Multimodal Imaging Characteristics and Presumed Cause of Intrapapillary Hemorrhage with Adjacent Peripapillary Subretinal Hemorrhage.

PURPOSE: To describe the multimodal imaging findings of intrapapillary hemorrhage with adjacent peripapillary subretinal hemorrhage (IHAPSH) and reveal the possible mechanism of this rare benign disease. PATIENTS AND METHODS: Observational study. Three eyes in three patients with intrapapillary hemorrhage with adjacent peripapillary subretinal hemorrhage were evaluated at the retina division of our institution. We describe the multimodal imaging findings including visual field examination, fundus photography, fluorescein and indocyanine green angiography (FFA&ICGA), spectral-domain optical coherence tomography (OCT), and ultrasonography. RESULTS: Three myopic patients with IHAPSH shared a similar clinical course and multimodal imaging appearance. The symptom was sudden dark shadows floating in the affected eye with mild visual blurring. Fundus photography showed hemorrhage in intrapapillary and subretinal, as well as optic disc bulges on the nasal side with local vitreoretinal separation in the affected eyes. OCT confirmed intrapapillary and subretinal hemorrhage with obviously elevated optic papilla in the affected eye and local vitreoretinal separation at the temporal side of optic disc together with vitreoretinal adhesion at the superonasal edge. FFA&ICGA ruled out optic drusen and neovascularization. B-ultrasonography in one case revealed optic disc bulge in the affected eye with tight traction by local detached vitreous posterior limiting membrane at the edge. The overall visual prognosis was excellent and the bleeding could be completely absorbed. CONCLUSION: IHAPSH tends to appear in young women with myopia. The mechanism may be attributed to an incomplete posterior vitreous detachment (PVD), followed by a tightly vitreous-papilla adhesion and concentrated traction to the superonasal part of the tilted small optic disc.

A quantitative analysis infection of ovarian cyst based on examination data of computed tomography and type-B ultrasonography.

In order to explore the accuracy of computed tomography (CT) and type-B ultrasonography in the examinations infection of ovarian cyst, the computed tomography and type-B ultrasonography were used for the examinations of 50 patients with infection of ovarian cysts, whose results were analyzed to determine the accuracy. Results have shown that the misdiagnosis rates of CT for patients with infection of ovarian cyst reached 18%, in which the misdiagnosis rate of small lesion 2.1×1.5×1.8cm was relatively higher; in addition, the misdiagnosis rates of type-B ultrasonography reached 26%, in which the misdiagnosis rate of large lesion 2.6×1.6×1.5cm was relatively higher; however, the misdiagnosis rates of the joint examination of these methods were only 2%. In summary, the deficiencies of CT and type-B ultrasonography may lead to misdiagnosis; therefore, in the clinical practices, the examinations of patients with infection of ovarian cyst should combine CT and type-B ultrasonography together to avoid the misdiagnosis and obtain the most accurate results as much as possible, which is important to both the patients and the development of medical examinations.

A case of unplanned pregnancy at 2 months after uterine curettage in a patient with a hydatidiform mole.

Whether an unplanned pregnancy should be terminated during follow-up of a hydatidiform mole is controversial. We report a patient who had an unplanned pregnancy with a hydatidiform mole at 2 months after uterine curettage when the human chorionic gonadotropin level had decreased to a negative value. Hydatidiform mole was confirmed by histopathology. Uterine curettage was performed twice and regular follow-ups were performed after surgery. The patient achieved a full-term pregnancy. The Apgar score of the newborn was 10 at 1, 5, and 10 minutes, and the newborn had no malformations. We conclude that the pregnancy outcome might be good in an unplanned pregnancy when the human chorionic gonadotropin level is negative.

Non-alcoholic fatty liver disease: An early mediator predicting metabolic syndrome in obese children?

AIM: To investigate if non-alcoholic fatty liver disease (NAFLD) is an early mediator for prediction of metabolic syndrome, and if liver B-ultrasound can be used for its diagnosis. METHODS: We classified 861 obese children (6-16 years old) into three subgroups: group 0 (normal liver in ultrasound and normal transaminases); group 1 (fatty liver in ultrasound and normal transaminases); and group 2 (fatty liver in ultrasound and elevated transaminases). We measured the body mass index, waist and hip circumference, blood pressure, fasting blood glucose, insulin, homeostasis model assessment of insulin resistance (HOMA-IR), whole-body insulin sensitivity index (WBISI), lipid profile and transaminases in all the participants. The risk of developing metabolic syndrome (MS) was assessed according to the degree of liver fatty infiltration based on the B-ultrasound examination. RESULTS: Among the 861 obese children, 587 (68.18%) were classified as having NAFLD, and 221 (25.67%) as having MS. The prevalence of MS in NAFLD children (groups 1 and 2) was 37.64% (221/587), which was much higher than that in non-NAFLD group (group 0, 12.04%) (P < 0.01). There were significantly higher incidences concerning every component of MS in group 2 compared with group 0 (P < 0.05). The incidence of NAFLD in MS patients was 84.61% (187/221), which was significantly higher than that of hypertension (57.46%, 127/221) and glucose metabolic anomalies (22.62%, 50/221), and almost equal to the prevalence of dyslipidemia (89.14%, 197/221). Based on the B-ultrasound scales, the presence of moderate and severe liver fatty infiltration carried a high risk of hypertension [odds ratio (OR): 2.18, 95% confidence interval (95% CI): 1.27-3.75], dyslipidemia (OR: 7.99, 95% CI: 4.34-14.73), impaired fasting glucose (OR: 3.65, 95% CI: 1.04-12.85), and whole MS (OR: 3.77; 95% CI: 1.90-7.47, P < 0.01). The state of insulin resistance (calculated by HOMA-IR and WBISI) deteriorated as the degree of fatty infiltration increased. CONCLUSION: NAFLD is not only a liver disease, but also an early mediator that reflects metabolic disorder, and liver B-ultrasound can be a useful tool for MS screening.