Objective To observe the efficacy of glucocorticoid and Mecobalamin in the treatment of optic neuritis. Methods Seventy-four patients (118 eyes) with optic neuritis were enrolled in this study. There were 38 patients (55 eyes) with optic nerve papillitis, 36 patients (63 eyes) with retrobulbar neuritis. The patients were divided into treatment and control group, 37 patients (59 eyes) in each group. The treatment group received semiretrobulbar injection of 500 μg Mecobalamin per day, 10 times for one course; after two to three courses changed oral 500 μg Mecobalamin, three times per day. Systemic intravenous injection of 15 dexamethasone mg per day for one week, then prednisolone 30 mg per day orally, the dosage was reduced every five days for 5 mg; oral administration of vitamin B1, 10 mg three times per day, use of energy mixture, vasodilators. Control group underwent the same therapy as the treatment group without Mecobalamin. The efficacy differences between two groups were comparatively analyzed. Results Among 59 eyes in the treatment group, 42 eyes (71.19%) were markedly effective, 15 eyes (25.42%) were valid and two eyes (3.39%) were invalid. The total effective rate was 96.61%. Among 59 eyes in the control group, 30 eyes (50.85%) were markedly effective, 26 eyes (44.07%) were valid and three eyes (5.08%) were invalid. The total effective rate was 94.92%. The difference of total effective rate between two groups was not statistically significant (χ2=1.10, P＞0.05); but there was a difference in markedly effective rate between two groups (χ2=5.65, P＜0.05). Conclusion Mecobalamin combined with glucocorticoids was effective in the treatment of optic neuritis.
Objective To explore the interaction of postmastectomy radiotherapy （PMRT） and breast reconstruction， and elucidate how to choose the type and timing of breast reconstruction. Method Literatures about PMRT and breast reconstruction were reviewed. Results PMRT might increase the incidence of complications and impair the cosmetic satisfaction of breast reconstruction. Breast reconstruction might also compromise the effect of PMRT. Conclusions In patients who will receive or have already received PMRT， the optimal approach is delayed autologous tissue reconstruction after PMRT. If PMRT appears likely but may not be required at the time of mastectomy，delayed-immediate reconstruction may be considered， or immediate autologous tissue reconstruction may be considered in case of patients awareness of the increased complications and impaired cosmetic outcomes from PMRT.
ObjectiveTo compare the efficacy among 30% and 50% dose of verteporfin photodynamic therapy (PDT) and intravitreal anti-vascular endothelial growth factor (anti-VEGF) in the treatment of chronic central serous chorioretinopathy (CSC). Methods138 eyes of 125 patients with chronic CSC, who were treated in our hospital from March 2006 to May 2014, were enrolled in this retrospective study. All patients were confirmed by spectral domain optical coherence tomography (SD-OCT) and best corrected visual acuity (BCVA), which was recorded with logMAR BCVA. And all the patients were divided into three groups by different treatments: 30% dose group (42 eyes of 39 patients); 50% dose group (77 eyes of 67 patients); anti-VEGF group (19 eyes of 19 patients). The differences of age, gender, eyes, courses, mean logMAR BCVA among three groups were not significant. Disappearing of fluid under retina in SD-OCT was considered to be cured and fluid remaining was not cured. If fluid appeared again the eyes were relapsed. We comparatively analyzed the cure rate, relapse rate and changing of BCVA, central macular thickness (CMT) among 3 groups of patients after 1, 3, 6 months. ResultsThe cure rate among 3 groups after 1 month was statistically different (χ2=6.926, P=0.031). The cure rates of 50% dose PDT treatment group after 3 months and 6 months were better than 30% dose PDT treatment group, but the differences were not significant (χ2=2.218, 1.682; P=0.136, 0.195). The relapse rate between 30% dose and 50% dose PDT treatment groups after 3 months and 6 months were not significant (χ2=2.133, 3.366; P=0.144, 0.067). The improvement of BCVA in 50% dose PDT treatment group was the best, but comparing with the other two groups, the differences were not significant in statistics (P > 0.05). The improvement of CMT in 50% dose PDT treatment group was the best. Comparing with anti-VEGF group, the differences was significant (P < 0.05). But comparing with 30% dose PDT treatment group, the differences was not significant (P > 0.05). Logistic regression analysis showed that after treatment, the cure rates after 1 month and 6 months were negatively correlated with the age (regression coefficient=-0.942, -0.979; odds ratio=0.390, 0.375; P < 0.05) and the cure rates after 3 months was positively correlated with the dose of verteporfin (regression coefficient=0.855, odds ratio=2.351, P < 0.05). Conclusion50% dose verteporfin PDT is recommend for chronic CSC treatment.
Objective To evaluate the clinical efficacy of oral calcium dobesilate(CaD) on diabetic optic neuropathy (DON).Methods The clinical data of 235 eyes of 235 patients with DON diagnosed by examination of ocular fundus were retrospectively analyzed.The patients were divided into 3 groups according to the subtypes of DON: anterior ischemic optic neuropathy(AION)group(71 eyes of 71 patients), papilloedema group (71 eyes of 71 patients),and neovascularization of disc (NVD) group (93 eyes of 93 patients).The patients in each groups were randomly subdivided into CaD treating group and control group, in which the patients underwent oral administraion of CaD at a dose of 500 mg twice per day or Vit.E at a dose of 10 mg twice per day,respectively.The course of therapy was 6 months and consecutive 2 courses were performed with the 3-4 days interval between the courses; the courses lasted for 6 months.Several parameters (VFD/V),EA/d,NA/d,LA/d) were semiquantitative analyzed 2,4,6,8 months after initial treatment. Repeated ANOVA measures and t test were used as statistical methods.Results In CaD group,VFD/V (0.25plusmn;0.10),EA/d (0.94plusmn;0.53), and LA/d(1.83plusmn;1.12) 2 months after initial treatment was obviously better than the results before the treatment (0.49plusmn;0.13,1.57plusmn;0.71,3.42plusmn;1.88)(P＜0.001), respectively.VFD/V,EA/d and LA/d in CaD group 2,4,6,and 8 months after initial treatment significantly differed from which in the control group (P＜0.01). There was significant difference of VED/V,EA/d,and LA/d between the CaD and control group during the follow-up period (P＜0.01).At each time point in the followup period, there was no significant difference of NA/d among groups and between the treating and control group (P＞0.05).Conclusion Oral administration of CaD can rapidly and remarkably decrease the extent of visual field defect,relieve optic disc edema and lessen the leakage of NVD.
ObjectiveTo evaluate the efficacy of intra-arterial chemotherapy (IAC) for advanced retinoblastoma (RB) after failure of intravenous chemotherapy (IVC). MethodsFifteen eyes of 13 patients with advanced RB were treated with IAC (1-5 cycles) after failure of IVC (2-8 cycles). The patients included 10 boys and 3 girls, with the mean age of (15.67±8.16) months. Six patients had bilateral RB and 7 patients had unilateral RB. There were 14 eyes (93.33%) in stage D, 1 eye (6.67%) in stage E according to the International Classification of intraocular retinoblastoma. The main reasons for failure of IVC were recurrent primary tumor in 3 eyes (20.00%), subretinal seeds recurrence in 9 eyes (60.00%), viable vitreous seeds in 2 eyes (13.33%) and poor response of primary tumor in 1 eye (6.67%). The mean interval between IVC completion and IAC start was 3 months. The mean follow-up was 19 months (ranged from 3 to 52 months). ResultsAfter IVC and secondary IAC, the retinoblastoma and seeds were regressed in 12 eyes (80.00%). Three eyes required enucleation for severe vitreous seeds, subretinal seeds recurrence and primary tumor recurrence. There was no evidence of metastasis in any case. ConclusionIAC can achieve high global salvage rate (80.00%) for patients with advanced retinoblastoma after failure of IVC.
ObjectiveTo evaluate the clinical and cosmetic outcome of patients with early breast cancer underwent oncoplastic techniques in breast conserving surgery. MethodsClinical data of 59 patients with early stage breast cancer who underwent oncoplastic techniques in the breast conserving surgery were analyzed retrospectively from January 2007 to March 2011. Cosmetic outcome score and patient satisfaction questionnaire were also assessed. ResultsThe age of the patients was (53.5±9.8) years (range, 32 to 77 years). The diameter of tumors was (1.6±0.7) cm (range, 0.5 to 4.0 cm). The foci located at upper quadrant in 38, lower quadrant in 17, central area in 4. During operation, single incision approach was used in 25 patients, two incisions approach in 34 patients. A variety of methods were used to repair breast defects including mammary gland direct suture in 9 patients, mammary gland pedicle flaps in 35, local flaps or adipofascial flap in 9, latissimus dorsi myocutaneous flaps in 2, and reduction mammaplasty with “J” or double ring incision in 4. The mean followup period was 30 months (range, 3 to 53 months), no local recurrence was detected. However, bone metastases was found in one patient on 14 months after operation. Fifty-three patients (89.8%) had good to excellent aesthetic results with cosmetic outcome score ≥26. Patient satisfaction questionnaire showed that 40 patients (67.8%) were excellent, 14 (23.7%) good, 3 (5.1%) fair, and 2 (3.4%) poor. ConclusionOncoplastic techniques in the breast conservative therapy for early stage breast cancer is a safe and effective procedure, with highly satisfactory cosmetic outcomes in the majority of patients.
Since 2015, when the day surgery mode was officially reckoned and supported by the National Health Commission, the day surgery model has entered the new period of rapid development. But at the same time, challenges in the vacancy of the evaluation indexes of the medical quality and safety of day surgery still pose obstacles to its growth. At present, there is no nationally unified evaluating index or appraising system for the day surgery-related medical quality and safety. In this paper, based on structure-process-outcome theory, the day surgery practice and involved researching literature were retrieved, reviewed, and analyzed. Also, the practice model at West China Hospital of Sichuan University (a pioneer day surgery hospital in China) was comprehensively compared with the National Clinical Improvement System. From the aspect of day surgery medical quality and safety evaluation indicators, it is hoped to provide an evidence-based method and evaluation of day surgery, and a theoretical basis for establishing policies and data reference.
Objective To observe the therapeutic effect of photodynamic therapy (PDT) and transpupillary thermotherapy (TTT) on circumscribed choroid hemangioma (CCH).Methods Clinical data of 32 patients (33 eyes) with CCH diagnosed by ocular fundus examination, fundus fluorescein angiography (FFA),indocyanine green angiography (ICGA),optical coherence tomography (OCT) and Bultrasound examination were retrospectively analyzed.Before the therapy the selected cases had best corrected visual acuity (BCVA) of fingercounting/15 cm-0.2,the sizes of 2-10 disc diameter (DD) and serous retinal detachment.Twentyone patients (22 eyes) whose tumor located at the posterior pole except for the papillomacular bundle and arch ring area underwent TTT.The parameters of TTT included: Iris 810 nm infra red diode laser，7001200 mW,60 s,and 1-3 spots. Eleven patients (11 eyes) with tumor located at the posterior pole except for the papillomacular bundle and arch ring area underwent. After 15 minutes of intravenous injection with Visudyne, laser irradiation with the wavelength of 689 nm was performed with the time of 83-123 s. The followup period was 12-48 months with the mean of 25.6 months.BCVA and results of indirect ophthalmoscopy,fundus photogrphy,FFA,ICGA,OCT and B ultrasound examination were exanmined and anlyzed.Results In the 22 eyes in TTT group, the BCVA improved in 15 and kept unchanged in 7;the results of fundus examinations showed healed retina and atrophy tumor with greywhite organized scar;the results of FFA revealed no fluorescence leakage and scar fluorescence dyeing of the lesion in later period；the results of OCT indicated disappeared retinal detachment, completely absorbed subretinal liquid and increased reflection of choroid tumor with scar；the results of Bultrasound examination showed no retinal detachment and atrophy tumor.In 11 eyes in PDT group,the BCVA improved in 9, unchanged in 2;the results of fundus examinations showed atrophy tumor with pigmentation；the results of FFA revealed disappeared fluorescence leakage；the results of OCT indicated completely absorbed subretinal liquid；the results of B-ultrasound examination showed atrophy tumor.Conclusions Both TTT and PDT can make the tumor atrophy,improve BCVA or keep it still;but apply to different area.