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Biomedical subjects

V Rummelt

Publications and source records attributed to V Rummelt.

At least 37 records · Page 2Linked to original sources
PubMed1994

Triple retinal infection with human immunodeficiency virus type 1, cytomegalovirus, and herpes simplex virus type 1. Light and electron microscopy, immunohistochemistry, and in situ hybridization.

PURPOSE: This report describes the histopathologic and virologic findings of the retina from a 55-year-old bisexual patient with the acquired immune deficiency syndrome (AIDS), who had concurrent human immunodeficiency virus type 1 (HIV-1), cytomegalovirus (CMV), and herpes simplex virus type 1 (HSV-1) retinitis, and was treated with ganciclovir. METHODS: The eyes were obtained at autopsy and processed for light microscopy and transmission electron microscopy. Immunohistochemical stains for HSV-1, CMV, HIV-1, varicella zoster virus, and glial fibrillary acidic protein were carried out using the peroxidase-antiperoxidase and streptavidin-biotin-alkaline phosphatase techniques. For in situ hybridization, a radiolabeled CMV DNA probe (Eco-RI-Y fragment of strain AD 169) was used. RESULTS: Results of histopathologic examination showed a full-thickness necrotizing retinitis with cytomegalic and herpes viral intranuclear inclusions in cells of the neurosensory retina, retinal vascular endothelium, and the retinal pigment epithelium. Some areas of the retina were replaced by glial tissue. The choroid contained only a few chronic inflammatory cells. Immunoperoxidase studies disclosed CMV antigens diffusely distributed throughout all layers of the retina and the retinal pigment epithelium. Herpes simplex virus type 1 antigens were present in retinal cells and the retinal vascular endothelium. Human immunodeficiency virus type 1 antigens were found in mononuclear cells in all layers of the sensory retina. Dual infections with HIV-1 and CMV of individual multinucleated giant cells of glial origin were demonstrated immunohistochemically. Transmission electron microscopy showed herpes viral particles in the vascular endothelium of the retinal vessels and the choriocapillaris. Human immunodeficiency virus particles were identified in the endothelium of the choriocapillaris. CONCLUSIONS: The possibility of multiple viral infections of the retina, mimicking classic CMV retinitis, should be considered in the clinical and histologic differential diagnosis of necrotizing retinitis in patients with AIDS.

Antibodies, Viral↗
PubMed1994

Three-dimensional relationships between tumor cells and microcirculation with double cyanine immunolabeling, laser scanning confocal microscopy, and computer-assisted reconstruction: an alternative to cast corrosion preparations.

The morphology of the microcirculation of uveal melanomas is a reliable market of tumor progression. Scanning electron microscopy of cast corrosion preparations can generate three-dimensional views of these vascular patterns, but this technique sacrifices the tumor parenchyma. Formalin-fixed wet tissue sections 100-150 microns thick from uveal melanomas were stained with the lectin Ulex europaeus agglutinin I (UEAI) and proliferating cell nuclear antigen (PCNA) to demonstrate simultaneously the tumor blood vessels and proliferating tumor cells. Indocarbocyanine (Cy3) was used as a fluorophore for UEAI and indodicarbocyanine (Cy5) was used for PCNA. Double labeled sections were examined with a laser scanning confocal microscope. Images of both stains were digitized at the same 5-microns intervals and each of the two images per interval was combined digitally to form one image. These combined images were visualized through voxel processing to study the relationship between melanoma cells expressing PCNA and various microcirculatory patterns. This technique produces images comparable to scanning electron microscopy of cast corrosion preparations while permitting simultaneous localization of melanoma cells expressing PCNA. The microcirculatory tree can be viewed from any perspective and the relationship between tumor cells and the tumor blood vessels can be studied concurrently in three dimensions. This technique is an alternative to cast corrosion preparations.

Antigens, Neoplasm↗
PubMed1993

Ocular pathology of MELAS syndrome with mitochondrial DNA nucleotide 3243 point mutation.

PURPOSE: The authors describe the clinical, histopathologic, and ultrastructural findings in two eyes obtained at autopsy from a 21-year-old woman with mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS syndrome). METHODS: The eyes were obtained immediately after death. The right eye was fixed in 10% neutral-buffered formalin and processed for standard histologic examination. The left eye was fixed in a neutral-buffered 2.5% glutaraldehyde solution and processed for transmission electron microscopic examination. The authors compared the histologic and ultrastructural findings with the clinical features recorded photographically. RESULTS: The main clinical ophthalmologic features were bilateral ptosis, chronic external ophthalmoplegia, diffuse choroidal atrophy, atypical pigmentary retinopathy with macular involvement, and patchy atrophy of the iris stroma. Molecular genetic analysis detected a tRNA Leu (UUR) point mutation at position 3243 of mitochondrial DNA (MELAS genotype). Results of histologic and ultrastructural examination showed ragged-red fibers in the rectus muscles, degeneration of photoreceptor outer segments in the macula, hyperpigmentation and atrophy of the retinal pigment epithelium of the macula, atrophy of the iris stroma, early posterior subcapsular cataract, and optic atrophy. The retinal pigment epithelium, inner segments of the photoreceptors, smooth muscle cells of the choroidal and retinal vessels, the dilator and sphincter muscle of the iris, cornea, lens epithelium, and ciliary epithelium all contained many, often enlarged, structurally abnormal mitochondria with occasional paracrystalline inclusions and circular cristae. CONCLUSIONS: The MELAS-associated mitochondrial DNA nucleotide 3243 point mutation can cause a spectrum of ocular signs and symptoms that may be dependent on the patient's age and the amount of mutant mitochondrial DNA in the tissue. MELAS syndrome should be considered in the differential diagnosis of bilateral ptosis, external ophthalmoplegia, and atypical pigmentary retinopathy with macular involvement.

Adult↗
PubMed1993

The prognostic value of tumor blood vessel morphology in primary uveal melanoma.

BACKGROUND: It is possible to identify at least nine vascular patterns in melanomas of the ciliary body and choroid from histologic sections. An association between the presence of at least one closed vascular loop and death from metastases was shown in a matched-pair, case-control study of 40 patients whose eyes were removed for ciliary body or choroidal melanomas. METHODS: Two independent observers who were masked to the follow-up of patients examined histologic preparations of 234 eyes removed for ciliary body or choroidal melanomas for the presence of each of the tumor vascular patterns. Statistical analyses included tests for interobserver reliability, Kaplan-Meier survival curves, and the fitting of Cox regression models. RESULTS: The detection of each of the nine vascular patterns is highly reproducible. The Cox model indicates that the presence of vascular networks, defined as at least three back-to-back closed vascular loops, is the feature most strongly associated with death from metastatic melanoma. Other significant factors in the Cox model include (in descending order of importance) largest tumor dimension, mitoses, the parallel with cross-linking vascular pattern, age, the presence of tumor-infiltrating lymphocytes, and male gender. CONCLUSIONS: The presence of vascular networks provides the most significant association with death from metastatic melanoma of all variables tested. The presence of this pattern should be recorded on pathology reports. If it becomes possible to detect this vascular pattern clinically using a noninvasive imaging technique, then ophthalmologists may be able to determine the likely biologic behavior of a melanoma before resorting to the removal of tissue.

Adolescent↗
PubMed1993

Congenital nonpigmented epithelial iris cyst after amniocentesis. Clinicopathologic report on two children.

BACKGROUND: Congenital nonpigmented epithelial iris cysts are not common. They may arise spontaneously from developmental entrapment of surface ectodermal epithelium or from occult ocular trauma prenatally or at birth. PATIENTS AND METHODS: Between 1989 and 1991, an 8-month-old child and a 6-year-old child presented with large, progressive congenital epithelial iris cysts. Both children had a maternal history of diagnostic amniocentesis after an ultrasound scan, and there was no history of postnatal ocular trauma. The cysts were successfully removed by a modified block excision and tectonic corneoscleral grafting. RESULTS: A dense adherence of the cyst wall to Descemet's membrane resembled old anterior synechiae after occult perforation of the globe in both patients. On histopathologic examination, the epithelial lining of the cysts consisted of non-keratinizing stratified squamous epithelium with goblet cells resembling conjunctival epithelium. A perforating limbal scar with a corresponding break in Descemet's membrane could be detected in one eye. The long-term visual acuity of both children was encouraging, and there was no evidence of recurrence of the iris cyst during the follow-up period (average, 23 months). CONCLUSIONS: The authors conclude that the clinical and histopathologic features of these congenital iris cysts may be consistent with an occult intrauterine limbal perforation of the anterior chamber with a needle during amniocentesis. Amniocentesis, when not guided by a real-time ultrasound scan, may be a risk factor for prenatal ocular trauma, which should be considered in the differential diagnosis of congenital ocular disorders.

Amniocentesis↗
PubMed1993

[Clearing of the para-transplant host cornea after perforating keratoplasty in Maroteaux-Lamy syndrome (type VI-A mucopolysaccharidosis)].

BACKGROUND: The results of penetrating keratoplasty in patients with systemic mucopolysaccharidosis (MPS) type VI-A are controversial. Clouding of the transplant was often observed and was thought to be related to storage of glycosaminoglycans also in the donor button. PATIENTS AND METHODS: We performed penetrating keratoplasties successfully in three children with MPS VI-A (severe type) at the age of 7-11 years. RESULTS: The transplants remained clear during the follow-up of 2.5-5 years and the longterm visual acuity was encouraging. In two patients we could observe a partial, circular clearing of the host's cornea adjacent to the transplant. The related pathomechanism and the clinical, histopathological and ultrastructural findings of the cornea will be discussed. CONCLUSION: As the intellectual development is normal, decrease of vision impairs the patient's life extremely. Thus, the indication of penetrating keratoplasty should be made early to improve the patient's quality of living, who have a reduced life-span.

Adolescent↗
PubMed1993

Epithelial transformation of the corneal endothelium in forceps birth-injury-associated keratopathy.

Using light and electron microscopy, we studied four keratectomy specimens obtained by penetrating keratoplasty from four patients (ages 33-54 years; mean age: 43 years old) who had clinical evidence of Descemet's folds and bullous keratopathy after ruptures in Descemet's membrane after forceps injury at birth. Histopathologically, three patients showed the typical features of forceps birth injury: Descemet's membrane at the margin of the rupture was folded and assumed a scroll-shape configuration. The fourth patient showed clusters of proliferated endothelial cells at the site of two ruptures, and from one site of the ruptures, these cells invaded into Descemet's membrane, forming a new basement membrane. Transmission electron microscopy revealed that these proliferated cells were epithelial-like cells characterized by desmosomal junctions, basal lamina, numerous microvilli, and 8-nm cytoplasmic filaments. The epithelial transformation of the corneal endothelium was identified in cases of posterior polymorphous dystrophy and assumed to be specific for this entity. The findings in our fourth patient represent the first documentation of epithelial-like cells on the posterior corneal surface in forceps birth-injury-associated keratopathy. Our results suggest that epithelial transformation may be a nonspecific reaction of the young cornea to various stimuli.

Adult↗
PubMed1993

Detection of varicella zoster virus DNA and viral antigen in human cornea after herpes zoster ophthalmicus.

This article describes the histopathology, immunohistochemistry, and varicella zoster virus DNA in situ hybridization of 14 corneal buttons obtained from 14 patients (average age 69.0 years) after perforating keratoplasty (four patients) or surgical enucleation (10 patients) at different times after the clinical onset of herpes zoster ophthalmicus (average 58.7 months). The main histopathologic features were intense stromal vascular scarring (12 patients) and granulomatous reaction to Descemet's membrane (nine patients). Using the peroxidase-antiperoxidase method, varicella zoster virus (VZV) antigen could be detected by immunohistochemistry in two patients within epithelial cells of the cornea and in the limbal episclera during the active phase of herpes zoster ophthalmicus. For in situ hybridization we used the 35S-labeled HindIII A and C fragment of VZV and identified viral DNA in five corneal buttons obtained 1 day to 8 years after the clinical onset of infection. Viral DNA was mainly found in mononuclear cells with eosinophilic intracytoplasmic inclusions within vascular stromal scars, in keratocytes, and in epithelial cells of the cornea. Our results show that VZV DNA is detectable in human cornea even 8 years after the clinical onset of herpes zoster ophthalmicus and may indicate VZV persistence in a latent form in corneal tissue or reactivation of the virus from an endogenous or exogenous source causing a severe and often recurrent keratitis in the progress of herpes zoster ophthalmicus.

Adult↗
PubMed1993

Chronic postoperative endophthalmitis following cataract extraction and intraocular lens implantation. Report on nine patients.

Between 1987 and 1992, nine patients (three men and six women; mean age, 75 years) presented with chronic postoperative endophthalmitis after cataract extraction and intraocular lens (IOL) implantation. Eight patients were referred from another institution. The interval between IOL implantation and the beginning of intraocular inflammation averaged 5.6 months (range, 1-19 months). The referral diagnosis was "toxic lens" syndrome in seven patients. The main clinical findings were a hypopyon in the anterior chamber (n = 8) and in the capsule bag (n = 2), and "fibrosis" of the lens capsule (n = 7). In eight patients a vitrectomy was performed, combined with removal of the IOL in six cases and with a total posterior capsulectomy in five cases. Pathogenic organisms were identified in vitreous aspirate (6/8), in culture (3/3), and on histopathological examination (4/5) of lens capsule and included coagulase-negative staphylococci (n = 3, Staphylococcus epidermidis), Propionibacterium acnes (n = 1), Streptococcus viridans (n = 1), Rhodococcus erythropodes and R. luteus (n = 1), and one hyphomycete (Alternaria alternata). In chronic recurrent intraocular inflammations following IOL implantation, an infectious agent should be excluded by diagnostic and therapeutic pars plana vitrectomy including removal of the IOL and posterior capsulectomy.

Aged↗
PubMed1992

Block excision of cystic and diffuse epithelial ingrowth of the anterior chamber. Report on 32 consecutive patients.

From 1980 to 1990, 32 consecutive patients with progressive cystic or diffuse epithelial ingrowth of the anterior chamber were treated successfully with block excision. This technique consists of simultaneous removal of adjacent iris, pars plicata of ciliary body, and all layers of sclera and cornea in contact with the lesion acting as a shell. The resulting defect is covered by a tectonic corneoscleral graft. Twelve patients had suffered from perforating ocular injury, 10 patients had previously undergone cataract extraction, and 10 patients had various causes of epithelial ingrowth. Cystic epithelial ingrowth occurred in 27 patients, diffuse sheetlike epithelial ingrowth occurred in four patients, and one lesion was identified as foreign body granuloma. On histopathologic examination, all but two patients revealed epithelial involvement of the surface of the ciliary body. All patients were followed up for an average of 60.1 months (range, 1 to 120 months). Long-term visual acuity was better than 20/60 in 37.5% of the patients. No recurrence of ingrowth was noted and enucleation was not necessary. Our results indicate that block excision currently may be the treatment of choice for cystic and diffuse sheetlike epithelial ingrowth of the anterior chamber.

Adolescent↗
PubMed1992

Detection of varicella zoster virus DNA and viral antigen in the late stage of bilateral acute retinal necrosis syndrome.

We describe the clinicopathologic and virologic findings in the right, blind eye of an immunocompetent 61-year-old woman. The eye was enucleated 32 months after the clinical onset of a bilateral acute retinal necrosis syndrome. Histopathologic study showed a diffuse, full-thickness, necrotizing retinitis with replacement of sensory retinal structures by glial tissue, occlusive retinal arteritis, granulomatous choroiditis, and optic neuritis with ischemic optic atrophy. Varicella zoster virus could be identified as the causative agent by DNA in situ hybridization and by immunohistochemical stains in mononuclear cells with eosinophilic intracytoplasmic inclusions. Virus was detected only within the choroid and the choriocapillaris. We conclude that these histopathologic and virologic features are consistent with a "burned-out phase" of a varicella zoster virus-induced acute retinal necrosis syndrome.

Antigens, Viral↗
PubMed1992

[Incidence of postoperative bacterial infections after planned intraocular interventions].

Between August 1982 and August 1984 3059 intraocular operations were performed with topical prophylactic antibiotics. Results of conjunctival cultures did not influence the surgical schedule. 8179 intraocular operations were performed between September 1984 and August 1988. An intraocular operation was postponed until conjunctival cultures were negative using topical antibiotics administered at hourly intervals. The rate of postoperative intraocular infections decreased significantly (p less than 0.0001) from 21 (0.69%) of 3059 during the first to 9 (0.11%) of 8179 intraocular operations during the second observation period. In the first period 11 vitrectomies and 2 enucleations due to bacterial endophthalmitis had to be performed. In the second period 2 vitrectomies and no enucleations were necessary (p less than 0.0001). Our results indicate, that decontamination of the conjunctiva may be an import factor for the prevention of postoperative endophthalmitis following elective intraocular surgery.

Adult↗
PubMed1992

[Orbital, osseous, meningeal and cerebral findings in oculodermal melanocytosis (nevus of Ota). Clinico-histopathologic correlation in 2 patients].

In two patients suffering from congenital oculodermal melanocytosis (nevus of Ota) orbital, osseous, meningeal, and cerebral manifestations are documented. In a 38-year-old European with a nevus of Ota on the right side an ipsilateral orbital tumor was diagnosed and surgically removed. The histological examination revealed a primary spindle shaped malignant melanoma of the orbit. In addition, many benign melanocytes were found in the optic nerve, in the extraocular muscles, in the orbital fat tissue, and in the dura of the sphenoid. In a 17-year-old Ethiopian with a nevus of Ota of the right side an increase in size of the pigmented process was observed during puberty in the orbital fat tissue, in the extraocular muscles, in the optic nerve, in the periorbital bones, in the temporal muscle, and in the cortex of the frontal brain lobe. A deep excision from the lower eye lid revealed a histologically benign oculo-orbito-dermal melanocytosis. An irradiation was performed because of growth again after segmental excision, however without success. In the ipsilateral eye a secondary open-angle glaucoma was diagnosed. In the nevus of Ota an involvement of the orbit and of the meningo-cerebral tissue must be considered.

Adolescent↗
PubMed1992

[Persistence and transient conjunctival pathogen colonization before planned intraocular interventions].

The risk of a postoperative endophthalmitis is influenced by the presence of a significant bacterial colonisation of the conjunctiva before intraocular surgery. Between February and August 1990 we performed conjunctival smears in 481 patients 1) on the eve of the operation and 2) just before planned intraocular surgery, to evaluate a persistent or transient microbial colonisation of the conjunctiva. 352 patients showed insignificant ("negative") and 129 patients a significant ("positive") bacterial growth in the first conjunctival smear. 96% of the patients (n = 336) had a negative result in both smears. 30% of the patients (n = 37) with a positive conjunctival smear showed a persisting bacterial colonisation, whereas 70% of the patients (n = 92) had a transient colonisation of the conjunctiva with a negative second smear. As a persisting microbial colonisation of the conjunctiva may be an important factor for the development of postoperative endophthalmitis, we recommend prophylactic conjunctival smears before surgery to diminish the risk of intraocular infections after surgery.

Bacteria↗
PubMed1992

Light and electron microscopy of the cornea in systemic mucopolysaccharidosis type I-S (Scheie's syndrome).

A 37-year-old man with coarse facies, stiff joints, corneal clouding, and normal intelligence sought medical attention. The diagnosis of a systemic mucopolysaccharidosis (MPS) type I-S (Scheie's syndrome) was confirmed by the presence of lysosomal alpha-L-iduronidase deficiency and excessive urinary dermatan and heparan sulfate excretion. The corneal button after perforating keratoplasty of the right eye demonstrated mucopolysaccharides consisting of numerous vacuoles containing fibrillogranular and partly membranebound material in epithelial cells, histiocytes, keratocytes, and extracellular matrix. Endothelial cells were distinctly free of storage material. The epithelial basement membrane showed frequent breaks, whereas Bowman's layer was only slightly attenuated. Irregular collagen fibrils and fibrous long-spacing collagen were noted near degenerating distended keratocytes. The Descemet's membrane was normal. The literature of six reported histopathological examinations of the cornea in Scheie's syndrome is reviewed. Detection of fibrous long-spacing collagen seems to be a typical abnormality of the cornea in MPS I-S.

Adult↗
PubMed1992

Block excision of congenital and infantile nonpigmented epithelial iris cysts. Report on eight infants.

Spontaneous congenital and acquired nonpigmented epithelial iris cysts are rare unilateral lesions of the anterior uvea. From 1980 to 1991, eight infants with progressive nonpigmented epithelial iris cysts were successfully treated by block excision. This technique consists of simultaneous removal of the adjacent iris, the pars plicata of the ciliary body, and all layers of the sclera and cornea in contact with the lesion that serve as a shell for the proliferating epithelium. The resulting defect is covered with a tectonic corneoscleral graft. Five of the children, whose ages ranged from 1 month to 7 years (average, 3.7 years), presented with a congenital nonpigmented epithelial iris cyst and three infants presented with a cystic epithelial ingrowth following perforating injury. On histopathological examination, all but one patient revealed epithelial involvement of the surface of the ciliary body. All patients were followed for an average of 45.5 months. The long-term visual acuity of our very young patients was encouraging, ranging from 20/200 to 20/20. No recurrence of iris cysts was noted and no enucleation was necessary. Our results indicate that block excision may be the treatment of choice for congenital and infantile nonpigmented epithelial iris cysts.

Child↗