[Treatment of deep venous thrombosis. Comparative study of a low molecular weight heparin fragment (Fragmin) by the subcutaneous route and standard heparin by the continuous intravenous route. A multicenter study]. / Traitement des thromboses veineuses profondes constituées. Etude comparative d'un fragment d'héparine de bas poids moléculaire (Fragmine) administrée par voie sous-cutanée et de l'héparine standard administrée par voie intraveineuse continue. Etude multicentrique.

This open, randomised multicenter trial compares the efficacy and safety of Fragmin administered subcutaneously twice daily with standard heparin administered by continuous infusion in the treatment of deep vein thrombosis (DVT). The initial dose of Fragmin is 100 U anti-Xa/kg/12 h and the further doses are adjusted according to the anti-Xa activity between 0.5 and 0.8 U/ml, 3 hours after the morning injection. The initial dose of standard heparin is 240 UI/kg/12 h. The dose adjustments are based on the daily results of APTT (1.5 - 3 times the control). Treatments efficacy are appreciated when comparing the venography performed before and after 10 days of treatment. The safety is evaluated on clinical parameters and iterative biological tests. Sixty-six patients have been included in this study. Efficacy of the two treatments is equivalent with a phlebographic improvement in respectively 79.3 p. 100 (Heparin Group) and 71.0 p. 100 (Fragmin Group) of the cases and an aggravation in 3.4 p. 100 and 6.4 p. 100 (NS) respectively. The frequency of dosage adjustments is lower and the stability of biological tests is better in the Fragmin group. In conclusion, the administration of Fragmin twice daily by subcutaneous route seems to be equivalent at least to standard heparin continuous infusion in the treatment of recent DVT. The better convenience and safety of Fragmin have to be verified on a larger panel of patients.

[An observational, retrospective two-year cost study in primary open-angle glaucoma and ocular hypertension in newly diagnosed patients]. / Etude observationnelle rétrospective de coûts des deux premières années de traitement dans le glaucome primitif à angle ouvert et l'hypertension oculaire en France.

PURPOSE: To investigate the different treatment strategies in France and the direct costs for patients with newly diagnosed primary open-angle glaucoma or ocular hypertension who have started treatment with beta-blockers, and to estimate the total direct cost for two years of treat. MATERIAL: and methods: We analyzed 225 medical charts retrospective in eleven academically and office-based centers in France over the first two years after diagnosis. Standard costs for each resource in current medical practice were determined from the French Social Security perspective. RESULTS: The vast majority of patients (90%) had a diagnosis of primary, open-angle glaucoma or ocular hypertension in both eyes. In 60% of the patients we found a moderate or severe defect in their visual field or optic nerve. Intraocular pressure before treatment was 23.9+4.7mmHg and 17.5+4.2mmHg after two years of treatment. Over the first two years, 25% of visits led to a change in therapy (medical or surgical), involving 64% of the patients. Two-thirds of the changes occurred during the first year of treatment and in around 80% of cases for low intraocular pressure at check-up. Laser surgery or surgical intervention was performed in 25% of the patients. Total direct costs for two years were 5698F.F. The intraocular pressure before treatment was positively correlated (p<0.01) with treatment costs, while the initial intraocular pressure-lowering effects of treatment were negatively correlated with two-year costs. CONCLUSION: After two years of treatment, the mean intraocular pressure decreased from 24 to 17.5mmHg. The higher the basal intraocular pressures is, the more intensive the treatment and the higher the costs. The more efficient the treatment to decrease baseline intraocular pressure is, the earlier the costs will be reduced.

An interim report of an intervention strategy for diabetes care in Jamaica.

The high prevalence (17.9%) of diabetes mellitus and its attendant costs have been recognized for some time. The diabetic public has hitherto been too oriented to seeking health care at the secondary and tertiary health care centres; a much too costly approach. As a part of a wellness promotion thrust as well as an awareness and intervention strategy, a number of health care agencies have collaborated in a training programme of lay diabetes facilitators. This was intended to allow a domino effect of "each one teach one" within the community. This intervention programme was undertaken over an 18-month period. No significant changes were achieved in glycaemia levels. The impact on hospital admissions and community awareness is yet to be assessed. Laboratory results indicated good correlation between glycosuria and hyperglycaemia. This could influence the thrust in maintaining glycosuria assessment alongside blood glucose monitoring. This approach would have a cost benefit for government clinics islandwide. Whilst it may be difficult to identify any one parameter that may be responsible for change, it will be possible to assume that this intervention strategy, the only innovation in the health care delivery modalities, may have contributed.

[Phacoemulsification and acrylic intraocular lens in uveitis: a comparative study]. / Facoemulsificación con implante de lente acrílica en pacientes con uveítis: estudio comparativo.

OBJECTIVE: To describe the outcomes of phacoemulsification with the implant of an acrylic intraocular lens (IOL) in cataracts of adult patients with and without uveitis METHODS: Descriptive retrospective comparative study of 35 patients (45 eyes) with uveitis (group 1) and 38 (44 eyes) control patients (group 2), who were operated on by the same surgeon, and were homogeneous as regards sex, surgical technique, IOL (hydrophobic or hydrophilic) and follow-up. The pre-surgical characteristics of risk, the difficulties and intra-surgical and postsurgical complications, the date of posterior capsulotomy (PC) and the pre- and post-surgical visual acuity (VA), were analysed. RESULTS: In both groups the coaxial phacoemulsification was used in 75% of the eyes, bimanual microincision cataract surgery (MICS) in 20% and micro-coaxial in the rest. The pre-surgical risk factors (P = .002, OR 6.83), the surgical difficulties and complications (P = .001, OR 7.54) and postsurgical complications (P = .069, OR 3.42) were more frequent in the uveitis group. In both 93% and 91% respectively of eyes improved 2 or more lines of VA. After an average follow-up of 4.9 years in both groups, 22.7% and 32% eyes (log-rank P = .357) needed PC. The hydrophilic IOLs needed PC earlier than the hydrophobic ones (log rank P = .001), neither the location nor the uveitis course influenced the PC rate. CONCLUSIONS: The consequences because of previous ocular inflammation make cataract surgery in uveitis more difficult, but with postsurgical complications, visual results and need of PC similar to our patients without inflammation.

[Postsurgical WEBINO, a new form of this syndrome]. / Síndrome de WEBINO postquirúrgico, una nueva forma de este síndrome.

CASE REPORT: A 20 year-old woman was submitted to resection of an ependymome of the fourth ventricle. After surgery the patient began to refer diplopia and oscillopsia. WEBINO syndrome (wall-eyed bilateral internuclear ophthalmoplegia), vertical nystagmus and skew deviation were diagnosed. DISCUSSION: WEBINO syndrome is considered a special form of bilateral internuclear ophthalmoplegia. It is characterized by bilateral absence of adduction, nystagmic abduction of both eyes, convergence deficiency and frequently exotropia. Ischemic, demyelinating and infectious etiologies have been described, but to our knowledge this is the first report of a postsurgical form of this syndrome.

An interim report of an intervention strategy for diabetes care in Jamaica

The high prevalence (17.9) of diabetes mellitus and its attendant costs have been recognized for some time. The diabetic public has hitherto been too oriented to seeking health care at the secondary and tertiary health care centres; a much too costly approach. As a part of a wellness promotion thrust as well as an awareness and intervention strategy, a number of health care agencies have collaborated in a training programme of lay diabetes facilitators. This was intended to allow a domino effect of [quot ]each one teach one[quot ] within the community. This intervention programme was undertaken over an 18-month period. No significant changes were achieved in glycaemia levels. The impact on hospital admissions and community awareness is yet to be assessed. Laboratory results indicated good correlation between glycosuria and hyperglycaemia. This could influence the thrust in maintaining glycosuria assessment alongside blood glucose monitoring. This approach would have a cost benefit for government clinics islandwide. Whilst it may be difficult to identify any one parameter that may be responsible for change, it will be possible to assume that this intervention strategy, the only innovation in the health care delivery modalities, may have contributed.