. Cotton-wool spots were counted as an indicator of retinal microvasculopathy. Conjunctival blood-flow sludging in conjunctival vessels was determined by a standardized rating scale as an indicator of blood-cell adhesion abnormalities. Parameters of immunosystemic damage were determined by fluorescein-activated cell-sorter scan, radioimmunoassay, and enzyme-linked immunosorbent assay. Conjunctival blood-flow sludging was present in 92% of our patients, and cotton-wool spots were observed in 44%. Cotton-wool spots occurred only in patients with significant blood-flow sludging, and the quantity of cotton-wool spots was closely associated with blood-flow sludging (r = 0.64, P < 0.0001). Lower correlations were found between the numbers of cotton-wool spots and the serum level of neopterin (r = 0.40, P = 0.01) or the CD4+ count (r = -0.39, P = 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Acquired Immunodeficiency Syndrome↗
PubMed1994

Traditional herbal eye medicine in Kenya.

A study was conducted in Kenya on 16 traditional healers in order to obtain information about their knowledge of eye conditions, the herbal medicines they used, and their indications for referral to ophthalmologists. Evidence remains scanty that traditional treatments are beneficial, and in some instances harmful effects have been reported. Nevertheless there is a solid case, based on economic and other grounds, for integrating traditional healers into the modern health care system.

Adult↗
PubMed1994

Retinal detachment in patients with acquired immunodeficiency syndrome.

Cytomegalovirus retinopathy is the most frequent opportunistic infection of the eye in patients with acquired immunodeficiency syndrome (AIDS). We studied 71 patients with cytomegalovirus retinopathy (n = 69) or acute retinal necrosis (n = 2) with respect to the frequency and management of retinal detachment. Retinal detachment was seen in 14 patients (relative frequency, 19.7%). In 2 patients, the retinal detachment was bilateral. In 5 patients, pars plana vitrectomy and silicone-oil tamponade was performed, and in 1 of these patients scleral buckling was applied before vitrectomy. In 3 other patients scleral buckling was performed, and 1 of these individuals had sulfur-hexafluoride injection. In 8 eyes (6 patients), retinal detachment occurred in eyes with completely burned-out retinopathy without relevant function, and no surgical treatment was performed. Long-term retinal reattachment was seen in all 5 patients undergoing pars plana vitrectomy with silicone-oil tamponade. Visual acuity was preserved until the last follow-up in 4 of these 5 patients. In the patients undergoing a buckling procedure alone, no anatomic or functional success was observed. During vitrectomy, reduced retinal vascular perfusion and blood-flow sludging was observed in 2 patients. As the duration of survival of patients with AIDS and cytomegalovirus retinopathy or acute retinal necrosis is increasing, more cases of retinal detachment will be observed. Overall, 5% of patients with AIDS are expected to develop retinal detachment. In conclusion, treatment of cytomegalovirus-associated retinal detachment by pars plana vitrectomy with silicone-oil tamponade seems to be successful and safe and may maintain the patient's quality of life.

AIDS-Related Opportunistic Infections↗
PubMed1993

[Strategy for examination and therapy of mycotic keratitis].

BACKGROUND: Keratomycosis still represents a major problem in ophthalmology because of diagnostic and therapeutic difficulties. This is caused by difficult clinical differentiation and problems in microbiological analysis due to pretreatment and lack of sample material in early stages of the infection. MATERIAL AND METHODS: A 16-year-old female contact lens wearer suffered from a monocular central stromal opacification of the cornea. Analysis of the contact lens storage case liquid (CLCL) was based on investigation of the direct sample, Gram and Lactophenol staining and on specific cultures for aerobic bacteria, anaerobic bacteria and fungi. RESULTS: The patient suffered from a mycotic keratitis caused by Acremonium kiliense. First microbiological results were obtained from the CLCL subsequently confirmed from aqueous and from cornea tissue after keratoplasty. Continuation of the systemic Itraconazol therapy resulted in cure and improvement of the visual acuity. CONCLUSION: Success factors for diagnosis and therapy are early detection of the causative agent in the cornea and/or in the contact lens storage case as well as diagnosis related intensive drug therapy and eventually surgical intervention.

Acremonium↗
PubMed1993

Intravascular ultrasound assessment of the balloon-expandable Palmaz-Schatz coronary stent.

BACKGROUND: Coronary stenting is an effective method for the treatment of acute coronary dissection and restenosis. In the comprehensive assessment of restenosis and of the complex interaction between coronary stent and vessel wall, coronary arteriography has significant limitations. Intravascular ultrasound as a high-resolution tomographic imaging method is a promising tool for resolving these limitations. METHODS: A 3.5, 5.0 or 5.5F, 20 MHz multi-element ultrasound catheter was used in 27 patients who had received a Palmaz-Schatz coronary stent for the treatment of symptomatic coronary dissection. Intravascular ultrasound study was performed during routine follow-up arteriography at 3-10 months in all 27 patients and had also been performed in four patients during stent deployment. Four patients with restenosis within the stent were re-investigated 3 months later after repeat angioplasty. RESULTS: Complete analysis of the stented coronary segment could be performed in 34 out of 35 studies (97%); no adverse effects occurred. The three layer appearance of the vessel wall was not discernible in most patients because of a complex and often eccentric lesion surrounding the stent resulting in an asymmetrical arrangement of stent filaments. The beginning and the end of the stent, the central strut, and the overlap of a double stent could be well assessed. Luminal diameters ranged from 1.95 to 4.15 mm and cross-sectional areas from 3.83 to 10.85 mm2. Correlations with quantitative arteriography revealed r-values of 0.58 for diameter and 0.59 for area. A stent-covering layer, indicative of neointima, was clearly visible in all patients during follow-up arteriography with a diameter of 0.10-0.95 mm (mean 0.25 +/- 0.15 mm), which resulted in a reduction of 2-63% in the cross-sectional area of the vessel. This layer did not exceed a thickness of 0.4 mm in asymptomatic patients. CONCLUSIONS: This study demonstrates the safe and feasible application of intravascular ultrasound in patients with stented coronary lesions. Differences between the angiographic and ultrasonic measurements are presumably the result of the limitations of radiography in complex and eccentric lesions. Intracoronary ultrasound provides a unique comprehensive assessment of stent expansion, neointimal proliferation, and restenosis mechanisms. Thus, intravascular ultrasound may also have implications regarding the indication for, and optimal deployment of, intracoronary stents.

Aged↗
PubMed1993

Reproducibility of myocardial contrast echocardiography in human studies.

Experimental and clinical studies were performed to assess the ability of myocardial contrast echocardiography for quantitation of regional myocardial blood flow. To evaluate whether myocardial contrast echocardiography is a reproducible technique in humans, 18 nonselected patients undergoing coronary angiography were studied. A total of 107 intracoronary injections into either the left or the right coronary artery were analyzed by computer assisted videodensitometry for peak intensity, contrast decay half-time, and area under the curve. By means of these parameters intraobserver, interobserver, and interinjection variability were determined. Intraobserver measurements showed lowest variability with correlation coefficients of 0.83 for contrast decay half-time, 0.93 for peak intensity, and 0.95 for area under the curve. Mean percent error varied between 6.8% (peak intensity) and 11.2% (area under the curve). The correlation coefficients for interobserver variability ranged from 0.73 for area under the curve to 0.97 for peak intensity. Mean percent error revealed a range between 7.5% for peak intensity and 19% for area under the curve. For interinjection variability, the correlation coefficient for contrast decay half-time was lower (0.56) than for peak intensity (0.73) and area under the curve (0.84). Mean percent error were higher than for intraobserver and interobserver variability (range 24.1% to 34.2%). Thus, intraobserver and interobserver variability for parameters derived from time-intensity curves after intracoronary injection of echo contrast agent in humans are sufficient and comparable to data from animal studies. Interinjection variability, however, showed a higher mean percent error.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Impairment of colour contrast sensitivity and neuroretinal dysfunction in patients with symptomatic HIV infection or AIDS.

Ophthalmic and neurological complications are frequent findings in patients with AIDS. Little is known about neuroretinal dysfunction in patients with HIV infection. The purpose of this study was to measure and evaluate colour vision in patients with HIV infection or AIDS. Colour contrast sensitivity tests were performed on 75 patients (150 eyes) in different stages of HIV infection. A highly sensitive computer graphics system was used to measure tritan, deutan, and protan colour contrast thresholds. Patients were classified into three clinical groups: (a) asymptomatic HIV infection, (b) lymphadenopathy syndrome or AIDS-related complex, and (c) AIDS. Overall, tritan (p < 0.0001), deutan (p = 0.003), and protan (p = 0.009) colour contrast sensitivities were significantly impaired in patients with HIV infection compared with normal controls. Colour thresholds in patients with asymptomatic HIV infection (mean tritan threshold: 4.33; deutan: 4.41; protan: 3.97) were not impaired compared with normal controls. Colour vision was slightly impaired in patients with lymphadenopathy syndrome or AIDS-related complex (tritan: 6.25 (p < 0.0001); deutan: 4.99 (p = 0.02); protan: 4.45 (p = 0.05)). In patients with AIDS the impairment was even more marked (tritan: 7.66 (p < 0.0001); deutan: 5.15 (p < 0.0009); protan: 4.63 (p = 0.004)). Analysis of covariance controlling for age demonstrated a close association between impairment of tritan colour contrast sensitivity and progression of HIV disease (p < 0.0001). Following Köllner's rule, our study suggests that neuroretinal dysfunction occurs in patients with symptomatic HIV infection or AIDS. This is emphasised by the finding that the relative impairment in tritan vision compared with deutan/protan vision might reflect the difference in the number of cones or receptive fields. Measurement of tritan colour contrast sensitivity appears to be an appropriate and easily applicable method to detect early neuroretinal dysfunction in patients with HIV disease.

Acquired Immunodeficiency Syndrome↗
PubMed1993

[Endophthalmitis. Importance of microbiologic studies for therapy and prognosis].

The fast and precise identification of infectious agents and their characterization is of upmost importance for the diagnosis and therapy of infectious endophthalmitis. A preliminary estimate of the most probable predominant agents may improve the choice of an adequate antimicrobial therapy prior to definitive microbiological analysis in culture media. A prospective study was performed in 46 patients with endophthalmitis. During surgery mostly undiluted samples were inoculated in 10 different culture media. Microscopic investigation and laboratory processing were performed within the next 10-120 min. A presumptive classification based on immediate direct microscopy and a preliminary recommendation on treatment were achieved in 25 cases. Culture yielded positive results in 38 cases (83%). In 8 cases the inoculates remained negative. Most of the positive cultures (92%) contained only gram-positive bacteria, including 10 cases of mixed gram-positive infections. In 2 samples bacteria and fungi were present, while 2 contained fungi only. Of 8 posttraumatic eyes, 4 were infected with Bacillus spp. The results show that specific therapeutic approaches are required. Direct inoculation of surgical culture media combined with immediate microscopic investigation permits a fast and precise microbiological diagnosis.

Adolescent↗
PubMed1993

[Contrast echocardiography in the evaluation of myocardial flow reserve].

In order to determine whether changes in myocardial perfusion can be assessed by myocardial contrast echocardiography, intracoronary injections of 2 ml of sonicated iopromid were performed before and 30 to 45 s after application of papaverine in 31 patients (mean age 58 years). 13 patients showed coronary artery disease (KHE), 6 patients hypertensive heart disease (HHE), and 12 patients had no proven heart disease (KTR). Contrast decay-halftime (T/2), maximal video-intensity (Imax) and area under the curve (Area) were derived by computer-assisted videodensitometry. After papaverine KTR showed a significant increase of T/2 (from 5.1 +/- 1.5 to 6.8 +/- 3.2 s, p < 0.05), of Imax (from 36 +/- 13 to 52 +/- 16 E, p < 0.002) and of Area (from 203 +/- 95 to 379 +/- 188 E*s, p < 0.002) compared to baseline values. In this group the ratios of hyperemia to baseline flow conditions were 1.5 +/- 0.4 (from 1.0 to 2.4) for Imax and 1.9 +/- 0.9 (from 1.1 to 3.9) for Area. In HHE and KHE, hyperemia induced no significant changes of T/2, Imax and Area. Heart rate was increased by 4.3% and mean aortic pressure was decreased by 6.2% in all groups after papaverine. Double-product was not altered significantly in any group. Myocardial contrast echocardiography revealed a significant increase in variables of contrast wash-out curves only in patients without proven heart disease. In contrast, no relevant changes of T/2, Imax and Area on average were observed in patients with coronary and hypertensive heart disease. Thus, myocardial contrast echocardiography seems to be suitable to document a reduced papaverine vasodilator response in these patients.

Adult↗
PubMed1993

Main sources of infection in 145 cases of epidemic keratoconjunctivitis.

Epidemic keratoconjunctivitis (EKC) is a combination of conjunctivitis and keratitis induced by an adenovirus that is found especially in eye clinics and in eye hospitals. In Bavaria, EKC represents a common eye disease and occurs in epidemics in the spring and early autumn. We report on 145 patients who presented with EKC in our hospital between March 17 and September 12, 1991, and who were evaluated prospectively (67 men and 78 women ranging in age from 4 to 85 years). The recent patient history was noted using a standardized protocol to analyze possible sources and pathways of the infection. Overall, 44 of the EKC patients (30%) remembered having undergone eye treatment during the incubation period of 2 weeks before the onset of symptoms. In all, 18 patients (12%) recalled that a family member had also had conjunctivitis during that time, and 4 patients (3%) reported the infection of a workmate during the 2 weeks prior to the onset of symptoms. In 82 patients (55%), no presumed source of infection was apparent. A total of 24 patients (17%) presumably acquired the infection during examination or treatment in our hospital. The main cause was the removal of foreign body, followed by cataract operation. In all, 20 patients (14%) had been treated in private practice during the incubation period; 14 of these remembered having had tonometry, and 4 patients had undergone contact-lens fitting. In 18 patients, virus isolation and serotyping from a conjunctival smear was conducted. In 12 of these patients an adenovirus could be isolated; in all cases it proved to be serotype 8.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenovirus Infections, Human↗