[Ethics in pediatric emergencies: Care access, communication, and confidentiality]. / L'éthique dans les services d'accueil des urgences pédiatriques : accès aux soins, communication et confidentialité.

Children suffer most from today's increasing precariousness. In France, access to care is available for all children through various structures and existing measures. The support for foreign children is overseen by specific legislation often unfamiliar to caregivers. Pediatric emergencies, their location, organization, actors, and patient flow are a particular environment that is not always suitable to communication and may lead to situations of abuse. Communication should not be forgotten because of the urgency of the situation. The place of the child in the dialogue is often forgotten. Considering the triangular relationship, listening to the child and involving the parents in care are the basis for a good therapeutic alliance. Privacy and medical confidentiality in pediatric emergencies are governed by law. However, changes in treatments and medical practices along with the variety of actors involved imply both individual and collective limitations, to the detriment of medical confidentiality.

[External beam radiation in treatment of subfoveal vascularized pigment epithelium detachment in age-related macular degeneration. Long-term results of a pilot study]. / Radiothérapie externe dans le traitement des décollements vascularisés rétrofovéolaires de l'épithélium pigmentaire de la DMLA. Résultats à long terme d'une étude pilote.

PURPOSE: The purpose of this study was to contribute to the evaluation of long-term external beam radiation treatment in patients with subfoveal occult choroidal neovessels complicated with pigment epithelium detachment in age-related macular degeneration. MATERIALS AND METHODS: This was a retrospective study of ten patients with a mean age of 75 years and a mean follow-up of 18.7 months. External beam radiation of 14.4 Gy was administered with a daily dose of 1.8 Gy. The efficacy of the treatment was assessed based on visual acuity, the size of the membrane and the persistence or not of neovascular activity. RESULTS: We observed stabilization of visual acuity in 44% of the cases at 6 months but only in 20% at 19 and 30 months. The mean initial visual acuity was measured at 0.2 at presentation and 0.1 at the final evaluation. At the end of the study, 60% of patients attained the level of legal blindness; 90% of patients developed a disciform scar, with persistence of neovascular activity in 27% of the cases. On fluorescein angiography, the size of pigment epithelium detachment increased more than one optic disc diameter in 20% of the cases at 1 year. On the other hand, no radiation complication was observed. DISCUSSION: The visual and anatomical results of our study are similar to the natural progression of occult neovascular membrane. External beam radiation at a dose of 14.4 Gy did not seem to provide a long-term benefit in the treatment of subfoveal occult neovessels associated with pigment epithelium detachment.

[Proliferative retinal vasculitis and multiple sclerosis: a case report]. / Vascularites rétiniennes proliférantes et sclérose en plaques. A propos d'un cas.

INTRODUCTION: Retinal periphlebitis can precede the neurological effects of multiple sclerosis and reveal the disease. Although these occurrences of vasculitis are noted in 10% - 35% of multiple sclerosis patients, proliferative retinopathy is, on the contrary, an exceptional complication. CASE REPORT: We report the case of a 28-year-old woman who presented bilateral, proliferative, retinal vasculitis complicated with recurrent vitreous hemorrhages occurring with multiple sclerosis. Initially, there was a unilateral, central venous thrombosis in a particularly ischemic and proliferative form. After a neurological, biological and radiological check-up, the diagnosis of multiple sclerosis was pronounced and treatment with Interferon was started. A pan-retinal laser photocoagulation and vitrectomy with proliferative membrane peeling were performed. After a follow-up of 2.5 years, a bilateral epiretinal membrane on the macula with a chronic macular edema persisted, with visual acuity limited to 0.2 Parinaud 4 in the right eye and 0.5 Parinaud 2 in the left eye. DISCUSSION: This case shows that the diagnosis of multiple sclerosis must be established in cases of ischemic retinal vasculitis, especially as the literature does not seem to report a correlation between the retinal vascular affect and how far multiple sclerosis has progressed. Moreover, the visual prognosis of these proliferative lesions remains uncertain. CONCLUSION: Multiple sclerosis can be revealed initially, although exceptionally, by bilateral, proliferative and severe retinal vasculitis complicated with recurrent vitreous hemorrhages and tractional retinal detachment.

[Treatment of post-traumatic cyclodialysis using by direct cyclopexy]. / Traitement des cyclodialyses post-traumatiques par cyclopexie directe.

INTRODUCTION: We report 2 cases of posttraumatic cyclodialysis treated by direct cyclopexy. We decided to operate because of the presence of a macular and disc oedema after an ocular chronic hypotony. PATIENTS: The case was a blunt ocular trauma and the other case a perforating injury. For the latter, a cycloplegic treatment was ineffective. The ocular hypotony persisted 2 months in the first case and 2 and a half years in the second. In both cases, the hypotony was major (0mmHg) and the cyclodialysis cleft was extended to 90 degrees (in the superior temporal quadrant and the inferior nasal quadrant). A direct cyclopexy was performed with cilioscleral sutures with 10-0 monofilament. RESULTS: One patient presented a moderate and temporary postoperative hypertony. The maximal follow-up was 9 months: ocular tonus was normalized (10 and 11mmHg), the fundus aspect was improved, and visual acuity was either the same (hand movement perception) or increased from 0.1, 14 to 1.0, 2 on the Parinaud scale. DISCUSSION: The direct cyclopexy was effective in both cases. It precisely defined the cyclodialysis limits, it allowed the suprachoroïdal fluid to drain and restored the anatomic features. Moreover, it allowed treating larger cyclodialysis for which a simple laser treatment would be incomplete. On the other hand, it was invasive intraocular surgery which presented risks of hemorrhage, infection and retinal detachment. CONCLUSION: The direct cyclopexy is an advisable method in the treatment of cyclodialysis. It normalized an ocular tonus and improved of hypotonus retinopathy. However, vision remained sometimes limited because of the posttraumatic sequels are or ocular hypotony that was too lengthy.

[A familial case of chronic progressive external ophthalmoplegia associated with mitochondrial disease]. / Une observation familiale d'ophtalmoplégie externe chronique progressive liée à une mitochondriopathie.

Mitochondrial myopathies are rare hereditary diseases that affect the energy functions of the mitochondria. Clinical manifestations are variable and sometimes multisystemic. Progressive external ophthalmoplegia constitutes the most frequent clinical form. Unfortunately, the diagnosis and the treatment of these mitochondrial abnormalities stay, today, even difficult. We report ophthalmic findings and the course of the disease in members of a family with chronic progressive external ophthalmoplegia presenting with severe acquired blepharoptosis. From study at the family background, the inheritance seemed autosomal dominant. In one case, a comprehensive workup, including muscular biopsy and molecular genetics disclosed a mitochondrial myopathy. During the 30-year follow-up, the patients were operated on for their ptosis several times, because of recurrences and uneven results.

Use of 99mTc-labeled albumin microspheres in cerebral vascular disease.

The intracarotid injection of radioalbumin microspheres (15 and 30 mum) is followed by scanning procedures that permit the description of the cerebral bloodflow distribution. The method is reproducible. Injection can be made into the internal and common carotid arteries, as well as into the aortic arch or the left ventricle. This last procedure makes it easy to examine patients with severe extracranial vascular stenosis or thrombosis and permits comparison of the two hemispheres. Most patients (88%) injected on the affected side showed one or more local vascular deficits. The method therefore is more efficient than pertechnetate scanning or arteriography.

Study in cerebrovascular disease: brain scanning with technetium 99m pertechnetate; clinical correlations.

A prospective brain scanning study using technetium 99m pertechnetate was performed in 84 patients with cerebral infarction. No correlation was found between vascular angiographic findings and the frequency of positive scans. A comparison with clinical motor and mental evaluation showed a good correlation between abnormal scans (58 percent) and poor initial test resutls. A half-life of 17 days characterized the time course of positive scans according to their density and abnormal radioisotopic uptake area.