[Visual Impairment and Eye Diseases in St. Louis, Senegal]. / Déficience Visuelle et Pathologies Oculaires À Saint-Louis, Sénégal.

Background: Few epidemiological data describe the prevalence of blindness and visual impairment in Senegal. Data from West African studies estimate blindness prevalence between 1.2 - 3.4% and that of visual impairment between 10.4 - 17.1%. IRIS Mundial (IM) is a non-governmental organization collaborating with l'Association St-Louisienne pour la Vue (ASV) to develop eye care in Senegal. Objective: Describe the relative importance of and causes of blindness and visual impairment in a population consulting for vision problems in the Senegalese region of St. Louis, to assist in planning of relevant eye care programs. Methods: Results from eye exams carried out by a team from IM in 2018 have been complied and analyzed. Results: In all, 1944 patients were examined (56.5% female). Some 25.7% of patients presented a visual impairment (22.5% moderate; 3.2% severe). Regarding refractive error, 15.3% of patients had myopia, 10.7% had hyperopia, 54.8% had astigmatism and 55.8% were presbyopic. Clinically significant cataracts is present in 17.4% of patients and glaucoma in 2.5%. Conclusion: Our data give a glimpse of the prevalence of visual impairment and ocular disease in St. Louis, Senegal. Uncorrected refractive error, cataracts and glaucoma are present in this population and may guide the planning of relevant eye care interventions.

Influence of Induced Blood Pressure Variability on the Assessment of Cerebral Autoregulation in Patients after Cardiac Arrest.

OBJECTIVE: To determine if increasing variability of blood pressure influences determination of cerebral autoregulation. METHODS: A prospective observational study was performed at the ICU of a university hospital in the Netherlands. 13 comatose patients after cardiac arrest underwent baseline and intervention (tilting of bed) measurements. Mean flow velocity (MFV) in the middle cerebral artery and mean arterial pressure (MAP) were measured. Coefficient of variation (CV) was used as a standardized measure of dispersion in the time domain. In the frequency domain, coherence, gain, and phase were calculated in the very low and low frequency bands. RESULTS: The CV of MAP was significantly higher during intervention compared to baseline. On individual level, coherence in the VLF band changed in 5 of 21 measurements from unreliable to reliable and in 6 of 21 measurements from reliable to unreliable. In the LF band 1 of 21 measurements changed from unreliable to reliable and 3 of 21 measurements from reliable to unreliable. Gain in the VLF and LF band was lower during intervention compared to baseline. CONCLUSIONS: For the ICU setting, more attention should be paid to the exact experimental protocol, since changes in experimental settings strongly influence results of estimation of cerebral autoregulation.

Cerebral Perfusion and Cerebral Autoregulation after Cardiac Arrest.

Out of hospital cardiac arrest is the leading cause of death in industrialized countries. Recovery of hemodynamics does not necessarily lead to recovery of cerebral perfusion. The neurological injury induced by a circulatory arrest mainly determines the prognosis of patients after cardiac arrest and rates of survival with a favourable neurological outcome are low. This review focuses on the temporal course of cerebral perfusion and changes in cerebral autoregulation after out of hospital cardiac arrest. In the early phase after cardiac arrest, patients have a low cerebral blood flow that gradually restores towards normal values during the first 72 hours after cardiac arrest. Whether modification of the cerebral blood flow after return of spontaneous circulation impacts patient outcome remains to be determined.

Prevalence of eye disease and visual impairment in Île de la Gonave, Haïti.

Epidemiological data describing the prevalence of blindness and visual impairment in Haiti are sparse. The Haitian National Committee for the Prevention of Blindness (CNPC) estimates the prevalence of blindness at 1 %. Other regional data estimate moderate and severe visual impairment at 5% and 22%, respectively. IRIS Mundial (IM) is a non-governmental organization collaborating with the CNPC to develop eye care infrastructure in Haiti. To estimate the prevalence and causes of blindness and visual impairment on the Haitian island of Gonâve, to assist in planning of relevant eye care infrastructure. Results from eye exams carried out by a team from IM in January 2013 have been compiled and analyzed. In all, 1724 patients were examined (38% men, 62% women). In the best eye, 87% of patients had visual acuity, 6% had moderate visual impairment, and 7% had severe visual impairment. Moreover, 1% of patients had high myopia, 1% high hyperopia, 1% high astigmatism, and 32% were presbyopic. Clinically significant binocular cataracts were found in 1.5 % of patients, while 2 % were diagnosed with probable glaucoma. Our data give a glimpse of the prevalence of visual impairment and ocular disease on Gonâve Island in Haiti. Uncorrected refractive error, cataracts, and glaucoma are confirmed as prevalent conditions in this population and their presence should guide the planning of relevant eye care interventions.

Low spontaneous variability in cerebral blood flow velocity in non-survivors after cardiac arrest.

OBJECTIVE: To investigate spontaneous variability in the time and frequency domain in mean flow velocity (MFV) and mean arterial pressure (MAP) in comatose patients after cardiac arrest, and determine possible differences between survivors and non-survivors. METHODS: A prospective observational study was performed at the ICU of a tertiary care university hospital in the Netherlands. We studied 11 comatose patients and 10 controls. MFV in the middle cerebral artery was measured with simultaneously recording of MAP. Coefficient of variation (CV) was used as a standardized measure of dispersion in the time domain. In the frequency domain, the average spectral power of MAP and MFV were calculated in the very low, low and high frequency bands. RESULTS: In survivors CV of MFV increased from 4.66 [3.92-6.28] to 7.52 [5.52-15.23] % at T=72h. In non-survivors CV of MFV decreased from 9.02 [1.70-9.36] to 1.97 [1.97-1.97] %. CV of MAP was low immediately after admission (1.46 [1.09-2.25] %) and remained low at 72h (3.05 [1.87-3.63] %) (p=0.13). There were no differences in CV of MAP between survivors and non-survivors (p=0.30). We noticed significant differences between survivors and non-survivors in the VLF band for average spectral power of MAP (p=0.03) and MFV (p=0.003), whereby the power of both MAP and MFV increased in survivors during admission, while remaining low in non-survivors. CONCLUSIONS: Cerebral blood flow is altered after cardiac arrest, with decreased spontaneous fluctuations in non-survivors. Most likely, these changes are the consequence of impaired intrinsic myogenic vascular function and autonomic dysregulation.

[Drug-induced cataracts]. / Les cataractes d'origine médicamenteuse.

The fact that corticosteroids, phenothiazines and myotics induce cataract is well known. Moreover some informations about lens opacities have been reported less frequently after the use of cytostatics, deferoxamine, phenytoine, isotretinoine, oral contraceptives, allopurinol, synthetics antimalarial agents, diazepam, tetracyclines and sulfamides. Occasionally some others drugs have been suspected from experimental observations to produce cataract. Amongst all these drugs, corticosteroids are the most often incriminated.

[Infectious complications of corneal surgery]. / Complications infectieuses de la chirurgie cornéene.

The frequency of infectious complications after corneal surgery depend on the type of surgery: after trauma and perforations, corneal graft and perforations, and thus the previous status of the eye, surgical care and patient follow-up.

[Captopril test for detecting renal artery stenosis: changes in plasma renin concentration]. / Test au captopril en vue de la détection d'une sténose de l'artère rénale: variations de la concentration en rénine plasmatique.

The aim of this study was to demonstrate the diagnostic value of changes in active renin concentration during the captopril test (measurements of plasmatic active renin concentrations, before 12.5 or 37.5 mg of captopril p.o., and 30 and 90 minutes after) in order to screen a significant renal artery stenosis. After a renal angiography, 88 hypertensive patients suspected of renovascular hypertension were classified according to the percentage of stenosis in the main renal artery: class I (< 30% - n = 50), II (30 to < 75% - n = 21), III (75 to < 90% - n = 8) and IV (90 to 100% - n = 11). The results of the captopril test were compared to those of renal angiography. The active renin before the test (basal AR), the greater increase in active renin after captopril (max AR), the difference between max AR and basal AR (DIF) and the active renin relative change after the test (RC) were compared in the 4 classes (ANOVA). There were no differences in diastolic blood pressure (> or = 90 mmHg) natriuresis (100 mmol/24 h in mean) between these different classes. The basal AR, the max AR, the DIF and the RC significantly differed between the 4 classes. They were greater in class III and IV than in class I. The positive criteria for the captopril test were max AR, DIF and RC. The positivity thresholds were max AR > or = 70 ng/l, DIF > or = 50 ng/l and RC > or = 165% (upper limit in the class I 95% confidence interval for each criterion).(ABSTRACT TRUNCATED AT 250 WORDS)

[Patients with high spinal cord injuries: evaluation of diaphragmatic function, indication of electrophrenic ventilation]. / Traumatisé médullaire haut: évaluation de la fonction diaphragmatique, indication de la ventilation électrophrénique.

Electrophrenic Respiration (REP) is a technic specially reserved to the patients with a first motoneuron disease but having moreover normal phrenic nerve, diaphragm and lungs. Electrical pulse trains are applied to the phrenic nerve by a surgically implanted electrode. They produce rhythmic inspiratory diaphragm contractions; expiratory time is passive. The energy is delivered by a transcutaneous radiofrequency external pacer. Before to decide to implant a REP device, it should be wait for a sufficient time to avoid either a possible return to a spontaneous breathing or, on the contrary, a peripheral nerve disease initially unrecognized. After regularly repeated external detection exams, surgery must be done gently on a stabilised patient, out of infection and, if possible, without intellectual trouble. The training needs a long time (many months) since to become fatigue-resistant a paced muscle must be trained progressively and durably. In that way the results are generally good, as the 13 patients we have implanted may give an evidence.

[Phrenic stimulation in respiratory paralysis caused by spinal cord injuries]. / La stimulation phrénique dans les paralysies respiratoires des traumatismes médullaires.

Phrenic stimulation is reserved for the rare patients with central neurogenic apnea due to isolated upper spinal cord injuries. Presenting a series of ten cases the authors describe the indications for phrenic stimulation, the technique of implantation and the conditions for diaphragmatic training by the use of stimulation by low frequency trains allowing for an increase in the number of low muscular fibers. The continuation of accompanying neurological rehabilitation and nursing of these severely handicapped patients is not to be neglected because of the length of the training protocole as the aim is their return home. This technique, therefore, seems particularly suitable for application in a few specialized centers where research for material totally implantable and adapted to the physiological requirements of the patient can be conducted parallel to treatment.

[Primary hyperparathyroidism. Apropos of 102 recent exploratory cervicotomies: diagnostic and clinical pitfalls]. / Hyperparathyroïdisme primaire. A propos de 102 cervicotomies exploratrices récentes: pièges diagnostiques et cliniques.

The authors report on various diagnostic pitfalls on 102 patients having undergone exploratory cervicotomy for primary hyperparathyroidism. A false positive diagnostic error was made on 2% of the cases, bringing to 100 the number of patients with a confirmed diagnosis of primary hyperparathyroidism. False negative diagnosis was made on 4% of the patients: two late diagnoses leading to an acute toxic state and death postoperatively in both cases; two pure psychiatric variants leading to repetitive hospitalizations in psychiatry. Error in diagnosis because of a masking effect was made in 4% of the cases:--one association with a clear cell nephro--epithelioma--one association with a multiple myeloma--two associations with a benign monoclonal gammapathy. The absence of hypercalcemia, a diagnostic pitfall in the modern form of this disease was found in 7% of the cases. PTH hypersecretion which is virtually a constant finding in the normocalcemic form of the disease obviates in most cases the need of a bone biopsy and quantitative histomorphometric analysis. The association with another endocrinopathy was found in 12% of the cases (2 MEN I, 1 MEN II, 9 hyperthyroidism). Because of its high frequency in the aged (22% greater than 75 years) the diagnosis of this disease is difficult for its signs are mimicked as well by the aging process. The preoperative topographic diagnostic error is avoided since there doesn't seem to be any test which would preclude the normal surgical procedure of carefully exploring all 4 topographic sites of the parathyroid. Surgical errors can be numerous but minimized with the increasing experience of the operator. Histological errors are seen mainly in the normocalcemic variety where only electron microscopy can detect the typical signs of cellular hyperactivity.

[MRI study of parathyroid adenoma. Value of T2-weighted sequences]. / Exploration IRM de l'adénome parathyroïdien. Intérêt des séquences pondérées en T2.

The authors report a series of 22 patients operated for primary hyperparathyroidism. The parathyroid adenoma was located preoperatively by MRI and ultrasonography. Measurement of the relaxation time was performed in vitro at 37 degrees C in a 0.47 Tesla field during the 30 minutes following resection. The relaxation times obtained at a precession frequency of 20 mHz were 0.844 +/- 0.16 sec for T1 and 0.082 +/- 0.025 sec for T2. MRI had a sensitivity of 73% and a specificity of 88% for the localization of the parathyroid adenoma, while ultrasonography had a sensitivity of 73% and a specificity of 98%.

Chronic vegetative state after severe head injury: clinical study; electrophysiological investigations and CT scan in 15 cases.

Fifteen cases of chronic vegetative state (CVS), following severe head injury and lasting for two years or more, are reported. Vegetative state, in most instances after a period of coma, consists of a return of wakefulness accompanied by an apparent total lack of higher mental activity. A protracted period of vegetative state has been chosen to ensure that the possibility of further recovery could virtually be excluded. The term of CVS could therefore be reasonably used to designate these cases. Moreover, cerebral lesions were then thought to be the same as in neuropathological studies. Severe head injury, responsible for CVS, initially affected adults in 11 cases and children in four cases. The range of duration of the vegetative state was 2 to 14 years, with a mean of five years. The data of clinical study and electrophysiological investigations (EEG, brain stem auditory evoked potentials, somatosensory evoked potentials) are reported. A CT scan was carried out in each case to study the impairment of cerebral hemispheres and brain stem, with particular attention to the ventricular size. The results confirm that in the CVS, lesions affect mainly the hemispheres, while brain stem functions are mainly preserved. Vegetative State (VS) is the term proposed by Jennett and Plum (1972) to describe the condition that sometimes emerges after a period of coma, after a severe head injury (SHI). This condition consists of a return of wakefulness accompanied by an apparent total lack of higher mental activity. A practical definition of this state characterised by wakefulness without responsiveness is that the eyes open spontaneously and/or in response to verbal stimuli. Sleep-wake cycles exist. The patients can neither obey simple orders nor locate painful stimuli. They utter no comprehensible words. Blood pressure and breathing remain steady. It is much more difficult to specify exactly how long such a state must persist before it can be confidently declared permanent. Persistent vegetative state, or chronic vegetative state (CVS) is one of the five categories of the Glasgow Outcome Scale (Jennett and Bond, 1975). Bricolo et al (1980) think that the term CVS should never be applied before completion of the first year after the onset of traumatic coma. It actually seems possible to exclude the possibility of any further recovery after unresponsiveness for one year. The term CVS may then be rightfully used to denote this condition. For such protracted periods of VS, we have tried to state in a retrospective study the clinical and electroencephalographic (EEG) course.(ABSTRACT TRUNCATED AT 400 WORDS)

[Does echography contribute to the diagnosis and treatment of acute unknown, tied or bilateral torsion of testis?]. / L'échographie apporte-t-elle quelque chose dans le diagnostic et le traitement des torsions aiguës méconnues, unies ou bilatérales du testicule?

The authors present three cases of testicular torsion lately seen after a mistaken diagnosis. The interpretation of scrotal ultrasonographic examination was difficult. The authors insist to a carefully interpretation of an ultrasonographic examination in this cases particularly.