ObjectiveTo investigate the characteristics of fundus image in patients with combined hamartoma of the retina and retinal pigment epithelium (CHRRPE). Methods Eight eyes of 8 cases with CHRRPE were included in this study.There were 5 males and 3 females, ranging from 6 to 21 years old (mean 14.13 years).In all cases, unilateral eye was affected. The best-corrected visual acuity (BCVA) was 0.02 to 0.2. The intraocular pressure in all eyes was normal. The ocular anterior segment in all cases was alright. For all cases, fundus photography, fundus autofluorescence (AF), fundus fluorescein angiography (FFA) and spectral-domain optical coherence tomography (SD-OCT) were taken. The characteristics of fundus image were analyzed. ResultsAll the CHRRPE lesions located at posterior pole, presenting as yellow-white elevations, surrounded by hyperpigmentation. Retinal vascular tortuosity and proliferation of epiretinal membrane were found in all CHRRPE lesions. In 8 affected eyes, lesions were involved in macula and optic disc in 3 eyes (37.5%), lesions were located in macula in 5 eyes (62.5%). AF images showed lesion bulges and the surrounding hyperpigmentation corresponding to the local hypo-AF in 7 eyes (87.5%), dense epiretinal membrane corresponding to the local hyper-AF in 1 eye (12.5%). FFA showed local hypofluorescence of choroidal background corresponding to lesions and the surrounding hyperpigmentation, tortuous retinal vascular due to traction of shrinkage membranes. Retinal capillary leakage and the fluorescence brightness gradually increased in all lesions.No retinal hemorrhage, exudation, area of capillary non-perfusion, retinal and choroidal neovascularization could be found in 8 CHRRPE eyes. SD-OCT showed disorganized and elevated lesion with uneven reflectivity in inner retina, mild attenuation of the retinal pigment epithelium (RPE) and photoreceptor inner segment/outer segment junction in all CHRRPE eyes. Of the 8 CHRRPE eyes, cavernous hypo-reflective shadowing due to the shielded optical signal acquisition below dense epiretinal membranes in 2 eyes (25.0%), membrane-like hyper-reflective signals connecting with RPE in 1 eyes (12.5%). ConclusionsDecreased AF appear in the location of CHRRPE lesion and the surrounding hyperpigmentation. Hypofluorescence of choroidal background can be found in the early phase of FFA, the fluorescence brightness of CHRRPE lesion gradually increases in FFA process. The retinal elevation, attenuated signal reflection of the RPE and photoreceptor inner segment/outer segment junction in CHRRPE lesion can be verified by OCT.
ObjectiveTo observe the imaging features of short-wave length fundus autofluorescence (SW-AF), near-infrared fundus autofluorescence (NIR-AF)and spectral-domain optical coherence tomograph (SD-OCT) in acute central serous chorioretinopathy (CSC). MethodsThis is a retrospective observational consecutive case series study. Eighty-two eyes with acute CSC from 76 patients were enrolled in this study.There were 50 males (56 eyes) and 26 females (26 eyes), average age was (41.32±7.37) years old, average course of the disease was (0.47±1.73) months. The routine clinical examinations included best corrected visual acuity, slit lamp microscope, indirect ophthalmoscope, fundus fluorescein angiography (FFA), SW-AF, NIR-AF and SD-OCT. The imaging features of NIR-AF, SW-AF, SD-OCT and FFA in same eye with acute CSC were analyzed comparatively. ResultsSD-OCT showed retinal pigment epithelium (RPE) detachment corresponding to RPE leakage point on FFA images in all CSC eyes. RPE leakage points in all eyes corresponding to local hypo-NIR-AF, whereas corresponding to normal SW-AF. NIR-AF demonstrated the area of decreased AF corresponding to serous retinal detachment in all eyes, of which, the area of hypo-SW-AF was consistent with that of sensory retinal detachment in 75 eyes. Except for RPE leaking fluorescein in 82 eyes, FFA showed window defects corresponding to clusters of hypo-NIR-AF in 45 eyes, of which, 27 eyes showed hypo-SW-AF appearing concurrently with the locations of window defects of FFA. In 18 eyes, the extent and amount of hypo-SW-AF were less than that of hypo-NIR-AF. ConclusionsThere was local RPE detachment in all eyes with acute CSC. The locations of sensory retinal detachment, local RPE detachment and RPE depigmentation showed hypo-NIR-AF. The locations of sensory retinal detachment and RPE depigmentation showed hypo-SW-AF in most of acute CSC eyes.
ObjectiveTo improve the knowledge of pulmonary actinomycosis. MethodsOne case of pulmonary actinomycosis with positive blood culture diagnosed on December 2013 in North Huashan Hospital was analyzed,and related literature from CNKI and Medline after 1990 were reviewed. ResultsA 57-year-old male had recurrent fever for 24 days.Chest CT showed pneumonia in the right middle lobe.Actinomyce culture was twice positive by anaerobic blood culture.The patient's temperature was normal after large doses of penicillin and doxycycline therapy.Literature review revealed that the incidence of pulmonary actinomycesis is common in males.Poor oral hygiene is the main predisposing factors.The common clinical presentations include cough,sputum production,chest pain and hemoptysis.The peripherally progressive enhancement on CT has a certain diagnostic value for pulmonary actinomycosis.Pulmonary actinomycosis can increase FDG uptake on 18F-FDG PET scan and can mimic lung cancer.Accurate diagnosis is generally made by histopathological examination of lung biopsy or surgical samples.High-dose intravenous penicillin therapy is preferred for pulmonary actinomycosis followed by prolonged oral antibiotics for 6 to 12 months.Surgical intervention may be necessary for refractory hemoptysis or patients who do not respond to antibiotic therapy. ConclusionPulmonary actinomycosis is a rare disease.Symptoms of pulmonary actinomycosis are atypical.This patient is the first reported case of actinomyces with positive blood cultures.
ObjectiveTo observe the relationship of serum tumor necrosis factor α (TNF-α), interleukin 6 (IL-6), and C-reactive protein (CRP) with obstructive sleep apnea hypopnea syndrome (OSAHS) associated pulmonary hypertension (OSAHS-PH). MethodsFrom September 2013 to October 2014, 38 OSAHS patients, 32 OSAHS-PH patients and 35 healthy subjects were enrolled from the General Hospital of Ningxia Medical University. OSAHS was diagnosed by polysomnography. The pulmonary artery systolic pressure (PASP) was measured by echocardiograph, and the diagnose criteria for pulmonary hypertension was PASP≥40 mm Hg. Serum TNF-α, IL-6, CRP and endothelin 1 (ET-1) were detected by enzyme-linked immunosorbent assay. The correlation between TNF-α, IL-6, CRP, ET-1 and PASP was analyzed. ResultsThe serum levels of TNF-α, IL-6, CRP and ET-1 were remarkably different among three groups (F=55.34, 25.05, 23.85, 34.06 respectively; all P < 0.05). The levels of TNF-α, IL-6, CRP and ET-1 in the OSAHS group were higher than those in the healthy group, and lower than those in the OSAHS-PH group (all P < 0.05). The PASP was positively correlated with the levels of the four factors (r=0.755, 0.762, 0.747, 0.759 respectively; all P < 0.01). ConclusionThe levels of serum TNF-α, IL-6 and CRP are correlated with pulmonary hypertension and they may be involved in the process of OSAHS-PH.