153 results on '"F. Birnbaum"'
Search Results
102. Patient engagement and the design of digital health.
- Author
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Birnbaum F, Lewis D, Rosen RK, and Ranney ML
- Published
- 2015
- Full Text
- View/download PDF
103. [Adenoviral keratoconjunctivitis].
- Author
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Pleyer U and Birnbaum F
- Subjects
- Cyclosporine administration & dosage, Diagnosis, Differential, Humans, Ophthalmic Solutions, Treatment Outcome, Adenoviridae Infections diagnosis, Adenoviridae Infections prevention & control, Eye Infections, Viral diagnosis, Eye Infections, Viral prevention & control, Keratoconjunctivitis diagnosis, Keratoconjunctivitis prevention & control
- Abstract
Keratoconjunctivitis caused by adenoviruses (epidemic keratoconjunctivitis, EKC, ICD-10 B30.0+) is common, can be severe and may cause significant morbidity. In the early stages of adenoviral infections it is often difficult to differentiate the clinical presentation from other causes of a red eye. Because of its highly contagious nature that can rapidly lead to epidemic outbreaks, prompt viral identification and prevention of further spread are major challenges. Even today the diagnosis is still mainly clinical, with laboratory tests only rarely contributing. New diagnostic tests, such as the Rapid Pathogen Detector (RPS, Sarasota FL) AdenoPlus detection kit, that are practical, rapid and inexpensive to use in the general practice may obviate these problems. Because of its highly resistant properties to desiccation and highly developed escape mechanisms which protect the virus from the host's immune response, long-term problems often remain. Remnants of viral proteins often persist on the corneal surface of Bowman's layer for a long time and may lead to the formation of subepithelial infiltrates. No treatment other than symptomatic eye drops is available. The major sequelae are subepithelial infiltrates, which are difficult to treat. Cyclosporin A eye drops are a good option with a low risk profile. The use of topical steroids can possibly be disadvantageous but can be discussed at all stages of the disease. As nosocomial spread of adenoviruses is relatively common, preventive measures remain a major responsibility for ophthalmologists.
- Published
- 2015
- Full Text
- View/download PDF
104. [Integrity of the anterior capsulotomy after femtosecond laser-assisted cataract surgery].
- Author
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Birnbaum F
- Subjects
- Female, Humans, Male, Anterior Capsular Rupture, Ocular etiology, Anterior Capsule of the Lens injuries, Cataract Extraction adverse effects, Laser Therapy adverse effects, Phacoemulsification adverse effects
- Published
- 2014
- Full Text
- View/download PDF
105. [Immunosuppressives to prevent rejection reactions after allogeneic corneal transplantation].
- Author
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Lapp T, Maier P, Birnbaum F, Schlunck G, and Reinhard T
- Subjects
- Humans, Keratitis etiology, Transplantation, Homologous adverse effects, Corneal Transplantation adverse effects, Graft Rejection etiology, Graft Rejection prevention & control, Immunosuppressive Agents administration & dosage, Keratitis prevention & control, Premedication methods
- Abstract
In order to prevent rejection of an allogeneic corneal transplant after perforating (high risk) keratoplasty, active agents from different classes of pharmacological substances are used, as with solid organ transplantation. In addition to glucocorticoids, antiproliferative agents, small molecule inhibitors and antibodies, those belonging to the group of macrolides with their many derivatives represent an interesting class of substances in this context. As a supplement to cyclosporin A (CSA) the most successful macrolide in transplantation medicine, animal experiments are currently being carried out to test newer macrolide derivatives, such as sanglifehrin A (SFA). This overview describes the classes of drugs and modes of action of currently administered standard medications in the clinical routine and new developments are presented.
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- 2014
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106. Contrast sensitivity with bifocal intraocular lenses is halved, as measured with the Freiburg Vision Test (FrACT), yet patients are happy.
- Author
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Anton A, Böhringer D, Bach M, Reinhard T, and Birnbaum F
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- Adult, Aged, Aged, 80 and over, Female, Humans, Lens Implantation, Intraocular, Male, Middle Aged, Phacoemulsification, Prosthesis Design, Retrospective Studies, Surveys and Questionnaires, Treatment Outcome, Contrast Sensitivity physiology, Lenses, Intraocular, Patient Satisfaction, Pseudophakia physiopathology, Vision Tests, Visual Acuity physiology
- Abstract
Background: As the desire for spectacle independence following cataract surgery grows, so does interest in the implantation of multifocal intraocular lenses. However, glare phenomena, reduced intermediate vision and loss of image quality are known problems associated with this new generation of lenses. We compared the functional results achieved by the implantation of the diffractive-refractive Acri.LISA 366D lenses to those achieved from implanting monofocal Acri.Smart 46LC lenses., Methods: In a retrospective data analysis we followed ten patients who received bifocal intraocular lenses (Acri.LISA 366D) and ten patients who received monofocal intraocular lenses (Acri.Smart 46LC). Lenses were always implanted in both eyes. In each group we assessed visual acuity and contrast sensitivity with the Freiburg Vison Test (FrACT) at multiple distances ranging from 0.5 to 5 m. Additionally, we assessed near vision with the Birkhaeuser charts. We also evaluated photopic phenomena and patient satisfaction using a standardised questionnaire. One patient in the Acri.LISA group and six patients in the control group missed the recommended follow-up visits., Results: We found good uncorrected distance and near visual acuity. Only three of nine patients wore glasses occasionally. Although their contrast sensitivity decreased by a factor of two compared to the control group, patients did not complain about visual disturbances. Patient satisfaction was predominantly high following Acri.LISA 366D implantation., Conclusions: With the Acri.LISA 366D, patients demonstrate excellent near and distance vision, albeit with reduced contrast sensitivity. Acri Lisa is a viable option in patients that do not want to depend on spectacles.
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- 2014
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107. Clinical results of 123 femtosecond laser-assisted penetrating keratoplasties.
- Author
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Birnbaum F, Wiggermann A, Maier PC, Böhringer D, and Reinhard T
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- Adult, Astigmatism diagnosis, Astigmatism physiopathology, Corneal Diseases immunology, Corneal Diseases physiopathology, Corneal Diseases surgery, Corneal Topography, Female, Fluocortolone therapeutic use, Glucocorticoids therapeutic use, Graft Rejection drug therapy, Graft Rejection immunology, Humans, Male, Middle Aged, Prednisolone analogs & derivatives, Prednisolone therapeutic use, Refraction, Ocular physiology, Suture Techniques, Tomography, Optical Coherence, Treatment Outcome, Visual Acuity physiology, Wound Healing physiology, Astigmatism etiology, Keratoplasty, Penetrating methods, Laser Therapy methods, Postoperative Complications
- Abstract
Background: Postoperative astigmatism following penetrating keratoplasty is a major problem after corneal transplantation. The main goal of new trephination techniques such as femtosecond laser or excimer-laser trephination is to improve refractive and visual outcomes. The femtosecond laser technique makes profiled corneal trephinations such as the top hat or mushroom profile possible. We present the postoperative outcome of femtosecond laser-assisted penetrating keratoplasties., Methods: We performed 123 femtosecond laser-assisted penetrating keratoplasties in 119 patients. The main outcome measures were intraoperative specifics, astigmatism, and irregularity in Orbscan corneal topography, as well as the occurrence of immune reactions and side-effects., Results: All sutures have been removed in 49 of these 123 eyes. Their mean follow-up was 13.9 ± 4.5 months. Time to complete suture removal (n = 49) was 12.0 ± 3.7 months in the mushroom group and 9.8 ± 2.1 months in the top hat group. Mean astigmatism in Orbscan topography was 6.4 ± 3.0 diopters in the mushroom and 5.8 ± 4.6 diopters in the top hat group (all sutures out)., Conclusions: Femtosecond laser-assisted penetrating keratoplasty is a safe surgical technique. Due to the steps in profiled trephinations, the wound area is larger and theoretically the wound healing is, thus, faster and more stable. Complete suture removal is possible at an earlier time point compared to conventional penetrating keratoplasty. However, refractive results are not superior to those following conventional trephination.
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- 2013
- Full Text
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108. Improved wound stability of top-hat profiled femtosecond laser-assisted penetrating keratoplasty in vitro.
- Author
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Maier P, Böhringer D, Birnbaum F, and Reinhard T
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- Humans, Lasers, Excimer therapeutic use, Surgical Wound Dehiscence diagnosis, Suture Techniques, Cornea surgery, Keratoplasty, Penetrating, Laser Therapy methods, Wound Healing physiology
- Abstract
Purpose: The femtosecond laser is a new option for cutting corneal tissue at high precision. The "top-hat" profile has an overlapping graft-host interface at the edge because of a larger inner trephination diameter. This may enhance graft fixation, thus improving the outcome and accelerating rehabilitation after penetrating keratoplasty., Methods: Femtosecond laser top-hat keratoplasties with overlaps of 0 and 3 mm between inner and outer trephination diameters were performed in vitro. After trephination, the excised corneal buttons were readapted by different suturing profiles. Pressure in the artificial anterior chamber was then raised until we observed wound leakage and ultimately wound prolapse., Results: Better wound stability was found in conjunction with all profiled trephinations. When using 4 interrupted sutures, wound leakage occurred at a median of 13.0 cm H2O (mean, 12.3 cm H2O) and "zero overlap," at 19.0 cm H2O (mean, 20.8 cm H2O) and 1-mm overlap, at 32.0 cm H2O (mean, 32.8 cm H2O) and 2-mm overlap, and at 48.5 cm H2O (mean, 49.4 cm H2O) and 3-mm overlap. Comparing zero overlap with the mean values of 1- to 3-mm overlaps, wound leakage happened at 13.0 (mean, 12.3) versus 32.0 (mean, 34.3) cm H2O with 4 interrupted sutures, at 57.5 (mean, 58.3) versus 61.0 (mean, 70.8) cm H2O with 8 interrupted sutures, at 31.5 (mean, 32.0) versus >97.0 (mean, 75.5) cm H2O with 1 running and 4 interrupted sutures, and at 34.0 (mean, 32.3) versus 80.0 (mean, 69.9) cm H2O with 1 running suture. The analysis of variance revealed a statistically significant increase in wound stability for all overlaps independently from the size of the overlap., Conclusions: Femtosecond laser-assisted profiles with even small overlaps for penetrating keratoplasty may make fewer sutures and earlier suture removal possible because of better wound stability, contributing to earlier visual recovery and helping to prevent wound rupture after trauma. However, further study is required to identify the optimum profile including the various technical parameters.
- Published
- 2012
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109. Allogenic limbo-keratoplasty with conjunctivoplasty, mitomycin C, and amniotic membrane for bilateral limbal stem cell deficiency.
- Author
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Eberwein P, Böhringer D, Schwartzkopff J, Birnbaum F, and Reinhard T
- Subjects
- Adult, Amnion transplantation, Corneal Diseases physiopathology, Cyclosporine therapeutic use, Female, Follow-Up Studies, Graft Survival drug effects, Graft Survival physiology, Humans, Immunosuppressive Agents therapeutic use, Male, Middle Aged, Mycophenolic Acid analogs & derivatives, Mycophenolic Acid therapeutic use, Retrospective Studies, Transplantation, Homologous, Visual Acuity physiology, Alkylating Agents administration & dosage, Conjunctiva transplantation, Corneal Diseases surgery, Keratoplasty, Penetrating methods, Limbus Corneae, Mitomycin administration & dosage, Stem Cells pathology
- Abstract
Objective: To present the technique and report the results of up to 36 months after allogenic central penetrating limbo-keratoplasty in conjunction with conjunctivoplasty, mitomycin C (MMC), and amniotic membrane (AM) transplantation in patients with bilateral limbal stem cell deficiency (LSCD)., Design: Retrospective, consecutive subject cohort study., Participants: Case records of 20 eyes from 20 patients who presented with bilateral LSCD due to aniridia, chemical/thermal burn, cicatrizing pemphigoid, and chronic ocular surface inflammation and who were treated at the University Eye Hospital, Freiburg., Methods: All eyes were treated with central limbo-keratoplasty in conjunction with conjunctivoplasty, MMC, and AM. There were 20 human leukocyte antigen-typed allolimbal transplants from cadaveric donors. All patients received systemic immunosuppression with mycophenolate mofetil or cyclosporine A., Main Outcome Measures: Surgical success was measured by the duration for which a healthy corneal epithelium was maintained. Visual success was measured by an improvement in visual acuity (VA) in the eye during follow-up and directly correlated with central clear graft survival., Results: The follow-up period was up to 34 months (mean, 20 months; median, 22.4 months). Mean VA, measured in decimal fractions, increased from 0.029 (∼20/400; median, 0.005; first quartile 0.005; third quartile 0.005) before surgery to 0.281 (20/70; median, 0.2; first quartile 0.04; third quartile 0.55) after surgery. Healthy corneal epithelium showing survival of limbal stem cells was observed in 14 eyes (70%) during complete follow-up., Conclusions: Penetrating limbo-keratoplasty with conjunctivoplasty, MMC, and AM transplantation is a promising new surgical technique for improving vision and conjunctivalization in patients with severe bilateral LSCD necessitating allogenic transplants., (Copyright © 2012 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)
- Published
- 2012
- Full Text
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110. [Corneal tumour following anterior chamber lens implantation in a patient with Marfan syndrome. Case study of a 57-year-old patient].
- Author
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Lapp T, Birnbaum F, Evert M, Reinhard T, and Auw-Hädrich C
- Subjects
- Humans, Male, Middle Aged, Treatment Outcome, Anterior Chamber surgery, Corneal Diseases etiology, Corneal Diseases surgery, Eye Neoplasms etiology, Eye Neoplasms surgery, Lens Implantation, Intraocular adverse effects, Marfan Syndrome complications
- Abstract
A 57-year-old male patient with Marfan syndrome presented at our clinic with a whitish gelatinous corneal tumour in the right eye. The initial examination revealed pronounced corneal oedema, bullous keratopathy, as well as an iris-fixed anterior chamber lens implanted 7 years previously. After the tumour was removed, the anterior chamber lens was explanted and keratoplasty was explanted and a two stage keratoplasty was performed. Histological analysis of the tumour and the cornea revealed vimentin and a number of smooth muscle actin (SMA)-positive tumour cells. The cornea below the tumour displayed a partially absent Bowman's layer and extensive pannus tissue. The characteristics of the corneal tumour and the subjacent cornea as described above are typical of secondary corneal myxoma. The influence of Marfan syndrome, a systemic connective tissue disorder present in the patient, on the etiopathogenesis of the corneal myxoma could not be fully determined.
- Published
- 2012
- Full Text
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111. Regulation of RKIP function by Helicobacter pylori in gastric cancer.
- Author
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Moen EL, Wen S, Anwar T, Cross-Knorr S, Brilliant K, Birnbaum F, Rahaman S, Sedivy JM, Moss SF, and Chatterjee D
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- Antigens, Bacterial metabolism, Apoptosis genetics, Bacterial Proteins metabolism, Cell Line, Tumor, Helicobacter pylori pathogenicity, Humans, Interleukin-6 pharmacology, Phosphatidylethanolamine Binding Protein genetics, Phosphorylation drug effects, Protein Kinase C metabolism, Protein Stability, Protein Transport, STAT3 Transcription Factor genetics, STAT3 Transcription Factor metabolism, Snail Family Transcription Factors, Stomach Neoplasms genetics, Transcription Factors metabolism, Transcription, Genetic drug effects, Helicobacter Infections metabolism, Helicobacter pylori metabolism, Phosphatidylethanolamine Binding Protein metabolism, Stomach Neoplasms metabolism
- Abstract
Helicobacter pylori (H. pylori) is a gram-negative, spiral-shaped bacterium that infects more than half of the world's population and is a major cause of gastric adenocarcinoma. The mechanisms that link H. pylori infection to gastric carcinogenesis are not well understood. In the present study, we report that the Raf-kinase inhibitor protein (RKIP) has a role in the induction of apoptosis by H. pylori in gastric epithelial cells. Western blot and luciferase transcription reporter assays demonstrate that the pathogenicity island of H. pylori rapidly phosphorylates RKIP, which then localizes to the nucleus where it activates its own transcription and induces apoptosis. Forced overexpression of RKIP enhances apoptosis in H. pylori-infected cells, whereas RKIP RNA inhibition suppresses the induction of apoptosis by H. pylori infection. While inducing the phosphorylation of RKIP, H. pylori simultaneously targets non-phosphorylated RKIP for proteasome-mediated degradation. The increase in RKIP transcription and phosphorylation is abrogated by mutating RKIP serine 153 to valine, demonstrating that regulation of RKIP activity by H. pylori is dependent upon RKIP's S153 residue. In addition, H. pylori infection increases the expression of Snail, a transcriptional repressor of RKIP. Our results suggest that H. pylori utilizes a tumor suppressor protein, RKIP, to promote apoptosis in gastric cancer cells.
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- 2012
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112. [Perspectives of femtosecond laser-assisted keratoplasty].
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Birnbaum F, Maier P, and Reinhard T
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- Astigmatism surgery, Descemet Stripping Endothelial Keratoplasty instrumentation, Epikeratophakia instrumentation, Equipment Design, Follow-Up Studies, Humans, Microsurgery instrumentation, Postoperative Complications diagnosis, Sutures, Tissue and Organ Harvesting instrumentation, Tomography, Optical Coherence, Visual Acuity physiology, Wound Healing physiology, Corneal Diseases surgery, Corneal Surgery, Laser instrumentation, Corneal Transplantation instrumentation, Keratoplasty, Penetrating instrumentation
- Abstract
The femtosecond laser technique allows completely new trephination procedures in penetrating and lamellar keratoplasty. With femtosecond laser-assisted penetrating keratoplasty it is possible to perform profiled trephination, such as top hat and mushroom profiles. Thus, it is easier to get a watertight wound closure intraoperatively and due to the larger wound surface wound healing is faster and allows early complete suture removal. In lamellar keratoplasty the femtosecond laser enables the surgeon to cut to any depth in the corneas resulting in thin corneal donor buttons, e.g. for DSAEK. In this manuscript an overview is given of the state of the art and of the perspectives of femtosecond laser keratoplasty.
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- 2011
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113. The intrastromal corneal ring in penetrating keratoplasty-long-term results of a prospective randomized study.
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Birnbaum F, Schwartzkopff J, Böhringer D, and Reinhard T
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- Corneal Topography, Follow-Up Studies, Humans, Prospective Studies, Prosthesis Implantation, Titanium, Treatment Outcome, Visual Acuity physiology, Vitallium, Astigmatism prevention & control, Corneal Stroma surgery, Fuchs' Endothelial Dystrophy surgery, Keratoconus surgery, Keratoplasty, Penetrating, Postoperative Complications, Prostheses and Implants
- Abstract
Purpose: Postoperative astigmatism after penetrating keratoplasty is a major problem in corneal transplantation. The purpose of this prospective randomized study was to evaluate the efficacy and safety of an intrastromal corneal ring after penetrating keratoplasty., Methods: Twenty patients were included, 10 of whom received an intracorneal ring (group 1) and 10 who did not (group 2, control group). Astigmatism in Orbscan corneal topography, occurrence of immune reactions, and occurrence of side effects were this study's main outcome criteria., Results: Mean follow-up time was 27.6 ± 5.3 months. Mean astigmatism (Orbscan) was 4.4 diopters in group 1 and 4.4 diopters in group 2 (P = 0.695). Spontaneous suture rupture occurred in 5 patients with corneal ring but in none of those in the control group. We observed 3 immune reactions in 3 patients with corneal ring, whereas group 2 experienced no rejection (P < 0.05). Endothelial cell loss was 15.1% in the group with the ring and 8.7% in the control group. That difference was not statistically significant (P = 0.146)., Conclusions: The use of the intrastromal corneal ring after penetrating keratoplasty caused no reduction in postoperative astigmatism. However, its use was statistically significantly associated with adverse events.
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- 2011
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114. Operational post-keratopasty graft tolerance due to differential HLAMatchmaker matching.
- Author
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Böhringer D, Daub F, Schwartzkopff J, Maier P, Birnbaum F, Sundmacher R, and Reinhard T
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- Cohort Studies, Histocompatibility Antigens Class I immunology, Humans, Kaplan-Meier Estimate, Middle Aged, Proportional Hazards Models, Reproducibility of Results, Histocompatibility Testing methods, Keratoplasty, Penetrating, Transplantation Tolerance immunology
- Abstract
Purpose: Penetrating keratoplasty can restore vision in corneal blindness. However, immunologic rejection threatens graft survival. Matching donors at swine leukocyte antigen (SLA)-class II convey allo-specific tolerance in a large animal kidney-transplantation model despite mismatches at SLA-class I. The same matching pattern seems to account for the blood transfusion effect in kidney transplantation. Relying on the molecular basis of HLAMatchmaker eplets, we assessed whether this finding would also apply to keratoplasty, and if it would enhance the benefit from matching human leukocyte antigen (HLA)-class I alone., Methods: We retrospectively selected two independent cohorts comprising 586 and 975 penetrating keratoplasties. Our computations revealed a quantitative tolerogenicity factor analogous to the animal model. The number of mismatched HLA-class I eplets functioned as a factor for conventional histocompatibility. In the first cohort, we empirically determined the thresholds with the highest predictive power on graft rejection for both factors, and confirmed those thresholds in the second cohort. We applied Cox proportional hazards regression for these analyses., Results: The thresholds with highest predictive power revealed 220 eplets(2) for the tolerance factor and 10 eplets for HLA-class I histocompatibility. The respective hazards ratios were 2.22 (p=0.04) versus 3.63 (p<0.01) in the first cohort and 2.09 (p<0.01) versus 1.51 (p=0.02) in the second, confirmatory cohort. The threshold factors proved to be additive in predicting immune reactions in both cohorts, (hazard ratios 2.66 in cohort 1 versus 1.70; p<0.01 in cohort 2)., Conclusions: Operational tolerance may be inducible by balanced matching of HLA-class I and II HLAMatchmaker eplets. Furthermore, such tolerance is additive to histocompatibility at HLA-class I.
- Published
- 2010
115. NK cell depletion delays corneal allograft rejection in baby rats.
- Author
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Schwartzkopff J, Schlereth SL, Berger M, Bredow L, Birnbaum F, Böhringer D, and Reinhard T
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- Animals, Animals, Newborn, Cell Movement immunology, Female, Graft Survival immunology, Immunity, Innate immunology, Killer Cells, Natural cytology, Leukocyte Common Antigens immunology, Lymphocyte Subsets cytology, Lymphocyte Subsets immunology, Macrophages cytology, Macrophages immunology, Rats, Transplantation, Homologous, Cornea immunology, Corneal Transplantation, Graft Rejection immunology, Killer Cells, Natural immunology, Lymphocyte Depletion
- Abstract
Purpose: Penetrating keratoplasty has a very poor outcome compared with adults if performed in the first years of life. Rejection in these young patients occurs even in the absence of known immunological risk factors. Recently, a baby rat model was introduced and an essential contribution of natural killer (NK) cells during allograft rejection was suggested. To analyze this, NK cells were depleted in baby rats before keratoplasty., Methods: Allogeneic keratoplasty was performed between Lewis and Fisher rats. The recipient's ages were 10 and 3 weeks, respectively. NK cells were depleted by an intraperitoneal injection of a monoclonal antibody. All experiments were controlled by the injection of isotypic control antibodies and syngeneically. Survival rates were calculated and cellular infiltrates were analyzed histologically., Results: NK cell depletion did delay median graft survival times in a statistically significantly way compared with the control animals (p<0.01). At median rejection time points, macrophages, CD4(+) T cells and CD25(+) leukocytes infiltrated to a greater extent in the depleted recipients. No significant changes in the cell numbers of infiltrating CD8(+) T cells were observed., Conclusions: We conclude that NK cells play a role during allograft rejection in baby rats, but their effect is replaceable. A greater infiltration of macrophages and CD4(+) T cells suggests that they might compensate for the missing NK cells' response in this experimental setting. Our results represent another step toward understanding the complex mechanisms of an accelerated corneal graft rejection in infant recipients.
- Published
- 2010
116. Long-term graft survival in penetrating keratoplasty: the biexponential model of chronic endothelial cell loss revisited.
- Author
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Böhringer D, Böhringer S, Poxleitner K, Birnbaum F, Schwartzkopff J, Maier P, Sundmacher R, and Reinhard T
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- Adolescent, Adult, Aged, Aged, 80 and over, Cell Count, Child, Chronic Disease, Endothelium, Corneal pathology, Follow-Up Studies, Humans, Middle Aged, Retrospective Studies, Corneal Endothelial Cell Loss physiopathology, Graft Survival physiology, Keratoplasty, Penetrating, Models, Statistical
- Abstract
Aim: To present a novel interpretation of the biexponential nature of chronic endothelial cell loss after penetrating keratoplasty (PK). We hypothesize that the fast component of endothelial cell loss reflects the endothelial cells of graft origin. The slow component might just reflect cell loss of the recipient endothelium. We investigate herein whether this hypothesis is in line with long-term survival in bullous keratopathy (BK: almost no endothelium in the recipient bed) and keratoconus (KK: recipient bed with plenty of endothelium)., Methods: We reviewed endothelial graft failures in PK for BK (n = 88) and KK (n = 87). Patients with immune reactions or a history of glaucoma were excluded. We built a statistical model to predict graft failures from biexponential endothelial cell loss and compared this data to the actual outcomes., Results: After 15 years, the incidence of late endothelial failures was 8% in KK and 33% in BK. The 95% confidence intervals of the simulated outcomes corresponded completely to the actual outcomes during follow-up., Conclusions: Our novel interpretation of the biexponential model is in line with long-term data of PK for BK and KK. Our findings highlight the importance of the recipient bed endothelial reservoir on the long-term prognosis in PK.
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- 2010
- Full Text
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117. Accelerated corneal graft rejection in baby rats.
- Author
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Schwartzkopff J, Berger M, Birnbaum F, Böhringer D, and Reinhard T
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- Adaptive Immunity, Age Factors, Animals, CD4-Positive T-Lymphocytes immunology, CD8-Positive T-Lymphocytes immunology, Disease Models, Animal, Female, Graft Rejection pathology, Immunity, Innate, Killer Cells, Natural immunology, Postoperative Period, Rats, Rats, Inbred F344, Rats, Inbred Lew, Transplantation Immunology, Graft Rejection immunology, Keratoplasty, Penetrating
- Abstract
Background: Penetrating keratoplasty in infants has a very poor outcome compared to adults. It is of intrinsic interest to gain insight into the still unknown immunological mechanisms of graft failure because any form of uncorrected corneal opacity leads to amblyopia., Methods: Allogeneic keratoplasty was performed between Lewis and Fisher rats. The recipients' ages were 10 and 3 weeks, respectively. All experiments were controlled syngeneically. Survival rates were calculated and cellular infiltrates analysed histologically., Results: Median graft survival times were 15 days in old recipients and 9 days in young recipients (p<0.01). There were fewer infiltrating cells in the younger rats than in the older ones on the day of rejection. Despite the fact that T cells dominated there were significantly more NK cells in young recipients at all time points after transplantation when compared to old recipients., Conclusions: An animal model has been established that shows similar rejection kinetics as in children, that is corneal graft failure occurs sooner in young rats. Already little infiltration was sufficient to reject a corneal allograft. The dominance of infiltrating NK cells and the vigorous rejection process suggest an involvement of the innate immune system in this process.
- Published
- 2010
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118. [Therapeutic applications of the femtosecond laser in corneal surgery].
- Author
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Maier PC, Birnbaum F, and Reinhard T
- Subjects
- Humans, Cornea surgery, Keratoplasty, Penetrating instrumentation, Keratoplasty, Penetrating trends, Laser Therapy instrumentation, Laser Therapy trends
- Abstract
Since 2001 the femtosecond laser has primarily been used in refractive surgery, e. g., for lasik, implantation of intracorneal ring segments or antiastigmatic corneal incisions. However, the femtosecond laser is more and more used for therapeutic reasons in corneal surgery. In this context it is used for profiled trephinations in penetrating keratoplasty where various profiles of the cutting edge can be designed (e. g., top-hat profile, mushroom profile, zig-zag profile). The potential advantages of these profiles include improved graft adaptation, better and more stable wound healing leading to earlier suture removal and eventually prolonged graft survival. However, none of these potential advantages has been demonstrated by reliable study results until now. First clinical experiences show that much earlier suture removal is possible without significant complications. However, with sutures in there seems to be no advantage of the femtosecond laser compared to mechanically guided trephination systems regarding visual acuity and postoperative astigmatism. Besides penetrating profiles, the femtosecond laser also allows for lamellar cuts. As deep anterior lamellar keratoplasty can only be supported by the femtosecond laser, it is mostly used for posterior lamellar grafts in this context. However, first clinical results using the femtosecond laser for DSAEK (descemet stripping automated endothelial keratoplasty) are poorer than those using microkeratome-prepared lamellar grafts for DSAEK., (Georg Thieme Verlag KG Stuttgart, New York.)
- Published
- 2010
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119. [Penetrating keratoplasty in corneal infections with herpes simplex virus and varicella zoster virus].
- Author
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Birnbaum F and Reinhard T
- Subjects
- Humans, Herpes Zoster Ophthalmicus surgery, Keratitis, Herpetic surgery, Keratoplasty, Penetrating methods, Keratoplasty, Penetrating trends
- Abstract
Penetrating keratoplasties due to herpetic corneal scars are more often performed compared to persisting Varicella zoster virus infections, which are quite seldom. Penetrating keratoplasties in herpetic corneas are risk keratoplasties due to the vascularisation and the risk of recurrent virus replication. The prognosis in these corneal transplantations has been improved in recent years due to better postoperative medical treatment with virustatics and systemic immunosuppression. Indications for and treatment following penetrating keratoplasty in herpetic eyes are the topics of this review.
- Published
- 2010
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120. [Femtosecond laser-assisted penetrating keratoplasty].
- Author
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Birnbaum F, Maier P, and Reinhard T
- Subjects
- Equipment Design, Humans, Suture Techniques, Astigmatism prevention & control, Fuchs' Endothelial Dystrophy surgery, Keratoconus surgery, Keratomileusis, Laser In Situ instrumentation, Keratoplasty, Penetrating instrumentation, Postoperative Complications prevention & control, Refraction, Ocular
- Abstract
The femtosecond laser technique allows completely new trephination methods in penetrating keratoplasty with profiles in the graft and the host cornea. The most common so-called profiled trephinations are the top hat and mushroom profiles. Due to the profile it is easier to get a watertight wound closure intraoperatively and due to the larger wound surface the wound healing is faster and more stable. This will possibly allow an earlier suture removal with final visual rehabilitation. First clinical results show that femtosecond laser-assisted penetrating keratoplasty is a safe surgical procedure. The long term results after complete suture removal will show whether the astigmatism results are better than those of conventional trephination techniques.
- Published
- 2010
- Full Text
- View/download PDF
121. Mycophenolate mofetil (MMF) following penetrating high-risk keratoplasty: long-term results of a prospective, randomised, multicentre study.
- Author
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Birnbaum F, Mayweg S, Reis A, Böhringer D, Seitz B, Engelmann K, Messmer EM, and Reinhard T
- Subjects
- Adult, Aged, Analysis of Variance, Female, Graft Rejection etiology, Humans, Male, Middle Aged, Mycophenolic Acid therapeutic use, Prospective Studies, Graft Rejection prevention & control, Graft Survival drug effects, Immunosuppressive Agents therapeutic use, Keratoplasty, Penetrating methods, Mycophenolic Acid analogs & derivatives
- Abstract
Background: The purpose of this prospective, randomised, multicentre study was to prove the efficacy and safety of mycophenolate mofetil (MMF) in preventing graft rejection and in improving clear graft survival following high-risk keratoplasty., Methods: In all, 98 of 140 scheduled patients were included in this study (57 MMF, 41 control). Recruitment was stopped prematurely due to a statistically significant result. The patients in the MMF group received MMF orally 2 x 1 g daily for 6 months. All of the patients received fluocortolone 1 mg/kg/day tapered over 3 weeks and topical prednisolone acetate 5 x /day tapered over 5 months. Main criteria were immune reaction-free and clear graft survival, and the occurrence of side effects., Results: The mean follow-up time was 34.9+/-16.3 (mean+/-SD) months. Eleven patients withdrew from the study (nine patients due to protocol deviation, two because of side effects). Six reversible and two irreversible graft rejections occurred in the MMF group, and five reversible and seven irreversible rejections in the control group. The Kaplan-Meier analysis revealed an immune reaction-free graft survival after the mean follow-up time of 83% in the MMF group and 64.5% in the control group (P=0.044). Graft failure occurred in 10 MMF-treated patients (two due to rejection) and in nine patients in the control group (seven due to rejection). A total of 36 of 57 MMF-treated patients experienced mostly reversible adverse events., Conclusions: Systemic immunosuppression with MMF over 6 months is relatively well tolerated and improves rejection-free graft survival following high-risk keratoplasty statistically significant, even in the long run.
- Published
- 2009
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- View/download PDF
122. Long term use of topical tacrolimus (FK506) in high-risk penetrating keratoplasty.
- Author
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Birnbaum F, Reis A, and Reinhard T
- Subjects
- Administration, Topical, Drug Therapy, Combination, Humans, Ointments, Ophthalmic Solutions, Pilot Projects, Randomized Controlled Trials as Topic, Risk Factors, Steroids administration & dosage, Immunosuppressive Agents administration & dosage, Keratoplasty, Penetrating methods, Tacrolimus administration & dosage
- Published
- 2009
- Full Text
- View/download PDF
123. Toxic anterior segment syndrome following penetrating keratoplasty.
- Author
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Maier P, Birnbaum F, Böhringer D, and Reinhard T
- Subjects
- Cell Count, Cryopreservation, Disease Outbreaks, Endothelium, Corneal pathology, Humans, Keratitis diagnosis, Keratitis epidemiology, Organ Preservation, Shock, Septic diagnosis, Shock, Septic epidemiology, Syndrome, Anterior Eye Segment pathology, Equipment Contamination, Keratitis etiology, Keratoplasty, Penetrating adverse effects, Shock, Septic etiology
- Abstract
Objectives: To describe an outbreak of toxic anterior segment syndrome (TASS) following penetrating keratoplasty (PK) and to examine its possible causes., Methods: Owing to a series of TASS following PK between June 6, 2007, and October 2, 2007, we reviewed the records of all patients who had undergone PK during that time. In addition to routine microbial tests on organ culture media, we looked for specific pathogens and endotoxins in all of the materials used for organ culture or PK. Furthermore, we analyzed all of the perioperative products and instrument processing., Results: Of the 94 patients who underwent PK, we observed 24 cases of postoperative sterile keratitis. Causal research revealed that the accumulation of cleaning substances or heat-stable endotoxins on the surface of the routinely used guided trephine system was most likely responsible for the TASS., Conclusions: To our knowledge, this is the first report on TASS following PK. Suboptimal reprocessing of surgical instruments may be an important cause of TASS as in this series the TASS-like symptoms resolved after modified instrument-cleaning procedures. The standardization of protocols for processing reusable trephine systems might prevent outbreaks of TASS following PK.
- Published
- 2008
- Full Text
- View/download PDF
124. [Cyclosporin A eyedrops for keratitis nummularis after adenovirus keratoconjunctivitis].
- Author
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Böhringer D, Birnbaum F, and Reinhard T
- Subjects
- Adenovirus Infections, Human drug therapy, Chronic Disease, Humans, Keratoconjunctivitis drug therapy, Ophthalmic Solutions, Adenovirus Infections, Human complications, Corneal Opacity drug therapy, Cyclosporine administration & dosage, Immunosuppressive Agents administration & dosage, Keratitis drug therapy, Keratoconjunctivitis complications
- Abstract
Keratoconjunctivitis is a common infectious disease of the eye surface, which is caused by adenovirus. The chronic form is keratitis nummularis. Cyclosporin A is a calcineurin inhibitor which has been used in ophthalmology for approximately 15 years for local therapy of chronic inflammation of the eye surface. Since the 1990s this medication has proven effective for the treatment of keratitis nummularis. The indications for treatment with cyclosporin A eyedrops are given when a reduction in vision due to keratitis nummularis has not shown any improvement within 6 weeks after acute inflammation.
- Published
- 2008
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125. [Penetrating keratoplasty with intrastromal corneal ring. A prospective randomized study].
- Author
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Birnbaum F, Schwartzkopff J, Böhringer D, and Reinhard T
- Subjects
- Adult, Astigmatism etiology, Humans, Postoperative Complications etiology, Surgical Wound Dehiscence etiology, Visual Acuity, Astigmatism prevention & control, Corneal Stroma surgery, Fuchs' Endothelial Dystrophy surgery, Keratoconus surgery, Keratoplasty, Penetrating instrumentation, Postoperative Complications prevention & control, Prostheses and Implants, Titanium, Vitallium
- Abstract
Background: The purpose of the study was to evaluate the efficacy and safety of Krumeichs' intrastromal corneal ring following penetrating keratoplasty. Postoperative astigmatism and occurrence of complications were the main criteria of this study., Material and Methods: A total of 20 patients were included in this prospectively randomized study (10 patients with and 10 patients without corneal ring). Follow-up examinations were performed 6 weeks, 4, 12, and 18 months postoperatively, including best corrected visual acuity and Orbscan corneal topography., Results: The mean follow-up time is currently 18.9+/-2.8 months. The mean astigmatism (Orbscan) is 3.9 D in the group with ring and 4.0 D in the group without a ring. Spontaneous suture rupture occurred in five patients with corneal ring., Conclusions: The use of the intrastromal corneal ring following penetrating keratoplasty caused no reduction of postoperative astigmatism. The reason for the spontaneous suture ruptures is unclear.
- Published
- 2008
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126. [Long-term results of FK 506 eye drops following corneal transplantation].
- Author
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Reis A, Mayweg S, Birnbaum F, and Reinhard T
- Subjects
- Aged, Chemotherapy, Adjuvant, Female, Humans, Immunosuppressive Agents administration & dosage, Longitudinal Studies, Male, Middle Aged, Ophthalmic Solutions administration & dosage, Treatment Outcome, Corneal Transplantation adverse effects, Graft Rejection etiology, Graft Rejection prevention & control, Tacrolimus administration & dosage
- Abstract
Background: Immunological graft rejection is the main reason for graft failure following corneal transplantation despite the use of topical and systemic steroids. As steroids are associated with side effects, alternative therapeutic strategies are needed., Patients and Methods: In this clinical trial patients undergoing corneal transplantation have been prospectively randomised to receive either prednisolone acetate 1 % eye drops 5 x /day, tapering off by one drop every month (n = 20), or to receive FK 506 eye drops 3 x /day for six months (n = 20). Patients in both groups received additionally systemic steroids for three weeks (fluocortolon 1 mg/kg body weight). Primary endpoints were the number of immune reactions and the clear graft survival, the secondary endpoint was the number of side effects., Results: Three immune reactions in the steroid group and one immune reaction in the FK 506 group were seen within the follow-up time of three years. No irreversible graft rejections occurred in either group. Eight patients in the FK 506 group concluded the study early due to local side effects., Conclusions: In this long-term follow-up the use of FK 506 eye drops following corneal transplantation resulted in a lower number of immune reactions when compared to topical steroids. With a change in the galenic formulation FK 506 might be a powerful therapeutic option for preventing immunological graft rejection.
- Published
- 2008
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- View/download PDF
127. [Corneal melting after cross-linking and deep lamellar keratoplasty in a keratoconus patient].
- Author
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Eberwein P, Auw-Hädrich C, Birnbaum F, Maier PC, and Reinhard T
- Subjects
- Female, Humans, Middle Aged, Conjunctivitis, Allergic complications, Conjunctivitis, Allergic surgery, Corneal Injuries, Eye Burns etiology, Keratoconus complications, Keratoconus surgery, Keratoplasty, Penetrating adverse effects
- Abstract
We present the case of a 45-year-old patient with severe atopic disease and keratoconus who suffered from corneal melting following cross-linking and deep anterior lamellar keratoplasty (DALK) due to subclinical infection with Herpes simplex virus (HSV). Penetrating keratoplasty and intensive antiviral and immunosuppressive medical treatment were necessary to control the infection. The case demonstrates the difficulties in the treatment of keratoconus in patients with severe atopic disease.
- Published
- 2008
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128. [Steam cautery of the cornea in microbial keratitis].
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Maier P, Birnbaum F, and Reinhard T
- Subjects
- Humans, Steam, Cautery methods, Eye Infections, Bacterial pathology, Eye Infections, Bacterial surgery, Keratitis pathology, Keratitis surgery
- Abstract
In some cases topical antimicrobial treatment of microbial keratitis or corneal ulcers remains unsuccessful, with increasing infiltration of the corneal stroma. In this situation the steam cautery procedure developed by Karl Wessely in 1911 can lead to rapid healing of the inflammatory process, avoiding further corneal surgery. In this article we describe the steam cautery technique and discuss its indications for microbial keratitis.
- Published
- 2008
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129. [Basiliximab following penetrating risk-keratoplasty--a prospective randomized pilot study].
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Birnbaum F, Jehle T, Schwartzkopff J, Sokolovska Y, Böhringer D, Reis A, and Reinhard T
- Subjects
- Basiliximab, Chemotherapy, Adjuvant, Female, Humans, Immunosuppressive Agents administration & dosage, Male, Middle Aged, Pilot Projects, Prospective Studies, Treatment Outcome, Antibodies, Monoclonal administration & dosage, Graft Rejection diagnosis, Graft Rejection etiology, Graft Rejection prevention & control, Keratoplasty, Penetrating adverse effects, Recombinant Fusion Proteins administration & dosage
- Abstract
Background: Until now cyclosporin A (CSA) and mycophenolate mofetil (MMF) are the only available systemic immunosuppressants for patients undergoing risk keratoplasty. Basiliximab is a chimeric monoclonal interleukin 2-receptor antibody, which inhibits T-cell proliferation. Basiliximab is approved for the treatment in patients after kidney transplantation. The aim of this study was to prove the efficacy and safety of Basiliximab after penetrating risk keratoplasty., Patients and Methods: 20 patients undergoing risk keratoplasty received as postoperative medication fluocortolon 1 mg/kg/d (tapered off within three weeks) and prednisolone acetate eye-drops 5x/d (tapered off within five months). In addition, 10 patients received 20 mg basiliximab immediately following surgery and four days postoperatively. 10 patients in the control group received oral CSA adapted to the blood-trough level (120-150 ng/mL) for six months., Results: After a mean follow-up time of 477 +/- 263 days 4 patients of the basiliximab group showed corneal immune reactions (2 irreversible), while no side effects were observed. In the CSA group 2 immune reactions occurred (1 irreversible). In 2 CSA-treated patients the CSA administration had to be stopped due to side effects., Conclusions: Basiliximab has a lower efficacy in preventing immune reactions after risk keratoplasty than CSA. However, the side effect profile of basiliximab is more favourable than that of CSA.
- Published
- 2008
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130. The new malononitrilamide immunosuppressant FK778 prolongs corneal allograft survival in the rat keratoplasty model.
- Author
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Birnbaum F, Schwartzkopff J, Scholz C, Reis A, and Reinhard T
- Subjects
- Alkynes toxicity, Animals, Cornea immunology, Disease Models, Animal, Drug Evaluation, Preclinical methods, Female, Graft Rejection prevention & control, Graft Survival immunology, Immunosuppressive Agents toxicity, Isoxazoles toxicity, Mycophenolic Acid analogs & derivatives, Mycophenolic Acid therapeutic use, Mycophenolic Acid toxicity, Nitriles toxicity, Postoperative Care methods, Postoperative Period, Rats, Rats, Inbred F344, Rats, Inbred Lew, Survival Analysis, Treatment Outcome, Alkynes therapeutic use, Graft Survival drug effects, Immunosuppressive Agents therapeutic use, Isoxazoles therapeutic use, Keratoplasty, Penetrating immunology, Nitriles therapeutic use
- Abstract
Purpose: Aim of this study was to prove the efficacy and safety of the new malononitrilamide immunosuppressive FK778 in prolonging clear graft survival following allogeneic orthotopic keratoplasty in rats., Methods: Sixty-seven penetrating keratoplasties were performed using Fisher and Lewis rats as donors and recipients, respectively: group 1 (n=11), allogeneic control without therapy; group 2 (n=12), syngeneic control; group 3 (n=11), mycophenolate mofetil (MMF) 40 mg/kg bodyweight; group 4 (n=12), FK778 5 mg/kg bodyweight; group 5 (n=12), FK778 10 mg/kg bodyweight; and group 6 (n=9), FK778 20 mg/kg bodyweight. Four animals in each group were killed for immunohistological evaluation on day 14. Therapy was administered orally for 18 days. The grafts were evaluated every three days by means of a scoring system including opacity, oedema, and vascularization. Time to rejection was analysed with the Kaplan-Meier survival analysis and compared with the log-rank test. The densities of infiltrating immune cells were compared statistically using the non-parametric Mann-Whitney test., Results: Mean rejection-free graft survival was 11.4 days in group 1 (allogeneic control), 100 days (total follow-up time) in group 2 (syngeneic control), 24.0 days in group 3 (MMF 40 mg/kg), 15.7 days in group 4 (FK778 5 mg/kg), 19.1 days in group 5 (FK778 10 mg/kg), and 25.4 days in group 6 (FK778 20 mg/kg) (P<0.005)., Conclusions: Systemic immunosuppression with FK778 prolongs graft survival in the rat keratoplasty model. FK778's efficacy is comparable with that of MMF in preventing immunologic graft rejection.
- Published
- 2007
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131. Topical pimecrolimus does not prolong clear graft survival in a rat keratoplasty model.
- Author
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Birnbaum F, Schwartzkopff J, Scholz C, and Reinhard T
- Subjects
- Administration, Topical, Animals, Antigens, CD metabolism, Cornea metabolism, Cornea pathology, Female, Immunoenzyme Techniques, Rats, Rats, Inbred F344, Rats, Inbred Lew, Tacrolimus administration & dosage, Cornea drug effects, Disease Models, Animal, Graft Survival drug effects, Immunosuppressive Agents administration & dosage, Keratoplasty, Penetrating, Tacrolimus analogs & derivatives
- Abstract
Background: Long-term application of topical steroids following penetrating keratoplasty is disadvantageous due to side effects (steroid response, cataract, surface disorders). In this study we investigated the efficacy of topical pimecrolimus regarding clear graft survival following allogeneic orthotopic keratoplasty in rats., Methods: A total of 46 penetrating keratoplasties were performed using Fisher rats (allogeneic groups) and Lewis rats (syngeneic group) as donors and Lewis rats as recipients: group 1 (n = 11), allogeneic control without therapy; group 2 (n = 12), syngeneic control; group 3 (n = 11), mycophenolate mofetil (MMF) 40 mg/kg body weight; group 4 (n = 12), pimecrolimus 1% ointment twice daily. Four animals of each group were sacrificed for immunohistological evaluation on day 14. Therapy was administered for 18 days. The grafts were evaluated once every 3 days regarding opacity, oedema and vascularisation. Graft rejection was defined as total graft opacity., Results: Mean rejection-free graft survival was 11.4 days in group 1 (allogeneic control), 100 days (total follow-up time) in group 2 (syngeneic control), 24.0 days in group 3 (MMF 40 mg/kg) and 11.6 days in group 4 (topical pimecrolimus). The immunohistological evaluation showed no statistically significant difference in cell infiltration of the grafts comparing groups 1 and 4., Conclusions: Topical immunosuppression with pimecrolimus does not prolong graft survival in the allogeneic keratoplasty rat model.
- Published
- 2007
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- View/download PDF
132. [Intracameral application of corticosteroids for treating severe endothelial rejection after penetrating keratoplasty].
- Author
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Birnbaum F, Maier P, and Reinhard T
- Subjects
- Anti-Inflammatory Agents administration & dosage, Anti-Inflammatory Agents therapeutic use, Dexamethasone administration & dosage, Dexamethasone therapeutic use, Drug Administration Routes, Endothelium, Corneal immunology, Graft Rejection immunology, Humans, Adrenal Cortex Hormones administration & dosage, Anterior Chamber, Graft Rejection drug therapy, Keratoplasty, Penetrating adverse effects
- Abstract
Immune reaction is the main cause for graft failure following penetrating keratoplasty. Endothelial immune reaction is the most frequent and most dangerous subtype of rejection because destruction of the graft endothelium can lead to graft failure. "Acute" endothelial rejection is treated by administration of topical and systemic steroids. Intracameral application of corticosteroids by means of an anterior chamber flush is an adjunctive measure that can stop the immune reaction immediately. This measure is thus recommended in all intermediate and severe endothelial rejections.
- Published
- 2007
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133. [Immune suppression following perforating keratoplasty].
- Author
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Birnbaum F, Reis A, and Reinhard T
- Subjects
- Drug Therapy, Combination, Graft Survival drug effects, Humans, Prognosis, Corneal Opacity prevention & control, Graft Rejection prevention & control, Immunosuppressive Agents therapeutic use, Keratoplasty, Penetrating, Postoperative Complications prevention & control
- Published
- 2007
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- View/download PDF
134. [Topical immunosuppressives after penetrating keratoplasty].
- Author
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Birnbaum F, Reis A, and Reinhard T
- Subjects
- Administration, Topical, Animals, Corneal Opacity immunology, Graft Rejection immunology, Graft Survival drug effects, Humans, Immunosuppressive Agents adverse effects, Postoperative Complications immunology, Corneal Opacity drug therapy, Graft Rejection drug therapy, Immunosuppressive Agents administration & dosage, Keratoplasty, Penetrating, Postoperative Complications drug therapy
- Abstract
Topical steroids are routinely used in the postoperative treatment following penetrating keratoplasty. Due to the known side effects such as steroid-response glaucoma, cataract, and surface disorders, a broader armamentarium of topical immunomodulating drugs with comparable efficacy, better tolerance and less side effects is desirable. Cyclosporine A and FK506 eye drops are a promising alternative. A new approach involves subconjunctival drug delivering implants and locally applied antiangiogenic substances, which still have to be tested in clinical studies.
- Published
- 2007
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135. [Systemic immunosuppressives after penetrating keratoplasty].
- Author
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Reis A, Birnbaum F, and Reinhard T
- Subjects
- Administration, Oral, Administration, Topical, Animals, Humans, Immunosuppressive Agents adverse effects, Infusions, Intravenous, Ophthalmic Solutions, Corneal Opacity prevention & control, Graft Rejection prevention & control, Immunosuppressive Agents administration & dosage, Keratoplasty, Penetrating, Postoperative Complications prevention & control
- Abstract
Immunologic rejection is the main cause of corneal graft failure. If corneal transplantation is performed in a high-risk situation without the use of systemic immunosuppression, corneal graft failure has to be expected in over 50% of patients within the first postoperative year. The clonal expansion of graft-specific lymphocytes occurs in lymphoid tissues. As topical steroids do not reach the secondary lymphoid organs, and even systemic steroids do not interfere sufficiently with the clonal expansion of activated T cells, it is essential to administer systemic immunosuppressives in order to achieve clear graft survival. As corneal transplantation is not a life-saving procedure, the profile of side-effects is a central issue when choosing an immunosuppressive medication.
- Published
- 2007
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136. Successful treatment of cystoid macular edema with valdecoxib.
- Author
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Reis A, Birnbaum F, Hansen LL, and Reinhard T
- Subjects
- Aged, Aged, 80 and over, Cyclooxygenase 2 Inhibitors adverse effects, Female, Humans, Isoxazoles adverse effects, Lens Implantation, Intraocular, Macular Edema etiology, Male, Middle Aged, Prospective Studies, Sulfonamides adverse effects, Visual Acuity, Cyclooxygenase 2 Inhibitors therapeutic use, Isoxazoles therapeutic use, Macular Edema drug therapy, Phacoemulsification, Postoperative Complications, Sulfonamides therapeutic use
- Abstract
Purpose: To evaluate the safety and efficacy of the COX-2 inhibitor valdecoxib in treating macular edema after cataract surgery., Setting: University Eye Clinic, Freiburg, Germany and Reis Medical Institution, Liechtenstein., Methods: The COX-2 inhibitor valdecoxib (Bextra) was administered systemically to patients with significant visual loss resulting from macular edema in a prospective clinical trial., Results: Ten patients were enrolled. Valdecoxib was tolerated well and led to a significant visual improvement within 10 days of therapy in all patients., Conclusion: The fast and persistent control of macular edema with valdecoxib warrants further investigation.
- Published
- 2007
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137. An open prospective pilot study on the use of rapamycin after penetrating high-risk keratoplasty.
- Author
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Birnbaum F, Reis A, Böhringer D, Sokolowska Y, Mayer K, Voiculescu A, Oellerich M, Sundmacher R, and Reinhard T
- Subjects
- Adult, Aged, Female, Fluocortolone therapeutic use, Graft Rejection immunology, Humans, Immunosuppressive Agents adverse effects, Male, Middle Aged, Mycophenolic Acid adverse effects, Mycophenolic Acid therapeutic use, Pilot Projects, Postoperative Period, Sirolimus adverse effects, Corneal Transplantation immunology, Graft Rejection prevention & control, Immunosuppressive Agents therapeutic use, Mycophenolic Acid analogs & derivatives, Sirolimus therapeutic use
- Abstract
Background: The purpose of this study was to prove efficacy and safety of systemic immunosuppression with rapamycin following penetrating high-risk keratoplasty. Rapamycin has shown its immunosuppressive potential in the rat keratoplasty model and is a component of several immunosuppressive protocols after solid organ transplantation. In this pilot study, we compared the efficacy and safety of rapamycin and mycophenolate mofetil (MMF)., Methods: Ten patients (group 1) undergoing high-risk keratoplasty were included in this study, receiving rapamycin as postoperative immunoprophylaxis. Rapamycin was administered orally once daily (blood trough level 4-10 ng/ml) for 6 months. Thereafter, it was tapered over 2 weeks. The control group (group 2) consisted of 24 patients who received 1000 mg MMF twice daily for 6 months. All of the patients received postoperative medication with fluocortolone 1 mg/kg/day (tapered over 3 weeks) and prednisolone acetate eyedrops 5 times per day (tapered over 5 months)., Results: Mean follow-up of all patients (n=34) was 739 days. No immune reaction was observed in groups 1 and 2 during the first 6 months under immunosuppression. Two immune reactions occurred in group 1, and five in group 2 within a 2-year follow-up. All of the immune reactions were reversible. The side effects observed in both groups were mostly reversible., Conclusions: Rapamycin and mycophenolate mofetil seem to be similarly efficacious in preventing immune reactions after high-risk keratoplasty, as long as they are administered. However, we observed a broad spectrum of side effects from rapamycin.
- Published
- 2006
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138. Cyclooxygenase-2 inhibitors: a new therapeutic option in the treatment of macular edema after cataract surgery.
- Author
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Reis A, Birnbaum F, Hansen LL, and Reinhard T
- Subjects
- Aged, Female, Humans, Lens Implantation, Intraocular, Macular Edema etiology, Visual Acuity, Cyclooxygenase Inhibitors therapeutic use, Isoxazoles therapeutic use, Macular Edema drug therapy, Phacoemulsification, Postoperative Complications, Sulfonamides therapeutic use
- Abstract
Two patients had uneventful phacoemulsification. After initial improvement, vision deteriorated because of cystoid macular edema (CME). In 1 patient, treatment with systemic nonsteroidal antiinflammatory drugs showed significant improvement in visual acuity but had to be discontinued because of side effects and a relapse of the disease. In the other patient, this therapy was not sufficient. Both patients were given valdecoxib, a cyclooxygenase-2 inhibitor. The new therapy was tolerated well and led to significant and stable improvement in visual acuity in both patients. To our knowledge, this is the first report of using a cyclooxygenase-2 inhibitor in the treatment of clinically significant CME.
- Published
- 2005
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- View/download PDF
139. Immunosuppression with cyclosporine A and mycophenolate mofetil after penetrating high-risk keratoplasty: a retrospective study.
- Author
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Birnbaum F, Böhringer D, Sokolovska Y, Sundmacher R, and Reinhard T
- Subjects
- Cyclosporine adverse effects, Donor Selection, Female, Follow-Up Studies, Graft Survival, Humans, Male, Middle Aged, Mycophenolic Acid adverse effects, Retrospective Studies, Survival Analysis, Cyclosporine pharmacology, Immunosuppression Therapy, Keratoplasty, Penetrating, Mycophenolic Acid analogs & derivatives, Mycophenolic Acid pharmacology
- Abstract
Background: Graft-prognosis after penetrating high-risk keratoplasty has improved considerably with the use of systemic immunosuppressive medications. In this retrospective investigation we analyzed the long-term results of 417 high-risk keratoplasties with systemic immunosuppression (cyclosporine A [CsA] or mycophenolate mofetil [MMF])., Methods: A total of 417 high-risk keratoplasties with postoperative systemic immunosuppression were evaluated retrospectively: CsA has been given in 252 keratoplasties since 1987, aiming at blood trough levels of 120 to 150 ng/mL. Systemic MMF at a daily dose of 2 x 1 g was administered in 149 surgical procedures. After 16 high-risk keratoplasties, combined systemic immunosuppression with CsA and MMF was administered. Systemic immunosuppression was scheduled for 6 to 12 months. All patients received fluocortolone 1 mg/kg body weight per day, tapered over 3 weeks, and topical prednisolone acetate 1%, tapered over 5 months., Results: Rejection-free graft survival after 1 year was 75% in the CsA group and 89% in the MMF group; 60% of the grafts in the CsA group and 72% of the grafts in the MMF group were rejection-free 3 years postoperatively (Kaplan-Meier log-rank test P=0.03). Clear graft survival after 1 and 3 years was 92% and 77% (CsA) and 96% and 87% (MMF), respectively. The MMF-treated patients showed fewer side effects than the CsA-treated patients. The side effects attributable to both drugs were reversible., Conclusions: We found a statistically significant, stronger effect of MMF compared with CsA in preventing immune reactions after high-risk keratoplasty, despite a shorter MMF administration compared with CsA. Both systemic immunosuppressants were shown to have comparable potency regarding clear graft survival and were well tolerated.
- Published
- 2005
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140. Endothelial cell loss after autologous rotational keratoplasty.
- Author
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Birnbaum F, Reinhard T, Böhringer D, and Sundmacher R
- Subjects
- Adult, Cell Count, Cell Death, Corneal Diseases surgery, Humans, Rotation, Transplantation, Autologous, Endothelium, Corneal pathology, Keratoplasty, Penetrating adverse effects, Postoperative Complications
- Abstract
Purpose: To investigate whether it may be possible to ascertain the influence of immunological factors on chronic endothelial cell loss by comparing chronic endothelial cell loss after autologous rotational penetrating keratoplasty and after homologous penetrating keratoplasty., Methods: For six patients who had undergone autologous rotational penetrating keratoplasty the relative annual loss of endothelial cells was calculated by means of an exponential regression analysis. The findings were compared with those in a homogeneous historical control group (53 patients undergoing homologous penetrating keratoplasty for keratoconus)., Results: After autologous rotational keratoplasty relative annual loss of endothelial cells was 1.1%+/-2.6% (mean +/- standard deviation). Relative annual loss of endothelial cells in the control-group was 16.7%+/-20.8%., Conclusions: The results of the study lead to the assumption that immunological influences might be the main cause for chronic endothelial cell loss after homologous penetrating keratoplasty.
- Published
- 2005
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141. FTY720 prolongs clear corneal allograft survival with a differential effect on different lymphocyte populations.
- Author
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Mayer K, Birnbaum F, Reinhard T, Reis A, Braunstein S, Claas F, and Sundmacher R
- Subjects
- Animals, Antigens, CD immunology, Female, Fingolimod Hydrochloride, Graft Rejection immunology, Immunosuppressive Agents immunology, Lymphocyte Count, Lymphocytes immunology, Mycophenolic Acid immunology, Mycophenolic Acid therapeutic use, Propylene Glycols immunology, Rats, Rats, Inbred F344, Rats, Inbred Lew, Sphingosine analogs & derivatives, Weight Loss immunology, Corneal Transplantation, Graft Rejection prevention & control, Immunosuppressive Agents therapeutic use, Lymphocytes drug effects, Mycophenolic Acid analogs & derivatives, Propylene Glycols therapeutic use
- Abstract
Background: FTY720 is a potent immunomodulator with unique effects on lymphocyte homing and has recently proved to be safe and effective in renal transplantation in man. The authors investigated the potency of FTY720 in inhibiting allograft rejection in the rat model of orthotopic allogeneic penetrating keratoplasty., Methods: Penetrating keratoplasties were performed using Fisher rats as donors and Lewis rats as recipients or donors: group 1 (n = 10), allogeneic control; group 2 (n = 10), Lewis/Lewis syngeneic control; group 3 (n = 9), mycophenolate mofetile (MMF) 40 mg/kg; group 4 (n = 10), FTY720 1.2 mg/kg; group 5 (n = 8), FTY720 0.3 mg/kg. Four animals from each group were sacrificed for immunohistological evaluation on day 14. Medication in the therapy groups was given for 18 days., Results: The mean (SD) rejection free graft survival time was 11.3 (0.8) days for the allogeneic control (group 1), 24.6 (2.5) days for group 3 (MMF), 44.5 (5.7) days for group 4 (FTY720 1.2 mg/kg), and 35.3 (5.7) days for group 5 (FTY720 0.3 mg/kg) (p<0.05). The allogeneic control showed a dense infiltration with CD4+, CD8+, CD161+ (NK-cells), CD25+ (IL2 receptor), and macrophages. In the therapy groups the density of infiltrating CD4+, CD8+, CD161+ (NK-cells), and CD25+ (IL2 receptor) cells was notably reduced compared with the allogeneic control (p<0.05). In group 5 however, the reduction of infiltration by CD4+ cells was higher than the reduction of infiltration by CD8+ (p<0.05) and CD161+ (NK) cells., Discussion: Oral immunosuppression with FTY720 significantly prolongs corneal allograft survival in this transplant model. The results suggest that FTY720 has a different effect on certain lymphocyte populations. CD4+ cells seem to be more affected than CD8+ cells and NK-cells.
- Published
- 2004
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- View/download PDF
142. [Functional results after autologous rotational keratoplasty. A retrospective study].
- Author
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Birnbaum F, Reinhard T, Ulbricht T, Hausser J, and Sundmacher R
- Subjects
- Adult, Follow-Up Studies, Humans, Retrospective Studies, Rotation, Transplantation, Autologous methods, Treatment Outcome, Vision Tests, Cicatrix diagnosis, Cicatrix surgery, Corneal Diseases diagnosis, Corneal Diseases surgery, Corneal Transplantation methods, Recovery of Function, Visual Acuity
- Abstract
Background: Autologous rotational keratoplasty is a therapeutic option in patients with central corneal scars. Its advantage compared to allogeneic procedures is the absence of immunologic destruction. In this retrospective analysis, long-term results are presented., Patients: Since 1988, autologous rotational keratoplasty was performed in 19 patients. The trephine size varied between 7.0 mm and 9.0 mm. Mean follow-up was 7.1+/-4.6 years., Results: In 16 of the patients, the graft center remained clear during the entire follow-up period. Visual acuity improved from 0.25+/-0.16 preoperatively to 0.34+/-0.27 postoperatively with spectacles and to 0.43+/-0.3 with contact lenses. The mean postoperative astigmatism was 6.41+/-3.87 dpt with irregular components in six patients., Conclusion: Only a few postoperative graft complications were observed. Especially in patients with a markedly elevated risk for immune reactions (e.g., small infants), autologous rotational keratoplasty is a safe alternative to allogenic procedures.
- Published
- 2004
- Full Text
- View/download PDF
143. [Percutaneous transfemoral implantation of a new, flexible thoracic aorta endoprosthesis using a percutaneous suture system for vascular suture--initial experiences].
- Author
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Manke C, Kobuch R, Lenhart M, Strotzer M, Merk J, Birnbaum F, Feuerbach S, and Link J
- Subjects
- Aged, Aged, 80 and over, Aortic Dissection diagnostic imaging, Angiography, Digital Subtraction, Aortic Aneurysm, Thoracic diagnostic imaging, Aortography, Female, Femoral Artery diagnostic imaging, Hemostasis, Surgical instrumentation, Humans, Image Processing, Computer-Assisted, Male, Postoperative Complications diagnostic imaging, Surgical Instruments, Tomography, X-Ray Computed, Wound Healing physiology, Aortic Dissection surgery, Angioplasty, Balloon instrumentation, Aortic Aneurysm, Thoracic surgery, Blood Vessel Prosthesis Implantation instrumentation, Femoral Artery surgery, Stents, Suture Techniques instrumentation
- Abstract
Purpose: To evaluate the transfemoral placement of a new, flexible stent-graft into the thoracic aorta and the suture-mediated closure of the femoral access., Patients and Methods: Five patients were treated endovascularly with a stent-graft for an aneurysm (n = 3) or acute dissection (n = 2) of the thoracic aorta via a femoral 24 F sheath. The femoral access site was closed with two suture-mediated closure devices after placement of the stent-graft., Results: The aneurysm or the false lumen was excluded from perfusion by the placement of the stent-graft in all patients. Hemostasis at the femoral access site was successful in all patients with the percutaneous suture device. A minor stenosis of the femoral artery was found angiographically in four patients after suture-mediated closure. Besides a reversible renal failure due to the medically induced hypotension for the treatment of an acutely ruptured aneurysm, no complications resulted from the stent-graft placement or the percutaneous suture., Conclusion: The percutaneous transfemoral placement of stent-grafts in the thoracic aorta using a suture-mediated closure of the access site is technically feasible. Long-term results of the technique have to be awaited.
- Published
- 2001
- Full Text
- View/download PDF
144. Bone marrow features and clinical findings in chronic myeloid leukemia--a comparative, multicenter, immunohistological and morphometric study on 614 patients.
- Author
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Thiele J, Kvasnicka HM, Schmitt-Graeff A, Zirbes TK, Birnbaum F, Kressmann C, Melguizo-Grahmann M, Frackenpohl H, Sprungmann C, Leder LD, Diehl V, Zankovich R, Schaefer HE, Niederle N, and Fischer R
- Subjects
- Adult, Biopsy, Female, Humans, Immunohistochemistry, Leukemia, Myelogenous, Chronic, BCR-ABL Positive complications, Leukemia, Myelogenous, Chronic, BCR-ABL Positive mortality, Macrophages pathology, Male, Middle Aged, Neoplasm Staging, Primary Myelofibrosis etiology, Survival Rate, Bone Marrow pathology, Leukemia, Myelogenous, Chronic, BCR-ABL Positive pathology
- Abstract
A multicenter, immunohistochemical and morphometric study was performed on diagnostic pretreatment bone marrow biopsies in 614 adult patients with Ph1+ chronic myeloid leukemia (CML) to compare histological features with clinical findings. For identification of megakaryopoiesis we used the monoclonal antibody CD61 and additionally the PAS reaction to determine the subfraction of atypical micromegakaryocytes and precursors. Labelling of erythroid precursors was carried out by a monoclonal antibody directed against glycophorin C. In order to selectively stain macrophages and their activated subset we applied CD68 and the GSA-I lectin. Density of argyrophilic fibers (reticulin plus collagen) was measured following Gomori's silver impregnation method. In accordance with laboratory data morphological variables revealed a comparable amount of congruence in the various groups of CML patients derived from different sources. In about 26% of patients early (reticulin) to advanced (collagen) fibrosis was detectable. Significant correlations were calculated between the extent of myelofibrosis with splenomegaly, anemia and increasing numbers of erythroblasts and myeloblasts in the peripheral blood count. These features were assumed to indicate more advanced stages of the disease process with ensuing transition into myeloid metaplasia and consequently were associated with an unfavorable prognosis. Significant relationships were revealed between the number of CD61+ megakaryocytes and more important, also their precursor fraction with the degree of fibrosis. This result extends previous experimental findings regarding the impact of immature elements of this cell lineage for the generation of myelofibrosis. The significant association of erythroid precursors with the number of mature (resident) macrophages including their activated GSA-I subset may shed some light on their functional involvement in iron turnover and hemoglobin synthesis. A modified histological classification of predominant bone marrow features is introduced. This simplified synthesis staging system (Cologne Classification) is not only associated with certain sets of laboratory data, but also with different survival patterns.
- Published
- 2000
- Full Text
- View/download PDF
145. Hepatitis B virus nucleocapsid assembly: primary structure requirements in the core protein.
- Author
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Birnbaum F and Nassal M
- Subjects
- Amino Acid Sequence, Blotting, Northern, Cloning, Molecular, DNA Mutational Analysis, DNA, Viral analysis, Escherichia coli, Macromolecular Substances, Molecular Sequence Data, Morphogenesis, RNA, Messenger analysis, RNA, Viral analysis, Structure-Activity Relationship, Viral Core Proteins genetics, Capsid ultrastructure, Hepatitis B Core Antigens physiology, Hepatitis B virus ultrastructure, Viral Core Proteins ultrastructure
- Abstract
As a step toward understanding the assembly of the hepatitis B virus (HBV) nucleocapsid at a molecular level, we sought to define the primary sequence requirements for assembly of the HBV core protein. This protein can self assemble upon expression in Escherichia coli. Applying this system to a series of C-terminally truncated core protein variants, we mapped the C-terminal limit for assembly to the region between amino acid residues 139 and 144. The size of this domain agrees well with the minimum length of RNA virus capsid proteins that fold into an eight-stranded beta-barrel structure. The entire Arg-rich C-terminal domain of the HBV core protein is not necessary for assembly. However, the nucleic acid content of particles formed by assembly-competent core protein variants correlates with the presence or absence of this region, as does particle stability. The nucleic acid found in the particles is RNA, between about 100 to some 3,000 nucleotides in length. In particles formed by the full-length protein, the core protein mRNA appears to be enriched over other, cellular RNAs. These data indicate that protein-protein interactions provided by the core protein domain from the N terminus to the region around amino acid 144 are the major factor in HBV capsid assembly, which proceeds without the need for substantial amounts of nucleic acid. The presence of the basic C terminus, however, greatly enhances encapsidation of nucleic acid and appears to make an important contribution to capsid stability via protein-nucleic acid interactions. The observation of low but detectable levels of nucleic acid in particles formed by core protein variants lacking the Arg-rich C terminus suggests the presence of a second nucleic acid-binding motif in the first 144 amino acids of the core protein. Based on these findings, the potential importance of the C-terminal core protein region during assembly in vivo into authentic, replication-competent nucleocapsids is discussed.
- Published
- 1990
- Full Text
- View/download PDF
146. Gallium scintigraphy in bronchogenic carcinoma. The effect of tumor location on sensitivity and specificity.
- Author
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Waxman AD, Julien PJ, Brachman MB, Tanasescu DE, Ramanna L, Birnbaum F, Berman DS, and Koerner SK
- Subjects
- Carcinoma, Bronchogenic secondary, False Negative Reactions, False Positive Reactions, Humans, Lymphatic Metastasis, Mediastinal Neoplasms diagnostic imaging, Mediastinal Neoplasms secondary, Radionuclide Imaging, Carcinoma, Bronchogenic diagnostic imaging, Gallium Radioisotopes, Lung Neoplasms diagnostic imaging
- Abstract
Fifty-one patients with primary lung cancer were evaluated using 67Ga citrate scintigraphy with respect to detection of peripheral primary, hilar metastasis, and mediastinal metastasis. The results demonstrated the necessity for an understanding of the criteria used in considering the gallium scintigram as either positive or negative, as well as the instrumentation employed in performing the test before any meaningful sensitivity and specificity figures can be derived within a given institution. Only with this understanding can actual strategy for instituting invasive procedures be achieved.
- Published
- 1984
- Full Text
- View/download PDF
147. [Cyclocryotherapy of haemorrhagic glaucoma: clinical long time and histopathologic results (author's transl)].
- Author
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Faulborn J and Birnbaum F
- Subjects
- Aged, Cryosurgery adverse effects, Eye blood supply, Glaucoma physiopathology, Hemorrhage surgery, Humans, Intraocular Pressure, Middle Aged, Necrosis, Postoperative Complications pathology, Postoperative Complications physiopathology, Time Factors, Cryosurgery methods, Glaucoma surgery, Hemorrhage complications
- Abstract
67 eyes with a haemorrhagic glaucoma have been treated with different methods of cyclocryotherapy. 54 of the 67 patients were painless after a follow-up from 6 to 53 months. In 49 eyes the intraocular tension was under 25 mm Hg regardless of the applicationmethod used. 9 of the 67 eyes were found to be phthistic most of them in the series with the longest follow-up. The histopathologic findings of 8 eyes which had been excised after different postoperative periods show severe necrosis and chronic tissue reaction following cyclocryotherapy.
- Published
- 1977
148. [So-called preretinal hemorrhage of the posterior pole].
- Author
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Birnbaum F
- Subjects
- Adult, Humans, Male, Meningitis, Meningococcal complications, Retinal Hemorrhage etiology, Vision Disorders etiology, Retinal Hemorrhage physiopathology
- Published
- 1975
149. [Acute myopia with increased intraocular pressure due to a decompensated juvenile diabetes mellitus (author's transl)].
- Author
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Birnbaum F and Leu P
- Subjects
- Acute Disease, Adult, Diabetes Mellitus, Type 1 physiopathology, Diabetic Retinopathy physiopathology, Humans, Male, Myopia physiopathology, Diabetes Mellitus, Type 1 complications, Diabetic Retinopathy complications, Intraocular Pressure, Myopia etiology
- Abstract
We report on a 33-year-old woman, whose diabetes mellitus was kept under control with depot insulin and diet for 18 years. One evening she notices blurred vision in both eyes which markedly increased during the following days. We found flat anterior chambers, an increased ocular pressure up to 34 mm Hg, and a myopia up to-3,5 D. on both sides. Bloodsugar tests revealed varying results. After the diabetic metabolic state was normalized, the myopia and the raised intraocular pressure ceased to exist.
- Published
- 1975
150. [Primary reconstruction of severely injured eyes by microsurgery (author's transl)].
- Author
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Faulborn J and Birnbaum F
- Subjects
- Adult, Humans, Lens, Crystalline surgery, Male, Methods, Microsurgery, Sclera surgery, Vision, Ocular, Vitreous Body surgery, Eye Injuries surgery
- Published
- 1974
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