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Clinical results of two orbital walls decompression for 12 cases of compressive optic-neuropathy

Objective To evaluate the effectiveness and safety of orbital decompression for compressive optic-neuropathy. Methods Fourteen eyes of twelve cases with Graves opthalmopathy and compressive optic-neuropathy undergone two orbital walls decompression with the follow-up period of more than 3 months were analyzed. Results The effect of complete closure of palpebral fissure was attained in all of the postoperative eyes and the visual acuity was increased in eleven eyes, remained no change in two eyes and decreased in one eye. The mean value of the recession of exophth almic eyes after operation was mean 4.0 mm. Conclusion Two or bital walls decompression is an effective method for compressive optic-neuropathy in Gaves ophthalmopathy. (Chin J Ocul Fundus Dis, 2001,17:303-304)

Application of Evidence-Baqsed Medicine in Endocrine Disorders

Immunoglobulin G4-related thyroid diseases

Immunoglobulin G4-related disease (IgG4-RD) is a new disease entity recognized at the start of this century noted to be involving many organ systems including endocrine system and thyroid in particular. It represents an immune mediated fibro inflammatory condition with characteristic histopathological appearance affecting single or multiple organs. In general, immunoglobulin G4-related thyroid disease (IgG4-RTD) is rarely considered and it may be isolated or with other organ involvement. Four subcategories of IgG4-RTD have been identified so far: Riedel thyroiditis, fibrosing variant of Hashimoto thyroiditis, immunoglobulin G4-related Hashimoto thyroiditis, and Graves disease with elevated immunoglobulin G4 levels. The diagnostic approach is complex and the work up relies on the coexistence of clinical features, histological features and serological evidence. Demonstration of the classic histopathological features is vital to diagnose IgG4-RD in most cases, and biopsy proof is preferred strongly by most disease experts before the initiation of treatment. The treatments for IgG4-RTD include medical and surgical options. Steroids are first line treatment though it may need further evaluation. Tamoxifen and rituximab are second line treatment for steroid resistant patients. Surgical excision of thyroid gland in presence of compression symptoms is the surgical option. Inspite of pathophysiology of the disease being poorly understood till now, early and prompt diagnosis and an early treatment initiation can improve the outcomes.

地榆升白片對Graves病所致白細胞減少的治療觀察

目的:觀察地榆升白片配合甲巰咪唑治療甲亢所致的白細胞減少癥的療效。方法:選擇初發Graves病伴白細胞減少患者108例,隨機分為3組,在甲巰咪唑基礎上分別加用地榆升白片(A組)、鯊肝醇(B組)、安慰劑(C組),治療10周,定期檢查游離T3(FT3)、游離T4(FT4)、促甲狀腺激素(TSH)、促甲狀腺激素受體抗體(TRAB)、血白細胞(WBC)、中性粒細胞(N)、肝功能。結果:治療后2周,A組、B組的WBC、N較治療前均有顯著升高,且A組升高程度明顯優于B組,C組的WBC和N在治療后 6周開始顯著升高,治療后10周,A、B組WBC和N均較6周時繼續顯著上升,C組則無繼續顯著上升。治療前后3組間FT3、FT4、TSH均無顯著差別。TRAB水平僅有A組治療后較治療前顯著下降(Plt;0.05)。結論:甲巰咪唑加用地榆升白片能顯著縮短升高白細胞的時間和很好地維持白細胞水平,效果優于加用鯊肝醇和單用抗甲狀腺藥物治療,且TRAB水平有所減低,提示可能對甲亢治療有正面作用。