伴球内异物的开放性眼外伤早期行玻璃体手术的疗效观察

目的评估伴有球内异物的开放性眼外伤在伤后48 h内行玻璃体手术的疗效。方法回顾性分析我院2009年1月1日至2015年3月1日收治的56例(56眼)开放性眼外伤(OGIs)患者的临床资料;所有患者均伴有球内异物(IOFB),且在受伤48 h内行经睫状体扁平部的玻璃体切割术(PPV)。结果在56眼中,IOFB发生眼内炎的有16眼,不伴有眼内炎的有40眼;术后异物取出率100%。52例患者术后眼球得以保存,4眼眼球保存失败。在24~48 h行PPV的球内异物伴眼内炎患者的比率是24 h内手术的2.09倍。24 h内行PPV的患者眼球保存、一次性视网膜复位、眼压异常情况与24~48 h手术者比较差异无统计学意义。结论早期玻璃体切割手术是治疗伴有球内异物的开放性眼外伤安全、有效的手段。     

玻璃体切割术治疗复杂性眼内异物伤

我们自1994～1999年采用手术显微镜直视下玻璃体切割联合眼内异物取出术治疗63例65眼复杂性眼内异物伤,取得良好效果,现报告如下。1 一般资料63例65眼复杂性眼内异物伤中,男55例,女8例;年龄6～65岁,平均年龄23.5岁;     

玻璃体视网膜手术对开放性眼外伤的治疗研究

目的 探讨玻璃体视网膜手术在治疗开放性眼外伤中的疗效.方法 回顾性分析2004年9月至2008年10月行玻璃体切除术治疗开放性眼外伤53例(53眼).结果 33例眼内异物,摘出率100%,11例复杂视网膜脱离,复位率31.7%,3例继发性青光眼,眼压均控制在正常范围,6例眼内炎,5例得到控制.所有53例53只眼中,术后视力较术前提高者45只眼(84.9%),术后视力不变或下降8只眼(15.1%).结论 玻璃体视网膜手术对大部分开放性眼外伤患者的视力有所改善.     

铁质和非磁性异物对球内异物伤患者致盲和并发症的影响

目的分析93例球内异物伤患者术后并发症和视力恢复的情况,探讨损伤部位、损伤异物与并发症及术后视力恢复的相关性。方法收集2010年1月至2016年1月在我院进行的93例急诊球内异物取出术患者临床资料,重点分析患者伤情、球内异物以及术后1年以上的并发症和最佳矫正视力。结果球内异物伤患者术后致残率15. 05%,致盲率51. 61%,并发症发生率39. 78%;球内异物伤患者术后复致盲与术后并发症密切相关(r=0,P=-0. 429),术后并发症的发生与铁质材质密切相关(r=-0. 589,P=0. 00)。结论对于外伤性异物眼球内损伤患者,应积极处置并遏制并发症发生,特别是铁质异物的患者应及时取出,避免损伤视神经视网膜进而影响视力恢复能力。     

玻璃体视网膜手术对开放性眼外伤的治疗研究

目的探讨玻璃体视网膜手术在治疗开放性眼外伤中的疗效。方法回顾性分析2004年9月至2008年10月行玻璃体切除术治疗开放性眼外伤53例（53眼）。结果 33例眼内异物,摘出率100%,11例复杂视网膜脱离,复位率31.7%,3例继发性青光眼,眼压均控制在正常范围,6例眼内炎,5例得到控制。所有53例53只眼中,术后视力较术前提高者45只眼（84.9%）,术后视力不变或下降8只眼（15.1%）。结论玻璃体视网膜手术对大部分开放性眼外伤患者的视力有所改善。     

眼内异物的B型超声扫描诊断分析

目的分析B型超声扫描在眼异物探查中的声像学特点,确定其在临床诊断中的特异性。方法采用眼科专用B型超声波扫描仪对42例(62眼)眼内异物进行探查。结果本组42例经B超探查发现53眼异物回声,异物检出率64.3%(53/62),其中眼球内异物27例(50.9%),眼球壁异物9例(16.9%),眼眶内异物6例(11.3%),其中眼内异物16例(57.9%);眼球壁异物9例(23.7%);眶内异物1例(2.6%)。有26例行X光检查,16例发现异物,异物检出率为61.1%(16/26),其中眼内异物16例(53.3%);眼球壁异物4例(13.3%);眶内异物3例(10.0%)。结论B型超声探查对于眼内异物具有特异性的诊断价值。     

黄斑裂孔手术治疗增生型T2DM视网膜病变效果及预后影响因素探讨

目的:分析增生型2型糖尿病(T2DM)视网膜病变黄斑裂孔手术治疗效果及预后影响因素.方法:随机选择本院2018年6月至2020年6月诊治的增生型T2DM视网膜病变患者172例作为研究对象.采用计算机随机数字法将其分成对照组与观察组,例数86例/组.对照组接受玻璃体切割术治疗.观察组采用黄斑裂孔手术治疗,随访3 m,以患者术后视力提高2行及以上为治愈,为预后良好,其余为预后不良,统计并发症发生率.问卷调查危险因素,包括术前视力水平、眼内异物、餐后2 h血糖、是否注射VEGF、是否植入晶体.结果:对照组患者中50例治愈,为预后良好;36例未能治愈,为预后不良.观察组患者中62例治愈,为预后良好;24例未能治愈,为预后不良.观察组患者预后良好率高于对照组(P<0.05).观察组术后共发生短暂高压眼(3例)、晶状体核硬化(4例)、视网膜脱离复发(2例)共9例,并发症发生率为10.47％.对照组术后共发生短暂高压眼(5例)、晶状体核硬化(4例)、视网膜脱离复发(6例)共15例,并发症发生率为17.44％.年龄不是影响黄斑裂孔手术预后的影响因素(P>0.05),而眼内异物、餐后2h血糖、注射VEGF、植入晶体均是黄斑裂孔手术预后的影响因素(P<0.05).结论:增生型T2DM视网膜病变黄斑裂孔手术治疗效果较好,但容易受眼内异物、晶状体植入的影响.     

单次Nd-YAG激光治疗黄斑区视网膜内界膜下出血

目的探讨单次Nd-YAG激光治疗黄斑区视网膜内界膜下出血的疗效。方法回顾性非病例对照研究,收集2015年1月至2016年3月临床诊断为视网膜内界膜下出血6例6眼患者的临床资料。6例患者均进行了Nd-YAG激光行视网膜内界膜下积血引流术。术后1个月、3个月门诊复查最佳矫正视力(best corrected visual acuity,BCVA)、进行黄斑区光学相干断层扫描(optical coherence tomography,OCT),观察和记录术后BCVA变化、黄斑区视网膜内界膜下积血消退和并发症情况。结果 6例患者年龄23~60岁。其中4例年轻患者发病与咳嗽有关;1例合并高血压,1例合并双眼糖尿病视网膜病变;眼底镜检查显示黄斑区舟样视网膜内界膜下出血,BCVA从数指(count finger,CF)到0.05,平均视力0.03;发病时间5 h至12 d。Nd-YAG激光单次治疗后所有患者视力即刻部分恢复,积血吸收平均时间为2周,术后3个月OCT检查显示黄斑区视网膜内界膜平复,中心凹形态恢复。合并高血压和糖尿病2例患者分别于激光术后2周和1个月因玻璃体大量出血进行了玻璃体切除手术。结论单次Nd-YAG激光治疗单纯性视网膜内界膜下出血是安全有效的。     

有晶状体眼后房型人工晶体植入术后黄斑出血1例

<正>有晶状体眼后房型人工晶体(implantable collamer lens,ICL)植入是目前矫治高度近视甚至超高度近视的安全有效手段~([1-2]),技术成熟,手术时间短,对眼内组织影响较小,但是仍然可能出现一些严重的并发症。术后黄斑出血就是ICL术后并发症之一,可使患者的视力急剧下降,造成严重后果~([3-4])。只有及时发现,找准病因,精确治疗,才能及时挽救受损的视功能。2015年10月我院收治1例高度近视患者ICL术后黄斑出血,现将相关诊治经验报告如下。1资料与方法1.1临床资料患者,女,34岁。视力:右眼裸眼视力0.02,-20.5DS→0.5,左眼裸眼视力0.02,-20.0DS→0.5;眼压:右眼12 mmHg,     

无光感球后视神经炎的视力恢复

对20例(22眼)急性球后视神经炎持续无光感1～15天患者采用大剂量激素冲击疗法加球后注射治疗,全部病人脱离无光感,其中治疗1周内出现光感6眼,2周内8眼,3周内5眼,22天3眼.随访6个月～5年,视力达0.1～0.2 5眼,0.3～0.6 12眼,0.8 3眼,1.5 2眼.无光感球后视神经炎只要视盘无褪色,早期坚持积极的治疗,恢复部分视力是可能的.     

Improved bronchodilation with levalbuterol compared with racemic albuterol in patients with asthma

Background: Racemic albuterol is an equal mixture of (R)-albuterol (levalbuterol), which is responsible for the bronchodilator effect, and (S)-albuterol, which provides no benefit and may be detrimental. Objective: We sought to compare 2 doses of a single enantiomer, levalbuterol (0.63 mg and 1.25 mg), and equivalent amounts of levalbuterol administered as racemic albuterol with placebo in patients with moderate-to-severe asthma. Methods: This was a randomized, double-blind, parallel-group trial. Three hundred sixty-two patients 12 years of age or older were treated with study drug administered by means of nebulization 3 times daily for 28 days. The primary endpoint was peak change in FEV₁ after 4 weeks. Results: The change in peak FEV₁ response to the first dose in the combined levalbuterol group was significantly greater compared with the combined racemic albuterol group (0.92 and 0.82 L, respectively; P = .03), with similar but nonsignificant results after 4 weeks (0.84 and 0.74 L, respectively). Improvement in FEV₁ was similar for levalbuterol 0.63 mg and racemic albuterol 2.5 mg and greatest for levalbuterol 1.25 mg. Racemic albuterol 1.25 mg demonstrated the weakest bronchodilator effect, particularly after chronic dosing. The greatest increase in FEV₁ was seen after levalbuterol 1.25 mg, especially in subjects with severe asthma. All active treatments were well tolerated, and β-adrenergic side effects after administration of levalbuterol 0.63 mg were reduced relative to levalbuterol 1.25 mg or racemic albuterol 2.5 mg. At week 4, the predose FEV₁ value was greatest in patients who received levalbuterol or placebo when compared with those who received racemic albuterol. The difference was more evident and was statistically significant in patients who were not receiving inhaled corticosteroids. Conclusion: Levalbuterol appears to provide a better therapeutic index than the standard dose of racemic albuterol. These results support the concept that (S)-albuterol may have detrimental effects on pulmonary function. (J Allergy Clin Immunol 1998;102:943-52.)     

Infectious diseases and immunological markers associated with patients with non-Hodgkin lymphoma treated with rituximab

Background: The use of rituximab (RTX) is increasing, even in developing countries. It has become the first-line therapy or adjuvant to chemotherapy (CHOP; cyclophosphamide, hydroxydaunorubicin, oncovin and prednisone) for various diseases, including B cell lymphoma and autoimmune diseases.

Aim: We describe the infectious diseases and immunological markers associated with RTX treatment of patients with non-Hodgkin lymphoma (NHL).

Methods: Serum immunoglobulins were determined before and after intravenous immunoglobulin (IVIg) administration. Pneumo-23IgG-specific anti-pneumococcal antibodies were evaluated before and after vaccination. Immunophenotyping and lymphocyte proliferation were determined in the course of the treatment.

Results: Seven patients were followed and median age was 56.0?±?5.0?years (range, 41.9–71.6?years). At baseline, the mean level of IgG was 333.7?±?40.8?and IgM 40.9?±?11.3?mg/dL, respectively; immunoglobulin A and E (IgA and IgE) were under the limit of detection. Two patients had reduced or absent B cells and T cell subsets were at normal levels in five patients. All patients failed to mount an efficient post-vaccination immune response against hepatitis B virus, tetanus, diphtheria and against the 23-valent pneumococcal polysaccharide vaccine. During RTX/CHOP treatment, human-IgG-immunoglobulin (IVIg) therapy was introduced in six patients after recurrent infections, including community-acquired pneumonia (85.7%), chronic sinusitis (85.7%) and gastroenteritis (42.9%).

Conclusion: Poor response against pneumococcal vaccines increases the susceptibility of respiratory diseases in these patients. In patients with NHL treated with RTX, the benefits achieved with IVIg replacement for the control of recurrent infectious diseases is of paramount importance. Clinicians dealing with monoclonal antibodies against cancer therapy, especially RTX, should be aware of the increasing risks for symptomatic induced hypogammaglobulinemia and respiratory infections.     

Establishing Safety with Patients with Dissociative Identity Disorder

Abstract

The incidence of self-mutilation and suicidality among patients with dissociative disorders is quite high. It is necessary for clinicians working with this population to be adept at dealing with safety problems. This article presents a sequence of basic steps that can be used when helping dissociative patients establish safety, a discussion of the functions of self-destructiveness, and an overview of specific experiences and thinking patterns that contribute to self-destructiveness among dissociative patients.     

Gynecomastia with marked cellular atypia associated with chemotherapy

Gynecomastia is a common benign male breast disease, which may exhibit mild cellular atypia in cytology specimens. However, marked cytologic atypia can be seen in gynecomastia superimposed by chemotherapy. The case described in this report demonstrated severe cytologic atypia of gynecomastia mimicking carcinoma in a patient treated with chemotherapy for acute leukemia. A distinct cytologic feature helpful in avoiding the diagnostic error is described, namely, atypical cells admixed with bland ductal cells and appearing at a different plane. The importance of applying strict diagnostic criteria in breast cytology and clinical correlation is also emphasized.     

Intervention with epinephrine in hypotension associated with mastocytosis

The occurrence of the episodes of vasodilatory hypotension can be a life-threatening manifestation of systemic mastocytosis. This article describes the reversal by epinephrine of episodes of severe hypotension in two hospitalized patients with mastocytosis. Recognition of the efficacy of epinephrine in hypotension associated with mastocytosis can be important when other methods fail to restore hemodynamic stability.