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H Elsner

Publications and source records attributed to H Elsner.

At least 19 recordsLinked to original sources
PubMed2006

[Selective retina therapy in patients with diabetic maculopathy].

Selective Retina Therapy (SRT) is a new laser treatment that selectively targets the retinal pigmen epithelium (RPE). In this study, we treated 39 patients presenting with nonischemic, focal and focal-diffuse diabetic maculopathy with SRT. In the main. the results indicate that SRT had stabilizing effects on visual acuity, angiographic leakage, lipid exudation, and foveal retinal thickness. SRT is safe and is especially useful for treating pathologies that are located close to the fovea, which cannot be treated with conventional argon laser photocoagulation.

Aged↗
PubMed2006

[Selective retina therapy in central serous chorioretinopathy with detachment of the pigmentary epithelium].

BACKGROUND: Selective Retina Therapy (SRT) is a new and innovative laser treatment modality that selectively treats the retinal pigmentary epithelium while sparing the photoreceptors. This therapeutic concept appears to be particularly suitable for treating patients with acute or chronic central serous chorioretinopathy (CSC). We present preliminary results obtained in five patients who had CSC associated with pigmentary epithelium detachment (PED) and serous subretinal fluid (SRF) and who were treated with SRT. METHODS: This case series was made up of five male patients (mean age 47 years) with chronic CSC and SRF resulting from PED. Examinations performed before and at 1 month and 3 months after the treatment were: BCVA, FLA, OCT (Zeiss OCT III). For SRT, confluent treatment of the PED (area of leakage) was carried out using a pulsed frequency-doubled, Q-switched Nd-YLF prototype laser (lambda=527 nm, t= 1.7 s, 100 Hz, energy = 150-250 J). RESULTS: Best corrected visual acuity at baseline was 0.53, while after 4 weeks it was 0.56 and after 12 weeks, 0.5. At baseline leakage was seen at the PED on fluorescein angiography in all patients. After 4 weeks leakage activity was no longer noted on angiography in 4 of 5 patients. OCT at baseline showed SRF at the edge of the PED in all patients, but in 4 of the 5 patients this was no longer detectable after 4 weeks. CONCLUSION: SRT is a safe and effective treatment for patients with CSC in which PED has caused SRF. Not a single case of rip syndrome was observed in this study, even though the PED was treated confluently. Since SRT spares the photoreceptors it is particularly suitable for the treatment of CSC, especially when the origin of leakage is located close to the fovea. The results indicate that SRT leads to reconstruction of the outer blood-retina barrier.

Adult↗
PubMed2006

[Selective retina therapy: methods, technique, and online dosimetry].

Selective retina therapy (SRT) is currently under evaluation, as a new and very subtle laser method, for the treatment of retinal disorders associated with a degradation of the retinal pigmentary epithelium (RPE). SRT makes it possible to selectively effect the RPE, sparing the adjacent neural retina with the photoreceptors and also the choroid below the RPE. In the best case, the therapy leads to regeneration of the RPE and a long-term metabolic increase at the chorio-retinal junction. In contrast to conventional laser photocoagulation, which is associated with complete thermal necrosis of and around the treated site, absolutely no scotoma occurs in SRT. This paper reviews the methods and mechanisms behind the selective effects of the RPE. In vitro and preclinical results are used to describe the bandwidth of selective effects with respect to different irradiation settings. An optoacoustic technique is introduced to visualize effects that cannot be seen by ophthalmoscopy and to facilitate dosimetry control without recourse to angiography completes the report.

Humans↗
PubMed2006

Selective retina therapy in patients with central serous chorioretinopathy.

BACKGROUND: Central serous chorioretinopathy (CSC) is a disease with a localized breakdown of the outer blood-retinal barrier located within the retinal pigment epithelium (RPE) causing subretinal fluid accumulation. Selective retina therapy (SRT) is a new, minimally invasive laser technology that has been designed to selectively target the RPE. SRT spares retinal tissue. METHODS: Twenty-seven eyes of 27 patients with active CSC were treated with SRT using a pulsed double-Q-switched Nd-YLF prototype laser (lambda=527 nm, t=1.7 micros). At baseline, best-corrected visual acuity was determined and fluorescein angiography and optical coherence tomography were performed. The patients were followed for up to 3 months. RESULTS: After 4 weeks 85.2% of patients showed complete resolution of subretinal fluid and in 96.3% there was no leakage visible on fluorescein angiography. After 3 months 100% of patients demonstrated no subretinal fluid and 100% of patients had no leakage activity on fluorescein angiography. Visual acuity, 20/40 at baseline, improved to 20/28 after 4 weeks and to 20/20 after 3 months. CONCLUSION: SRT is a safe and effective treatment for active CSC. Especially if the RPE leak is located close to the fovea, SRT is the favoured therapeutic option. We recommend earlier treatment of patients with acute CSC in order to prevent development of chronic changes due to CSC with irreversible anatomical and functional damage. SRT might be considered as a first-line treatment for active CSC.

Adult↗
PubMed2003

[German diagnosis-related groups. Problems in the field of mental and behavioural disorders shown in the example of hospital treatment of alcoholics].

Hospital treatment in Germany will clearly change: instead of paying by the number of days, blanket prices including all necessary benefits will become the norm. The nearly innumerable treatments possible were collected into diagnosis-related groups (DRGs) requiring similar clinicomedical benefits and consuming similar financial resources. The DRG classification in Germany (G-DRG) will be oriented to the Australian refined diagnosis-related group (AR-DRG) system, which has existed since 1998. German psychiatric hospitals have by policy not yet been involved in the new system. However, a big sector of psychiatric activity--as far as number of patients is concerned--has already been incorporated in this new system: detoxification from legal and illegal drugs is involved in G-DRG inasmuch as it does not take place in psychiatric hospitals. If the DRG system becomes established in German psychiatric hospitals, grave difficulties will occur. These problems are described together with the expected results in the example of hospital treatment of alcoholics.

Alcoholism↗
PubMed2003

Postictal serum levels of antiepileptic drugs for detection of noncompliance.

Medication noncompliance (NC) is thought to be a major cause of insufficient seizure control. In an explorative study we investigated whether postictal serum levels (PISLs) of antiepileptic drugs (AEDs) are a reliable indicator of NC. Young adults with epilepsy on a stable AED regimen were asked to contact medical service as soon as possible when a seizure occurred to obtain serum levels of their AEDs. PISLs were compared with the mean value of two routine serum levels of the same medication. PISLs lower than 50% of the individual reference value were regarded as an indicator of NC. PISL samples in 61 seizures of 52 patients treated mainly with carbamazepine, valproic acid, or lamotrigine were evaluated. A drop in serum levels >50% indicating NC was noted in 44.3% of the seizures. Determination of PISLs seems to be a simple and useful method for detecting or ruling out irregular intake patterns as a cause of "breakthrough" seizures.

Adolescent↗
PubMed2002

[Photodynamic therapy of subfoveal choroid neovascularization. Analysis of fixation behavior].

BACKGROUND: In a prospective, randomized, placebo-controlled clinical trial, we have analyzed the pattern of fixation in patients with subfoveal choroidal neovascularization in age-related maculopathy, who have been treated with photodynamic therapy (Verteporfin). MATERIALS AND METHODS: The patients in this study were participating in the TAP trial at a study center (Lübeck). The TAP study inclusion criteria have been applied and photodynamic therapy was carried out by the TAP study standard protocol. For microperimetric analysis we used the Scanning Laser Ophthalmoscope 101 (Rodenstock). Fixation was classified into foveal and excentric fixation. In addition we quantified the area of fixation (mm2). All patients had a follow-up of 2 years. RESULTS: Out of 33 patients in the Verteporfin group, 29 showed central fixation at baseline and only 11 out of 33 had foveal fixation after 24 months. The area of fixation in this group was measured at baseline at 0.44 mm2, at 1.76 mm2 after 6 months and at 2.4 mm2 after 12, 18 and 24 months, respectively. In the placebo group 11 out of 13 patients had foveal fixation at baseline and after 24 months 2 out of 13 demonstrated central fixation. The area of fixation increased from 0.76 mm2 at baseline up to 2.4 mm2 after 6 months, to 4.9 mm2 after 12 months, to 7.1 mm2 after 18 months and finally after 24 months up to 9.61 mm2. CONCLUSIONS: Photodynamic therapy with Verteporfin does not prevent loss of central fixation in patients with subfoveal choroidal neovascularization in age-related maculopathy, however PDT has a significant stabilizing effect on the development of the area of fixation.

Aged↗
PubMed2001

[Spontaneous course of classical, subfoveal choroid neovascularization in age-related macular degeneration].

In a prospective, double-blind study, 19 patients with a classical subfoveal choroidal neovascularisation due to AMD were followed-up over a period of 2 years. Every 3 months a standardised visual acuity test, a contrast sensitivity test and fluorescein-angiography were performed. Overall, visual acuity dropped from 20/125 initially down to 20/250 after 2 years. Contrast sensitivity decreased from 23 down to 19 recognised letters. The functionally superior group 1 (n = 7) with a visual acuity of 20/65 at baseline, improved up to 20/50 after 2 years, while group 2 (n = 12) with a baseline visual acuity of 20/125 showed a decrease down to 20/400 after 24 months. Contrast sensitivity stabilised or improved in 10 patients from 22 to 25 letters, while in 9 patients the score dropped from 23 down to 8 recognised letters. The results underline the unfavourable functional prognosis of classical subfoveal lesions in AMD. However, stabilisation is possible depending on baseline visual acuity which is critical whenever results of nonplacebo-controlled studies have to be assessed. Moreover these results suggest that the urgency of a therapeutical intervention might be overestimated. As treatment, a fairly gentle, primarily atraumatic, CNV-selective strategy should be chosen, so that the self-limiting potential of this disease can be utilised in addition to the therapeutic effect.

Aged↗
PubMed2000

[Micro-perimetric documentation of retinal function in photodynamic therapy of choroid neovascularizations].

PURPOSE: Photodynamic therapy provides occlusion of choroidal neovascularization by intravascular endothelial damage. The photodynamic approach offers the potential to occlude choroidal neovascularization selectively without altering adjacent sensory retina and therefore to preserve visual acuity. To determine the selectivity of photodynamic therapy photoreceptor function was measured by microperimetry allowing topic mapping of retinal function. METHODS: A Rodenstock scanning laser ophthalmoscope was used to document preservation of central visual fields before and after photodynamic therapy. Single photodynamic therapy without known efficient parameters was performed in 13 patients and repeated photodynamic therapy using optimised light doses was performed in 10 patients with subfoveal choroidal neovascularization using benzoporphyrin derivate (verteporfin). Intensity and dimension of central scotomas were measured, using a grading system of stimuli ranging from 0-32 dB. Areas of absolute and relative defect were defined and fixation localisation was monitored. Perimetric testing was done pre photodynamic therapy, one week, one month and three months post photodynamic therapy. RESULTS: Postoperative scotomas after single photodynamic therapy were smaller in 8%, identical in 61% and larger in 31% compared with preoperative findings. After repeated photodynamic therapy postoperative scotomas were smaller in 70%, identical in 30% and larger in no case. The observed increase was less than 25% of the original size. Postoperative defects were always significantly smaller than the entire size of the irradiated area. No new scotomas were found after photodynamic therapy. Angiographically visible occlusion post photodynamic therapy was in general larger than scotoma size. CONCLUSION: Documentation of the retinal function by microperimetry after photodynamic therapy of subfoveal choroidal neovascularization shows no new scotoma in the treated area. This can also be documented in the hypofluorescent area around the lesion one week after the treatment. After repeated treatment a reduced scotoma size due to choroidal neovascularization could be seen in 2/3 of the patients after 3 months. No initial vision loss as seen in conventional photocoagulation could be documented after photodynamic therapy.

Aged↗
PubMed1998

[In vitro studies to determine the degree of stenosis using spiral CT angiography].

UNLABELLED: Aim of the study was to evaluate the influence of different spiral-CT parameters for the visualisation of vascular stenoses, especially of the renal arteries. MATERIAL AND METHODS: Models with a density equivalent to that of fat, filled with diluted contrast agent, and an inner lumen of 4, 6, 8 mm were scanned in x-, y- and z-direction. Data were acquired in up to 24 second long spiral-CT scans using different spiral-CT parameters (collimation, table speed, reconstruction algorithm, tube current). Detection of the degree of stenosis was achieved by assessment of the axial images and 3D reconstructions. RESULTS: The best correlation between real and measured degree of stenosis was seen by using a small collimation, a low table increment and assessment of the axial images reconstructed in standard algorithm. The stenosis degrees of models directed in x- and y-direction were overestimated and those in z-direction were underestimated depending on the spiral-CT parameters. CONCLUSION: For optimal imaging of renal artery stenoses, collimation of 2 mm (pitch = 1-2 and a reconstruction interval of 1 mm is recommended.

Algorithms↗
PubMed1995

[Protective effect of omeprazole against low-dose acetylsalicylic acid. Endoscopic controlled double-blind study in healthy subjects].

Protective Effects of Omeprazole against Low-dose Acetylsalicylic Acid/An endoscopic controlled double-blind study in healthy volunteers. In a randomized double-blind parallel study the gastroduodenal tolerability of 300 mg acetylsalicylic acid (CAS 50-78-2, ASA) daily (8 p.m.) has been evaluated in the presence of 20 mg and 40 mg omeprazole (CAS 73590-58-6) daily (8 p.m.) or placebo in 36 healthy volunteers using upper GI-endoscopy. The treatment periods lasted 14 days. Endoscopic controls were performed at entry and repeated at day 14. At entry the mean endoscopic score averaged 0.9 +/- 0.08 in the ASA/placebo (n = 12), the ASA/omeprazole 20 mg (n = 12) and the ASA/omeprazole 40 mg group (n = 12). The median values were 1.0. In the placebo experiments 300 mg ASA daily induced marked gastroduodenal lesions at day 14 (12.4 +/- 1.7). The median value was 10.0. Concomitant administration of 20 mg omeprazole daily afforded significant protection against 300 mg ASA daily on day 14 (2.9 +/- 0.9) (p < 0.0005 vs. ASA/placebo). 300 mg ASA + 40 mg omeprazole daily reduced the damaging score to 1.8 +/- 0.5 (p < 0.00002 vs. ASA/placebo). The median values in the ASA/omeprazole 20 mg and in the ASA/omeprazole 40 mg group were 1.0. The difference in the damaging score between ASA/omeprazole 20 mg and ASA/omeprazole 40 mg after 14 days did not reach statistical significance. Our data suggest that coadministration of 20 mg omeprazole daily reduces almost completely gastroduodenal lesions evoked by 300 mg ASA.

Adult↗
PubMed1994

Attachment of oligosaccharides to peptide antigen profoundly affects binding to major histocompatibility complex class II molecules and peptide immunogenicity.

To investigate the immunogenicity of glycopeptides, a peptide fragment from hen egg lysozyme, HEL(81-96)-Y (here named 1) which is immunogenic in H-2k mice and known to bind to the murine major histocompatibility complex (MHC) class II molecule Ek, was synthesized in five different glycosylated forms. The N-terminal serine of HEL(81-96)-Y was derivatized with D-glucose (2), maltotriose (3), and a branched D-glucose pentasaccharide (4). Furthermore, 1 was prepared with a central serine or asparagine derivatized with the branched D-glucose pentasaccharide (5) and GlcNAc (6), respectively. The ability of the five glycopeptides and the non-glycosylated peptide, labeled with 125I, to bind to the two MHC class II molecules, Ak and Ek, was studied using a gel filtration assay. None of them could bind to Ak. Neither 5 nor 6 were able to bind to Ek. Surprisingly 2, 3 and 4 bound better to Ek than did the non-glycosylated peptide 1. The increased binding varied depending on the type of oligosaccharide attached to the N terminus of the peptide. The better binding to Ek of glycopeptide 4 was found to be due to an increased association rate. The binding of 1 as well as 4 was optimal at pH 5.0. Functional studies showed that 4 was able to elicit a heteroclitic proliferative response from T cells of mice immunized with the native non-glycosylated peptide. Circular dichroism studies of 1 and 4 indicated a more unordered structure of 4 and a predominant alpha-helical conformation of 1, suggesting that the MHC class II molecule may bind to peptides which are in a non-alpha-helical conformation. These results demonstrate that glycosylation has considerable influence on peptide immunogenicity for T lymphocytes.

Amino Acid Sequence↗
PubMed1994

MHC class II-bound self-peptides can be effectively separated by isoelectric focusing and bind optimally to their MHC class II restriction elements around pH 5.0.

More than 90% of the major histocompatibility complex (MHC) class II molecules on antigen-presenting cells (APC) have in their binding site a peptide derived from an extracellular protein ingested by the APC or from a protein of the APC itself. These self-peptides can be eluted from affinity-purified MHC class II molecules by acid elution, and have been studied with a variety of techniques. We show here that the self-peptides eluted from the mouse MHC class II molecules Ad, Ed and Ek bind specifically to MHC class II molecules of the allelic type from which they were derived. The pH optimum for binding is around 5.0, i.e. the same optimum at which synthetic peptides representing sequences of foreign antigens bind to MHC class II molecules. This suggests that the physiological compartment where MHC class II molecules bind self-peptides may be very late in the endocytic pathway. The chemical properties of the eluted and labelled MHC class II peptides were studied by isoelectric focusing. This method was able to separate the peptides very efficiently, and enabled a rapid comparison of peptides eluted from different MHC molecules. The 125I-labelled peptides displayed a broad range of isoelectric points with values predominantly below neutral. This suggests that such peptides bind to MHC in a predominantly non-charged state.

Amino Acid Sequence↗
PubMed1990

Delayed traumatic intracerebral hematomas: "Spät-Apoplexie". Report of two cases.

Two patients who suffered a head trauma experienced sudden clinical deterioration more than 1 week after their injury. The initial computerized tomography (CT) scan demonstrated a small hematoma underlying a depressed skull fracture in one patient and a small interhemispheric subdural hematoma in the other. Both patients had made a complete recovery and follow-up CT scans were normal when clinical deterioration suddenly occurred. Both patients developed a large intracerebral hematoma and underwent emergency evacuation of the mass. The first patient recovered with the exception of a moderate hemiparesis and dysphasia, but the second patient died. Delayed traumatic intracerebral hematomas have been described in the literature. Since the advent of CT scanning, the incidence of this phenomenon has been estimated as between 1.7% and 7.4% of closed head injuries. In 1891, Otto Bollinger described four patients who suffered head injury, followed days to weeks later by death from an apoplectic event. His criteria for diagnosis of "traumatische Spät-Apoplexie" included the absence of preexisting vascular disease, a definite history of trauma, an asymptomatic interval of at least several days, and an apoplectic episode. These two cases reemphasize the existence of Spät-Apoplexie as a rare clinical condition. In the presence of CT findings of even small traumatic intracerebral or extracerebral hematomas, the possibility of this late complication should be kept in mind.

Adolescent↗
PubMed1989

Traumatic trochlear nerve palsy diagnosed by magnetic resonance imaging: case report and review of the literature.

Although head trauma is the leading cause of acquired trochlear nerve dysfunction, it receives little attention in the neurosurgical literature. A case is reported of closed head injury that resulted in a right superior oblique palsy in association with incoordination on the left side. Diagnostic imaging revealed a normal cranial computed tomographic scan and a left dorsal midbrain lesion on magnetic resonance imaging scan. The relevant anatomy is reviewed, as well as the action of the superior oblique muscle, its agonists and antagonists, and the clinical manifestations of superior oblique dysfunction. This case is one of the few we are aware of in which a relatively isolated trochlear nerve palsy is the result of a lesion that can be documented by diagnostic imaging, and the first in which the imaging modality is magnetic resonance imaging scan.

Adult↗
PubMed1985

Photochemical crosslinking of protein and DNA in chromatin. II. Synthesis and application of psoralen-cystamine-arylazido photocrosslinking reagents.

The synthesis and testing of a new type of nucleic acid-protein photocrosslinking reagent is described. The reagents are composed of a psoralen ligand for nucleic acid photoattachment, which is linked to an azidobenzoyl group, for protein photoattachment. The linker contains a disulfide bridge which can be opened by reduction with mercaptans. The reagents were tested in a chromatin system, where it was found that they induced cleavable crosslinks between the histones and the DNA upon irradiation with long-wavelength ultraviolet light (lambda greater than 300 nm).

Azides↗