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Biomedical subjects

J Esser

Publications and source records attributed to J Esser.

At least 19 recordsLinked to original sources
PubMed1999

Association of left ventricular systolic performance and cavity size with angiotensin-converting enzyme genotype in idiopathic dilated cardiomyopathy.

The insertion-deletion (ID) polymorphism of the angiotensin-converting enzyme (ACE) gene is a marker linked to differences in plasma and cardiac ACE activity as well as to an increased mortality in patients with idiopathic heart failure. We examined the possibility that ACE gene ID variants are associated with differences in left ventricular (LV) systolic performance or internal LV dimensions in a high-risk cohort of patients with idiopathic dilated cardiomyopathy (IDC). The ACE genotype was determined in 171 patients selected with IDC in New York Heart Association functional class II to III heart failure and with a LV ejection fraction of < or = 40%. Left ventricular performance and dimensions were assessed using echocardiography (n = 161) and radionuclide ventriculography (n = 169). The frequency of ACE gene ID alleles was not different in the study versus non-age-matched (n = 171; odds ratio 0.94) and age-matched (n = 106, odds ratio 0.88) control groups. Ejection fraction was found to be worse in patients with the DD genotype (echocardiography, DD = 23.5 +/- 0.70, ID + II = 26.8 +/- 0.8, p = 0.009; ventriculography, DD = 21.7 +/- 0.9, ID + II = 25.3 +/- 0.8, p = 0.003). LV end-systolic and end-diastolic diameters were increased in patients with the DD genotype. Multifactor regression analysis showed the ACE genotype to be an independent predictor of both ejection fraction (echocardiography, p <0.02; ventriculography, p <0.03) and end-diastolic diameter (p <0.02). In conclusion, the results of this study indicate that the DD genotype of the ACE gene is independently associated with both a reduced LV systolic performance and an increased LV cavity size in patients with IDC.

Aged↗
PubMed1999

Ocular muscle and eyelid surgery in thyroid-associated orbitopathy.

The aim of ocular muscle surgery in Graves' disease is to determine how an optimal normalization of ocular motility disorders - diplopia, compensatory head posture, eyelid dispositions - can be achieved. The results of ocular muscle surgery of fibrotic ocular muscles allow the following conclusions to be drawn. Correcting the motility disorder can be precisely dosed by recessing only one fibrotic ocular muscle with a strabismic angle of up to 15 degrees. This leads to reproducible and dependable results, with a dose-effect coefficient independent of the initial strabismus angle. Indications as to the amount of surgery and which side should be varied according to horizontal an vertical deviations, and are also dependent on the compensatory head posture. Improvement of the binocular visual field is possible in nearly all cases. Over corrections occur more often when the muscle is not directly fixed at the sclera but adjusted on the following day. The time factor is important both before and after the operation. Before the operation, the motility status should have been stable for at least six months. Postoperatively, within the first few days, an insufficient correction should be expected, however this should not lead to premature revision of the amount of surgery. The surgery of the vertical rectus muscles influences the eyelid position. The upper lid retraction is improved with surgery on the vertical extraocular muscle and depends on prior upper lid motility. In contrast, an increase in lower lid retraction is not dependent on an inferior rectus recession. The results permit a precise series of steps to be drawn up in Graves' disease regarding surgical indications, proportionally correcting each side, and the dosage of ocular muscle operations.

Eyelids↗
PubMed1999

[Introduction of the project "Westdeutsche Allgemeine Zeitung (WAZ) for visually impaired" (a talking electronic daily newspaper)].

In order to complete the range of topical media, that is currently available for the visually impaired, a working group is developing and testing the "Westdeutsche Allgemeine Tageszeitung (WAZ) for the visually impaired", an auditive electronic daily newspaper. The intention of this project is to take into consideration the needs of the visually impaired, especially of those who acquired the handicap in middle or later age and might feel that not being able to read the daily newspaper anymore reduces their quality of life to a great extent. The central aim therefore is to put the modern computer technology at the disposal of the impaired in a way that enables them to make use of the newspaper without having had previous experience. In a first phase of several months twelve probands in different personal settings will test a first prototype of the newspaper reading machine, a modified and optimated multimedia computer system with modern and speech output, at home. During this period the users will be intensively looked after and undergo psychodiagnostic examination. By means of analysing the data collected in extended talks and questionnaires concrete proposals on how to improve the machine are to be made and a statement about the potential impact of the electronic newspaper on the quality of life of the visually impaired--in the sense of a contribution to their rehabilitation--is to be given.

Adolescent↗
PubMed1998

[Orbital decompression in treatment of endocrine orbitopathy].

Graves' ophthalmopathy (Graves' disease) is a grave, rare immunological inflammatory reaction of the postorbital connective, adipose and ocular muscle tissue. Graves' disease occurs only within the scope of immunothyropathies and constitutes the most frequently encountered extrathyroidal manifestation. Typical symptoms are a result of the volume increase of the postbulbar connective and adipose tissue and of the interstitial swelling of the ocular muscles. Clinically, we find a spectrum of increasingly grave changes in the orbita, such as infiltration of the eyelid and connective tissue, exophthalmos, swelling of the muscles, damage to the cornea and involvement of the optic nerve with loss of vision. Regarding functional impairment of the optic nerve (optic nerve compression), orbita decompression represents an operative ultima ratio. Between January 1992 and April 1997, 11 patients (22 orbitae) from a group of more than 600 patients with Graves' disease with vision involvement were treated surgically. All treatment data were documented prospectively. Surgical intervention was performed only in cases where a progressive loss of vision existed in spite of retrobulbar irradiation and high-dose glucocorticoid therapy. Surgical therapy consisted of decompression of the medial, inferior and lateral orbital wall and of the orbital contents via combined bi-coronary and anterior access. The long-term results demonstrated improved vision conditions with 17 of the 22 eyes operated on. Parameters such as vision, exophthalmos, VEP, motility, double vision and field of vision were documented pre- and post-operatively. The prediction of post-operative deviations of the bulb axis was limited, and these were rectified through secondary displacements of the ocular muscle. No complications worth mentioning were encountered. In extreme events of therapy-resistant Graves' ophthalmopathies with progressive loss of vision, the three-wall decompression method has proved to be the correct one.

Adult↗
PubMed1998

[Normal accommodative convergence excess--long-term follow-up of conservative therapy with bifocal eyeglasses].

BACKGROUND: In patients with normaccommodative convergence excess it is possible to reduce or eliminate the excess of accommodative convergence by adding plus lenses. The resulting reduction of near deviation can lead to an improvement in the quality of binocular vision at near, and also to a better compensation of an esophoria at near. The aim of the paper was to study long term results in patients with small angle esotropia and esophoria and accommodative convergence excess treated by bifocals. METHODS: Clinical data of 91 patients were analysed retrospectively. Among them were 13 patients with esophoria, 32 patients with microesotropia and 46 with microesotropia and a phoric component. An orthoptic status was performed every three months and at every examination it was tried to reduce the added plus lenses. The mean follow up was 5.6 +/- 2.4 years (range: 1.1-13.2). RESULTS: The mean onset of strabismus was similar in all groups: i.e. 2.5 (+/- 1.7) years. The patients received their first bifocals on average 3.4 (+/- 1.9) years later. In 40 of the 91 patients the near addition could be stopped because of sufficient decrease of accommodative convergence excess during the follow-up period. The convergence excess decreased continuously in all patients with esophoria and microesotropia and the additional plus lenses could be stopped on average after 6.4 (3.5-8.4) years (esophoria) and 5.0 (2.6-8.1) years (microesotropia) respectively. In patients with microesotropia and an additional phoric deviation bifocals were only partly successful to reduce the convergence excess. The basic angle decompensated in more than half of the patients (27 out of 46) and was operated in 14 cases by unilateral resection/recession procedure. After the operation the convergence excess decreased rapidly and the bifocals could be stopped after 4.4 (3.4-7.4) years. In the remaining 19 cases it was possible to reduced the convergence excess with bifocals in 8 patients after about 8.1 (4.1-9.3) years and in some of the remaining 11 cases a Fadenoperation has been suggested. CONCLUSION: While wearing bifocals the accommodative convergence excess decreased completely in patients with esophoria and microesotropia. In the condition with markedly reduced binocular vision and a large phoric component at far and near, the convergence excess decreased only in some of the patients while wearing bifocals. Conventional strabismus surgery to reduce the basic angle has a positive influence. A Fadenoperation is only necessary in a few cases.

Accommodation, Ocular↗
PubMed1998

[Prevention of amblyopia in acute eyelid closure--a new method for keeping the optical axis open by insertion of a small tube].

BACKGROUND: Complete eyelid closure by capillary eyelid hemangioma or ptosis in the first months of life is an indication for acute measures to prevent amblyopia. Since it is sometimes not possible to hold up the affected upper eyelids with adhesive tape (mechanical obstacle, danger of skin maceration in involvement of the forehead) or not sufficiently (intense divergence), an alternative method will be presented for emergency treatment of blockade of the optical axis. METHODS: The eyelids are kept open mechanically with a cylindrical tube of perspex (scleral immersion shell), which is normally used for echography of the anterior segment and for biometry (immersion technique). After surface anesthesia, it can be readily inserted. Its area of contact to the sclera has the form of a scleral shell. A drop of lubricant is applied into the tube at intervals of about five minutes. PATIENTS AND RESULTS: In a six-week-old girl with complete eyelid closure owing to a facial hemangioma, adequate eyelid opening could only be achieved by insertion of the scleral immersion shell. In an eleven-months-old boy with complete ptosis and divergence as well as vertical deviation, the optical axis could only be kept open by insertion of the scleral immersion shell and by simultaneous displacement to the temporal side (adhesive tape). The uncomplicated performance for up to two hours daily was initially carried out in the hospital and later by the parents, and could be terminated after five and three and a half weeks, respectively, thanks to improvement due to therapy or spontaneous improvement. CONCLUSIONS: Mechanical eyelid opening by insertion of a scleral immersion shell serves to bridge over the time interval to the onset of spontaneous improvement or the success of a causal therapy. The advantages consist in the good handling, also for parents, the low danger of injury and the ubiquitous and rapid availability (basic equipment of an ophthalmological ultrasonography unit).

Amblyopia↗
PubMed1998

[Connection between disease progress and coping with stress in patients with retinopathy centralis serosa].

To illuminate the disease progression in retinopathy centralis serosa, 50 patients were enrolled in a basic study. Evaluated data included medical and sociodemographic data as well as data regarding the patient's coping with everyday conflicts and the disease. Hence, the German multidimensional coping inventory (SVF, Janke, Erdmann u. Boucsein 1985), measuring the trait aspects of coping with everyday troubles, as well as the German coping questionnaire (EFK, Franke 1997), dealing with coping with retinopathy, were applied. We described three different clusters of patients according to active and passive coping strategies. These three clusters also differed in terms of coping with the disease as well as in ophthalmological parameters. To illuminate the individual situation of the members of the clusters, we discuss the specific situation of three patients.

Adaptation, Psychological↗
PubMed1997

Orbital exenteration: surgical and reconstructive strategies.

BACKGROUND: Radical exenteration procedures, which include the removal of orbital content and eyelids, result in serious functional limitations, especially with respect to eating and speaking. Therefore we have recently changed our surgical concept. METHODS: Seventy-seven patients underwent orbital exenteration during the 20-year period from 1974 to 1995 at the Department of Maxillofacial Surgery, Essen University. The simultaneous removal of periorbital bone was performed in 45 of these cases. RESULTS: The 1-year survival rate was 89%, the 5-year rate was 63% and the 10-year rate was 48%. The surgical approach, the amount of resected orbital tissue and the reconstructive procedure have been adapted to the individual needs, depending on the location and extent of the tumor. Subsequently, the surgical morbidity has decreased. DISCUSSION: Detailed consideration of all clinical and histological findings is essential before surgery, in order to prevent a higher rate of recurrence following these modified operations.

Adolescent↗
PubMed1996

["Filtered normality": psychological causes and sequelae of specific retinal diseases].

Until now there is a lack of investigation in psychological aspects of retinopathy in patients of the middle ages. The few studies have been found, focused on an old-fashioned psychopathology. Medical treatment, f.e. laser therapy is only partially available, constant visual loss to blindness is possible. Life events, coping strategies, social support, and symptomatic distress of patients with presumed ocular histoplasmosis (group 1) and patients with retinopathy centralis serosa (group 2) were compared with another and with a comparison group. Group 1 scored higher on the Schedule of Recent Experiences (Holmes and Rahe 1967) and showed better social support. Group 2 scored higher on the Brief Symptom Inventory (Derogatis and Melisaratos 1983) and showed low social support. Additionally gender differences were discussed.

Adaptation, Psychological↗
PubMed1995

An anatomic and physiological model of hepatic vascular system.

Hepatic function can be characterized by the activity/time curves obtained by imaging the aorta, spleen, and liver. Nonparametric deconvolution of the activity/time curves is clinically useful as a diagnostic tool in determining organ transit times and flow fractions. The use of this technique is limited, however, because of numerical and noise problems in performing deconvolution. Furthermore, the interaction of part of the tracer with the spleen and gastrointestinal tract, before it enters the liver, further obscures physiological information in the deconvolved liver curve. In this paper, a mathematical relationship is derived relating the liver activity/time curve to portal and hepatic behavior. The mathematical relationship is derived by using transit time spectrum/residence time density theory. Based on this theory, it is shown that the deconvolution of liver activity/time curves gives rise to a complex combination of splenic, gastrointestinal, and liver dependencies. An anatomically and physiologically plausible parametric model of the hepatic vascular system has been developed. This model is used in conjunction with experimental data to estimate portal, splenic, and hepatic physiological blood flow parameters for eight normal volunteers. These calculated parameters, which include the portal flow fraction, the splenic blood flow fraction, and blood transit times are shown to adequately correspond to published values. In particular, the model of the hepatic vascular system identifies the portal flow fraction as 0.752 +/- 0.022, the splenic blood flow fraction as 0.180 +/- 0.023, and the liver mean transit time as 13.4 +/- 1.71 s. The model has also been applied to two portal hypertensive patients. The variation in some of the model parameters is beyond normal limits and is consistent with the observed pathology.

Blood Flow Velocity↗
PubMed1994

Large platelets continue to circulate in an activated state after myocardial infarction.

This study was intended to investigate the actual platelet activation status after an acute coronary event. The activation status of circulating platelets was assayed directly by measuring the membrane activation markers CD62 and CD63 with the Düsseldorf III flow cytometry test in 22 patients with the diagnosis of acute myocardial infarction during the 48-h observation period following the acute event. The number of activated, marker-positive sample platelets was significantly increased in the post-MI patients: CD62: 5.8% x 2.25 +/- 1 vs. 3.5% x 2.32 +/- 1, P < or = 0.05; CD63: J8.7% x 1.77 +/- 1 vs. 4.6% x 2.16 +/- 1, P < or = 0.00.1. The platelet volume and count were concomitantly increased (12.1 +/- 2.4 fl/ 236 +/- 90 x 10(3) microliters-1 compared to 8.3 +/- 1.6 fl/ 187 +/- 42 x 10(3) microliters-1) in the control group. Particularly large platelets were identified as being activated documented by the exponential increase in the difference in CD63-binding sites per sample platelet above the 90%-percentile and below the 10%-percentile of the volume distribution: delta + 1341 +/- 903 (MI patients) vs. delta + 276 +/- 126 (controls), P < or = 0.00.1. Significant creatine kinase elevation and decrease in platelet count was found in the non-survivor subset (n = 5). We conclude that predominantly large platelets continue to circulate in an activated state after MI. This study provides direct evidence that the assumption of an increased thrombotic potential becomes operative in vivo in MI patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Distal splenorenal shunt for non-cirrhotic variceal bleeding in black South Africans.

Distal splenorenal shunt (DSRS) is a once-only form of treatment. It is suitable for many black South Africans with non-cirrhotic variceal bleeding who cannot attend repeated follow-up sclerotherapy sessions. However, persistent hyperbilirubinaemia and encephalopathy may occur following DSRS in schistosomiasis. Forty-one consecutive patients with DSRS have been treated over a 7-year period. The causes of portal hypertension were schistosomiasis (32), portal vein thrombosis (8) and diffuse nodular hyperplasia (1). Operative mortality was 6%. Encephalopathy was observed in 1 patient. Galactose elimination capacity (GEC) and technetium-diethylenetriamine penta-acetic acid hepatic perfusion index (HPI) were used to assess liver function and hepatic perfusion pre- and postoperatively, respectively, in schistosomiasis. GEC was 348 +/- 37 (M +/- SD) before, compared with 343 +/- 67 postoperatively (P = 0.78). HPI showed long-term preservation of hepatopetal portal venous flow following DSRS. Morbidity and mortality were observed only in patients with schistosomiasis associated with hepatitis B chronic active hepatitis. DSRS is ideal treatment in selected patients with non-cirrhotic variceal bleeding.

Adult↗
PubMed1994

[Endocrine orbitopathy. Interventions on the external eye muscles].

Eye muscle surgery in Graves' disease is conducted to normalize eye motility disorders-diplopia, abnormal head posture, eyelid malposition. A review of the literature to determine the results of eye muscle surgery on the fibrotic eye muscles indicated the following: Correction of the motility disorder can be done precisely by recessing only one fibrotic eye muscle with a strabismus angle of up to 15; this leads to reproducible and dependable results, with a dose-effect coefficient independent of the initial strabismus angle. Indications vary as to how much to do as well as which side, dependent on whether the deviation is horizontal or vertical and whether the head posture is abnormal. Improvement of the fusional visual field is possible in nearly all cases. Hypercorrections occur more often when the muscle is not directly fixed at the sclera but adjusted on the following day. The time factor is important both before and after the operation: before the operation, the motility situation should have been stable for at least 6 months; postoperatively, a correction should be expected, which is not yet sufficient in the first few days; this should not lead to premature revision. Surgery on the vertical rectus muscles influences eyelid position: upper-lid retraction is improved and depends on the previous upper-lid motility; in contrast, an increase in lower-lid retraction is not dependent on recession of the inferior rectus. The results reported permit a precise series of steps to be drawn up as regards indication, the proportion of correction of each side, and eye muscle operations in Graves' disease.

Convergence, Ocular↗
PubMed1993

Do high fetal catecholamine levels affect heart rate variability and meconium passage during labour?

OBJECTIVES: To determine the relationship between umbilical arterial catecholamine levels and fetal heart rate variability and meconium passage. STUDY DESIGN: A prospective descriptive study was performed. Umbilical artery catecholamine levels were measured in 55 newborns and correlated with fetal heart rate before delivery, umbilical arterial pH, base excess and the presence of meconium-stained liquor. RESULTS AND CONCLUSION: The range of catecholamine levels was enormous, with very high epinephrine or norepinephrine levels in several fetuses. We were unable to demonstrate an association between high catecholamine levels and the presence of normal fetal heart rate variability despite acidaemia. We postulate that high catecholamine levels may inhibit fetal meconium passage.

Adolescent↗
PubMed1991

Circulating activated platelets in myeloproliferative disorders.

Platelet activation in patients with myeloproliferative disorders is often suggested by increased platelet alpha-granule secretion and an acquired storage pool defect of dense granules. To determine whether activated platelets circulate in patients with chronic myeloproliferative disorders, we evaluated the binding of monoclonal antibodies against activation-dependent epitopes on resting platelets (P 12, CD 63, and CD 62) in 12 patients with prominent megakaryocytic proliferation (8 patients with essential thrombocythemia, 2 with chronic myeloid leukemia, and 2 patients with polycythemia rubra vera). In addition, platelet aggregation in response to collagen, adenosine diphosphate, platelet activating factor, and agglutination with ristocetin was investigated. In 3 patients there was an increased percentage of platelets binding at least 1 activation marker. In 2 other patients, a trend towards increased antibody binding was observed. Binding of the antibody to thrombospondin (P 12) was related to expression of the GMP 140 protein (CD 62, r = 0.76, p = 0.004). There was no correlation of platelet aggregation defects in vitro to increased expression of platelet activation markers or to thrombohaemorrhagic complications. However, circulating activated platelets were detected in three out of five patients with a history of bleeding or thrombotic complications. The results of this preliminary study suggest that some but not all patients with myeloproliferative disorders showed increased amounts of circulating activated platelets. The relation of bleeding and thrombotic complications to the expression of activation-dependent epitopes on platelets in myeloproliferative disorders requires further investigation.

Adult↗
PubMed1991

The effect of direct selection and circular scanning on visual sequential recall.

The purpose of this study was to investigate the influence of selection techniques on visual sequential recall. Specifically, this study investigated whether there are visual sequential recall differences between direct selection and scanning in task performance in normally developing 4-year-old children. Results suggested that there were no significant differences between direct selection and scanning for visual sequential recall. However, subjects correctly recalled significantly fewer symbols in a specific sequence represented by Blissymbols than by Picsyms. In addition they recalled significantly fewer three-symbol sequences than two-symbol sequences regardless of the type of symbol set.

Analysis of Variance↗
PubMed1991

Large platelets circulate in an activated state in diabetes mellitus.

Diabetes mellitus is associated with aggravated development of vascular complications. Yet, it has not been established whether platelet hyperreactivity contributes as a pathogenetic factor. In order to study the role of activated platelets in diabetes mellitus, we investigated the expression of the membrane activation markers CD63 (GP53) and CD62 (GMP-140) as direct indicators of in vivo activation. The CD63-positive fraction was significantly higher in patients (6.1% X 3.7 +/- 1) than in controls (2.7% X 3 +/- 1). In parallel, the CD62-positive fraction was significantly elevated in patients to 5% X 2.5 +/- 1 in comparison to controls (3% X 2 +/- 1). Patients with angiopathy had a mean increase of 304% in CD63-positive and of 223% in CD62-positive platelets. Patients without clinically detectable angiopathy showed a trend to an increased fraction in CD63-/CD62-positive platelets. There was no correlation of the activation markers with fasting blood glucose, HbA1 or platelet count. CD63 platelet bound fluorescence significantly increased with platelet size in the patient group. We conclude that in diabetes mellitus an increased number of large platelets circulate in an activated state predominantly in patients with angiopathy. This could imply that platelets become activated by vascular lesions. The trend in patients without vascular disease, however, suggests that activated platelets may also basically contribute to the prethrombotic state in diabetes mellitus.

Adult↗