玻璃体切割联合眼内激光治疗视网膜静脉周围炎

目的：探讨玻璃体切割联合眼内激光治疗视网膜静脉周围炎的疗效。方法：对36例46眼视网膜静脉周围炎采用玻璃体切割术中应用眼内激光光凝并进行随访。结果：1次手术成功40眼,4眼经2次手术成功。失败2眼。结论：玻璃体切割联合眼内激光治疗视网膜静脉周围炎疗效确切可靠。     

合并弥漫性视网膜水肿和大片硬性渗出的糖尿病视网膜病变术后长期随访结果

目的 通过对长期随访结果的分析,评价手术(包括玻璃体切割、眼内激光光凝、长效气体充填)治疗糖尿病视网膜病变(DR)合并弥漫性视网膜水肿(DlDRE)及视网膜下大片硬性渗出(MSHE)的临床效果.方法 2001年10月-2006年12月,共筛选DR伴DDRE和MSHE的患者25例30眼,其中男性14例17眼,女性11例13眼,年龄36～68岁,平均54.6岁.术前进行最佳矫正视力(BCVA)、彩色眼底照相、眼底荧光血管造影(FFA)和光学相干断层扫描(OCT)检查.治疗方法为闭合式玻璃体切除、后界膜剥除,眼内视网膜激光光凝和长效气体充填.结果 术前30眼的BCVA均≤0.05.术后随访12～23个月,2眼视力无变化,其余28眼(93.3%)视力不同程度提高,BCVA有3眼提高至0.03～0.04,25眼≥0.09,其中1眼为1.0.术后视网膜水肿均明显消退,视网膜出血和其下的硬性渗出明显吸收或完全吸收,黄斑区视网膜厚度由≥450μm1下降到160～220μm.术后24～42个月,7眼(23.3%)视力下降,其中3眼(10%)为前部缺血性视神经病变,4眼黄斑水肿复发(其中2眼黄斑下重新出现硬性渗出物),黄斑区视网膜厚度310～410μm.视力为指数至0.04的5眼硬性渗出物吸收后黄斑旁中心凹和中心凹下视网膜下瘢痕形成.结论 包括后界膜的玻璃体切除、眼内视网膜激光光凝及长效气体充填术对DR伴DDRE和MSHE有较好的治疗效果.     

玻璃体切割术治疗糖尿病性视网膜病变术后护理

目的 探讨使用玻璃体切割术治疗糖尿病性视网膜病变术后的护理.方法 通过对50例(54眼)视网膜玻璃体病变患者,在使用玻璃体切割、视网膜复位、重水置换、视网膜光凝、硅油填充术后,进行术后恢复期的体位护理及相应各种并发症护理.结果 玻璃体切割术后,在有计划有针对性的专业护理下,36例患者术后视力提高1行以上,12例患者视力无明显改变,2例较前有所降低.结论 手术后的良好护理对减少并发症,提高治愈率,对疾病的康复起到了至关重要的作用.     

视网膜激光光凝治疗增殖性糖尿病视网膜病变的疗效

目的:观察视网膜激光光凝治疗增殖性糖尿病视网膜病变的疗效。方法:回顾性分析增殖性糖尿病视网膜病变患者92例162只眼,先用低能量激光环绕血管弓行格栅状视网膜光凝,产生淡灰白色光凝斑,随后分次分象限行常规视网膜光凝治疗。随访3个月,观察患者视网膜恢复情况。结果:92例162只眼术后,视力提高133只眼,视力维持不变26只眼,视力下降3只眼,视力恢复率82%。3只眼发生视网膜出血,发生率2%;6只眼出现黄斑水肿,发生率为结论:视网膜激光光凝术治疗增殖性糖尿病视网膜病变安全、有效。     

巩膜环扎外加压术联合氩激光治疗陈旧性视网膜脱离

目的：观察巩膜环扎外加压术联合氩激光治疗陈旧性视网膜脱离的疗效。方法：回顾分析2007-01~2009-12经巩膜环扎外加压术联合氩激光治疗陈旧性视网膜脱离32例36眼,所选病例均为孔源性视网膜脱离合并以视网膜下膜为主的PVRC级的患者。结果：术后随访3个月~1年,视网膜完全复位25眼,4眼明显好转,2眼因PVR进展行玻璃体切割术,1眼放弃治疗。术后视力提高21眼,7眼视力不变,4眼视力下降。结论：巩膜环扎外加压术联合氩激光治疗陈旧性视网膜脱离损伤小,操作简单,并发症少,疗效满意。     

532nm激光治疗糖尿病视网膜病变的临床疗效

目的观察532 nm激光治疗糖尿病视网膜病变的临床疗效。方法糖尿病视网膜病变患者152例208只眼,分为重度非增殖性糖尿病视网膜病变(nonproliferative diabetic retinopathy,NPDR)104例144只眼,增殖性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)48例64只眼,均采用532 nm倍频Nd∶YAG激光行标准全视网膜激光光凝或超全视网膜激光光凝,对合并黄斑水肿者行局限光凝或格栅光凝。术后6~24个月随访,无灌注区或新生血管未消退者行补充光凝,观察各组最佳矫正视力、眼底血管造影(fundus fluorescein agiography,FFA)及眼底视网膜病变进展变化。结果重度NPDR组视力提高和不变115只眼(占79.9%),PDR组视力提高和不变47只眼(占73.4%),两组比较差异有显著意义(P0.05);眼底视网膜改变,重度NPDR组有效率81.9%,PDR组有效率71.9%,两组比较差异有显著意义(P0.05);39只眼因黄斑水肿行黄斑局限光凝或格栅光凝,24只眼水肿减轻或消退。结论采用激光治疗DR的临床疗效显著,重度NPDR组疗效好于PDR组,选择合适的时机和有效的光凝治疗是稳定视力和延缓眼底病变的关键。     

倍频532nm激光治疗合并白内障的糖尿病视网膜病变

目的 探讨合并白内障的糖尿病视网膜病变光凝治疗的影响因素及疗效.方法 将83只眼合并白内障的糖尿病视网膜病变按晶体混浊程度分为两组,根据FFA结果分增殖前期及增殖期糖尿病视网膜病变行全视网膜光凝治疗.Ⅰ组49只眼,超声乳化人工晶体(IOL)植入术前行激光治疗,术后1个月对无激光斑覆盖或光斑稀疏部位补充激光治疗.Ⅱ组34只眼,IOL植入术后1个月行FFA检查后再行激光治疗.如合并黄斑水肿,加黄斑局部"C"形光凝.激光光斑直径后极部为200 μm、中周部为300～500 pin,功率150-370 mW,曝光时间0.2～0.3 8,总点数1 200～1 800点,光斑问隔1/2～1光斑直径,分3～4次完成;黄斑局部光凝光斑直径75-125 μm,时间0.1～0.15 s,功率60～150 mW;新生血管部位采用融合光凝.术后15 d、1和3个月复查眼底,必要时补充光凝.3个月后复查荧光素眼底血管造影.结果 80只眼行全视网膜光凝,3只眼因玻璃体积血而未完成光凝.3个月后荧光素眼底血管造影检查显示,新生血管萎缩,光凝斑清晰,出血部分吸收,无遗漏治疗区域.83只眼光凝全部结束后3个月视力提高1～2行或以上34只眼,占41.0%;视力无变化38只眼,占45.8%;视力下降11只眼,占13.3%.18只眼黄斑水肿部分或全部消退13只眼,占72.2%.结论 合并白内障的糖尿病视网膜病变患者适时选择光凝治疗时机,对保持白内障术后视力稳定和延缓控制糖尿病视网膜病变进展尤为重要.     

532nm激光治疗白内障超声乳化术后糖尿病视网膜病变

目的探讨合并白内障的糖尿病视网膜病变患者行白内障超乳摘除联合人工晶体植入术后行532 nm激光治疗的安全性及临床效果。方法对因合并白内障而难以进行详细眼底检查或激光治疗的糖尿病视网膜病变患者103例120只眼,先行白内障超乳摘除联合人工晶体植入术治疗,术后对有眼底激光治疗指征者及时进行532 nm激光光凝,随访6个月。结果手术经过均较顺利,人工晶体均植入囊袋内,术后检查发现需行激光光凝治疗者共35例38只眼(31.7%),激光治疗后视力提高者12例12只眼(31.6%),保持不变者23例26只眼(68.4%),无视力下降者,经眼底镜检查及FFA检查眼底病变明显好转并保持稳定,无继续进展者。结论对合并白内障的糖尿病视网膜病变患者及时进行白内障超乳摘除联合人工晶体植入术,术后及早进行详细眼底检查,并对发现的病变及时行激光光凝治疗是安全和有效的,能有效地控制糖尿病视网膜病变的进展。     

多点扫描激光全视网膜光凝治疗增生期糖尿病性视网膜病变疗效观察

目的:探讨单纯使用多点扫描激光全视网膜光凝治疗严重增殖前和增殖期糖尿病性视网膜病变的疗效。方法:增殖性糖尿病视网膜病变患者接受多点扫描激光治疗,光斑强度达白色反应,30 ms,3×3扫描模式,激光治疗范围符合标准PRP范围,有玻璃体积血和膜牵拉区不予激光。激光治疗1个月后荧光血管造影结果中新生血管、玻璃体积血的回退情况,非灌注区的改变,用以评价激光疗效。应用SD-OCT观察视网膜光凝斑情况,了解激光对视网膜的影响。结果:非随机性选择本院治疗的增殖前期糖尿病视网膜病变Ⅲ期患者10只眼,Ⅳ期(不含玻璃体积血)患者10只眼,Ⅳ期(含玻璃体积血)患者10眼Ⅴ～Ⅵ期患者5只眼,激光后接受玻璃体手术15只眼。多点扫描激光术后1个月复查荧光血管造影,新生血管完全消退7只眼,仍存在明显非灌注区缺少激光者8只眼,需要补激光12只眼。激光治疗当天OCT显示色素上皮层、杆锥体细胞层有水肿,1个月显示局限破坏杆锥体细胞层,未达到内核层(双极细胞层)。结论:单纯多点扫描激光无法控制增殖性糖尿病视网膜病变,需要补充单点激光。对已出现玻璃体积血和视网膜牵拉的患者建议单点激光治疗。     

增殖性糖尿病视网膜病变行玻璃体切割术的护理

为总结增殖性糖尿病视网膜病变玻璃体切割术的护理经验,我们对34例增殖性糖尿病视网膜病变的患者行玻璃体切割手术治疗的术前和术后护理情况进行了分析.包括术前做好心理护理、充分的术前准备,术后加强体位护理、并发症的观察和护理、患眼护理及出院指导,认为细致周密的术前术后护理可有效减少并发症的发生,提高治疗效果.     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

The role of interventional radiology in trauma

Introduction Interventional Radiology has evolved into a specialty having enormous input into the care of the traumatized patient.In all hospitals,regardless of size,the Interventional Radiologist must consider their relationships with the trauma service in order to     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Diagnóstico ecográfico del neumotórax

The ultrasonographic diagnosis of pneumothorax is based on the analysis of artifacts. It is possible to confirm or rule out pneumothorax by combining the following signs: lung sliding, the A and B lines, and the lung point. One fundamental advantage of lung ultrasonography is its easy access in any critical situation, especially in patients in the intensive care unit. For this reason, chest ultrasonography can be used as an alternative to plain-film X-rays and computed tomography in critical patients and in patients with normal plain films in whom pneumothorax is strongly suspected, as well as to evaluate the extent of the pneumothorax and monitor its evolution.     

Carbohydrate Supplementation during Exercise: Does It Help? How Much is Too Much?

KEY POINTS· Carbohydrate intake during exercise can delay the onset of fatigue and improve performance of prolonged exercise as well as exercise of shorter duration and greater intensity (e.g., continuous exercise lasting about 1h and intermittent high-intensity exercise), but the mechanisms by which performance is improved are different.