Outcome for bilateral cochlear implantation in patients with congenital Cytomegalovirus infection.

OBJECTIVES: To analyze the impact of bilateral cochlear implantation (CI) on perceptual and linguistic development in hearing-impaired children with congenital Cytomegalovirus (CMV) infection. PATIENTS AND METHOD: A retrospective study was performed for the period 1991-2016 in a pediatric CI reference center. Closed Set Word (CSW) recognition scores, Categories of Auditory Performance (CAP) and linguistic level on the MT Lenormand scale (MTL) were compared between bilateral (Bi) and unilateral (Uni) groups 12, 24 and 36 months after first CI (CI-1). RESULTS: 84 patients with congenital CMV infection who underwent CI were included, in 2 groups: sequential or simultaneous bilateral CI (Bi) (N=20), and unilateral CI (Uni) (N=64). Twelve, 24 and 36 months after CI-1, CSW scores were 35.56%, 64.52% and 82.93% in Uni and 60.3%, 85% (P=0.0084*), and 100% (P=0.00085*) in Bi. CAP scores 12, 24 and 36 months after CI-1 were 2.57, 3.85 and 4.3 in Uni and 3.91 (P=0.0068*), 5.00 (p=0.029*) and 5.50 (P=0.051*) in Bi. MTL linguistic level scores at 12, 24 and 36 months were 0.72, 1.25 and 1.65 in Uni, and 1.72, 3 (P=0.033) and 3.11 (P=0.045) in Bi. These significantly better scores in Bi at 24 and 36 months after CI-1 were also found on analysis of subgroups with no associated neurologic disorder (P=0.046* and P=0.032*), no associated psychiatric pathology (P=0.0055* and P=0.0073*), and no other associated disorder (P=0.0018* and P=0.035*), and for all subgroups together (P=0.0036 and P=0.037). CONCLUSION: Bilateral CI is a faster way than unilateral CI for patients with congenital CMV infection to achieve structured fluent oral language. 50% of the series showed cerebral abnormalities on MRI, without difference between groups. This was not in itself predictive of poor progression of oral communication, unless associated with major neurologic disorder. Some children made little or no use of their CI in the medium term.

[Influenza A H1N1 in neonatal intensive care unit: analysis and lessons]. / Grippe A H1N1 en unité de néonatologie : analyse et enseignements.

Since WHO announced the flu-like pandemic H1N1v in autumn 2009, data on clinical presentation and treatment of H1N1v infection in preterm infants with oseltamivir remain scarce. We cared for four infected preterm infants and ordered prophylactic treatment with oseltamivir in 13 additional contact preterm infants. A number of lessons can be drawn from this experience. The first two cases in twins were revealed by an increase in the number of apnea and one infant required mechanical ventilation. Cough was the major symptom in the two other infected infants. No digestive intolerance was observed among the 17 preterm infants during oseltamivir treatment. Polymerase chain reaction (PCR) quickly determined whether an infant was infected, making it helpful in deciding on initial containment. PCR remained positive, whereas culture became negative. Therefore, culture appeared to be more relevant in deciding on the end of containment. Follow-up of the four infected infants showed their ability to develop immunity against H1N1v.

Relativistic quasimonoenergetic positron jets from intense laser-solid interactions.

Detailed angle and energy resolved measurements of positrons ejected from the back of a gold target that was irradiated with an intense picosecond duration laser pulse reveal that the positrons are ejected in a collimated relativistic jet. The laser-positron energy conversion efficiency is ∼2×10{-4}. The jets have ∼20 degree angular divergence and the energy distributions are quasimonoenergetic with energy of 4 to 20 MeV and a beam temperature of ∼1 MeV. The sheath electric field on the surface of the target is shown to determine the positron energy. The positron angular and energy distribution is controlled by varying the sheath field, through the laser conditions and target geometry.

Supersonic-jet experiments using a high-energy laser.

In this Letter, laboratory astrophysical jet experiments performed with the LULI2000 laser facility are presented. High speed plasma jets (150 km.s(-1)) are generated using foam-filled cone targets. Accurate experimental characterization of the plasma jet is performed by measuring its time evolution and exploring various target parameters. Key jet parameters such as propagation and radial velocities, temperature, and density are obtained. For the first time, the required dimensionless quantities are experimentally determined on a single-shot basis. Although the jets evolve in vacuum, most of the scaling parameters are relevant to astrophysical conditions.

[Corneal ulcers associated with rheumatoid arthritis]. / Les ulcères de cornée associés à la polyarthrite rhumatoïde.

Keratoconjonctivitis sicca, scleritis and keratitis remain the major ocular manifestation, associated with rheumatoid arthritis. Corneal ulcers are a rare complication but can lead to perforation. Unstable epithelial barrier and immune disorders play a key role in the pathophysiology of such corneal melting. Moreover the association with systemic vasculitis reveals the need for an appropriate immunosuppressive treatment. New surgical approaches and early immunotherapy allow to maintain ocular integrity even if the visual prognosis is poor.

Eigenmodes for capillary tubes with dielectric walls and ultraintense laser pulse guiding.

The properties of the eigenmodes of a capillary tube are examined in the context of ultrashort intense laser pulse guiding. The dispersion relation for the eigenmodes of a cylindrical hollow waveguide is derived and the family of eigenmodes EH(nus) is shown to be a solution of the wave equation up to the first order under the condition k(0)a >>1, where k(0) is the light wave number and a the capillary tube radius. The expressions of the fields for the eigenmodes are given at zero and first order of a small parameter equal to the ratio of the perpendicular to longitudinal wave number and the absorbed intensity at the wall is estimated.

Nonlinear propagation of short intense laser pulses in a hollow metallic waveguide.

The propagation of a short intense laser pulse in the femtosecond range in a hollow metallic waveguide gives rise to heating of the metallic wall. The temperature of the degenerate electron gas in the wall is increased during the pulse duration and this heating affects the propagation and dissipation of the laser pulse. Analytical and numerical analysis shows that, as the dissipation is increased, the leading edge of the pulse decreases more slowly than the rear, resulting in a pulse shortening.

[Report of a case of Acanthamoeba keratitis]. / A propos d'un cas de kératite à Acanthamoeba.

CLINICAL REPORT: A clinical report of a contact lenses wearer with Acanthamoeba keratitis pointed out the diagnosis problem. The medical treatment is needed previously to any surgery. Finally the patient underwent enucleation. DISCUSSION: The authors are considering the microbiological aspects and laboratory techniques are described. CONCLUSION: For this very severe but hopefully rare pathology, the sooner the treatment the best. A therapeutic approach is described.

Implications of the Memory Controversy for Clinical PracticeAn Overview of Treatment Recommendations and Guidelines.

The controversy surrounding delayed and recovered memories of incest/child sexual abuse has had a profound impact on clinical practice. This article first provides an overview of the positions taken by both sides in the dispute, the “false memory” proponents and the traumatic stress proponents. It then presents the major findings of several of the professional task forces charged with reviewing the controversy and arriving at recommendations for research, clinical practice, and forensic practice regarding delayed recall of memories for sexual abuse. The current status of scientific and clinical knowledge is discussed, especially in terms of its implications for therapists and clinical practice. Nineteen recommendations and practice guidelines are presented for therapists working with individuals who report or suspect childhood sexual abuse on the basis of continuous and/or recovered memory.

[Use of the cryopreserved human amniotic membrane for reconstruction of the ocular surface]. / Utilisation de la membrane amniotique humaine cryo-préservée pour la reconstruction de la surface oculaire.

The aim of this human research protocol is to determine the efficacy of using preserved human amniotic membrane for reconstruction surgery for ocular surface. Case report and literature will be presented. The characteristics of a new surgical approach using human amniotic membrane will be described.

[Types of corneal transplantation: experience and review]. / Greffes de cornée typées: expérience et revue.

The authors review the 12 cases of matched corneal transplantation, performed at the CHU of Liège between 1991 and 1997. They expose their results together with a summary of the different hypotheses published so far in the field of corneal graft matching.

[A case of Exophiala dermatitidis ulceration]. / Cas d'un ulcère à Exophiala dermatitidis.

The authors present one case of corneal Exophiala dermatitidis ulceration. This case is analyzed in the field of corneal mycosis infection. Classification, rate, clinical history, biomicroscopy aspects will be discussed. Technical samples will be described. Anatomopathologic slides will be discussed. Finally the medical or surgical treatment will be considered.

Efficacy and safety of 0.3% carbomer gel compared to placebo in patients with moderate-to-severe dry eye syndrome.

PURPOSE: Carbomer gel is a water-soluble polymeric resin that has been reported to maintain the tear film in contact with the eye for an extended period. The efficacy and safety of this new artificial tear were assessed. METHODS: A multicenter, single-masked, randomized, placebo-controlled study was carried out on 123 patients with moderate-to-severe dry eyes. The placebo was a mannitol solution with benzalkonium chloride 0.008% as preservative. Patients were observed over an 8-week period, and subjective and objective changes analyzed, compared to a baseline of no therapy, after 1 to 7 days washout period from previous medication. RESULTS: All primary subjective symptoms decreased significantly in the carbomer gel-treated group compared to the placebo group (i.e., dryness, discomfort, and foreign body sensation). The carbomer gel also significantly improved the rose bengal staining score relative to placebo. When data for the primary subjective efficacy variables were stratified for disease severity, there was a statistically significant improvement from baseline by day 10 for severely affected patients and from day 42 for patients with moderate disease. Secondary subjective symptoms that improved significantly in the tear gel group compared to placebo were photophobia, erythema, tear breakup time, blurry-filmy, dry-sandy sensation, and physician impression. However, no significant improvements in the secondary subjective symptoms of tearing, itching, scaling, conjuctival discharge, palpebral conjunctival redness, bulbar conjuctival redness, conjunctival luster, relief of discomfort, ease of use, and overall acceptability were found in either group over the baseline score. In addition, neither carbomer gel nor placebo improved the baseline fluorescein staining score or the Schirmer test score. Two patients suffered local allergic reactions to the carbomer gel or its preservative, which settled on withdrawal of the medication. CONCLUSIONS: Carbomer gel was more efficacious than was placebo in improving a number of subjective and objective symptoms of moderate-to-severe dry eye syndrome. The results of this study indicate that carbomer gel was a safe as was the placebo.

Healing the incest wound: a treatment update with attention to recovered-memory issues.

This article provides an updated treatment model for adults who report having experienced incestuous abuse in childhood. It integrates psychodynamic, traumatic stress, developmental and feminist formulations, accords greater emphasis to object relations and self-psychology perspectives, includes more attention to dissociative reactions, and utilizes more cognitive-behavioral interventions. It is also responsive to issues raised in the recovered/false memory controversy. This holistic model is sequenced, paced, and titrated according to the patient's characterological structure, ego strength, and needs as well as the range and severity of presenting problems and life difficulties. Special consideration is given to issues pertaining to memory and the maintenance of a neutral stance by the therapist, especially in the case of recovered rather than continuous memories and/or suspicions rather than actual knowledge of abuse. Contemporary perspectives regarding some of the unique transference, countertransference, and vicarious traumatization issues with this population and their potential impact on treatment are also discussed.

Guidelines for the treatment of adults abused or possibly abused as children (with attention to issues of delayed/recovered memory). NATO Advanced Study Institute.

These guidelines provide practicing clinicians with information regarding psychotherapy with adults who (1) disclose an abuse history (physical, sexual, emotional) at the beginning of therapy; (2) do not disclose abuse despite having knowledge and memory about such events in their past; (3) report new (delayed or recovered) memories of abuse during the course of therapy; and/or (4) suspect past abuse but have no clear memories of having been abused. The more common clinical scenario involves an individual who has retained memory for past abuse but recalls additional events or details during therapy. The less common scenario is for an individual to have totally absent memory of abuse and to later develop highly detailed memory. Practitioners should expect a range of memory presentations and must work to neither suggest nor suppress abuse-related issues that arise in the course of therapy.

Percutaneous gallstone removal: long-term follow-up.

PURPOSE: To evaluate gallstone and symptom recurrence rates, long-term complications, and life expectancy after percutaneous gallstone removal. PATIENTS AND METHODS: Medical records of 87 patients (mean age, 69 years +/- 14 [standard deviation]) undergoing percutaneous gallstone removal between 1987 and 1992 were reviewed. Physicians and patients (or their families) were contacted for clinical follow-up. Thirty-one patients returned for follow-up ultrasound (US). RESULTS: The final study group consisted of 65 patients. Mean survival from the time of initial gallbladder drainage was 33 months +/- 19. Over a mean clinical follow-up period of 33 months, eight of 65 patients (12%) developed recurrent symptoms; six of these eight had recurrent gallstones shown at US. Of 30 patients with technically adequate US images (mean follow-up, 14 months +/- 12), 12 (40%) had recurrent gallstones. Six of these 12 patients had recurrent symptoms. No long-term complications were identified. CONCLUSION: The risk of gallstone recurrence after percutaneous removal is notable, but the symptom recurrence rate is much lower. Percutaneous gallstone removal is beneficial for patients at prohibitive surgical or general anesthetic risk.

[Emergency corneal grafts]. / Les greffes de cornée à chaud.

Corneal ulceration leading to perforation can mainly occur after infection, trauma, corneal dryness and exposure keratitis. When corneal ulceration does not respond to medical treatment, a penetrating keratoplasty allows the elimination of infected tissue and antigenic material. It can restore the integrity of the anterior segment of the eye. The tissue taken could serve for bacteriologic research. In spite of the great number of complications the percentage of success is about 50%.

[A case of keratitis due to Mycobacterium chelonae]. / A propos d'un cas de kératite à Mycobacterium chelonae.

The authors presents one case of primitive corneal mycobacterium keratitis after corneal graft. This rare form of keratitis is analysed in the field of mycobacterial infections who's nowadays more developed in our industrialised countries. The description of the case point out the multiresistance of this mycobacterium and describe the different treatments.