[Simplified anesthesia protocol for cataract surgery under topical anesthesia: one year retrospective study]. / Protocole simplifié de prise en charge anesthésique chez les patients opérés de cataracte sous topique : étude rétrospective sur un an.

INTRODUCTION: The reduced supply of anesthesiologists in the hospital setting calls for a reconsideration of anesthesia management for ophthalmology patients. Therefore, a simplified management protocol has been designed through close collaboration between the involved specialists for cataract surgery under topical anesthesia (anesthetic eye drops or sub-Tenon's injection). MATERIALS AND METHODS: At the conclusion of the visit confirming the need for surgery, the surgeon completes a questionnaire designed to elicit a history of the presence of diabetes mellitus (type I or II), prior organ transplantation, chronic renal insufficiency requiring dialysis, communication difficulties, psychiatric disorders, allergy and/or a complex cataract. If one of the items is positive, the patient is scheduled for a preoperative anesthesia consult. If all the items are negative, this anesthesia evaluation is waived. The surgeon explains the fasting requirement and how to take the patient's usual medications on the morning of surgery. The patient continues his/her medications. No lab tests or chest X-ray are performed. If necessary, the surgeon prescribes preoperative antibiotic prophylaxis and any other preparation. During the surgery, the patient receives IV fluids and is monitored via EKG, non-invasive blood pressure and pulse oxymetry by a certified nurse anesthetist. The anesthesiologist on duty (one per every four rooms) is immediately available for the slightest problem. The surgeon signs the postoperative anesthesia note and discharge order. RESULTS: This procedure was assessed by one surgeon over a one year period, including 145 patients (60% of the patients recruited for this surgery), primarily outpatient (77%) under topical anesthesia (Oxybuprocaine(®)+Visthesia(®), Zeiss) or under sub-Tenon's injection (Xylocaïne(®)). No major complications were observed. Seven cases of arterial hypertension, treated with calcium channel blockers (nicardipine), and three episodes of brief anxiety were observed. CONCLUSION: This simplified anesthesia protocol appears to be safe and effective but requires more demanding involvement of the surgeon, whose scope of competence and responsibility must naturally increase. This is the only way by which cataract surgery can remain competitive.

Effects of fluctuating moisture and temperature regimes on the persistence of quiescent conidia of Isaria fumosorosea.

Conidia of Isaria fumosorosea were submitted to three regimes of temperature and moisture to simulate microclimatic conditions which prevail in temperate (43% RH and 28 degrees C to 98% RH and 15 degrees C), subtropical (75% RH and 35 degrees C to 98% RH and 25 degrees C), and arid areas (13% RH and 40 degrees C to 33% RH and 15 degrees C) with daily fluctuating cycles. Germination, conidial viability, and virulence to Spodoptera frugiperda larvae were less affected after 20 days exposure under temperate cycling conditions than under arid and subtropical conditions. Exposure of conidia for 20 days to constant nocturnal simulated conditions of any tested regime weakly affected conidial persistence, whereas diurnal conditions exerted the most detrimental effects of high temperatures. However, when tested at both 45 degrees C and 50 degrees C at 33% RH for 160 h, the persistence of I. fumosorosea conidia was relatively higher than expected. These results emphasize that climatic conditions prevailing in environments and ecological fitness of fungal isolates have to be taken into account for assessing microbial control strategies.

[Comparison of two methods of cryoconservation of sperm when in very small numbers]. / Comparaison de deux méthodes de cryoconservation de spermatozoïdes en très petit nombre.

OBJECTIVE: In case of severe oligozoospermia or following testicular biopsy in case of azoospermia, fertilization remains possible by intracytoplasmic sperm injection (ICSI). However, if there are only a few spermatozoa available to be preserved for a delayed ICSI, these gametes must be cryopreserved according to a specific method. We have found that, using the straw classical technique, less than 2 sperm were recovered at thawing when 20 sperm were frozen and no sperm were available following freezing-thawing of only 1 to 10 sperm per straw. Then, the feasibility of programmed ICSI is always uncertain in these cases and unnecessary medical acts (ovarian stimulation and egg collection) as well as patient disappointment are frequent. MATERIAL AND METHODS: We have tested a new technique by introducing (with an ICSI pipette) 1 to 100 sperm in a microdrop (0.5 microl) of freezing medium setting in a culture dish under paraffin oil. RESULTS: Following freezing-thawing the dish, all (100%) of the frozen spermatozoa were recovered. DISCUSSION AND CONCLUSION: Since only motile sperm were frozen, the sperm which are non motile after thawing (more than 50%) are nevertheless considered usable for ICSI.