[A novel retrograde intubation procedure for treatment of nasolacrimal duct obstruction].

OBJECTIVE: To investigate the effect of a novel intubation procedure for the treatment of nasolacrimal duct obstruction. METHODS: Nasolacrimal duct obstruction patients with chronic dacryocystitis were selected for undergoing the procedure of intubation in outpatient clinic. This procedure was performed under local anesthesia. Retrograde intubation was inserted into the nasolacrimal duct and guided with probing. The location of drainage tube, cleanliness, epiphora, secretion from lacrimal sac and other signs were observed 2-4 weeks after intubation. Patients were grouped according to postoperative follow-up time. Group A consisted 521 cases (613 eyes) who underwent operations from May 1997 to December 2001 in Shenzhen Ophthalmic Hospital and observed for 3-5 years to evaluate long-term results. Group B consisted 381 cases (411 eyes) who underwent operations from October 2003 to October 2005 in Shenzhen Ophthalmic Hospital and 5 cases (6 eyes) who underwent operations at the same time period in Beijing Shunyi District Hospital (a total of 386 cases, 417 eyes) and observed for 0.5-1.5 years as the recent treatment group. The cure rates of these two groups were compared using the chi-square test. RESULTS: The lacrimal system was able to be irrigated one week after the operation. Epiphora symptoms were eliminated 2-3 weeks postoperatively. Lacrimal sac secretions disappeared within 1-3 weeks in most cases, few patients still had mucous secretions after 3 weeks and needed the second intubation operation. The cure rate of second intubation was 92.3% (23/26). The cure rates of Group A and Group B were 84.5% and 88.2%, respectively. There was no significant difference in cure rate between these two groups. Surgery and anesthesia could lead to a short period of diplopia and discomfort without any other complications. CONCLUSIONS: The novel lacrimal retrograde tube and the operation procedure are safe, simple and without obvious trauma. The prognosis of the intubation operation is good and this method could be used as a treatment for nasolacrimal duct obstruction and chronic dacryocystitis.

Anatomic study of the synovial folds of the occipito-atlanto-axial joints.

This study was performed to observe and measure synovial folds of the occipito-atlanto-axial joints and to explore their clinical significance. Two hundred ninety eight occipito-atlanto-axial joints from 30 embalmed cadavers of children and 20 of adults were dissected to find the incidence, quantity, distribution, forms, dimension, and histology of synovial folds. Synovial folds were found in most joints in both groups except for the posterior median atlantoaxial joints. Most of synovial folds were crescent-shaped, distributed on the superior aspects of the anterior median atlantoaxial joints, or in the antero-lateral aspects of the atlantooccipital joints and the lateral atlantoaxial joints. Compared to the adult group, the child group had a higher incidence of synovial folds (72.5% joints). The adult incidence was found to be 58.5%. 54.3% of the synovial folds in child were medium size or large size, but only 30.1% of the synovial folds in adult were medium size and there were no large ones. Microscopically, there were three histologic types synovial folds in these cervical joints, and 78.9% of them belonged to adipose type or fibro-adipose type in child, but only 45.8% belonged to the two types in adult. Our data suggest that the larger synovial folds in children may predispose them to an increased rate of entrapment with resultant edema and subluxation of the associated joint complex. This may be the cause why some cervical spine diseases preferentially take place in children rather than in adult, such as benign paroxysmal torticollis'atlantoaxial rotatory deformity and Grisel's syndrome.