Role of PASCAL and optical coherence tomography angiograpgy in the treatment of diffuse unilateral subacute neuroretinitis caused by large live motile worm

A 46-year-old male presented with best corrected visual acuity (BCVA) of 20/125 in his right eye. Fundus showed disc edema, multiple yellow outer retinal crops, macular edema and a live motile worm in the subretinal space. Diagnosis of diffuse unilateral subacute neuroretinitis (DUSN) was made and pattern scanning laser photocoagulation (PSLP) was performed along with administration of oral albendazole, diethylcarbamazine and corticosteroids. Complete disappearance of the worm was observed at 2 weeks. At last follow up, final BCVA improved to 20/30. Herein, we report role of PSLP in the management of DUSN.

Lacan e o Deus-infinito de Pascal: considerações sobre a aposta pascaliana e o início de uma análise / Lacan and the God-infinite of Pascal: considerations about Pascal's wager and the beginning of a psychoanalysis treatment / Lacan y el Dios-infinito de Pascal: consideraciones sobre la apuesta de Pascal y el inicio de un análisis

O artigo tem como objetivo analisar a utilização que Jaques Lacan faz de um ponto específico da obra de Blaise Pascal, relacionado à aposta em um Deus-infinito. Lacan complementa o estudo da aposta pascaliana com uma referência à graça religiosa como momento inaugural de abertura ao infinito. A partir dessas considerações, sustenta-se a hipótese de que a aposta de Pascal pode ser aproximada à operação necessária para o início de uma análise. A aposta de Pascal coloca em jogo o infinito. Com a ajuda do filósofo Alain Badiou, tentaremos demonstrar que Lacan parte da mesma ideia ao considerar que não há abertura ao inconsciente - correlativa ao início de uma análise - sem alguma dimensão de infinitude

The article aims to analyze the use of a certain point in the work of Blaise Pascal, according to Jacques Lacan's, specifically about the wager on a God-infinite. Lacan complements the study of the Pascal's wager referring to the concept of the religious grace as the inaugural moment of opening to the infinite. From these considerations, the supported hypothesis is that Pascal's wager approaches the course necessary to the beginning of the psychoanalysis treatment. Pascal's wager puts infinite at stake. With the help of the philosopher Alain Badiou, we will try to demonstrate that Lacan shares the same idea when he considers that there is no opening to the unconscious - correlative to the beginning of an analysis - without some dimension of infinity

El artículo tiene como objetivo analizar la utilización que Jaques Lacan hace de un punto específico de la obra de Blaise Pascal, relacionada con apostar en un Dios-infinito. Lacan complementa el estudio de la apuesta de Pascal con una referencia a la gracia religiosa como momento inaugural de apertura al infinito. A partir de estas consideraciones se apoya la hipótesis de que la apuesta de Pascal se aproxima a la operación requerida para iniciar un análisis. La apuesta de Pascal pone en juego el infinito. Con la ayuda del filósofo Alain Badiou, trataremos de demostrar que Lacan parte de la misma idea al considerar que no hay apertura al inconsciente - correlativo al comienzo de un análisis- sin alguna dimensión de infinidad

Comparación en la medición de presión intraocular con los tonómetros de Goldmann, Pascal® y ORA (Ocular Response Analyzer) / Intraocular pressure measurement with Goldmann, Pascal and ORA tonometers

Introducción: el glaucoma es la principal causa de ceguera irreversible en el mundo, siendo la presión intraocular alta el factor de riesgo más importante para desarrollarlo, por eso la importancia de realizar una adecuada medición de la presión intraocular (PIO) durante el examen oftalmológico. Objetivo: evaluar la concordancia de la medida de la presión intraocular tomada con los tonómetros de Goldmann, Pascal® y ORA, en pacientes con glaucoma de la consulta externa del servicio de oftalmología del Hospital de San José. Diseño: estudio descriptivo, de corte transversal y concordancia. Métodos: se compararon las medidas de Goldmann corregido, Pascal® y ORA corregido en 90 pacientes (167 ojos) con diagnóstico de glaucoma que asisten a consulta de oftalmología del Hospital de San José. Resultados: el coeficiente de correlación y concordancia de Lin entre Goldmann corregido y Pascal® es de 0.61; entre Goldmann corregido y ORA corregido de 0.64 y entre Pascal® y ORA corregido de 0.81. Conclusiones: se encontró una concordancia moderada para los tres tonómetros en la medición de la PIO en los ojos con glaucoma del servicio de oftalmología del Hospital de San José. Los tres métodos no son reemplazables, por lo tanto el seguimiento de los pacientes siempre debe ser tomado con un mismo método.

Introduction: glaucoma is the leading cause of worldwide irreversible blindness, high intraocular pressure remains the most important risk factor; because of that, it is essential to measure accurately the intraocular pressure (IOP). Objective: to evaluate the intraocular pressure correspondence of Goldmann-correlated IOP, Pascal® dynamic contour tonometer and Reichert Ocular Response Analyzer ORA tonometers in patients with glaucoma diagnosis at Ophthalmology Service, Hospital de San José. Design: a descriptive, cross-sectional and matching. Methods: measurements of Goldmann correlated IOP, Pascal® and ORA corneal compensated IOP were compared, in patients (167 eyes) diagnosed with glaucoma attending at ophthalmology Hospital San José. Results: the correlation coeffi cient and concordance Lin between Goldmann correlated IOP and Pascal® is 0.61; between ORA and Goldmann correlated IOP is 0.64 and between Pascal® and ORA is 0.81. Conclusions: we found a moderate agreement for the three tonometers for measuring IOP in eyes glaucoma attending at ophthalmology Hospital San José. The three methods are not replaceable, therefore monitoring of patients should always be taken with the same method.

Short-Term Clinical Outcomes of Laser Trabeculoplasty Using a 577-nm Wavelength Laser

PURPOSE: To evaluate the pressure-lowering effects of single-spot laser trabeculoplasty and patterned laser trabeculoplasty using a 577-nm wavelength laser. METHODS: A total 35 eyes of 35 patients with primary open-angle glaucoma were enrolled in this study. Eighteen eyes of 18 patients were treated with 360degrees single-spot laser trabeculoplasty and 17 eyes of 17 patients were treated with 360degrees patterned laser trabeculoplasty. All patients were evaluated after laser trabeculoplasty at 1 week, 1 month, 3 months, and 6 months using slit lamp examination and Goldmann applanation tonometry. RESULTS: At 6 months postoperatively, the single-spot laser trabeculoplasty group had a mean IOP of 15.89 +/- 3.89 mm Hg with a mean IOP reduction of 37.1%, while the patterned laser trabeculoplasty group had a mean IOP of 17.57 +/- 2.64 mm Hg with a mean IOP reduction of 27.1%. CONCLUSIONS: Laser trabeculoplasty with a 577-nm optically pumped semiconductor laser was safe and demonstrated an IOP lowering effect. There were no significant differences in the IOP lowering effects between the single-spot laser trabeculoplasty and the patterned laser trabeculoplasty.

A justificação do inconsciente e a aposta de Pascal / The justificacion of the inconscious and Pascal's wager

O presente artigo busca apreender a importância da justificação freudiana do inconsciente para a definição do estatuto da Psicanálise. Um exame do objeto, da motivação e dos momentos argumentativos dessa justificação evidencia que a prova da existência do inconsciente intentada nela não se conforma ao modelo de demonstração empírica perseguido por Freud. Trata-se, antes, de uma demonstração pragmática, procedimento semelhante ao utilizado por Pascal na sua aposta em favor da existência de Deus. Contudo, essa similaridade não implica que a Psicanálise seja um saber especulativo: a admissão do inconsciente, embora não inteiramente justificável empiricamente, mostra-se como a condição da experiência analítica.

The present article seeks to apprehend the importance of Freud’s justification of the unconscious for defining the status of psychoanalysis. Examining subject, motivation and argumentative steps of this justification, reveals that the intended proof of the existence of the unconscious doesn’t conform itself to the model of empirical demonstration pursued by Freud. His proceeding is rather a pragmatic demonstration, similar to the one used by Pascal in his wager in favour of God’s existence. However, this similarity doesn’t mean that psychoanalysis is equal to speculative knowledge: the admission of the unconscious, although empirically not entirely justifiable, reveals itself as the condition of analytical experience.

Experience with the Pascal® photocoagulator: An analysis of over 1200 laser procedures with regard to parameter refinement.

Aim: To systematically refine and recommend parameter settings of spot size, power, and treatment duration using the Pascal® photocoagulator, a multi-spot, semi-automated, short-duration laser system. Materials and Methods: A retrospective consecutive series with 752 Caucasian eyes and 1242 laser procedures over two years were grouped into, (1) 374 macular focal / grid photocoagulation (FP), (2), 666 panretinal photocoagulation (PRP), and (3) 202 barrage photocoagulation (BP). Parameters for power, duration, spot number, and spot size were recorded for every group. Results: Power parameters for all groups showed a non-gaussian distribution; FP group, median 190 mW, range 100 – 950 mW, and PRP group, median 800 mW, range 100 – 2000 mW. On subgroup comparison, for similar spot size, as treatment duration decreased, the power required increased, albeit in a much lesser proportion than that given by energy = power × time. Most frequently used patterns were single spot (89% of cases) in FP, 5 × 5 box (72%) in PRP, and 2 × 2 box (78%) in BP. Spot diameters as high as ≈ 700 μm on retina were given in the PRP group. Single session PRP was attempted in six eyes with a median spot count of 3500. Conclusion: Overall, due to the small duration of its pulse, the Pascal® photocoagulator tends to use higher powers, although much lower cumulative energies, than those used in a conventional laser. The consequent lesser heat dissipation, especially lateral, can allow one to use relatively larger spot sizes and give more closely spaced burns, without incurring significant side effects.

Effect of Focal and Grid Pattern PASCAL Photocoagulation Treatment in Diabetic Macular Edema

PURPOSE: To investigate the effect of focal and grid pattern PASCAL photocoagulation treatment in diabetic macular edema patients. METHODS: A total of 72 patients (75 eyes) who were diagnosed as diabetic macular edema were retrospectively analyzed. The patients were divided into 3 groups as follows: group 1 (31 patients, 31 eyes) received an intravitreal bevacizumab injection, group 2 (17 patients, 20 eyes) underwent focal and grid pattern PASCAL photocoagulation treatment, and group 3 (24 patients, 24 eyes) underwent focal and grid pattern argon photocoagulation treatment. Macular thickness and visual acuity (logMAR) of 75 eyes were compared among groups before and after treatments. RESULTS: Visual acuity improved in 13 eyes (65.0%) in group 1, 16 eyes (51.6%) in group 2, and in 10 eyes (41.6%) in group 3; however, there was no statistical significance. Macular thickness reduction occurred in 24 eyes (77.4%) in group 1 and 13 eyes (65.0%) in group 2 which were statistically significant decreases at only 1 month after treatment (p < 0.05). CONCLUSIONS: Focal and grid pattern PASCAL photocoagulation is a good therapeutic option for diabetic macular edema. Focal and grid pattern PASCAL photocoagulation is as effective as intravitreal bevacizumab injection or focal and grid pattern argon photocoagulation treatment.

Cruces entre ciencia y literatura: Freud y Zola: familia, sexo y redención / Convergences between science and literature: Freud and Zola: family, sex and redemption

En numerosas oportunidades Sigmund Freud se refirió al novelista Émile Zola. En 1900 dictó una conferencia acerca de una de las novelas del escritor francés y en 1906 se refirió positivamente a sus ficciones en un pequeño escrito. El presente trabajo intenta justificar la existencia de un entrecruzamiento entre las producciones de ambos pensadores. Para tal fin, se analizan en detalle diversas novelas, sobre todo Fécondité, La Bête Humaine y Le Docteur Pascal, al tiempo que se mencionan brevemente otras páginas del autor de Les Rougon-Macquart. Prescindiendo de consideraciones biográficas, el escrito propone que hay una homogeneidad entre algunas de las preocupaciones y temas que recorren las páginas de Freud y Zola. En tal sentido, se sugiere que sendos pensadores produjeron enunciados, científicos y ficcionales, tendientes a narrar y describir una serie de temáticas que se ligan a la institución familiar. En consonancia con ello, el texto señala la forma en que ciertas tesis referidas al sexo, los antepasados y la herencia, vertebran las obras de ambos escritores.

Tonometría Goldmann versus tonometría de Pascal en pacientes poscirugía refractiva con LASIK / Results of Goldman tonometry vs Pascal tonometry in patients after the refractive surgery with LASIK

Comparar las cifras de presión intraocular obtenidas mediante el tonómetro de aplanación de Goldmann y el tonómetro de contorno dinámico de Pascal, así como la variación del espesor corneal central, antes y después de la cirugía refractiva con LASIK y así establecer la relación entre los dos tonómetros. Se estudiaron 74 pacientes (140 ojos), mayores de 21 años, con miopía estable (de -1 dioptrías a -10 dioptrías), defecto cilíndrico inferior a -3 dioptrías y espesor corneal central menor de 480 micras. Los pacientes fueron intervenidos con excímer láser (técnica de LASIK), en el Servicio de Cirugía Refractiva del Instituto Cubano de Oftalmología Ramón Pando Ferrer, de diciembre de 2006 a marzo de 2007, con un seguimiento posoperatorio de 1 a±o, aunque se estimó el comportamiento de las variables al mes de la cirugía. Predominó discretamente el sexo femenino, el grupo de edad de 21 a 39 años constituyó el 81 por ciento, y la miopía moderada en 74 ojos el 52,8 por ciento. El valor de la presión intraocular con tonómetro de contorno dinámico superó al obtenido con el de Goldmann en 2 mm Hg en el preoperatorio y en 3,7 mm Hg en el posoperatorio. Se correlacionó la variación del espesor corneal posterior al LASIK y la presión intraocular según el tonómetro utlizado. Los valores de la presión con el tonómetro de Pascal son mßs confiables que los obtenidos con el tonómetro de aplanación de Goldmann, cuando el espesor corneal central se aleja de lo estipulado como normal.

To compare the intraocular pressure figures obtained with Goldman applanation tonometer and with Pascal dynamic contour tonometer, as well as the central corneal thickness variation before and after the refractive surgery with LASIK, and to set the relationship between both tonometers. Seventy four patients (140 eyes) aged over 21 years, with stable myopia (-1 to -10 dioptres), cylinder defect lower than-3 dioptres and central corneal thickness under 480 microns. The patients were operated on using Excimer laser (LASIK technique) at the Refractive Surgery Service of Ramón Pando Ferrer Cuban Institute of Ophthalmology in the period from December, 2006 to March 2007; then they were followed up for one year, even though the variables were estimated one month after surgery. Females slightly predominated; the 21-39 years age group represented 81 percent of cases and moderate myopia present in 74 eyes accounted for 52,6 percent of the total number. The intraocular pressure value taken with the dynamic contour tonometer was higher than that of the Goldmann tonometer by 2 mm Hg in the preoperative phase and by 3,7 mm Hg in the postoperative phase. The corneal thickness variation after surgery with LASIK and the intraocular pressure according to the used tonometer were correlated. The figures of intraocular pressure measured with Pascal tonometer are more reliable than those obtained with Goldmann applanation tonometer, whenever the central corneal thickness is not within the set normal value range.

Measurements of Dynamic Contour Tonometry After Penetrating Keratoplasty and EpiLASIK

PURPOSE:To analyze the clinical results of Goldmann applanation tonometry (GAT) and Pascal dynamic contour tonometry (PDCT) and the influences of central corneal thickness and keratometric power in eyes that underwent EpiLASIK or penetrating keratoplasty. METHODS: Measurements of intraocular pressure by GAT and PDCT as well as keratometric power and central corneal thickness were measured in 45 eyes that underwent penetrating keratopasty and 63 eyes that underwent EpiLASIK. These parameters were also measured in healthy eyes with no specific disorders to create a control group. RESULTS: In the keratoplasty group, the PDCT results were significantly higher than the GAT results by 1.22+/-2.84 mmHg (p=0.006), but neither method showed a significant correlation with CCT or keratometric power. In the EpiLASIK group, PDCT was higher as 3.45+/-2.35 mmHg than GAT, and the corrected results of GAT were not different from the results of PDCT. In the control group, GAT was affected by central corneal thickness and keratometric power, but PDCT showed no significant relationship with these two factors. CONCLUSIONS: After EpiLASIK or penetrating keratoplasty, both of which change CCT and keratometric power, IOP cannot be accurately measured by GAT. In these patients, PDCT may play an important clinical role since it is less affected by corneal properties.

Intraocular Pressure Measurements Using Dynamic Contour Tonometer After Photorefractive Keratectomy

PURPOSE: To assess the performance of the dynamic contour tonometer (DCT) in eyes undergoing excimer laser photorefractive keratectomy (PRK). METHODS: Intraocular pressure (IOP) was measured in 30 eyes after first time excimer laser PRK pre and three months post operatively using Goldmann applanation tonometer (GAT), noncontact air tonometer (NCT), and the DCT. RESULTS: There was significant correlation between central corneal thickness (CCT) and IOP measurements by GAT and NCT (CCT vs GAT: r2=0.31, p<0.01, CCT vs NCT: r2=0.39, p<0.01). However, the correlation between CCT and IOP measurements by DCT was not significant (CCT vs DCT: r2=0.14, p=0.32). After PRK, the mean change in CCT and IOP measurements using GAT, NCT, DCT were 73.70+/-26.92 micrometer (mean+/-SD), 2.43+/-2.86 mmHg (p<0.01), 3.83+/-2.34 mmHg (p<0.01) and 0.44+/-1.51 mmHg (p=0.125), respectively. The preoperative and postoperative DCT measurements did not differ significantly. CONCLUSIONS: The reduction in CCT induced by PRK doesn't appear to influence DCT measurements; therefore, DCT may be better suited over GAT or NCT for monitoring IOP in eyes that underwent refractive surgery.

Rupture of the Giant Vertrbrobasilar Aneurysm After Hunterian Vertebral Artery Occlusion / 대한뇌혈관외과학회지

A 32-year-old woman with a giant vertebrobasilar junction aneurysm underwent a Hunterian coil occlusion. Two months later she was readmitted with aggravation of her previous symptoms. Shortly after the admission, fatal bleeding occurred. She underwent emergency surgery and the aneurysm was trapped by clipping at the vertebrobasilar junction; however, she died. For treating unclippable giant vertebrobasilar aneurysms, proximal vertebral occlusion is an alternative. By occluding the proximal parent artery, we expect reduced inflow of blood into the aneurysm and thereby induce intra-aneurysmal thrombus formation. Based on the experience with this patient in which the hemodynamics resulted in continued pressure on the inner wall of the giant aneurysm, we postulate that Pascal's law might play a role in the rupture of a giant aneurysm after Hunterian occlusion.

Unidades de pressão usadas em pneumologia, terapia intensiva e anestesia / Units of pressure used in pulmonary medicine, intensive care units and anesthesia

Existem mais de oito unidades de pressão, sendo seis de uso mais rotineiro em ambientes hospitalares: pascal (Pa), cmH2O, mmHg, psi, kgf/cm2 e bar. Esta diversidade dificulta o médico quando ele necessita converter unidades para interpretar um resultado. Nosso objetivo é enfocar a atenção do médico pneumologista, intensivista ou anestesista para as várias unidades de pressão, de uso comum em ambientes hospitalares, indicar modos de grafia destas unidades, propor métodos mnemônicos de conversão e demonstrar a importância do uso de apenas uma só unidade internacional de pressão, o pascal (Pa). O CONMETRO, órgão normalizador das unidades de medida sem uso no Brasil, determina e adota o uso do pascal (Pa) - unidade de pressão do Sistema Internacional de Unidades (SI) - e admite temporariamente o uso de outras unidades como atmosfera, bar e mmHg (Torr), embora não cite as unidades psi, kgf/cm2 ou cmH2O amplamente utilizadas em aparelhos hospitalares. Este Órgão legisla também sobre a grafia das unidades de pressão. As unidades depressão podem ser convertidas com o uso de regra de três e o endereço da Internet: http://www.webcalc.com.br pode ser consultado para conversão rápida. Fato importante é que os aparelhos médicos pneumáticos são padronizados para serem conectados em sistema de pressão de 3,45kgf/cm2, o que equivale a ~50psi ou 338kPa. Concluímos que o uso de múltiplas unidades de pressão traz para o médico diversas dificuldades de interpretação. A adoção do pascal (Pa) e seus múltiplos, como única unidade internacional de pressão vai unificar a linguagem médica. Esta adoção tem que ser gradativa considerando-se o grande número de aparelhos médicos em utilização. A única exceção será a permanência da unidade mmHg para medidas de pressão arterial.