[Creation and evaluation of a triage survey for ophthalmology emergencies]. / Élaboration et évaluation d'un autoquestionnaire de triage pour les demandes de soins non programmés en ophtalmologie.

PURPOSE: The demand for eye care is growing continuously. We created a triage survey system, based on categories of severity, to optimize first line patient care in an ophthalmology emergency department. METHODS: This cross-sectional study was carried out from July 7th, 2021 to October 10th, 2021. During this period, a survey was taken by patients upon arrival to the emergency department. Patients completed the survey by ticking boxes that best fitted their situation. The survey classified patients into three categories of severity: GREEN, ORANGE and RED. A chart review was performed to record the final diagnoses. The severity of each diagnosis was rated according to the Base Score. This score was then compared to the level of severity as determined by our survey to calculate the agreement between the two methods. RESULTS: We collected 767 survey forms, with an 80% response rate. We noted 78 different diagnoses. We scored 564 patients as GREEN, 107 as ORANGE and 96 as RED. The sensitivity rates for the green, orange and red categories were 90%, 70% and 96% respectively. The specificity rates were 90% for the green category, 95% for orange and 94% for red, with good agreement (kappa coefficient=0.70). CONCLUSION: Our results suggest that a self-administered survey could be useful as a triage tool for common ocular emergencies. This survey could be performed better if complete by the patients with the assistance of emergency staff. Potentially helpful for high flow structures such as university-based hospitals, this triage survey might also help in comprehensive clinics or emergency departments.

[Ocular toxicity of targeted therapies with MEK inhibitors and BRAF inhibitors in the treatment of metastatic cutaneous melanoma]. / Toxicité oculaire des thérapies ciblées anti-MEK et anti-BRAF dans le traitement des mélanomes cutanés métastatiques.

INTRODUCTION: Cutaneous melanoma is a malignant tumor, which develops from dermal melanocytes. Targeted therapies have changed the therapeutic management of metastatic melanoma and improved the survival rate. Among the various targeted therapies, MEK inhibitors and BRAF inhibitors have demonstrated efficacy, but they may lead to ocular toxicity. The goal of this study was to assess the incidence of ocular complications caused by the use of MEK inhibitors and BRAF inhibitors and to report their clinical features and therapeutic management. MATERIAL AND METHODS: This retrospective, observational, descriptive, single center study was conducted between May 2015 and December 2019 and included all patients with metastatic cutaneous melanomas treated with MEK inhibitors and BRAF inhibitors in whom ophthalmic toxicity was suspected. The data collected were demographic data (age, sex), the type of MEK inhibitors and BRAF inhibitors used, the length of time from melanoma diagnosis, mean duration of ophthalmological follow-up, time differential between starting therapy and the emergence of ocular complications, initial and final logMAR visual acuity, biomicroscopic examination of the anterior segment, dilatated fundus examination, and treatment administered. RESULTS: Fifty-four eyes of 27 patients with a mean age of 61.3±14.3 were included. The mean time delay between melanoma diagnosis and initiation of treatment was 23.2±8 months. Twenty patients (74%) were treated with a combination of MEK inhibitors and BRAF inhibitors (trametinib/dabrafenib), 5 patients (19%) were treated with MEK inhibitor monotherapy (cobimetinib), and 2 patients (7%) were treated with BRAF inhibitor monotherapy (vemurafenib). The mean duration of ophthalmological follow-up was 77.8±29 days, and the delay between the start of therapy and the emergence of symptoms was 87.2±78 days. The mean initial visual acuity was 0.075±0.13 logMAR, and the final visual acuity was 0.01±0.03 logMAR. Twelve patients (44%) developed ocular complications due to the targeted therapy. In the patients who received combination trametinib/dabrafenib, 5 patients (18.5%) developed clinical signs of uveitis, from acute anterior uveietis to panuveitis, and 2 patients (7.4%) developed bilateral central serous chorioretinopathy; in the patients who received cobimetinib, 4 patients (14.8%) developed bilateral central serous chorioretinopathy; and one patient (3.7%) who received vemurafenib developed acute anterior uveitis. For these 12 patients with ophthalmic side effects, temporary discontinuation of therapy was chosen for six patients (22.2%), three patients (11.1%) received half the initial dose, and for three patients (11.1%), normal dosing was continued. CONCLUSION: The two main side effects of targeted therapies are uveitis for BRAF inhibitors and central serous chorioretinopathy for MEK inhibitors. A multidisciplinary approach including ophthalmologists, dermatologists and oncologists is essential in order to adapt treatment in the advent of these ocular complications.

[Comparison of visual acuity, complications and patient satisfaction between outpatient and inpatient keratoplasty surgery]. / Comparaison de l'acuité visuelle, des complications et de la satisfaction des patients entre la chirurgie de kératoplastie ambulatoire ou en hospitalisation.

INTRODUCTION: Our objective in this work was to compare visual acuity, complication rate, rate of unplanned visits in the month following the procedure, and patient satisfaction between patients who received a corneal transplant as an outpatient or inpatient. PATIENTS AND METHODS: Our work focused on 19 patients (6 inpatients and 13 outpatients), who had undergone unilateral keratoplasty between May 2018 and December 2018. The indications for corneal transplant were keratoconus, Fuchs dystrophy and graft rejection. RESULTS: All patients who were followed for at least one month had an improvement in their VA. There were on average as many postoperative consultations in the inpatient group as in the outpatient group. Complications occurred in 77% of inpatients versus 40% of outpatients. The rate of consultations in the month following the operation was similar in both groups. Patients were satisfied with outpatient management. DISCUSSION: No similar studies have been conducted to our knowledge. This preliminary work is limited by the small number of patients and questionnaires received and the length of follow-up. The criteria for outpatient care are very important to limit complications. For corneal transplantation, hospitalisation is most often performed with an average stay of 2 to 5 days. Outpatient management seems, according to our preliminary work, to be able to be extended into more centres without changing the postoperative follow-up or increasing the rate of complications, allowing lower cost and patient satisfaction. CONCLUSION: The previous lack of this type of study, as well as the encouraging results of this work, open the way to larger scale prospective comparative as well as medico-economic studies.

[Functional results and prognostic factors in open-globe ocular trauma with presenting visual acuity of no-light perception]. / Résultats fonctionnels et facteurs pronostiques des traumatismes oculaires à globe ouvert avec acuité visuelle initiale à perception lumineuse négative.

PURPOSE: To analyse the clinical ocular characteristics and determine prognostic factors for functional recovery in eyes presenting with no light perception (NLP) after open globe ocular trauma. MATERIALS AND METHODS: In this retrospective study were included all the patients with no light perception after open globe trauma who presented to Amiens University Hospital between October 2014 and June 2018. RESULTS: Fifteen eyes of 15 patients were included in this study. The main mechanism of the trauma was globe rupture (80 %, n=12). The most common location was zone III (66 %, n=10). The wound size was greater than 10mm in 9 patients (60 %). The ocular lesions included expulsion of the crystalline lens or posterior chamber intraocular lens, hyphema, retinal detachment, vitreous hemorrhage and ciliochoroidal lesions. Damage to the ciliary body was a negative prognostic factor for functional recovery (P=0.04). Nine patients remained with no light perception, whereas 6 patients experienced an improvement in visual acuity (2.3 logMAR in 3 patients, 0.7 logMAR in 1 patient, 0.4 logMAR in 1 patient and 0.2 logMAR in 1 patient). These 6 patients had undergone posterior vitrectomy due to vitreoretinal involvement (P<0.001). CONCLUSION: In the case of open globe trauma with no light perception on presentation, a functional recovery is possible if there is no irreversible anatomical damage.

[Pulmonary causes of chest pain]. / Pneumologische Ursachen für Thoraxschmerz.

Chest pain represents one of the most frequent symptoms of pulmonary diseases, in addition to dyspnea and cough. The broad differential diagnostics include the intensely painful but prognostically benign acute pleurisy as well as potentially life-threatening events, such as acute pulmonary embolism or malignant chest diseases. Primary spontaneous pneumothorax is characterized by acute chest pain. Pain associated with a respiratory infection, such as pneumonia rarely poses a difficult diagnostic problem. Painful diseases of the lungs can be differentiated in an initial approach by asking the patient if the pain is related to breathing, which is characteristic of pleuritic chest diseases. Pulmonary hypertension, lung cancer and mesothelioma show more constant pain unrelated to respiratory movements. It is most important to differentiate pain associated with acute exacerbation of chronic obstructive pulmonary disease (COPD), whereby a possible cardiac comorbidity, such as acute coronary syndrome (ACS) should always be considered.

Data on step-by-step atomic force microscopy monitoring of changes occurring in single melanoma cells undergoing ToF SIMS specialized sample preparation protocol.

Data included in this article are associated with the research article entitled 'Protocol of single cells preparation for time-of-flight secondary ion mass spectrometry' (Bobrowska et al., 2016 in press) [1]. This data file contains topography images of single melanoma cells recorded using atomic force microscopy (AFM). Single cells cultured on glass surface were subjected to the proposed sample preparation protocol applied to prepare biological samples for time-of-flight secondary ion mass spectrometry (ToF SIMS) measurements. AFM images were collected step-by-step for the single cell, after each step of the proposed preparation protocol. It consists of four main parts: (i) paraformaldehyde fixation, (ii) salt removal, (iii) dehydrating, and (iv) sample drying. In total 13 steps are required, starting from imaging of a living cell in a culture medium and ending up at images of a dried cell in the air. The protocol was applied to melanoma cells from two cell lines, namely, WM115 melanoma cells originated from primary melanoma site and WM266-4 ones being the metastasis of WM115 cells to skin.

[Cannabis--Position Paper of the German Respiratory Society (DGP)]. / Cannabis--Positionspapier der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin e.V. (DGP).

In this position paper, the adverse health effects of cannabis are reviewed based on the existing scientific literature; in addition possible symptom-relieving effects on some diseases are depicted. In Germany, cannabis is the most widely used illicit drug. Approximately 600,000 adult persons show abusive or addictive cannabis consumption. In 12 to 17 year old adolescents, cannabis use increased from 2011 to 2014 from 2.8 to 6.4%, and the frequency of regular use from 0.2 to 1.5%. Currently, handling of cannabinoids is much debated in politics as well as in general public. Health aspects have to be incorporated into this debate. Besides analysing mental and neurological side effects, this position paper will mainly focus on the influences on the bronchopulmonary and cardiovascular system. There is strong evidence for the induction of chronic bronchitis. Allergic reactions including asthma are known, too. Associations with other diseases like pulmonary emphysema, lung cancer and pneumonia are not sufficiently proven, however cannot be excluded either. In connection with the use of cannabis cardiovascular events such as coronary syndromes, peripheral vascular diseases and cerebral complications have been noted. Often, the evidence is insufficient due to various reasons; most notably, the overlapping effects of tobacco and cannabis use can frequently not be separated adequately. Empirically, early beginning, high-dosed, long-lasting and regular cannabis consumption increase the risk of various psychological and physical impairments and negatively affect age-based development. Concerns therefore relate especially to children and adolescents. There is only little scientific evidence for medical benefits through cannabis as a remedy; systematic research of good quality, in particular prospective, randomised, placebo-controlled double-blinded studies are rare. The medical societies signing this position paper conclude that cannabis consumption is linked to adverse health effects which have to be taken into consideration in the debate about the social attitude towards cannabinoids. The societies agree that many aspects regarding health effects of cannabis are still uncertain and need clarification, preferably through research provided by controlled studies.

Tolerability of intracameral cefuroxime during cataract surgery in case of penicillin allergy.

INTRODUCTION: Since the results of the ESCRS study in 2007 and then the AFSSAPS recommendations of 2011, postoperative endophthalmitis prophylaxis in cataract surgery has evolved toward intracameral cefuroxime. Penicillin allergy is frequent and is not considered as a contra-indication to cefuroxime injection, but cross-reactions do exist. The goal of this study was to assess the tolerability of intracameral cefuroxime in patients with a penicillin allergy. MATERIALS AND METHODS: In this monocentric open prospective study, adult patients undergoing cataract surgery and declaring themselves penicillin-allergic were included. A subcutaneous test of cefuroxime was performed preoperatively. If negative, patients received the intracameral injection of cefuroxime at the conclusion of the surgical procedure. The primary assessment criteria, evaluated on the day after the surgery, was the occurrence of allergic reactions. RESULTS: Forty-eight eyes of 40 patients, 72 ± 8 years old, were included. Forty-three skin tests were performed: 1 was positive and one was unreliable. Thirty-six patients were examined in our center the day after the surgery: 2 presented a conjunctival allergic reaction. No severe anaphylactic reaction was reported. DISCUSSION: Of our patients, 95.3% declaring a penicillin allergy had a negative pre-operative cefuroxime test. According to literature, 80 to 90% of presumed penicillin allergic patients would not actually be allergic to cefuroxime. In our population, we reported 2 benign conjunctival cross-reactions. CONCLUSION: Intracameral cefuroxime injection during cataract surgery seems well-tolerated in penicillin-allergic patients with a negative preoperative skin test.

[Pulmonary hypertension and Langerhans' cell granulomatosis: successful treatment with sildenafil and iloprost]. / Pulmonale Hypertonie und Langerhanszell-Granulomatose--erfolgreiche langfristige Therapie mit Sildenafil und Iloprost.

HISTORY AND CLINICAL FINDINGS: A 51-year-old woman (Case A) who had suffered from pulmonary Langerhans' cell granulomatosis for four years presented with progressive exertional dyspnea. A 39-year-old man (Case B) with pulmonary Langerhans' cell granulomatosis for eight years presented with right heart failure. INVESTIGATIONS: In Case A we found fixed airflow obstruction, hypoxemia, pulmonary fibrosis, bronchiectasis, severe precapillary pulmonary hypertension and a reduced right ventricular function, in Case B moderate airflow obstruction, hypoxemia, pulmonary fibrosis, emphysema and severe precapillary pulmonary hypertension. TREATMENT AND COURSE: Pulmonary hypertension due to pulmonary Langerhans' cell granulomatosis was assumed in both patients. After treatment with sildenafil, the woman has experienced long-term improvement for 2.5 years so far. An initially planned lung transplantation was therefore postponed. During inhaled iloprost the man also showed hemodynamic and clinical improvement and was stable for several years. Five years later recurrent right heart failure required an increase in iloprost dose; lung transplantation was then performed. CONCLUSION: Although no approved drug is available for pulmonary hypertension in Langerhans' cell granulomatosis specific targeted therapies can lead to hemodynamic and long-term clinical improvement. Treatment could be helpful for selected patients with pulmonary hypertension in Langerhans' cell granulomatosis.

[Corneal tumor secondary to trichiasis]. / Tuméfaction cornéenne secondaire à un trichiasis.

A rare lesion of secondary amyloidosis of the cornea caused by trichiasis is reported. A 33-year-old Asian woman presented with progressive decrease of visual acuity of the right eye evolving over several years, combined with the growth of a lower budding, gelatinous, pink corneal mass located next to an inferior lid trichiasis. The treatment consisted of eyelid surgery for trichiasis, followed by ablation of the corneal lesion by anterior keratectomy. After 14 months of follow-up, no recurrence was observed. Visual acuity is 9/10 P3 without correction. Pathological examination of the mass revealed secondary corneal amyloidosis, AL type (light chains), rarely reported in the literature (18 cases). No other organ involvement by amyloidosis was identified. Corneal amyloidosis is a rare complication of trichiasis. To avoid recurrence, this anomaly should be recognized as the cause and should be treated prior to removal of the corneal lesion.

[Post-traumatic endocapsular blood effusion]. / Epanchement sanguin endocapsulaire post-traumatique.

A rare complication after extracapsular surgery of the cataract, blood effusion is often a fortuitous discovery when a drop in visual acuity occurs. The subject reported herein is a 76-Year-old patient who presented an endocapsular blood effusion with no liquid level 1 Year after the extracapsular surgery of the cataract, discovered while examining a decrease in visual acuity. Questioning led to the discovery of eye trauma due to Nd: YAG laser posterior capsulotomy 3 Months before, which had progressed spontaneously and favorably for 2 Months, with a reduction of the effusion and better visual acuity. The bleeding seems to have come from a vascular injury due to a direct contusion, with blood possibly coming from the ciliary body, the iridocorneal angle, or the vitreous. The liquid effusion may have been caught at the back by the implant and enclosed in the area located between the capsular bag and the anterior hyaloid, without intravitreous diffusion. Most of reported cases in the literature discuss observations made on an intact posterior capsule, which appeared during or after close surgery. The treatment was simple supervision. Some Authors propose a Nd: YAG laser capsulotomy in case resorption is too slow.

Inhalation of aerosolized vitamin a: reversibility of metaplasia and dysplasia of human respiratory epithelia -- a prospective pilot study.

The objective of this preliminary uncontrolled study was twofold: First, to assess the feasibility of retinyl palmitate inhalation and second, to analyze the changes of metaplastic lesions of the respiratory epithelium (metaplasia or dysplasia) following retinyl palmitate inhalation. The response to a daily dose of 18.000 I.U. retinyl palmitate by inhalation over a period of 3 month was assessed in 11 subjects (9 smokers, 2 ex-smokers). Using white-light bronchoscopy combined with autofluorescence bronchoscopy, bronchial biopsies were taken before and after a 3 month-period. The biopsy samples were evaluated blind by a referee lung pathologist. The overall response rate (remission or partial remission) was 56% (95% CI 0.30 0.79; p<0.05). These data suggest that inhalation of retinyl esters could be a promising therapeutical approach for chemoprevention of lung cancer. Vitamin A; chemoprevention; lung cancer; squamous metaplasia; dysplasia; retinoids

[Smokers with chronic bronchitis and emphysema. Utilize the entire therapy spectrum!]. / Raucher mit chronischer Bronchitis und Emphysem. Nutzen Sie das gesamte Therapiespektrum!

In the majority of cases, chronic obstructive bronchitis is due to inhalative cigarette smoking. Not only does it cause high costs, but it also has a poor prognosis. The pathogenesis of the illness is now considered to be chronic, mainly neutrophilic, inflammation of the airways and the peripheral parts of the lungs--chronic hypersecretion is a common feature of the disease. Successful treatment requires the giving up of inhalative cigarette smoking. Pharmacological options include anticholinergics, beta sympathomimetics, theophylline and inhalative or systemic corticosteroids. Long-acting beta sympathomimetics such as formoterol, and salmeterol, and still experimental long-acting parasympatholytics, represent significant advances. Such additional measures as vaccination, long-term administration of oxygen and, more recently, surgical procedures such as lung volume reduction to treat severe pulmonary emphysema are described.

[A patient with muscle pain after a journey to the tropics. Myocardial involvement in proximal myotonic myopathy]. / Ein Patient mit Muskelschmerzen nach einer Tropenreise. Myokardbeteiligung bei der proximalen myotonen Myopathie.

HISTORY AND ADMISSION FINDINGS: A 36-year-old man reported feeling generally unwell and experiencing shooting and tearing pain, especially in the thighs and over the precordium, just after returning from a five-week holiday in Central Africa. An active sportsman in his youth (fencing) he was known to have incomplete right bundle branch block in the ECG and a raised concentration of gamma-glutamyl transferase, of unknown aetiology. Physical examination on admission was negative except for discrete weakness on head bending and slightly delayed finger stretching after making a fist. INVESTIGATIONS: Multiple tests excluded tropical diseases. There were abnormal T waves in leads III and V1 of the ECG. Serum concentrations of creatine kinase (CK; maximally 822 U/l), gamma-glutamyl transaminase (gamma-GT; 446 U/l), glutamyl-pyruvate transaminase (GPT; 510 U/l) and of glutamate-oxalate transaminase (GOT; 108 U/l) were all elevated. Erythrocyte sedimentation rate and C-reactive protein were within normal limits. TREATMENT AND COURSE: At first the suspected diagnosis was myocarditis and he was placed on bed-rest, monitored and treated symptomatically. Because the levels of CK, gamma-GT, GPT and GOT improved only transiently, there were no signs of inflammatory disease and the muscle pains continued, biopsies of skeletal muscle and the liver were done. They revealed nonspecific liver changes and a noninflammatory myopathy. As congenital myopathy was suspected he was transferred to the neurology department where the diagnosis of proximal myotonic myopathy (PROMM) was established. CONCLUSION: We assume that an unknown viral infection triggered the illness that, in addition to the usual nonspecific symptoms, accentuated the signs of the existing multi-system proximal myotonic myopathy.