PURPOSE: Few data exist on the actual recurrence rates of thrombosed external hemorrhoids. We wished to determine the incidence of recurrence, intervals to re currence, and factors predicting recurrence of thrombosed ...PURPOSE: Few data exist on the actual recurrence rates of thrombosed external hemorrhoids. We wished to determine the incidence of recurrence, intervals to re currence, and factors predicting recurrence of thrombosed external hemorrhoids a fter conservative or surgical management. METHODS: Two hundred and thirty-one c onsecutive patients with thrombosed external hemorrhoids treated from 1990 to 20 02 were identified. Recurrence was defined as complete resolution of the index l esion with subsequent return of a thrombosed external hemorrhoid and did not inc lude patients with chronic symptoms. Data were gathered retrospectively. Multipl e potential risk factors were reviewed. RESULTS: The index thrombosed external h emorrhoid was managed conservatively in 51.5 percent of cases and surgically in 48.5 percent. There were no differences between groups in gender, age, or race, and 44.5 percent of all patients had a prior history of thrombosed external hemo rrhoid. A prior history was less common in the conservative group than in the su rgical group (38.1 percent vs. 51.3 percent; P < 0.05). The frequency of pain or bleeding as the primary complaint was higher in the surgical group (P< 0.001 and P< 0.002) . In addition, the surgical group was more likely to report all three symptoms o f pain, bleeding, and a lump (P< 0.005). Mean follow-up was 7.6 months, with th e range extending to 7 years. Time to symptom resolution averaged 24 days in the conservative group vs. 3.9 days in the surgical group (P< 0.0001). The overall incidence to recurrence was 15.6 percent-80.6 percent in the conservative group vs. 19.4 percent in the surgical group. The rate of recurrence in the conservat ive group was 25.4 percent (4/29; 14 percent were excised) whereas only 6.3 perc ent of the surgical patients had recurrence (P < 0.0001). Mean time to recurrenc e was 7.1 months in the conservative group vs. 25 months in the surgical group ( P < 0.0001). Survival analysis for time to recurrence of thrombosed external hem orrhoid indicated that t展开更多
Purpose: To report the clinical features of 93 eyes of 48 pa-tients with chro nic and delayed-onset mustard gas keratitis. Clinicopathologic correlation in 5 eyes and a review of related literature are presented. Desi...Purpose: To report the clinical features of 93 eyes of 48 pa-tients with chro nic and delayed-onset mustard gas keratitis. Clinicopathologic correlation in 5 eyes and a review of related literature are presented. Design: Retrospective, n oncomparative case series. Participants: Forty-eight Iranian survivors of Iraqi chemical warfare with chronic or delayed-onset mustard gas keratitis. Methods: We reviewed the symptoms, clinical findings, course, and treatment of our patie nts and reviewed the literature. In 5 patients, histopathologic features of corn eal and conjunctival specimens were evaluated. Main Outcome Measures: Ocular fin dings, clinical course, treatment measures, and histopathologic studies. Results : Of 48 patients, 31 (64.6%) had chronic symptomatology, whereas 17 (35.4%)-e xperienced delayed-onset lesions. Visual acuity at referral ranged from hand mo tions to 20/20. Ocular surface changes included chronic blepharitis and decrease d tear meniscus in all patients, limbal ischemia (81.3%), and conjunctival vasc ular abnormalities (50%). Corneal signs in order of frequency were: scar or opa city (87.5%), neovascularization (70.8%), thinning (58.3%), lipoid deposits ( 52.1%), amyloid deposits (43.8%), and epithelial defects and irregularity (31. 3%). Many patients received conservative treatment; others underwent allograft stem cell transplantation (20 eyes of 17 patients), penetrating keratoplasty (12 eyes of 12 patients), and lamellar keratoplasty (4 eyes of 3 patients). Conjunc tival specimens were evaluated by light microscopy. Decreased goblet cell densit y, attenuated or thickened epithelium, scarring in the substantia propria associ ated with plasmacytic and lymphocytic infiltration, and dilated lymphatic vessel s were noted. Excised corneal buttons disclosed absence of epithelium and Bowman ’s layer, fibrovascular pannus, stromal scarring, and vascularization. Conclusi ons: Mustard gas causes chronic and delayed destructive lesions in the ocular su rface and cornea, leading to progressive visu展开更多
文摘PURPOSE: Few data exist on the actual recurrence rates of thrombosed external hemorrhoids. We wished to determine the incidence of recurrence, intervals to re currence, and factors predicting recurrence of thrombosed external hemorrhoids a fter conservative or surgical management. METHODS: Two hundred and thirty-one c onsecutive patients with thrombosed external hemorrhoids treated from 1990 to 20 02 were identified. Recurrence was defined as complete resolution of the index l esion with subsequent return of a thrombosed external hemorrhoid and did not inc lude patients with chronic symptoms. Data were gathered retrospectively. Multipl e potential risk factors were reviewed. RESULTS: The index thrombosed external h emorrhoid was managed conservatively in 51.5 percent of cases and surgically in 48.5 percent. There were no differences between groups in gender, age, or race, and 44.5 percent of all patients had a prior history of thrombosed external hemo rrhoid. A prior history was less common in the conservative group than in the su rgical group (38.1 percent vs. 51.3 percent; P < 0.05). The frequency of pain or bleeding as the primary complaint was higher in the surgical group (P< 0.001 and P< 0.002) . In addition, the surgical group was more likely to report all three symptoms o f pain, bleeding, and a lump (P< 0.005). Mean follow-up was 7.6 months, with th e range extending to 7 years. Time to symptom resolution averaged 24 days in the conservative group vs. 3.9 days in the surgical group (P< 0.0001). The overall incidence to recurrence was 15.6 percent-80.6 percent in the conservative group vs. 19.4 percent in the surgical group. The rate of recurrence in the conservat ive group was 25.4 percent (4/29; 14 percent were excised) whereas only 6.3 perc ent of the surgical patients had recurrence (P < 0.0001). Mean time to recurrenc e was 7.1 months in the conservative group vs. 25 months in the surgical group ( P < 0.0001). Survival analysis for time to recurrence of thrombosed external hem orrhoid indicated that t
文摘Purpose: To report the clinical features of 93 eyes of 48 pa-tients with chro nic and delayed-onset mustard gas keratitis. Clinicopathologic correlation in 5 eyes and a review of related literature are presented. Design: Retrospective, n oncomparative case series. Participants: Forty-eight Iranian survivors of Iraqi chemical warfare with chronic or delayed-onset mustard gas keratitis. Methods: We reviewed the symptoms, clinical findings, course, and treatment of our patie nts and reviewed the literature. In 5 patients, histopathologic features of corn eal and conjunctival specimens were evaluated. Main Outcome Measures: Ocular fin dings, clinical course, treatment measures, and histopathologic studies. Results : Of 48 patients, 31 (64.6%) had chronic symptomatology, whereas 17 (35.4%)-e xperienced delayed-onset lesions. Visual acuity at referral ranged from hand mo tions to 20/20. Ocular surface changes included chronic blepharitis and decrease d tear meniscus in all patients, limbal ischemia (81.3%), and conjunctival vasc ular abnormalities (50%). Corneal signs in order of frequency were: scar or opa city (87.5%), neovascularization (70.8%), thinning (58.3%), lipoid deposits ( 52.1%), amyloid deposits (43.8%), and epithelial defects and irregularity (31. 3%). Many patients received conservative treatment; others underwent allograft stem cell transplantation (20 eyes of 17 patients), penetrating keratoplasty (12 eyes of 12 patients), and lamellar keratoplasty (4 eyes of 3 patients). Conjunc tival specimens were evaluated by light microscopy. Decreased goblet cell densit y, attenuated or thickened epithelium, scarring in the substantia propria associ ated with plasmacytic and lymphocytic infiltration, and dilated lymphatic vessel s were noted. Excised corneal buttons disclosed absence of epithelium and Bowman ’s layer, fibrovascular pannus, stromal scarring, and vascularization. Conclusi ons: Mustard gas causes chronic and delayed destructive lesions in the ocular su rface and cornea, leading to progressive visu
