BACKGROUND Unilateral exophthalmos is often caused by inflammation, neoplasm, infection,metabolic disease, vascular disorder and several other less common conditions.Reflex sympathetic dystrophy related to unilateral ...BACKGROUND Unilateral exophthalmos is often caused by inflammation, neoplasm, infection,metabolic disease, vascular disorder and several other less common conditions.Reflex sympathetic dystrophy related to unilateral exophthalmos has not been reported in the past literature.CASE SUMMARY We describe a 45-year-old female with unilateral exophthalmos caused by reflex sympathetic dystrophy and its unexpected spontaneous disappearance after a standard anterior cervical discectomy and fixation operation with two PEEK interbody cages and a plate. To our surprise, the patient’s left unilateral exophthalmos improved spontaneously in the morning on postoperative day 2-with no relapse, without any further medication, as of seven years. We have named this condition "cervicogenic exophthalmos."CONCLUSION We would inform other clinicians that unilateral exophthalmos was caused not only by inflammation, vascular disorder, infection, neoplasm, or metabolic disease, but also by reflex sympathetic dystrophy related with cervicogenic spondylosis. To the best of our knowledge, ours is the first related case report and use of the term "cervicogenic exophthalmos" after reviewing previous literature.展开更多
AIM: To investigate computed tomography (CT) features of exophthalmos in Chinese subjects with thyroid-associated ophthalmopathy (TAO). METHODS: A total of 605 eyes of 325 patients with exophthalmos due to TAO were cl...AIM: To investigate computed tomography (CT) features of exophthalmos in Chinese subjects with thyroid-associated ophthalmopathy (TAO). METHODS: A total of 605 eyes of 325 patients with exophthalmos due to TAO were classified as grade Ⅰ (mild exophthalmos) or Ⅱ (severe exophthalmos) based on orbital CT imaging. The increased orbital volume features, such as changes from extraocular muscles, orbital fat, or both, were analyzed. RESULTS: A total of 605 eyes were analyzed, among them 62.98% presented grade Ⅰ exophthalmos, while 36.02% showed grade Ⅱ exophthalmos. In grade Ⅰ, 56.69% showed orbital fat change, and in grade Ⅱ, 89.29% exhibited extraocular muscle enlargement. CONCLUSION: Orbital fat and extraocular muscle enlargement are likely to be observed on CTs of subjects with mild and severe exophthalmos, respectively. Our results suggest that CT findings may guide TAO clinical therapy recommendations and prognosis.展开更多
AIM:To assess changed spontaneous brain activity in hyperthyroid exophthalmos(HE)patients by the amplitude of the low-frequency fluctuation(ALFF)method,and to analyze the correlation between brain activity and ALFF va...AIM:To assess changed spontaneous brain activity in hyperthyroid exophthalmos(HE)patients by the amplitude of the low-frequency fluctuation(ALFF)method,and to analyze the correlation between brain activity and ALFF values in these patients.METHODS:Totally 18 HE and 18 hyperthyroid nonexophthalmos(HNE)patients were enrolled.The participants were tested by resting-state functional magnetic resonance imaging,and receiver operating characteristic(ROC)curves were generated to classify the ALFF values of the study population.Pearson’s correlation analysis was utilized to evaluate the relationship between the ALFF values obtained from different brain areas and clinical manifestations.RESULTS:Contrary to HNE patients,we observed lower ALFF values in the left calcarine fissure and surrounding cortex(LCFSC)in HE patients.In the ROC curve analysis of the LCFSC,the area under the curve reflected a high degree of accuracy.In addition,there was positive correlation between mean ALFF values of the LCFSC and the bestcorrected visual acuity of the affected eyes.CONCLUSION:The study displays abnormal brain activity in LCFSC in patients with HE,which might suggest pathological mechanism of visual impairment of HE patients.展开更多
目的探讨商业化软件计算球后脂肪体积,分析其与甲状腺相关性眼病(TAO)进展及预后的关系。方法收集2016年1月~2016年12月在我院内分泌科确诊的35例(70个眼眶)TAO患者的临床资料。测量1.5T眼眶MRI球后脂肪体积及眼外肌信号强度比值(SIR)...目的探讨商业化软件计算球后脂肪体积,分析其与甲状腺相关性眼病(TAO)进展及预后的关系。方法收集2016年1月~2016年12月在我院内分泌科确诊的35例(70个眼眶)TAO患者的临床资料。测量1.5T眼眶MRI球后脂肪体积及眼外肌信号强度比值(SIR)分析其与临床各项指标的相关性,并收集12例(24个眼眶)健康人测量球后脂肪体积,初步比较TAO组及健康组体积的差异。结果脂肪体积与病程成正相关(r=0.480,P<0.01),病程6个月以内组与6~12个月组相比,脂肪体积差异不显著(P=0.084)。病程6个月以内组及病程6~12个月组球后脂肪体积均显著低于病程大于12个月组(P<0.01,P<0.05)。脂肪体积与突眼度存在相关性(r=0.622,P<0.01),突眼度每增加1 mm,球后脂肪体积将增加0.88 m L。临床活动性评分(CAS)与SIR值及促甲状腺素受体抗体(TRAb)存在相关性(r=0.536,r=0.416,P<0.01)。TAO组球后脂肪体积显著高于正常组(P<0.01)。结论 TAO病程1年以上可能是球后脂肪组织增多的高峰阶段,球后脂肪体积结合SIR值的测量有助于最佳激素治疗时机的探索及预后分析。展开更多
Introduction: One of the most common causes of hyperthyroidism is Graves’ disease. The malignant exophthalmos is a rare condition characterized by the loss of visual function that doesn’t adequately respond to vario...Introduction: One of the most common causes of hyperthyroidism is Graves’ disease. The malignant exophthalmos is a rare condition characterized by the loss of visual function that doesn’t adequately respond to various forms of treatment, requiring, in most cases, surgical correction. Objective: We report a case of conjunctival edema and protrusion of the eyeball in patients secondary to Graves’ disease, characterizing malignant ophthalmopathy and discuss their surgical treatment. Case Report: A 73-year-old male patient presenting bilateral conjunctive hyperaemia, decreased visual acuity, exophtalmos with progressive deterioration. Pulse therapy was performed without improvement and then underwent bilateral ethmoidectomy. Discussion: Late diagnosis is harmful due to the fact that malignant disease is extremely aggressive and fast, as reported in this case. Most often, the ophthalmopathy follows a relatively mild and self-limiting course, making a proper diagnosis difficult if the disease progresses. In extreme cases acute orbital decompression is indicated complementing appropriate medical treatment, which will allow herniation of orbital contents. Many orbital decompression techniques have been used in the treatment of Graves’ ophthalmopathy. The most common of these is the endoscopic sinus surgery which potentiated act in decompression of the medial wall safely and minimally invasive. In our case, open bilateral ethmoidectomy was used, due to the fact that surgeons are most experienced in this technique. Although the post-operative has been successfully submitted, no signs of recurrence were observed after fifteen days due to the evolution of Graves’ disease. Even with outpatient treatment, he walked to the total visual loss. Conclusion: We observed that the malignant ophthalmopathy is rare and aggressive;however, in spite of therapeutic resources used, it can progress to total visual loss.展开更多
Obejctive To investigate the cellular immune mechanism of thyroid associated ophthalmopathy (TAO) and provide a basis for treating TAO with cytokine or anti cytokine agents, we determined whether interferon (IFN) ...Obejctive To investigate the cellular immune mechanism of thyroid associated ophthalmopathy (TAO) and provide a basis for treating TAO with cytokine or anti cytokine agents, we determined whether interferon (IFN) γ and interleukin (IL) 4, representative cytokines of Th1 and Th2 cells, may have some effect on the development and progression of TAO Method Retroorbital fibroblasts (RF) proliferation and the synthesis of hyaluronic acid (HA) and type Ⅳ collagen were measured with liquid scintillation and radioimmunoassay Results IFN γ stimulated RF proliferation and HA synthesis and had a significant inhibitory effect on type Ⅳ collagen synthesis IL 4 stimulated proliferation and type Ⅳ collagen synthesis in RF and had inhibitory effect on HA synthesis When IFN γ (100?U/ml) and IL 4 (1?μg/L) were incubated together with RF, they antagonized their respective stimulatory or inhibitory effect on the proliferation and synthesis of HA and type Ⅳ collagen Thyrotropin (TSH) stimulated RF proliferation and type Ⅳ collagen synthesis in a dose dependent manner, while only at high dose (100?U/L and 200?U/L), stimulated RF to synthesize HA Conclusions IFN γ, a representative cytokine of Th1 cells, is responsible for the inflammatory process of TAO; whereas IL 4, a representative cytokine of Th2 cells, has some effect on the repair process IL 4 could antagonize the inflammatory effect of IFN γ on RF TSH may have aggravating effect on the pathogenesis of TAO展开更多
文摘BACKGROUND Unilateral exophthalmos is often caused by inflammation, neoplasm, infection,metabolic disease, vascular disorder and several other less common conditions.Reflex sympathetic dystrophy related to unilateral exophthalmos has not been reported in the past literature.CASE SUMMARY We describe a 45-year-old female with unilateral exophthalmos caused by reflex sympathetic dystrophy and its unexpected spontaneous disappearance after a standard anterior cervical discectomy and fixation operation with two PEEK interbody cages and a plate. To our surprise, the patient’s left unilateral exophthalmos improved spontaneously in the morning on postoperative day 2-with no relapse, without any further medication, as of seven years. We have named this condition "cervicogenic exophthalmos."CONCLUSION We would inform other clinicians that unilateral exophthalmos was caused not only by inflammation, vascular disorder, infection, neoplasm, or metabolic disease, but also by reflex sympathetic dystrophy related with cervicogenic spondylosis. To the best of our knowledge, ours is the first related case report and use of the term "cervicogenic exophthalmos" after reviewing previous literature.
基金Sichuan Science and Technology Department the Tackling Key Project Fund, China (No.05SG022-014-1)
文摘AIM: To investigate computed tomography (CT) features of exophthalmos in Chinese subjects with thyroid-associated ophthalmopathy (TAO). METHODS: A total of 605 eyes of 325 patients with exophthalmos due to TAO were classified as grade Ⅰ (mild exophthalmos) or Ⅱ (severe exophthalmos) based on orbital CT imaging. The increased orbital volume features, such as changes from extraocular muscles, orbital fat, or both, were analyzed. RESULTS: A total of 605 eyes were analyzed, among them 62.98% presented grade Ⅰ exophthalmos, while 36.02% showed grade Ⅱ exophthalmos. In grade Ⅰ, 56.69% showed orbital fat change, and in grade Ⅱ, 89.29% exhibited extraocular muscle enlargement. CONCLUSION: Orbital fat and extraocular muscle enlargement are likely to be observed on CTs of subjects with mild and severe exophthalmos, respectively. Our results suggest that CT findings may guide TAO clinical therapy recommendations and prognosis.
基金the National Natural ScienceFoundation (No.82160195)Central Government GuidesLocal Science and Technology Development Foundation(No.20211ZDG02003)+2 种基金Key Research Foundation of JiangxiProvince (No.20181BBG70004No.20203BBG73059)Excellent Talents Development Project of Jiangxi Province(No.20192BCBL23020).
文摘AIM:To assess changed spontaneous brain activity in hyperthyroid exophthalmos(HE)patients by the amplitude of the low-frequency fluctuation(ALFF)method,and to analyze the correlation between brain activity and ALFF values in these patients.METHODS:Totally 18 HE and 18 hyperthyroid nonexophthalmos(HNE)patients were enrolled.The participants were tested by resting-state functional magnetic resonance imaging,and receiver operating characteristic(ROC)curves were generated to classify the ALFF values of the study population.Pearson’s correlation analysis was utilized to evaluate the relationship between the ALFF values obtained from different brain areas and clinical manifestations.RESULTS:Contrary to HNE patients,we observed lower ALFF values in the left calcarine fissure and surrounding cortex(LCFSC)in HE patients.In the ROC curve analysis of the LCFSC,the area under the curve reflected a high degree of accuracy.In addition,there was positive correlation between mean ALFF values of the LCFSC and the bestcorrected visual acuity of the affected eyes.CONCLUSION:The study displays abnormal brain activity in LCFSC in patients with HE,which might suggest pathological mechanism of visual impairment of HE patients.
文摘目的探讨商业化软件计算球后脂肪体积,分析其与甲状腺相关性眼病(TAO)进展及预后的关系。方法收集2016年1月~2016年12月在我院内分泌科确诊的35例(70个眼眶)TAO患者的临床资料。测量1.5T眼眶MRI球后脂肪体积及眼外肌信号强度比值(SIR)分析其与临床各项指标的相关性,并收集12例(24个眼眶)健康人测量球后脂肪体积,初步比较TAO组及健康组体积的差异。结果脂肪体积与病程成正相关(r=0.480,P<0.01),病程6个月以内组与6~12个月组相比,脂肪体积差异不显著(P=0.084)。病程6个月以内组及病程6~12个月组球后脂肪体积均显著低于病程大于12个月组(P<0.01,P<0.05)。脂肪体积与突眼度存在相关性(r=0.622,P<0.01),突眼度每增加1 mm,球后脂肪体积将增加0.88 m L。临床活动性评分(CAS)与SIR值及促甲状腺素受体抗体(TRAb)存在相关性(r=0.536,r=0.416,P<0.01)。TAO组球后脂肪体积显著高于正常组(P<0.01)。结论 TAO病程1年以上可能是球后脂肪组织增多的高峰阶段,球后脂肪体积结合SIR值的测量有助于最佳激素治疗时机的探索及预后分析。
文摘Introduction: One of the most common causes of hyperthyroidism is Graves’ disease. The malignant exophthalmos is a rare condition characterized by the loss of visual function that doesn’t adequately respond to various forms of treatment, requiring, in most cases, surgical correction. Objective: We report a case of conjunctival edema and protrusion of the eyeball in patients secondary to Graves’ disease, characterizing malignant ophthalmopathy and discuss their surgical treatment. Case Report: A 73-year-old male patient presenting bilateral conjunctive hyperaemia, decreased visual acuity, exophtalmos with progressive deterioration. Pulse therapy was performed without improvement and then underwent bilateral ethmoidectomy. Discussion: Late diagnosis is harmful due to the fact that malignant disease is extremely aggressive and fast, as reported in this case. Most often, the ophthalmopathy follows a relatively mild and self-limiting course, making a proper diagnosis difficult if the disease progresses. In extreme cases acute orbital decompression is indicated complementing appropriate medical treatment, which will allow herniation of orbital contents. Many orbital decompression techniques have been used in the treatment of Graves’ ophthalmopathy. The most common of these is the endoscopic sinus surgery which potentiated act in decompression of the medial wall safely and minimally invasive. In our case, open bilateral ethmoidectomy was used, due to the fact that surgeons are most experienced in this technique. Although the post-operative has been successfully submitted, no signs of recurrence were observed after fifteen days due to the evolution of Graves’ disease. Even with outpatient treatment, he walked to the total visual loss. Conclusion: We observed that the malignant ophthalmopathy is rare and aggressive;however, in spite of therapeutic resources used, it can progress to total visual loss.
基金ThisstudywassupportedbytheNationalNaturalScienceFoundationofChina (No 39470 341)
文摘Obejctive To investigate the cellular immune mechanism of thyroid associated ophthalmopathy (TAO) and provide a basis for treating TAO with cytokine or anti cytokine agents, we determined whether interferon (IFN) γ and interleukin (IL) 4, representative cytokines of Th1 and Th2 cells, may have some effect on the development and progression of TAO Method Retroorbital fibroblasts (RF) proliferation and the synthesis of hyaluronic acid (HA) and type Ⅳ collagen were measured with liquid scintillation and radioimmunoassay Results IFN γ stimulated RF proliferation and HA synthesis and had a significant inhibitory effect on type Ⅳ collagen synthesis IL 4 stimulated proliferation and type Ⅳ collagen synthesis in RF and had inhibitory effect on HA synthesis When IFN γ (100?U/ml) and IL 4 (1?μg/L) were incubated together with RF, they antagonized their respective stimulatory or inhibitory effect on the proliferation and synthesis of HA and type Ⅳ collagen Thyrotropin (TSH) stimulated RF proliferation and type Ⅳ collagen synthesis in a dose dependent manner, while only at high dose (100?U/L and 200?U/L), stimulated RF to synthesize HA Conclusions IFN γ, a representative cytokine of Th1 cells, is responsible for the inflammatory process of TAO; whereas IL 4, a representative cytokine of Th2 cells, has some effect on the repair process IL 4 could antagonize the inflammatory effect of IFN γ on RF TSH may have aggravating effect on the pathogenesis of TAO
