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001-es BibID:BIBFORM030314
Első szerző:Nagy Endre V. (belgyógyász, endokrinológus)
Cím:Graves' ophthalmopathy : eye muscle involvement in patients with diplopia / Endre V. Nagy, Judit Toth, Ildiko Kaldi, Judit Damjanovich, Emese Mezosi, Agota Lenkey, Laszlo Toth, Jeno Szabo, Zsolt Karanyi, Andras Leovey
Megjegyzések:Background: Diplopia identifies patients with eye muscle involvement in Graves' ophthalmopathy (GO).Objective: To identify clinical parameters that could eliminate the need for magnetic resonance imaging(MRI) to assess the activity of inflammation in the eye muscles of GO patients with diplopia.Methods: In 43 patients with GO with recently developed diplopia, orbital ultrasound and MRI wereperformed. Muscle diameters and MRI T2 relaxation times were measured, and the amount of orbitalconnective tissue was calculated from MRI scans and compared with ultrasound readings, diplopiagrades, degree of protrusion, ocular pressure, tear production, antibody levels and hormonalparameters of thyroid function.Results: No correlation was found between diameters of 233 extraocular muscles measured by MRIand by ultrasound. For each of the four muscles, there was a diameter above which ultrasound wasalways unreliable. MRI data were used in further analysis. Of the muscles examined, the inferiorrectuses were the most frequently enlarged ? at least one, in 93% of cases. Medial, lateral and superiorrectuses were enlarged in 59%, 37% and 34% of the orbits respectively. The pattern of muscleinvolvement of the two orbits tended to be symmetric (r?0.49, P?0.003), particularly for the medialrectuses (r?0.90, P?0.000). Proptosis correlated with the sum of the muscle diameters for a giveneye (right eye: r?0.54, P?0.003; left eye: r?0.57, P?0.001), but it failed to correlate with theamount of orbital connective tissue. In 53% of the patients, normal T2 relaxation times were found inall eight muscles. There was only a weak correlation between muscle thickness and T2 relaxation time(r?0.49, P?0.003), indicating that muscle enlargement alone is not a sign of disease activity. Theseverity of diplopia was independent of T2 relaxation time. The amount of orbital connective tissueshowed a negative correlation with the greatest T2 relaxation time for a given eye (r? ?0.52,P?0.004); this suggests that disease types exist that have predominant muscle involvement andpredominant connective tissue expansion. No correlation between connective tissue expansion andproptosis, diplopia grade, muscle thickness or disease duration was found ? that is, connective tissueexpansion is not a major factor in diplopia. Both muscle and connective tissue findings wereindependent of thyroid function.Conclusion: Ultrasound and MRI eye muscle diameter readings do not correlate, because of the inherentinaccuracy of orbital ultrasound. Muscle enlargement alone does not mean oedematous swelling andactive disease. Neither ultrasound, nor any combination of 11 clinical and laboratory parametersprovided the degree of information on muscles and connective tissue that was obtainable by MRI. Inunclear cases of recently developed diplopia, before orbital decompression surgery, in the case oftreatment failure or if, for any other reason, imaging is needed in GO, MRI is the method of choice.
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
egyetemen (Magyarországon) készült közlemény
Megjelenés:European Journal of Endocrinology. - 142 : 6 (2000), p. 591-597. -
További szerzők:Tóth Judit Káldi Ildikó (szemész) Damjanovich Judit (1963-) (szemész) Mezősi Emese Lenkey Ágota (1944-) (biológus) Tóth László (1957-) (fül-orr-gégész) Szabó Jenő (belgyógyász, endocrinologus) Karányi Zsolt (1961-) (biostatisztikus, bioinformatikus) Leövey András (1926-) (belgyógyász)
Internet cím:Intézményi repozitóriumban (DEA) tárolt változat
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