Interferon Alpha-2a Treatment for Post-Uveitic Refractory Macular Edema.

Purpose: To assess the efficacy of interferon (IFN) alpha-2a in the treatment of post-uveitic refractory macular edema (ME).Methods: Retrospective cohort of patients with post-uveitic refractory ME, who received subcutaneous IFN alpha-2a injections for at least 3 months. Baseline central macular thickness (CMT) and best-corrected visual acuity (BCVA) were compared with those at follow-up visits up to 12 months.Results: Thirty-seven patients were included. Treatment duration (median [interquartile range]) was 14[8-24] months with a follow-up of 17[10-38] months. CMT (mean [standard deviation]) decreased from 438[140] to 335[119] µm after 1 month (p < 0.0001) and remained significantly lower up to 12 months (286[98] µm, p = 0.001). BCVA (0.48[0.33] logMAR at baseline) improved by 0.26[0.33] logMAR (p = 0.001) at 12 months. There were 14 recurrences. Seven patients had treatment side effects, without serious adverse events.Conclusions: IFN alpha-2a was effective, safe, and well tolerated in treating post-uveitic refractory ME.

Optimized FIB silicon samples suitable for lattice parameters measurements by convergent beam electron diffraction.

The aim of this paper is to check the effect of artefacts introduced by focused ion beam (FIB) milling on the strain measurement by convergent beam electron diffraction (CBED). We show that on optimized silicon FIB samples, the strain measurement can be performed with a sensitivity of about 2.5 x 10(-4) which is very close to the theoretical one and we conclude that FIB preparation can be suitable for such measurements in microelectronic devices. To achieve this, we first used CBED and electron energy loss spectroscopy (EELS) which provide a procedure permitting an exact knowledge of the sample geometry, i.e. the thickness of both amorphous and crystalline layers. This procedure was used in order to measure the FIB-amorphized sidewall layer. It was found that if the FIB preparation is optimized one can reduce this amorphous layer down to around 7 nm on each side. Secondly different preparation techniques (cleavage, Tripodtrade mark and FIB) permit to check if the surface damaged layer introduced by FIB influences the strain state of the sample. Finally, it was found that the damaged layer does not introduce measurable strain in pure silicon but reduces appreciably the quality of the CBED patterns.

Treatment of pilonidal disease with laser epilation.

Pilonidal disease is a debilitating, chronic disease of the natal cleft. It mainly involves the sacrococcygeal region and the presentation varies from asymptomatic pits to painful draining abscesses. Treatment options vary from observation to wide excision. Unfortunately, surgical treatment often results in recurrence. The etiologic agent remains in question, as does the optimal treatment. Our objective was to assess the efficacy of laser epilation as an adjunctive therapy to surgical excision of the pilonidal sinus. Eighteen men and five women were treated with laser epilation in our office from 2001 to 2004. All patients had experienced recurrent folliculitis and had undergone some form of drainage procedure or prior excision. After surgical excision of the affected area, a Vasculite Plus laser was used for the epilation treatments. Each session involved 9 to 12 treatments and the patients underwent an average of two sessions. All 19 of the patients that remain in follow-up report no recurrence of their folliculitis or need for further surgical procedures. During treatment, six of the men and one of the women experienced a superficial wound dehiscence. All healed with local wound care and continued laser treatments. Laser epilation is an effective adjunctive therapy for the treatment of pilonidal disease. Although not curative in and of itself, the removal of hair allows better healing and decreases the chance of recurrence by removal of a significant etiology of pilonidal disease.

Enoxaparin associated with hugh abdominal wall hematomas: a report of two cases.

Enoxaparin is a low-molecular-weight heparin used for prophylaxis against deep venous thrombosis. Indications include hip and knee replacement surgery, risk of deep venous thrombosis during abdominal surgery, and prevention of ischemic complications of unstable angina and non-Q-wave myocardial infarction. Its efficacy in the prevention of the above complications has been previously studied; however, the liberal use of enoxaparin is not without incident. Complications of enoxaparin include hemorrhage, thrombocytopenia, and local reactions. Since 1993 there have been more than 40 reports of epidural or spinal hematoma formation with the concurrent use of enoxaparin and spinal/epidural anesthesia or spinal puncture. Herein reported are two cases of abdominal wall hematomas in patients receiving prophylaxis with enoxaparin. Both patients sustained an unexplained fall in the hematocrit and abdominal pain. A CT scan confirmed the diagnosis. One patient recovered uneventfully; however, the other patient, on chronic hemodialysis, became hemodynamically unstable and hyperkalemic and sustained a fatal cardiac arrhythmia. An extensive review of the literature revealed no similar cases of abdominal wall hematomas associated with enoxaparin although other complications, including spinal and epidural hematomas, psoas hematomas, and skin necrosis have been reported. The extended use of enoxaparin as an anticoagulant requires the physician to be vigilant of these rare complications. Bleeding can occur at any site during therapy with enoxaparin. An unexplained fall in the hematocrit or blood pressure should lead to a search for a bleeding site.

[Systemic lupus erythematosus and Salmonella enteritidis osteomyelitis]. / Lupus érythémateux disséminé et ostéomyélite à Salmonella enteritidis.

Infections in systemic lupus erythematosus are frequent. However, osteoarticular Salmonella infections are rarely reported. We report a case of systemic lupus erythematosus diagnosed in a 15 year-old girl. Seven months later, she presented with fever and a localized collection of the upper extremity of the left tibia related to a Salmonella enteritidis acute osteomyelitis (sub periosteal abscess). The out-come was chronic and led to death. The authors emphasize the severity of non typhoidal salmonellosis in systemic lupus erythematosus.

[Rheumatoid arthritis in Morocco. Apropos of 404 observations]. / Polyarthrite rhumatoïde au Maroc. A propos de 404 observations.

A retrospective study of 404 cases of rheumatoid arthritis seen in a department of internal medicine in Casablanca highlights a number of specific features of the disease in Morocco. Onset occurred early and mean age of patients was 34.4 years. Analysis of joint manifestations showed that the disease tended to be mild in the hips and perhaps in the cervical spine. Thirty-five percent of patients were Steinbrocker's class II and 25.5% had carpal bone fusion. Only 20 patients had severely erosive disease, which manifested as giant geodes in 8 cases and as main en lorgnette deformity in one case. Subcutaneous nodules (7.9%) and systemic visceral disorders were fairly infrequent. Only three cases of malignant rheumatoid arthritis were found. Gougerot-Sjögren syndrome was present in 13.6% of patients. Among comorbid conditions, thyroid gland diseases and tuberculosis were fairly common. Serologic tests were positive in 61.14% of cases, often in low titres. Gold salt therapy was well tolerated. No patients in this group had surgical treatment. These data suggest that in Morocco rheumatoid arthritis may be less aggressive than in Europe.

Hemodialysis access operations performed upon patients with human immunodeficiency virus.

Hemodialysis in known patients infected with human immunodeficiency virus (HIV) has been a subject of controversy. During a 60 month period, 28 hemodialysis access operations were performed upon 22 HIV infected patients. The indication for all procedures was need of dialysis access secondary to end-stage renal failure (ESRF). Operations included 24 arteriovenous dialysis grafts and four Cimino arteriovenous fistulas. All patients had a diagnosis of acquired immunodeficiency syndrome (AIDS) (five), AIDS related complex (six) or were HIV-positive (11) at the time of the operations. All of these patients were intravenous drug abusers. Follow-up study ranged from nine days to 13 months. During the course of this study, two patients died of the progression of AIDS for a mortality rate of 9 per cent. There were nine perioperative complications for a rate of 32 per cent. These results led us to conclude that hemodialysis access operations have application in HIV infected patients with ESRF, and hemodialysis should be considered an appropriate modality in those patients requiring long term dialysis.

Abdominal pain and anorectal disease in AIDS.

The diagnosis and treatment of abdominal pain and anorectal disease in AIDS patients are discussed. Emphasis is placed on the practical aspects of patient care.

Improved subclavian cannulation technique.

An improved subclavian cannulation technique using a 3 milliliter syringe attached to a No. 16 gauge needle and a guide wire is presented. Major complications, such as air embolism, vein laceration and retained catheter fragments, are eliminated by using this method of catheterization.

Improved house staff results with subclavian cannulation.

In the teaching hospital, insertion of subclavian lines is frequently the responsibility of the House Staff. This paper reviews 225 subclavian cannulations by the Surgical House Staff of St. Barnabas Medical Center over an eight-month period. Twenty-six complications were documented. The major complication rate was 1.8 per cent and minor complications, 9.8 per cent. No correlation could be found between age, sex, or side of the catheter insertion with regard to complications. The overall complication rate was highest in the postgraduate year I (PGY) and PGY II levels, and this decreased with the more experienced residents. These results were statistically significant (P less than 0.05). The literature is reviewed, and recommendations concerning subclavian cannulation techniques are made.

Subclavian cannulation. Valuable dialysis access alternative.

The subclavian vein was used for temporary dialysis access in 67 patients. There were 733 dialysis treatments performed using a total of 87 catheters during the study period. The catheters were left in place for an average of 24.5 days per patient and 18.9 days per catheter. A mean of 10.9 dialysis treatments per patient, and 8.4 dialysis treatments per catheter were performed. Seven patients expired with their catheters indwelling. None of these deaths were related to the catheter. There were 21 associated catheter complications. Twelve of these catheter complications were corrected by changing the catheter over a guide wire. The technique for catheter insertion, proper catheter care including home care, and complications due to the catheters are discussed. Subclavian catheter dialysis access appears to be a valuable adjunct for dialysis and has replaced the use of Scribner shunts and repeated femoral catheterizations for temporary access in our institution.