Long-term experience and Visual Acuity outcomes in Peters Anomaly cases.

PURPOSE: To report the results in a series of Peters Anomaly cases, and propose management and treatment approaches according to the alterations associated with each case. MATERIAL AND METHODS: A retrospective analysis was performed on the records of 27 patients (32 eyes) clinically diagnosed with Peters Anomaly. Each patient was subjected to different treatment modalities according to the type of Peters Anomaly, anywhere from medical follow-up clinics to a Penetrating Keratoplasty procedure (PKP). RESULTS: Of the 27 patients (32 eyes), 74% were male and 26% female, with 18.5% (5) being bilateral and 81.5% (22) unilateral. The mean number of years of follow-up was 10.2 years (Range: 3.5 to 18 years). The results of long-term VA correlate directly with the type of Peters Anomaly. For the total number of patients, the VA results were LogMAR 1.71 ±â€¯1.04. The results by groups were: Type I with only medical monitoring LogMAR 0.3 ±â€¯0, Type I with only Optical Iridectomy (OI) LogMAR 0.97 ±â€¯0.78, Type I with PKP LogMAR 1.22 ±â€¯0.97, Type II without a compromised posterior pole with PKP LogMAR 2.41 ±â€¯0.80, and Type II with a compromised posterior pole with PKP LogMAR 2.56 ±â€¯0.48. CONCLUSIONS: The result of VA and long-term corneal failure is directly related to the type of Peters Anomaly. Patients with Type I who only required medical follow-ups had the most favourable prognosis. Patients who underwent Peripheral Iridectomy followed and patients in which PKP was performed had an inferior prognosis.

Experiencia a largo plazo de pacientes con anomalía de Peters / Long-term experience and Visual Acuity outcomes in Peters Anomaly cases

ObjetivoComunicar los resultados de una serie de casos con anomalía de Peters, y proponer el manejo y sugerencias terapéuticas según alteraciones asociadas.Material y métodosSe analizaron las historias clínicas de 27 pacientes (32 ojos) con diagnóstico clínico de anomalía de Peters, los cuales fueron sometidos a diferentes tratamientos. Distintos parámetros y condiciones asociadas fueron evaluadas: presión intraocular (PIO), agudeza visual (AV), técnica quirúrgica y complicaciones postoperatorias.ResultadosDe los 27 pacientes (32 ojos), 74% sexo masculino y 26% femenino. El promedio de años de seguimiento fue de 10,2 años. La PIO preoperatoria fue de 23 ± 9,21 mmHg y al último control fue de 18,81 ± 7,45 mmHg. El resultado de AV a largo plazo se correlaciona directamente con el tipo de anomalía de Peters. Para el total los resultados de AV fueron LogMAR 1,71 ± 1,04 y por grupos: Tipo I sólo con seguimiento médico LogMAR 0,3 ± 0, Tipo I sólo con iridectomía periférica LogMAR 0,97 ± 0,78, Tipo I con queratoplastia penetrante (QPP) LogMAR 1,22 ± 0,97, Tipo II sin compromiso de polo posterior LogMAR 2,41 ± 0,80 y Tipo II con compromiso de polo posterior LogMAR 2,56 ± 0,48.ConclusionesEl resultado de AV y fracaso del injerto corneal a largo plazo se correlaciona directamente al tipo de anomalía de Peters, con mejor pronóstico la Tipo I en que se realizó sólo seguimiento médico, luego en los que se practicó iridectomía periférica, en los que se realizó QPP los que presentan peor pronóstico visual son con anomalía de Peters Tipo II con compromiso de polo posterior (p = 0.0087).

PurposeTo report the results in a series of Peters Anomaly cases, and propose management and treatment approaches according to the alterations associated with each case.Material and methodsA retrospective analysis was performed on the records of 27 patients (32 eyes) clinically diagnosed with Peters Anomaly. Each patient was subjected to different treatment modalities according to the type of Peters Anomaly, anywhere from medical follow-up clinics to a Penetrating Keratoplasty procedure (PKP).ResultsOf the 27 patients (32 eyes), 74% were male and 26% female, with 18.5% (5) being bilateral and 81.5% (22) unilateral. The mean number of years of follow-up was 10.2 years (Range: 3.5 to 18 years). The results of long-term VA correlate directly with the type of Peters Anomaly. For the total number of patients, the VA results were LogMAR 1.71 ± 1.04. The results by groups were: Type I with only medical monitoring LogMAR 0.3 ± 0, Type I with only Optical Iridectomy (OI) LogMAR 0.97 ± 0.78, Type I with PKP LogMAR 1.22 ± 0.97, Type II without a compromised posterior pole with PKP LogMAR 2.41 ± 0.80, and Type II with a compromised posterior pole with PKP LogMAR 2.56 ± 0.48.ConclusionsThe result of VA and long-term corneal failure is directly related to the type of Peters Anomaly. Patients with Type I who only required medical follow-ups had the most favourable prognosis. Patients who underwent Peripheral Iridectomy followed and patients in which PKP was performed had an inferior prognosis.

[Serodiagnosis of toxoplasmosis: a comparative multicenter study of a standard scale through various actual tests and expression of the results in international units. Groupe de travail toxoplasmose du Contrôle national de qualité en parasotologie. Syndicat des fabricants de réactifs de laboratoire. Groupe de travail standardisation des tests sérologiques du Réseau européen de lutte contre la toxoplasmose congénitale]. / Le sérodiagnostic de la toxoplasmose: etude comparative multicentrique d'une gamme étalon, par les différents tests actuels et avec expression des résultats en unités internationales. Groupe de travail toxoplasmose du Contrôle national de qualité en parasitologie, Syndicat des fabricants de réactifs de laboratoire, Groupe de travail standardisation des tests sérologiques du Réseau européen de lutte contre la toxoplasmose congénitale.

Reported are the results of a multicentre study involving 40 laboratories that was carried out in France to assess all the currently available methods used for the serodiagnosis of toxoplasmosis. For this purpose 10 batches of control sera were prepared with titres in the range 0-260 IU per ml. These sera were tested in nine laboratories using immunofluorescence methods; in three laboratories using dye tests; in forty laboratories using enzyme-linked immunosorbent assay; in four laboratories using direct agglutination and haemagglutination; in seven laboratories using the high-sensitivity IgG agglutination test; and in three laboratories using the latex agglutination test. In this way, 70 series of titrations were carried out using seven procedures and the results were compared with those obtained using the WHO reference serum in 15 cases, with the French national E6 serum in 16 other cases, and in 39 cases using 15 reference sera supplied by the reagent manufacturers. Rigorous comparison of the tests was not possible in all cases because one aim of the study was to ensure that the tests were carried out under the usual working conditions that prevailed in the participating laboratories. The results obtained indicate that the serological tests currently available for toxoplasmosis are acceptable for its serodiagnosis. Presentation of the titres in IU has advantages; however, caution is required since the definition of IU varies according to the test and reagents used. It is therefore essential that the conditions and limits for a positive reaction be carefully defined in each case, especially for commercially available kits.

New perspectives in the chemoprophylaxis of toxoplasmosis.

The usual chemoprophylaxis of toxoplasmosis consists of spiramycin or the combination of pyremethamine-sulfamide. This chemoprophylaxis can be used: 1 - In the pregnant woman: spiramycin avoids or has low fetal damage. In case of maternal contamination after 33 weeks of pregnancy, pyrimethamine-sulfadiazine combination should be used in spite of its potential toxicity. 2 - In the newborn infant, chemoprophylaxis prevents the emergence of retinochoroiditis. 3 - In congenital toxoplasmic retinochoroiditis, systematic repetitive cures of pyrimethamine-sulfamide reduce frequency of recurrences. 4 - In immunocompromised patients, the systematic use of pyrimethamine and sulfadoxine prevents neurotoxoplasmosis, in case of kidney, heart, and allogeneic bone marrow transplantations, and also in case of patients with malignant hemopathy or AIDS.

[Leishmania braziliensis Vianna, 1911 in French Guiana]. / Leishmania braziliensis Vianna, 1911 en Guyane française.

A new case of cutaneous Leishmaniasis to L. braziliensis Vianna, 1911, contracted in French Guyana is reported. The parasite, isolated in culture, is identified by enzymatic typing (13 zymoden). The identified zymodem is zymodem MON-43. It is the same of the WHO reference strain L. braziliensis s. st.

[Monitoring and treatment of toxoplasmosis in the pregnant woman, fetus and newborn]. / Surveillance et traitement de la toxoplasmose chez la femme enceinte, le foetus et le nouveau-né.

A protocol of monitoring and treatment in toxoplasmosis is suggested by the authors. During pregnancy, the administration of spiramycine at a 9 m UI daily dose remains the basic preventive treatment when a seroconversion occurs after a 4 week post-conception period. In the fetus, the antenatal diagnosis is made by ultrasound started on the 18th week after conception and repeated every 4 weeks, amniocentesis and eventually umbilical cord puncture associated with a pyrimethamine-sulfamide drug treatment in case of positive diagnosis. A therapeutic pregnancy termination is considered when lesions have been detected by ultrasound. In the newborn (neonatal or post-natal period), the diagnosis is made by transfontanel ultrasonography, ocular fundi and spinal fluid examination, detection of specific IgM antibodies in cord blood and the evolution and importance of serum antibodies response requiring a drug treatment during 15-18 months with spiramycine and pyrimethamine + sulfadoxine (Fansidar).

Sero-epidemiological survey for toxoplasmosis in Burundi.

The first sero-epidemiological survey for toxoplasmosis in Burundi was conducted in 1985. The global prevalence among 622 subjects tested in ELISA and IFI was 44.1% with a higher rate in men (49.6%) than in women (39.2%, p less than 0.01). The highest prevalences were observed in rural areas with intensive farming activities: the crest (57.9%), the plain (53.3%). The central platform, where people and farming activities are widespread, had a lower prevalence (29.3%, p less than 0.001). The risk of infection is much lower in urban people with high levels of hygiene (22.4%) specially in women (13%), than in those of poor condition (45%, p less than 0.001). These data suggest that toxoplasmic infection is mainly due to oocysts ingestion associated with low levels of hygiene and to a lesser extent to meat consumption in men.

Invasive nosocomial pulmonary aspergillosis: risk factors and hospital building works.

A retrospective epidemiological study of 22 observations of invasive pulmonary aspergillosis, of which 18 were fatal, occurring over a period of 30 months, implicated certain building sites within the hospital. The building works were responsible for the diffusion into the atmosphere of fungal spores from normally closed reservoirs, notably false ceilings, fibrous thermal and/or acoustic insulation materials and roller-blind casings. The results of our study permit us to suggest that protective measures should be set up or that immunodepressed patients are evacuated when such works are to be carried out in an in-patient establishment.

[Early diagnosis and surveillance of congenital toxoplasmosis. The comparative immunological profiles method]. / Diagnostic précoce et surveillance de la toxoplasmose congénitale. Méthode des profils immunologiques comparés.

More than 8000 samples (sera, cord blood, CSF, etc.) from patients who had, or were likely to have, toxoplasmosis were studied by the CIP-ELIFA technique. The first stage in this technique is immunoelectrodiffusion on a microporous cellulose acetate membrane. In the second stage, immunodetection and isotypic characterization of the precipitating systems are rapidly carried out by immunofiltration with anti-IgG, IgM, IgA or IgE-labelled antibodies (enzyme-linked immunofiltration assay or ELIFA). Several samples are jointly laid out on the same membrane for compared immunological profiles (CIP). When applied to the mother-foetus relationship in toxoplasmosis, this procedure provides an early diagnosis of congenital infestation in 85% of the cases. Positive criteria are based on evidence of specific IgM, IgE or IgA in the child, but also on the detection of foetal or neonatal antitoxoplasmosis IgG which can be distinguished from the IgG transmitted by the mother. Polyisotypic supervision is of considerable value for assessment of prognosis and of therapeutic effectiveness at the end of treatment. Satisfactory isotypic characterization can only be achieved by using particular functional antigens.

Host serum protein levels in cysts of human hydatidosis.

8 proteins (albumin, IgG, IgM, IgA, C3c, C4, orosomucoid and alpha 1 antitrypsin) were determined by laser immunonephelometry in hydatid cyst fluid from cysts and sera from 16 patients. The cystic level of albumin was 34.5 +/- SD 59.1 micrograms/ml (range 3.6-85); of IgG 12.9 +/- 18.7 micrograms/ml (1.9-75); of IgM 10.5 +/- 10.4 micrograms/ml (3-37); and of IgA 7.2 +/- 3.5 micrograms/ml (4-19.7). The 4 other proteins represented a smaller fraction: C3c, 0.9 +/- 0.6 micrograms/ml (0.5-2.5); C4, 1.3 +/- 0.9 micrograms/ml (0.5-3.5); orosomucoid, 2.8 +/- 2.3 micrograms/ml (1.4-9.2); and alpha 1-antitrypsin, 5 +/- 4.5 micrograms/ml (2-19). These 8 host proteins constituted 24.6 +/- 24.5% (2.4-76) of the total hydatid cyst fluid proteins (343.7 +/- 172.1 micrograms/ml, range 180-900). The albumin/IgG ration of 3 +/- 2.8 (0.4-10.8) in hydatid cyst fluid was more variable than that in sera, 2 +/- 0.5 (1.2-2.7).

[Bacterial infections and early Plasmodium falciparum malaria]. / Infections bactériennes et primo-invasion à Plasmodium falciparum.

Two cases of Plasmodium falciparum malaria associated with bacterial infections--streptococcus A septicemia and Legionnaires' disease--are described. The association of these two infections is probably not incidental, and the hypothesis of Plasmodium falciparum induced immuno-deficiency is discussed.

[First case of subcutaneous phycomycosis seen in Gabon and treated successfully with ketoconazole]. / Premier cas de phycomycose sous-cutanée observée au Gabon et traitée avec succès par kétoconazole.

First observation of subcutaneous phycomycosis observed in Gabon. Diagnosis was made by histological study. Biopsy permitted isolation of B. haptosporus. Sensitivity in vitro against ketoconazole was 1 microgram/ml. The patient cured with 33 g of ketoconazole in 84 days.

[Presence of Leishmania major Yakimoff and Schokhor, 1914 in Mali. Enzymatic identification of a strain of human origin]. / Présence de Leishmania major Yakimoff et Schokhor, 1914 au Mali. Identification enzymatique d'une souche d'origine humaine.

The first case of oriental sore reported to Leishmania major is identified in Mali. The characterization of the stain isolated from a left arm lesion of a 30 years old european woman is carried out by electrophoretic analysis using enzymes, i.e. PGM, PGI, G-6-PDH, 6-PGDH, IDH, MDH, ME, GOT.