[Vitreous surgery for retinal detachment with severe proliferative vitreoretinopathy and probe of failed cause]

Eighty-one cases (81 eyes) of retinal detachment with severe proliferative vitreoretinopathy were treated using vitrectomy, scleral buckling and air or silicone oil tamponade technique. After a follow-up period of 6-28 months, 54 cases obtained anatomic retinal attachment (66.7%). For the serious cases of PVR D3, we also gained a success rate of 50%. Vision improved in 50 cases, whereas 34 cases got a vision better than 0.05. For the failed cases, cause that prevent the retina from attachment was probed. We think that vitrectomy is an essential and important procedure for retinal detachment with severe PVR, membrane peeling is the key of success and prevention of reproliferation can avoid recurrent retinal detachment and further raise the success rate of treatment. A new classification is recommended in this article.

[Micro-vitreoretinal surgery for failed common retinal detachment repair]

In this paper we analyzed 49 cases (49 eyes) of micro-vitreoretinal surgery for failed common retinal detachment repair. Reattachment was achieved in 37 cases (75.51%) and final visual acuity of 10/200 or better was attained in 32 cases (65.31%). It was suggested that common operation failure in these patients was due to PVR. Cryopexy, diathermy and repeat operation can render the formation of the PVR. Micro-vitreoretinal surgery should be performed on these patients. There was a linear relationship between the effectiveness and the degree of PVR. It is best to perform the surgery 3 months after common operation. Finally, the authors discuss the reasons for failure of vitreoretinal surgery and conclude that the anterior PVR and the invalid fixing are the main reasons for failure of vitreoretinal surgery.

Quantitative assessment of regional wall motion abnormalities with 2DE in cases of myocardial infarction

The severity, extent and localization of regional wall motion abnormalities (RWMA) were quantitatively assessed with apical biplane two-dimensional echocardiography (2DE) using a fixed-axis system, ten-segment division area method in 56 patients with old myocardial infarction (OMI). RWMA were found to be more severe in the anterior wall MI (AWMI) group than in the inferoposterior wall MI (IWMI) group and most severe in the extensive AWMI with ventricular aneurysm (EAWMI with VA) group; the extent of RWMA was smallest in the IWMI group, significantly larger in the AWMI group, and largest in the EAWMI with VA group. The location of the RWMA segments showed group-specific tendencies. For example, both coronal and sagittal apices were much more frequently involved in both the EAWMI with VA and the AWMI groups than in the IWMI group (100%, 87% and 0%, respectively, all P < 0.001). The results demonstrated that quantitative analysis of RWMA using 2DE in cases of MI is accurate and feasible.

Misclassification of exposure in a case-control study: the effects of different types of exposure and different proxy respondents in a study of pancreatic cancer

This investigation addressed three questions about misclassification in a case-control study of risk factors for pancreatic cancer in which all exposure data were obtained from proxy respondents. These questions were: (1) To what degree was misclassification dependent on the type of exposure? (2) To what degree did misclassification vary by the type of proxy? (3) What was the magnitude of the effect of proxy misclassification on odds ratios measured across several levels of exposure? To answer these questions, we interviewed 163 control (index) subjects and next-of-kin (proxy) respondent pairs. Each of the controls and their respective proxies reported the control's use of coffee, cigarettes, and alcohol and weekly exposure to beef, milk, bacon, fruits, and vegetables. Nonspouse proxies misclassified exposures more than spouse proxies with the exception of cigarettes. Cigarette use was the most accurately reported exposure, followed by alcohol, coffee, and foods. For nondifferential misclassification between cases and controls, the slope of a dose-response curve was decreased from 6.6% to 100% depending on the exposure and the type of proxy respondent. Investigators conducting studies using proxy respondents need to recognize that misclassification is a function of multiple factors, including both the type of exposures under study and the type of proxies available.

[Reperfusion arrhythmias in acute myocardial infarction]

Twenty-seven patients with acute myocardial infarction (AMI), in whom infarct-related coronary artery was occluded and thrombolytic therapy or PTCA were performed, were studied. Reperfusion confirmed by immediate coronary angiography was achieved in 24 patients. Reperfusion arrhythmias (RA) occurred in 19(79.2%) of the patients, including ventricular arrhythmias in 13 (54.2%). Ventricular fibrillation (VF) and sustained ventricular tachycardia (VT) developed in 2(8.4%), and accelerated idioventricular rhythm in 5(20.8%); the latter showed a reliable indicator of coronary artery recanalization. Transient sinus bradycardia or AV block occurred in 10 (66.7%) of the 15 patients with inferior-posterior MI, which was an indicator of recanalization of coronary artery and salvage of myocardium in inferior-posterior MI. The occurrence of RA was not correlated with the duration of ischemia; ventricular RA was not related to the location of AMI and the occurrence and severity of ischemic arrhythmias before reperfusion. The patients with RA were treated with ordinary antiarrhythmic therapy, VF and sustained VT in 2 patients were converted by electric defibrillation. No death related to RA occurred. RA couldn't be prevented by lidocaine.

The electrophysiology in idiopathic senile macular hole

Of 12 patients with idiopathic senile full-thickness macular hole, 3 had bilateral involvement, 9 had monocular macular hole. Flash ERG and pattern VEP were performed in the bilateral eyes of all patients. The abnormal rate of the pattern VEP was 93.3% when we used 15' checkboard stimulus, the changes of the VEP appeared as delayed latencies, reduced amplitudes or malformation of P100. The abnormal rate of the flash ERG was 53.3%, showing primary characteristics of reduced amplitudes of cone response b-wave. There was statistically significant difference between the abnormal rates of the VEP and the ERG (P < 0.05). The halo diameters of the macular hole were significantly related to the latencies of P100 (P < 0.01), but there was no correlation between the hole diameter and the latencies of P100. In 9 fellow eyes which did not form macular hole, 3 eyes had the abnormal pattern VEP, including one eye having formed macular cyst. The results show that, in idiopathic senile macular hole, the pattern VEP provides more functional information than does the ERG, and prompts the importance of close follow-up of fellow eye.

[Comparison of Chinese traditional therapy combined with Western medicine and Western medicine alone in the treatment of uveitis]

Seventy nine eyes of 46 patients with uveitis were treated with two therapeutic methods. One was mainly Chinese traditional dialectic therapy combined with western medicine. The other was western medica treatment using mainly corticosteroid. The group treated with combined methods (37 eyes of 22 cases) showed an effective rate of 91.8%. The group treated only with western medicine (42 eyes of 24 cases) showed a 66.6% < effective rate. In a follow-up period of six months to one year. The disease relapsed in 13 eyes out of the 33 eyes in the combined method group with recurrent rate of 39.4%. The recurrent rate of the western medical treatment was 86.4% (19 eyes out of the 22 eyes). It shows the Chinese traditional dialectic therapy combined with eastern medicine is better than the solely western medical treatment.

[Bullous retinal detachment and its classification of fluorescence angiography]

Nineteen cases with (27 eyes) of bullous retinal detachment, male (24 eyes), female (3 eyes), were reported. The age of onset was from 16 to 46, mean 36.7. All of them underwent fundus fluorescence angiography (FFA). According to the results of FFA, it could be divided into two types of fluorescence angiograph changes were seen: type I, multiple pigmental epithelial damage at posterior pole, it consisted of twelve cases (16 eyes); type II, extensive pigmental epithelial damage at posterior pole, it consisted of seven cases (11 eyes). The treatments consist: medicine; medicine and photocoagulation; combined medicine, transscleral drainage and photocoagulation. Among 27 eyes, 20 had their vision improved after treatment, 4 eyes unchanged and 3 eyes decreased in vision. 22 eyes obtained their retinal reattachment (81.4%). The diagnosis, differential diagnosis, classification and treatment are discussed.

Intravenous recombinant tissue-type plasminogen activator in acute myocardial infarction

The efficacy and safety of intravenously administered recombinant tissue-type plasminogen activator (rt-PA, Boehringer Ingelheim Corp.) was investigated in 10 patients with acute myocardial infarction (AMI). rt-PA was given as a 10 mg bolus dose followed by infusions of 50 mg, 20 mg and 20 mg in three successive hours. All patients underwent baseline coronary angiography before thrombolytic therapy. Ninety minutes after the initiation of rt-PA infusion, recanalization of infarct-related coronary arteries as confirmed by angiography was achieved in 7 patients. The largest reduction in circulating fibrinogen was observed 4 to 6 h after the start of rt-PA infusion--14.3%. Moderate hemorrhage at the sites of arterial puncture occurred in 2 cases, probably as a result of heparin anticoagulation. No other side effects occurred. So rt-PA is an effective and safe thrombolytic agent.

Secondary prevention of myocardial reinfarction with low dose aspirin

A clinical trial of secondary prevention of reinfarction with low dose aspirin is reported. 50 mg aspirin per day was administered in 216 case. 211 cases did not take aspirin or any other antiplatelet agents as a control group. The follow-up periods in the two groups were 19.4 +/- 12.6 mon and 20.7 +/- 13.0 mon, respectively. There were 175 males in the aspirin group and 137 males in the control group. The incidence of reinfarction was reduced by 65% and platelet aggregation was inhibited obviously in the aspirin group as compared to the control group in men, whereas no significant trends were observed in women.

[Intravenous recombinant tissue-type plasminogen activator in acute myocardial infarction]

The efficacy and safety of intravenous administration of recombinant tissue-type plasminogen activator (rt-PA, made by Boehringer Ingelheim Corp.) was investigated in 10 patients with acute myocardial infarction (AMI). The rt-PA was given as a bolus dose of 10 mg followed by an infusion of 50 mg, 20 mg and 20 mg in successive hours. Heparin and aspirin were given to all the patients. The time interval from the onset of chest pain to thrombolysis was from 2.3 to 6.1 h with mean of 3.9 h. Coronary angiography, performed before administration of rt-PA and every 30 minutes thereafter, demonstrated total coronary occlusion (grade O) in 9 patients and grade 1 in 1 at baseline study. The infarct-related coronary artery were LAD in 5, RCA in 3 and LCX in 2. At 90 minutes after infusion of rt-PA reperfusion of the infarct-related artery was observed in 7 patients, the success rate was 70%. In one case the infarct-related LCX was not opened at 90 minutes, but it was reperfused at 170 minutes, after intracoronary administration of 10 mg of rt-PA. The total dose in this case was 130 mg. During 30 days of hospitalization death occurred in only one case with cardiogenic shock, in whom the infarct-related RCA was not reperfused by rt-PA but was successfully recanalized by PTCA. The patient died from rupture of the left ventricle on the 4th day. No patient had clinical evidence of reinfarction. Follow-up angiography in 2 patients showed that the arteries reperfused initially were patent.(ABSTRACT TRUNCATED AT 250 WORDS)

[Evaluation of clinical criteria of coronary artery recanalization in acute myocardial infarction]

Clinical features of recanalization of infarct-related coronary artery during thrombolytic therapy or emergency PTCA and their correlation with immediate coronary angiography were analysed in 23 patients with acute myocardial infarction (AMI) to evaluate the predictive value of clinical criteria of reperfusion. The coronary angiography was performed before treatment and every 15 to 30 minutes during intravenous (rt-PA) or intracoronary (UK or SK) thrombolysis. Reperfusion was achieved in 16 cases by thrombolysis and in 4 cases by PTCA. The results revealed that in patients with reperfusion chest pain was relieved rapidly at least 70% in a period of 30 minutes, the ST segments fell by 50% or more from their elevated levels during a period of 30 minutes. Transient "paradoxical" increase of ST segment elevation followed by rapid falling was observed in 4 patients. This phenomenon was considered as a reliable marker of reperfusion. The changes in cardiac rhythm and conduction were noticed in 90% of the patients with reperfusion, among them accelerated idioventricular rhythm and disappearance of new-onset AVB and intraventricular conduction defects were useful bedside evidences of reperfusion, and transient significant sinus bradycardia or AVB with or without transient hypotension were useful markers of reperfusion in inferior myocardial infarction. When these clinical criteria were separately used as predictor of infarct-related coronary artery recanalization, the specificity was about 70% to 80%. Using the presence of all 3 criteria, the specificity and predictive value increased to 100% and the sensitivity was 70.6%. The time interval between onset of symptoms and peak CK and CK-MB were significantly shorter in patients with reperfusion than in those without persistent reperfusion.(ABSTRACT TRUNCATED AT 250 WORDS)

[Vitrectomy for nondiabetic vitreous hemorrhage]

Fifty cases (fifty-three eyes) of nondiabetic vitreous hemorrhage underwent vitrectomy. The visual acuity improved in 39 eyes (73.6%) postoperatively. Twenty seven eyes obtained a visual acuity of 0.05 or better. The postoperative vision was related to the etiology and macular function. Vitreous hemorrhage due to blunt trauma responded best. All of them had vision improved. Eales's disease also had a good result. 77% was improved in vision postoperatively. The main complications of surgery were recurrent vitreous hemorrhage and secondary glaucoma, especially hemolytic glaucoma (4/6). The timing for vitrectomy, degree of cutting and hemolytic glaucoma were briefly discussed.

Comparative epidemiology of cancers of the colon, rectum, prostate and breast in Shanghai, China versus the United States

Incidence rates of cancers of the colon, rectum, female breast, and prostate were compared among native Chinese (Shanghai), Chinese-American, and American populations. Americans had fourfold higher age-adjusted rates of colon cancer, and twofold higher rates of rectal cancer than Chinese, which is consistent with elevated per capita intake of fat and lower intake of cereals and vegetables in the US. Incidence rates of colon and rectal cancers in Chinese-Americans were nearly equal to the American rates, suggesting that the risk for tumour development in the lower intestinal tract is rapidly increased with transition to the US diet. Rates of prostate cancer and postmenopausal breast cancer were 26-fold and tenfold higher in Americans than in Chinese, whereas the rates for Chinese-Americans were intermediate. Environmental factors such as dietary fat apparently had a more gradual effect in promoting cancers of the breast and prostate relative to their influence on neoplasms of the lower intestinal tract.

[New approach for management of retinal detachment with macular hole]

Three kinds of unconventional methods were used to treat retinal detachment with macular hole in 17 cases (17 eyes). A combination of vitrectomy, transscleral drainage and intraocular air injection was used for the cases of retinal detachment with macular hole and evident vitreous traction. Transscleral drainage combined with air injection was used for those of macular hole without vitreous traction. For the cases of combined peripheral and macular holes, we treated only peripheral holes, ignoring the macular hole. After a 3-16 months follow-up, 15 out of the 17 eyes obtained retinal anatomic reattachment (88.2%), 10 eyes had their vision improved, 4 eyes remained unchanged, 9 eyes obtained a visual acuity of better than 0.05 postoperatively. Compared with the conventional method of macular buckling, these procedures have the advantages of less damage to macula, less complications and more satisfactory visual improvement.

[Iatrogenic central artery embolism]

This paper presented 3 cases of central retinal artery embolism (CRAE) caused by the drug injection at the head and neck. In two of the three cases, the emboli were formed by the suspended drug which entered CRA resulting in the occlusion. Another case was caused by the large amount of meglucamini diatrizoas which was injected too quickly during angiography. The CRA was filled up with fluorescein in a very short time, which lead to ischemia and hypoxia of the retina. This paper stressed the importance of early diagnosis and prompt treatment. The authors also Discussed the method of drug injection at the head and neck.

[Obliterative peripheral retinal vascular disease in children]

Obliterative peripheral retinal vascular disease in children is a rare disease. Only 4 cases had been reported abroad. No case of this disease was reported in China before. This paper reported a 13-year-old girl suffering from this disease in both eyes. Neovascular glaucoma of her left eye has developed and that of her right eye was still in early stage. Fluorescein angiography changes, diagnosis and differential diagnosis, pathogenesis and treatment of the disease were discussed.

[A study on treatment of retinal detachment with unseen retinal breaks]

64 cases (66 eyes) of retinal detachment in which no breaks can be found were treated with pars plana vitrectomy, scleral buckling or encircling procedures. The selection of operation depended on the shape and size of retinal detachment, the position of peripheral retinal lattice degeneration, phakia or aphakia, traumatic situation and the appearance of proliferative vitreoretinopathy. The results showed that the detached retina was successfully reattached in 53 eyes (80.3%), 4 eyes were improved (6%), only 9 eyes failed (16.7%). The technic of operation and application are discussed. We consider that suitable active surgical treatment for this kind of cases is encouraging.

Micro-vitreous surgery combined with scleral encircling for the management of complex retinal detachment

50 cases (50 eyes) of various complex retinal detachments (RD) were treated with a combination of vitrectomy, membrane peeling, intraocular air tamponade and scleral encircling. RD with opaque media, RD with proliferative vitroretinopathy, traction RD due to trauma or other factors, RD with posterior breaks, and giant tears were included. During the follow-up periods of 3-12 months, 27 cases (54%) obtained anatomic reattachment, 23 failed (46%). Of the successful case, 24 eyes achieved improvement, 2 eyes remained unchanged, and one eye became worse in their vision. The surgery complications were: retinal haemorrhage, choroidal haemorrhage, iatrogenic tears, and the development of cataract.