Multilevel Arthroplasty for Cervical Spondylosis: More Heterotopic Ossification at 3 Years of Follow-up

STUDY DESIGN.: Retrospective cohort study. OBJECTIVE.: To investigate the differences between single- and multilevel degenerative disc diseases (DDDs) treated with cervical arthroplasty. SUMMARY OF BACKGROUND DATA.: The US Food and Drug Administration clinical trials compared arthroplasty with anterior cervical discectomy and fusion for single-level DDD. However, cervical arthroplasty for multilevel DDD is rarely addressed in the literature. METHODS.: A total of 102 consecutive patients who underwent Bryan arthroplasty were divided into either a single- or multilevel group. Clinical outcomes were measured by the visual analogue scale (VAS) of neck and arm, and by the neck disability index with a minimum follow-up of 25 months. Every patient had radiographical evaluations, and computed tomography. RESULTS.: Eighty-six patients (84.3%) completed the follow-up with a mean time of 38.3 ± 8.7 months. Postoperatively, there were significant improvements in clinical outcomes (i.e., VAS neck, VAS arm, and neck disability index) at each time point of evaluation (i.e., 3-, 6-, 12-, and 24 mo postoperation). The sex composition and clinical outcome improvements between the single- and multilevel groups were not significantly different. The multilevel group was older (51.3 ± 8.6 vs. 46.3 ± 11.2 yr; P = 0.02), had more intraoperative blood loss (218.0 ± 182.4 vs. 102.8 ± 79.2 mL; P = 0.001), and demonstrated a higher rate of heterotopic ossification (HO) than the single-level group (66.0% vs. 25.0%; P < 0.001). The majority (97.7%) of the artificial discs in this series remained mobile despite HO. CONCLUSION.: Clinical outcomes of cervical arthroplasty in multilevel spondylosis are similar to single-level outcomes. However, the significantly higher rate of HO found in multilevel arthroplasty and its long-term effect warrant further investigation.     

氩激光光凝治疗视网膜分支静脉阻塞所致黄斑水肿

目的:探讨应用氩绿激光治疗视网膜分支静脉阻塞所致的黄斑水肿。方法 :对 30例BRVO合并黄斑水肿眼行黄斑区格栅状光凝 ,光斑直径 10 0 μm ,曝光时间 0 1S ,以局部视网膜出现淡白色光凝斑为宜。同时对阻塞区行区域行弥漫性光凝 ,光斑直径 2 0 0 μm ,3个月后复诊 ,仍有渗漏者行二次光凝。结果 :3个月后 ,93 3%患者水肿吸收 ,5 0 0 %视力提高二行以上 ,80 0 %提高 1行以上。结论 :氩绿激光光凝视网膜可使多数视网膜分支静脉阻塞所致黄斑水肿获得缓解     

Moving muscles with microchips, mathematics and models: an update on the 'reverse' model

This paper reviews the current status of our computer model for the management of strabismus and its future direction. Vector analysis was first used in the 1950s for the assessment of strabismus. Robinson's model' was the first computer simulation of ocular motility. Using physiological principles and anatomical approximations, Robinson's model sought to predict the strabismic pattern to be expected from a given injury. The Kault/Stark 'reverse' model works in the opposite direction, to first simulate the given strabismic pattern and then advise the surgery required to restore orthophoria. The surgeon is able to 'trial' various operations and compare the expected postoperative results. An automated system is currently being developed to ease the difficulty in measuring the position of the eyes in all nine positions of gaze. This paper includes three illustrative case reports.     

穿透性角膜移植术后移植片内皮细胞远期形态学观察

目的 :分析穿透性角膜移植术 (PK)后透明植片内皮细胞远期的形态学变化和与植片寿命的关系。同时调查穿透性角膜移植术后 2 3年间白内障、青光眼、角膜排斥反应、植片失活的机率。方法 :应用非接触内皮显微镜和图像分析技术对 14 8名单眼PK手术患者移植片和手术眼角膜进行活体内皮细胞形态定量分析。结果 :1 术后 3月～ 10年 ,植片内皮细胞数量下降迅速 ,达到 72 5± 17 7% (M±SD) (r =13 % ) ;细胞面积、形态系数、细胞周长和非六角形细胞比率增大P <0 0 1,而六角形细胞比率和细胞形态系数变小P <0 0 0 6。 2 术后 10～ 2 3年 ,植片内皮细胞丢失速度减慢 (r =3 % ) ,同时细胞面积的变异系数变得相对稳定 (2 7 8% )P <0 0 1。六角形细胞比率和细胞形系数逐渐恢复到正常水平P <0 0 5。 3 PK术后白内障手术率 14 % ,青光眼和排斥反应的发病率是 16%和 2 9%。 4 PK术后植片失活率是18%。晚期植片内皮功能衰竭是晚期植片失活的主要原因 ,术后 5～ 2 3年 12例植片失活患者中发生了 7例。结论 :1 PK术后 11～ 2 3年 ,每年内皮细胞密度稳定下降。六角形细胞比率和细胞形状系数恢复正常 ,面积变异系数稳定说明内皮细胞层稳定性得以恢复。细胞密度和细胞形态在评估PK术后的愈合过程是同样重要。 2 PK术     

原发性青光眼血浆血管紧张素—Ⅱ测定的初步报告

为探讨原发性青光眼的发病机理,进行了血浆血管紧张素—Ⅱ的测定。结果表明:原发性青光眼病人41倒,其血浆血管紧张素—Ⅱ的含量平均值为72.8±27.4Pg/ml,对照组26例,平均值为47.6±25.5Pg/ml,两者有显著差异。并对青光眼病人血管紧张素—Ⅱ含量增高的原因进行了分析。     

The development of fixing and focusing behaviour in normal human infants as observed with the Otago photoscreener

The Otago photoscreener is an optical instrument which gives a very sensitive indication of the accuracy with which a subject's eyes are fixing and focusing. Early experience suggested that this instrument could be used effectively to screen for the presence of amblyogenic factors in pre-verbal infants. This communication describes the development of ocular fixation and focusing in 137 normal infants who were followed at regular intervals during the first year of life. Accurate fixation and focusing was found in 13% of three-month-old infants, in 68% of six-month-old infants and in 76% of one year olds. The levels of 'focusing' visual acuity obtained from the photoscreen data are considerably better than the levels of cortical acuity measured by the standard behavioural and electrophysiological methods. This suggests that human infants fix and focus accurately for a considerable period before they are able to perceive all the details obtained in their retinal images.     

Atypical mycobacterium keratitis

We present two cases of Mycobacterium chelonae keratitis, both of which followed minor corneal trauma. One case initially showed improvement with medical therapy alone but eventually required penetrating keratoplasty. The second case required surgical intervention to provide tectonic support, but the infection resolved with antibiotic therapy.     

Merkel cell carcinoma: Long term survival in a patient with proven brain metastasis and presumed choroid metastasis

Merkel cell carcinoma (Trabecular carcinoma) is a rare malignant tumor of the skin. Because these tumors tend to spread locally via the lymphatic system, very few papers have dealt with the treatment of distant metastasis. Systemic disease is uncommon and usually fatal.

In this paper, we report a case of Merkel cell carcinoma with proven brain metastasis and a solid choroidal tumor. The patient responded well to radiation and chemotherapy and is alive and neurologically intact three years after diagnosis. All previous patients with metastatic Merkel cell carcinoma to the brain died within two months of the diagnosis. We use this case to discuss possible routes of metastatic dissemination and to review the treatment options in patients with distant metastatic disease. To our knowledge, this is the first reported case of presumed choroidal metastasis of Merkel cell carcinoma and the longest documented survival in a patient with brain involvement.     

A foveal-sparing pattern of cytomegalovirus retinitis in the acquired immunodeficiency syndrome

Purpose: We describe the clinical course of 12 eyes of 10 patients in whom recurrent cytomegalovirus (CMV) retinitis exhibited a foveal-sparing pattern.
Methods: We retrospectively reviewed the case records and photographic charts of 10 patients (12 eyes) with the acquired immunodeficiency syndrome (AIDS), in whom recurrent CMV retinitis exhibited a foveal-sparing pattern within 1500 mm of the foveola.
Results: The site of primary retinitis was temporal in 10 eyes of nine patients in whom it was known. The median number of recurrences up to the observation of foveal-sparing retinitis was two (range one to eight), and five patients had active CMV retinitis despite treatment for at least two continuous months. Once established, the median rate of progression in a non-foveal vector was 2.3 times faster than toward the fovea, and the median time to reduction in acuity to < 6/30 (or death) was 11 to 14 weeks. Three eyes of three patients retained 6/30 or better acuity up to death. Foveal CMV retinitis ultimately reduced acuity to < 6/30 in five eyes. Six eyes suffered retinal detachment, involving the fovea in five, and being the primary reason for acuity of < 6/30 in four. Four patients suffered dose-limiting toxicity.
Conclusion: Foveal-sparing CMV retinitis arises in patients with recurrent CMV retinitis resistant to treatment ('clinically resistant'), particularly that which has arisen temporally. Despite its foveolar proximity, and ultimate significant loss of function, the pattern of progression allows for preservation of useful foveal vision for longer periods than would have been expected.