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Biomedical subjects

A Neugebauer

Publications and source records attributed to A Neugebauer.

At least 19 recordsLinked to original sources
PubMed2006

[Surgical options in retraction syndrome].

BACKGROUND: A causative therapy for Duane's retraction syndrome, which is the most prominent example of connatal ocular misinnervation, does not exist. Eye muscle surgery is indicated in cases with manifest strabismus in primary position and an annoying compensatory head posture to maintain binocular single vision. Different surgical approaches to the different types of Duane's retraction syndrome, mostly on the affected eye but also on the fellow eye, are described in the literature. METHOD: We retrospectively analyzed the pre- and postoperative findings of 55 patients in whom we performed surgery because of Duane's retraction syndrome during the years 1999 to 2004. The type of retraction syndrome, the angle reduction in primary position and the reduction of head posture were evaluated in regard to the surgical procedure chosen. RESULTS: In 37 cases surgery was primary. In 25 cases a single recession of the medial rectus (16 cases) or the lateral rectus (9 cases) muscle of the affected eye was performed. For a dose-response relationship of the one-muscle recessions, the mean angle reduction in the primary position was 2 pdpt (cm/m) per mm recession. The mean reduction of head posture was 1.5 degrees per mm recession. In 10 cases combined surgery on the affected eye was performed. The correlation between the mean angle reduction and the recession was 3 pdpt (cm/m) per 1 mm. CONCLUSION: Depending on the type of retraction syndrome, the angle in primary position, the head posture and the globe retraction, different surgical options exist which aim at rehabilitation of the patient suffering from Duane's retraction syndrome.

Adolescent↗
PubMed2005

[Extra-ocular muscle surgery using combined topical and subconjunctival anesthesia].

A retrospective study of a consecutive series of 284 cases of strabismus surgery under local anesthesia is presented. A total of 284 operations on the extraocular muscles, performed with topical and subconjunctival application of local anesthetics-in some cases combined with anesthesiological sedation and monitoring-were analyzed retrospectively for adverse effects or complications caused by the type of anesthesia chosen. No ophthalmological complications caused by the mode of anesthesia and no vital complications occurred. In three cases, the intended surgery could not be fully completed due to discomfort of the patient caused by pain perception. In this case series, combined topical and subconjunctival anesthesia in strabismus surgery had a low frequency of complications.

Adolescent↗
PubMed2004

[Dissociated nystagmus in side gaze. Major symptoms in the diagnosis of an internuclear ophthalmoplegia].

A prerequisite for a qualified analysis of nystagmus is the recognition of uncommon forms of this condition. In internuclear ophthalmoplegia (INO), a dissociated nystagmus in side gaze is typical. This is accompanied by limited medial excursion of the adducted eye together with a dissociated nystagmus, which is stronger in the abducting fellow eye. This motility disturbance stems from a lesion in the medial longitudinal fasciculus running in the brain stem between the sixth and the third nerve nuclei. The lesion is often due to multiple sclerosis, but can also be ischemic, traumatic, neoplastic or inflammatory (e.g. HIV infection).

Adult↗
PubMed2003

Assessment of regional myocardial hypoperfusion with myocardial contrast echocardiography using intravenous bolus application in patients with acute chest pain: a double case report.

Myocardial contrast echocardiography using power Doppler harmonic imaging is able to document myocardial hypoperfusion. Two case reports demonstrate the potential of intravenous bolus application of microbubbles in patients with acute chest pain due to myocardial ischaemia to detect regional low flow conditions. The case reports will focus on the necessity to present Doppler intensity kinetics by Doppler intensity vs time plots or coloured M-modes to present the data more objectively. In addition, the hypoperfusion detected with myocardial contrast echocardiography via bolus injection of microbubbles can only be proven by changes of regional perfusion between repetitive myocardial contrast echocardiography measurements or by additional perfusion analysis, e.g. by scintiscanning.

Acute Disease↗
PubMed2003

Intravenous myocardial contrast echocardiography during angioplasty.

Myocardial contrast echocardiography (MCE) using power Doppler harmonic imaging (PDHI) has been reported to document regional myocardial perfusion. Two case reports demonstrate the potential of intravenous myocardial contrast echocardiography during angioplasty.

Angioplasty, Balloon↗
PubMed2002

[Cyclotropia in macula translocation. Possible eye muscle surgery solutions].

BACKGROUND: Macular translocation for treatment of age-related maculopathy often necessitates surgical counter-rotation of the external eye muscles. Excyclorotatory effects can be attained generally by various surgical methods on all extraocular eye muscles. If procedures on different muscles are combined, anterior segment perfusion has to be maintained. PATIENTS AND METHODS: The results of 29 operations were analysed in order to examine the excyclorotatory effects of 4 different combined surgical approaches. RESULTS: In 23 patients a partial transposition of all 4 m. recti together with a high dose combined operation on both oblique muscles yielded a mean effect of 21.6 degrees excyclorotation. In four patients a vertical transposition of the horizontal m. recti in opposite directions together with a high dose combined operation on both oblique muscles led to a mean excyclorotation of 22 degrees. A full tendon transposition of the superior oblique muscle to the nasal part of the orbit in one case combined with a downward transposition of the medial rectus muscle resulted in an excyclorotation of 37 degrees, in another case combined with an anterior margin advancement of the inferior oblique muscle led to an excyclorotation of 35 degrees. CONCLUSIONS: All approaches yielded mean counter-rotatory effects over 20 degrees. The indications are discussed under the aspects of the possibility of a one-step correction of horizontal or vertical angles, dosage, induction of inconcomitancies and operation time.

Humans↗
PubMed2002

[Childhood vision disorders. Screening programs in international comparison].

Worldwide in a number of countries, screening programs aimed at detecting visual disorders in children are established. Repeatedly, proposals are brought forward to optimize already existing programs. Countries without such a program are interested in learning about current models as a guide for planning their own program. This study was performed to take stock of the screening programs for visual dysfunction in children in existence in the years 1999-2000 worldwide. The aspects considered were the child's age at examination, examiner's qualification, type of examinations performed, cost-bearing entity, and cost-efficacy analysis. The health ministries of 190 sovereign countries were asked via a questionnaire for information about possibly existing screening programs. The results of the survey were analyzed quantitatively regarding geographic, political, and socioeconomic aspects, yielding data for the exchange of experience in optimizing existing programs and developing new programs.

Child↗
PubMed2002

[Macular translocation with 360 degree retinotomy in the treatment if exudative macular degeneration. Functional and angiographic results].

BACKGROUND: During surgical extraction of choroidal neovascular membranes (CNV) in age-related macular degeneration (AMD), the defective foveal retinal pigment epithelium (RPE) is removed. Subsequent translocation of the foveal neural retina to adjacent healthy RPE should result in stabilization and possibly improvement of visual acuity. METHODS: A prospective case series was carried out using controlled surgery and examination protocols with examinations made at fixed intervals. The surgical procedures combine counterrotation of the globe, phacoemulsification and implantation of a posterior chamber lens, complete vitrectomy, induction of a total retinal detachment, 360 degrees anterior retinotomy, removal of the subfoveal neovascular complex, foveal translocation outside the RPE defect, reattachment of the retina using F6H8, peripheral laser retinopexy and temporary silicone oil tamponade. PATIENTS: Macular translocation surgery was performed on 100 patients between December 1997 and December 1999. All patients had experienced recent visual loss due to exudative AMD and of these, 26 patients had major macular subretinal hemorrhage, 39 patients had occult and 25 patients classic subfoveal choroidal neovascularization. The preoperative findings in the remaining patients included tears in the pigment epithelium (n = 4), polypoidal choroidal vasculopathy (n = 1), recurrent subfoveal CNV following laser therapy (n = 2) and deep retinal vascular anomalous complexes (n = 3). RESULTS: A total of 97 patients completed the 12-month examination. Visual acuity increased by 15 or more ETDRS chart letters in 24 patients, remained stable in 42 patients and deteriorated by 15 or more EDTRS chart letters in 34 patients 12 months postoperatively. The silicone oil tamponade was removed in 97 patients, in 10 patients, silicone oil had to be reinjected because of severe complications. A secondary procedure was necessary in 25 patients, primary PVR was observed in 9 eyes, secondary PVR developed in 10 eyes, a macular pucker in 5 eyes and a macular hole in 1 patient. Other postoperative complications included persistent hypotonia, macular edema, IOL dislocation, keratopathy and recurrent CNV (n = 3). CONCLUSIONS: Macular translocation is a technically demanding operation, which requires a considerable learning curve. Although the procedure has a high rate of surgical and postoperative complications, the functional and anatomical results appear to be promising for selected patients with subfoveal CNV secondary to AMD.

Aged↗
PubMed2002

[Sensory problems after macular translocation].

Following macular translocation, spontaneous compensation of subjectively felt tilt can occur by central adaptation to the rotation of the retinal meridians. However, in cases of large angle rotations or under binocular conditions, efforts to counter-rotate the globe have to be made in order to achieve comfortable vision. For restoring binocular vision postoperatively, the fusionable residual angle of 7-8 degrees should not be exceeded.

Adaptation, Ocular↗
PubMed2002

[Surgical eye muscle counter-rotation after macular translocation].

Surgical counter-rotation after macular translocation is indicated when a non-fusionable cyclodeviation exists by lack of suppression. Different surgical options exist to counter-rotate the globe after macular translocation. Primary angles of retinal rotation up to 40 degrees can be compensated for.

Eye Movements↗
PubMed2001

Does satisfaction with abilities mediate the relationship between the impact of rheumatoid arthritis on valued activities and depressive symptoms?

OBJECTIVE: Both impact of rheumatoid arthritis (RA) on valued life activities and dissatisfaction with abilities have been linked to depression among individuals with RA. We integrated these concepts by examining the hypothesis that satisfaction with one's abilities may explain the mechanism by which the impact of RA on valued activities leads to depression. METHODS: Data were collected over 2 years (1997 and 1998) through interviews with the University of California, San Francisco, RA panel. Analyses examined whether activity impairment in 1997 predicted later (1998) dissatisfaction with abilities and depression. RESULTS: Greater impact on activities predicted dissatisfaction with abilities, which in turn was associated with higher depression scores. There was no direct relationship between activity impact and depression when satisfaction with abilities was considered. CONCLUSION: Satisfaction with abilities mediated the relationship between the impact of RA on valued activities and an increase in depressive symptoms, suggesting a need to assess not only physical decline but also individuals' interpretation of the decline.

Aged↗
PubMed2001

Modified transposition procedure of the vertical recti in sixth nerve palsy.

PURPOSE: To report a modified transposition procedure of the vertical recti for severely limited abduction of the globe caused by sixth nerve palsy and to compare this with the Hummelsheim transposition procedure. METHODS: Retrospective study of 13 eyes of 12 patients that had Hummelsheim transposition procedure and 19 eyes of 17 patients that had modified transposition procedure of the vertical recti for severely limited abduction of the globe caused by sixth nerve palsy. The modified transposition procedure joins lateral strips of the vertical recti and sutures this junction to the lateral rectus muscle. Functional results of the Hummelsheim procedure are compared with functional results of the modified transposition procedure. RESULTS: Abductive capacity improved by 4.19 +/- 1.67 mm in the Hummelsheim group and 4.08 +/- 1.7 mm in the modification. The angle of squint changed from +22.33 +/- 6.74 degrees to -0.20 +/- 2.61 degrees in the Hummelsheim group and from +25.54 +/- 5.66 degrees to +0.95 +/- 5.26 degrees in the modification group. The functional results as to abductive capacity and postoperative angle of squint showed no significant difference between the two methods (P >.05, t test). The modification was less time consuming. CONCLUSIONS: A modification of the transposition techniques of eye muscles in sixth nerve palsy is introduced. Its functional results are comparable to the classic technique of Hummelsheim. Operative risk and trauma are reduced, because the technique avoids scleral stitches and was found to be less time consuming than the Hummelsheim procedure.

Abducens Nerve Diseases↗
PubMed2001

Follow-up of transnasal orbital decompression in severe Graves' ophthalmopathy.

OBJECTIVE: To evaluate the safety and efficacy of transnasal orbital decompression for severe Graves' ophthalmopathy. DESIGN: Retrospective noncomparative case series with extended clinical follow-up. PARTICIPANTS: Seventy-eight consecutive subjects who were operated on for compressive optic neuropathy with loss of visual acuity or visual field defects after failure of medical and radiation therapy. INTERVENTION: Strictly transnasal, endoscopic-controlled bilateral decompression of the medial and inferomedial wall of the orbit. MAIN OUTCOME MEASUREMENTS: Preoperative and postoperative examination, including vision, Hertel exophthalmometry, ocular motility, visual fields, Goldmann perimetry, and notification of complications, intranasal signs of inflammation, and subjects' assessment of the procedure. RESULTS: One hundred forty-five endonasal decompressions were performed on 78 subjects (63 women, 15 men, 52.2 +/- 10.3 years) during a 10-year period. Sixty five patients were bilaterally operated on; 15 required only unilateral decompression. Four of 78 needed repeat surgery. Visual acuity increased from a preoperative average of 0.50 +/- 0.27 (range, 0.01-1.25) to 0.75 +/- 0.21 (range, 0.01-1.25) postoperatively. An average reduction of proptosis of 3.94 +/- 2.73 mm (range, -1.0-11.0 mm) was achieved with a mean preoperative Hertel measurement of 22.19 +/- 3.13 mm (range, 15-34 mm). Ocular motility was corrected by recession of the medial rectus muscle in 58 of 78 cases. Twenty-six of these 58 cases were simultaneously operated on in the same surgical session immediately after the transnasal decompression, and the others after a period of 2 to 3 months. CONCLUSIONS: The transnasal orbital decompression procedure improved vision, decreased proptosis in a range comparable to more invasive techniques, and had favorable cosmetic results without additional disfiguration by scars. Morbidity was far less than with other approaches. Postdecompression strabismus was successfully managed by recession of both medial orbital muscles in the same surgical session.

Adult↗
PubMed2000

[Alcohol concentration in the coronary sinus after transarterial ablation of septal hypertrophy in hypertrophic obstructive cardiomyopathy].

BACKGROUND AND OBJECTIVE: The size of the resulting myocardial necrosis varies after percutaneous transarterial ablation (PTA) of hypertrophied septum in patients with hypertrophic obstructive cardiomyopathy (HOCM). It was the aim of this study to discover whether the alcohol concentration in coronary sinus (CS) blood is a useful and appropriate parameter and what conclusions can be drawn from it. PATIENTS AND METHODS: PTA was done in four patients (two women and two men, aged 30-53 years) with HOCM. Before the intervention the gradient across the left ventricular outflow tract ranged form 20 to 80 mmHg, postextrasystolic it ranged from 40 to 180 mmHg. 1 x 2 ml ethanol was injected into the first septal branch in 3 patients, 2 x 2 ml in one. The alcohol concentration in coronary sinus blood was measured every 30 sec for up to 5 min before and after ablation. The amounts were compared with the size of the akinetic area in the echocardiogram and the maximal value of creatine kinase, as a measure of the size of myocardial necrosis. RESULTS: The left ventricular outflow gradient was reduced in all patients, to 0-30 mmHg and postextrasystolic to 30-90 mmHg. A pacemaker had to be implanted in one patient who developed a 3 degrees AV block. The alcohol concentration in coronary sinus blood ranged from maximally 1.53 and 0.23 per thousand after 30 sec and then fell to 0.56-0.12 per thousand after 5 min. The patient with the highest CS alcohol concentration also had the highest maximal value for creatine kinase (68 mumol/l) and the largest akinetic area in the echocardiogram. CONCLUSION: The extent of myocardial necrosis can probably be estimated from the CS blood concentration of alcohol after alcohol ablation. If, after the first injection, high alcohol concentrations are measured, further alcohol injections are not indicated.

Adult↗
PubMed2000

Alzheimer's disease, depression and normal ageing: merit of simple psychomotor and visuospatial tasks.

INTRODUCTION: A brief psychometric test battery was used to differentiate Alzheimer's disease (AD) patients from patients with depression and healthy age-matched control subjects. The purpose was to investigate the discriminative value of simple psychomotor and visuospatial tasks that were implemented in a computer-assisted test battery. METHODS: Manumotoric coordination, discrimination reaction time and performance on a visuospatial pattern-matching task were assessed. Subjects were 30 patients with the diagnosis of probable AD (mild to moderate), 22 patients with a major depression and 15 healthy normal control subjects. RESULTS: Discrimination reaction time separated the three groups most distinctly, but general level of cognitive functioning was a significantly confounding variable. There were no differences between the AD and the depressed patients when the MMSE was used as a covariate. Substantial deficiencies in manumotoric coordination were found in both demented and depressed patients. The visual pattern-matching task yielded longer reaction times in both patient groups than in the control group. CONCLUSION: Translated into neuropsychological terms, these data suggest deficiencies in basic central operations, a slowing of central information processing and attentional deficits in AD and depressed patients. Psychomotor tasks were able to distinguish effectively healthy elderly persons from AD and depressed patients. This test battery, however, appears to be limited in differentiating AD from depression.

Aged↗
PubMed2000

Vertical and cyclotorsional deviations following peribulbar anesthesia.

BACKGROUND: Motility disorders may occur consecutive to peribulbar anesthesia. The underlying pathology is still debated. The aim of the study was to contribute to the discussion by a meticulous orthoptic examination of a series of patients. METHODS: In a series of 16 patients with diplopia after peribulbar anesthesia, measurements of the angle of squint in the nine directions of gaze, Bielschowsky's headtilt test and motility analysis were performed. The findings were discussed with regard to the possible types of muscular lesions. RESULTS: Hypotropia and deorsoadduction accompanied by relatively small cyclotropia were found in all cases. Bielschowsky's head-tilt test mostly revealed neutral findings. CONCLUSION: The findings were discussed under the hypothesis of a fibrotic muscular change in the superior oblique and inferior rectus muscle. This hypothesis turned out to be concordant with the orthoptic measurements, implying that treatment of the disorder should consist in low-dosage recession of the fibrotic muscles, which in our experience was rewarding.

Aged↗