[Selective laser trabeculoplasty (SLT): our experience in African blacks]. / La trabéculoplastie au laser sélectif (TLS) : notre expérience chez le noir africain.

INTRODUCTION: The purpose of our study was to evaluate in the short and medium term, intraocular pressure results after selective laser trabeculoplasty in black patients with chronic open angle glaucoma or isolated ocular hypertension. MATERIALS AND METHODS: We conducted a retrospective study with a mean 12.5-month follow-up in black patients who underwent SLT. Inclusion criteria were: an open iridocorneal angle greater than or equal to Schaeffer grade 3, data recorded and available on trabecular pigmentation, data on SLT parameters available, and intraocular pressure by Goldmann applanation tonometry recorded.A positive result was defined as a post-laser IntraOcular Pressure (IOP) less than 21 mmHg after 1-month follow-up. The main motivation was the reduction of number of eye drops used. Performed first was a treatment of the inferior 180° (3:00-9:00), possibly supplemented by a second session at 15 days or 1 month if a pressure decrease was noted after the first session. IOP results were evaluated prior to SLT, immediately following SLT and then depending on the drop in pressure. Statistical analysis was performed using the EPI.info 7 software. RESULTS: A total of 69 eyes of 40 patients treated with SLT were identified. The mean IOP prior to SLT was 18.3 mmHg ± 4. Our results showed 90% of patients who positively responded to the treatment (10% failure) with a mean IOP decrease of 2.3 ± 1 mmHg, that is 13%, by the second week. The mean pressure decrease continued to 4.78 ± 1 mmHg for patients (30%) in the group treated for 360°, that is 27% in the same period of time. SLT permitted discontinuation of a prostaglandin in 60% (42 cases). Eyes on triple-drug therapy went from 23 before SLT to 5 following SLT (a 26% decline), eyes on two medications went from 32 to 16 (24% decline). In result association tests, only pigmentation of the angle and visual field stage had a statistically significant probability. DISCUSSION: In our experience, SLT is indicated in black patients to potentiate less effective treatments, to reduce the number of drops in order to limit side effects, but also to avoid or delay monotherapy treatment-naïve, hypertensive eyes. CONCLUSION: In the short and medium term, SLT brought about an IOP decrease in 90% of black patients, and discontinuation of a prostaglandin in 60% of our patients. In addition, the iridocorneal angle in blacks appears to be less pigmented than previously thought, and a protocol systematically treating 360° seems to provide better results.

[Epidemiological and clinical characteristics of primary ocular cancers in blacks: our experience with 111 cases]. / Aspects épidémiologiques et cliniques des cancers oculaires primitifs du mélanoderme : notre expérience à propos de 111 cas.

INTRODUCTION: In this work, the authors aim to study clinical and epidemiological characteristics of ocular and orbital primary cancers in sub-Saharan African. PATIENTS AND METHODS: This is a retrospective study over a period of 21 years, from 1984 to 2004, including all cases of ocular cancer, histologically proven after surgery of the globe or the orbit. For each patient, we studied the following parameters: age, sex, reason(s) for consultation, the affected eye, and histological result of the operative specimen. These data were collected by studying the departmental surgical registry, patient medical records and the tumor registry of the anatomicopathology laboratory of a tertiary care hospital in sub-Saharan Africa. RESULTS: We collected data on 111 black patients, among whom 15 cases (13.5%) presented with bilateral involvement, for a total of 126 eyes. The sex ratio was 1.17. Presenting signs showed a predominance of leukocoria (30.2%) followed by proptosis (21.7%) and in third place, protruding conjunctival mass (10.8%). Retinoblastoma was found most frequently, representing 66.6% of the oculo-orbital tumors and 95.45% of the tumors of the globe; followed by epidermoid carcinoma, representing 15.08% of cases. Malignant melanoma was third most common, representing 4.76%, with 83% arising in the anterior uvea and 7% in the choroid. Basal cell carcinoma and rhabdomyosarcoma follow in fourth place. Basal cell carcinoma constituted half (50%) of the eyelid tumors. Rhabdomyosarcoma was the most common orbital tumor in our series (57%). Next were lymphomas with conjunctival localization (2.38%), acute leukemia with orbital localization (1.59%) and rare tumors, palpebral dermatofibrosarcoma (0.79%), an orbital angiosarcoma (0.79%), a glioblastoma of the globe (0.79%) and a malignant solitary fibrous tumor of the orbit (0.79%). CONCLUSION: Ocular and orbital primary cancers in blacks remain tumors of the young, equally distributed between the sexes. Retinoblastoma is the most frequent, followed by epidermoid carcinoma. The globe is the preferential localization of these cancers.

[Non-invasive diagnosis of pulmonary hypertension: ESC/ERS Guidelines with commentary of the Cologne Consensus Conference 2010]. / Nicht-invasive Diagnostik der pulmonalen Hypertonie: ESC/ERS-Leitlinien mit Kommentierung der Kölner Konsensus-Konferenz 2010.

The 2009 European Guidelines on Diagnosis and Treatment of Pulmonary Hypertension have been adopted for Germany. The guidelines contain detailed recommendations for the diagnosis of pulmonary hypertension. However, the practical implementation of the European Guidelines in Germany requires the consideration of several country-specific issues and already existing novel data. This requires a detailed commentary to the guidelines, and in some aspects an update y appears necessary. In June 2010, a Consensus Conference organized by the PH working groups of the German Society of Cardiology (DGK), the German Society of Respiratory Medicine (DGP) and the German Society of Pediatric Cardiology (DGPK) was held in Cologne, Germany. This conference aimed to solve practical and controversial issues surrounding the implementation of the European Guidelines in Germany. To this end, a number of working groups was initiated, one of which was specifically dedicated to non-invasive diagnosis of PH. This commentary summarizes the results and recommendations of the working group on treatment of PAH.

Static compressive loading reduces the mRNA expression of type II and X collagen in rat growth-plate chondrocytes during postnatal growth.

The mechanisms by which chondrocytes modulate longitudinal bone growth are not well understood. This in vitro study investigated the effects of loading on the mRNA expression pattern of key molecular components of the growth-plate related to the extracellular matrix (type II and type X collagen) and the PTH-PTHrP feedback loop. Short-term static compressive loading was applied to rat proximal tibial growth-plate explants. Four age groups at specific developmental stages were investigated. The spatial variation in the mRNA expression was compared among loaded explants, their contralateral sham controls, and uncultured growth plates from normal animals. Basic cell metabolism (18S rRNA) was unaffected by load. Results indicated a narrower spatial distribution of mRNA expression of type II collagen throughout the growth plate; similarly, a narrowed distribution of expression of type X collagen was noted in the lower hypertrophic zone of the growth-plate. This suggests that mechanical compression influences chondrocytes of the hypertrophic zone to alter their expression of specific genes encoding proteins of the extracellular matrix, while PTH-PTHrP receptor mRNA, a regulatory protein, remained unaffected by loading. The effects of compression were similar at the different stages of growth, suggesting that additional factors may be involved in the clinical progression of skeletal deformities observed during growth spurts. Although this study was done in vitro and limited to static loading, it furthers our understanding of growth-plate mechanobiology as a first step toward providing a scientific rationale for treating progressive musculoskeletal deformities.

The effects of mechanical loading on the mRNA expression of growth-plate cells.

Bone growth is a complex process involving proliferation, maturation and hypertrophy of chondrocytes in the growth plates. Mechanical forces applied to growing bones alter their longitudinal growth. However, the mechanisms by which chondrocytes modulate longitudinal bone growth are not well understood. This in vitro study investigated the effects of mechanical loading on the mRNA expression pattern of key molecular components of the growth-plate. Short-term static loading was applied to rat proximal tibial growth-plate explants. Various age groups at specific developmental stages were investigated. In situ hybridization was used to assess the mRNA expression of the cells in different zones of the growth-plate. Four key components were investigated: 18s (basic cell metabolism), type II collagen (major extracellular matrix component), type X collagen (matrix component in hypertrophic zone) and PTH-PTHrP receptors (pre-hypertrophic chondrocytes). The spatial variation in the mRNA expression between loaded explants and their contralateral controls was compared to establish: -the sensitivity of the different growth-plate zones to mechanical loading; -the sensitivity of the different developmental stages to loading. Preliminary results indicated that static loading on the growth plate of 80 d.o. rats affects type II and X collagen gene expressions while PTH-PTHrP remains insensitive to static loading. Improved understanding of growth-plate mechanics and the underlying biology is required to provide a scientific basis for the treatment of progressive deformities.

[Cataract surgery with posterior chamber lens implantation in Senegalese children less than 15 year-old]. / Chirurgie de la cataracte avec implantation en chambre postérieure chez l'enfant de moins 15 ans au Sénégal.

PURPOSE: To assess short and medium term outcomes of cataract surgery with intraocular lens implantation in Senegalese children less than fifteen years. METHODS: From 1992 to 1997, 50 eyes of 40 children between the age of 5 months and 14 years, suffering from cataract were operated. Some of them were seen untill 2000. Twenty-seven cataracts were congenital, 19 were traumatic, 2 were from corticosteroid side effects, 1 after uveitis, and 1 had no determined cause. Thirty-one had manual extracapsular surgery and 19 ultrasound cataract surgery. They all have a standard single-piece PMMA intraocular lens of 21 to 22 diopters, 12.0-12.5mm long, under the ciliaris silcus (34 cases) or in the capsular bag (16). The results were noted in the first week, at one month, at 3 months, and after. RESULTS: Exudative reactions were frequent in the anterior chamber: 20% of the eyes had such reactions during the operation, especially when a manual extracapsular extraction was performed, and 34% soon after operation. The reactions were generally revealed with one month of survey. Corticosteroids used before and after surgery reduced inflammation disorders but seemed to speed up the onset of secondary cataract. Posterior capsule opacification was observed in the first week after surgery. It increased from 45% at 3 months to 74% at 1 year and 100% after 3 years. Intraocular cristal lens implants are well tolerated with limited complications. Fifty-seven percent of the operated eyes we observed after 3 years had 30/60 or better visual acuity. CONCLUSION: Despite fairly frequent inflammation and secondary cataract, posterior chamber lens implantation in children is well tolerated. This suggest that, as in adults, intraocular lens implant would be the best treatment for aphakia.

[Trabeculectomy in black Africans in primary open angle glaucoma]. / La trabéculectomie chez le noir africain dans le glaucome primitif à angle ouvert.

PURPOSE: To assess simple trabeculectomy in black Africans with open angle glaucoma. METHODS: We studied retrospectively 80 eyes of 62 patients with primary open angle glaucoma operated by Cairn's trabeculectomy without adjunction of antimetabolites. Thirty seven eyes had a limbal-based conjunctival flap and the others 43 had a fornix-based conjunctival flap. Failures and success were assessed with the Kaplan-Meier's method. RESULTS: Patients were all seen at least 12 months after surgery. The mean follow up was 24 months. At mid-term survey we found complications to be frequent. Pathological blebs occurred in 22.5% (18 cases). The survival probability grew shorter with time. Only 44% of patients were reviewed at 36 months and 29% at 48 months. The success rate (IOP less than 21 mmHg of all glaucoma medications) varied according to the conjunctival flap. It was respectively at 12 months, 24 months and 36 months: 97%, 70 % and 54% with limbal-based flap, and 46%, 18% and 18% with fornix-base flap. The overall rate of tonometric failures was 33.75%. Failures were more often with fornix- based flap (85%). Generally they set in before one year of survey. This was so in 91% of absolute failures and in 87% of relative failures. The failures rate seems to increase with topical polytherapy given more than 12 months before operation. CONCLUSIONS: Trabeculectomy with limbal-based conjunctival flap is at mid-term follow up successful in black Africans. However the following up difficulties in Africa makes it a too delicate assessment objective for long-term results of trabeculectomy.

[Non-sarcomatous bilateral exophthalmos disclosing acute myeloblastic leukemia in children]. / Exophtalmie bilatérale non sarcomateuse révélant une leucémie aiguë myéloblastique de l'enfant.

The authors report a bilateral exophthalmos due to a leukemic infiltration of the orbital lacrimal glands during an acute myeloblastic leukemia in a ten-year-old boy. This rare orbital localization revealed the leukemia. It was not a granulocytic sarcoma. Its importance leads to the extraction of the lacrimal glands in order to prevent the eyes from corneal perforation.

[Spontaneous and bilateral anterior luxation of the lens in a 5-year-old child]. / Luxation antérieure bilatérale et spontanée du cristallin chez un garçon de 5 ans.

The authors report a case of bilateral spontaneous dislocation of the lens in a five-year-old boy. This rare complication can be encountered in certain congenital abnormalities of the lens and zonule. The dislocation has been revealed by an acute glaucoma. The mains causes like Marfan's syndrome and homocystinuria were not found but due to their most severe prognosis. The patient must be followed carefully.

[A familial form of epidermoid carcinoma of the conjunctiva]. / Une forme familiale de carcinome épidermoïde de la conjonctive.

Two two-sided cases of conjunctival epidermoid carcinoma and one dysplasia in the same family are reported. The three sisters concerned were teenagers. This familial disease with bilateral localizations in young female patients, is quite rare. Clinical, histological and epidemiological conclusions were based on familial investigation.

La Retinopathie chloroquinique: une cause rare de sclerose areolaire centrale secondaire. [Lettre]

Les auteurs rapportent un cas de retinopathie chloroquinique tres evoluee realisant une sclerose areolaire centrale bilaterale. Ils pensent que la survenue de cette affection au cours de la prophylaxie antipalustre est negligeable. Compte-tenu de la mortalite elevee du paludisme dans les zones concernees; cette retinopathie ne devrait en aucun moment gener l'un des moyens de prevention les plus efficaces actuellement

Pronostic du traumatisme oculaire necessitant une hospitalisation : une evaluation du Service d'Ophtalmologie de l'Hopital Principal de Dakar sur une periode de 3 ans

Apres une analyse retrospective de 117 dossiers de patients hospitalises dans le service d'Ophtalmologie de l'Hopital Principal de Dakar pour un traumatisme oculaire de janvier 1990 a decembre 1992 dans le but d'evaluer leur pronostic; les auteurs constatent que les sequelles anatomiques et fonctionnelles sont tres importantes. 48;4 pour cent des sujets ont perdu l'usage de leur oeil traumatise. Le pronostic est plus grave entre 11-15 ans; apres 40 ans; chez la femme et paradoxalement sur les traumatismes operes en urgence. Les plaies corneennes depassant 2/3 de meridien et celles prenant la cornee de part en part sont redoutables; aboutissant presque toutes a la cecite et plus souvent a la phtyse. 46 pour cent des sujets ayant recu un projectile (jet de pierre surtout) perdent la vision. Les traumatismes par brindille de balai a cause de leur septicite n'ont laisse aucune chance de recuperation. Face a cette grande morbidite; les auteurs preconisent la prevention comme principal recours; meme s'il faut ameliorer sans cesse la prise en charge de ces patients

Le phlegmon orbitaire : ses origines et complications : a propos de 20 cas

Le phlegmon ou abces orbitaire se presente comme une exophtalmie inflammatoire aigue febrile. En vue d'en etudier les origines et les complications; les auteurs rapportent 20 cas colliges en 4 ans (1989-1993). 65 pour cent (13/20 sujets atteints) ont 20 ans ou moins; les sinusites en sont la premiere cause avec 11/20 cas soit 55 pour cent; les traumatismes suivent avec 25 pour cent (5/20 cas). Les phlegmons orbitaires (surtout d'origine ou traumatismes) se compliquent tres souvent; certaines complications peuvent rapidement engager le pronostic vital ou fonctionnel. tel a ete le cas de 2 deces suite a une thrombophlebite du sinus caverneux et 4 cecites dont 3 par atrophie optique. Pour ces raisons le traitement doit etre institue en urgence; utilisant une antibiotherapie puissante et adaptee associee aux anti-inflammatoires de preference cortisonnes. Le drainage de la collection sinusienne avec lavage a l'aide d'une solution antibiocortisonnee en cas de sinusite est tres efficace et permet d'eviter de nombreuses complications

Seasonal migration: a risk factor for HIV infection in rural Senegal.

Sociodemographic and epidemiological data collected on a rural population of the Ziguinchor region of Senegal showed that a large part of the adult population, 80% of women between 15 and 24 years old and 82% of men between 20 and 40 years old, move each year on seasonal labor migrations to the main cities of Senegal or the Gambia or their proximity. In October 1990, an exhaustive seroprevalence survey of the population aged 20 years or older (3,230 persons tested) showed that 0.8% was HIV-2 and 0.1% HIV-1 seropositive. Interviews of 91 persons (24 seropositive persons and 67 seronegative controls) revealed that seropositivity was associated with a history of blood transfusions, injections, sexually transmitted diseases, and seasonal migration. Our findings suggest that in the rural area under study, beside a few cases of transmission by blood transfusion or injection, HIV-2 and HIV-1 are mainly transmitted first to adult men through sexual contacts with infected women met during their seasonal migration and second to their wives or regular partners once they are back home.

[Posterior chamber implantation in black Africa. Apropos of 150 cases with an 18 months follow-up]. / L'implantation de chambre postérieure en Afrique noire. A propos de 150 cas suivis pendant 18 mois.

The purpose of this article is to report our study of 150 cases of posterior chamber implantations carried out at the Hôpital Principal de Dakar between 1988 and 1991. We report the specific difficulties of such operations in black Africans and their complications and follow-up. At the end of this study, after observations over an eighteen month period, we noticed a visual acuity of more than 20/30 for 105 patients (70%) and a secondary cataract in 22 cases (14.6%). Despite less favourable material conditions, we think that such an operation can perfectly be made in Africa and that it gives quite acceptable results.

HIV-2 infections in a rural Senegalese community.

In a community study in rural Senegal, 22 human immunodeficiency virus type-2 (HIV-2) seropositive cases and 64 matched controls were examined clinically and evaluated immunologically. The presence of clinical signs was highly correlated with HIV-2 seropositivity: 9 anti-HIV-2 positive patients and 5 controls presented with clinical signs (odd ratio [OR] = 8.2, confidence limits [CL] 2-35). The main symptom associated with HIV-2 seropositivity was a chronic cough (OR = 18.5, CL 1.8-899). The presence of diarrhoea was not significant (OR = 3.1, CL 0.3-3.5). The total number of CD8 cells, CD4/CD8 ratio, beta 2 microglobulin, and IgG level discriminated between seropositive and seronegative individuals (P less than 0.05). When the anti-HIV-2 positives were grouped as 13 healthy and 9 sick people, red blood cells, lymphocytes, T lymphocytes, CD4 cells, and beta 2 microglobulin differed significantly. Clinical symptoms were associated with immunodepression: 5 of 14 sick people had less than 500 CD4/microliters vs. 1 of 72 healthy persons. This study at the community level emphasizes the clinical and immunological impact of HIV-2 infection. Even if it presents with a longer incubation period than HIV-1, this virus is a major threat to public health.

PIP: In the early 1990s, HIV seroprevalence in the rural community in Casamance, Senegal was .8% (age range from 24 to 68 years). 25 people had HIV-2 infection and 2 had HIV-1 infection. Health workers evaluated 22 of the HIV-2 positive adults and compared them with 64 matched controls. The HIV-2 positive adults were 7.25 times more likely to suffer from ill health than the controls (50% vs. 12.5%). Clinical signs of HIV-2 positive status were more common among HIV-2 positive adults than controls (40.9% vs. 7.8%; odds ration [OR] = 8.2), especially chronic cough (OR - 18.5). Presence of diarrhea was insignificant (22% vs. 40%). HIV-2 positive adults had much higher levels of CD8 cells (p = .03), IgG (p = .0001), and beta 2 macroglobulin (p =.001) than the controls. Their CD4/CD8 ratio levels were much lower than those of the HIV-2 negative individuals (1.1 vs. 1.9; p = .0001). Among HIV-2 positive adults, symptomatic adults had significantly lower levels of red blood cells (p = .02), white blood cells (p = .02), lymphocytes (p = .01), T cells (p = .01), and CD4 cells (p = .002) than the healthy adults. Their beta 2 macroglobulin levels were much greater than controls (4.6 mg/vs. 2.9 mg/l, p = .03). 5 HIV-2 cases (22.7%) researchers suffered from immunosuppression (500 CD4 cells/mcl) compared with only 1 control (1.6%) (OR = 18.5). Clinical symptoms were more likely to be present in immunodepressed people than in non immunodepressed people (35.7% of 14 sick adults vs. 1.4% of healthy adults). 1 person who had AIDS as defined by WHO (weight loss, persistent cough, and diarrhea) had 429 CD4 cells/mcl. 1 person suffered from bronchopneumonia (326 CD4 cells/mcl). Another person had chronic diarrhea and bronchopneumonia (350 CD4 cells/mcl). The mean age of HIV-2 infected people who had a respiratory condition was 51 years (42-68 years) while it was 41 years (26-68 years) for asymptomatic HIV-2 infected people indicating a rather long incubation period. These results suggested that HIV-2 can be significant public health problems.