[Treatment delay in patients with first episode of retinal detachment in the studied eye in Midi-Pyrénées]. / Délai de prise en charge des patients atteints d'un premier épisode de décollement de rétine sur l'œil étudié en Midi-Pyrénées.

INTRODUCTION: Retinal detachment (RD) is a potentially blinding condition. Delay in management is a major prognostic factor. In our study, we analyzed the treatment delay for retinal detachments in the Midi-Pyrenees area, and factors which may influence it. MATERIAL AND METHODS: Observational, cross-sectional, multicentric study, carried out over a 6-month period. PRIMARY OUTCOME: time between diagnosis and surgery. Secondary outcome: time between first symptoms and surgery. Non-parametric tests were used to analyze the influence of sociodemographic features, clinical features, distance between home and surgical center, and occurrence over a weekend. RESULTS: One hundred and fiftty-nine patients were included. The mean time between diagnosis and surgery was 4.4 ± 12.3 days (2.7 ± 4.3 for recent RD, less than 1 month), and was increased by the presence of a weekend (P<0.001), or of a weekend with public holiday (P=0.023), and by macular detachment (P=0.008). The mean time between first symptoms and surgery was 12.0 days and was increased by the absence of RD history (P=0.023), and by macular detachment (P=0.046). No association was observed between these times to surgery and the distance between the patient's home address and the place of surgery. CONCLUSION: The time between diagnosis and surgery was relatively short in the Midi-Pyrénées area, but we often noted a delayed diagnosis, which may be due to the patient's lack of awareness of the symptoms and difficult access to specialty consultations. However, no relationship was found between this time-to-surgery and the distance between the patient's home and the surgical center.

[Macular holes that should not be operated]. / Ces trous maculaires qu'il vaut mieux ne pas opérer...

The prognosis for macular holes has greatly improved since the advent of vitrectomy. Most improve both anatomically and functionally with effective treatment. However, some situations challenge the indication for surgery: old holes, large holes, and holes associated with retinal pathology.

[A large intraocular foreign body]. / Corps étranger intra-oculaire de grande taille.

INTRODUCTION: Penetrating wounds to the eyeball with penetration of a foreign body at the posterior segment are often extremely serious for the eye. The equipment available to extract them can sometimes be inadequate. OBSERVATION: We report the case of a 38-year-old man hospitalized for a penetrating wound of the eyeball with a voluminous foreign body incarcerated in the retina. Because of the size of the foreign body it could not be extracted with the usual forceps. We describe the assembly put together during the intervention using an intramuscular needle and 7/0 virgin silk that allowed its extraction. CONCLUSION: This lasso provides a very effective, easy and nontraumatic grasp of voluminous foreign bodies in the vitreal cavity.

[Floating membranes]. / Les membranes "flottantes."

INTRODUCTION: Floating membranes are epiretinal membranes that spontaneously detach from the retina and float in the vitreous cavity. PATIENTS AND METHOD: We studied a series of nine patients with a spontaneous separation of a premacular membrane. The majority of these detached membranes were secondary to vitreomacular traction syndrome. In four patients, the presence of peripheral retinal tears treated in the past by laser photocoagulation were found. None of the patients had complete vitreoretinal detachment before progressing to floating membranes. RESULTS: The separation of the membrane from the macular area occurred at the time of posterior vitreous detachment. The appearance of a bulky intravitreous floating body attached to the posterior vitreous cortex sometimes proved to be very awkward for vision, resulting in a vitrectomy in four patients for ablation of this large floating body. In five patients who were not operated, the presence of the membrane in the vitreous cavity was not responsible for significant functional disorders. DISCUSSION: The epimacular membranes concerned in this series were not very symptomatic before their detachment. They seemed to be integrated within the context of vitreomacular traction syndrome. The most invalidating cases that required surgery were those where the separation of the vitreous cortex remained incomplete, leaving an opaque membrane floating with a little mobility in front of the macular area (three out of four cases). CONCLUSION: The spontaneous detachment of a premacular membrane is an event that is quite seldom observed and generally follows the spontaneously favorable progression of vitreomacular traction syndrome.

Capillary gas chromatography mass spectrometry and identification of substituted carboxylic acids in lipids extracted from a 4000-year-old Nubian burial.

Polar carboxylic acid fractions of lipids extracted from samples from a 4000-year-old Nubian mummy were investigated by capillary gas chromatography mass spectrometry. They contain series of alpha,omega-dicarboxy, monohydroxy, dihydroxy and keto fatty acids, some of which were found for the first time outside the synthetic laboratory. Their chromatographic and mass spectrometric characteristic properties are reported.

Lumbosacral hyperlordosis due to fibrosis of the paravertebral muscles. Case report.

The authors present a case of lumbosacral hyperlordosis due to primary fibrosis of the paravertebral muscles. This very rare lesion in described and the surgical treatment used in this case is illustrated. The clinical and cosmetic results were both excellent.

Ammonium urate urinary stones.

Until the last century, ammonium urate stones were quite common in preindustrial Europe. In contemporary practice these stones are found in developing countries, and are associated with uric acid and ammonium-enriched urine. Such conditions may occur with urealytic infection, resulting in mixed ammonium urate/magnesium ammonium phosphate precipitates and urinary phosphate deficiency of alimentary origin, resulting in precipitates free of magnesium ammonium phosphate, in sterile urine. The latter situation is closely related to a diet poor in phosphate and to a low fluid intake common in endemic lithiasis areas. Ammonium urate and uric acid have different solubility patterns dependent on pH, and consequently treatment will be different in each case.