PURPOSE: To analyze the clinical presentation, microbiological profile, and treatment outcome in cases of nocardial endophthalmitis after cataract surgery. DESIGN: Retrospective, observational case series. METHODS: SE...PURPOSE: To analyze the clinical presentation, microbiological profile, and treatment outcome in cases of nocardial endophthalmitis after cataract surgery. DESIGN: Retrospective, observational case series. METHODS: SETTING: Tertiary referral hospital. PATIENTS: Retrospective analysis of 24 cases of culture-proven exogenous nocardial endophthalmitis following cataract surgery between January 2000 and December 2003. MAIN OUTCOME MEASURES: Visual acuity and anatomic outcome. RESULTS: Visual outcome was poor in most patients, with 79%(19/24) of patients obtaining a final visual acuity of hand motions or worse and 46%(11/24) of patients with no light perception. Initial presenting visual acuity was strongly associated with final visual outcome (P=.0026). There was a statistically significant trend favoring better visual outcome in patients who presented early after the onset of symptoms (P=.01). The majority of the eyes (23/24) had an early onset with predominately anterior segment involvement. Wound infection was noted in 46%(11/24) of the patients at presentation. Clinical features included scleral abscess, cotton ball exudates in the anterior chamber, fluffy exudates on the corneal endothelium, nodular exudates on the iris, and hypopyon. Among the specimens cultured, the highest positivity was seen with the anterior chamber aspirate (15/16 =93.75%), which was significantly higher than the vitreous aspirate cultured (1/22=4.54%) (P=.001). CONCLUSION: Nocardia endophthalmitis after cataract surgery is an aggressive disease with poor visual prognosis. Early diagnosis and treatment with good visual acuity at presentation may be associated with better visual outcome.展开更多
Objective: To investigate an approach for the analysis of samples obtained in screening for trisomy 21 that retains the advantages of quantitative fluorescent polymerase chain reaction (qf- PCR) over full karyotyping ...Objective: To investigate an approach for the analysis of samples obtained in screening for trisomy 21 that retains the advantages of quantitative fluorescent polymerase chain reaction (qf- PCR) over full karyotyping and maximises the detection of clinically significant abnormalities. Design: Observational study. Setting: Tertiary referral centre. Subjects: 17 446 pregnancies, from which chorionic villous samples had been taken after assessment of risk for trisomy 21 by measurement of fetal nuchal translucency (NT) thickness at 11 to 13th weeks of gestation. Interventions: Analysis of chorionic villous samples by full karyotyping and by qf- PCR for chromosomes 13, 18, 21, X, and Y. Main outcome measure: Detection of clinically significant chromosomal abnormalities. Results: The fetal karyotype was normal in 15 548 (89.1% ) cases and abnormal in 1898 (10.9% ) cases, including 1722 with a likely clinically significant adverse outcome. Karyotyping all cases would lead to the diagnosis of all clinically significant abnormalities, and a policy of relying entirely on qf- PCR would lead to the diagnosis of 97.9% of abnormalities. An alternative strategy where by qf- PCR is the main method of analysis and full karyotyping is reserved for those cases with a minimum fetal NT thickness of 4 mm would require full karyotyping in 10.1% of the cases, would identify 99.0% of the significant abnormalities, and would cost 60% less than full karyotyping for all. Conclusions: In the diagnosis of chromosomal abnormalities after first trimester screening for trisomy 21, a policy of qf- PCR for all samples and karyotyping only if the fetal NT thickness is increased would reduce the economic costs, provide rapid delivery of results, and identify 99% of the clinically significant chromosomal abnormalities.展开更多
肺胎盘样变形(placental transmogrification of the lung,PTL)为一种肺部罕见良性囊性病变,其特征为组织学形态类似未成熟胎盘结构。本文报道1例本院确诊的PTL患者,为75岁老年男性,影像学表现为局限性分隔样囊腔性病变。免疫组织化学...肺胎盘样变形(placental transmogrification of the lung,PTL)为一种肺部罕见良性囊性病变,其特征为组织学形态类似未成熟胎盘结构。本文报道1例本院确诊的PTL患者,为75岁老年男性,影像学表现为局限性分隔样囊腔性病变。免疫组织化学表现为绒毛结构表面增生的肺泡上皮甲状腺转录因子1、细胞角蛋白7弥漫阳性,绒毛样间质内细胞CD10及波形蛋白阳性,绒毛样间质内血管CD34及D2-40阳性,HMB45、人绒毛膜促性腺激素β均阴性,Ki-67低表达。描述其组织学特点、免疫表型、诊断要点,并复习相关文献。展开更多
文摘PURPOSE: To analyze the clinical presentation, microbiological profile, and treatment outcome in cases of nocardial endophthalmitis after cataract surgery. DESIGN: Retrospective, observational case series. METHODS: SETTING: Tertiary referral hospital. PATIENTS: Retrospective analysis of 24 cases of culture-proven exogenous nocardial endophthalmitis following cataract surgery between January 2000 and December 2003. MAIN OUTCOME MEASURES: Visual acuity and anatomic outcome. RESULTS: Visual outcome was poor in most patients, with 79%(19/24) of patients obtaining a final visual acuity of hand motions or worse and 46%(11/24) of patients with no light perception. Initial presenting visual acuity was strongly associated with final visual outcome (P=.0026). There was a statistically significant trend favoring better visual outcome in patients who presented early after the onset of symptoms (P=.01). The majority of the eyes (23/24) had an early onset with predominately anterior segment involvement. Wound infection was noted in 46%(11/24) of the patients at presentation. Clinical features included scleral abscess, cotton ball exudates in the anterior chamber, fluffy exudates on the corneal endothelium, nodular exudates on the iris, and hypopyon. Among the specimens cultured, the highest positivity was seen with the anterior chamber aspirate (15/16 =93.75%), which was significantly higher than the vitreous aspirate cultured (1/22=4.54%) (P=.001). CONCLUSION: Nocardia endophthalmitis after cataract surgery is an aggressive disease with poor visual prognosis. Early diagnosis and treatment with good visual acuity at presentation may be associated with better visual outcome.
文摘Objective: To investigate an approach for the analysis of samples obtained in screening for trisomy 21 that retains the advantages of quantitative fluorescent polymerase chain reaction (qf- PCR) over full karyotyping and maximises the detection of clinically significant abnormalities. Design: Observational study. Setting: Tertiary referral centre. Subjects: 17 446 pregnancies, from which chorionic villous samples had been taken after assessment of risk for trisomy 21 by measurement of fetal nuchal translucency (NT) thickness at 11 to 13th weeks of gestation. Interventions: Analysis of chorionic villous samples by full karyotyping and by qf- PCR for chromosomes 13, 18, 21, X, and Y. Main outcome measure: Detection of clinically significant chromosomal abnormalities. Results: The fetal karyotype was normal in 15 548 (89.1% ) cases and abnormal in 1898 (10.9% ) cases, including 1722 with a likely clinically significant adverse outcome. Karyotyping all cases would lead to the diagnosis of all clinically significant abnormalities, and a policy of relying entirely on qf- PCR would lead to the diagnosis of 97.9% of abnormalities. An alternative strategy where by qf- PCR is the main method of analysis and full karyotyping is reserved for those cases with a minimum fetal NT thickness of 4 mm would require full karyotyping in 10.1% of the cases, would identify 99.0% of the significant abnormalities, and would cost 60% less than full karyotyping for all. Conclusions: In the diagnosis of chromosomal abnormalities after first trimester screening for trisomy 21, a policy of qf- PCR for all samples and karyotyping only if the fetal NT thickness is increased would reduce the economic costs, provide rapid delivery of results, and identify 99% of the clinically significant chromosomal abnormalities.
文摘肺胎盘样变形(placental transmogrification of the lung,PTL)为一种肺部罕见良性囊性病变,其特征为组织学形态类似未成熟胎盘结构。本文报道1例本院确诊的PTL患者,为75岁老年男性,影像学表现为局限性分隔样囊腔性病变。免疫组织化学表现为绒毛结构表面增生的肺泡上皮甲状腺转录因子1、细胞角蛋白7弥漫阳性,绒毛样间质内细胞CD10及波形蛋白阳性,绒毛样间质内血管CD34及D2-40阳性,HMB45、人绒毛膜促性腺激素β均阴性,Ki-67低表达。描述其组织学特点、免疫表型、诊断要点,并复习相关文献。
