外伤性视神经病变24例回顾研究

目的:探讨的外伤性视神经病变的临床表现,评估在眼科第三病区住院的经过三组不同处理(保守估计,单独静脉注射皮质类固醇,静脉注射和口服皮质类固醇联合治疗)的外伤性视神经病变患者的治疗效果。方法:对2007-01/2009-12在马来西亚医科大学眼科连续住院的24例27眼外伤性视神经患者进行了回顾性研究。结果:本次研究对象为24例27眼男性外伤性视神经患者(平均年龄为33岁)。车祸是导致发病的主要原因(83%)。大部分患者的视力低下(手动/眼前～无光感约占82%),其中有22眼并发眶周血肿,20眼并发有结膜下出血。并发多于一骨(颅骨或眶骨)骨折有19例(79%),5例(21%)没有出现骨折。CT扫描或核磁共振检查显示患者均没有视神经压迫的证据。第一组: 11例(46%)患者进行静脉注射联合口服类固醇的治疗;第二组:7例患者(29%)进行保守治疗;第三组:6例(25%)患者给予静脉注射皮质类固醇治疗。92%(11/12眼)给予静脉注射和口服类固醇治疗的患者和78%保守治疗患者视力能提高1行。单独静脉注射皮质类固醇治疗的患者4例呈现无光感,1例有轻度视力改善,而其他患者视力保持不变。保守治疗患者和单独静脉注射皮质类固醇患者视力改善不显著,且两组间相比在统计学上无显著性差异(P=0.368)。静脉注射联合口服类固醇治疗的患者有明显的视觉改善(P<0.05)。没有患者接受视神经减压手术。在本研究中,随访时间为6mo～3a。结论:大部分外伤性视神经病变患者都存在有眶周血肿,结膜下出血,眶壁骨折的症状。对比保守治疗,经过静脉注射和口服皮质类固醇联合治疗的患者有更好的治疗效果。     

Abnormal temporal lobe morphology in asymptomatic relatives of patients with hippocampal sclerosis: A replication study

We investigated gray and white matter morphology in patients with mesial temporal lobe epilepsy with hippocampal sclerosis (mTLE+HS) and first‐degree asymptomatic relatives of patients with mTLE+HS. Using T1‐weighted magnetic resonance imaging (MRI), we sought to replicate previously reported findings of structural surface abnormalities of the anterior temporal lobe in asymptomatic relatives of patients with mTLE+HS in an independent cohort. We performed whole‐brain MRI in 19 patients with mTLE+HS, 14 first‐degree asymptomatic relatives of mTLE+HS patients, and 32 healthy control participants. Structural alterations in patients and relatives compared to controls were assessed using automated hippocampal volumetry and cortical surface–based morphometry. We replicated previously reported cortical surface area contractions in the ipsilateral anterior temporal lobe in both patients and relatives compared to healthy controls, with asymptomatic relatives showing similar but less extensive changes than patients. These findings suggest morphologic abnormality in asymptomatic relatives of mTLE+HS patients, suggesting an inherited brain structure endophenotype.     

纤维蛋白胶封闭早期滤过泡漏1例(英文)

患者,男,63岁,以"左眼突发视力下降,眼部不适,眼红,流泪"主诉就诊。1wk前因继发性青光眼行青光眼阀植入术。同一眼1a前曾行扩大的小梁切除术,手术失效。眼科检查结果:最佳矫正视力为6/18,有滤过泡漏,前房浅,眼压6mmHg。应用纤维蛋白胶成功封闭滤过泡漏,前房加深,眼压升至13mmHg。此病例说明纤维蛋白胶是治疗早期滤过泡漏的有效方法。     

Traumatic optic neuropathy:a review of 24 patients

AIM:To evaluate the clinical presentations of traumatic optic neuropathy and to assess the visual outcome of three groups of patients managed differently(conservative, intravenous corticosteroids only and combination of intravenous and oral corticosteroids)at an academic tertiary care referral centre. METHODS:A retrospective study was conducted involving 24 consecutive patients(27 eyes)with traumatic optic neuropathy attending Hospital Universiti Sains Malaysia from January 2007 till December 2009. RESULTS:Twenty-four patients(27 eyes)were included. All cases involved were males.Mean age was 33 years old. Motor vehicle accident was the major cause(83.3%).Both eyes were equally involved.Most of the eyes had poor vision on presentation(HM-NPL,81.5%)with associated periorbital haematoma(22 eyes)and subconjunctival haemorrhage(20 eyes).Majority of patients(19 patients,79.2%)presented with more than one bony fracture of skull or orbit and 5 patients(20.8%)had no fractures.None of the patients had evidence of optic nerve compression on CT scans or MRI done.Eleven patients(45.8%)had been treated with intravenous and oral corticosteroids.The other 7 patients (29.2%)were treated conservatively and the third group(6 patients,25.0%)was on intravenous corticosteroids only. Eleven of 12 eyes(91.7%)treated with intravenous and oral corticosteroids had shown 1 line improvement of visual acuity. Those eyes treated conservatively(77.8%)had shown 1 line improvement of visual acuity.As for patients treated with intravenous corticosteroids only,four patients remained NPL, one patient had mild visual improvement and the other one’s vision remained the same.The visual improvement in patients treated with conservative management was not significant (P=0.386).Patients treated with intravenous corticosteroids alone have shown no visual improvement statistically(P<0.05).Patients treated with intravenous followed by oral corticosteroids had significant visual improvement(P<0.05). There was no statistically significant difference in visual outcome between patients treated with corticosteroids and patients treated conservatively(P=0.368).No patient underwent surgical decompression of the optic nerve.In this series,the follow up ranges from 6 months to 3 years. CONCLUSION:Most of the traumatic optic neuropathy patients presented with periorbital haematoma,subconjunctival haemorrhage and orbital wall fractures.Patients treated with intravenous followed by oral corticosteroids have better visual outcome compared to conservative management.     

Thyroid carcinoma in patients with familial adenomatous polyposis

There has been a growing awareness of the association between papillary thyroid carcinoma and familial adenomatous polyposis (FAP). The cases of four young patients with papillary thyroid carcinoma occurring with FAP are presented. Three patients underwent surgery to provide specimens for detailed histological examination. The surgical specimens showed well-encapsulated multicentric tumours exhibiting a predominantly papillary architectural growth pattern. In some areas, follicular architecture and cribriform patterns were noted. Atypical areas of spindle cells in a trabecular or solid configuration, which are not normally seen in classical papillary thyroid carcinoma, were evident. Malignant cells exhibited a graduation of cuboidal to tall cells with abundant amphophilic cytoplasm. The nuclei did not exhibit the typical nuclear clearing as seen in papillary thyroid carcinoma, but nuclear grooving and inclusions were noted. Psammoma bodies were not seen in any of the specimens. In a limited review of these patients, features such as young age at presentation, multicentricity and unusual histology suggest that thyroid carcinoma associated with FAP may represent a distinct form of thyroid cancer.     

Treatment of delayed chylothorax complicating oesophagectomy

A patient with carcinoma of the cardia underwent Ivor-Lewis oesophagogastrectomy. He developed right chylothorax postoperatively, which is a rare complication. Attempts to treat the chylothorax by conservative means and thoracoscopic ligation failed. Finally, pleurodesis using bleomycin successfully sealed the leak and he was discharged.