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Biomedical subjects

M Küchle

Publications and source records attributed to M Küchle.

At least 127 records · Page 7Linked to original sources
PubMed1994

[Peridural morphine administration in restless legs status].

The restless-legs syndrome is known to occur in a familial form. The paraesthesias, which are hard to define, are sometimes compared to a painful sensation that can be alleviated only by movement. The pathomechanism of the syndrome and its aetiology are still unknown. A 67-year old patient was admitted as an emergency with most severe pain in her legs. In her family the syndrome occurred in an autosomal dominant form. A long-standing history of abuse of various analgesics was known. Initially the symptoms could not be influenced by any of the various drugs given; even epidural bupivacaine showed no effect. Dramatic relief, however, was obtained by epidural morphine. The maintenance therapy with oral morphine sulfate provided equally good results.

Administration, Oral↗
PubMed1994

[Tyndallometry in monitoring therapy of sympathetic ophthalmia].

BACKGROUND: The Laser Flare-Cell Meter allows noninvasive quantitative measurement of aqueous flare in human eyes. In this study we analysed changes of aqueous flare in eyes with sympathetic ophthalmia under immunosuppressive treatment. PATIENTS AND METHOD: Two men (54- and 59-year-old) with sympathetic ophthalmia (histological examination of the enucleated eyes confirmed the clinical diagnosis) were examined regularly with the Laser Flare-Cell Meter (Kowa). According to the flare values the dose of immunosuppressive treatment with cyclosporin A and prednisolone was gradually titrated. RESULTS: Under immunosuppressive treatment flare values of patient 1 normalized within 21 months. The dose of immunosuppressive treatment was carefully reduced according to flare values. Patient 2 showed very high flare values before treatment, which decreased to flare values of 20 flare counts/ms within 5 months of treatment with cyclosporin A and prednisolone. Both patients stopped immunosuppressive treatment because of systemic side-effects. Thereafter flare values increased acutely and a recurrence of sympathetic ophthalmia was observed in both patients. Under renewed immunosuppressive treatment aqueous flare values decreased again. CONCLUSION: Measurement of aqueous flare with the LFCM appears to be an effective tool for follow-up examinations, and especially for titrating of immunosuppressive treatment in eyes with manifest sympathetic ophthalmia.

Cyclosporine↗
PubMed1994

[Quantification of disorders of the blood-aqueous humor barrier in retinitis pigmentosa--initial results].

BACKGROUND: Clinical findings in patients with retinitis pigmentosa (RP) frequently include cystoid macular edema (CME) and vitreous pigment dusting (VPD) indicating alterations of the blood-ocular barriers. It was the aim of this study to determine whether alterations of the blood-aqueous barrier (BAB) are present in RP. PATIENTS AND METHODS: Aqueous flare was quantitatively determined in 56 eyes of 29 patients (mean age 36.4 +/- 11.2 years) with RP using the noninvasive laser flare-cell photometer (Kowa FC-1000, Tokyo, Japan). All RP patients had common forms of RP with markedly reduced or nondetectable ERG. The presence of CME and VPD was determined semiquantitatively by biomicroscopy. Fifty-eight eyes of 58 normal controls (mean age 38.2 +/- 8.5 y.) were also examined. RESULTS: Aqueous-flare values were significantly higher in RP eyes (mean 9.65 +/- 3.24 photon counts/ms, range 4.0-18.1) than in the normal control eyes (mean 3.89 +/- 1.05, range 1.9-6.0, p < 0.0001, Mann-Whytney test). Forty-eight of the 56 RP eyes (86%) showed increased flare values (> 6.0 photon counts/ms). RP eyes with moderate to marked CME (n = 11) had significantly higher flare values (mean 14.66 +/- 1.92) than RP eyes without or with only questionable CME (8.52 +/- 2.18, p < 0.0001), and RP eyes with moderate to marked VPD (n = 17) had significantly higher (12.05 +/- 2.84) flare values than RP eyes without or with only minimal VPD (8.74 +/- 2.22, p < 0.0005). CONCLUSIONS: Our findings show that the majority of patients with RP have alterations of the BAB with consecutively increased aqueous protein concentrations. The impairment of the BAB appears to be associated with CME and VPD. Measurement of aqueous flare in RP allows quantification of the impairment of the BAB and may be helpful in the future in choosing and monitoring patients with RP and CMP for possible antiinflammatory or antiedematous therapeutic measures.

Adult↗
PubMed1994

Schwannoma of the ciliary body treated by block excision.

A 26-year-old man developed a non-pigmented ciliary body tumour of his right eye. A 7 mm block excision and tectonic corneoscleral graft were performed. The excised tissue was studied using histopathological, immunohistochemical, and electron microscopic techniques. The tumour revealed characteristic features of a Schwann cell neoplasm including Antoni A and B patterns, acid mucopolysaccharides, S-100, and vimentin positivity, and--by electron microscopy--Luse bodies. It was classified as a schwannoma. Although rare, schwannoma should be included in the clinical differential diagnosis of non-pigmented ciliary body tumours. Local excision should be considered to avoid over-treatment by enucleation.

Adult↗
PubMed1994

Necrotic malignant melanoma of the choroid and concurrent intraocular manifestation of malignant non-Hodgkin's B cell lymphoma.

An 80-year-old white female developed clinical signs of a large choroidal malignant melanoma in her left eye. There were no signs of metastatic disease, but an asymptomatic chronic lymphatic leukemia was discovered. Histopathologic examination of the enucleated left eye showed a mostly necrotic malignant melanoma of the choroid with areas of spindle B cell differentiation, episcleral extension and secondary angle-closure glaucoma with necrosis of the anterior segment of the eye. On the basis of immunocytochemical studies of the lymphocytic infiltrates in the iridal blood vessels, retinal blood vessels and the choroid, the leukemic disease was classified as B cell lymphoma of low malignancy (lymphoplasmacytoid immunocytoma). A reactive T lymphocytic infiltration of the conjunctival stroma was also noted. Patients with malignant melanomas of the uvea require exclusion of a second malignancy.

Aged↗
PubMed1994

Laser tyndallometry in anterior segment diseases.

Laser tyndallometry refers to in vivo quantification of aqueous flare by measuring the scatter of a laser beam that is scanned into the anterior chamber. The laser flare-cell meter was introduced in 1988 and allows noninvasive, reproducible tyndallometry. Because biochemical studies have shown that the amount of laser light scattering correlates with aqueous protein concentration, laser tyndallometry allows noninvasive analysis of the integrity of the blood-aqueous barrier. Laser tyndallometry has been mainly applied to uveitis and to postoperative anterior segment changes with many of studies focusing on the anti-inflammatory effects of postoperative medications. In addition, the method was shown to give valuable information on the integrity of the blood-aqueous barrier in ocular and systemic diseases including diabetic retinopathy and pseudoexfoliation syndrome, in eyes with graft rejection after penetrating keratoplasty, and in various disease processes that mainly affect the posterior segment including retinitis pigmentosa, retinal vein occlusion, and uveal melanoma.

Anterior Eye Segment↗
PubMed1994

[Tyndallometry with the laser flare cell meter and biochemical protein determination in the aqueous humor of eyes with pseudoexfoliation syndrome].

UNLABELLED: Slit-lamp examination and flare measurement in eyes with pseudoexfoliation (PSX) syndrome frequently reveal signs of impairment of the blood-aqueous barrier. We studied both aqueous flare and aqueous protein concentration in PSX eyes to verify and quantify these alterations. PATIENTS: Aqueous flare was measured using the Laser Flare-Cell Meter Kowa FC-1000 in 158 normal control eyes (age 56.0 +/- 12.0 years), in 60 PSX eyes (age 72.5 +/- 9.4 years), and in 84 eyes with primary chronic open-angle glaucoma (PCOAG) (age 56.3 +/- 12.4 years). Total aqueous protein concentration was determined biochemically in 12 "normal" control eyes with senile cataracts (age 57.6 +/- 20.4 years), in 27 PSX eyes (age 72.6 +/- 9.1 years), and in 25 PCOAG eyes (age 63.3 +/- 13.5 years). After the primary aqueous humor was aspirated during cataract extraction or trabeculectomy, a modified BCA-Peirce method was employed. RESULTS: In PSX eyes, both aqueous flare (12.3 +/- 8.2 photon counts/ms) and aqueous protein concentration (0.42 +/- 0.16 mg/ml total protein) were significantly increased in comparison with normal control eyes (4.3 +/- 1.1 photon counts/ms and 0.22 +/- 0.08 mg/ml) and with PCOAG eyes (4.7 +/- 1.6 photon counts/ms and 0.26 +/- 0.09 mg/ml) (P < 0.0001). Differences between normal control eyes and PCOAG eyes were not significant (P > 0.05). There was a high correlation between aqueous flare measurements and aqueous protein concentration in eyes with PSX (y = 0.27x + 0.29, r = 0.65, P = 0.0006, n = 24). CONCLUSIONS: Our results indicate that impairment of the blood-aqueous barrier with an increase in aqueous protein concentration is a feature of PSX and may be quantified both by flare measurement and biochemical protein determination. These alterations should be considered in the pharmacological and surgical treatment of PSX eyes.

Adult↗
PubMed1994

Aqueous flare in eyes with age-related macular degeneration.

It is unknown whether aqueous flare is increased in eyes with prominent fundus lesions other than choroidal malignant melanoma. Therefore, we studied the aqueous flare in eyes with age-related macular degeneration (ARMD) using the laser flare-cell meter. Forty-three eyes of 27 patients with ARMD (age 67.0 +/- 14.0 years, range 43-81 years), and 41 healthy eyes of 41 randomly selected age- and gender-matched control patients (age 68.9 +/- 9.8 years, range 43-89 years) were examined. The macular degeneration was diagnosed and classified using fluorescein angiograms. Flare values in eyes with ARMD were 0.28 +/- 0.18 mg/ml, being significant in comparison with the control (0.12 +/- 0.05 mg/ml). The differences among the subgroups of ARMD were not statistically significant (P > 0.5): macular drusenosis (0.21 +/- 0.05 mg/ml, n = 6), subretinal neovascularization without marked subretinal hemorrhage (0.27 +/- 0.15 mg/ml, n = 19), subretinal neovascularization with marked subretinal hemorrhage (0.29 +/- 0.24 mg/ml, n = 7), and disciform scar (0.31 +/- 0.24 mg/ml, n = 9).

Adult↗
PubMed1994

[Tyndallometry with the laser flare cell meter in intraocular inflammation].

The laser flare-cell meter (LFCM) allows noninvasive, quantitative measurement of aqueous flare in human eyes. In this study we analysed changes in aqueous flare in eyes with various forms of intraocular inflammations. PATIENTS. We examined 100 eyes of 100 patients aged (mean +/- SD) 40.2 +/- 19.8 years with acute and chronic intraocular inflammations. The inflammatory diseases were classified according to morphological criteria. In addition, 163 normal eyes of 163 subjects (mean age 44.8 +/- 17.9 years) were evaluated. The eyes were examined by three examiners using the LFCM (Kowa, FC-1000) after pupillary dilatation with mydriatics. The instrument was calibrated with standardized concentrations of human albumin concentrations, and flare values were transformed into human albumin concentration equivalents. For statistical analysis, the non-parametric Wilcoxon-Mann-Whitney test was used. RESULTS. Flare values (mean +/- SD) in the eyes with intraocular inflammations were 4.38 +/- 11.82 mg/ml human albumin equivalents and were significantly higher than in the group of normal eyes (0.11 +/- 0.06 mg/ml, P < 0.0001). In addition, flare values differed in the various inflammation groups, with human albumin concentration equivalents decreasing in the following order: acute iridocyclitis (n = 27, 10.81 +/- 21.12), chronic iridocyclitis (n = 19, 5.19 +/- 6.12), necrotizing retinitis (n = 6, 1.92 +/- 1.11), acute retinochoroiditis (n = 9, 1.46 +/- 2.35), retinal vasculitis (n = 24, 1.03 +/- 0.90), chorioretinitis (n = 5, 0.98 +/- 0.71), Fuchs' uveitis (n = 10, 0.52 +/- 0.25). CONCLUSION. Measurement of aqueous flare with the LFCM is a noninvasive examination that yields objective, quantitative and reproducible results and therefore has advantages over slit-lamp assessment. It gives valuable information about the integrity or impairment of the blood-aqueous barrier. Its possible clinical applications include follow-up examinations and "monitoring" of therapeutic regimens in uveitis.

Adolescent↗
PubMed1994

Protein quantification and electrophoresis in aqueous humor of pseudoexfoliation eyes.

PURPOSE: Pseudoexfoliation (PSX) eyes frequently show clinical signs of blood-aqueous barrier impairment. To analyze these alterations, the authors examined aqueous humor of human eyes with and without PSX. METHODS: After aqueous humor samples had been obtained during cataract or filtering glaucoma surgery, a modified Pierce-bicin choninic acid assay was used to quantify total aqueous protein concentration in 27 PSX eyes and 37 eyes without clinical signs of PSX (12 cataract eyes and 25 eyes with primary open-angle glaucoma). In addition, aqueous protein composition was analyzed by sodium dodecylsulfate polyacrylamide gel electrophoresis, silver staining, and laser densitometry in 27 PSX eyes and 59 eyes without PSX. RESULTS: Aqueous protein concentration was significantly higher in PSX (mean 0.42 +/- 0.16 mg/ml) than in normal cataract eyes (0.22 +/- 0.08 mg/ml, P < 0.0001) and in eyes with open-angle glaucoma (0.26 +/- 0.09 mg/ml, P < 0.0001, Wilcoxon-Mann-Whitney test). Electrophoresis revealed a characteristic increase of a 12.5-kDa band in 15 of 27 PSX eyes but in only 1 of 59 eyes without PSX (P < 0.00001, chi-square test). CONCLUSIONS: These results substantiate increased aqueous protein concentration and aqueous barrier impairment in PSX. The additional finding of an increased 12.5-kDa band in 56% of PSX eyes may be related to the pathogenesis of PSX in the anterior ocular segment.

Aged↗
PubMed1993

[Correlation between tyndallometry with the "laser flare cell meter" in vivo and biochemical protein determination in human aqueous humor].

INTRODUCTION: The laser flare-cell meter allows noninvasive measurement of aqueous flare in humans. In vitro studies have shown good correlations between flare values and albumin concentrations. In this study, we compared aqueous flare values and aqueous protein concentrations in living human eyes. PATIENTS AND METHODS: We measured aqueous flare and the total aqueous protein concentration in 52 eyes of 52 patients (age 58.4 +/- 18.8 years) that underwent cataract extraction (22 eyes) or trabeculectomy (30 eyes). Before surgery, aqueous flare was determined with the laser flare-cell meter (Kowa FC-1000). During surgery, 50 microliters of primary aqueous humor was aspired, and total aqueous protein concentration was performed using a modified Pierce-BCA assay. Linear regression analysis was calculated. RESULTS: There was a high correlation between aqueous flare values and total aqueous protein concentration (y = 0.52x + 0.15, r = 0.98, p < 0.00001). This correlation was observed both in eyes with and without cataract. CONCLUSION: Our results indicate that aqueous flare values as determined with the laser flare-cell meter reflect the true aqueous protein concentration quite accurately. Lens opacities appear not to significantly alter the results of aqueous flare measurements. As expected by theoretical assumptions, flare measurements overestimate aqueous protein concentrations in eyes with severely impaired blood-aqueous barriers because, according to Rayleigh's law, larger protein molecules cause more light scattering. However, transformation and expression of flare values as "albumin concentration equivalents" according to in vitro-calibration may still be useful, especially if the results of different instruments are to be compared.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Keratoplasty in childhood. Report of 71 keratoplasties].

BACKGROUND: Keratoplasty is a routine method in adults but there are some additional problems in children. These include difficulties in examining the patients, amblyopia and an increased rate of graft rejection. PATIENTS AND METHODS: Between 1980 and 1990 71 keratoplasties in 66 eyes of 61 patients under 16 years of age were performed. The indications and results were studied retrospectively and since 1987 prospectively. The average follow-up was 24 months. Main indications were traumatic scarring (22 eyes), corneal dystrophy (13 eyes), scarring after keratitis (10 eyes), graft failure (7 eyes), and chemical burn (5 eyes). There were 15 lamellar homologous not HLA-matched keratoplasties, 11 autologous penetrating rotating, 42 penetrating homologous not HLA-matched, and 3 penetrating homologous HLA matched. The most frequent complications were loosening or rupture of the suture in 38% and graft rejection in 20% of the homologous penetrating keratoplasties. 10 of 15 eyes after lamellar grafting showed a clear graft at the last control. 40 of 42 eyes after penetrating keratoplasty had also a clear graft, however second keratoplasties were necessary in 4 eyes. 21 of the 42 eyes after penetrating keratoplasty developed a visual acuity of 0.5 or better. CONCLUSION: We recommend interrupted single sutures for keratoplasties in children and an earlier suture removal to avoid severe suture problems. Visual outcome depends on the primary diagnosis and on avoiding irreversible amblyopia. In cases of traumatic corneal and lens opacification an early rehabilitation of the optic system is important, therefore in patients under 7 years of age we prefer a posterior chamber lens implantation for a more effective amblyopia therapy.

Adolescent↗
PubMed1993

Pseudoexfoliation syndrome as a risk factor for acute ciliary block angle closure glaucoma.

Two patients presented with unilateral ciliary block angle closure glaucoma and bilateral pseudoexfoliation (PSX) syndrome and were treated successfully with posterior sclerotomy (one case), extracapsular cataract extraction and posterior chamber lens implantation. None of the eyes had undergone previous ocular surgery except Nd: YAG-laser iridotomy. Axial lengths as measured with A-scan ultrasonography were 22.48 mm and 24.30 mm. During follow-up of 5 and 12 months, intraocular pressure was well controlled without antiglaucoma medication in both patients. We suspect that the well-known changes of the zonula origin at the ciliary epithelium in PSX syndrome lead to anterior subluxation of the lens with consecutive ciliary block angle closure glaucoma. Ciliary block angle closure glaucoma seems to be another serious complication in PSX syndrome. Therefore, miotics should probably be used with care in PSX eyes with signs of zonular alterations because they may trigger this mechanism.

Aged↗
PubMed1993

Aqueous flare and cells in eyes with retinal vein occlusion--correlation with retinal fluorescein angiographic findings.

The laser flare cell meter (LFCM) was used to evaluate alterations of the blood-aqueous barrier in eyes with retinal vein occlusion (RVO). In 42 eyes of 42 patients with RVO (30 branch vein occlusions, 12 central vein occlusions) aqueous flare and aqueous cells were determined and retinal fluorescein angiography was performed. Flare and cell values were compared with 59 normal age and sex-matched control eyes and correlated with fluorescein angiographic findings. Both aqueous flare (12.321 (SD 6.717) photon counts/ms) and aqueous cells (mean 3.37 cells/0.075 x 10(6)/l) were significantly increased in eyes with RVO in comparison with the normal control group (flare 4.288 (SD 1.144) photon counts/ms, cells 0.54 cells/0.075 x 10(6)/l, p < 0.0001 and p < 0.005). Flare values in eyes with central RVO (19.517 (SD 7.762) photon counts/ms) were significantly higher than in eyes with branch RVO (9.443 (SD 3.307) photon counts/ms, p < 0.0001). Significant correlations were found between flare values and area of RVO (r = 0.70, p < 0.0001) and between flare values and area of retinal non-perfusion (r = 0.76, p < 0.0001). There were also significant correlations between flare values and number of cotton wool spots (r = 0.54, p < 0.0002) and between cell counts and degree of cystoid macular oedema (r = 0.46, p < 0.006). Our findings show that aqueous protein concentration, as indicated by flare, and aqueous cells are increased in RVO and that changes of aqueous flare correlate with fluorescein angiographic findings that reflect the severity of RVO. Measurements with LFCM may be useful non-invasively to quantify changes of the ocular barrier functions in RVO.

Adult↗
PubMed1993

Pseudoexfoliative material in the eyelid skin of pseudoexfoliation-suspect patients: a clinico-histopathological correlation.

The pseudoexfoliation (PSX) syndrome has recently been suggested to represent the intraocular manifestation of a systemic disorder. In the present study, we examined the correlation between the extraocular occurrence of PSX material in eyelid skin and clinical indications of early stages of PSX syndrome using transmission and immunoelectron microscopy. Typical PSX aggregates were demonstrated in 7 of the eyelid-skin biopsy specimens taken from 12 patients who had been categorized as "PSX suspects" on the basis of certain clinical signs related to loss and dispersion of melanin from the iris pigment epithelium and to iris stromal atrophy but showed no clinical evidence of PSX syndrome in either eye. Another 3 lid specimens obtained from PSX suspects exhibited signs of atypical PSX fibrillopathy. The PSX deposits revealed immunolabeling for heparan and chondroitin sulfate proteoglycan, entactin/nidogen, elastin, amyloid P, and vitronectin. These findings suggest that certain clinical signs indicating early PSX syndrome obviously correlate with the extraocular occurrence of PSX material before its clinically visible appearance on the surfaces of the anterior and posterior chambers.

Aged↗