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Ocular choristoma is composed of ectopic tissues with normal structures. The pathogenesis still remains uncertain. Histopathologically, it is a dense connective tissue mixed with epidermal appendages, smooth muscle cells, mature adipose tissue, lacrimal glands, lymph nodes, skeletal muscle fibers, cartilage and bone. Because of its low incidence, most of published literature are case reports. The clinical manifestations are non-specific and we need to distinguish it from other ocular masses. The choice of surgical resection depends on the ocular symptoms, the effect on appearance, and the need for clinical confirmation. This paper reviews the epidemiology, etiology, pathogenesis, clinical manifestations, diagnosis, differential diagnosis and treatment of ocular choristoma.
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Thyroid-associated ophthalmopathy (TAO) is a common orbital disease in the adults, which leads to a series of ocular symptoms and signs, seriously affecting the visual function and life quality of patients.Grasping the disease progression accurately and evaluating the severity and activity of TAO objectively play a crucial role in improving the management and prognosis of TAO patients.Grading and staging methods of TAO have been constantly improved.In the descriptive evaluation of subjective symptoms and signs of TAO, four international grading and staging systems with similarities and different focuses, namely, NOSPECS, CAS, VISA and EUGOGO, have been proposed successively.In recent years, with the rapid development of science and technology, objective evaluation methods such as imaging technology and laboratory examination have played an important role in the grading and staging of TAO.Among them, the application of orbital CT and MRI has made a great breakthrough in quantitative analysis of the disease.Continuous summary of grading and staging methods of TAO can contribute to the guidance for improving diagnosis, treatment and prognosis of TAO.
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Background Thyroid associated ophthalmopathy (TAO) is an autoimmune disease.Current research on the pathogenesis focuses on common autoantigen.Insulin-like growth factor-1 receptor (IGF-1R) is necessary for the function of IGF-1,also IGF-1 plays an important role in signaling pathway of thyroid stimulating hormone receptor (TSHR).Objective This study was to investigate the effects of IGF-1 on the proliferation,expression of IGF-1R and TSHR on cultured orbital fibroblasts (OFs) derived from TAO.Methods Human orbital tissue was obtained from 17 TAO patients who received orbital adipectomy and 4 normal controls who received cosmetic surgery in West China Hospital from March 2016 to June 2016.OFs were cultured by explant culture with DMEM/F12 containing 5％ fetal bovine serum and identified by immunochemistry.The OFs were treated with different concentrations of IGF-1.IGF-1 at different concentrations (0,50,100,125 μg/L) was added into the medium,respectively,and the proliferation of the cells (absorbancy) was detected by MTS.The percentages of IGF-1R and TSHR expressions in the cells were assayed by flow cytometry.Results Cultured cells appeared to be spindle-like in shape and grew well with abundant cytoplasm.The characteristics of the cells derived from TAO patients were consistant with normal ones.The cells showed the positive response for vimentin and absent respose for desmin,S-100,myoglobin and cytokeratin.The proliferative values of OFs were gradually elevated with the increase of IGF-I dose in both TAO group and normal group (Fgroup =219.639,P＜0.001;F ion =17.752,P＜0.001) with the optimal effects in 100 μg/L IGF-1.The expression levels of IGF-1R in the OFs were (0.009 1 ±0.008 7)％,(0.095 3±0.023 3) ％,(0.083 7±0.022 7) ％ and (0.070 9 ± 0.024 1) ％ in the TAO group,and those in the normal group were (0.0023± 0.0006)％,(0.0093±0.0012)％,(0.0073±0.0015)％ and (0.0083±0.0012)％ after treatment of 50,100,125 μg/L IGF-1.The expression levels of IGF-1 R were significantly higher after treatment of 50,100 and 125 μtg/L IGF-1 than those treatment of 0 μg/L IGF-1 in both TAO group and normal group,and the expression levels of IGF-1R in the OFs were significantly increased in the TAO group compared with the normal group (all at P＜0.05).No statistical difference was seen in the TSHR expression between the TAO group and normal group after treatment of 0,50,100 and 125 μg/L IGF-1 (Fgroup =0.133,P ＞ 0.05;F ion =0.004,P ＞ 0.05).Conclusions IGF-1 can promote the proliferation of OFs and up-regulate the expression of IGF-1R in OFs.However,IGF-1 dose not play a regulating effect on the expression of TSHR in OFs.
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Background Insulin-like growth factor-1 (IGF-1) participates in the regulation of the biological activity of cells.Researches showed that the serum IGF-1 level is significantly raised in the patients with Graves diseases.Thyroid associated ophthalmopathy (TAO) is one of Graves diseases,and orbital adipose cells are the target cells of thyroid autoantigens.However,whether IGF-1 is associated with TAO is still unclear.Objective This study was to investigate the expressions of IGF-1 in both circulating blood and orbital adipose tissue in TAO patients.Methods A retrospective cohort study was performed.Eighty-six TAO patients were enrolled in West China Hospital of Sichuan University from August 2009 to February 2014.According to the clinical activity score criteria(CAS) ,the patients were divided into active stage (CAS ≥ 4,35 patients) and inactive stage (CAS ＜4,51 patients).Eighty-six health adult persons were enrolled as the controls.The periphery blood of 3 ml was collected from each subject to detect the serum IGF-1 level by ELISA.Orbital adipose tissues were obtained during the surgery from 35 TAO patients and 35 patients with benign orbital tumor or orbital adipose prolapse from August 2009 to February 2014.The histopathological examination of orbital adipose tissue was carried out to evaluate the pathological characteristics, and the expression of IGF-1 in orbital adipose tissue was assessed by immunochemistry.This study protocol was approved by Ethic Committee of West China Hospital of Sichuan University, and informed consent was obtained from each subject before entering the cohort.Results The mean serum IGF-1 level was (0.862±0.026)ng/ml in the TAO patients,and that in the normal controls was (0.767 ± 0.480) ng/ml, without significant difference between them (P=0.281).The mean serum IGF-1 level was (0.877±0.355) ng/ml and (0.803±0.031) ng/ml in active stage and inactive stage of patients, respectively, and no significant difference was found between them (P =0.834).IGF-1 expression located in cellular membrane and cytoplasm.The expressing intensity of IGF-1 in orbital adipocytes was significantly enhanced in the TAO patients with the positive rate of 74.29% , and that in the controls was 45.46％ ,showing a statistical difference between the two groups (x2=5.289,P=0.021).Conclusions Serum IGF-1 level dose not rise in TAO patients, but the expression of IGF-1 in orbital adipocytes up-regulates, indicating that mature orbital adipocytes of TAO are regulated mainly by IGF-1.
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Objective To investigate toe-brachial index ( TBI) in the diagnosis of peripheral artery disease ( PAD) and its risk factors in the patients with type 2 diabetes.Methods TBI was examined in the 238 patients with type 2 diabetes.The patients were divided into the group with low TBI ( TBI≤0.7 ) and the group with normal ABI ( TBI>0.7 ) .The two groups were compared for clinical parameters.Results Thirty two patients (13.4%)with abnormal ABI (TBI≤0.7) showed older age [(63.8 ±9.9) yrs vs (54.9 ±10.8) yrs, P =0.000] , lower diastolic blood pressure [(70.5 ±6.9) mmHg vs (74.9 ±9.1) mmHg, P =0.003], more frequency of hypertension (56.3%vs 38.3%, P =0.043), coronary artery heart disease (28.7%vs 10.7%, P =0.020) and cere-bral vascular disease (15.6%vs 4.4%, P =0.025).Step-wise analysis screened that age and diastolic blood pressure were the inde-pendent risk factors for TBI .Conclusions Aging and hypertension were the risk factors in the patients with abnormal TBI in type 2 di-abetes.TBI was an easy and economical method for diagnosing PAD in patients with type 2 diabetes.
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Background Thyroid-associated ophthalmopathy (TAO) is characterized by increased amount of orbital fat tissue.Leptin is a specific adipocytokine,and it may play an important role in the pathogenesis of TAO.Objective The present study investigates the effect of rh-leptin on the differentiation of orbital preadipocytes in subjects suffering from thyroid-associated ophthalmopathy (TAO).Methods The orbital fatty tissue was obtained from 7 patients with TAO during orbital decompression surgery.Orbital preadipocytes were cultured using the explant method and differentiated cells were identified with oil red staining.The subcultured preadipocytes were incubated with different concentrations of rh-leptin,and no rh-leptin was added in the control group.The average optical density of cytoplasm/nucleolus in differentiated adipocytes was measured by oil-red staining to evaluate the influence of different concentrations of rh-leptin on lipid formation of orbital adipocytes.Results Cultured preadipocytes in vitro were identified to be of mesenchymal origin by immunohistochemical staining.The average optical density of cytoplasm/nucleolus was 1.07±0.22,0.80±0.17,0.56±0.11,0.25±0.10,and 0.17±0.08,respectively in the control group,10μg/L of leptin group,50μg/L of leptin group,100μg/L of leptin group and 500μg/L of leptin group,showing a significant difference among the five groups (F=20.64,P=0.00).Compared to the control group,the lipid formation of orbital adipocytes gradually declined in various concentrations of rh-leptin (P＜0.05,P＜0.01).Conclusion Rh-leptin may suppress the differentiation and lipid formation of TAO orbital preadipocytes in vitro in a dose-dependent manner.Leptin may be a feedback modulator in TAO pathogenesis.
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Risk factors of hyperamylasemia in 152 diabetic ketoacidosis(DKA)patients who had no acute pancreatitis were examined.Serum levels of hemodiastase,natrium,kalium,chlorine,calcium,phosphonium,creatinine,carbon dioxide combining power,osmotic pressure,blood glucose,blood lipids and uric acid were measured.With hemodiastase and other 14 factors as independent variables,the multiple linear regression analysis was performed and the partial regression coefficient was estimated.Blood glucose,serum natrium,osmotic pressure and triglyceride entered the regression equation,and their partial coefficients were 10.26,10.35,2.21 and 8.00,respectively.The constant quantitv was -2162.06.Compared with amylase-normal group,hyperamylasemia group showed statistically significant difference in blood glucose,serum natrium,osmotic pressure and triglyceride levels.Higher blood glucose and triglyceride might be the primary causes of hyperamylasemia.
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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 exophthalmic eyes after operation was mean 4 0 mm. Conclusion Two orbital walls decompression is an effective method for compressive optic-neuropathy in Gaves ophthalmopathy.
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Objective To probe the clinical character,the histopathological classification and misdiagnoses of intraocular tumors. Methods The clinical and pathological data of 359 patients with intraocular tumor diagnosed clinically between 1980～2000 were retrospectively analyzed. Results There were 300 cases of malignant tumor and 23 cases of benign tumor respectively. Non oncologic malady and benign tumor misdiagnosed as tumor or malignant tumor were 40 cases. The two leading malignant tumors were retinoblastoma and melanoma. Conclusion The clinical and pathological analysis of intraocular tumor is beneficial to the correct clinical diagnosis and treatment.