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Biomedical subjects

J Messerli

Publications and source records attributed to J Messerli.

At least 19 recordsLinked to original sources
PubMed2004

Increased endothelin-1 plasma level in young adults with retinal vascular occlusive diseases.

BACKGROUND: Vascular occlusive diseases are usually seen in the elderly but can occur even in younger patients without arteriosclerosis. We assume a vascular dysregulation as a underlying pathogenetic mechanism. PATIENTS AND METHODS: In a prospective study we analysed the clinical findings of six patients under 55 years of age, three men with retinal vein occlusions and three women with branch retinal arterial obstructions. They were examined for signs of a vascular dysregulation and the endothelin-1 (ET-1) plasma level was measured. RESULTS: In all patients the ET-1 plasma level was markedly elevated. The mean value (3.72 +/- 0.8 pg/ml) was significantly increased compared to normal values for that age (1.52 +/- 0.24 pg/ml; p < 0.001). In all cases an increased tendency for vascular dysregulation could be demonstrated in nailfold capillaroscopy. Furthermore, frequent coldness of the extremities was mentioned by every patient and migraine was mentioned by four patients whereas neither changes of the vessels in carotis and ophthalmica region nor disturbances in the haemostasis and fibrinolysis could be found. CONCLUSIONS: All six patients with vascular occlusive diseases occurring before the age of 55 had a vascular dysregulation and increased ET-1 plasma levels. A relationship between the vascular dysregulation and the vascular occlusive diseases is therefore likely.

Acute Disease↗
PubMed2001

[Localized argyrosis 58 years after strabismus operation--an ophthalmological rarity].

BACKGROUND: A pigmented episcleral lesion may have several etiologies. We describe the rare occurrence of a localized argyrosis secondary to former strabismus treatment. HISTORY: A 70-year old female patient was referred to our clinic for diagnosis and treatment of a pigmented episcleral process near the insertion of the left lateral rectus muscle which was noticed on a routine control by her ophthalmologist. The patient was free from ocular symptoms. There was a history of strabismus surgery on the left eye at the age of twelve. Due to the suspicious appearance of the lesion the possibility of a conjunctival malignant melanoma was considered. A ultrasound exam could not exclude this suspicion and therefore a biopsy was performed. Silver deposits and rests of a suture could be found. CONCLUSION: Silver deposits are a rare cause of a pigmented localized episcleral lesion. Several possibilities of silver contamination in our patient are discussed. The most likely explanation is the use of silver containing suture material in strabismus surgery performed 58 years ago. A localized argyrosis secondary to past strabismus surgery should therefore be included in the differential diagnosis of a pigmented episcleral lesion.

Aged↗
PubMed2001

Immunosuppressive therapy in serpiginous choroiditis--case report and brief review of the literature.

BACKGROUND: At present there is no consensus regarding the efficacy of the immunosuppressive therapy in serpiginous choroiditis. PATIENT AND METHODS: We describe the case of a patient with a macular serpiginous choroiditis. Despite corticosteroid therapy the choroiditis was progressive and threatened the central vision. Therefore a triple immunosuppressive therapy with prednisone 1 mg/kg body weight/day (mg/kg/d), azathioprine 1.5 mg/kg/d, and low-dose cyclosporine A 4.5 mg/kg/d was introduced. RESULTS: Under this triple immunosuppressive therapy a prompt stabilisation of the chorioretinal process could be observed in fluorescein angiography. After five months of therapy the examination of the visual field shows an impressive recovery. No significant side effects have been noted. CONCLUSIONS: In the literature, until now only six patients with serpiginous choroiditis treated with a triple agent immunosuppressive therapy have been reported. In all cases this regimen seemed to have a positive influence on the disease. Our present observation corroborates the beneficial effect of a triple agent immunosuppressive therapy on the course of serpiginous choroiditis. However, the beneficial effect of such a therapeutic approach needs to be confirmed by further observations.

Adult↗
PubMed2000

[Endonasal dacryocystorhinostomy: technique and results].

BACKGROUND: Endonasal dacryocystorhinostomy has recently become an important alternative to the classical external Toti procedure. OBJECTIVE: To analyse the outcome after endonasal dacryocystorhinostomy. METHODS: For this purpose 28 of 34 patients treated by endonasal dacryocystorhinostomy between May 1994 and November 1998 were investigated. RESULTS: After an average follow-up of 28 months, 23 of the 28 patients (82%) are free of symptoms. Two additional patients became symptom-free after revision surgery. The total success rate is 89%. The only complications seen were 2 cases of asymptomatic synechiae and one case of mild hyposmia. CONCLUSIONS: Endonasal dacryocystorhinostomy is a rapid, safe, and elegant method for the treatment of post-saccal nasolacrimal duct obstructions.

Dacryocystorhinostomy↗
PubMed1999

Potential role of nitric oxide and endothelin in the pathogenesis of glaucoma.

Glaucoma is an optic nerve head neuropathy in which retinal ganglion cells are lost. A clear association exists between glaucoma and different risk factors, such as high intraocular pressure (IOP) or blood-flow dysregulation. Nitric oxide (NO) and endothelin, two recently identified cellular mediators, appear to be involved in the regulation of IOP as well as in the modulation of ocular blood flow. To some extent, NO is also involved in apoptosis, a mechanism of cell death that can lead to retinal ganglion cell loss in glaucoma. This article provides a short and simplified overview of the biochemistry of NO and endothelin and highlights the potential role of these two mediators in certain important aspects related to the pathogenesis of glaucoma.

Apoptosis↗
PubMed1998

[Latanoprost--a new prostaglandin F2 alpha analog in therapy of glaucoma--an overview].

An ideal glaucoma drug reduces intraocular pressure profoundly and long-lastingly without known major side effects. Latanoprost, a new prostaglandin F2 alpha-analogue, indeed has these properties. However, we need long-term experience to exclude major, clinically relevant side effects. The influence of latanoprost on ocular circulation also needs further evaluation. Nevertheless, the clinician does have a new and very potent drug to reduce intraocular pressure. Literature search by Medline.

Animals↗
PubMed1996

[Central vein thrombosis in younger patients].

BACKGROUND: Vein thromboses are not seldom, even in young patients. The pathogenesis of such perfusion disorders is poorly understood-accordingly, it is difficult to choose therapy specific to the causality and appropriate prophylaxis against recurrence. PATIENTS AND METHODS: In a retrospective study we analyzed the clinical findings of seven patients under 45 years of age who suffered a retinal vein occlusion in the past two years. RESULTS: Anatomical changes of the vessels in carotis and ophthalmica regions were not found, as was the case in hemostasis and fibrinolysis, as well. However, all patients reported stress problems in family and occupation. Migraine was often mentioned in the anamnesis. Coldness of the extremities and perfusion disorders in the nailfold capillaries examined under capillary microscopy indicated increased vasospasm. CONCLUSIONS: Vein thromboses are affections of both the arterial and venous circulation. We hypothesize that dysregulation of vascular tone plays an essential role in the genesis of retinal vein thromboses. Increased vasospasm and the incapacity to reactively dilate are potential mechanisms for such perfusion disorders. When counseling patients and applying medical therapy, such a possible pathogenesis should be taken into consideration.

Adult↗
PubMed1996

[Vision disorders to vascular dysregulation].

As in the case in other organs, there are infarctions in the eye due to arterial sclerosis. Here, the classic risk factors apply. In addition to such infarctions, there are reversible perfusion disturbances caused by vascular dysregulation. These very frequently lead to slight, transient functional failures which are scarcely noticed by the patient. In more seldom cases, such dysregulation can contribute to the pathogenesis of various disease entities. Of these, the ocular vasospastic syndrome, migraine, glaucoma, apoplexy of the optic nerve, and vein thrombosis were examined.

Glaucoma↗
PubMed1993

[Acute loss of vision due to ocular perfusion disorders].

Particularly in patients over 40 years of age, disturbances of perfusion at the optic nerve head and retina are a frequent cause of acute visual acuity loss. As the most important disease entities, we must distinguish between ischemic optic neuropathy and arterial and venous perfusion disturbances. The prognosis with regard to visual acuity is, at any rate, serious: a considerable, persistent loss of vision must be expected. Unfortunately, at present there is no therapy available which could normalize perfusion quickly enough. In individual cases of ocular venous thrombosis, isovolumetric hemodilution can be effective. Use of argon-laser coagulation may markedly reduce the occurrence of severe complications (hemorrhagic glaucoma, vitreous bleeding). As an emergency measure, brief massage of the globe as well as administration of 100 mg prednisone and 250 mg acetazolamide are recommended. Disturbances in ocular perfusion call investigation with regard to hematological and vascular risk factors. It is always important to rule out giant-cell arteritis (Horton's disease).

Acute Disease↗
PubMed1993

[Vitrectomy in oculocerebral non-Hodgkin's lymphoma].

Ocular non-Hodgkin lymphoma (NHL) is thought to be a rare intraocular tumor; the clinical diagnosis, however, is difficult, and ocular NHL might occur more frequently than we thought. Vitrectomy is essential for establishing the diagnosis. During the last 6 years, we performed vitrectomies for ocular NHL in seven eyes of four patients. We report on the visual outcome and cytological findings. In three patients, we suspected the oculocerebral form of the disease; one patient suffered from a systemic lymphoma. The mean observation time was 19 months (5-30 months). In one patient, we failed to examine the vitreous fluid; this patient has since died. The other three patients underwent radiation treatment and/or chemotherapy; they are alive, and no recurrence of the NHL has since occurred. In all five cases in which cytological examination of the vitreous fluid was performed, we were able to establish the diagnosis of NHL on the first attempt. This accuracy is due to rapid and careful processing by the cytologist. Vision improved considerably in most cases. In only one eye with heavy retinal infiltration could vision not be restored. Secondary cataract extraction was necessary in five cases; otherwise, vision remained stable. We conclude that vitrectomy has to be done early in atypical vitreous "inflammations". Immediate processing and cytological examination of the vitreous fluid establishes the diagnosis of NHL and permits accurate radiation or chemotherapy. Early vitrectomy is greatly beneficial not only for visual rehabilitation but maybe even for a longer life expectancy.

Aged↗
PubMed1992

[Chronic uveitis: course after vitrectomy].

Vitrectomy is an acknowledged method in the therapy of chronic uveitis and its complications. We analysed the functional results after vitrectomy of 106 patients (121 eyes). In more than 61% of the patients, the visual acuity improved more than one line. There is less glare, and stereoscopic vision is better. In 10% of the patients, the follow-up was complicated by a retinal detachment; in contrast, a primary retinal detachment was the indication for the vitrectomy in 19%. Our study shows that vitrectomy helps reducing the frequency of recurrence of uveitis and the intensity of drug therapy.

Chronic Disease↗
PubMed1990

[Primary optic nerve decompression in mid-face fractures].

In severe craniofacial-frontobasal injuries the optic nerve is quite often damaged. We report the findings and the visual outcome in 21 patients with severe mid-face fractures, who underwent primary optic nerve decompression after showing an afferent pupillary defect. During the subcranial exploration and the optic nerve decompression, fractures of the optic canal were found in 13 cases; a dislocated bone fragment could be removed in 6 patients. 9 eyes remained blind, but another 9 eyes regained good final visual acuity between 0.5 and 1.0. We conclude that fractures of the optic canal and dislocated bone fragments are often causes of optic nerve damage in mid-face injuries. The primary subcranial decompression of the optic nerve is a safe method to prevent secondary damage.

Adolescent↗
PubMed1989

[Intraocular inflammations. Anamnesis and clinical study].

Extensive laboratory work-ups are often called for to establish the diagnosis in uveitis cases. In order to interpret the results, however, the degree of validity of the tests must be known. As the number of laboratory tests increases there is a considerable increase in the probability of false-positive results. Demographic peculiarities help in interpreting the results and findings. The information value of laboratory results can be increased by establishing a clear differential diagnosis and compiling a list of precise questions, on the basis of a meticulous clinical examination and a detailed history. The clinical examination remains the key to uveitis diagnosis. If the clinical diagnosis is obvious, contradictory laboratory results should be disregarded.

Diagnosis, Differential↗