非手术治疗儿童外伤性视神经损伤临床分析

目的分析非手术治疗儿童外伤性视神经损伤的临床特点。方法选取本院2014-11—2015-11收治的43例(45眼)外伤性视神经损伤患儿为本次研究对象,对其临床资料进行回顾性分析,并对其临床表现、发病特征、临床诊断、临床治疗等进行总结。结果本院所收治的外伤性视神经损伤患儿,其发病原因多为车祸,且视力受损严重,在经相应治疗后,多数患儿视力有所恢复。结论针对儿童外伤性视神经损伤,应及早诊断、及早治疗,确保治疗效果,改善其预后。     

视神经管减压术治疗外伤性视神经病变有效性及安全性Meta分析

目的系统评价神经内镜辅助视神经管减压术治疗外伤性视神经病变（TON）的临床疗效及安全性。方法计算机检索PubMed、EMBASE、Cochrane临床试验数据库、中国生物医学文献数据库（CBM）、维普数据库（VIP）、中国期刊网全文数据库（CNKI）、万方数据库等,纳人所有关于神经内镜辅助视神经管减压术治疗TON患者的随机对照研究及临床对照研究。使用Cochrane系统评价员手册（版本5．0．1）评定所有纳入研究的质量,并用RevMan5．1软件对收集的数据进行Meta分析。结果最终纳入12个符合标准的研究,共1176例患者。Meta分析结果显示：①对于提高患者的视力恢复程度,神经内镜组明显优于激素治疗组（OR=1．83;95％可信区间：1．09～3．06;P〈0．05）;②对于提高患者视力恢复程度,神经内镜组与经颅视神经管减压术组比较,差异无统计学差异（OR=0．71;95％可信区间：0．47～1．06;P〉0．05）。结论神经内镜辅助经鼻视神经管减压术治疗TON的临床疗效优于传统激素治疗。虽然神经内镜组与开颅手术视神经管减压术组比较,对视力恢复的有效率无统计学差异,但其具有创伤更小、恢复更快、手术时间更短、并发症更少等优点。     

Anterior ischemic optic neuropathy in moyamoya disease: a first case report

Neuro-ophthalmological manifestations in moyamoya disease are usually the result of cerebrovascular involvement of the visual pathways. We report a case of ischemic optic neuropathy due to ocular hypoperfusion as a result of moyamoya disease, despite a prior internal to external carotid artery bypass with normal hemisphere perfusion. The blood supply of the optic nerve, a proposed pathogenesis of an anterior ischemic optic neuropathy and complications of the ocular ischemic syndrome are discussed.     

外伤性视神经病变的治疗进展

外伤性视神经病变(TON)是颌面部损伤后造成单侧或双侧视力受损的罕见临床并发症.对TON迄今尚无公认的金标准治疗方案,对治疗方式的选择及手术治疗时间窗仍存在争议.传统观点认为伤后立即丧失视力及伤后约1个月的未手术患者为手术禁忌.越来越的学者提出了不同的观点,其治疗方案仍存在严重分歧.现对近10年相关文献进行归纳总结,从...     

Primary extramedullary orbital plasmacytoma in a child

We describe a rare case of extramedullary plasmacytoma of the orbit in an 11-year-old boy. Immunoperoxidase staining of the tissue was positive for IgG, chain and negative for chain. Serum and urine electrophoresis showed no M spike. Systemic examination and bone marrow aspirate failed to show generalised involvement. The tumour was completely excised and radiotherapy given postoperatively.     

磁共振扩散张量成像技术在外伤性视神经病中应用研究

目的 探讨磁共振扩散张量成像技术在评价外伤性视神经病中的作用. 方法选择6例单侧外伤性视神经病患者,采用磁共振扩散张蛩成像技术检测双侧视神经.应用DTV2和Volume One 1.44软件测量视神经的部分各向异性值、平均表观扩散系数,并进行损伤眼和正常眼的自身对比;应用神经白质纤维柬追踪技术显示视神经的空间完整性和连续情况.结果 所有患者眶内段视神经显示良好,2例患者双侧管内段显示欠佳.6例患者损伤眼眶内段视神经部分各向异性平均值较正常眼明显下降,分别为0.244±0.067和0.452±0.053,差异有统计学意义(P=0.000);平均表观扩散系数平均值较正常眼明显上升,分别为(1.417±0.121)×10<'-3>mm<'2>/s和(1.087±0.118)×10<'-3>mm<'2>/s,差异有统计学意义(P=0.003).4例患者可以获得用于评估双侧视神经空间连接情况的扩散张量纤维束成像图,损伤眼和正常眼之间存在明显差异.结论磁共振扩散张量成像技术能够为评估外伤性视神经病的视神经纤维病理情况提供有价值的信息.     

Double function of noninvasive intracranial pressure monitoring based on flash visual evoked potentials in unconscious patients with traumatic brain injury

Intracranial pressure (ICP) monitoring based on flash visual evoked potentials (F-VEP) is a noninvasive method of monitoring ICP. The early diagnosis of traumatic optic neuropathy (TON) in unconscious patients with traumatic brain injury (TBI) is a challenge. The aim of this study was to evaluate the function of F-VEP ICP monitoring in predicting TON and detecting contusion enlargement (CE) in unconscious TBI patients using a modified approach. A series of F-VEP ICP-monitored unconscious TBI patients were included in the study. The interocular differences in N2 wave latency (DL) and amplitude (DA) were obtained through monocular flash stimulation. The increases in ICP (dxP) and interchannel difference (dxDC) across various time points were obtained through binocular flash stimulation. The predictive power of DL and DA on TON, as well as of dxP and dxDC on CE, was assessed by logistic regression and receiver operating characteristic (ROC) curve analysis. Patients with TON had a longer DL and a higher DA than those without TON. The dxP and dxDC of patients with CE were both higher than those of patients without CE. The differences were statistically significant. The logistic regression showed that both DL and DA were predictors of TON, whereas only dxDC was a predictor of CE. However, the ROC curve analysis showed that DL had greater predictive power for TON, and dxDC had greater predictive power for CE. An F-VEP ICP monitoring system with a modified approach is beneficial for early diagnosis of TON and prediction of CE in unconscious TBI patients.     

103眼外伤性视神经病手术治疗效果及预后影响因素分析

目的 探讨经鼻内镜视神经减压术治疗外伤性视神经病的疗效以及影响预后的因素. 方法 回顾性总结中山大学附属第三医院耳鼻咽喉-头颈外科自1995年1月至2001年2月(53例)、自2001年3月至2009年12月(50例)收治的103眼外伤性视神经病的临床特征以及应用经鼻内镜视神经减压术治疗的临床结局,通过单因素分析(x2检验)和多因素分析(Logistic回归分析)筛选出影响外伤性视神经病外科手术治疗预后的因素,并建立回归方程. 结果 103眼的手术总有效率为37.86％(39/103).术前有残余视力者有效率为83.3％(20/24),无残余视力者有效率为24.05％(19/79),比较差异有统计学意义(P＜0.05).单因素和多因素分析显示术前无残余视力、伤后至手术间隔时间＞3d以及筛蝶窦积血这3个因素与手术效果呈显著相关性(P＜0.05),年龄、有无意识障碍、伤后至手术间隔时间是否＞7d、视神经管有否骨折、是否切开鞘膜、术前是否使用激素等因素与手术效果不相关(P＞0.05),但在有视神经管骨折的患者中,骨折部位和严重程度不同其疗效也有差别.预测手术效果的Logistic回归方程为P(1)=1/[1 +e-(2.139+2.839X3+1.372X5+2.263X9)] (X3:术前残余视力;X5:外伤至手术间隔时间;X9:筛蝶窦积血). 结论 经鼻内镜视神经减压术治疗外伤性视神经病的总体疗效并不令人满意,特别是对于术前无光感者.影响外伤性视神经病外科手术疗效的不良预后因素多且相互影响.临床上应根据患者不同的临床特点慎重选择手术方式.     

Efficacy of granulocyte-colony stimulating factor treatment in a rat model of anterior ischemic optic neuropathy

Non-arteritic anterior ischemic optic neuropathy （NA-AION） is the most common cause of acute ischemic damage to the optic nerve （ON）, and the leading cause of seriously impaired vision in people over 55 years of age. It demonstrated that subcutaneous administration of Granulocyte colony-stimulating factor （G-CSF） reduces RGC death in an ON crush model in rats, and that the neuroprotective effects may involve both anti-apoptotic and anti-inflammatory processes. Our recent work shows that the protective actions of G-CSF in rAION models may involve both anti-apoptotic and anti-inflammatory processes. However, the exact rescuing mech- anisms involved in the administration of G-CSF in rAION models need further investigation. In addition, further studies on the administration of G-CSF at different time intervals after the induction of rAION may be able to illustrate whether treatment given at a later time is still neu- roprotective. Further, it is unknown whether treatment using G-CSF combined with other drugs will result in a synergistic effect in a rAION model. Inflammation induced by ischemia plays an essential role on the ON head in NA-A1ON, which can result in disc edema and compartment changes. Therefore, it is reasonable that adding an anti-inflammatory drug may enhance the therapeutic effects of G-CSF. An ongoing goal is to evaluate the novel sites of action of both G-CSF and other anti-inflammatory drugs, and to identify the functionally protective pathways to enhance RGC survival. These investigations may open up new therapeutic avenues for the treatment of ischemic optic neuropathy.     

外伤性视神经病变患者视神经减压术围手术期综合护理干预

目的探讨综合护理干预对外伤性视神经病变患者行鼻内镜下视神经减压术围手术期心理应激反应及生活质量的影响。方法选取我院2015-02—2017-04外伤性视神经病变107例,均行鼻内镜下视神经减压术治疗,按入院顺序分组,对照组53例予以常规护理干预,研究组54例在对照组基础上予以综合护理干预,比较2组干预前后抑郁(SDS)、焦虑(SAS)、生活质量(SF-36)评分、临床效果及并发症发生率。结果研究组干预后SDS、SAS评分低于对照组,差异有统计学意义(P0.05);研究组临床效果优于对照组,研究组总有效率96.30%(52/54)高于对照组81.13%(43/53),差异有统计学意义(P0.05);研究组并发症发生率1.85%(1/54)低于对照组20.75%(11/53),差异有统计学意义(P0.05);研究组术后躯体功能、社会功能、精力、心理健康等SF-36评分均高于对照组,差异有统计学意义(P0.05)。结论给予外伤性视神经病变行鼻内镜下视神经减压术患者围手术期综合护理干预效果显著,可明显改善其心理应激反应及生活质量,且安全性较高。     

Leber's hereditary optic neuropathy mutations in ethambutol-induced optic neuropathy

Primary mitochondrial DNA (mtDNA) mutation at the nt 11778 site in Leber's hereditary optic neuropathy (LHON) has been reported to be present in patients with ethambutol-induced optic neuropathy. To study further this association between LHON and ethambutol-induced optic neuropathy, we tested ethambutol-induced optic neuropathy patients for the presence of the mtDNA mutations at nucleotides (nt)–11778, nt–14484, nt–3460, nt–15257, nt–9438, nt–9804, nt–13730, and nt–14459 in 24, 15, 8, 6, 5, 5, 5, and 5 patients respectively. However, none of the ethambutol-induced optic neuropathy patients was found to exhibit any pathogenic LHON mtDNA mutation. In conclusion, we found no evidence of any association between ethambutol-induced optic neuropathy and the LHON mutations. Received: 21 January 2002, Received in revised form: 26 August 2002, Accepted: 30 August 2002 Correspondence to Jeong-Min Hwang, M. D.     

成人烟雾病临床特征分析

目的 探讨244例成人烟雾病（Moyamoya病）的临床特征。 方法 分析244例成人Moyamoya病患者的发病年龄、性别及临床症状,并与日韩及北美Moyamoya病患 者进行比较分析。 结果 244例病例年龄为18岁～72岁,平均36岁,其中男124例,女120例,男女比例为1∶1.03;以脑出血为 首发症状入院的57例,187例以脑缺血为首发症状入院。本组患者来自我国28个不同省市,河南省34人、 河北省30人,所占病例数最多。全部患者均行数字减影血管造影（DSA）和磁共振血管成像（MRA）检查, 血管成像按照铃木分期,其中1期24侧半球,2期96侧半球,3期112侧半球,4期152侧半球,5期80侧 半球,6期24侧半球。本组244例Moyamoya病患者行硬脑膜动脉血管融通术（encephalo-duro-arteriosynangiosis, EDAS）,57例出血发病的病例均未出现再出血。187例缺血发病的病例中症状明显缓解的161 例,26例无明显变化。 结论 本研究样本显示的Moyamoya病临床特征与日本、韩国及北美有所不同,即出血型病例发病率 较低而脑梗死发病率明显较高。其发病机制是否有所不同需进一步深入研究;EDAS手术是治疗成人 Moyamoya病的有效方法。     

胆囊收缩素在高血压性脑血管疾病病程中的表达及临床意义

目的:探讨CCK-8在高血压性脑血管病不同阶段的表达和意义,在出血性和缺血性卒中中的差异和意义。方法:高血压性脑血管病病例135例,分为二组:缺血性卒中70例;出血性卒中65例。对照组60例。分别于发病24小时、3天、2周、4周、8周抽静脉血2ml,测定血浆CCK-8含量。结果:出血性卒中早期血浆CCK-8明显升高(P<0.01),第二周明显降低(P<0.01),第二周到第四周无明显变化(P>0.05),第八周比第四周进一步降低(P<0.01),第八周仍高于对照组(P<0.05)。缺血性卒中早期血浆CCK-8明显升高(P<0.01),第二周明显降低(P<0.01),第二周到第四周无明显变化(P>0.05),第八周比第四周进一步降低(P<0.01),但仍高于对照组(P<0.01)。梗死组第二周、第四周、第八周血浆CCK-8均高于出血组(P<0.05)。结论:CCK的确参与了高血压性脑血管病的发病和恢复过程,但在缺血性和出血性卒中过程中的作用可能不同。     

Symptomatic diabetic and non-diabetic neuropathies in a series of 100 diabetic patients

We have reviewed the clinical and pathological data of a series of 100 consecutive diabetic patients with symptomatic neuropathy in order to learn more about the causes of neuropathy in this population and on the signs and symptoms that could suggest another cause than diabetes in this setting. After diagnostic procedures, patients were assigned one (at most two) of a final total of 18 different causes of neuropathy. Diabetes accounted for 74 % of the neuropathies in the whole group of patients and for 79 % of those with a fiber length dependent pattern of neuropathy. One third of patients had a neuropathy unrelated to diabetes. As a group, 71 % of the patients presented either a length dependent diabetic polyneuropathy (LDDP) or a proximal diabetic neuropathy (PDN). The LDDP group was biased towards more severely affected patients owing to our specialization. Conversely, most patients with proximal diabetic neuropathy had usual features. Chronic inflammatory demyelinating neuropathy that was diagnosed in 9 % of the patients was the most common non-diabetic cause of neuropathy in this population. We conclude that a short interval between diagnosis of diabetes and the onset of the neuropathy, early motor deficit, markedly asymmetrical deficit and generalized areflexia, which are all uncommon in the LDDP, argue in favor of a non diabetic origin of the neuropathy and should lead to further investigation. Received: 19 June 2001, Received in revised form: 21 September 2001, Accepted: 8 October 2001     

Sensory-predominant,painful, idiopathic neuropathy: inflammatory changes in sural nerves

Sensory-predominant, painful, idiopathic neuropathies are a common clinical problem. In this retrospective study of 11 patients with such a neuropathy, we found axonal loss in 9, with multifocal axonal loss in 4 patients; there were large perivascular mononuclear inflammatory infiltrates (>50 cells) in 4 and smaller infiltrates (10-20 cells) in 4. These findings suggest that some cases of this neuropathy may be due to autoimmune vasculopathy and therefore may respond to immunotherapy.