Prophylactic perifoveal laser treatment of soft drusen.

PURPOSE: To assess the efficacy and safety of perifoveal laser to cause drusen to resorb, and establish a treatment protocol. METHODS: Treatment technique was determined by the outcome in one patient with 15-year follow-up. In an uncontrolled series a perifoveal ring of gentle laser was applied to 30 eyes of 28 patients, 18 with bilateral drusen and 10 with exudative disease in the fellow eye. Comparison was made between treated and untreated eyes in 14 patients with bilateral drusen. Mean follow-up was 16.8 months (range, three to 42 months). RESULTS: Soft drusen resorbed in all treated eyes in the vicinity of laser and within the fovea. Large soft confluent drusen (> 500 microns) responded most rapidly. Visual acuity improved one or more lines in 12 (40%) treated eyes, was unchanged in 16 (53%) and deteriorated in two (7%). In 14 patients with bilateral drusen in whom only one eye was treated, VA remained unchanged in 10 eyes and improved in four treated eyes while none of the untreated eyes improved (P = 0.03, chi 2) and decreased in four eyes. Atrophic expansion of laser burns was minimal. CNV developed in two of 30 eyes (7%). CONCLUSION: Perifoveal laser treatment appears to expedite the regression of soft drusen within the fovea. The risks of complications may be reduced by treating eyes early, before pigment changes develop and by applying a minimum number of burns at a distance greater than 750 microns from the foveal centre. Treatment should currently be administered only in the context of a prospective clinical trial, which is required to assess whether this treatment results in lowered risk of visual loss from CNV or geographic atrophy.

[Distribution of expenses (personnel, consumption, procedures) in a pediatric unit in a university hospital center]. / Répartition des dépenses (personnel, consommation, actes) dans un service de pédiatrie de centre hospitalier universitaire.

A study has been undertaken in a unit of pediatric gastroenterology and nutrition. The unit also deals with general pediatric emergencies. The purpose of this study was to calculate the cost of hospitalization and the distribution of the cost between the different components: personnel expenses (medical and non-medical staff), cost of products used (enteral and parenteral nutrition included), cost of medicotechnical intervention. The study was carried out over a period of 28 days and included 117 hospitalized children. Only the expenses directly linked to the patient's care were taken into account. The exact time spent with each patient by every category of staff, the quantity of products and the treatment given had to be carefully recorded. The results reveal the share of the cost which goes to non-medical staff (about 60%), except when pathological cases need frequent and detailed investigations. Once the budget has been determined, department heads are required to play administrative role and this study underlines the process of cost build-up and thus enables a selective intervention in one sector or another of hospital expenses.