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Biomedical subjects

K Landau

Publications and source records attributed to K Landau.

At least 19 recordsLinked to original sources
PubMed2006

[Corneal and conjunctival findings in systemic silver intoxication].

BACKGROUND: Chronic silver intoxication is a rare disease and therefore the typical ocular findings may be missed. Based on a case with severe intoxication, the clinical and histological findings as well as the prognosis in argyria are presented. HISTORY: A 33-years-old-employee of a battery production plant developed a biopsy proven systemic argyria. On slit lamp examination the conjunctiva showed a dark, blue-grey discoloration in the areas of the tear flow and the small conjunctival arteries. Diffuse silver deposits were noticed on the level of Descemet's membrane without endothelial damage. Silver deposits were also visible in the trabecular meshwork. Chemical reaction of the silver particles upon exposure to UV light results in irreversible tissue discoloration. Without options for an effective treatment, early diagnosis and prevention of overexposure are most important. CONCLUSIONS: The typical ocular findings in systemic argyria are helpful in occupational medicine for establishing the correct diagnosis.

Adult↗
PubMed2006

[Corticosteroids in giant cell arteritis: primum nil nocere?].

BACKGROUND: Steroids are the treatment of choice for giant cell arteritis but bear the risk of serious side effects. PATIENTS AND METHODS: We carried out a retrospective study on 34 patients with documented giant cell arteritis (24 with ocular involvement) by means of a questionnaire sent to the treating physicians. RESULTS: After a mean follow-up of 48 months, side effects occurred in 90 % of the patients. The most frequent were weight gain (> 50 %) and osteoporosis (> 40 %, F >> M). Side effects were more common in patients with ocular involvement and in women. Severe complications were significantly more frequent in patients with ocular involvement. CONCLUSIONS: Side effects are the rule and not the exception in the treatment of giant cell arteritis. They can affect quality of life. Physicians should bear them in mind as many are preventable and/or treatable.

Adrenal Cortex Hormones↗
PubMed2006

[Orbital MALT lymphomas: clinicopathological correlation].

BACKGROUND: Extranodal MALT lymphomas are slow growing tumors of B-cell origin which may be found in the orbit. They are associated with mucosa and epithelial structures. PATIENTS AND METHODS: We present eight patients with biopsy confirmed orbital MALT Lymphomas. The diagnostic imaging techniques are described. Histopathological and immunohistological analysis showed typical findings of MALT lymphomas. RESULTS: After staging six patients had radiation therapy. Two patients refused treatment due to lack of discomfort. CONCLUSIONS: MALT lymphomas should be considered in the differential diagnosis of orbital tumors. While ultrasonography and MRI are needed to determine the extension of these tumors, their identification requires excision or biopsy with histological/immunohistochemical analysis, especially in view of new treatment options.

Adult↗
PubMed2005

Optic atrophy as a sign of wolfram syndrome.

BACKGROUND: The hallmark of Wolfram syndrome -- an extremely rare autosomal recessive disorder -- is the association of juvenile onset diabetes mellitus with optic atrophy. Additional symptoms such as deafness and diabetes insipidus may develop. HISTORY AND SIGNS: An 18-year-old man suffered progressive visual loss over the last seven years. Severe optic atrophy with extensive cupping and slightly elevated intraocular pressure in both eyes were found. Perimetry revealed peripheral defects with paracentral scotomas. ERG results excluded tapetoretinal degeneration; visual evoked responses were delayed. At the age of nine the patient had been diagnosed with diabetes mellitus type I and neurosensory deafness, seven years later a beginning hypogonadism was found. THERAPY AND OUTCOME: Wolfram syndrome is a progressive degenerative disorder with reduced life expectancy. Treatment is symptomatic. CONCLUSIONS: Wolfram syndrome should be considered in every patient who presents with optic atrophy and juvenile onset diabetes mellitus.

Adolescent↗
PubMed2004

[Blast injury. Acute blindness caused by thoracoabdominal compression trauma].

Blindness can be the consequence of trauma, which until now had only been described in cases involving direct facial or cranial trauma. In our case a 53-year-old street worker became irreversibly blind after a thoracoabdominal compression trauma. The investigations performed were inconclusive regarding the cause of blindness. We postulate a massive increase in venous blood pressure with capillary stasis and consequent optic nerve damage. Fat emboli syndrome or posterior ischemic optic neuropathy could be causes, but unrealistic for this case. It still comes into question why such a mechanism has not been seen in other blast injury cases. In the end, the additional factor that resulted here in complete irreversible blindness remains unclear.

Abdominal Injuries↗
PubMed2004

Normalisation of ocular pulse amplitude after embolisation of dural cavernous sinus arteriovenous fistula.

BACKGROUND: The difference in the ocular pulse amplitude between an individual's eyes may reflect abnormalities of the cerebrovascular circulation and has been shown to be helpful in assessing patients with cavernous sinus arteriovenous fistulas. HISTORY AND SIGNS: A 71-year-old woman presented with episcleral injection, proptosis, bruit and retro-orbital pain on the left side. Ocular pulse amplitude as measured by dynamic contour tonometry was 4.38 +/- 1.23 mm Hg in the right and 9.57 +/- 2.71 mm Hg in the left eye. Angiography revealed the haemodynamics of a dural left cavernous sinus arteriovenous fistula. THERAPY AND OUTCOME: Successful occlusion of the fistula was performed by transvenous embolisation. After embolisation, ocular pulse amplitude was 2.84 +/- 0.60 mm Hg in the right and 1.88 +/- 0.29 mm Hg in the left eye. CONCLUSION: In this case of a dural arteriovenous fistula the ocular pulse amplitude as measured by dynamic contour tonometry parallels closely both clinical findings and neuroimaging.

Aged↗
PubMed2004

The value of white blood cell count in patients with swollen discs.

BACKGROUND: A broad differential diagnosis has to be considered in a patient with swollen discs. Myeloproliferative disorders such as leukemia and lymphoma can in rare cases cause infiltrative optic neuropathy. HISTORY AND SIGNS: Two patients initially presented with slowly progressive severe visual loss. History was unremarkable except for previously noted slightly elevated white blood cell count for which - according to their general physicians - no treatment or work-up was required. At presentation, bilateral disc swelling was present. Magnetic resonance imaging showed enhancement of the entire optic nerves sparing the chiasm. No other intracranial lesion was found. Cerebrospinal fluid contained no malignant cells. THERAPY AND OUTCOME: After bone marrow aspiration the diagnosis of non-Hodgkin's lymphoma and granulocytic leukemia, respectively, was made. Treatment resulted in visual recovery. CONCLUSION: Work-up in a patient with swollen discs should always include white blood cell count. If the result is abnormal further exploration should be pursued. Elevated white blood cell count may be the only hint of optic nerve infiltration caused by a myeloproliferative disorder and its treatment can result in remarkable recovery.

Aged↗
PubMed2002

[Treatment of acne with consequences -- pseudotumor cerebri due to hypervitaminosis A].

Pseudotumor cerebri (PTC) is an entity characterized by elevated intracranial pressure of probably multifactoral origin, but most cases remain idiopathic. We report a 15-year-old girl with PTC due to prolonged consumption of Arovit (Vitamin A) for treatment of acne. The diagnosis was established by measuring raised cerebrospinal fluid pressure after an intracranial mass lesion and dural venous sinsus thrombosis were excluded. The increased level of vitamin A confirmed the diagnosis of hypervitaminosis A as the causative pathogen. The patient was treated with lumbar punctures and acetazolamide (Diamox). PTC due to hypervitaminosis A is a serious complication, which can cause permanent visual impairment. Patients treated with retinoids require proper surveillance. The elevated serum level of retinoids after withdrawal may persist for weeks.

Acetazolamide↗
PubMed2002

Axonal loss from acute optic neuropathy documented by scanning laser polarimetry.

BACKGROUND/AIMS: Retinal nerve fibre layer analysis by scanning laser polarimetry has been shown to facilitate diagnosis of glaucoma while its role in glaucoma follow up is still unclear. A major difficulty is the slow reduction of retinal nerve fibre layer thickness in glaucomatous optic neuropathy. Eyes of patients were studied after acute retrobulbar optic nerve lesion in order to evaluate the usefulness of scanning laser polarimetry in documenting retinal nerve fibre layer loss over time. METHODS: Five patients who suffered severe retrobulbar optic neuropathy have had repeated measurements of the retinal nerve fibre layer using scanning laser polarimetry at various intervals, the first examination being within 1 week of injury. RESULTS: All eyes showed a marked decrease in peripapillary retinal nerve fibre layer thickness, which followed an exponential curve and occurred predominantly within 8 weeks of injury. Compared to a previous study using red-free photographs, scanning laser polarimetry showed retinal nerve fibre layer loss earlier in the course of descending atrophy. CONCLUSION: Scanning laser polarimetry is useful for early detection and documentation of retinal nerve fibre layer loss following acute injury to the retrobulbar optic nerve. It seems to be a promising tool for follow up of individual glaucoma patients.

Acute Disease↗
PubMed2001

Unilateral swollen disc due to increased intracranial pressure.

Truly unilateral papilledema is rare and poses a diagnostic problem. The authors have prospectively looked for patients with truly unilateral papilledema and found 15 patients, 10 of whom had idiopathic intracranial hypertension. Neuroimaging did not indicate a reason for the lack of swelling in the other nerve. The visual deficits and outcomes were similar to those of patients with bilateral papilledema. Although monocular papilledema is uncommon, a lumbar puncture with opening pressure measurement should be considered.

Adolescent↗
PubMed2001

[Endocrine orbitopathy].

Dysthyroid orbitopathy is an autoimmune disorder usually occurring in the setting of Graves' disease. The pathogenesis is incompletely understood but involves autoantibodies against orbital tissue. The clinical course is highly variable. Signs range from mild to severe soft tissue swelling, lid retraction, proptosis and extraocular muscle involvement with diplopia, to corneal damage and optic nerve compression with irreversible visual loss. After a few years, the phase of active inflammation is usually followed by a chronic stage with or without residual damage through fibrosis. Each stage requires a carefully adjusted therapy and optimal cooperation between the general practitioner, the ophthalmologist and other specialists involved. Therapeutic options range from topical lubricants to systemic steroids, radiation and surgery.

Diagnosis, Differential↗
PubMed2001

Three-dimensional Hess screen test with binocular dual search coils in a three-field magnetic system.

PURPOSE: To establish an objective Hess screen test that allows a simultaneous and binocular analysis of all three axes of eye rotation. METHODS: In orthotropic and strabismic human subjects, both eyes were recorded with dual scleral search coils in a three-field magnetic system. Before mounting the search coil annuli on the eyes, the voltage offsets of each channel and the relative magnitudes of the three magnetic fields were determined. For calibration, subjects were only required to fix monocularly on a single reference target. During fixation of targets on the Hess screen by the uncovered eye, the three-dimensional eye position of both the occluded and the viewing eye was simultaneously measured. RESULTS: For clinical interpretation, an easy to understand graphical description of the three-dimensional Hess screen test was developed. Positions of orthotropic and strabismic eyes tended to follow Listing's law, which in both eyes allowed the determination of the primary position, that is, the position of gaze from which pure horizontal and pure vertical movements do not lead to an ocular rotation about the line-of-sight. To a first approximation, the location of primary position is a result of the summation of the individual rotation axes of the six extraocular muscles and thus can be used to infer which muscle is paretic. CONCLUSIONS: The three-dimensional Hess screen test with binocular dual search coils in a three-field magnetic system is an objective method to assess the ocular alignment in three dimensions with high precision. From these recordings, the clinician can relate deviations of primary position to specific eye muscle palsies.

Algorithms↗
PubMed2000

[Pronounced physiological pupillary hippus].

BACKGROUND: The term "hippus" describes pupillary oscillations of variable amplitude and frequency and may be physiological or part of a pathological entity. Thus, pupillary hippus is often the target of extensive clinical investigation. CASE REPORT: A 9-year-old boy was seen in our emergency room in March 1998. Examination showed distinct pupillary oscillations in the absence of any other pathological findings. We presented the patient to a pediatric neurologist. Apart from a history of enuresis and of motor tics in the neck region, the present neurological examination was normal. CONCLUSIONS: Even a pronounced hippus may be physiological and does not necessarily require extensive diagnostic investigations.

Child↗
PubMed2000

Development of a novel, rapid integrated Cryptosporidium parvum detection assay.

The aim of this study was to develop a reverse transcription-PCR assay and lateral flow detection protocol for specific identification of Cryptosporidium parvum. The method which we developed is sensitive and specific and has a low limit of detection. In our protocol a solid phase material, the Xtra Bind Capture System, was used for extraction and purification of double-stranded RNA (dsRNA) specific for C. parvum. The Xtra Bind Capture System interfaced with pellets concentrated from water samples collected with previously developed filtration devices. The pellets were resuspended in reagent water (final volume, 0.5 ml), and an equal amount of rupture buffer and the Xtra Bind Capture System was added to the resuspended pellet mixture. The dsRNA target sequences in a 0. 5-ml portion were captured by the solid phase material via hybridization. The debris and potential inhibitors were removed by washing the Xtra Bind material several times with buffer. The Xtra Bind material with its bound dsRNA was added directly to an amplification reaction mixture, and the target was amplified without elution from the Xtra Bind material. A PCR was performed in the presence of the Xtra Bind Capture System, which resulted in robust amplification of the target. The detection system which we used was adapted from lateral flow chromatography methods typically used for antigen-antibody reactions. The result was a colored line that was visible if the organism was present. When this method was used, we were able to reproducibly and correctly identify 10 oocysts added to 0.5 ml of reagent water. When the protocol was evaluated with a small set of environmental samples, the level of detection was as low as 1 oocyst/liter. The total time from resuspension of the pellet to detection was about 3 h, which is considerably less than the 5 h required for immunomagnetic separation followed by an indirect immunofluorescence assay and microscopy.

Animals↗
PubMed1999

A comparison of imaging techniques for diagnosing drusen of the optic nerve head.

OBJECTIVE: To determine the best imaging procedure for diagnosing drusen of the optic nerve head. METHODS: We reviewed retrospectively the clinical records of 142 patients (261 eyes) with suspected drusen of the optic disc. The patients were referred to our hospital over a 7-year period and evaluated by B-scan echography, orbital computed tomographic (CT) scan, and/or preinjection control photography for detection of autofluorescence. The relative diagnostic yield of these imaging techniques was compared. RESULTS: Thirty-six of the 261 eyes were evaluated using all 3 imaging techniques, with drusen of the optic nerve head diagnosed in 21 eyes. Findings from B-scan echography were positive in all 21 eyes compared with 9 positive findings from the CT scans and 10 positive findings from the preinjection control photographs (P<.01 for B-scan echography vs both CT scan and preinjection control photography). In 82 eyes with suspected buried drusen of the optic nerve head, B-scan echography showed drusen in 39 eyes compared with 15 eyes in which drusen were shown using preinjection control photography (P<.001). In the whole series, no diagnosis of drusen was made by either preinjection control photography or CT scan and was missed on B-scan echography. CONCLUSIONS: Drusen of the optic nerve head are diagnosed most reliably using B-scan echography compared with both preinjection control photography and CT scans. Preinjection control photography should be performed mainly when confirmation of visible drusen of the optic disc is desired. Neuroimaging using CT is suitable to exclude diagnosis of an intracranial mass lesion and possibly to detect buried drusen of the optic nerve head at the same time.

Adolescent↗