AIM： To evaluate the safety and efficacy of posterior sub-Tenon＇s carboplatin injection compared to intravitreal melphalan injection in the management of retinoblastoma （RB） with secondary vitreous seeds. The outc...AIM： To evaluate the safety and efficacy of posterior sub-Tenon＇s carboplatin injection compared to intravitreal melphalan injection in the management of retinoblastoma （RB） with secondary vitreous seeds. The outcome measures were vitreous seeds regression, need for other treatment modalities to achieve ocular salvage and treatment side effects. METHODS： A prospective interventional comparative nonrandomized study included RB eyes developed secondary vitreous seeds during the period of follow up. They subdivided into two groups： study group Ⅰ where posterior sub-Tenon＇s carboplatin （20 mg/2 mL） was injected and study group Ⅱ where intravitreal melphalan （20 μg/0.1 mL） was injected. The injections repeated every 2-4wk. RESULTS： Thirty-three eyes were included in the study. Seventeen eyes （16 patients） in study group Ⅰ and 16 eyes （16 patients） in study group Ⅱ. Ten eyes （30.3%） were completely salvaged following local chemotherapies, Ocular salvage was 23.5% following posterior sub-Tenon＇s carboplatin injection versus 37.5% following intravitreal melphalan raised to 47.1% and 75% with addition of external beam radiotherapy （EBR） with no statistically significant difference between the study groups （P=0.16）. A statistically significant correlation was found between ocular salvage rate and type of vitreous seeds either dust, spheres and clouds （r=0.42, P=-0.015） and eyes harbor new solid tumor growth （r=0.35, P=0.045）. The mean and median follow up periods following local chemotherapy injections were 2.0y in the study group Ⅰand 2.37y in the study group Ⅱ. Few complications were reported： periorbital edema in all eyes and ocular motility disturbances in 13 eyes （76.5%） following posterior sub-Tenon＇s carboplatin injection. Vitreous hemorrhage developed in 2 eyes （12.5%） and localized retinopathy in 5 eyes （31.25%） following intravitreal melphalan. ~ CONCLUSION： Local chemotherapy for treatment of RB with secondary vitreous seeds is safe and can salvage 30.3% of eyes without EBR. There is a superiority of intravitreal melphalan in ocular salvage however, no statistically significant difference between both groups.展开更多
BACKGROUND Eosinophilic granuloma(EG)is a proliferative condition that affects the cells of bone tissue.There are no specific clinical signs or imaging manifestations in the early stages of the disease,making it simpl...BACKGROUND Eosinophilic granuloma(EG)is a proliferative condition that affects the cells of bone tissue.There are no specific clinical signs or imaging manifestations in the early stages of the disease,making it simple to overlook and misdiagnose.Because of the disease's rarity,there is presently no standardized treatment principle.There are few accounts of such occurrences affecting the axis among children.We discovered a case of a child whose EG resulted in atlantoaxial joint dislocation and destruction of the axial bone.CASE SUMMARY After having pharyngeal discomfort for more than six months without a clear explanation,a 6-year-old boy was brought to our hospital.Following a careful evaluation,the pathology indicated a strong likelihood of an axial EG.Ultimately,we decided to treat the boy with posterior pedicle screw fixation and local steroid injections.CONCLUSION EGs of the upper cervical spine are quite uncommon in children,and they are exceedingly easy to overlook or misdiagnose.Posterior pedicle screw fixation and local steroid injections are effective treatments for patients with axial EGs affecting the atlantoaxial junction.展开更多
AIM: To determine whether intravitreal dexamethasone(DEX) implant induces posterior vitreous detachment or not. METHODS: We retrospectively reviewed 810 eyes of 405 patients who underwent intravitreal DEX implantation...AIM: To determine whether intravitreal dexamethasone(DEX) implant induces posterior vitreous detachment or not. METHODS: We retrospectively reviewed 810 eyes of 405 patients who underwent intravitreal DEX implantation due to macular edema caused by diabetic and retinal venous occlusion in our clinic. The eyes having no injection were determined as the control group. The examination findings of the patients before the injection and 3 mo after the injection and optical coherence tomography(OCT) images were scanned. The pre-injection OCT findings and OCT findings of the patients having no posterior vitreous detachment(PVD) and determined to have partial PVD were compared. RESULTS: The separation in vitreoretinal adhesion and total PVD development of DEX-injected 56/208(26.9%) eyes were statistically greater in comparison with the 12/129(9.3%) eyes that had not been injected(P=0.001). PVD development was observed more in the patients that were younger, had larger macula thickness and lower visual acuity. CONCLUSION: It can be stated that intravitreal DEX implant induces PVD development. Prospective, controlled studies are required in order to determine prognosis of vitreoretinal disease in PVD-developed patients and in non-PVD-developed patients.展开更多
Posterior disc displacement of the temporomandibular joint is rare. We present a unique treatment method and magnetic resonance (MR) images of this condition. The patient was a 43-year-old male with a chief complaint ...Posterior disc displacement of the temporomandibular joint is rare. We present a unique treatment method and magnetic resonance (MR) images of this condition. The patient was a 43-year-old male with a chief complaint of abnormal occlusion. Regarding the present status, there was no occlusion on the right side. No temporomandibular joint pain, myalgia, or clicking were observed while mouth opening. On MR images, the posterior disc displacement without reduction on the right was observed and it was assumed that occlusal abnormality was due to this condition. We treated him with the following methods. After injection into the superior articular cavity with 2% lidocaine, a sodium hyaluronate preparation was injected followed by intermaxillary traction applied using rubber. The recovery of occlusion was confirmed in follow-up at 5 days after treatment. In the 13th days, the intermaxillary traction was removed. On MR images, the right disc condition was changed to anterior disc displacement with reduction. We consider our treatment methods are effective for this clinical condition.展开更多
Spinal pain(SP)is a common condition that has a major negative impact on a patient’s quality of life.Recent developments in ultrasound-guided injections for the treatment of SP are increasingly being used in clinical...Spinal pain(SP)is a common condition that has a major negative impact on a patient’s quality of life.Recent developments in ultrasound-guided injections for the treatment of SP are increasingly being used in clinical practice.This clinical expert consensus describes the purpose,significance,implementation methods,indications,contraindications,and techniques of ultrasound-guided injections.This consensus offers a practical reference point for physicians to implement successfully ultrasound-guided injections in the treatment of chronic SP.展开更多
BACKGROUND Posterior interosseous nerve(PIN)entrapment syndrome is one of the causes of weakness and pain of the arm muscles,which is prone to missed diagnosis and misdiagnosis in clinic practice.This paper reports a ...BACKGROUND Posterior interosseous nerve(PIN)entrapment syndrome is one of the causes of weakness and pain of the arm muscles,which is prone to missed diagnosis and misdiagnosis in clinic practice.This paper reports a case of PIN entrapment syndrome,with PIN injury indicated by electrophysiology.Musculoskeletal ultrasound was applied to identify that the entrapment point was located at the inlet of the Frohse arch and the outlet of the supinator muscle.Treatment with ultrasound-guided nerve hydrodissection was performed on the entrapment point,which significantly improved the symptoms.Ultrasound-guided nerve hydrodissection is an effective therapeutic method for PIN entrapment syndrome.CASE SUMMARY A male patient,35 years old,worked as an automobile mechanic.He felt slightly weak extension activity of his right fingers 2 years ago but sought no treatment.Later,the symptoms gradually became aggravated and led to finger drop,particularly severe in the right middle finger,accompanied by supination weakness of the right forearm.Neural electrophysiological examination showed that the patient had partial PIN injury of the right radius.Musculoskeletal ultrasound examination indicated PIN entrapment at the inlet of the Frohse arch and the outlet of the supinator muscle.Therefore,PIN entrapment syndrome was diagnosed.After treatment with ultrasound-guided nerve hydrodissection around the entrapment point,the dorsiflexion weakness of the right hand was significantly improved compared with before treatment.CONCLUSION Ultrasound-guided hydrodissection is efficacious for PIN entrapment syndrome,with high clinical value and great application prospects.展开更多
文摘AIM： To evaluate the safety and efficacy of posterior sub-Tenon＇s carboplatin injection compared to intravitreal melphalan injection in the management of retinoblastoma （RB） with secondary vitreous seeds. The outcome measures were vitreous seeds regression, need for other treatment modalities to achieve ocular salvage and treatment side effects. METHODS： A prospective interventional comparative nonrandomized study included RB eyes developed secondary vitreous seeds during the period of follow up. They subdivided into two groups： study group Ⅰ where posterior sub-Tenon＇s carboplatin （20 mg/2 mL） was injected and study group Ⅱ where intravitreal melphalan （20 μg/0.1 mL） was injected. The injections repeated every 2-4wk. RESULTS： Thirty-three eyes were included in the study. Seventeen eyes （16 patients） in study group Ⅰ and 16 eyes （16 patients） in study group Ⅱ. Ten eyes （30.3%） were completely salvaged following local chemotherapies, Ocular salvage was 23.5% following posterior sub-Tenon＇s carboplatin injection versus 37.5% following intravitreal melphalan raised to 47.1% and 75% with addition of external beam radiotherapy （EBR） with no statistically significant difference between the study groups （P=0.16）. A statistically significant correlation was found between ocular salvage rate and type of vitreous seeds either dust, spheres and clouds （r=0.42, P=-0.015） and eyes harbor new solid tumor growth （r=0.35, P=0.045）. The mean and median follow up periods following local chemotherapy injections were 2.0y in the study group Ⅰand 2.37y in the study group Ⅱ. Few complications were reported： periorbital edema in all eyes and ocular motility disturbances in 13 eyes （76.5%） following posterior sub-Tenon＇s carboplatin injection. Vitreous hemorrhage developed in 2 eyes （12.5%） and localized retinopathy in 5 eyes （31.25%） following intravitreal melphalan. ~ CONCLUSION： Local chemotherapy for treatment of RB with secondary vitreous seeds is safe and can salvage 30.3% of eyes without EBR. There is a superiority of intravitreal melphalan in ocular salvage however, no statistically significant difference between both groups.
基金Supported by the Natural Science Foundation of Fujian Province,No.2021J01546the Innovation and Entrepreneurship Star Fund Project of Zhangzhou,No.ZCZZ[2019]17.
文摘BACKGROUND Eosinophilic granuloma(EG)is a proliferative condition that affects the cells of bone tissue.There are no specific clinical signs or imaging manifestations in the early stages of the disease,making it simple to overlook and misdiagnose.Because of the disease's rarity,there is presently no standardized treatment principle.There are few accounts of such occurrences affecting the axis among children.We discovered a case of a child whose EG resulted in atlantoaxial joint dislocation and destruction of the axial bone.CASE SUMMARY After having pharyngeal discomfort for more than six months without a clear explanation,a 6-year-old boy was brought to our hospital.Following a careful evaluation,the pathology indicated a strong likelihood of an axial EG.Ultimately,we decided to treat the boy with posterior pedicle screw fixation and local steroid injections.CONCLUSION EGs of the upper cervical spine are quite uncommon in children,and they are exceedingly easy to overlook or misdiagnose.Posterior pedicle screw fixation and local steroid injections are effective treatments for patients with axial EGs affecting the atlantoaxial junction.
文摘AIM: To determine whether intravitreal dexamethasone(DEX) implant induces posterior vitreous detachment or not. METHODS: We retrospectively reviewed 810 eyes of 405 patients who underwent intravitreal DEX implantation due to macular edema caused by diabetic and retinal venous occlusion in our clinic. The eyes having no injection were determined as the control group. The examination findings of the patients before the injection and 3 mo after the injection and optical coherence tomography(OCT) images were scanned. The pre-injection OCT findings and OCT findings of the patients having no posterior vitreous detachment(PVD) and determined to have partial PVD were compared. RESULTS: The separation in vitreoretinal adhesion and total PVD development of DEX-injected 56/208(26.9%) eyes were statistically greater in comparison with the 12/129(9.3%) eyes that had not been injected(P=0.001). PVD development was observed more in the patients that were younger, had larger macula thickness and lower visual acuity. CONCLUSION: It can be stated that intravitreal DEX implant induces PVD development. Prospective, controlled studies are required in order to determine prognosis of vitreoretinal disease in PVD-developed patients and in non-PVD-developed patients.
文摘Posterior disc displacement of the temporomandibular joint is rare. We present a unique treatment method and magnetic resonance (MR) images of this condition. The patient was a 43-year-old male with a chief complaint of abnormal occlusion. Regarding the present status, there was no occlusion on the right side. No temporomandibular joint pain, myalgia, or clicking were observed while mouth opening. On MR images, the posterior disc displacement without reduction on the right was observed and it was assumed that occlusal abnormality was due to this condition. We treated him with the following methods. After injection into the superior articular cavity with 2% lidocaine, a sodium hyaluronate preparation was injected followed by intermaxillary traction applied using rubber. The recovery of occlusion was confirmed in follow-up at 5 days after treatment. In the 13th days, the intermaxillary traction was removed. On MR images, the right disc condition was changed to anterior disc displacement with reduction. We consider our treatment methods are effective for this clinical condition.
文摘Spinal pain(SP)is a common condition that has a major negative impact on a patient’s quality of life.Recent developments in ultrasound-guided injections for the treatment of SP are increasingly being used in clinical practice.This clinical expert consensus describes the purpose,significance,implementation methods,indications,contraindications,and techniques of ultrasound-guided injections.This consensus offers a practical reference point for physicians to implement successfully ultrasound-guided injections in the treatment of chronic SP.
基金Supported by the Guangxi Natural Science Foundation,No.2022GXNSFBA035519 and No.2023GXNSFAA026175Self-funded Project of Guangxi Health Commission,No.Z20180776 and No.Z20210179Guangxi Medical and Health Appropriate Technology Development and Promotion Application Project,No.S2020081.
文摘BACKGROUND Posterior interosseous nerve(PIN)entrapment syndrome is one of the causes of weakness and pain of the arm muscles,which is prone to missed diagnosis and misdiagnosis in clinic practice.This paper reports a case of PIN entrapment syndrome,with PIN injury indicated by electrophysiology.Musculoskeletal ultrasound was applied to identify that the entrapment point was located at the inlet of the Frohse arch and the outlet of the supinator muscle.Treatment with ultrasound-guided nerve hydrodissection was performed on the entrapment point,which significantly improved the symptoms.Ultrasound-guided nerve hydrodissection is an effective therapeutic method for PIN entrapment syndrome.CASE SUMMARY A male patient,35 years old,worked as an automobile mechanic.He felt slightly weak extension activity of his right fingers 2 years ago but sought no treatment.Later,the symptoms gradually became aggravated and led to finger drop,particularly severe in the right middle finger,accompanied by supination weakness of the right forearm.Neural electrophysiological examination showed that the patient had partial PIN injury of the right radius.Musculoskeletal ultrasound examination indicated PIN entrapment at the inlet of the Frohse arch and the outlet of the supinator muscle.Therefore,PIN entrapment syndrome was diagnosed.After treatment with ultrasound-guided nerve hydrodissection around the entrapment point,the dorsiflexion weakness of the right hand was significantly improved compared with before treatment.CONCLUSION Ultrasound-guided hydrodissection is efficacious for PIN entrapment syndrome,with high clinical value and great application prospects.
