硅胶泪点或泪管栓塞术治疗干眼症

目的 评价硅胶泪点或泪管栓塞术治疗干眼症的临床效果。 方法 确诊为干眼症并用其他方法治疗无效16例 ,先行自溶型胶原泪管栓塞术 ,以确定该方法的初步效果 ,然后行永久型硅胶泪点 (顶盖式 )或泪管 (喇叭式 )栓塞术 ,利用主觉和客观临床检测方法评价其效果。 结果 泪点或泪管栓塞术后 ,泪液量明显增加 ,泪膜稳定性有所改善 ,干眼症状明显缓解 ;若下眼睑张力较大时 ,使用顶盖式泪点栓时有可能产生异物感。 结论 泪点或泪管栓塞术可有效、动态地改变眼表面泪液动力学。主动限制泪液的排除 ,重建泪液平衡 ,是治疗干眼症的有效方法。

Intraocular complications of IFN-α and ribavirin therapy in patients with chronic viral hepatitis C

We report a panel of severe inflammatory and vascular intraocular disorders occurring during interferon-alpha （IFN-α） treatment in eight hepatitis C virus （HCV）- infected patients. These events include three cases of Vogt-Koyanagi-Harada like （VKH） disease （an association of panuveitis, retinal detachment, ear and meningeal detachment and skin and hair changes）, two cases of central retinal vein occlusion, one case of central retinal artery occlusion, one case of severe hypertensive retinopathy and one case of bilateral ischemic optic neuropathy with severe visual impairment. Rare as they are, such severe ophthalmological complications require a close follow-up of HCV-infected patients under IFN-α breabnent with ophthalmological monitoring if any ocular manifestation occurs.

Gastrointestinal and hepatic complications of hematopoietic stem cell transplantation

Recognition and management of gastrointestinal and hepatic complications of hematopoietic stem cell transplantation has gained increasing importance as indications and techniques of transplantation have expanded in the last few years.The transplant recipient is at risk for several complications including conditioning chemotherapy related toxicities,infections,bleeding,sinusoidal obstruction syndrome,acute and chronic graftversus-host disease(GVHD) as well as other long-term problems.The severity and the incidence of many complications have improved in the past several years as the intensity of conditioning regimens has diminished and better supportive care and GVHD prevention strategies have been implemented.Transplant clinicians,however,continue to be challenged with problems arising from human leukocyte antigen-mismatched and unrelated donor transplants,expanding transplant indications and age-limit.This review describes the most commonly seen transplant related complications,focusing on their pathogenesis,differential diagnosis and management.

Bilateral Macular Lesions Following Electrical Injury

HIGH-VOLTAGE electrical injuries can result in a variety of ocular complications. Cataract and macular edema are the most common injuries.Other injuries include punctate keratopathy,uveitis,macular hole,subretinal macular haemorrhage,and choroidal atrophy.We report a case that optical coherence tomography （OCT） and multifocal electro- retinogram （mfERG） clearly demonstrated the bilateral macular lesions following electrical injury, while the fundus examination was nearly normal.

High-fibre diet and Lactobacillus paracasei B21060 in symptomatic uncomplicated diverticular disease

AIM： To investigate in symptomatic uncomplicated di- verticular disease the efficacy of symbiotics associated with a high-fibre diet on abdominal symptoms. METHODS： This study was a multicentre, 6-too ran- domized, controlled, parallel-group intervention with a preceding 4-wk washout period. Consecutive out- patients with symptomatic uncomplicated diverticular disease, aged 40-80 years, evaluated in 4 Gastroenterology Units, were enrolled. Symptomatic uncomplicated diverticular disease patients were randomized to two treatment arms A or B. Treatment A （n = 24 patients） received 1 symbiotic sachet Flortec~ （Lactobacillus paracasei B21060） once daily plus high-fibre diet for 6 mo. Treatment B （n = 21 patients） received high-fibre diet alone for 6 rno. The primary endpoint was regres- sion of abdominal symptoms and change of symptom severity after 3 and 6 mo of treatment. RESULTS： In group A, the proportion of patients with abdominal pain 〈 24 h decreased from 100% at base- line to 35% and 25% after 3 and 6 mo, respectively （P 〈 0.001）. In group B the proportion of patients with this symptom decreased from 90.5% at baseline to 61.9% and 38.1% after 3 and 6 mo, respectively （P = 0.001）. Symptom improvement became statistically sig- nificant at 3 and 6 mo in group A and B, respectively. The proportion of patients with abdominal pain 〉24 h decreased from 60% to 20% then 5% after 3 and 6 too, respectively in group A （P 〈 0.001） and from 33.3% to 9.5% at both 3 and 6 mo in group B （P = 0.03）. In group A the proportion of patients with ab- dominal bloating significantly decreased from 95% to 60% after 3 mo, and remained stable （65%） at 6-mo follow-up （P = 0.005） while in group B, no significant changes in abdominal bloating was observed （P = 0.11）. After 6 mo of treatment, the mean visual analogic scale （VAS） values of both short-lasting abdominal pain （VAS, mean ± SD, group A： 4.6 ± 2.1 vs 2.2 ± 0.8, P = 0.02; group B： 4.6 ± 2.9 vs 2.0 ± 1.9, P = 0.03） and abdom- inal bloating （VAS, mean ± SD, group A： 5.3 ± 2.2 vs 3.0 ± 1.7, P = 0.005; group B： 5.3 ±3.2 vs 2.3 ± 1.9, P = 0.006） decreased in both groups, whilst the VAS values of prolonged abdominal pain decreased in the Flortec group, but remained unchanged in the high-fibre diet group （VAS, mean ± SD, group A： 6.5 ± 1.5 vs 4.5 ± 2.1, P = 0.052; group B： 4.5 ± 3.8 vs 5.5 ± 3.5）. CONCLUSION： A high-fibre diet is effective in relievingabdominal symptoms in symptomatic uncomplicated di- verticular disease. This treatment may be implemented by combining the high-fibre diet with Flortec~.

Impacts of acupuncture on brainstem evoked potentials in patients with primary depression

Objective To observe the impacts of acupuncture on brainstem evoked potentials in the patients with primary depression. Methods Forty cases of primary depression were treated by acupuncture at Baihui （百会 GV 20）, Yinatng （印堂 GV 29）, DazhuT （大椎 GV 14）, bilateral Shenmen （神门 HT 7）, bilateral Taichong （太冲 LR 3）, bilateral Neiguan （内关 PC 6） and SanyTnjiao （三阴交 SP 6）. The needles were retained for 30 min. Acupuncture treatment was given once every two days, three treatments a week. The brainstem auditory evoked potential （BAEP） and visual evoked potential （VEP） were observed in 6 weeks of treatment. The change in Hamilton depression scale （HAMD） score was observed before and after treatment in the depression group. Results After treatment, VEP wave latency was shortened significantly in patients of depression （P〈0.05）, BAEPIII wave latency was shortened significantly （P〈0.05）. The score of HAMD was decreased apparently in the depression group （P〈0.05）. Conclusions The stressability of visual and auditory stimuli in the central nervous system was decreased in the patients of depression. Acupuncture shortens remarkably the brainstem evoked potentials latency in the patients of depression and achieves the effective results in the treatment of primary depression.

Effects of auricular point sticking on dry eye in myopia patients after SMILE surgery:a prospective randomized controlled clinical trial

Objective:To observe the intervention effect of auricular point sticking on dry eye in myopia patients after small-incision lenticule extraction(SMILE)surgery.Methods:This was a prospective randomized controlled study conducted among the myopia patients who received SMILE surgery at Eye and ENT Hospital of Fudan University.The post-SMILE operation patients who screened by the inclusion and exclusion criteria were randomized into a control group and a treatment group.Patients in the control group were given 0.1%fluorometholone and 0.5%carboxymethylcellulose sodium eye drops,while the treatment group was given additional unilateral auricular point sticking for 1 month.The patients were estimated using ocular surface disease index(OSDI),Schirmer tear test-1(STT-1),tear film break-up time(TF-BUT),corneal fluorescein staining(CFS)score,corneal sensitivity(CS)and visual quality(VQ)at 1 d,1 week and 1 month after surgery;the changes in anxiety and depression were also observed in the patients.Results:Compared with the first day after operation,CS in the nasal region was improved in the treatment group,and the VQ score increased in the control group patients at 1 week after operation(both P<0.05);at 1 month after operation,the TF-BUT increased,CFS score decreased,CS in the central and nasal regions increased(all P<0.05),and VQ score increased(P<0.01)in the treatment group,and the CS in the central,upper,lower and nasal regions were improved(all P<0.05),and VQ score increased(P<0.01)in the control group.The between-group comparison showed that the differences in the change of TF-BUT were statistically significant at 1 week and 1 month after surgery,respectively(both P<0.05).Conclusion:Auricular point sticking therapy can increase the TF-BUT and accelerate the repair of ocular surface function in post-SMILE patients.