“Double eyes” sign of congenital bilateral dacryocystoceles

Dacryocystocele is caused by nasolacrimal duct obstruction and results in cystic dilatation of the proximal part of the nasolacrimal duct, which is located inferomedial to the orbit, leading to fluid accumulation. It is important to consider that persistent congenital bilateral dacryocystoceles may cause neonatal nasal obstruction resulting in respiratory difficulty, and large dacryocystoceles may require surgical drainage. Ultrasonography demonstrates that congenital bilateral dacryocystoceles and normal eyeballs prenatally resemble two pairs of cystic “lesions” of different sizes. We herein present a case of prenatally diagnosed isolated congenital bilateral dacryocystoceles and propose the new name of “double eyes” sign for this rare condition to create an impact on medical students and residents.     

逆行性人工鼻泪管植入修复泪道阻塞性疾病：18个月随访（英文）

背景：人工鼻泪管植入治疗泪道阻塞性疾病不会改变泪道的解剖结构,是一种简单有效的治疗方法。目的：评价人工鼻泪管植入治疗泪道阻塞性疾病的有效性及安全性。方法：选择2008/2009逆行性人工鼻泪管植入治疗泪道阻塞患者87例,共94眼,年龄26～71岁,平均56岁。其中鼻泪管阻塞患者31例,慢性泪囊炎患者56例。随访时间为18个月。结果与结论：人工鼻泪管植入后第2天92眼溢泪症状完全缓解,成功率为98%（92/94）。随访中,85眼人工鼻泪管保持通畅,8眼发生阻塞,1眼发生人工鼻泪管移位,植入有效率为90%（85/94）。植入后有7例患者出现疼痛,2例出现眼睑水肿,所有患者均有少量鼻出血,经对症处理后均缓解。结果可见人工鼻泪管植入是治疗泪道阻塞性疾病简单有效安全的方法。     

鼻泪管支架置入术治疗鼻泪管阻塞

目的　探讨介入性鼻泪管支架置入术治疗鼻泪管阻塞的临床疗效。方法　采用Ｓｏｎｇ ６０１ 型鼻泪管支架组套,经鼻侧逆行置入支架治疗鼻泪管阻塞５ 例。结果　技术成功率１００ ％ 。术后即刻造影鼻泪管通畅。１ 例术后１ 周出现再堵塞,其余４ 例溢泪症状完全缓解。随访５ ～１２ 个月,１ 例４ 个月后复发,另３ 例保持通畅至今。结论　鼻泪管支架置入术是治疗鼻泪管阻塞简单有效的方法。     

合并眼眶内侧壁骨折的鼻泪管骨折螺旋CT诊断

目的探讨合并眼眶内侧壁骨折的鼻泪管骨折螺旋CT诊断价值。方法对45例临床确诊为眼眶内侧壁骨折的病人行螺旋CT横断位扫描,扫描后行MPR图像后处理。其中5例出现典型的溢泪症状,6例有明显泪管断裂或泪道阻塞的临床体征。结果检出22例(49%)病人合并鼻泪管骨折。所有具有临床症状及体征的病人均被检出。22例病人均为单侧性的鼻泪管骨折。其中除合并眼眶骨折外,6例合并其它部位骨折。22例鼻泪管骨折在螺旋CT横断位中均可显示,应用MPR图像后处理方法可显示20例。横断位显示稍优于MPR。结论眼眶内侧壁骨折易并发鼻泪管骨折,以单侧最为多见。以横断位扫描为基础,辅以MPR技术能够清楚地显示眼眶内侧壁骨折所并发的鼻泪管骨折及鼻泪管的阻塞情况。同时MPR还能清楚地显示骨折线的全程及鼻泪管的走行,对于指导手术治疗及评价预后具有重要的临床价值。     

自行设计定制“鱼形针”在泪道植管术中的应用价值

目的探讨"鱼形针"在泪道植管术中的应用价值。方法单纯慢性鼻泪管阻塞51眼,复杂性泪道阻塞19眼,急性泪囊炎3眼,采用自行设计定制的"鱼形针"配合送管器,将硅胶管植入鼻泪管和泪囊,随访6～18月。结果 73眼中67眼(91.7%)无溢泪、泪道冲洗通畅,6眼有流泪症状(8.2%)、泪道冲洗欠通畅。单纯慢性鼻泪管阻塞平均手术时间为3分钟。手术操作后多数患者无明显鼻腔出血。结论鱼形针与送管器配合硅胶管置入术无需使用鼻镜、额镜等观察器械来辅助,是治疗鼻泪管阻塞,慢性泪囊炎的一种安全、可靠、方便、快捷、并发症少、复发率低的治疗方法 ,而且在急性泪囊炎的治疗中疗效满意。     

自制金属支架治疗鼻泪管阻塞

目的 探讨自制金属支架治疗鼻泪管阻塞的临床效果。方法 对15例18只眼鼻泪管阻塞植入自制不锈钢丝支架。先行泪道冲洗探通，从上泪点顺行插入导丝，沿导丝逆行引入扩展器，然后用导管鞘将金属支架植入鼻泪管阻塞段。术前与术后做泪道造影检查。结果 术后泪道造影均通畅，溢泪完全消失11例13只眼，好转4例5只眼。随访－219d，平均167d，仅2例2眼手术后3个月复发，阻塞的病例经手术取出支架，有肉芽组织增生。结论 自制金属支架治疗睛管阻塞是一种简单、安全、价廉、有效的方法。     

鼻内镜下泪囊鼻腔造孔术的护理

目的:探讨鼻内镜下泪囊鼻腔造孔术治疗外伤性鼻泪管阻塞的护理及治疗效果。方法:10例外伤性鼻泪管阻塞患者接受了鼻内镜下泪囊鼻腔造孔术。结果:10例接受鼻内镜下泪囊鼻腔造孔术的患者术后症状缓解,鼻腔造瘘口通畅。结论:鼻内镜下泪囊鼻腔造孔术是治疗外伤性鼻泪管阻塞的有效方法,而且具有损伤小,方法简便,并发症少等优点。     

Computed tomography imaging features for amyloid dacryolith in the nasolacrimal excretory system: A case report

BACKGROUNDNasolacrimal duct obstruction leading to epiphora is a common ophthalmologic complaint, and it may derive from amyloidosis in rare cases. There are a few reports about localized amyloidosis, and amyloidosis with involvement and obstruction of the nasolacrimal duct is exceedingly rare. CASE SUMMARYA 54-year-old male presented with a 2-year history of a lump overlying the left lacrimal sac that had grown rapidly for nearly half a year. Physical examination touched a firm lump in the left lacrimal sac. Nasal endoscopy discovered lesions in appearance of sediments with easy bleeding at the entry of the nasolacrimal duct of the left inferior nasal meatus. Computerized tomography scan revealed speckle high density in the left lacrimal sac and the dilated nasolacrimal duct. During an endoscopic exploration and excision, a large number of dacryoliths were exposed. Pathology indicated amorphous pink material and multinucleated giant cell reaction in the fibrous tissue.CONCLUSIONThis case showed amyloidosis in localized form mimicking dacryolith with nasolacrimal duct obstruction. In clinical practice, we should be aware of the possibility of localized amyloidosis in the nasolacrimal excretory system.     

Managing eye disease in primary care. Part 2. How to recognize and treat common eye problems

Many patients with symptomatic eye conditions present initially to their primary care physician. Comprehensive treatment of such conditions as dry eye syndrome, blepharitis, styes, chalazia, conjunctivitis, congenital nasolacrimal duct obstruction, superficial foreign bodies, corneal abrasion, and subconjunctival hemorrhage can often be provided in the primary care setting. Patients with persistent or severe conditions, particularly those involving foreign bodies and corneal abrasions due to high-velocity injuries, should be referred for immediate care by an ophthalmologist.     

软探针泪道探通术治疗先天性泪道阻塞和泪囊炎的护理

目的探讨软探针泪道探通术治疗先天性泪道阻塞和泪囊炎的效果。方法回顾性分析119例(133眼)先天性泪道阻塞和泪囊炎用软探针泪道探通术治疗的护理体会。结果随访3～6个月(平均4个月),57例(65眼)先天性鼻泪管阻塞治愈率达98.5%;62例(68眼)先天性泪囊炎治愈率为95.6%。未发生1例假道和泪小管损伤。结论掌握泪道探通及泪道冲洗的技巧,术后观察及处理是软探针泪道探通术成功的关键。     

新型泪道扩张引流管逆行置入治疗慢性泪囊炎的围术期护理

目的总结74例（89眼）经鼻逆行置入新型泪道扩张引流管治疗慢性泪囊炎的护理经验。方法术前评估患者心理状态,向患者讲解拜湖道的解剖结构,逆行置锊的方法、原理、效果及术中、术后的注意事项,消除患者焦虑与紧张心理;术中默契配合医生操作,给患者以安慰和鼓励;术后做好健康指导和泪道冲洗及拔管的护理。结果所有患者术中均成功霞入洲道扩张引流管。观察6～12个月,总有效率为95.62％。结论新型渭道扩张引流符逆行置管术是一种有效、安全的治疗慢性泪囊炎的方法,且具有对局部的解剖结构影响较小、临床再通半高等优点,恰当护理可以保证手术的顺利完成,提高治愈率和患者满意度。     

Congenital tear duct obstruction

Congenital nasolacrimal duct obstruction is a classic condition that has been well investigated and is readily identified. The suggested sequence of treatment includes massage, irrigation, probing, insertion of a silicone stent and, finally, dacryocystorhinostomy. Because of the relatively frequent occurrence of duct obstruction in normal infants, family physicians need to be familiar with its diagnosis and treatment. If problems still exist after an adequate trial of conservative treatment, referral before six months of age is suggested.     

骨性鼻泪管横截面断层解剖学与影像解剖学的比较

背景:目前研究集中于鼻泪管的局部解剖和影像解剖方面,而在干性颅骨标本上进行较系统的骨性鼻泪管横截面断层解剖学与影像解剖学对照研究尚较缺乏。目的:探讨骨性鼻泪管横截面断层解剖学与影像解剖学特点,为相关鼻内镜鼻泪管手术提供依据。设计:标本自身对照试验。单位:成都医学院教学保障处。材料:实验于2005-09/2006-09在成都医学院人体解剖学教研室局部解剖实验室完成。随机选取国人成人完整无损干性颅骨34例(68侧),其中男性34侧,女性34侧。方法:①使用SHIMADZU型CT机以头颅CT的常规扫描基线OM线为轴位扫描基线,对标本进行水平位扫描。人为将骨性鼻泪管分为3等分(上1/3段、中1/3段、下1/3段),每一等分的测量结果取其包括相应层面相应数据的平均值。②按影像扫描基线在颅骨标本上做好标记。使用切片刀沿CT的水平位扫描基线行横断面断层切片,分别测量骨性鼻泪管的相关测量指标,并与影像学的结果相对照。主要观察指标:①骨性鼻泪管上口、上1/3段、中1/3段、下1/3段、下口的前后径和左右径。②骨性鼻泪管上口、上1/3段、中1/3段、下1/3段、下口的内骨壁和后骨壁厚度。③骨性鼻泪管下口的位置和形态。④骨性鼻泪管相应指标的CT影像测量结果与横截面解剖测量结果的对照。结果:①骨性鼻泪管横截面前后径及左右径:骨性鼻泪管上口明显狭窄;下口的大小变异较大;管径由上至下逐渐增大;前后径大于左右径;骨性鼻泪管上口内径、下1/3段内径,男女之间比较,差异有显著性意义(t=2.458,2.227,P<0.05)。骨性鼻泪管上1/3段内径、中1/3段内径、下口内径,男女之间比较,差别无显著性意义(P>0.05)。②骨性鼻泪管横截面的内骨壁和后骨壁:骨性鼻泪管内骨壁的厚度为(0.87±0.23)mm,后骨壁的厚度为(0.21±0.19)mm,内骨壁的厚度和后骨壁的厚度之间比较,差异有显著性意义(t=2.547,P<0.05);骨性鼻泪管上口、上1/3段、中1/3段、下1/3段、下口的内骨壁厚度以及相应位置的后骨壁厚度,男女之间比较,差异均无显著性意义(P>0.05)。③鼻泪管下口的位置、开口的形态变异较大。骨性鼻泪管相应指标的CT影像测量结果与横截面解剖测量结果一致。结论:熟悉骨性鼻泪管的正常横截面解剖及影像解剖有助于鼻泪管相关手术的顺利进行和减少并发症。     

鼻泪管骨折HRCT扫描及诊断

目的：探讨鼻泪管骨折HRCT扫描方法及诊断意义。方法：回顾分析HRCT横断及冠状扫描25例鼻泪管骨折病人，其中21例为临床眶骨骨折病人，只有4例出现典型伯临床表现：溢泪，伴有泪囊内积脓后才行CT检查。结果：18例为双侧鼻泪管骨折，7例为单侧鼻泪管骨折，所有病人均合并其他骨折。25例鼻泪管骨折在HRCT横断扫描均可显示，但冠扫只显示4例，横断扫描显示鼻泪管优于冠状扫描。结论：HRCT扫描能清楚显示鼻泪管骨折，对临床诊断及早期治疗有指导价值。     

Endoscopic transnasal dacryocystorhinostomy -long-term results

Summary

Endoscopic dacryocystorhinostomy (DCR) was successfully performed in 40 patients, with four patients having bilateral surgery. Follow-up data were obtained on 43/44 eyes using clinical notes and a patient questionnaire. Range of follow up was 1–46 months, with an average of 18 months (in nine patients follow up was at least 3 years). Epiphora was successfully relieved in 86% of patients and there was no evidence of a recurrence of nasolacrimal obstruction in the long term. Endoscopic DCR is a relatively quick and simple procedure with low morbidity, and as such is suitable for day case surgery. Satisfactory long-term results make endoscopic DCR an alternative to external DCR as primary surgical treatment for nasolacrimal duct obstruction. In cases of failed external DCR, or when epiphora is iatrogenic following surgery to the lateral nasal wall, a transnasal endoscopic approach is probably the treatment of choice.     

两种方法治疗鼻泪管阻塞疗效比较

目的比较单纯鼻泪管支架植入术和鼻泪管支架植入术后糜蛋白酶液冲洗泪道治疗鼻泪管阻塞的疗效。方法对81例患者分别进行单纯鼻泪管支架植入术与鼻泪管支架植入术后糜蛋白酶液冲洗泪道治疗,术后随访,观察溢泪溢脓及泪道通畅情况。结果单纯鼻泪管支架植入术组在术后第6个月有4例出现再次阻塞,手术成功率为89.5%;鼻泪管支架植入术后糜蛋白酶液冲洗泪道组未见任何并发症,手术成功率为100%,两组比较差异有统计学意义(P<0.05)。结论鼻泪管支架植入术后糜蛋白酶液冲洗泪道的方法操作简单,并发症少,成功率高,值得临床推广应用。     

丝裂霉素在鼻泪管探通术中的应用研究

目的:探讨丝裂霉素(MMC)在鼻泪管探通术中的应用效果。方法:随机将107例鼻泪管阻塞溢泪患者分为两组,观察组(A组)55例施行鼻泪管探通术后予以0.1%MMC,对照组(B组)52例常规鼻泪管探通术治疗,观察比较两组治疗效果。结果:A组治疗效果显著优于B组(P<0.005,或P<0.001),两组并发症发生率差异有显著性(P<0.01)。结论:丝裂霉素抑制瘢痕形成,提高了探通术成功率,达到了预期效果。     

阴道检查代替肛门检查监测产程的临床观察

传统的观察产程进展的方法常是肛门检查（以下简称肛查），但是肛查时产妇疼痛便意感明显，并且常不能正确地判断产程进展状况。为此，2004年5月-2005年5月，我们对385例分娩孕妇采用杭州民生药业集团有限公司生产的5％聚维酮碘溶液消毒后进行阴道检查（以下简称阴查），代替传统的肛门检查来了解产程进展，并探讨产程中常规采用阴查是否增加母儿感染。与356例肛查观察产程者进行对比分析，以确定阴道检查监测产程的可行性，尤其是妊娠合并细菌性阴道病（BV）产妇的母儿感染情况，现报道如下。     

Endoscopic drill-assisted dacryocystorhinostomy

Summary

With the introduction of endoscopes for endonasal surgery, there have been an increasing number of endonasal dacryocystorhinostomies (DCR) performed. The advantages of the endonasal approach include the avoidance of an external facial scar and reduced risk of damage to the medial canthal ligament. We described our experience with the use of the Hall Osteon drill for endoscopic DCR. This procedure has been found to be technically reliable giving satisfactory post-operative results in 16 patients suffering from nasol-acrimal duct obstruction. The follow up was up to 12 months with a mean of 5 months. Three patients who had residual post-operative epiphora were considered as failures. There were no major complications and minor complications included one case of periorbital ecchymosis, one unretrieved silicone tube and a minor vestibule abrasion. The preliminary results suggest that the endoscopic drill-assisted DCR could offer a reliable treatment in patients with epiphora due to nasolacrimal duct obstruction.     

Respiratory variation of extrahepatic bile duct diameter during ultrasonography.

The attachments and adjacent structures of the extrahepatic bile duct may not move uniformly throughout the respiratory cycle, potentially affecting the diameter of the common bile duct. This study was performed to evaluate possible respiratory variation in extrahepatic bile duct diameter. Thirty consecutive subjects with maximal anteroposterior common bile duct diameter of 5 mm or greater were studied. Inspiratory increase in ductal diameter exceeding 1 mm was noted in 11 subjects (37%), eight without biliary obstruction. Awareness of this normal phenomenon may avert sonographic misdiagnosis of common bile duct obstruction, particularly during fatty-meal sonography.