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Biomedical subjects

H Gimbel

Publications and source records attributed to H Gimbel.

10 recordsLinked to original sources
PubMed2001

Hysterectomy on benign indication in Denmark 1988-1998. A register based trend analysis.

BACKGROUND: The aims of the study were to describe the trends in Danish hysterectomy rates from 1988 to 1998 for operations done on benign indication. METHODS: Data from all women (n=67,096) undergoing hysterectomy from 1988 to 1998 were obtained from the Danish National Patient Register. Data on the female population distribution were obtained from the Danish National Population Register. RESULTS: During the last 11 years the incidence rate of hysterectomy performed for benign diseases has been stable. However, the rate of women treated surgically for benign diseases of the uterus has increased by 14%. During the study period the number of total abdominal hysterectomies has decreased by 38%, the number of subtotal abdominal hysterectomies has increased by 458%, the number of vaginal hysterectomies has increased by 107% and two new methods of surgical treatment for benign diseases of the uterus have been introduced. Abdominal hysterectomy still accounts for 80% of the total number of hysterectomies performed in Denmark in 1998. The age distribution for all hysterectomies has changed, from a maximum of 36-45 years in 1988 to 46-55 years in 1998. The age maximum for abdominal hysterectomy corresponds to that of all hysterectomies. For vaginal hysterectomy the age maximum is 56 years or older, while it is 36-45 years for laparoscopic hysterectomy. CONCLUSIONS: The incidence rate of hysterectomy was stable during the study period and the age distribution for all hysterectomies has changed. The study showed a change in the choice of surgical methods, although no evidence supports this practice.

Adolescent↗
PubMed2000

[Diagnosis and treatment of gastroesophageal reflux disease in the mentally retarded: guidelines of a multidisciplinary consensus work group. Dutch Association of Physicians in Care of Mentally Handicapped].

Gastroesophageal reflux disease (GORD) is more frequent among people with intellectual disability than among the intellectually normal population. Also GORD is more serious in this population. The diagnosis is often missed, because most intellectually disabled cannot express their complaints of GORD. For that reason a multidisciplinary working group of the Dutch Association of physicians active in the care of persons with a mental handicap has developed guidelines. The working group recommends endoscopy in case of a (alarm) symptoms: haematemesis, prolonged vomiting, irondeficiency anaemia e.c.i., and a 24 hour oesophageal pH test in case of b (aspecific) symptoms: recurrent pneumonia, refusal of food, regurgitation, rumination, dental erosions. In general most patients are cured with drug treatment (omeprazol or another proton pump inhibitor). If symptoms are not improved after 6 months of optimal treatment, surgical treatment may be considered.

Adult↗
PubMed2000

Refractive error in cataract surgery after previous refractive surgery.

Bilateral cataract extraction with posterior chamber intraocular lens (IOL) implantation was performed in a patient after previous photorefractive keratectomy, radial keratotomy (RK) combined with astigmatic keratotomy, and retreatment of RK. Significant hyperopic error was observed after cataract surgery, and the IOLs were eventually exchanged in both eyes. A review of this case found that the refractive error was smaller when a refraction-derived keratometric value was selected for IOL power calculation. Nevertheless, hyperopic error still occurred.

Adult↗
PubMed2000

Does primary intraocular lens implantation prevent "aphakic" glaucoma in children?

PURPOSE: Open-angle glaucoma may develop after surgery for congenital or developmental cataract with an incidence ranging from 3% to 41%. The pathogenesis of "aphakic" (open-angle) glaucoma remains unknown. Despite numerous reported clinical series (>1000 eyes), we are unaware of any reported case of open-angle glaucoma after primary intraocular lens (IOL) implantation for congenital or developmental cataract. We decided to test the hypothesis that primary posterior chamber IOL implantation might decrease the incidence of open-angle glaucoma in children. METHODS: Pseudophakic eyes were collected from surgeons who contributed data to a refractive study and who monitored intraocular pressure on a regular basis. IOL implantation was commonly performed in eyes with a corneal diameter >10 mm. Comparable primary data on aphakic eyes were included from 2 published studies on aphakic glaucoma, which included corneal diameters and the patient's age at surgery. Glaucoma-free survival estimates for each cohort were estimated. RESULTS: Only 1 case of glaucoma was found among 377 eyes with primary pseudophakia (mean age of patient, 5.1 +/- 4.7 years; mean follow-up, 3.9 +/- 2.7 years). There were 14 eyes (11.3%) with glaucoma among 124 aphakic eyes (mean age of patient, 2.7 +/- 2.6 years; mean follow-up time, 7.2 +/- 3.9 years). CONCLUSIONS: We report a decreased incidence of open-angle glaucoma among eyes rendered primarily pseudophakic compared with those that remained aphakic after cataract surgery. We propose 2 theories on the possible mechanism of reduction in the incidence of glaucoma in pseudophakic eyes.

Adolescent↗
PubMed2000

The effect of transmission bandwidth on the quality of ophthalmological still and video images.

We have examined the minimum realtime transmission speed for video-angiography with the Rodenstock scanning laser ophthalmoscope (SLO) with respect to spatial and contrast resolution. An SLO fluorescein video-angiography sequence was recorded using high-quality media and relayed to a remote site at transmission speeds ranging from T3 (4.5 Mbit/s) to 0.125 T (197 kbit/s). Images were compared with each other subjectively by an ophthalmologist and objectively with image processing software. When compared qualitatively there was little difference between the T3 and T1 images. The T1 images scored well on clarity and contrast, while 0.5 T was satisfactory but inferior to T1. Transmission speeds below 0.5 T were inadequate. The digital analysis showed a slight difference between T3 and T1. We calculated that there was up to a 92% loss of resolution at 0.25 T and up to a 98% loss at 0.125 T. Based on our quantitative and qualitative analysis, a T3 line provided the highest bandwidth and best resolution, as expected. However, 0.5 T gave satisfactory results for realtime consultations and appears to be the minimum speed required for ophthalmic purposes, producing few motion artefacts and good resolution.

Cataract Extraction↗
PubMed1996

Intraocular availability and pupillary effect of flurbiprofen and indomethacin during cataract surgery.

PURPOSE: To compare the bioavailability and pupillary effect of flurbiprofen and indomethacin during phacoemulsification and intraocular lens implantation. SETTING: Gimbel Eye Centre, Calgary, Alberta, Canada. METHODS: In this prospective, randomized, double-masked study, 236 patients had cataract extraction by phacoemulsification and posterior chamber intraocular lens implantation. They received topical flurbiprofen 0.03% solution or indomethacin 1% suspension applied every 15 minutes for 60 to 75 minutes before surgery. An aqueous humor sample (100 microL) was taken immediately before the corneal incision was made. Pupil diameters (horizontal and vertical) were measured before aqueous humor sampling, after phacoemulsification, after irrigation and aspiration (I/A), and after acetylcholine instillation. RESULTS: Mean concentration of flurbiprofen and indomethacin in the aqueous humor was 59.8 ng/mL and 90.2 ng/mL, respectively (P < .001). The percentage of dose detected in the aqueous humor was 4.38% in the flurbiprofen group and 0.21% in the indomethacin group (P < .001). Pupil diameters were 7.2 and 7.3 mm presurgery and 7.0 and 7.0 mm after I/A in the flurbiprofen and indomethacin groups, respectively (P > .05). No adverse events were reported in either group. CONCLUSIONS: Although the absolute concentration of indomethacin was higher, the percentage of dose detected in the aqueous humor was 20 times greater in the flurbiprofen than in the indomethacin group. Flurbiprofen is absorbed 20 times more readily than indomethacin. Both drugs were equally effective in preventing miosis during cataract surgery.

Absorption↗
PubMed1995

Intraocular lens power calculation with an improved anterior chamber depth prediction algorithm.

The accuracy of intraocular lens (IOL) power calculation was evaluated in a multicenter study of 822 IOL implantations using the Binkhorst II, Sanders/Retzlaff/Kraff (SRK I, SRK II, SRK/T), Holladay, and Olsen formulas. All but the first of these were optimized in retrospect with calculation of the SRK A-constant, the Holladay surgeon factor, and the Olsen pseudophakic anterior chamber depth (ACD) for each lens style. The ACD prediction of the Olsen formula was based on a previously described regression formula incorporating preoperative ACD, corneal height, axial length, and lens thickness. Among the optical IOL power calculation formulas, the highest IOL power prediction error was found with Binkhorst's and the lowest with Olsen's, which was more accurate than the SRK/T and the Holladay formulas (P < .05). The SRK/T formula was significantly more accurate than the original SRK regression formulas (P < .001). When analyzed for axial length dependence, all formulas showed the least error in the normal range. Error of the Olsen formula was lower than that of the others in the axial length interval 20 mm to 26 mm. No differences in accuracy were found between the optical IOL calculation formulas in eyes with an axial length above 26 mm (P < .05). The accuracy of IOL power calculation can be improved with optical formulas using newer-generation ACD-prediction algorithms.

Adult↗
PubMed1994

Ultrasound biomicroscopy in refractive surgery.

The need for improved methods of assessing corneal topography arose from the advent of refractive surgery. Ultrasound biomicroscopy (UBM) is a high-resolution technique that uses high-frequency transducers to evaluate the cornea. We conducted a pilot study to assess the cornea after refractive surgery using UBM. Six patients who had prior epikeratophakia, radial keratotomy, or photorefractive keratectomy were examined with a 50 MHz transducer. Ultrasound biomicroscopy provided a striking image of the epigraft after epikeratophakia. Imaging after radial keratotomy and photorefractive keratectomy was less helpful. However, the corneal refractive power computed from the UBM data for the photorefractive keratectomy was close to the optical keratometry values. The study indicates UBM has some applications in analyzing the cornea after refractive surgery.

Cornea↗
PubMed1993

Phacoemulsification, capsulorhexis, and intraocular lens power prediction accuracy.

Phacoemulsification with capsulorhexis reduces the surgical variability and may result in a more predictable refractive outcome. To evaluate the prediction accuracy with current IOL power prediction formulas, we reviewed a retrospective series of 628 phacoemulsification cases, including 148 short (< 22 mm) and 80 long (> 25 mm) eyes. Using the Binkhorst II formula and the manufacturer's recommended anterior chamber depth (ACD) values, the mean absolute refractive prediction error was 0.56 diopters (D). This error could be reduced to 0.51 D by retrospectively optimizing the ACD values for each lens type. Under similar least error conditions, the mean error was 0.51 D with the SRK/T formula and 0.47 D with the Olsen formula (P < .01). The Binkhorst formula overestimated the refraction in short eyes and underestimated the refraction in long eyes. The SRK/T and the Olsen formula were unbiased with the axial length. We hypothesize that the high prediction accuracy may be partially explained by a more predictable pseudophakic ACD with the current surgical technique.

Anterior Chamber↗