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Biomedical subjects

M Severin

Publications and source records attributed to M Severin.

At least 19 recordsLinked to original sources
PubMed2001

[Painless acanthamoeba keratitis].

BACKGROUND: Acanthamoeba keratitis is a severe, painful corneal infection found in contact lens wearers. The entity can easily be confused with herpetic or fungal keratitis, especially if no ocular pain is reported. HISTORY AND SIGNS: A 32-year old myopic female presented a unilateral keratitis of unknown etiology since 3 weeks. Administration of topical antiviral substances and corticosteroids led only to temporary improvement of the condition. The patient complained of photophobia but not of ocular pain. The affected eye showed corneal edema, central stromal thickening, descemet's striae as well as fibrin deposits on the corneal endothelium and in the anterior chamber. DIAGNOSIS: An aqueous specimen was negative for a viral infection. A culture for bacteria was negative. Staphylococci were cultured from corneal scrapings and Enterococci from the contact lens solution. Another corneal scraping revealed Acanthamoeba class II (6 weeks after the onset of symptoms). CLINICAL COURSE: Under treatment with propamidine, polymyxin b, neomycin, gramicidin and polyhexidine (topical) as well as fluconazole/ketoconazole (systemic) the diameter of the annular infiltrate, which had developed decreased, but the infiltrate persisted. In the further course, the infiltrate persisted while the amount of fibrin in the anterior chamber increased. Penetrating keratoplasty was performed. Histologic examination of the host corneal tissue revealed massive infiltration with Acanthamoeba. CONCLUSIONS: Severe pain and history of wearing contact lenses are features suggestive of Acanthamoeba keratitis. The patient presented here had a history of contact lens wear, but no ocular pain was reported. The characteristic annular infiltrate had a late onset. Bacterial superinfection could not be ruled out. Therapeutic penetrating keratoplasty had to be performed as the condition deteriorated inspite of intensive chemotherapy. With penetrating keratoplasty a good visual acuity could be regained.

Acanthamoeba Keratitis↗
PubMed1999

Failure to diagnose hereditary colorectal cancer and its medicolegal implications: a hereditary nonpolyposis colorectal cancer case.

PURPOSE: We describe a patient who had precancerous colonic symptoms and a positive family history of multiple occurrences of early-onset colorectal cancer in her first-degree and second-degree relatives consistent with hereditary nonpolyposis colorectal cancer. Hereditary nonpolyposis colorectal cancer diagnosis had not been made before her diagnosis of carcinoma of the cecum with liver metastasis. She died at age 20, leading to litigation. Controversies about standards of care, their malpractice implications, and pertinent legal issues are discussed. METHODS: Review of the medical and family history was made by the expert witness (HTL) with appropriate documentation of the chronology of symptoms, as derived from depositions. These documents revealed that the patient's mother had repeatedly discussed with the caregivers her concern about the family history of colon cancer and the need for appropriate surveillance. RESULTS: The patient's colonic symptoms progressed for a period of three years. Flexible sigmoidoscopy was performed by a nonphysician. The physician who ordered the procedure considered this appropriate because isolated polyps were reported in the patient's father and paternal uncle, which apparently led him to believe that the diagnosis was familial adenomatous polyposis. During litigation procedures, a pedigree was constructed and found to be consistent with hereditary nonpolyposis colorectal cancer. The case was settled in favor of the plaintiff before trial. CONCLUSION: It is essential to understand the natural history of hereditary nonpolyposis colorectal cancer, inclusive of the need for surveillance colonoscopy in patients at increased risk by virtue of their position in their family pedigree.

Adenomatous Polyposis Coli↗
PubMed1999

Acute corneal necrosis after excimer laser keratectomy for hyperopia.

OBJECTIVE: To describe a new, rare clinical complication after routine excimer laser photorefractive keratectomy to correct hyperopia. DESIGN: Case report with clinicopathologic correlation. MAIN OUTCOME MEASURES: Four weeks after treatment with excimer laser, a perforating keratoplasty was performed for persistent corneal opacities. The corneal button was examined using light and electron microscopy. Special immunohistochemical stains were used to detect apoptosis. RESULTS: The patient developed corneal opacities, endothelial precipitates, and a fibrinous exudate in the anterior chamber after the laser treatment. The changes did not respond to therapy directed against bacteria, fungi, and Acanthamoeba. All examinations and special stains were negative for micro-organisms. By light microscopy, an anterior zone of corneal necrosis was present with a moderate amount of acute inflammatory cells. At the interface between necrotic and viable corneal stroma, keratocytes with typical features of apoptosis were detected by immunohistochemistry and electron microscopy. CONCLUSION: This is the first full histopathologic report of a case of acute corneal necrosis with signs of apoptosis after excimer laser therapy of the cornea. Surgeons should be aware of this rare but potentially severe complication.

Acute Disease↗
PubMed1998

Granular corneal dystrophy: treatment with soft contact lenses.

Perforating keratoplasty was performed in both eyes of two siblings (sister and brother) with typical granular corneal dystrophy. Three of the operated eyes showed a recurrence of the underlying disease. In one eye, a recurrence could not be detected 14 years after the operation. This eye had been fitted with a contact lens 16 months after keratoplasty because of aphakia. Thus a contact lens may have a therapeutic effect in this primary epithelial disease.

Adult↗
PubMed1998

Corneal injury after carbon dioxide laser skin resurfacing.

PURPOSE: To describe a corneal injury in both eyes of a patient who had undergone carbon dioxide laser skin resurfacing. METHOD: Case report. RESULTS: A 67-year-old woman had severe pain and decreased vision in both eyes after undergoing laser skin resurfacing treatment with a pulsed carbon dioxide laser. Clinical examination disclosed a corneal ulcer, a bullous keratopathy, and intrastromal bleeding. After perforating keratoplasty, the histologic examination of the cornea showed signs of thermal injury. CONCLUSIONS: The results of the histologic examination and the onset of symptoms within 24 hours after therapy suggest that the laser application caused the corneal damage. Safety guidelines for this procedure should be reviewed.

Aged↗
PubMed1997

Management of fibrous histiocytoma of the corneoscleral limbus: report of a case and review of the literature.

BACKGROUND: Fibrous histiocytomas of the corneoscleral limbus are rare tumors. We present an additional case and review the treatment approaches in the literature. So far, only light and electron microscopic studies have been performed. We used immunohistochemical stains to further characterize the cellular composition. METHODS: The excised lesion was routinely fixed and processed for light microscopy and immunohistochemical studies. For comparison, three dermal fibrous histiocytomas were also examined and processed similarly. RESULTS: The corneolimbal tumor was mainly composed of fibroblasts and histiocytes with a large amount of interstitial collagen, arranged in a storiform pattern. Immunohistochemical stains were positive for histiocytes, fibroblasts, and a marker for mesenchymal cells. The staining pattern of the dermal lesions was similar. CONCLUSION: Fibrous histiocytomas of the corneolimbal region are morphologically benign, slowly growing and infiltrative tumors. Complete resection, especially of the deep margin, is suggested. The immunohistochemical staining pattern is similar to that of dermal fibrous histiocytomas, which behave in a benign manner.

Adult↗
PubMed1997

Medos/HIA-assist system: first experiences with mechanical circulatory assist in infants and children.

The Medos/HIA-System is a new pneumatically driven system for mechanical circulatory assist. The system is characterized by excellent efficiency at high heart rates and is available with three ventricles of 10, 25 and 60ml stroke volume. It can be used as left-, right- or biventricular assist device. Our preliminary experiences with this novel system for support of infants and children are reported.

Blood Pressure↗
PubMed1996

Severe congenital lagophthalmos with tarsal aplasia.

Congenital elongation of the palpebral fissure associated with large eyelids was named euryblepharon after Desmarres in 1854. In some cases the length of the lower lid margin exceeded that of the upper lid margin by more than 3 mm. The lids are lax and the elongated lid margin of the lower lid is only partially in contact with the globe. In marked cases of euryblepharon there may be an additional minor vertical shortening of the upper lid. However, the abnormalities described by Desmarres did not produce severe kerato-conjunctival xerosis. We speculate that euryblepharon as originally described is merely a mild manifestation of congenital lagophthalmos. More severe forms show additional malformations, leading to pronounced insufficiency of lid closure. We report on four patients with severe congenital lagophthalmos. The appearance differs from that of euryblepharon by the following details: (a) a symmetrical congenital retraction of both the lower and the upper lid margins; (b) a marked vertical shortening of the lids (case 1 was referred for bilateral descemetoceles); (c) tarsal aplasia; and (d) severe kerato-conjunctival xerosis after insufficient surgical treatment, leading to different degrees of disability. The surgical approach involved bilateral shortening of the lid margins and free transplantation of retroauricular skin. Stabilization of the lax lower lid margin was achieved by lyodura strips applied with medium tension and in contact with the lid margin. At 5 years after the first operation a petty horizontal shortening of the lower lids was necessary because of circumscribed trichiasis. The dura strip remained present. The long-term result as evaluated at more than 8 years following the first operation was very satisfactory.

Adult↗
PubMed1995

Measurement of glucosinolates in rapeseeds.

Several ring tests have been organized by the International Organisation for Standardization (ISO) and the Measurement and Testing Programme (BCR) for improving glucosinolate methods. Finally, HPLC of desulphoglucosinolates is recommended by ISO, the European Committee for Standardization (CEN), and the European Commission (EC) as the official method. X-ray fluorescence has also become particularly common for fast analysis. After checking stability of intact glucosinolates in whole rapeseeds, the BCR has three reference materials (CRM 366, CRM 190, CRM 367) available, certified for their total glucosinolate and sulphur contents. Currently, the Measurement and Testing Programme is supporting a research project concerning the stability of desulphoglucosinolates and intact glucosinolates extracts. At the present time, best results are observed with lyophilized extracts sealed in brown glass ampoules and stored at -18 degrees C.

Brassica↗
PubMed1994

Psychological aspects of monitoring high risk women for breast cancer.

BACKGROUND: There is a paucity of knowledge pertaining to the attitudes, feelings, and emotions of women who are at increased familial risk for breast cancer and how these concerns will affect their surveillance behavior. A review of the literature shows an unevenness in the conclusions about these matters, with some reports indicating that anxiety aroused in the familial cancer setting may abet surveillance behavior, whereas other data indicates a negative effect. METHODS: The authors reported anecdotal accounts of such behavior in women from hereditary breast and hereditary breast-ovarian cancer prone families. RESULTS: Although these responses of fear, anxiety, and apprehension about cancer risk are not unique to this hereditary cohort, they nevertheless must have been tempered by often life-long exposure of cancer occurrences that may have decimated their families. CONCLUSIONS: All accounts agree with the need to devote more research to the special needs--psychological, social, insurance, and general public health measures--of these high risk women.

Adoption↗
PubMed1994

Relaxing incisions with compression sutures for control of astigmatism after penetrating keratoplasty.

BACKGROUND: Ten per cent of patients with persisting postoperative astigmatism following penetrating keratoplasty (PK) require surgical re-intervention, despite an otherwise "successful" transplant. Relaxing incisions (RIs) in combination with compression sutures seem to be the preferable procedure. However, poor predictability and lack of long-term experience complicate the issue. Here we report the 2-year follow-up results of 25 patients with high PK astigmatism treated by means of RIs and compression sutures. METHODS: Commonly, free-handed RIs were placed at the graft-host interface and 10-0 nylon compression sutures were placed perpendicular to the incisions. PK sutures had been removed no less than 4 months prior to refractive surgery. RESULTS: Nineteen eyes regained a functional vision of > or = 0.4. The net decrease in astigmatism was 6.1 +/- 4.3 D (47 +/- 21%). The mean vector-corrected change in astigmatism was 13.1 +/- 5.7 D. Cylinder axis variation was reasonably low, with a correlation of attempted versus achieved axis of r = 0.85. Within the first 3 months after operation the induced astigmatism regressed by, on average, 5.5 +/- 4.3 D, making intraoperative overcorrection necessary. As an inevitable side effect, refractive procedures resulted in a myopic shift (4.7 +/- 6.9 D) in spherical equivalence. CONCLUSION: RIs and compression sutures are very useful in reducing postkeratoplasty astigmatism if correction of extremely high cylinder (> 10 D) is not intended. However, predictability still remains unsatisfactory and more than one operation may be required.

Adult↗
PubMed1994

[Evaluating the noise problem in regional town planning].

While looking for enough living quarters for the town people regional planners are often confronted with high levels of noise due to traffic, highways and railways near the planning area. This may change or even stop the procedure of town planning. Generally, health authorities--who are more or less involved in the process of planning--should take the chance to demand compatibility of special planning with health care regarding noise. However, most guidelines on health-compatible noise levels are not legally binding. This paper describes the variety of health problems accompanied by moderate to high levels of noise. In regions with traffic noise problems efforts should be directed at maximum health compatibility coupled to highly imaginative planning. It is suggested that levels of noise of 55 dB(A) (daytime) and of 45 dB(A) (nighttime) should be tolerated near to the building. This would ensure tolerable levels of noise of 35 dB(A) (daytime) and of 30 dB(A) (nighttime) in the dwellings. Examples of different arrangements of buildings are shown. They demonstrate that these tolerable noise levels could even be observed in areas with traffic problems. It mostly depends on the planner's imagination whether the need for dwelling houses in problem areas could be met in keeping with health demands.

Automobiles↗
PubMed1993

[A study of the quantitative dual-parameter flow cytometry analyses of cellular antigens on transitional cells for the diagnosis of bladder cancer].

To establish a quantitative dual-parameter flow cytometry (FCM) analysis of cell surface antigens, possible obstacles caused by contaminated leucocytes in a specimen and staining and measuring conditions were investigated using human bladder cancer cell lines, 5637, T24 and SW1710. The first monoclonal antibody (MoAb) used to select urothelial cells in a specimen was applied with the second MoAb used to discriminate between normal and transformed urothelial cells. MoAbs Due AUT 2 and CD45 appeared to be suitable for the selection of urothelial cells, while Due ABC 3 and Due ABC 5 were applied to detect transformed cells. Tumor cell-leucocyte suspension was simultaneously stained with combinations of these MoAbs. The results demonstrated that Due AUT 2 and CD45 effectively eliminated contaminated leucocytes by means of positive and negative selection of the urothelial cells, respectively. Based on these experiments, dual-parameter FCM analyses of bladder washing from 5 patients with bladder cancer were performed using MoAbs Due AUT 2 and Due ABC 3. The results indicated that by dual-parameter FCM distinct antigenic features of transitional cells could be investigated even if considerable amounts of contaminated leucocytes were present. The clinical impact of this approach is a subject of ongoing trials.

Antibodies, Monoclonal↗
PubMed1991

[Postgastrectomy findings in the after care of 227 patients with stomach carcinoma].

Rehabilitation needs and problems in 227 gastric cancer patients. In an investigation on needs of rehabilitation in gastric cancer we evaluated postgastrectomy problems in 227 gastrectomized patients. The average weight loss was 5% prior to operation and there was a further weight loss of 16% in the follow-up 18 months after the operation due to the postgastrectomy syndrome. The most frequent complaints of gastrectomized patients were inappetence (32%), reflux oesophagitis (25.1%), eructation (54.2%), diarrhea (22%), flatulence (36.5%), dumping syndrome (20.4%). 176 patients (78%) observed an indigestion of certain food since the operation. Postgastrectomy syndromes were more frequent in totally than in partially gastrectomized patients.

Female↗
PubMed1990

Recurrent Salzmann's corneal degeneration.

Three keratoplasties were carried out on two patients because of nodular degeneration of the cornea. Progress after keratoplasty could be followed up in one eye for 17 months and in the other two eyes, for 2.5 and 9 years, respectively. The implant with the short follow-up of only 17 months remained glass-clear; nothing abnormal was discovered during the checkups. In the case of the other patient in whom a longer follow-up period was possible, the following findings were evident: (1) a remarkably late epithelial immune response in one eye (after 18 months) with subsequent incomplete reepithelisation and formation of fine, superficial, cloudy opacity (observation period 2.5 years); (2) formation of dense but flat, superficial areas of opacity in the cornea of the other eye (observation period 9 years). These areas may be regarded as a precursor of Salzmann's corneal degeneration. No difference could be found between the histological findings in the explants and those in a degenerative pannus or an older scar caused by inflammation of the Bowman membrane.

Aged↗