年龄小于45岁原发性慢性闭角型青光眼的显微手术治疗

目的探讨原发性慢性闭角型青光眼年轻患者临床治疗的经验和体会。方法对临床收治的41例52眼、年龄〈45岁、临床确诊为进展期或晚期原发性慢性闭角型青光眼的病例进行抗青光眼显微手术处理的病例进行回顾性分析。结果随访时间平均（32．50±5．08）个月；男16例，女25例；进展期28眼，晚期24眼；52眼均行抗青光眼手术-复合式小梁切除手术治疗；眼轴长平均（22．40±1．63）mm，其中〈21mm占17．31％，小眼球占13．46％；前房深度平均（1．90±0．39）mm，其中〈1．9mm占61．46％；超声生物显微镜检查高褶虹膜构型占59．62％，其中睫状突位置靠前者10眼；术前平均眼压（41．73±12．26）mmHg，末次术后平均眼压（12．03±4．57）mmHg，术前后眼压差异有统计学意义（t=3．520，P〈0．001）。术后并发症主要有浅前房，恶性青光眼。恶性青光眼手术处理方式包括玻璃体抽液、前段玻璃体切割以及超声乳化白内障吸除加人工晶状体植入术治疗。4眼因眼压控制不理想，行二次抗青光眼手术治疗。结论年轻原发性慢性闭角型青光眼患者，女性多见，多伴有眼轴短、前房浅等特点，抗青光眼复合式小梁手术治疗要注意防治术后浅前房、恶性青光眼的发生。术前详细检查、手术操作精细以及有效处理术后并发症将有助于提高手术成功率和减少并发症。     

Clinical performance of non-contact tonometry by Reichert AT550® in glaucomatous patients

Measuring intraocular pressure (IOP) by non-contact tonometry (NCT) has been demonstrated to be a valid and reliable technique to be used in primary eye care; it is easier to use, it does not transmit infectious diseases, and it is not necessary to use anaesthetic or staining eye drops. Recently, a new NCT device has showed an excellent level of agreement with Goldmann tonometry, but there are no records of its performance in glaucomatous eyes. To rectify this, IOP was measured in twenty-two patients (44 eyes) receiving medical treatment to control elevated IOP, with AT550 and Goldmann tonometry. Mean values of IOP were 18.98 +/- 2.77 and 19.08 +/- 3.02 mmHg using Goldmann and AT550, respectively. Plots of differences against means displayed good agreement (mean difference +/- limits of agreement, -0.09 +/- 3.30); this value was not significantly different from zero (t-test for dependent samples, p = 0.709). In conclusion, IOP values as measured with the AT550 NCT are clinically comparable with those obtained with Goldmann tonometry in glaucomatous patients. This validates this NCT not only for screening of IOP but to follow-up glaucomatous patients with a rapid, non-invasive method.     

The effect of central corneal thickness on estimates of the anterior chamber depth

Background: The slitlamp can be used to estimate the anterior chamber depth (ACD). The length of a slit object is increased until the corneal and iris/lens images appear to just touch. Multiplying the just‐touching‐slit‐length (JTSL) by a conversion factor gives an estimate of the ACD as measured by ultrasonography. The purpose of this study was to determine if central corneal thickness (CCT) affects the accuracy of this technique. Methods: The ACD of 50 subjects was measured by A‐scan ultrasonography and estimated by the slitlamp technique. CCT was measured by ultrasonic pachometry. The refractive error was determined subjectively. Results: The average ultrasonographic ACD for all subjects was 3.32 ± 0.65 mm. The average JTSL was 2.46 ± 0.38 mm. The conversion ratio between the ultrasonographic ACD and the average JTSL was 1.35. The predicted ACD using the regression equation of JTSL on the ultrasound anterior chamber depth (USACD) was 3.32 ± 0.54 mm. The corresponding value using the regression equation of JTSL and CCT on USACD was exactly the same, that is, 3.32 ± 0.54 mm. Conclusion: Incorporation of CCT into a regression equation does not improve the accuracy of the Smith technique.     

Mefenamic acid-induced bilateral transient myopia, secondary angle closure glaucoma and choroidal detachment

Drug-induced secondary angle closure is quite common and in the majority of cases simply stopping the medication leads to rapid reversal of the condition and resolution of glaucoma. We describe here a patient who presented with secondary angle closure glaucoma and myopia following mefenamic acid ingestion which was managed successfully by stopping the medication, symptomatic treatment and reassurance.     

原发性肝癌非规则性肝切除的疗效观察

目的探讨非规则性肝切除术治疗原发性肝癌的临床疗效。方法1995年1月～2003年5月采用非规则性肝切除治疗原发性肝癌106例，随访1～5年，对其临床资料进行分析。结果8例在术后3个月内死于肝肾功能衰竭，98例恢复良好。术后1、3、5年的生存率分别为84．9％、34．7％、27．8％。结论非规则性肝切除是治疗原发性肝癌的有效方法，特别对于合并肝硬化的患者更有临床应用价值。     

Clinical and demographical characteristics of primary progressive multiple sclerosis in Isfahan, Iran

Primary progressive multiple sclerosis (PPMS) is an uncommon form of multiple sclerosis (MS) in which the course of disease is progressive from onset. In a retrospective study amongst 1606 MS patients registered in Isfahan MS Society (IMSS) from April 2003 to 31 December 2005, 92 PPMS cases were identified. That means, the frequency of PPMS amongst all included MS patients would be 5.7% (95% CI: 6.7% and 4.7%). The mean expanded disability status scale (EDSS) for the group was 5.09 ± 1.3. The commonest mode of presentation was motor disturbance in 55 (59.8%), other modes of presentation were, vertigo in 15 (16.3%), visual problems in 12 (13%), sensory disturbances in six (6.5%), and diplopia in four (4.3%). The current existing symptoms were motor problems in all 92 (100%), cerebellar symptoms in 46 (50%), and cognitive impairment in only six (6.5%). Interestingly, two (2%) were affected by poliomyelitis during childhood and presenting symptom in both was limb weakness. Primary progressive form of MS is less common in Persian population and some of the rates observed in PPMS patients differ from those in other regions, these differences may be due to different ethnicity of Persian patients or to geographical differences.     

Optimising Hormone Therapy in Advanced Disease

Although most prostate cancer (PCa) patients nowadays are diagnosed at an early stage of disease, unfortunately still a significant number of patients will develop advanced PCa or will be diagnosed at an advanced (or metastatic) stage of disease. The group of patients showing the highest increase in incidence are those with rising prostate specific antigen (PSA) after radical therapy.In the last quarter of 2004, a Medline search has been performed targeting publications on patients diagnosed with advanced PCa, as well as with PSA relapse after previous radical therapy. This review aims at providing guidance to optimise hormone therapy in those selected groups of patients by addressing three pivotal questions; (i) who should receive hormonal treatment, (ii) what type of hormonal therapy should the patient be offered and (iii) what is the best timing of starting hormonal treatment.In patients relapsing after radical therapy, the PSA doubling time (PSA DT) has become a critical instrument to distinguish patients to have innocuous PSA evolution from patients at high risk for disease progression. A PSA DT of 3 months seems to be the cut-off point for identifying patients at risk. Therefore patients with a PSA DT of less than 3 months should be advised to initiate hormonal therapy. Antiandrogen monotherapy may be considered in this setting as it has been shown to delay progression; however, significant survival data are not yet available. Whether luteinising hormone releasing hormone (LHRH) agonists should be given continuously or intermittently (IHT) remains subject of debate.Surgical castration has been the standard of care in patients diagnosed with advanced PCa. Currently, LHRH agonists have become the preferred way of suppressing testosterone.Combination of an antiandrogen and a LHRH agonist (CAB) shows a modest benefit over LHRH agonist monotherapy. As CAB leads to increased side effects and costs, LHRH agonist monotherapy is preferred in the majority of patients.Conflicting data have been published concerning the optimal timing of LHRH agonist therapy. So it is not clear whether LHRH agonist therapy should be started immediately or deferred until appearance of symptoms. When initiating continuous hormone therapy, patients should be carefully monitored for the risk of long term androgen deprivation (anaemia, osteopenia and osteoporosis).     

对原发性骨质疏松诊断的一些看法

原发性骨质疏松的诊断首先要除外继发性骨质疏松。后者包括的范围很广，内容也很多，需要广博的内科学基础和辨证的逻辑思维才能予以正确鉴别。骨密度检查只能作为一种参考，而不能作为诊断原发性骨质疏松的唯一依据。     

外引流术后的白内障超声乳化手术

目的：探讨抗青光眼餐引流术后的白内障患眼进行超声乳化吸除术的手术入路，操作方式及临床效果。方法：避开功能性滤过泡，选择角巩膜隧道切口或透明角膜切口，瞳孔麻痹性散大时，做一个完美的直径约5mm的连续环形撕囊以补偿之；恰当处理虹膜后粘连后，在病理性小瞳孔下完成超声乳化手术；眼压失控者行青光眼白内障人工晶体植入三联术。结果：无后囊破裂，人工晶体全部囊袋内植入，术后1周视力≥0．5者20只眼（64．5％），0．1－0．4者8只眼（25．8％），＜0．1者3只眼（9．7％）。随访1－16个月，眼压均在20.55mmHg以下。结论：体外流术后的白内障患眼，超声乳化手术因其切口小，并发症少，不破坏功能性滤过泡，不损伤瞳孔，是目前各种手术方法中的最佳选择。     

派立明与贝特舒联合应用对降眼压的临床观察

目的评价1.00%派立明(AZOPT)与0.25%贝特舒点眼液每日两次点眼对原发性开角型青光眼、高眼压症及抗青光眼术后高眼压的降眼压效果及安全性。方法31例患者51只眼纳入为期2个月的前瞻性研究。在停用其他抗青光眼药物足够长的时间后测量基础值,用药后每2周复查一次共4次,同时观察眼局部及全身副作用。结果用药前眼压为23.85±1.80 mmHg,4次随访眼压下降均值6.55 mmHg(6.06～7.04),眼压下降率27.50%(26.62～28.59%)。少数病例出现烧灼感、视物模糊、口苦等症状,均为轻度能耐受,对视力、眼底无影响。结论派立明与贝特舒联合用药具有稳定的降眼压效果,具良好耐受性。