眼内硅油填充术后继发青光眼的临床分析

<正>随着科学技术的不断发展,玻璃体切除联合硅油填充手术已广泛应用于治疗复杂的视网膜疾病,但是硅油填充术后会出现一些并发症,继发性青光眼是硅油眼内填充术后最常见的并发症之一[1]。本文回顾性分析134例(134眼)硅油填充术后28例(28眼)发生继发性青光眼的原因及相应治疗措施,报告如下。     

两种方法治疗新生血管性青光眼的临床疗效分析

目的探讨玻璃体切割加视网膜光凝联合Ahmed青光眼阀植入与小梁切除加睫状体及全周视网膜冷凝术治疗新生血管性青光眼（NVG）的疗效。方法选择我院2006年至2009年28例（28眼）新生血管青光眼患者。其中,对15例（15眼）新生血管性青光眼患者实行玻璃体切割加视网膜光凝联合Ahmed青光眼阀植入,13例（13眼）NVG患者行小梁切除加睫状体及全周视网膜冷凝术。结果术后1周和2个月冷冻组炎症明显重于青光眼阀组,术后虹膜新生血管均有不同程度回退,两组比较差异无统计学意义。所有病例术后随访6~24个月,两组眼压〉21mm Hg的患者分别为青光眼阀组28%,冷冻组27.8%,两组比较差异无统计学意义。术后24个月两组视力变化比较,青光眼阀组明显优于冷冻组（P〈0.01）。结论玻璃体切割加视网膜光凝联合Ahmed青光眼阀植入治疗NVG即能及时降低眼压,又能提高视力是治疗NVG的一种安全有效的方法,而小梁切除＋睫状体及全周视网膜冷凝术是治疗NVG的一种简单经济有效的方法。     

新生血管性青光眼的治疗研究

青光眼是全球常见且不可逆的严重致盲眼病,严重影响患者视功能,其中新生血管性青光眼(NVG)是顽固性青光眼中疗效较差的一型,是一种常继发于多种眼部及全身血管性疾病或其他疾病的难治性青光眼.其治疗方法包括控制眼压,视网膜缺血治疗,综合运用治疗方法.其中控制眼压包括药物治疗及手术控制眼压,手术控制眼压包括联合应用抗代谢药的滤过性手术,房水引流物植入术,睫状体破坏术,睫状体冷冻术.综合运用治疗方法治疗包括:引流物植入联合经睫状体平坦部玻璃体切割术,视网膜光凝联合睫状体平坦部玻璃体切割术,小梁切除术联合激光或冷凝术.目前在临床上综合治疗以其优势的治疗作用渐渐被眼科医生所接受.     

护理干预增加玻璃体切割加硅油填充术后俯卧位患者舒适度的观察

目的通过护理干预使玻璃体切割加硅油填充术后俯卧位患者舒适度增加。方法选取2009年6月～2010年6月98例玻璃体切割加硅油填充术后行俯卧位的患者,随机分为实验组(49例)和对照组(49例),对照组采用传统的护理方法,实验组在传统护理方法的基础上增加几项新的护理措施。比较两组患者的术后舒适率。结果实验组患者的术后舒适率高于对照组,差别具有统计学意义(P<0.01)。结论通过护理干预可增加玻璃体切割加硅油填充术后俯卧位患者舒适度。     

晶体脱位继发性青光眼玻璃体切割手术治疗的临床分析

目的 探讨晶体脱位继发性青光眼玻璃体切割手术治疗的疗效.方法 对晶体脱位继发性青光眼的患者采用标准玻璃体三切口闭合下行晶体及玻璃体切割手术.结果 62例63只眼晶体脱位继发性青光眼经晶体玻璃体切割后,眼压控制理想.39例占(62.9﹪)39只眼占(61.9﹪)视力不同程度提高,21例占(33.9﹪)22只眼占(34.9﹪)视力不变,2例占(0.3﹪)2只眼占(0.3﹪)视力下降.结论 晶体脱位继发性青光眼采用标准玻璃体三切口闭合下行晶体及玻璃体切割手术,解除机械性阻塞,减少玻璃体腔容积,从而降低了眼压,减轻了眼压升高造成对视神经的损害,且切口小,避免了大切口突然眼压下降造成的脉络膜上腔出血,并发症少,对合并视网膜脱离可同时辅助重水、视网膜激光光凝、硅油填充等手术方式,使视网膜复位.术中能评估眼底的功能,确定植入人工晶体的价值,也能缝线固定人工晶体,做到咬除晶体、切割玻璃体和植入人工晶体一次完成.     

复杂性视网膜脱离患者行玻璃体切割术的围手术期护理

视网膜脱离是眼科常见的致盲性眼底疾病之一,及早发现并治疗能最大限度保留视功能。玻璃体切割合并硅油或膨胀气体(C3F8)填充术是目前治疗复杂性视网膜脱离最主要的方法,现将我院行玻璃体切割合并硅油或C3F8填充术治疗的视     

玻璃体切除联合硅油填充并全视网膜激光光凝术治疗Ⅴ期糖尿病视网膜病变

目的 探讨玻璃体切除联合硅油填充并全视网膜激光光凝术治疗Ⅴ期糖尿病视网膜病变的临床效果。方法将2012年6月至2013年12月收治的前来就诊的增殖性糖尿病视网膜病变Ⅴ期的患者33例(50眼),行玻璃体切除全视网膜激光光凝术,术中根据玻璃体及视网膜增殖与牵拉情况,有无活动性出血决定是否填充硅油。观察与随访术后视力的恢复,术中、术后并发症的发生及患者的满意度。结果 16例(26眼)行玻璃体切除联合硅油填充并全视网膜激光光凝术治疗,17例(24眼)单纯行玻璃体切除及全视网膜激光光凝,未给予玻璃体填充硅油;所有患者手术均顺利,术后硅油填充者3眼出现眼压增高,经治疗,眼压于1周后控制并平稳;无硅油填充者6眼再次发生出血,造成玻璃体积血;术后12个月内,无硅油填充者4眼发生视网膜脱离;在视力恢复及患者满意度上,有硅油填充者视力较术前提高者较多,患者满意率也较高。结论 玻璃体切除联合硅油填充并全视网膜激光光凝术治疗治疗Ⅴ期糖尿病视网膜病变安全有效,可降低术后再出血及视网膜脱离的发生。     

玻璃体切割联合硅油填充术治疗外伤性眼内炎疗效分析

目的观察玻璃体切除联合硅油填充术治疗外伤性眼内炎的疗效。方法回顾性分析14例外伤性眼内炎行玻璃体切除联合硅油填充术治疗的临床疗效。结果 14例患者13眼视力有不同程度提高,1眼眼球萎缩。结论玻璃体切除联合硅油注入术是治疗外伤性眼内炎的有效方法。     

复杂视网膜脱离的治疗中应用硅油的体会

目的：研究分析复杂视网膜脱落患者使用硅油治疗的临床效果。方法硅油填充术治疗复杂视网膜脱落76例患者,共有患眼76只进行研究分析。结果8例全氟丙烷(C3F8)填充术中有4只眼复位,成功率50%,未复位者4只眼,占50%。其中有2例在本院再次手术行玻璃体切割联合硅油填充术,获得复位。共计70例玻切硅油填充术后有66例获得解剖学的复位,成功率94.3%,4例未复位者占5.7%;但有6例在取硅油后复发,占8.6%,故总有成功率为85.7%。术后视力进步者38只眼,不变者20只眼,下降者18只眼。术后视力≥0.05者40只眼。结论复杂视网膜脱离选择玻璃体切割联合硅油填充术是比较普遍的情况,该手术作为该疾病的第一选择具有比较好的效果,硅油填充组患者的治疗有效率比较高。     

全视网膜冷凝联合睫状体冷凝治疗新生血管性青光眼

目的评价全视网膜冷凝联合睫状体冷凝治疗新生血管性青光眼的效果。方法回顾分析50例行全视网膜冷凝联合睫状体冷凝治疗的新生血管性青光眼的病例。结果术后随访6月至12月38例眼压控制在1.60~2.70kPa有效率达85.6%,优于单纯睫状体冷冻术和单纯全视网膜冷凝术,主要并发症为角膜水肿、球结膜水肿、前房纤维素性渗出、低眼压等。结论全视网膜冷凝联合睫状体冷凝是治疗新生血管性青光眼比较有效的方法。     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

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Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

Aquatic Insects and Trace Metals: Bioavailability,Bioaccumulation, and Toxicity

Abstract

The uptake of metals from food and water sources by insects is thought to be additive. For a given metal, the proportions taken up from water and food will depend both on the bioavailable concentration of the metal associated with each source and the mechanism and rate by which the metal enters the insect. Attempts to correlate insect trace metal concentrations with the trophic level of insects should be made with a knowledge of the feeding relationships of the individual taxa concerned. Pathways for the uptake of essential metals, such as copper and zinc, exist at the cellular level, and other nonessential metals, such as cadmium, also appear to enter via these routes. Within cells, trace metals can be bound to proteins or stored in granules. The internal distribution of metals among body tissues is very heterogeneous, and distribution patterns tend to be both metal and taxon specific. Trace metals associated with insects can be both bound on the surface of their chitinous exoskeleton and incorporated into body tissues. The quantities of trace meals accumulated by an individual reflect the net balance between the rate of metal influx from both dissolved and particulate sources and the rate of metal efflux from the organism. The toxicity of metals has been demonstrated at all levels of biological organization: cell, tissue, individual, population, and community. Much of the literature pertaining to the toxic effects of metals on aquatic insects is based on laboratory observations and, as such, it is difficult to extrapolate the data to insects in nature. The few experimental studies in nature suggest that trace metal contaminants can affect both the distribution and the abundance of aquatic insects. Insects have a largely unexploited potential as biomonitors of metal contamination in nature. A better understanding of the physico-chemical and biological mechanisms mediating trace metal bioavailability and exchange will facilitate the development of general predictive models relating trace metal concentrations in insects to those in their environment. Such models will facilitate the use of insects as contaminant biomonitors.     

Alzheimer’s disease – current trends in basic and clinical research. Highlights from the 16th ECNP

Advances in the molecular biological knowledge of neuronal nicotinic acetylcholine receptors (nAChRs) have led to a growing interest by the pharmaceutical industry in the development of novel compounds that selectively modulate nAChR function. The ability of (-)-nicotine, an activator of nAChRs, to enhance attentional aspects of cognition in animals and humans, to exert neuroprotective and anxiolytic-like effects, and presumably to mediate the negative correlation between smoking and Alzheimer's (and Parkinson's) Disease, has focused interest on the potential therapeutic utility of modulators of nAChR function for treatment of some of the deficits associated with these progressive, neurodegenerative conditions. Numerous compounds are known which activate nAChRs and which might serve as lead compounds toward the development of such agents. The pharmacologic diversity of neuronal nAChR subtypes suggests the possibility of developing selective compounds which would have more favourable side-effect profiles than existing agents. This broader class of agents, collectively called cholinergic channel modulators (ChCMs), is anticipated to encompass compounds which would have more favourable side-effect profiles than existing agents, which generally exhibit low selectivity. This selectivity may be achieved by preferentially activating some subtypes of nAChRs (i.e., Cholinergic Channel Activators, ChCAs) or inhibiting the function of other subtypes (Cholinergic Channel Inhibitors, ChCIs). An overview of the biology of nAChRs and the rationale for the use of ChCMs for the treatment of dementia related to neurodegenerative diseases are presented, followed by a discussion of lead compounds and compounds under consideration for clinical evaluation.     

Steroidal sapogenin contents in some domestic plants

In order to find out the values of the steroid resources for the future use. the compositions and contents of steroidal sapogenins from 13 domestic plants have been investigated. As a result,Dioscorea nipponica, D. quinqueloba andSmilax china were found to have large amount of diosgenin. And pennogenin inTrillium kamtschaticum andParis verticillata, yuccagenin inAllium fistulosum, hecogenin inAgave americana and neochlorogenin inSolanum nigum were appeared to be major steroidal sapogenins.