Electro-oculogram of Retinal Vein Occlusion

Twenty five cases, including 26 eyes with retinal vein occlusion (RVO) were examined by means of the electro-oculogram. The results showed that 23 of the 26 eyes suffering from RVO exhibited abnormalities of the electro-oculogram (EOG). The potential difference and Arden ratio in the RVO eyes were lower than those in the normal eyes (P<0.01). The more the visual acuity of ill eyes was decreased, the higher the abnormal rate of EOG in ill eyes was. 14 eyes had the visual acuity less than 0.1, whose EOGs were abnortmal. Six eyes had the visual acuity from 0. 2 to 0. 4, in which the EOGs of 5 eyes were abnormal. Six eyes had the visual acuity more than 0. 5, a-mong which the EOGs of 4 eyes were abnormal. Based on the above observations, it may be considered that the circulatory disturbance resulting from RVO damages not only the internal layer but also the external layer of the retina. We suggest that EOG is a useful method for distingquishing lesions caused by RVO and may reflect the functional condition     

玻璃体切除术治疗视网膜静脉阻塞所致的玻璃体出血

报告应闭合式玻璃体切除术治疗７例（７眼）因视网膜静脉阻塞所致的玻璃体出血。所有病人术后眼底清晰可见，视力明显提高。术后４例出现再出血，经药物治疗后出血吸收，加用氩离子激光视网膜光凝，无再出血。随访３至１８个月所有病人无新生血管性青光眼及牵引性视网膜脱离出现。认为玻璃体切除术不但能使屈光间质恢复透明，视力提高，预防牵引性视网膜脱离，而且为明确诊断和进一步激光治疗提供条件。     

Are common mutations of cystathionine β-synthase involved in the aetiology of neural tube defects?

Mildly elevated maternal plasma homocysteine (Hcy) levels (hyperhomocysteinemia) have recently been observed in some neural tube defect (NTD) pregnancies. Plasma levels of Hcy are governed by both genetic and nutritional factors and the aetiology of NTDs is also known to have both genetic and nutritional components. We therefore examined the frequency of relatively common mutations in the enzyme cystathionine β-synthase (CBS), which is one of the main enzymes that controls Hcy levels, in the NTD population. Neither the severely dysfunctional G307S CBS allele nor the recently reported 68 bp insertion/I278T CBS allele was observed at increased frequency in the cases relative to controls. We therefore conclude that loss of function CBS alleles do not account for a significant proportion of NTDs in Ireland.     

Fallopian tube carcinoma presenting as tubo-ovarian abscess: a report of two cases with literature review

Preoperative diagnosis of fallopian tube carcinoma is difficult, with fewer than 5% being diagnosed preoperatively. We describe tubal carcinoma, presenting as a tubo-ovarian abscess in two 47-year-old women. Both patients presented with abdominal pain, pelvic mass, and fever. Both patients were treated as having a tubo-ovarian abscess but failed to respond to therapy. During surgery a metastatic right tubal carcinoma was found. A definite operation was performed in both patients. Three additional cases of fallopian tube carcinoma, presenting as acute pelvic inflammatory disease, were found while reviewing the English literature. Actually all these three cases presented as tubo-ovarian abscess because of the existence of tender pelvic mass. Carcinoma of the fallopian tube should be considered in the differential diagnosis of tubo-ovarian abscess in those who failed to respond to a previously unreported clinical presentation.     

经皮扩张性气管切开术的临床应用

目的：探讨经皮扩张性气管切开术行气管切开及气道套管插入的方法与效果。方法：在内科ICU病房内，采用一步性扩张气管切开术，对35例患者进行气管切开，同时采用纤维支气管镜对其中l0例患者进行气道内检查。结果：按照操作规程，均完成了气管切开及气管套管的插入，平均操作时间为5．4min．所有患者在带管过程中及拔管后，未发现有气道狭窄的发生，无瘘管或瘘道形成，且创口愈合良好。结论：经皮扩张性气管切开术操作简便易行，值得临床推广使用。     

慢性阻塞性肺疾病前驱性呼吸衰竭患者呼吸驱动的改变

目的探讨慢性阻塞性肺疾病(COPD)和COPD前驱性呼吸衰竭(前驱呼衰)患者中枢呼吸驱动的改变;评价界定COPD前驱性呼吸衰竭的临床意义.方法试验对象为COPD前驱性呼吸衰竭、COPD尚未达前驱性呼吸衰竭的患者和健康对照者各30名.所有受试者均进行如下参数的测定:动脉血气分析;常规肺功能,主要以第1秒用力呼气容积(FEV1)占预计值的百分比(FEV1%)来评价;中枢呼吸驱动水平,以0.1 s口腔阻断压(P0.1)、校正中枢呼吸驱动(以每分通气量来校正,即P0.1/MV)和吸气阻抗P0.1/VT/Ti)等来评价.结果P0.1和P0.1/MV在COPD前驱呼衰组明显高于正常对照组和未达前驱呼衰组,P0.1/VT/Ti在COPD前驱呼衰组和未达前驱呼衰组明显高于正常对照组(P=0.002);P0.1,P0.1/MV,P0.1/VT/Ti与PaO2,FEV1%呈显著负相关(rs=-0.769,-0.495,-0.543;-0.747,-0.480,-0.526,P均＜0.01);与PaCO2呈显著正相关(rs=0.270,0.312,0.369,P分别为＜0.05,＜0.01,＜0.01).结论COPD前驱呼衰患者呼吸储备能力减低,呼吸效率下降;P0.1,P0.1/MV,P0.1/VT/Ti等参数在推断患者神经-肌力输出水平与呼吸衰竭发生阈值方面具有较大的意义.当COPD进展至前驱呼衰阶段,从血气分析、肺功能检查到呼吸驱动水平都发生了显著的改变,从而提示界定此阶段具有一定的临床意义.     

左双腔支气管导管管端位置与吸气峰压变化的关系

目的 观测无隆突钩双腔支气管导管(DLT)管端位置与吸气峰压(Ppeak)以及肺顺应性环形状改变的关系，探讨用Ppeak和顺应性环的变化评估DLT管端位置的可行性。方法 拟行右侧剖胸手术的成年患者32例，静脉诱导后插入左Mallinckrodt DLT，吸入氧化亚氮和地氟醚维持麻醉。按纤维支气管镜(FOB)确认DLT管端位置和通气方式将观测过程分为四个阶段：第一阶段(S1)，管端位置正确的双肺通气；第二阶段(S2)，管端位置正确的左侧单肺通气；第三阶段(S3)，管端插入左下支气管(置管过深)的左侧单肺通气；第四阶段(S。)，管端处在左支气管开口(置管偏浅)的左侧单肺通气。每阶段均机械通气15min。结果 回归方程预计插管深度与FOB检查符合者占71．9％。S2时Ppeak值比S1时增加50．8％，肺顺应性(Cdyn)值减少36．2％；S3时Ppeak值比S1时增加87．4％，Cdyn值减少56．8％。PV环曲线斜率向右明显移位，环体显著延长。结论 用无隆突钩DLT行肺隔离，在无FOB定位的条件时，联合应用听诊法、回归方程预计插管深度、动态监测气道峰压和P-V环的变化综合评估，可提高DLT管端的正确到位率。单肺通气的气道峰压超过双肺通气时的1．65倍，且气道峰压超过25cm H2O．应高度怀疑DLT管端发生过深移位。     

PRENATAL DIAGNOSIS Ⅰ. EARLY DIAGNOSIS OF OPEN NEURAL TUBE DEFECTS BY QUALITATIVE ACETYLCHOLINESTERASE ISOENZYME IN AMNIOTIC FLUID

The measurement of amniotic fluid (AF) acetylcholinesterase isoenzyme (AChEI) is a relatively new method for early diagnosis of open neural tube defects (NTDs). As quantitative methods are of unproven reliability at present, the authors used a high resolving power qualitative method-vertical slab polyaerylamide gel electrophoresis. The benefits of this technique are: simplicity of operation, accuracy, unsophisticated equipment, and easily available reagents. Combined results of 9 NTDs studies revealed that samples from early pregnancy gave more accurate results than those from late pregnancy.     

Safe anesthesia for endoscopic laryngeal laser surgery

Anesthesia safety for endoscopic laryngeal laser surgery has been a major limiting factor for laser applications in the larynx and the hypopharynx. Several anesthesia techniques have been proposed and each technique appears to have its own limitations. This paper will deal with the distinct advantages offered by the malleable copper tube which is used for delivery of the open Venturi system anesthesia for endoscopic laser surgery. A retrospective study of 100 patients who have undergone this modality of anesthesia at our institution will be presented. Our conclusion from this study shows clearly the superiority of the copper tube over the conventional aluminium-foil-wrapped endotracheal tube in safety and the exposure of the larynx during surgery.