Investigation of multiple nosocomial infections using a semi-Markov multi-state model.

BACKGROUND: The prevalence of multiple nosocomial infections (MNIs) is on the rise, however, there remains a limited comprehension regarding the associated risk factors, cumulative risk, probability of occurrence, and impact on length of stay (LOS). METHOD: This multicenter study includes all hospitalized patients from 2020 to July 2023 in two sub-hospitals of a tertiary hospital in Guangming District, Shenzhen. The semi-Markov multi-state model (MSM) was utilized to analyze risk factors and cumulative risk of MNI, predict its occurrence probability, and calculate the extra LOS of nosocomial infection (NI). RESULTS: The risk factors for MNI include age, community infection at admission, surgery, and combined use of antibiotics. However, the cumulative risk of MNI is lower than that of single nosocomial infection (SNI). MNI is most likely to occur within 14 days after admission. Additionally, SNI prolongs LOS by an average of 7.48 days (95% Confidence Interval, CI: 6.06-8.68 days), while MNI prolongs LOS by an average of 15.94 days (95% CI: 14.03-18.17 days). Furthermore, the more sites of infection there are, the longer the extra LOS will be. CONCLUSION: The longer LOS and increased treatment difficulty of MNI result in a heavier disease burden for patients, necessitating targeted prevention and control measures.

Ultrasound diagnosis and treatment of branchial cleft cyst and preoperative management.

OBJECTIVE: The ultrasonic diagnosis of cervical and facial cystic masses, as well as cases of missed diagnosis and misdiagnosis, was examined, to improve the diagnosis of branchial cleft anomalies. METHODS: A retrospective analysis was conducted on 17 patients with branchial cleft cyst anomalies, including 11 males and 6 females, aged 12-53 years, with an average age of 33 ± 2 years, were unilateral single. All patients who underwent an ultrasound examination and image storage for retrospective analysis, and both longitudinal and transverse sections were scanned to observe the shape, size, boundary, peripheral relationship, and blood flow signal of the masses. All cases were examined with an enhanced CT scan, and pathological reports were generated. RESULTS: Among the 17 cases of branchial cleft anomalies, 15 cases were branchial cleft cysts, while one case involved fistula formation and one case involved sinus tract formation. Based on the type of branchial cleft, the first, second, and third cysts were classified in 4, 12, and 1 case, respectively. The sensitivity rate and specificity of ultrasonic diagnosis were 14/17 (82.4%) and 4/6 (66.7%), respectively. Ultrasonic characteristic analysis for the masses can be found in simple cystic masses or hypoechoic masses, most of them are of a regular shape and have a distinct boundary, and almost no blood flow signal. All patients who were misdiagnosed exhibited blood flow signals, including 1 patient with an abundant blood flow signal, 1 patient suspected of having ectopic thyroid with an abnormal function due to the rat-tail sign, 2 patients misdiagnosed as local inflammatory focus, and 1 patient misdiagnosed with tuberculous lymphadenitis. CONCLUSION: Ultrasound has a detection rate of up to 100% for cervical and facial masses, providing a fundamental determination of lesion characteristics and specific guidance for preoperative diagnosis. If the blood flow signals can be identified and carefully considered their peripheral relationship, the diagnostic rate can be improved.

Long noncoding RNA PVT1 facilitates high glucose-induced cardiomyocyte death through the miR-23a-3p/CASP10 axis.

Dilated cardiomyopathy (DCM) is the leading cause of morbidity and mortality in diabetic patients. Long noncoding RNA plasmacytoma variant translocation 1 (PVT1) has been shown to be related to the pathogenesis of DCM. However, the mechanism by which PVT1 regulates DCM pathogenesis is unclear. High glucose level was employed to construct a DCM cell model in vitro. Cell viability was determined via cell counting kit-8 assay. The level of lactate dehydrogenase (LDH) was measured with the corresponding kit. Expression levels of PVT1, miR-23a-3p, and caspase-10 (CASP10) messenger RNA were evaluated with a quantitative real-time polymerase chain reaction. Cell apoptosis was assessed by flow cytometry assay. Protein levels of B-cell lymphoma 2-associated X (Bax), cleaved-caspase-3 (cleaved-casp-3), and CASP10 were examined via western blot analysis. The relationship between PVT1 or CASP10 and miR-23a-3p was verified with dual-luciferase reporter assay. We observed that PVT1 and CASP10 were upregulated while miR-23a-3p was downregulated in high glucose-induced cardiomyocytes. High glucose levels repressed cardiomyocyte activity and induced cardiomyocyte apoptosis, but this influence was antagonized by PVT1 knockdown or miR-23a-3p overexpression. Furthermore, PVT1 acted as a sponge for miR-23a-3p, and miR-23a-3p inhibition counterbalanced the influence of PVT1 silencing on viability and apoptosis of cardiomyocytes under high glucose level treatment. PVT1 could increase CASP10 expression via sponging miR-23a-3p. In conclusion, PVT1 acted as a deleterious lncRNA in DCM. PVT1 facilitated cardiomyocyte death by regulating the miR-23a-3p/CASP10, which offered a new mechanism to comprehend the pathogenesis of DCM.

Establishment of a combination scoring method for diagnosis of ocular adnexal lymphoproliferative disease.

Lymphoproliferative diseases (LPDs) of the ocular adnexa encompass the majority of orbital diseases and include reactive follicular hyperplasia (RFH), atypical lymphoid hyperplasia (ALH), and mucosa-associated lymphoid tissue lymphoma (MALToma). Lymphoid follicles (LFs) are usually observed during the histological examination of LPDs. Currently, because there is a lack of specific clinical signs and diagnostic immunohistochemical biomarkers, it is difficult for pathologists to distinguish MALToma from ocular RFH and ALH, which makes the clinical management of these conditions difficult. Here, we analyzed the clinical features of patients with ocular adnexal LPDs (n = 125) and investigated the structure of LFs in paraffin-embedded tissue samples using anti-CD23 and anti-IgD immunochemistry. We found that some clinical features including age, sex, and laterality were different among RFH, LFH, and MALToma. Additionally, immunohistochemistry revealed that the expression of IgD and CD23 was higher in RFH patients and decreased in patients with ALH and MALToma. Moreover, LFs in RFH were intact, whereas the structures of most LFs were disrupted in ALH. In MALToma specimens, few intact LFs were observed. In a further investigation, we combined the results for CD23/IgD immunohistochemistry and the structure of LFs to establish a scoring method for the differential diagnosis of LPDs. According to the BIOMED-2 protocol, we further detected IgH gene monoclonal rearrangement in 73 cases (35 RFH, 17 ALH, and 21 MALToma cases). The sensitivity of our scoring method, based on a comparison with the results of IgH gene monoclonal rearrangement detection, was 85.7% (18/21) for MALToma and 35.3% (6/17) for ALH. Our study provides a method that may be useful for the differential diagnosis of RFH, ALH, and MALToma.

Heparanase-1 and components of the hedgehog signalling pathway are increased in untreated alveolar orbital rhabdomyosarcoma.

BACKGROUND: To assess the activities of heparanase-1 and elements of the hedgehog signalling pathway in alveolar orbital rhabdomyosarcoma. METHODS: Specimens (n = 23) were divided into two groups, those from patients with preoperative chemoradiotherapy or untreated patients; six samples of normal extraocular muscle were used as a normal muscle group. The presence of heparanase-1, patched, smoothened and glioma-associated oncogene homologue-1 protein expression was determined in 23 cases of archival paraffin-embedded alveolar orbital rhabdomyosarcoma after immunohistochemistry. RNA was extracted from three groups of paraffin-embedded specimens and messenger RNA expressions of heparanase-1, smoothened and glioma-associated oncogene homologue-1 compared using nested reverse transcriptase polymerase chain reaction and a limiting dilution analysis. RESULTS: The heparanase-1, patched, smoothened and glioma-associated oncogene homologue-1 protein was expressed in 91.3%, 87.0%, 91.3% and 78.3%, respectively, of the alveolar orbital rhabdomyosarcoma specimens. Untreated rhabdomyosarcoma samples tended to stain intensely, but staining was relatively weak in tissue obtained from the chemoradiotherapy group. The expression levels of heparanase-1, smoothened and glioma-associated oncogene homologue-1 messenger RNA in untreated and chemoradiotherapy groups paralleled that seen with immunology, and there were no significant differences in heparanase-1, smoothened and glioma-associated oncogene homologue-1 messenger RNA levels between the chemoradiotherapy group and the normal muscle group (P > 0.05). However, the messenger RNA in the untreated group were all significantly higher than those in the chemoradiotherapy and normal muscle groups (P < 0.01). CONCLUSIONS: Both heparanase-1 and hedgehog signalling pathway are involved in the pathogenesis of alveolar orbital rhabdomyosarcoma; however, chemotherapy and/or radiotherapy appears to significantly inhibit their upregulation.

[Therapeutic efficiency of transsubperiosteal approach for excision of orbital cavernous hemangiomas].

OBJECTIVE: To evaluate the indications, operative skills and effects of transsubperiosteal approach for excision of orbital cavernous hemangiomas (OCH). METHODS: In a retrospective study, the records of 42 cases with OCH confirmed by pathologic examination between June 2004 and June 2010 were analyzed. Preoperative diagnoses were based on clinical signs, CT and MRI examinations. According to the locations of the tumor, patients were assigned to 4 groups: group I: tumors located in the superotemporal quadrant in 18 cases; group II: tumors located in or near the superior orbital fissure in 15 cases; group III: tumors in the inferior peripheral space extending to the orbital apex in 4 cases; group IV: tumors in the inferonasal quadrant in 5 cases. In all 4 groups the periorbital skin was incised and then the periosteum of orbital rim was exposed. Tumors were removed from subperiosteal space. The complications and follow-up results were recorded. RESULTS: The rate of preoperative correct diagnosis was 100%. All cases were cured by once surgical procedures for average 20-30 min. Thirty-eight (90.5%) tumors were removed intact. The deblocking removal was recorded in 4 (9.5%) cases. In order to improve the surgical exposure of orbital apex in group II, superolateral orbital rim was removed in 6 (14.3%) cases and the walls were drilled in 3 (7.1%) cases. Follow-up periods ranged 1 to 7 years. No recurrent or remnant was recorded on imaging reviews. The visual acuity was improved in 6 (14.3%) cases. The temporary complications included chemosis in 9 (21.4%) cases, limited ocular movement in 4 (9.5%) cases and ptosis in 3 (7.1%) cases. The permanent complications included limited ocular extreme movement and dilated pupil, both in 2 cases (4.7%). CONCLUSIONS: Transsubperiosteal approach is eligible for the removal of OCH in the superotemporal, inferonasal quadrant and the floor of the orbit and is recommended for the tumors near the superior orbital fissure. This approach is safe and effective for removal of OCH with less surgical complication.

[Preliminary study of microanatomy of cadaver skulls related to lateral orbital approach operation].

OBJECTIVE: To study the microanatomy of cadaver skulls related to lateral orbital approach operation. Microanatomy data were recorded and analyzed by multi-angle digital camera. METHODS: Experimental study. Five adult formalin-fixed cadaver skulls were examined, simulating the lateral orbital approach procedure, the optic nerve, oculomotor nerve, ophthalmic artery, superior ophthalmic vein and various levels anatomical structures and adjacent regions were dissected and examined on both sides of each specimen under surgical microscope. RESULTS: Lateral orbit approach operation involved many important structures in the orbit. From the lateral side, ophthalmic artery (the second segment), ciliary ganglion and abducens nerve located outside of optic nerve were involved. From the superior side, ophthalmic artery (the third segment), superior ophthalmic vein, nasociliay nerve and the upper branch of oculomotor nerve located above the optic nerve were involved. From the inferior side: ophthalmic artery (the first segment), central retinal artery, the inferior branch of oculomotor nerve located below the optic nerve were involved. There were many blood vessel and nerves in the orbital apex, including optic nerve, oculomotor nerve, ciliary ganglion, abducens nerve, the ophthalmic division of the trigeminal nerve, ophthalmic artery and superior ophthalmic vein. CONCLUSIONS: The anatomic structures involved in the lateral orbital approach surgery are complex, especially in the orbital apex. Optic nerve, oculomotor nerve, ophthalmic artery, superior ophthalmic vein are located in this region. The operative space is narrow, the damage of nerves and blood vessels will result in serious complications.

[Modified orbital decompression for severe thyroid associated ophthalmopathy].

OBJECTIVE: To present a new technique for orbital decompression that minimizes surgical approaches while maximizing the removed areas of orbital walls and to evaluate the efficacy and safety of it for patients with severe thyroid associated ophthalmopathy (TAO). METHODS: A retrospective review of 40 cases (66 eyes) with severe TAO undergoing the modified decompression between January 2009 and January 2011 was conducted. All patients were assigned to three groups, which were group CON: compressive optic neuropathy in 30 eyes, group MP: marked proptosis in 30 eyes, and group EK: exposure keratopathy in 6 eyes. The deep lateral, medial walls and orbital floor decompressions were underwent via an eyelid crease or a lateral sub-brow S-shape approach with a transcaruncular approach. Clinical outcomes were recorded including visual acuity, exophthalmometry, diplopia, clinical activity score (CAS) and CT scans before and 6 months after surgery. Intra- and postoperative complications were recorded. RESULTS: The postoperative visual acuity was improved in 17 eyes (56.7%, P < 0.05) of group CON. The mean proptosis reduction was (8.1 ± 2.7) mm (t = 11.73, P < 0.01) and (11.4 ± 3.1) mm (t = 15.52, P < 0.01) in group CON and group MP, respectively. The CAS was decreased in group CON (P < 0.01). Compared with preoperative records, the degree of diplopia was not significantly different in group CON (U = 131.0, P = 0.309) and group MP (U = 157.5, P = 0.881). Diplopia resolved in 7 cases (39%) of group CON, 5 cases (28%) of group MP. New-onset diplopia or its aggravation was recorded in 3 cases (17%) of group CON, 4 cases (22%) of group MP. The other postoperative improvement included recovered color vision, reduced intraocular pressure, and healing keratopathy. The important complications were intraoperative dural tears, new-onset diplopia and ocular inferior displacement. CONCLUSIONS: The modified orbital decompression offers wide exposure to the three orbital walls, marked proptosis reduction, and no apparent scar. It is efficacious and safety for the treatment of CON and inflammatory activity of TAO without serious complications, meanwhile, has little risk of induced diplopia.

Expression level of valosin containing protein is associated with prognosis of primary orbital MALT lymphoma.

OBJECTIVE: To investigate whether the expression level of valosin-containing protein (VCP) is correlated with the prognosis of primary orbital mucosa-associated lymphoid tissue (MALT) lymphoma. METHODS: VCP expression in 58 samples from primary orbital MALT lymphoma patients was determined by immunohistochemisty using monoclonal antibodies. Correlations between VCP expression level and prognosis were clarified by statistical analysis. RESULTS: It was found that the percentage of VCP positive cells in samples of primary orbital MALT lymphoma ranged from 32% to 95%. The samples were divided into two groups (level 1 and level 2) according to the median value (45%) of the percentage of VCP positive cells. It was found that the expression level of VCP was significantly correlated with recurrence (P=0.003) and tumor size (P=0.008). At the same time, the 5-year disease-free and overall survival rate of patients of level 1 was significantly better than that of level 2 (P=0.001; P=0.032). There was no observed correlation between the expression level of VCP and other clinical features. CONCLUSION: VCP could be a useful marker for predicting the prognosis of primary orbital MALT lymphoma.

[Reappraise the value of orbital decompression for thyroid associated ophthalmopathy].

Compressive optic neuropathy and exposure keratopathy is classical indications of orbital decompression surgery for thyroid associated ophthalmopathy. Recently, its therapeutic value should extend to cosmetic requirement, the entity of congestive orbitopathy, ocular hypertension and hormonal resistance. In order to improve the safe and efficacy of orbital decompressions, we need the graded decompression plans and the modified areas of bone removal. The preferred area of bone removal is deep lateral wall. In serious patients, a combined medial, inferior and deep lateral wall decompression is recommended. There have also been technical advances in the cosmetic incisions such as transconjunctival, eyelid crease or endoscopic access. Removing periorbital fat is a supplement skill for bony decompression. The removed amount and indications should be regulated strictly. Individual operative project is the tendency of development of orbital decompressions.

[Reconstruction of blowout fractures of medial orbital walls].

OBJECTIVE: To explore the classification of medial orbital blowout fractures (OBF) and the applications of reconstruction materials, to evaluate the efficacy and safety of surgical orbital reconstruction. METHODS: A retrospective review of 176 cases with medial OBF between January 2008 and January 2011 was conducted, they were classified to group I (pure medial wall fracture, 85 cases) and group II (combined medial and inferior walls fractures, 91 cases). Group I was classified into 3 subgroups, Ia, Ib, and Ic, according to the fractured appearances on CT scans. Group II was classified into 2 subgroups, IIa and IIb, according to the maxillo-ethmoidal bone buttress involved in or not. The operative designs and the choice of reconstruction materials were based on the fractured classification and diplopia. Materials used for repairing included artificial bone plates, titanium meshes and wedge implants. The surgical repairs were undergone via a trans-caruncular approach when necessarily combined with an inferior fornix or lower limbus palpebralis incision. Clinical outcomes and complications were recorded including visual acuity, exophthalmometry, diplopia, hypoglobus and CT scans before and follow-up period. RESULTS: Group II showed more significant enophthalmos than group I (-5.1 ± 0.8 mm vs -2.7 ± 0.7 mm, P = 0.000). Both groups improved after operations (group II: -5.1 ± 0.8 mm vs. -0.7 ± 1.2 mm, P = 0.000; group I: -2.7 ± 0.7 mm vs. 0.1 ± 0.8 mm, P = 0.000). Ocular displacement was more common in group II than in group I (62% vs. 0%, P = 0.000). The hypoglobus was more common in subgroup IIb than in IIa (71% vs. 38%, χ(2) = 8.19, P = 0.004) and significantly improved after operations in subgroup IIb (71% vs. 17%, χ(2) = 38.27, P = 0.000). Diplopia was more commonly noted in group II than in group I (100% vs. 83%, P = 0.000), and was significantly relieved in both groups (group I: Z = -4.475, P = 0.000; group II: Z = -9.751, P = 0.000). Postoperative CT displayed orbital walls reconstructed satisfyingly in 92%. No one was recorded with impaired vision after operation. The important complications were aggravated or new-onset diplopia, under- or over-correction of enophthalmos and ocular superior displacement. CONCLUSIONS: A reconstructive operation of medial OBF with proper materials and surgical skills could be helpful for improving diplopia, enophthalmos and hypoglobus. The operations for repairing of medial OBF is efficient and safe.

[Clinical analysis of 25 cases of intraorbital nonmetallic foreign bodies].

OBJECTIVE: To evaluate the clinical features, diagnostic methods and treatment of intraorbital nonmetallic foreign body injuries. METHODS: In a retrospective study, the records of 25 consecutive cases with nonmetallic foreign bodies in the orbit confirmed by surgery were analyzed with special attention to the types of injury, history, clinical manifestations, imaging findings, treatment and follow-up results. RESULTS: Among 25 cases with nonmetallic foreign bodies, 23 cases were caused by trauma, including 11 cases with wooden bodies, 3 cases with glass, grease, or stone, 2 cases with plastic pen point, and one case with fire crackers. The remaining two cases had iatrogenic foreign bodies. The distinctive clinical manifestation was the periorbital fistula recorded in 11 (44%) cases, mostly in patients with wooden foreign bodies. The CT findings were different in various foreign bodies. The wooden foreign bodies showed low density in the acute stage and the density increased gradually from the acute to the chronic stage. CT images with lower windows could distinguish a wooden foreign body better. The grease was seen as low density mimicking orbital fat on CT. The stone or glass showed as masses with high density. Wooden foreign bodies displayed low signals on both MRI T1- and T2-weighted images. The surrounding pus was seen as a ring with high signal on T2-weighted images. The inflammatory infiltration showed marked enhancement. The grease displayed high signal on both T1- and T2-weighted images and showed lower signal than that of the fat. All patients underwent surgical removal of retained foreign bodies and the surrounding decomposed tissues. The infected wounds were not sutured at one stage operation. After follow-up for 6 months, all wounds healed normally and all patients recovered well. No complications were encountered. CONCLUSIONS: There are various types of intraorbital nonmetallic foreign bodies. The clinical manifestations of these different foreign bodies are complex. CT is the preferred examination for this condition. With the combination of correct diagnosis, proper surgical skills, and complete removal of foreign bodies and surrounding decomposed tissues, nonmetallic foreign bodies can be treated efficiently.

[Clinical observation of extraocular extension of choroidal melanoma].

OBJECTIVE: To evaluate the clinical features, diagnostic methods and treatment of extraocular extension of choroidal melanoma. METHODS: It was a retrospective case series study. The records of 12 consecutive cases with extraocular extension of choroidal melanoma confirmed by pathologic examination were analyzed with special attention to the case histories, clinical manifestations, imaging findings, treatment and follow up results. RESULTS: Four patients were misdiagnosed as glaucoma. Another 4 patients were confirmed the diagnosis of melanoma and 3 of them received the operations of transscleral local resection. The common clinical manifestations included: impaired vision, exophthalmos, blepharoptosis, limited ocular motility, conjunctival hyperemia, and increased ocular or orbital pressure, etc. Characteristic sign was raised mass on the surface of sclera. All cases underwent orbital MRI preoperatively, 6 underwent ocular B-scan echography, and 6 underwent orbital CT scanning to evaluate for extraocular extension of tumor. Typical ultrasonography revealed the discontinued ocular wall and an intraocular mass with a continuous hypoechoic extraocular mass. In some cases the extraocular mass showed hypoechoic with medium echo area. CT scan showed a well-defined homogeneous intraconal mass connecting with intraocular lesion in 6 cases, which could infiltrate eye or optic nerve. The MR signal features of intraocular tumors with extraocular extension showed 4 patterns in all patients. The typical pattern was the tumor showed hyperintensity on T(1) and hypointensity on T(2)-weighted image. The maximum diameter of extraocular tumor was measured over 4 mm in 9 cases. MRI was useful for demonstrating multiple extraocular lesions, remote metastatic lesion or micro extraocular tumor, of which minimal diameter was 3 mm in our cases. Orbital exenteration was performed in 11 cases and ocular enucleation with excision of extraocular tumor was in 1 cases. Microscopic examination showed the epithelioid-cell-type tumors were the most common. The tumor extended out of the eye by three types of way in our cases. Follow-up ranged from 1 to 5 years in 8 cases, who underwent chemotherapy, radiotherapy or interferon. Six cases had no recurrences and general health. Death and metastasis was respectively recorded in one case. CONCLUSIONS: Delayed treatment could induce the growth of choroidal melanoma to the stage of extraocular extension, which has few specific clinical manifestations. The combination of multiple imaging examinations was helpful for the correct diagnosis. Surgical operation with adjunctive therapies could partly reduce recurrence and metastasis of melanoma.

Adhesion of cavernous hemangioma in the orbit revealed by CT and MRI: analysis of 97 cases.

AIM: To assess features of cavernous hemangioma (CH) in the orbit revealed by CT and MRI and summarize prediction of preoperative CT and MRI for the adhesion degree of CH in the orbit. METHODS: A total of 97 patients with pathologically confirmed CH in the orbit were examined with axial and coronal CT scan, and axial, coronal, sagittal, and enhanced fat suppression MRI scan. CT and MRI findings and intraoperative adhesion degrees were retrospectively analyzed. RESULTS: There were 47 patients with slight adhesion, for whom CT and MRI showed round masses with well defined margins in the extraocular muscles; 14 patients with mild adhesion, for whom CT and MRI revealed irregular masses with unclear boundary between CH and the optic nerve in coronal images, and emissary veins in the posterior region of masses in contrast-enhanced images; 36 patients with severe adhesion, for whom CT and MRI exhibited an irregular or ovoid mass filling the orbital apex, or showed distorted and even spiky margins in the posterior region of masses in contrast enhanced images at the presence of a transparent triangle between the mass and the orbital apex. CONCLUSION: Preoperative CT and MRI aid in accurate diagnosis, selection of the surgical approach, and assessment of the adhesion degree and surgical risks for CH.

[Clinical manifestations, diagnosis and management of recurrent orbital dermoid cysts].

OBJECTIVE: To evaluate the clinical features, diagnostic methods and treatment of recurrent orbital dermoid cysts. METHODS: In a retrospective study, the records of 30 consecutive cases with recurrent orbital dermoid cyst confirmed by pathologic examination were analyzed with special attention to the case histories, recurrent factors, clinical manifestations, imaging findings, treatment and prognosis. RESULTS: In the present series, the interval from first appearance in our institute to the operation ranged from 1 month to 36 years, with a median of 2.5 years. Once, twice and three times of operation history were noted in 20 cases, 9 cases and 1 case, respectively. The clinical characteristics included: periorbital masses with red swelling and tenderness in 16 cases, cutaneous fistulas in 4 cases, ectropion and adherence of upper lid in 4 cases. The risk factors for the recurrence included the incomplete excision the cyst or residual of the cyst wall in the bone sutures in 16 cases, misdiagnosis as subcutaneous mass leading to inappropriate operations in 11 cases, operation without imaging examinations in 8 cases, etc. CT scan was performed in all cases, which showed dermoid cysts with hypodensity or isodensity. The common imaging signs included dumbbell dermoid cysts located near the zygomaticofrontal suture in 8 cases, slender and circuitous tunnel within the orbital wall in 6 cases, and extensive and wavy impression of the bony walls in 6 cases. Surgical excision was performed in 28 cases and conservation therapy was used in 2 cases. Cystic content and wall were removed thoroughly during the operation. Follow-up ranged from 1 to 9 years and no recurrence or serious complications were noted. CONCLUSIONS: The recurrence of orbital dermoid cysts is correlated with various factors. The importance of recognition of clinical features and imaging findings of this tumor should be emphasized. With the guide of imaging examinations and the combination of various surgical skills, the recurrence of dermoid cysts could be prevented efficiently.

[Diagnosis and management of the tumors of extraocular muscles].

OBJECTIVE: To evaluate the spectrum, clinical features, diagnostic methods and treatment of the tumors of extraocular muscles. METHODS: In a retrospective case series study,the records of 11 consecutive cases with tumors of the extraocular muscles confirmed by pathologic examination were analyzed with special attention to the clinical manifestations, imaging findings, treatment and prognosis. RESULTS: There were fibromatosis in 3 cases, intermuscular hemangioma and granular cell tumor both in 2 cases, inflammatory myofibroblastic tumor, rhabdomyosarcoma, T cell lymphoma and metastatic adenocarcinoma all in 1 case. The most frequent symptoms were limited ocular movement, exophthalmos and ocular displacement. In respect to images of computed tomography or magnetic resonance imaging, the configuration of the extraocular muscles with tumors demonstrated 3 patterns, fusiform, globular and irregular. The tumors that involved inferior, medial and lateral rectus muscles, and inferior oblique muscle, their maximal diameters all exceeded 1 cm. Depending on the involved muscles, different operative approaches were applied. The choice of treatments was determined by the pathology of the tumors. CONCLUSIONS: The spectrum, clinical features and imaging findings of the tumors of extraocular muscles are unique. Earlier biopsy is important. The prognosis is correlated with treatments and the characteristic of tumors.

[The pathological changes of the orbital tissue in thyroid associated ophthalmopathy].

OBJECTIVE: To study the morphological representation of the orbital tissue in thyroid associated ophthalmopathy. METHODS: It was a retrospective case series. 138 specimens of TAO (include 77 specimens of orbital fat, 41 specimens of orbital periosteum and 20 specimens of lacrimal gland tissue) were analyzed by light microscopy and immunohistochemical staining. RESULTS: The notable hyperplasia of fat was found in orbital tissue from 73 of 77 and in lacrimal gland tissue from 12 of 20. The hyperplasia of fibrous tissue and muscular metaplasia were observed in orbital periosteum. CONCLUSIONS: The hyperplasia of fat in TAO orbital and lacrimal gland tissue is a very important and ubiquitous pathological changes. Study on the orbital fat and prevent against the hyperplasia of fat maybe have a significance of effective to hold back proptosis.

[Analysis of the results of surgical management of orbital osteoma].

OBJECTIVE: To analyze the results and skill of surgical management of orbital osteoma retrospectively. METHODS: It was a retrospective case series. Nineteen cases of orbital osteoma (the diagnosis was confirmed by surgical and pathological studies) were analyzed retrospectively in the present study. RESULTS: The location of orbital osteoma was as following: 10 cases in medial wall of the orbit, 4 cases in orbital roof and 5 cases in lateral wall of the orbit. Surgical approaches included anterior orbitotomy (8 cases), lateral orbitotomy (7 cases), and medial orbitotomy (2 cases). Complete resection was performed in 12 cases,while partial resection was done in 7 cases. CONCLUSIONS: Orbital osteoma is easy to diagnosis but difficult in surgical treatment. Appropriate surgical approach and skilled surgical technique are able to reduce the surgical complications.

[Diagnosis and management of orbital metastatic tumors].

OBJECTIVE: To evaluate the type, clinical features and diagnostic methods of orbital metastatic tumors. METHODS: In a retrospective study, the records of 30 consecutive cases with orbital metastatic tumors as confirmed by pathologic examination were analyzed with special attention to the epidemiology, clinical manifestations and imaging findings. RESULTS: Most orbital metastatic tumors in China originated from the breast, followed, in order, by the lung and liver. The metastatic tumors of the orbit most frequently originated from the liver and lung in males, and from the breast and lung in females. The male or female ratio of patients with orbital metastasis was 1:1. The orbital metastases were more common in the children and the elderly. In 50% of patients, the orbital symptoms were the first signs of the disease. The longest course was seen in metastasis from the breast and the shortest from various types of blastomas. Orbital metastases could occur unilaterally or bilaterally. The most common symptoms of orbital metastatic tumors included diplopia and orbital pain. The signs included proptosis, limited ocular movement and increased intraorbital pressure. Based on the images of computed tomography or magnetic resonance imaging, orbital metastatic tumors could be divided into four different types according to the location and morphology of the tumors. Follow-up results revealed that 60% of orbital metastasis had poor prognosis. CONCLUSIONS: The spectrum of orbital metastatic tumors in China is different from that in western countries. Familiarity with the clinical manifestation and diagnostic methods of orbital metastatic tumors can be helpful to relief the ocular symptoms and prolong the life of patients.

[Retrospectively analysis of diagnosis and treatment of the orbital neurilemomas].

OBJECTIVE: To evaluate the diagnosis and surgery of orbital neurilemoma. METHODS: Thirty-eight patients with pathologically confirmed orbital neurilemomas were analyzed retrospectively. The age of the patients ranged from 9 years to 69 years. Twenty-three patients were female and fifteen were male. Standardized A/B scan was performed in 37 cases. CT scanning was performed in 38 patients with contrast scanning in 15 patients and MR imaging was performed in 33 patients with contrast scanning in 32 patients. RESULTS: Neurilemoma was generally low to medium reflective or echo in the ultrasound. Of the 38 cases with orbital neurilemomas, location of tumors was superior of the orbit in 17 cases; lateral and inferior in 19 cases and medial in 2 cases. Shape of the tumors was elongate or round-like 26 cases, leaf-like and dumb-bell 12 cases. CT scanning showed soft tissue high density mass in 32 cases, 6 cases were heterogeneity (for cystoid change). MR imaging in 33 patients displayed a identical T1 and a long T2 signal intensity weighted images in 4 cases; identical T1 and T2 mixed signal (short, identical and long signal) in 28 cases; identical T1 and T2 in 1 cases. After Gd-DTPA enhancement in 32 cases, heterogeneity enhancement of the mass was seen in 28 cases, marked enhancement 4 cases. Four cases in all cases was found orbital-cranial communicate mass. Surgical approach was lateral orbitotomy in 26 cases, combined lateral and medial orbitotomy in 2 cases, anterior orbitotomy 4 cases and medial orbitotomy in 2 cases. CONCLUSIONS: Modern medical imaging, especial MR imaging can demonstrate the site, configuration, and characteristics of the tumors and contribute to the diagnosis and treatment. Skill of surgery can improve the rate of success and decrease the complications.