AIM: To document with spectral-domain optical coherence tomography the morphological regeneration of the fovea after resolution of cystoid macular edema(CME) without and with internal limiting membrane(ILM) detachment...AIM: To document with spectral-domain optical coherence tomography the morphological regeneration of the fovea after resolution of cystoid macular edema(CME) without and with internal limiting membrane(ILM) detachment and to discuss the presumed role of the glial scaffold for foveal structure stabilization. METHODS: A retrospective case series of 38 eyes of 35 patients is described. Of these, 17 eyes of 16 patients displayed foveal regeneration after resolution of CME, and 6 eyes of 6 patients displayed CME with ILM detachment. Eleven eyes of 9 patients displayed other kinds of foveal and retinal disorders associated with ILM detachment. RESULTS: The pattern of edematous cyst distribution, with or without a large cyst in the foveola and preferred location of cysts in the inner nuclear layer or Henle fiber layer(HFL), may vary between different eyes with CME or in one eye during different CME episodes. Large cysts in the foveola may be associated with a tractional elevation of the inner foveal layers and the formation of a foveoschisis in the HFL. Edematous cysts are usually not formed in the ganglion cell layer. Eyes with CME and ILM detachment display a schisis between the detached ILM and nerve fiber layer(NFL) which is traversed by Müller cell trunks. ILM detachment was also found in single eyes with myopic traction maculopathy, macular pucker, full-thickness macular holes, outer lamellar holes, and glaucomatous parapapillary retinoschisis, and in 3 eyes with Müller cell sheen dystrophy(MCSD). As observed in eyes with MCSD, cellophane maculopathy, and macular pucker, respectively, fundus light reflections can be caused by different highly reflective membranes or layers: the thickened and tightened ILM which may or may not be detached from the NFL, the NFL, or idiopathic epiretinal membranes. In eyes with short single or multiple CME episodes, the central fovea regenerated either completely, which included the disappearance of irregularities of the photoreceptor layer lines and the reformation of a fovea externa, or with remaining irregularities of the photoreceptor layer lines. CONCLUSION: The examples of a complete regeneration of the foveal morphology after transient CME show that the fovea may withstand even large tractional deformations and has a conspicuous capacity of structural regeneration as long as no cell degeneration occurs. It is suggested that the regenerative capacity depends on the integrity of the threedimensional glial scaffold for foveal structure stabilization composed of Müller cell and astrocyte processes. The glial scaffold may also maintain the retinal structure after loss of most retinal neurons as in late-stage MCSD.展开更多
目的:观察右美托咪定复合不同剂量舒芬太尼+地佐辛对直肠癌扩大根治术患者术后镇痛的效果。方法:选取我院择期行直肠癌扩大根治术患者60例,年龄45~65岁,ASAⅠ或Ⅱ级。随机均分为三组,每组均为20例,术后镇痛分别给予A组:舒芬太尼2μg/Kg...目的:观察右美托咪定复合不同剂量舒芬太尼+地佐辛对直肠癌扩大根治术患者术后镇痛的效果。方法:选取我院择期行直肠癌扩大根治术患者60例,年龄45~65岁,ASAⅠ或Ⅱ级。随机均分为三组,每组均为20例,术后镇痛分别给予A组:舒芬太尼2μg/Kg+地佐辛0.3mg/Kg;B组:右美托咪定1.5μg/Kg+舒芬太尼1.5μg/Kg+地佐辛0.3mg/Kg;C组:右美托咪定1.5μg/Kg+舒芬太尼1μg/Kg+地佐辛0.3mg/Kg。三组麻醉诱导:静注丙泊酚1.8mg/kg、舒芬太尼0.6μg/Kg、顺式阿曲库铵0.3mg/kg,于手术结束后连接静脉镇痛泵行患者自控静脉镇痛(Patient controlled intravenous analgesia,PCIA),背景输注流速2m L/h,单次追加药量0.5m L,锁定时间15min,总容量80m L。分别记录三组患者术后1h(T1)、3h(T2)、6h(T3)、12h(T4)、24h(T5)的疼痛视觉模拟评分(Visual analogue scale,VAS疼痛评分)、Ramsay评分(镇静评分)和PONV评分(恶心、呕吐评分)。结果:T1~T5时A、B、C三组VAS评分:B组低于A组(P<0.05),A组、C组差异无统计学意义;R a m s a y镇静评分:A、B、C三组差异无统计学意义;P O N V恶心、呕吐评分:C组低于A组(P<0.05);A组、B组差异无统计学意义。结论:1.5μg/Kg右美托咪定复合1~2μg/Kg舒芬太尼+0.3mg/Kg地佐辛(总容量80m L,输注流速2m L/h)用于直肠癌根治术术后镇痛、镇静效果良好,右美托咪定+地佐辛复合使用可减少舒芬太尼的用量,同时降低其恶心呕吐等不良反应的发生率。展开更多
文摘AIM: To document with spectral-domain optical coherence tomography the morphological regeneration of the fovea after resolution of cystoid macular edema(CME) without and with internal limiting membrane(ILM) detachment and to discuss the presumed role of the glial scaffold for foveal structure stabilization. METHODS: A retrospective case series of 38 eyes of 35 patients is described. Of these, 17 eyes of 16 patients displayed foveal regeneration after resolution of CME, and 6 eyes of 6 patients displayed CME with ILM detachment. Eleven eyes of 9 patients displayed other kinds of foveal and retinal disorders associated with ILM detachment. RESULTS: The pattern of edematous cyst distribution, with or without a large cyst in the foveola and preferred location of cysts in the inner nuclear layer or Henle fiber layer(HFL), may vary between different eyes with CME or in one eye during different CME episodes. Large cysts in the foveola may be associated with a tractional elevation of the inner foveal layers and the formation of a foveoschisis in the HFL. Edematous cysts are usually not formed in the ganglion cell layer. Eyes with CME and ILM detachment display a schisis between the detached ILM and nerve fiber layer(NFL) which is traversed by Müller cell trunks. ILM detachment was also found in single eyes with myopic traction maculopathy, macular pucker, full-thickness macular holes, outer lamellar holes, and glaucomatous parapapillary retinoschisis, and in 3 eyes with Müller cell sheen dystrophy(MCSD). As observed in eyes with MCSD, cellophane maculopathy, and macular pucker, respectively, fundus light reflections can be caused by different highly reflective membranes or layers: the thickened and tightened ILM which may or may not be detached from the NFL, the NFL, or idiopathic epiretinal membranes. In eyes with short single or multiple CME episodes, the central fovea regenerated either completely, which included the disappearance of irregularities of the photoreceptor layer lines and the reformation of a fovea externa, or with remaining irregularities of the photoreceptor layer lines. CONCLUSION: The examples of a complete regeneration of the foveal morphology after transient CME show that the fovea may withstand even large tractional deformations and has a conspicuous capacity of structural regeneration as long as no cell degeneration occurs. It is suggested that the regenerative capacity depends on the integrity of the threedimensional glial scaffold for foveal structure stabilization composed of Müller cell and astrocyte processes. The glial scaffold may also maintain the retinal structure after loss of most retinal neurons as in late-stage MCSD.
文摘目的:观察右美托咪定复合不同剂量舒芬太尼+地佐辛对直肠癌扩大根治术患者术后镇痛的效果。方法:选取我院择期行直肠癌扩大根治术患者60例,年龄45~65岁,ASAⅠ或Ⅱ级。随机均分为三组,每组均为20例,术后镇痛分别给予A组:舒芬太尼2μg/Kg+地佐辛0.3mg/Kg;B组:右美托咪定1.5μg/Kg+舒芬太尼1.5μg/Kg+地佐辛0.3mg/Kg;C组:右美托咪定1.5μg/Kg+舒芬太尼1μg/Kg+地佐辛0.3mg/Kg。三组麻醉诱导:静注丙泊酚1.8mg/kg、舒芬太尼0.6μg/Kg、顺式阿曲库铵0.3mg/kg,于手术结束后连接静脉镇痛泵行患者自控静脉镇痛(Patient controlled intravenous analgesia,PCIA),背景输注流速2m L/h,单次追加药量0.5m L,锁定时间15min,总容量80m L。分别记录三组患者术后1h(T1)、3h(T2)、6h(T3)、12h(T4)、24h(T5)的疼痛视觉模拟评分(Visual analogue scale,VAS疼痛评分)、Ramsay评分(镇静评分)和PONV评分(恶心、呕吐评分)。结果:T1~T5时A、B、C三组VAS评分:B组低于A组(P<0.05),A组、C组差异无统计学意义;R a m s a y镇静评分:A、B、C三组差异无统计学意义;P O N V恶心、呕吐评分:C组低于A组(P<0.05);A组、B组差异无统计学意义。结论:1.5μg/Kg右美托咪定复合1~2μg/Kg舒芬太尼+0.3mg/Kg地佐辛(总容量80m L,输注流速2m L/h)用于直肠癌根治术术后镇痛、镇静效果良好,右美托咪定+地佐辛复合使用可减少舒芬太尼的用量,同时降低其恶心呕吐等不良反应的发生率。
