[Persistent Eosinophilia--differential diagnosis and work-up]. / Persistierende Eosinophilie - Differenzialdiagnose und diagnostischer Algorithmus.

The differential diagnosis of eosinophilia is broad and constitutes a major challenge for both, the general practitioner and the hematologist. Whereas in developing countries secondary eosinophilia is commonly caused by parasitic infections, in Western and European countries eosinophilia is more often associated with atopic diseases or drug-related. This case-report presents an asymptomatic patient with marked persisting eosinophilia caused by Strongyloidiasis in whom parasitic stool examinations were repeatedly negative and infection could only be established by serologic testing.

[Epilepsy in children with cerebral palsy]. / Epilepsie chez des enfants infirmes moteurs-cérébraux.

The incidence of epilepsy in 110 patients with cerebral palsy (the majority with spastic tetraplegia) was 46,4%. Almost half of the patients with spastic tetraplegia (45%) and hemiplegia (52%) had epilepsy. The incidence was lower in patients with spastic diplegia (32%). Half of epilepsy in spastic hemiplegia were partial seizures and the other half consisted of generalized seizures, while generalized tonic-clonic episodes predominated in all other forms of C.P. A high incidence of West syndrome was observed in patients with spastic tetraplegia. Etiological factors of C.P. were perinatal in 75%. 16,65% had neonatal antecedents of convulsions; most of them had spastic tetraplegia (75%) and a significant mental retardation. A low intelligence quotient (I.Q.) was seen in most of the children with epilepsy, and patients with tetraplegia had significantly lower intelligence quotient than other groups.

[Multiprofessional healthcare team: concept and typology]. / Equipe multiprofissional de saúde: conceito e tipologia.

This paper introduces concept and typology to teamwork as well as criteria to identify types of teams. The concept and the typology were developed based on the literature and research on multi-professional work in healthcare, based in the theory of studies on work process in healthcare and in the theory of communicative action. According to this theoretical proposition, teamwork is a form of collective work characterized by a reciprocal relationship between technical interventions and the interaction of agents. The proposed typology refers to two forms of teams: integrated teams as opposed to groups of people. The criteria to identify the types of team are related to communication among work agents; technical differences and inequality in social recognition of specialized works; formulation of a common care program; specificity of each professional area; flexibility of work division; and technical autonomy.

Bilateral pigmented retinopathy following measles: long-term follow-up and possible association with keratoconus.

A case of pigmentary retinopathy following measles is presented with follow-up of 24 years. A 29-year-old man complained of almost complete blindness during measles infection at the age of 5 (1966). Ophthalmoscopy revealed retinal edema with pallor of the optic disc and in a few months pigment alterations gave the fundus a salt-and-pepper appearance. In 1974 and 1985 a pigmentary retinopathy was present with optic atrophy and typical bone corpuscle deposits, and marked impairment of visual function. In 1990 (i.e. 24 years after the onset of symptoms) the fundus shows pigmentary degeneration with optic atrophy and narrowed vessels, ERG is extinguished and visual fields and dark adaptation cannot be recorded owing to amaurosis. The patient also present bilateral keratoconus. The possible association between these two entities, which to our knowledge has not been previously reported, is discussed.

Familial pseudotumor cerebri in male heterozygous twins.

Papilledema due to raised intracranial pressure in absence of intracranial mass arose roughly at the same time in 2 male heterozygous twins. The diagnosis of benign intracranial hypertension (BIH) was confirmed by the finding of normal cerebrospinal fluid and high opening pressure. Neurologic examination was normal. In both cases choroidal folds were evident. The relationship between BIH and genetic factors is discussed.

[Screening of early color vision loss in diabetic patients]. / Dépistage des altérations précoces de la vision des couleurs chez les patients diabétiques.

Colour vision defects have been claimed to appear in diabetes before any retinopathy is visible. In the present study diabetic patients and non diabetic control subjects were screened with two different colour vision tests which include both red-green and blue-yellow parts, and are suitable for quantitative analysis of scores. The Lanthony 40 Hue test and the Tokyo Medical College--T.M.C. tables were used to assess colour vision in 106 diabetic (50 insulin dependent and 56 non insulin dependent) patients and in 99 non diabetic control subjects. Diabetic patients without visible retinopathy, familiar colour vision defects and/or lens changes, had significantly higher scores than control subjects in both eyes. The differences were more evident in non insulin dependent patients. Statistical analysis showed that early loss of colour vision was correlated with age and duration of diabetes for older patients, while correlation with glycosylated hemoglobin was moderately positive only for younger patients. Both tests (especially the Lanthony 40 Hue) resulted to be highly specific and could be used for the clinical study of colour vision losses in diabetic patients.

Abnormal blood rheology in retinal vein occlusion. A preliminary report.

Hemorheological factors were studied in 34 patients affected by retinal vein occlusion (RVO) and in 25 control subjects. Whole blood viscosity, plasma viscosity, fibrinogen and hematocrit were increased in RVO patients compared with controls. Whole-blood filterability was reduced in RVO patients compared with controls. However, when evaluating the type of capillaropathy at fluorescein angiography, blood viscosity and plasma viscosity were altered in both patients with and without evidence of capillary nonperfusion. Reduction of blood filterability showed statistical significance only in patients with capillary nonperfusion. This finding suggests that reduced whole-blood filterability might be a causal factor in the development of capillary nonperfusion in RVO patients.

[Hemorheological changes in retinal vein occlusions]. / Alterazioni emoreologiche nelle occlusioni venose retiniche.

Some hemorheological factors were studied in 34 patients affected by retinal vein occlusion (RVO) and in 25 healthy control subjects. Whole blood viscosity, plasma viscosity, fibrinogen and hematocrit were increased in RVO patients compared with controls. Erythrocyte filterability was reduced in RVO patients compared with controls. However, when evaluating the type of capillaropathy at fluorescein angiography, blood viscosity and plasma viscosity were altered both in patients with and without evidence of capillary non-perfusion. Reduction of red cell filterability showed statistical significance only in patients with capillary non-perfusion. This finding suggests that reduced erythrocyte filterability might be a causal factor in the development of capillary non-perfusion in RVO patients.

Disturbances of ocular motility after retinal detachment surgery.

In a series of 562 patients who underwent surgery for retinal detachment, 17 (3.02%) had significant post-operative muscle imbalance. On the basis of the patients histories and clinical examinations, it is possible to classify the disturbances of ocular motility according to the symptoms (type, time of onset) and the pathogenesis (lesion of muscular sheats or bodies, capsulo-conjunctival cicatricial retractions, prolonged muscular compression, decompensation of pre-existing squints). If diplopia does not cease spontaneously, treatment consists of use of temporary prisms, but in some cases surgery is required.

Bilateral pigmented paravenous retino-choroidal degeneration following measles.

A 26-year-old female showed a bilateral ophthalmoscopic picture of pigmented paravenous retino-choroidal distrophy 19 years after neuro-retinitis following measles. Pigmentary disturbances in the fundus were not reported in 1963 clinical record; however functional tests are at present practically unchanged. Some debated aspects of this condition are discussed.

Comparative evaluation of blood viscosity in diabetic retinopathy.

The viscosity of the whole blood, plasma and serum, haematocrit and plasma fibrinogen were studied in diabetic patients with (DR) and without (D) retinopathy and in non-diabetic control subjects (C). Blood viscosity was significantly higher in diabetics than in controls. No significant differences in viscosity of the whole blood were found when various types of retinopathy were compared according to the severity of retinal damage. Plasma viscosity was significantly higher (P less than 0.01) than controls (C) only in diabetic patients with retinopathy (DR). Serum viscosity was significantly increased compared with controls (C) only in diabetic patients affected by proliferative retinopathy. Plasma fibrinogen was significantly higher than controls (C) both in diabetics with retinopathy (DR) and without retinopathy (D). Haematocrit did not show a significant difference in the three groups considered (C, D, DR).