炎症的实验室指标

机体对各种内源性和外源性损害作出炎症反应,以提高防御能力,清除损伤以及重建受损的组织结构。炎症可以由于感染性病原体、机械性、温度或化学性组织损伤、不同原因的坏死以及免疫和自身免疫反应导致。 在损伤局部,炎症的连锁反应起始主要表现为自组织巨噬细胞和血液中的单核细胞,释放出肿瘤坏死因子(TNF)、白细胞介素1(IL-1)。这些释放出的细胞因子和其他因子通过血管内皮细胞的粘附分子和趋化作用的诱导。

垂体腺瘤

垂体腺瘤是来源于垂体前叶细胞的良性肿瘤,在常规尸检中,约27%患者存在垂体微腺瘤。多数肿瘤直径在2mm 左右。免疫组织化学显示多为无功能肿瘤和泌乳素腺瘤。这类腺瘤没有临床症状,所以术前没有行进一步检查。

Surgical Technique and Efficacy Analysis of Extra-pseudocapsular Transnasal Transsphenoidal Surgery for Pituitary Microprolactinoma

Objective To elucidate the role of transsphenoidal surgery in the treatment of pituitary microprolactinoma.Methods The clinical data of 107 prolactinoma cases treated by extra-pseudocapsular transnasal transsphenoidal surgery(ETTS)for different indications in our department since 2011 was retrospectively analyzed.Results The most common indication was the ineffectiveness of oral medication(41.1%),followed by the personal willingness of the patient(35.5%),and 20.6%of the patients were young women with clear tumor boundaries.The pseudocapsule was not observed in 63 cases(58.9%),incomplete pseudocapsule was observed in 26 cases(24.3%),and complete pseudocapsule in 18 cases(16.8%).A total of 97 patients(90.7%)obtained 1-year post-operation remission.According to the relative location of the adenoma and pituitary gland on the MRI scan,46 patients were classified into a central type,59 a lateral type,and 2 a supra-pituitary type.Two patients developed hypogonadism,one patient developed hypocortisolism,and one patient developed post-operative hypothyroidism.Two patients were administrated with hormone replacement treatment,and the treatment was stopped within one week.There was no permanent hypopituitarism.Further investigation demonstrated that the adenoma types could affect the remission rates of hyperprolactinemia and gross total resection rate in microprolactinoma.Conclusion ETTS was an effective treatment for pituitary microprolactinomas.This could be the first choice for patients who presented enclosed adenoma on the MRI and were potentially curable in a preoperative evaluation.Maximal safe removal of the adenoma by ETTS with the aim to increase the sensitivity of the drugs was also recommended for patients with invasive dopamine agonist resistant prolactinomas and patients with difficulty in childbirth.

Extra-pseudocapsular Transnasal Transsphenoidal Resection of Pituitary Macroadenoma:Technique Note and Evaluation of Endocrine Function

Objective In this study,we investigated the surgical technique and endocrine assessment of pituitary function of patients with macroadenoma treated by extra-pseudocapsular transnasal transsphenoidal surgery(ETTS).Methods Clinical data of 144 patients with pituitary macroadenomas in the same surgical group at the Department of Neurosurgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology were retrospectively analyzed from January 2019 to June 2021.Based on the results of the endocrinological evaluation and MRI examinations before and after surgery,the fluctuation of pituitary function and the extent of resection were analyzed.Multiple Logistic regression analysis was used to determine the predictors affecting postoperative tumor residual.Results Among the 144 patients with pituitary macroadenomas,72(50.0%)were female and 72(50.0%)were male,the median age was 50 years,26(18.1%)had invasiveness grade 0,46(31.9%)had grade I,57(39.6%)had grade II,and 15(10.4%)had grade III according to Lu’s classification method.Based on observation during surgery,37 cases(25.7%)had no pseudocapsule,54 cases(37.5%)had incomplete pseudocapsule,and 53 cases(36.8%)had intact pseudocapsule.In addition,91(63.2%)patients had total resection,39(27.1%)had subtotal resection,and 14(9.7%)had partial resection.As for anterior pituitary function,13 of 19 hypothyroid patients had recovery after surgery,with a remission rate of 68.4%.Eighteen of the 26 decreased cortisol patients got back to normal,with a remission rate of 69.2%.A total of 27 of 51 patients with hypogonadism improved,with a remission rate of 52.9%.Univariate and multivariate analyses indicated that gender,tumor size,and invasiveness were predictors of postoperative residual in patients(P<0.05).Conclusion The results showed that ETTS is an effective treatment modality for restoring the function of pituitary gland of the patients with macroadenomas.Tumor size and invasiveness are predictors of the extent of surgical resection and postoperative residual of macroadenomas.

眼睑无力综合征的发病机制:基质金属蛋白酶在弹性纤维降解中的作用

Objective: To investigate histopathologic alterations of eyelid biopsy specime ns from patients with floppy eyelid syndrome (FES) with special regard to elasti c fiber content and ultrastructure as well as to the expression of elastin-degr ading enzymes to elucidate the pathogenesis of this disorder. Design: Retrospect ive, interventional case series. Participants and Controls: Eleven consecutive p atients with FES and 10 age-matched control patients with basal cell carcinoma of the eyelid. Methods: Horizontal pentagonal eyelid resections of 16 upper lids were performed in 11 patientswith FES. Full-thickness eyelid biopsy specimens from study and control patients were examined by light and transmission electron microscopy, semiquantitative morphometry, and immunohistochemistry using antibo dies against matrix metalloproteinase (MMP)-2, MMP-7, MMP-9, and MMP-12 and neutrophil elastase. Results: All patients treated with surgical horizontal eyel id shortening were asymptomatic at follow-up. Histopa- thologic analysis of the surgical specimens showed, apart from unspecific sign s of chronic in-flammation, a significant decrease in the amount of elastin wit hin the tarsal plate and eyelid skin as compared with controls. Residual elastic fibers revealed an abnormal ultrastructure with a diminished elastin core. Immu nohistochemistry demonstrated an increased immunoreactivity for elastolytic prot eases, particularly MMP-7 and MMP-9, in areas of elastin depletion in FES spec imens as compared with controls. Conclusions: The findings indicate that upregul ation of elastolytic enzymes, most probably induced by repeated mechanical stres s, participates in elastic fiber degradation and subsequent tarsal laxity and ey elash ptosis in FES.

人垂体生长激素腺瘤的分子生物学 生化改变及潜在临床意义

分子生物学检测证实,30%～40%的人肢端肥大症生长激素(GH)垂体腺瘤有 Gsα基因单个碱基的误义突变,产生的基因称为 gsp 癌基因。此外,大部分 GH 腺瘤异常表达 GH 释放因子(GRF)基因。gsp 癌基因使腺苷酸环化酶活性增强,导致细胞内cAMP 水平过度升高。

采用回归模型研究穿透性角膜移植术拆线后角膜曲率及散光的自发性、长期性改变

PURPOSE: To assess the diagnosis-based spontaneous lon-gterm changes in corneal power and refraction with a regression model in the all-sutures-out time period following non-mechanical penetrating keratoplasty (PK). DESIGN: Retrospective non-randomized clinical trial. METHODS: setting: Clinical practice. study population: 147 eyes [47 Fuchs dystrophy (FD); 100 keratoconus (KC)] were studied after suture removal in this retrospective longitudinal study. MAIN OUTCOME MEASURES: Zeiss keratometry [equivalent power (KEQ) and astigmatism (KAST)], corneal topography analysis [equivalent power (TEQ) and astigmatism (TAST)], and subjective refractometry [spherical equivalent (SEQ) and refractive cylinder (RAST)]were assessed in at least three up to 16 ophthalmologic examinations in the all-sutures-out time period. observation procedure: The time course of each target variable was analyzed in a longitudinal manner (time interval < 12 months) separately for each patient with a linear regression model. RESULTS: Post-keratoplasty follow-up ranged from 31 months to 10.3 years. In the linear regression model, the annual change in FD/KC showed an increase/a decrease in KEQ (0.29 ± 0.50/- 0.63± 0.46 diopters, P=.02) and an increase/a decrease in TEQ (0.37 ± 0.54/- 0.69 ± 0.49 diopters, P=.04) corresponding to a decrease/an increase in SEQ (- 0.31 ± 0.47/0.63 ± 0.43 diopters, P=.02). KAST/TAST/RAST showed a minimal annual decrease (- 0.06 ± 0.41/- 0.05 ± 0.45/- 0.06 ± 0.41 diopters) in FD but an increase in KC(0.46± 0.41/0.51± 0.43/0.46± 0.38 diopters) (P=.05/0.06/0.12). CONCLUSIONS: In the followup after post- keratoplasty suture removal, patients with FD/KC tend to develop a spontaneous myopic shift (steepening of the cornea)/hyperopic shift (flattening of the cornea). In contrast with those with FD, patients with KC should be counseled on the fact that astigmatism may increase again over time after suture removal.

圆锥角膜行非机械性全层角膜移植术后拆除连续缝线导致的角膜功能和屈光度的改变情况

Purpose: To assess the changes in corneal power and refraction due to sequential suture removal after penetrating keratoplasty (PK). DESIGN: Retrospective consecutive case series. METHODS: SETTING: Clinical practice. STUDY POPULATION: We studied 67 phakic keratoconus eyes (central excimer laser trephination, primary keratoplasty, graft/recipient diameter 8.1/8.0 mm; double running suture) in this longitudinal study. MAIN OUTCOME MEASURES: Zeiss keratometry (equivalent power (KEQ), astigmatism (KAST)), corneal topography (equi-valent power (TEQ), astigmatism (TAST)) and subjective refractometry (spherical equivalent (SEQ), refractive cylinder (RAST)) were assessed with sutures in place (interval 1), with one suture out (interval 2), and with all sutures out (interval 3). OBSERVATION PROCEDURE: Corneal power and refraction was decomposed into vector components and the changes were derived between time stages. RESULTS: The mean follow-up period was 3.9 ±1.7 years. At interval 1, the axes of KAST/TAST/RAST were almost randomly distributed. At interval 2, the with/against the rule component of KAST/TAST/RAST decreased slightly and the oblique component increased significantly, so that the axes tended to have a preferred oblique direction. At interval 3, the with/against the rule component of KAST/TAST/RAST increased slightly and the oblique component decreased significantly, so that the with/against the rule component exceeded the oblique component by approximately 23%/28%/25%. Median KEQ/ TEQ/SEQ changed by 0.64/0.62/-1.11 diopters (interval 1 to interval 2) and by -0.85/-0.90/1.56 diopters (interval 2 to interval 3). CONCLUSIONS: As a result of removal of the first running suture, corneal astigmatismas well as the refractive cylinder tend to oblique axes. As a result of removal of the second running suture, the final corneal astigmatism and refractive cylinder tend to orientation axes with/against the rule.

正常人与开角型青光眼患者的视网膜血管内氧饱和度的差异

Purpose:To measure the oxygen saturation(SO2)in retinal arterioles and venules in patients with glaucomatous optic neuropathy.Methods:We examined SO2 in retinal arterioles and venules simultaneously by imaging spectrometry.Oxygen saturationwas evaluated according to the difference of the extinction spectra of haemoglobin and oxyhaemog-lobin.The arterio-venous difference(avD)was calculated by(SO2art-SO2ven).The optic nerve head topography was estimated by Heidelberg retinal tomography and the visual field using the Octopus G1.We examined one eye in each of 58 healthy persons(mean age 58.6 ± 10.7 years;mean rim area 1.52± 0.33mm2;mean defect 0.65± 1.31 dB;mean intraocular pressure IOP 18.5± 2.7 mmHg),49 patients with normal-tension primary open-angle glaucoma(NTG)(mean age 63.0± 8.5 years;mean rim area 0.89± 0.34 mm2;mean defect 5.4± 4.1dB;mean IOP 19.2± 2.9 mmHg),and 45 patients with high-tension primary open-angle glaucoma(POAG)(mean age 62.6± 10.3 years;mean rim area 0.97± 0.47 mm2;mean defect 7.1± 6.4 dB;mean IOP 31.6± 10.8 mmHg).Results:The intraclass correlation coefficients of the SO2 measurement were 0.82(arteriole)and 0.59(venule).In normal eyes,the SO2art,SO2ven and avD were 92.3± 3.4%,55.7 ± 6.8% and 36.6± 7.0%,respectively.Equivalent data were 89.7± 5.4%,56.0± 8.3% and 33.7± 10.6%,respectively,in NTG eyes and 91.4± 4.0%,58.3± 10.5% and 33.1± 11.5%,respectively,in POAG eyes.Over all examined eyes,the arteriolar SO2 and the retinal arterio-venous difference correlated significantly with the rim area.Conclusion:Eyes with NTG showed significantly decreased arteriolar SO2.These changes were not seen in POAG patients.

1984年～1994年德国Erlangen大学神经科医院辖区的脑死亡诊断

近10年来,现代人类医学取得了巨大进步,将脑死亡患者器官移植给器官有不可逆损伤患者的治疗不仅可行,而且起着重要作用。而获得用于移植目的器官的先决条件,为明确的脑死亡诊断。据统计,仅1％大医院重症监护病房的死亡病例是以脑死亡为基础,允许陈述有关人口统计学基础资料、所患疾病病因以及脑死亡患者器官捐献同意形式的报道也极少。本研究的目的在于根据547例脑死亡患者原始检查资料报道这一主题范畴。

国际眼科理事会(ICO)原主席Prof. G.O.H.Naumann给本刊来信(英文)

Dear President and Chief Editor! Dear Colleague Prof. Xiu-Wen Hu! Thank you so much for your kind email of February 25,2011. I congratulate you that your Journal was accepted for

视盘大小对激光扫描旋光分析视网膜神经纤维参数的影响

Purpose:The aim of the study was to evaluate the influence of optic disc size on the variables of laser scanning polarimetry(GDx).Patients and methods:One hundred and nineteen healthy controls and 161 patients with ocular hypertension(OHT)received detailed ophthalmologic investigation with respect to glaucoma including retinal nerve fiber analysis with GDx(Version 3.0.05× 1;Laser Diagnostic Technologies Europe).Optic disc size was measured with planimetry using 15° optic disc photographs.With respect to frequency of optic disc size in the normal population patients were divided in quartiles of equal sample size.Results:The ratio between retinal nerve fiber layer thickness in the superior and inferior areas in relation to the nasal and temporal regions decreases significantly with increasing optic disc size and the difference between the highest and lowest retinal nerve fiber layer thickness decreases significantly with increasing optic disc size.The results of multivariate neural network analysis increased with larger optic disc size in controls as well as in patients with OHT.Linear regression analysis showed an increase of 9 units(the Number)per 1 mm2 of optic disc size.A Number above 30,which indicates suspected glaucoma,was detected in more than a third of the normal population investigated if the optic disc area was larger than 3.5 mm2.Overall,patients with OHT had a higher Number than controls(20.5± 11.5 vs.18.1± 10.4;p >0.05),but the difference between the two groups did not reach a significant level.Conclusions:Retinal nerve fiber analysis in patients with an optic disc size larger than 3.5mm2 should be interpreted carefully;the Number in particular requires corrections for optic disc size.

有旅游史的卒中患者(提示为经济舱卒中综合征)中心源性脑栓塞和卵圆孔未闭发生率增加

目的:探讨近期曾外出旅游患者中急性卒中的发生率,分析这些患者中的危险因素、卒中类型和卵圆孔未闭(PFO)情况。设计:为期1年的前瞻性观察研究。地点:单中心研究。方法:纳入首次出现大脑缺血的所有患者并补充包括标准化旅游史的一般资料。结果:338例急性卒中患者中有42例(12.4%)有旅游史(PTH)。

PSORS5系统连锁不平衡分析证实了SLC12A8在寻常型银屑病易感性方面的作用

The gene for solute carrier family 12 member A8 has recently been proposed as a candidate gene for psoriasis susceptibility (PSORS5) on chromosome 3q based on association of five single nucleotide polymorphisms (SNP) in Swedish patients. To investigate whether this locus is relevant for German psoriasis vulgaris (PsV) patients, we analyzed a group of 210 trios and a case-control group including 375 patients. Based on our investigation of the linkage disequilibrium (LD) structure of SLC12A8, we assayed 35 haplotype tag SNP and grouped them into nine LD-blocks. In the case-control study, we detected an association for six SNP and three LD-based haplotypes. Association was strongest for ss35527511 (χ 2 = 11.224, p = 0.0008) and haplotype E-2 (χ 2 = 11.788, p = 0.00059) and independent of the presence of an HLA-associated risk allele. Through extended haplotype analysis, we could show that two independent association signals exist in SLC12A8, suggesting allelic heterogeneity. None of the SNP showed association in trios, apart from a weak association of rs2228674 (transmission disequilibrium test statistics p = 0.048), probably due to insufficient power. We conclude that SLC12A8 is a susceptibility locus for PsV. In order to establish the exact nature of this association, efforts to identify the disease-causing variants are ongoing.

假性剥脱综合征的角膜病变(PEX角膜病)行穿透性角膜移植术后的疗效

Purpose: Keratopathy in pseudoexfoliation syndrome (PEX- keratopathy) is a particular form of corneal endothelial decompensation, which requires a penetrating keratoplasty (PK) for visual rehabilitation at advanced states. The aim of this study was to evaluate the functional outcome and the development of intraocular pressure (IOP) after PK in patients with PEX- keratopathy depending on the presence of pre- exist- ing glaucoma. Patients and Methods: This retrospective study included 21 eyes of 21 patients (age 78.6± 7.5 years) with a mean postoperative follow- up of 1.8 ± 2.2 (median 2) years. The diagnosis of PEX- kerat- opathy was confirmed clinically as well as by electron microscopy. The recipient and donor trephinations were performed from the epithelial side using an 193 nm excimer laser (n=11) or mechanically (n=10). An iridotomy was performed routinely during PK. The postoperative treatment with topical steroid was standardized. Results: Preoperatively, a secondary open- angle glaucoma (SOAG) with optic nerve damage was diagnosed in 11 patients (52% ). Topical antiglaucomatous treatment was needed in 81 % of patients with SOAG. Six weeks postoperatively, patients with SOAG showed a higher prevalence of increased intraocular pressure (IOP) and/or antiglaucomatous treatment compared to patients without SOAG (45% vs. 20% ). Most of the mild- early intraocular pressure elevations were controlled in both groups during the follow- up. From one year post- PK, there was an increased need for topical antiglaucomatous treatment in both patient groups. In all eyes the IOP was controlled by topical antiglaucomatous treatment. Preoperatively, visual acuity was comparable in patients with and without SOAG (0.06 ± 0.09 vs.0.08 ± 0.1, P=0.7), but increased significantly more in patients without SOAG (0.38 ± 0.1, median 0.4) than in patients with SOAG (0.2 ± 0.1, median 0.2; P=0.01) after PK. Visual acuity remained stable in both groups throughout the follow- up period. During followup only one eye developed an episode of reversible endothelial graft rejection 18 months postoperatively. An irreversible graft failure was seen in none of the patients. Conclusion: The functional outcome after PK in PEX- keratopathy seems to be strongly associated with pre- existing SOAG. Patients without SOAG may expect good visual rehabilitation without persistent postoperative IOP increases. However, patients should be followed- up for a prolonged period of time, because from 1 year following PK the need for topical antiglaucomatous treatment increased significantly.

视网膜血管的远程医疗筛查技术(“能说话的眼”)

Background: Cerebral and retinal vessels behave similarly under the influence of vascular risk factors. Several groups have shown that retinal microvascular abnormalities represent an independent risk factor with regard to strokes and heart attacks. Aim of the Study: The aim of this study was to perform a prospective screening examinationwith regard to retinalmicrovascular abnormalities as well as an extended vessel diagnosis in a subgroup of patients with lower arteriovenous risk values. Methods: In the course of a prospective cross-sectional study (“Talking Eyes”) between 1.9.2001 and 1.8.2002 a telemedical-supported screening of the retina (study 1) was carried out in 7,163 subjects. The patients were selected without any inclusion or exclusion criteria. The mean age was 48.2±8 years (18-83 years) with a sex distribution of 39.2%females to 60.8%males. Digital fundus photos of the right and left eyes were taken for all patients. The pictures were taken without pupil dilation using a CANON-NM camera. The pictures and case histories were stored in a central server using web-based software (MedStage, Siemens). In a central reading centre, the arteriovenous ratio of both eyes was determined telemedically using the Parr-Hubbard formula and the retinas subjected to a standardised examination by an ophthalmologist. The retinal risk factor was calculated on the basis of the arteriovenous ration, the presence of microvascular abnormalities and the case history. The reproducibility of measurement of the arteriovenous ratio (Kronbach alpha coefficient) was evaluated by double measurements on 1,332 images. In a subgroup of study 1 with arteriovenous ratio values < 0.76 (N=107), an extended vessel diagnosis with measurement of 24-h blood pressure and vessel-relevant blood values (homocysteine, cholesterol, LDL, HDL, CRP, TG, HbA1c) was carried out (study II). Results: Study 1: The Kronbach alpha coefficient as a measure of reproducibility amounted to 0.77. The mean arteriovenous ratio of the retinal vessels was 0.83±0.09 and showed a pronounced age dependence (R=0.9, p< 0.0001). On multivariate testing the arteriovenous ratio correlated significantly (R=0.33, p< 0.001) with the factors age, systolic blood pressure, diastolic blood pressure and body mass index. Diastolic blood pressure followed by age had the largest influence. The prevalence of microvascular abnormalities in the right (RE) and left (LE)-eyes, respectively were: cotton wool foci RE 0.0015%, LE 0.003%, retinal haemorrhage RE 0.1%, LE 0.1%, focal stenoses RE 3.4%, LE 3.4%, tortuositas vasorumRE 4.1%, LE 4.0%, arteriovenous crossing signs RE 11.2%, LE 11.2%. On multivariate testing the occurrence of microvascular abnormalities correlated significantly (R=0.38, p < 0.001) with the factors high blood pressure known from case history, body mass index, and gender. Arterial hypertension had the strongest influence followed by diastolic blood pressure. The calculated retinal risk factor correlated with the prevalence of angina pectoris. Study 11: 2/3 of the subjects with arteriovenous risk factor values < 0.76 exhibited pathologically high 24-h blood pressure values. For these patients there were significant correlations between the arteriovenous ratio and the low-density lipoprotein concentration as well as the Framingham risk score. Conclusion: In the course of a prospective, telemedical-supported screening examination of the retinal vessels of more than 7,000 subjects the arteriovenous ratio exhibited a strong dependence on age and blood pressure. Among the subjects with lowered arteriovenous ratio values, 2/3 exhibited arterial hypertension in the 24-h blood pressure determination.

脉络膜破裂-Erlangen眼球挫伤后住院登记(EO-CR)的分析

Background: Ocular injuries may lead to severe damage of the posterior segment with manifest visual impairment. Choroidal ruptures are frequently masked by ac ute subretinal haemorrhage. We analysed possible predictive factors and function al results of eyeballs with rupture of the choroid after ocular contusion. Patie nts and Methods: We performed a retrospective study of 376 consecutive inpatient s (Erlangen Ocular Contusion Registry-EOCR, over a 10-year period), who were t reated because of a blunt eye injury at our eye hospital (86%males). Detailed n otes regarding the anterior and posterior segments were extracted from the stand ardised charts. Mean age was 28.8±16.1 years (4 to 84 years). Eyes with previou s trauma or globe ruptures were excluded. Results: Twenty-six of 376 patients d eveloped choroidal rupture due to ocular contusion (6.9%). A choroidal rupture was more frequent in females (9.4%) than in males (6.5%). Patients with choroi dal rupture were treated as inpatients 5 days longer than patients without (10.7 vs 5.5 days; P< 0.001). Twenty-two percent of the injuries occurred during wor k time. Main causes of choroidal ruptures were water jet (19%), fireworks (12% ), elastic cords (12%), metal pieces (12%), gotcha (8%) and champagne corks ( 8%). The risk for developing a choroidal rupture due to water jet or fireworks injuries was increased 9 or 4 times. Ninetytwo percent of choroidal ruptures wer e located at the posterior pole and concentric, 40%were submacular, 12%outside the large temporal vessels (4%were located both centrally and peripherally). I nitial visual acuity (VA) and VA at discharge were decreased significantly in ey es with rupture of the choroid (20/200 and 20/60) in contrast to eye swithout (2 0/40 and 20/25; P< 0.001). Choroidal ruptures were often associated with iridodi alysis, lens dislocation and contusion cataract (3 x), vitreous haemorrhage (4 x ), complete retinal defects (6 x), ciliary body clefts (7 x) or hyphema rebleedi ng (4 x). No association between the height of hyphema and choroidal ruptures wa s found. The predictive level of choroidal ruptures was 40%in eyes with a combi nation of lens dislocation, traumatic cataract and vitreous bleeding. The final VA was 20/200 or less in 11 eyes associated with a prevalence of 55%of ruptures submacularly. In contrast to this, eyes with VA >20/200 developed 26 %submacul ar choroidal ruptures. Conclusions: Additional severe traumatic changes of the a nterior and posterior II segment were found 2-7 times more frequently in eyes w ith choroidal ruptures compared to eyes without those ruptures. The visual impro vement was limited due to submacular ruptures. Frequent ophthalmological control s are recommended to III minimise the risk of choroidal neovascularisation in a submacular location.

与人单疱病毒6急性感染有关的双侧视神经病变和单侧强直性瞳孔1例

Background: Human herpesvirus 6 (HHV-6), a widesp- read virus and causative agent of exanthema subitum in children, has been asso ciated with a number of neurologic disorders including cranial nerve palsies, se izures, encephalitis, meningitis, and multiple sclerosis. Patient: A 31-year-old man presented with bilateral optic neuropathy, disc edema, and unilateral ton ic pupil, which were found to be associated with acute HHV-6 infection. The pat ient had been suffering from juvenile diabetes for 5 years. One week after onset of intravenous antiviral therapy with foscarnet, disc edema subsided, and tonic pupil reaction was no longer detectable. Conclusions: HHV6 infection may play a role as a causative agent in patients with optic neuropathy and tonic pupil.

Ictal semiology,functional anatomy and multimodal diagnostic in patients with insular epilepsies

Background:The insula is a hidden part in the cerebral cortex.Insular epilepsy is underrecognized and it bears a special risk for misdiagnosis with regard to nonepileptic seizures or wrong localization of epileptic seizures.Case presentations:The manuscript describes 2 cases with ictal semiology of paresthesia and pain followed by hyperkinetic movements,noninvasive findings of source localization and/or invasive SEEG exploration.Conclusion:Magnetic source imaging,ictal SPECT as noninvasive and invasive recordings with depth electrodes(SEEG)can provide important preoperative information for the involvement of insular and periinsular regions in focal pharmacoresistant epilepsies.The optimal use of these methods presupposes extensive knowledge of ictal semiology and other clinical characteristics.The clinical localization hypothesis can be optimally proofed by SEEG exploration.

Cases with parietal and occipital lobe epilepsies

Background:For seizures emerging from the posterior cortex it can be a challenge to differentiate if they belong to temporal,parietal or occipital epilepsies.Sensoric auras like visual phenomena may occur in all of these focal epilepsies.Ictal signs may mimic non-epileptic seizures.Case presentations:Case 1:Patient suffering from a pharmacoresistent focal epilepsy.Focal seizures with sudden visual disturbance,later during the seizure epigastric aura,vertigo-nausea,involvement to bilateral tonic-clonic seizures.MEG detected interictal spikes,source localization indicated focal epileptic activity parietal right.Case 2:Patient with focal pharmacoresistent epilepsy,semiology with focal unaware seizures,feeling that something like a coat is imposed from behind on him,then feeling cold over the whole body,goose bumbs from both arms to head,then block of motoric activity,later focal unaware seizures with stare gaze,blinking of eyes,clouding of consciousness,elevation of arms and legs,sometimes tonic-clonic convulsions.EEG/MEG source localization and MRI detected an epileptogenic lesion parietal left.Case 3:Patient with pharmacoresistent focal epilepsy,focal aware seizures,a dark spot occurring in the left visual field,sometimes anxiety during seizures(leading to the suspicion of non-epileptic psychogenic pseudo seizures).MRI demonstrated an atrophy occipito-temporal right after sinus vein thrombosis.Ictal video-EEG showed a focal seizure onset occipital right.Conclusion:Contribution of noninvasive and/or invasive confirmation of the localization of the underlying focal epileptic activity in posterior cortex is illustrated.Characteristics of posterior cortex epilepsies are ventilated.