ABSTRACT
PURPOSE: Since 1993, foldable intraocular lenses (Adatomed 90 D, Allergan SI26NB et SI30NB, Chiron C10, Medilas 127) have been implanted through a corneal or scleral tunel after phakoemulsification of the cataract. This retrospective study is made for evaluating the advantages and the disadvantages of these new silicon implants. PATIENTS AND METHOD: The first 250 implantations of a silicon foldable lens compared to 50 rigid PMMA lenses. Problems during implantation, final visual acuity, opacification of the anterior and posterior capsule, decentration of the lens and the stability of the refraction during the 3-19 months following cataract extraction were evaluated. RESULTS: 4 breaks of the capsule, 2 desinsertions of the capsular bag during the implantation of a foldable lens, a difference of less than 0.5 diopter in favour of the foldable lenses, no difference in the incidence of the secondary cataract (p = 0.3) and a more marqued postoperative opacification of the anterior capsule (p = 0.0275) among the foldable silicon lenses were observed. CONCLUSIONS: These results are very encouraging for the visual outcome, but the time of postoperative observations is too short to determine on a long term basis, which is the most important factor for a new implant. To avoid an early opacification of the anterior capsule, a large capsulorhexis, as wide as the optic of the silicon lens, is recommended.
Subject(s)
Lenses, Intraocular , Postoperative Complications/etiology , Silicones , Adolescent , Adult , Aged , Aged, 80 and over , Female , Follow-Up Studies , Humans , Male , Methylmethacrylates , Middle Aged , Prosthesis Design , Prosthesis Failure , Refraction, Ocular , Retrospective Studies , Surface PropertiesABSTRACT
Between July 1987 and May 1989, 11 liver transplants were performed on 10 patients at the University Hospital of Geneva. Of 15 patients evaluated for elective transplantation, 10 were accepted and put on the waiting list. 5 patients were rejected because of a contraindication or because another treatment seemed preferable. 8 transplantations were eventually performed. Emergency transplantation was considered for 6 patients, but could be performed in only 3. Indications for transplantation were as follows: one hepatocellular carcinoma in a non-cirrhotic patient, 2 post-hepatitis cirrhoses (one B and one non-A-, non-B), 3 primary biliary cirrhoses, one autoimmune cirrhosis, one primary sclerosing cholangitis, one cirrhosis on alpha-1-antitrypsin deficiency, and one fulminant B-Delta hepatitis. Most of these patients had advanced liver disease and a limited life expectancy. 8 of the 10 patients transplanted are nevertheless alive and none is hospitalized at the present time. More than mere survival, however, quality of life regained after transplantation prompts us to consider transplantation early in the progress of the disease. Earlier evaluation of patients would make transplantation feasible soon after the first complication of the disease. This attitude would probably prevent patients from dying while on a waiting list and decrease operative as well as early postoperative risks. Better information and coordination regarding potential donors is necessary in Switzerland to obtain better results in organ transplantation.
Subject(s)
Liver Transplantation , Adult , Cholangitis, Sclerosing/surgery , Emergencies , Female , Humans , Immunosuppression Therapy , Length of Stay , Liver Cirrhosis/surgery , Male , Middle Aged , Postoperative Complications/etiologySubject(s)
Family , Leukemia/psychology , Lymphoma/psychology , Patient Isolation , Adolescent , Adult , Defense Mechanisms , Female , Humans , Leukemia/therapy , Lymphoma/therapy , MaleSubject(s)
Hypnosis , Aged , Austria , Emergencies , Female , History, 18th Century , History, 19th Century , Humans , Hypnosis/history , Male , Middle Aged , Pain Management , Respiratory Insufficiency/therapy , Urination Disorders/therapySubject(s)
Anorexia Nervosa/therapy , Hospitalization , Adult , Anorexia Nervosa/psychology , Body Weight , Female , Follow-Up Studies , HumansABSTRACT
This paper deals with the effectiveness of emergency telephonic help services in suicide prevention; it gives an historical account, describes the activity of Geneva's "Main Tendue" and proposes some practical principles on emergency telephonic help. 41 calls of 35 callers of Geneva's telephonic help service are briefly analyzed. A review of the literature available on this subject leaves a pessimistic impression about effectiveness of such services.
Subject(s)
Crisis Intervention , Emergency Services, Psychiatric , Mental Health Services , Suicide Prevention , Adult , Evaluation Studies as Topic , Female , Humans , Male , Middle Aged , Switzerland , Telephone , VolunteersABSTRACT
Ten adult patients with psychiatric disorders in the intensive care ward were examined. The length of stay varied from one week to four months and mechanical ventilation was necessary for all patients. Their experience of intensive care and their psychosensorial problems were as follows: temperospatial disorientation, perturbation of the sense of posture, hallucinations which could go as far as oneiric delirium, anguish and symptoms of depression. No psychotic syndrome, literraly speaking, was observed objectively. In the monthes that followed the stay under intensive care many patients presented important psychosomatic disorders. Organic factors are responsible for these complications, though the environment of the intensive care could induce a marked disafferentation. An effort by the attending staff, aimed at orientating or "reafferenting" these patients, could reduce these problems.
