Stargardt病的眼底表现及眼底荧光血管造影特征

目的研究Stargardt病(Stargardts disease,STGD)的眼底表现和眼底荧光血管造影(fundus fluorescein angiography,FFA)的特征.方法对27例54眼STGD患者进行视力、眼底及FFA检查.结果STGD患者的视力在0.02～0.10者46眼,占85.2%.眼底检查黄斑部均有横径为1.5～3.0 PD大小、呈青灰色并有金箔样反光的横椭圆形萎缩灶,其中15例30眼伴有眼底黄色斑点,占55.6%.FFA检查黄斑部病变为透见荧光,其中8例16眼呈"牛眼"状;22例44眼呈暗脉络膜背景,占81.5%.结论FFA检查在STGD的诊断中极为重要,在病程的不同阶段可有不同FFA表现.     

激光光凝治疗黄斑水肿

应用氩绿激光治疗视网膜血管性疾病所致黄斑水肿50例,73只眼。治疗后,有20.5％(15/73)的患眼视力提高2行以上,76.8％(56/73)的患眼视力保持稳定。局部性和/或非囊样黄斑水肿患眼的视力预后较好,水肿易于吸收。弥漫性和/或囊样黄斑水肿患眼的视力预后较差,水肿较难吸收。术前视力可影响预后。对激光光凝治疗本病的疗效、影响因素、激光治疗技术及其机理,也进行了讨论。     

25G经结膜无缝合玻璃体切割手术系统在黄斑疾病手术治疗中的应用

目的 评估25G经结膜无缝合玻璃体切割手术系统（TSV25G）在黄斑疾病手术治疗中的应用价值。 方法 回顾分析应用TSV25G治疗18例黄斑疾病患者的临床资料。18例患者中，黄斑前膜8例，特发性黄斑裂孔3例，外伤性黄斑裂孔伴黄斑区视网膜下出血3例，玻璃体黄斑牵引综合征2例，糖尿病视网膜病变弥漫性黄斑水肿2例；其中，男13例，女5例，年龄25~73岁，患病时间3.5~30.0个月。手术使用TSV25G，切割速率1500次/min，负压吸引500~550 mm Hg（1mm Hg=0.133kPa），灌注瓶高度40~50cm，手术中眼压维持在29~35 mm Hg。手术后随访2.5~10.0个月。 结果 18例患者均顺利完成手术。手术时间26~44 min，平均手术时间35 min，无玻璃体手术并发症。1例患者手术中穿刺口漏水，用8-0可吸收缝线缝合。手术后平均住院时间3.5 d。6例患者视力恢复到0.8以上，占33.3%。12例手术前有黄斑水肿者手术后3~6个月黄斑水肿完全消退，10例患者视物变形消失，2例患者视物变形减轻；黄斑裂孔患者4例手术后视力无变化，2例视力增加。 结论 TSV25G应用于黄斑疾病手术治疗，手术安全 、省时、效果好。 （中华眼底病杂志，2004，20：137-138）     

Phagocytized corpora amylacea as a histological hallmark of astrocytic injury in neuromyelitis optica

Neuromyelitis optica (NMO) is an inflammatory demyelinating and necrotizing disorder of the CNS that mainly affects the optic nerve and spinal cord. The etiology is still uncertain; however, the discovery of serum anti‐aquaporin‐4 (AQP4) autoantibody is becoming the center of attention, and a new hypothesis is emerging that NMO is essentially astrocytopathy provoked by this autoantibody. In this study, we focused on corpora amylacea (CA), glycoproteinaceous inclusions in astrocytic processes. We examined 57 lesions in nine cases of NMO spectrum disorder, and demonstrated that CA were phagocytized by macrophages in 42 lesions (74%) of eight cases, while phagocytized figures were not seen in unaffected areas. Phagocytized CA were frequently encountered in early‐phase lesions still retaining myelin structures, while fewer or none were found in chronic destructive lesions. Moreover, phagocytized CA were significantly smaller in diameter than intact ones, and CA were decreased or absent in most lesions assessed. These findings suggest the following pathophysiological process: the astrocytes are affected at an early phase in NMO, CA are expelled from the astrocytes and phagocytized by macrophages finally leading to clearance. A phagocytized figure and subsequent loss of CA can be a histological hallmark of astrocytic injury of NMO.     

氨苄西林与红霉素联用的体外抑菌实验研究

目的:研究繁殖期杀菌荆和抑茵剂联用的可能性,降低细菌内毒素的释放量,改善临床感染症状.方法:采用微生物井式扩散法,在无茵条件下,用藤黄八叠球菌作茵悬液,氨苄西林、红霉素标准品为模型药物,测定两者合用后的抑茵圈.结果:两种抗生素联用后的抑茵圈与氨苄西林单用的抑茵圈相当(P＞0.05).结论:抑茵剂与繁殖期杀菌剂联用并不降低繁殖期杀菌剂的杀菌效能,联用时应以同时合用或先使用杀菌剂后使用抑茵剂为宜.     

视网膜黄斑分支静脉阻塞病变与视力预后关系的研究

目的探讨视网膜黄斑分支静脉阻塞(MBRVO)的部位、面积和黄斑中心凹毛细血管拱环破坏程度等因素对视力预后的影响和MBRVO患者黄斑中心凹无血管区(FAZ)面积的改变。方法分析荧光素眼底血管造影(FFA)检查确诊的27例27只眼的MBRVO部位、黄斑中心凹毛细血管拱环破坏程度和阻塞面积与视力恢复的关系及FAZ面积,用18例正常对照者FAZ面积的资料进行对比分析。结果27例MBRVO发生于黄斑上支者17只眼,占63%,平均阻塞面积为(16±10)mm2,平均视力0.32±0.28。黄斑下支者10只眼,占37%,平均阻塞面积为(12±10)mm2,平均视力0.37±0.20。黄斑上支与下支两组间视力恢复和阻塞面积差异无统计学意义(P>0.05)。拱环破坏≥1/2和<1/2两组间视力比较差异有统计学意义(P<0.05),面积比较差异无统计学意义(P>0.05)。27只眼阻塞面积平均值为(15±10)mm2,≥15mm2者10只眼,<15mm2者17只眼,视力在大于均值组与小于均值组的比较中差异无统计学意义(P>0.05)。MBRVO患者的FAZ面积明显大于正常人FAZ面积(P<0.05)。结论拱环破坏的范围是决定MBRVO预后视力的重要标准,MBRVO的FAZ面积比正常人的FAZ面积明显扩大。     

Tunica albuginea overlapping: a novel technique for the treatment of erectile dysfunction

Tunica albuginea (TA) in venogenic erectile dysfunction (VED) was found subluxated and flabby because of degeneration and atrophy of its collagen fibres. This had apparently led to derangement of TA veno-occlusive mechanism. We investigated the hypothesis that overlapping of the subluxated and flabby TA would achieve a competent veno-occlusive mechanism during erection. Tunical overlapping was performed in nine VED patients (age 35.6 +/- 1.6 years). Intracorporal pressure (ICP) was measured pre- and postoperatively. After penile degloving, TA on lateral penile aspect was divided along whole length of corpus cavernosum (CC) and tunical double-breasting for 1-1 1/2 cm was performed. A biopsy was taken from TA and stained with haematoxylin and eosin and Masson's trichrome. Clinical efficiency of the operation was evaluated after 6 months. ICP increased (P < 0.01) postoperatively in the nine patients. The increase was maintained during follow-up period in eight patients and decreased to preoperative level in one. Six months after operation, the eight patients had significantly (P < 0.01) improved scores for the erectile function domain over the preoperative scores. Microscopic examination of TA biopsies showed atrophy of the collagen fibres. Tunical overlapping aims at correction of TA flabbiness, corporal tissue support and improving of veno-occlusive mechanism.     

B超下阴茎海绵体"繁星征"与 ED

目的 探讨B超下阴茎海绵体出现的“繁星征”与ED的关系,研究其发病机制。方法 30例ED患者行阴茎海绵体B超检查,并与30例无ED志愿者行B超对照。另对l例ED“繁星征”患者行阴茎海绵体病理检查。结果 30例ED患者中,29例发现有B超下阴茎海绵体“繁星征”。其中26例全阴茎弥散分布强回声光点,为临床诊断的中、重度ED患者（IIEF-5评分〈11分）。另3例仅局限在一部分,且回声光点较少,为轻度ED（IIEF-5评分12～19分）。而无ED志愿者无此现象。1例“繁星征”患者病理检查为阴茎海绵体胶原纤维增生伴玻璃样变。结论 阴茎海绵体广泛纤维化是出现B超下“繁星征”的病理基础。因限制海绵窦充盈而影响阴茎勃起。外伤与炎症是其致病因素。     

Outpatient penile implantation with the patient under a novel method of crural block

Although local anaesthesia for penile implants has been substantially reported, its methodology, simplicity and reliability left room for improvement. We would like to report on an innovative penile crural block using local anaesthesia in patients who underwent penile implantation as outpatient surgery. From March 1987 to March 1991, a total of 21 organically impotent men, aged from 27 to 77 years, received penile prosthesis implantation. All these were performed under pudendal nerve block as an outpatient procedure. From August 1992 to January 2003 a proximal dorsal nerve block with peripenile infiltration and penile crural block was developed to replace the anaesthesia method of pudendal nerve blocks in 137 consecutive patients (aged from 35 to 83 years) undergoing penile implants. The anaesthetic effects and postoperative results with the crural block were very satisfactory. Common immediate side-effects included puncture of the vessels, subcutaneous ecchymosis, transient palpitations and dilation pain, but there were no significant late complications. In the group of pudendal nerve blockage, 42.9% patients (nine of 21) experienced severe aching pain over the perineum for 1-2 weeks postoperatively, whereas the newly developed method of crural block markedly reduced these adverse effects. This new anaesthetic method proved to be reliable, simple, and safe with fewer complications. It offers the advantages of less morbidity, preservation of patient's privacy, reduced adverse effects of anaesthesia, and a more-rapid return to activity with minimal complications.