Threshold Amsler grid testing in maculopathies

The Amsler grid is a suprathreshold target and thus may fail to detect relative scotomas. If the grid is viewed through two cross-polarizing filters creating low luminance conditions (threshold Amsler grid testing) the test is far more sensitive. Ten patients with disorders of the macula with normal standard white Amsler grid testing were studied with three other Amsler grid tests. Of the 15 involved eyes, 12 had visual field defects present with threshold Amsler grid testing. Tangent screen examination showed defects in 10 of these 12 eyes. The two red grids used were not as sensitive as the threshold grid. Three eyes had metamorphopsia with the white grid which became the site of a visual field defect with threshold testing. Threshold Amsler grid testing is a rapid and sensitive technique for the evaluation of the central 10 degrees of visual field in patients with maculopathies.     

膨体聚四氟乙烯填塞结合隆鼻手术治疗严重萎缩性鼻炎的临床观察#br#

目的　膨体聚四氟乙烯（expanded Polytetrafluoroethylene,e-PTFE）（简称膨体）填塞结合隆鼻手术综合治疗鼻中线低平的严重萎缩性鼻炎,提高疗效并改善患者生理及心理疾患。方法　收集联勤保障部队第九○八医院耳鼻咽喉头颈外科2010年1月至2021年1月期间确诊为萎缩性鼻炎患者50例,A组25例患者全部采用羟基磷灰石填塞法治疗,B组25例患者全部采用膨体填塞结合隆鼻手术综合治疗。采用鼻小柱切口,翻盖式手术切口暴露鼻中隔及鼻底部,在鼻腔内、下壁黏膜下填塞膨体及抬高鼻尖缩窄前鼻孔等综合治疗方法。结果　术后3个月、3~6个月除感染、外露手术失败者,A、B两组患者术后效果无统计学意义（P >0.05）,术后6~12个月后随诊B组满意率显著高于A组,鼻腔通气稳定,差异有统计学意义（P<0.05）。结论　膨体填塞结合隆鼻手术综合治疗鼻中线低平的严重萎缩性鼻炎,较唇龈切口黏骨膜下填入羟基磷灰石,长期效果稳定,患者满意度高,使用范围及前景更大,值得临床推广。     

张仲景禁用下法思路分析

目的探讨下法的使用禁忌,为临床准确选方用药提供有力依据。方法通过对《伤寒论》中与下法有关的110余条原文进行分析,并结合历代医家相关解析,在理解原文的基础上,对禁用下法的情况进行分类和归纳,以揭示张仲景禁用下法的整体思路。结果禁用下法可分3种情况：（1）无向下病势禁用下法;（2）虚症禁用下法;（3）腑实未成禁用下法。结论临床治疗中,需要使用下法时,应在排除禁忌情况的前提下,综合分析疾病的病势、病位及患者的虚实情况后方可选方用药。     

Endometriosis and angiogenesis

Endometriosis is a common gynecological condition, responsible for significant morbidity and social-economic impact. Although the condition has been recognized for many years, the underlying pathophysiology is poorly understood. In turn, this results in inadequate treatment and high recurrence rates. Various theories try to explain the presence of endometrial tissue outside the uterine cavity. However, none of them can explain all disease locations and appearances, and it is unclear how these fragments establish into endometriotic lesions. New vessel formation has long been recognized as a feature of endometriosis, often clearly visible at laparoscopy. Recent work has focused on identifying the role of vascularization in the pathogenesis of endometriosis, by allowing lesions to establish and grow. In this review the authors outline the basic mechanisms of angiogenesis and vasculogenesis in the human eutopic endometrium, and consider how this data can be applied to endometriotic implants. Furthermore, the authors discuss molecular mechanisms of angiogenesis and vasculogenesis, and how this may be used to therapeutic advantage in the treatment of endometriosis.     

Intravaginally applied metronidazole is as effective as orally applied in the treatment of bacterial vaginosis, but exhibits significantly less side effects

Objective

Metronidazole is the drug of choice for the treatment of bacterial vaginosis (BV). However, so far the oral administration has not been clinically compared to the intravaginal application regarding efficacy, side effects and patient satisfaction in a scientific sound fashion.

Study design

Therefore, this randomized, double-blind, placebo-controlled clinical trial was designed to demonstrate non-inferiority of short-term intravaginal (i.vag.) application of metronidazole (2× 1000 mg pessaries 24 h apart) vs. a single oral dose (p.o.) of metronidazole (1 × 2000 mg tablets) in 263 patients with BV (double-dummy design). The follow-up period was 12 weeks. In addition, the number and the type of adverse events induced by the two regimens were compared, assuming better tolerability of the intravaginal application.

Results

Following the diagnosis of BV a total of 129 women (mean age 36.2 years) was orally treated with a single dose of 2 g metronidazole whereas a total of 134 patients (mean age 35.5 years) was treated intravaginally with 1 g metronidazole each day on two consecutive days and included in the per-protocol analysis. Non-inferiority of i.vag. application compared to p.o. administration was statistically significant regarding efficacy: Following intravaginal application the cure rate, assessed on day 8 after starting of the treatment, was 92.5% as compared to 89.9% after oral administration. Nausea was the most common adverse event reported in 10.2% i.vag. vs. 30.4% p.o. of all cases (p < 0.001), abdominal pain in 16.8% i.vag. vs. 31.9% p.o. (p < 0.01), a “metallic taste” in 8.8% i.vag. vs. 17.9% p.o. (p < 0.05). Women treated i.vag. were highly satisfied with the treatment and more content as compared to the women treated p.o. with metronidazole (p < 0.05, intent-to-treat analysis).

Conclusion

In this clinical trial the intravaginal application was as effective as the oral administration of metronidazole in treating BV. However, significantly less adverse events were reported after short-term intravaginal as compared to oral application (p = 0.023) and probably led to a better patient compliance.     

Thrombophilic mutations in pre-eclampsia and pregnancy-induced hypertension

AIM: The aim of the present study was to determine the existence or prevalence of thrombophilic markers such as Factor V Leiden, prothrombin G20210A, protein S, protein C, activated protein C and anti-thrombin in pre-eclampsia and pregnancy-induced hypertensive patients. METHODS: Blood samples were collected from a total number of 124 women at the maternity unit, University of Malaya Medical Center. These included 49 patients with pre-eclampsia, 63 patients with pregnancy-induced hypertension and 12 normal pregnant women. DNA was extracted from the blood samples. Factor V Leiden (Taq I) and prothrombin G20210A (Hind III) genotyping was done on polymerase chain reaction-restriction fragment length polymorphism. Anti-thrombin activity and the concentrations of protein C, protein S and activated protein C were measured using the IL Coagulation System (Hemosil). RESULTS: Of the 124 subjects, one pre-eclampsia patient was homozygous for Factor V Leiden mutation but prothrombin G20210A mutation was not present in any of the subjects. The subject with Factor V Leiden mutation also had a low activated protein C resistance and a low protein S concentration. CONCLUSIONS: Factor V Leiden mutation is present in the Asian population and may very well serve as one of the genetic factors responsible for pre-eclampsia and other adverse pregnancy outcomes.