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Biomedical subjects

F Kuhn

Publications and source records attributed to F Kuhn.

At least 37 records · Page 2Linked to original sources
PubMed1998

Terson syndrome. Results of vitrectomy and the significance of vitreous hemorrhage in patients with subarachnoid hemorrhage.

OBJECTIVE: The purpose of study A was to assess the effectiveness of vitrectomy for Terson syndrome. The purpose of study B was to determine the incidence and significance of vitreous hemorrhage in patients with subarachnoid hemorrhage. DESIGN: Study A is a retrospective review of case series. Study B is a prospective study. PARTICIPANTS: Study A examined a consecutive series of 4 children (7 eyes) and 23 adults (26 eyes). Study B examined a consecutive series of 100 patients. INTERVENTION: Subjects in study A underwent pars plana vitrectomy for dense vitreous hemorrhage following intracranial hemorrhage. In study B, ophthalmoscopic examination of patients undergoing neurosurgery for ruptured cerebral aneurysms was used. MAIN OUTCOME MEASURES: In study A, the extent and rapidity of visual recovery and intraoperative and postoperative complications were examined. In study B, the incidences of intraocular hemorrhage and Terson syndrome in the cohort and the significance of the presence of vitreous hemorrhage in patients with subarachnoid hemorrhage were examined. RESULTS: Study A: There was substantial and rapid visual improvement in 25 of the 26 eyes (96%) of the adult patients, with 21 eyes (81%) achieving > or = 20/30 final visual acuity. Only limited improvement was achieved in children's eyes (< or = 20/60). Study B: Intraocular hemorrhage was found in 17% of eyes in patients with subarachnoid hemorrhage; the incidence of Terson syndrome was 8%. All patients with Terson syndrome and 89% of the patients with other types of intraocular hemorrhage had a history of coma compared with 46% of those without intraocular hemorrhage (P = 0.0003). CONCLUSIONS: Vitreous hemorrhage in patients surviving subarachnoid hemorrhage appears to be more common than previously thought, underscoring the need for routine funduscopic screening. Surgical intervention is highly effective in hastening visual rehabilitation of adults with Terson syndrome. The less encouraging results in infants may be due to amblyopia or direct brain damage caused by the cerebrovascular incident.

Adult↗
PubMed1998

Ferrous intraocular foreign bodies retained in the posterior segment: management options and results.

PURPOSE: Analysis of traditional versus comprehensive management techniques for eyes with ferrous IOFBs in the posterior segment. PATIENTS AND METHODS: Retrospective review of 30 eyes undergoing IOFB removal by EM and of 34 eyes managed by PPV techniques. RESULTS: Vitreous hemorrhage occurred commonly (EM group: 40%, PPV group: 50%). Only in the EM group did the intervention cause iatrogenic vitreous hemorrhage (23%) and has postextraction endophthalmitis developed (10%). Vision improved in 23% of eyes, deteriorated in 53%; >0.5 vision was achieved in 20%. Five EM eyes (17%) were anatomically lost; PVR developed in 48% of the remaining eyes. In the PPV group, no eye was anatomically lost and PVR developed in 12%. Vision improved in 68% of eyes, deteriorated in 15%; >0.5 vision was achieved in 68%. A single retinal impact site occurred in 71%, < or =2 impact sites in 21% of eyes. CONCLUSIONS: Approximately one of two eyes with posterior segment IOFB develops vitreous hemorrhage, over two-thirds sustain at least one retinal lesion, and one-fifth of eyes suffer multiple retinal injuries. Both the anatomical (p = 0, 003) and the functional (p = 0, 005) prognoses are significantly better in eyes undergoing PPV compared to eyes with EM use. Timely PPV appears to markedly reduce the risk of endophthalmitis development. These results confirm the need to abandon the EM and perform PPV for eyes with posterior segment IOFBs.

Adolescent↗
PubMed1997

pmg-1, a novel gene specifically expressed during the invasive growth phase of the mammary gland at puberty.

The acquisition of invasive properties is a crucial event during carcinogenesis, determining the clinical outcome. The mammary gland at puberty provides an ideal model for investigating the induction and control of invasive growth. During this growth phase, the mammary epithelium participates in a normal, hormonally controlled invasive penetration into the stroma. We have applied the differential display method to search for genes specifically activated during this developmental stage. We have identified and molecularly characterized a novel pubertal mammary gland specific gene, pmg-1. This gene is conserved in mammals and encodes a protein of 19.9 kDa. Northern blotting and in situ hybridization revealed that pmg-1 expression was exquisitely restricted to the epithelium at early puberty. To our knowledge this represents the first isolation of a gene specifically associated with the induction of mammary epithelial invasiveness at puberty.

Age Factors↗
PubMed1997

A system for classifying mechanical injuries of the eye (globe). The Ocular Trauma Classification Group.

PURPOSE: To develop a classification system for mechanical injuries of the eye. METHODS: The Ocular Trauma Classification Group, a committee of 13 ophthalmologists from seven separate institutions, was organized to discuss the standardization of ocular trauma classification. To develop the classification system, the group reviewed trauma classification systems in ophthalmology and general medicine and, in detail, reports on the characteristics and outcomes of eye trauma, then established a classification system based on standard terminology and features of eye injuries at initial examination that have demonstrated prognostic significance. RESULTS: This system classifies both open-globe and closed-globe injuries according to four separate variables: type of injury, based on the mechanism of injury; grade of injury, defined by visual acuity in the injured eye at initial examination; pupil, defined as the presence or absence of a relative afferent pupillary defect in the injured eye; and zone of injury, based on the anteroposterior extent of the injury. This system is designed to be used by ophthalmologists and nonophthalmologists who care for patients or conduct research on ocular injuries. An ocular injury is classified during the initial examination or at the time of the primary surgical intervention and does not require extraordinary testing. CONCLUSIONS: This classification system will categorize ocular injuries at the time of initial examination. It is designed to promote the use of standard terminology and assessment, with applications to clinical management and research stud ies regarding eye injuries.

Adult↗
PubMed1997

Retinal large vessel oxygen saturations correlate with early blood loss and hypoxia in anesthetized swine.

BACKGROUND: Noninvasive monitoring would likely improve trauma care. Using laser technology, we monitored the oxygen saturation in retinal vessels during exsanguination and hypoxia. METHODS: Seven anesthetized swine were bled at 0.4 mL/kg/min for 40 minutes. During exsanguination, retinal venous saturation (SrvO2) was measured using an eye oximeter, and central venous saturation (SvO2) was measured using a fiber-optic catheter. After the shed blood was reinfused, the FiO2 was progressively decreased from 0.97 to 0.07. Femoral artery oxygen saturation (SaO2) and retinal artery oxygen saturation (SraO2) were measured at each increment. RESULTS: During exsanguination, SrvO2 correlated with blood loss (r = -0.93) and SvO2 (r = 0.94). SraO2 correlated with SaO2 during incremental hypoxia (R2 = 0.93 +/- 0.15). CONCLUSIONS: In this model of exsanguination, retinal venous oxygen saturation correlates with blood volume and with central venous oxygen saturation. The SraO2 correlates with SaO2 during graded hypoxia. Use of an eye oximeter to noninvasively monitor trauma patients appears promising and warrants further study.

Anesthesia↗
PubMed1997

Screening for ocular hemorrhages in patients with ruptured cerebral aneurysms: a prospective study of 99 patients.

BACKGROUND: Terson's syndrome (vitreous hemorrhage) and other ocular hemorrhages (retinal hemorrhages) have been reported to occur in up to 40% of patients with ruptured cerebral aneurysms. Because microsurgical vitrectomy can safely restore vision in patients with visual loss secondary to Terson's syndrome, we hypothesized that prospectively screening a selected group of patients with aneurysms would result in a higher rate of vitrectomy in patients with more extensive subarachnoid hemorrhage. METHODS: Ninety-nine patients with ruptured cerebral aneurysms were prospectively screened for Terson's syndrome and other forms of ocular hemorrhage by an ophthalmologist. Follow-up data were obtained for seven of eight cases of Terson's syndrome, and vitrectomy was performed for visual restoration when indicated. RESULTS: Ocular hemorrhages were present in 17% of patients with ruptured cerebral aneurysms, and Terson's syndrome was present in 8% of patients. Screening of patients with histories of transient or prolonged comas sensitively identified patients with ocular hemorrhages in 100% of the patients with Terson's syndrome and 89% of the patients with other ocular hemorrhages. Fifty-five percent of the patients in the overall series had histories of transient or prolonged comas, and 53% (specificity) of those patients had ocular hemorrhages. Two of the eight patients with Terson's syndrome underwent vitrectomy, with dramatic improvement in vision. No other ocular hemorrhages required surgery. CONCLUSIONS: Ophthalmological screening of patients with histories of transient or prolonged comas after ruptured cerebral aneurysms very sensitively identifies patients with ocular hemorrhages, which are relatively common in patients with subarachnoid hemorrhage treated in an academic neurosurgical practice. The present study underestimates the true incidence of Terson's syndrome in that patients who died shortly after their subarachnoid hemorrhage were not included. Vitrectomy for patients who do not exhibit spontaneous improvement in vision results in a dramatic reversal of blindness.

Adult↗
PubMed1996

A standardized classification of ocular trauma.

BACKGROUND: No internationally standardized classification of ocular trauma terminology has existed heretofore. Despite a growing interest in eye injuries, the absence of a common language continues to impede both clinical care and research. METHODS: A classification was initially developed based on the authors' extensive personal experience. It then under-went repeated reviews over a 3-year period by international ophthalmic specialists. Written and oral suggestions from respondents in 19 countries and from selected ocular trauma experts were considered and incorporated. RESULTS: By always using the entire globe as the tissue of reference, the new classification is unambiguous, consistent, simple, and comprehensive. It provides definitions for the terms commonly used in eye trauma and creates a logical system of injury types. CONCLUSION: In addition to widespread international acceptance by professionals, the new classification has been endorsed by the International Society of Ocular Trauma, the United States Eye Injury Registry, the American Academy of Ophthalmology, the Hungarian Eye injury Registry, the Vetreous Society, and the Retina Society. It can be reasonably expected that the system will ultimately become the standardized international language of ocular trauma.

Eye Injuries↗
PubMed1996

A standardized classification of ocular trauma.

BACKGROUND: No internationally standardized classification of ocular trauma terminology has existed previously. Despite a growing interest in eye injuries, the absence of a common language continues to impede both clinical care and research. METHODS: A classification has been developed initially based on the authors' extensive personal experience. It then has undergone repeated reviews over a 3-year period by international ophthalmic audiences, incorporating suggestions from respondents in 13 countries and selected ocular trauma experts. RESULTS: By always using the entire globe as the tissue of reference, the new classification is unambiguous, consistent, and simple. It provides definitions for the commonly used eye trauma terms within the framework of a comprehensive system. CONCLUSION: The new classification has been endorse by the Board of Directors of the International Society of Ocular Trauma, the United States Eye Injury Registry, the Hungarian Eye Injury Registry, the Vitreous Society, the Retina Society, and the American Academy of Ophthalmology. It can be reasonable expected that the system eventually will become the standardized international language of ocular trauma. The authors urge ophthalmologists to begin using this terminology in both clinical practice and research.

Eye Injuries↗
PubMed1995

Eye injury and the air bag.

Although traffic-related mortality and morbidity figures have improved in recent years in the United States, motor vehicle crash remains a leading source of death and injury, requiring additional efforts to reduce its toll. The rationale for equipping passenger vehicles with air bags was to introduce a mechanical cushion between occupants and the car's hard interior surfaces. Although air bags have proven to be effective in saving lives and preventing injuries, a growing number of reports indicate that the air bag is also a potential source of ocular trauma. This article analyzes 24 eye injuries alleged to be air bag-related. The posterior segment was injured in less than half of cases, and only one eye sustained severe visual impairment. Although such reports may help to improve air bag design, the air bag should remain "innocent until proven guilty." We report that in motor vehicle crashes, the rate of ocular trauma increases 2.5 times if the car is not air bag-equipped. In contrast to injuries seen in vehicles without air bags, eye trauma sustained in vehicles with air bags is typically closed globe.

Accidents, Traffic↗
PubMed1995

Percentage scattergram to depict changes in large amounts of data over time.

Graphical representation of changes in epidemiologic or clinical parameters over time is difficult when a large amount of data is involved. The traditional methods either cannot incorporate all necessary information (bar graphs, pie charts, tables) or are unable to depict information on more than a limited number of individuals (scattergrams). We have designed an effective way of visual presentation of the changes a variable demonstrates over time. The percentage scattergram provides accurate and complete depiction of any number of data points, allowing comprehensive and rapid analysis.

Data Display↗
PubMed1994

Epidemiology of motor vehicle crash-related serious eye injuries.

The Eye Injury Registry of Alabama has been collecting epidemiologic, treatment, final outcome, and rehabilitation information on serious ocular trauma since 1982. By December 31, 1989, 150 motor vehicle crash-related eye injuries had been registered. This is the largest series of motor vehicle crash-related serious eye injuries reported. The mean age of those injured was 29 years; 61% were between 16 and 35 years of age, and 73% were males. Ten individuals (7%) suffered bilateral eye injuries. The retina was injured in 47% of eyes. The initial visual acuity was 19/200 or worse (legal blindness) in 47% of eyes. Of eyes with at least 3 months of follow-up, 63% had worse than 20/200 initial visual acuity and 41% remained legally blind. Twelve percent of eyes required removal. Possibly due to the large number of blunt ruptures, motor vehicle crash-related eye trauma carries a particularly unfavorable treatment prognosis. Prevention of these injuries is therefore of extraordinary importance.

Accidents, Traffic↗
PubMed1993

MR imaging related to p.m. findings in angiodysgenetic myelomalacia. A case report.

In a 65-year-old patient with slowly progressive myelopathy of the lower spinal cord MRI revealed slight thickening of the conus medullaris and discrete serpiginous areas of low signal intensity in contact to the surface of the myelon. The T2-weighted axial images demonstrated a zone of high signal intensity within the center of the lumbosacral cord. These findings corresponded to the results of autopsy: cord enlargement, dilatation of wall thickened and partially thrombosed pial veins, edema, damage of the myelin sheath with development of foam cells, areas of hemorrhage and necrosis. Although myelography and spinal digital subtraction angiography had been normal in this case we assume that perhaps a spinal dural av-fistula may have been the cause of MR- and pathological findings which indicate an angiodysgenetic myelomalacia (Morbus Foix-Alajouanine). The pathogenesis of spinal dural av-fistulas is discussed in order to explain why angiography has been negative.

Aged↗