[Assessment of anesthesiologist intervention during cataract surgery under topical anesthesia]. / Évaluation du recours à l'anesthésiste-réanimateur lors de la chirurgie de la cataracte réalisée sous anesthésie topique.

OBJECTIVES: The current demographic situation in France regarding anesthesiologists calls for a reconsideration of anesthesia management for patients undergoing cataract surgery under topical anesthesia. This prospective observational study aimed to assess the requirement for anesthesiologist intervention during cataract surgery performed under topical anesthesia. PATIENTS AND METHODS: Patients operated between November 2, 2011 and July 31, 2012 were included after indication of topical anesthesia for phacoemulsification proposed by the surgeon and confirmed by the anesthesiologist. Each patient was premedicated. All patients were monitored and supervised during the surgery by a nurse anesthesiologist. An anesthesiologist could be called at any time at the request of the surgeon or nurse anesthesiologist. For each patient, medical histories were recorded as well as the event "anesthesiologist called", along with the reason and the treatment performed. RESULTS: Five hundred and seventy-five phacoemulsifications were performed in 486 patients. The event "anesthesiologist called" was recorded 20 times: 18 times for hypertension, once for anxiety and once for non-emergent conversion to general anesthesia after a surgical complication. Each episode of hypertension was successfully treated by following the nicardipine protocol. Preoperatively uncontrolled hypertension was the only significant predictive risk factor for anesthesiologist requirement. CONCLUSIONS: These results question the usefulness of preoperative anesthesia consultation for all patients who underwent phacoemulsification under topical anesthesia, since this consultation does not lead to an anesthesiologist service. Intraoperative medical complications may be treated according to medical protocols developed jointly by surgeons and anesthesiologists. This practice may free up anesthesiologists' time, without compromising patient safety.

[Retinal detachment caused by ocular perforation during periocular anesthesia: three case reports]. / Décollement de rétine par perforation oculaire au cours d'anesthésies péri-oculaires: à propos de trois cas.

INTRODUCTION: Local anesthesia for eye surgery was first described in 1884; later Knapp popularized retrobulbar anesthesia. To reduce risks, peribulbar anesthesia appeared in the 1970s. Still used today, periocular anesthesia is not without complications, in particular the risk of ocular perforation. PATIENTS AND METHODS: Three patients were referred to our department for diagnosis and treatment of an intravitreous hemorrhage following cataract surgery. We report the clinical features, treatment, and visual outcome for these three patients. RESULTS: The most common presentation was vitreous hemorrhage: the three eyes were found to have associated retinal detachment on initial assessment. One patient presented severe vitreoretinal proliferation with two postoperative recurrences; the globe was finally enucleated. The two other patients presented attached retina after surgery but had achieved very poor visual recovery. CONCLUSION: Inadvertent globe perforation during local ocular anesthesia is rare. Careful attention to risk factors, early recognition, and prompt referral for management are recommended to improve the visual prognosis. Surgical management must be adapted to the severity of the perforation (vitreous hemorrhage, retinal detachment, vitreoretinal proliferation). The problems treating these patients with severe, often recurrent, retinal detachment, with poor visual prognosis, in a tricky forensic context should be emphasized.

[Critical review of the various treatments of temporomandibular joint pain-dysfunction syndrome. What will be the psychosomatic approach to these patients?]. / Regard critique sur les diverses thérapeutiques du SADAM. Que serait un abord psychosomatique de ces patients?

A multitude of theoretical, etiologic and therapeutic approaches to temporomandibular joint (TMJ) dysfunction have been developed. In spite of all the efforts for combined therapy that have proliferated over the last years, the therapeutic options proposed for these patients are extraordinarily diversified and vary with the different schools. The different opinions are rarely in agreement. Everyone appears to be satisfied with such an extremely divergent approach to treatment where some patients undergo surgery of the TMJ while relaxation is proposed for others! In view of these very diverging opinions, we raise the question as to whether the results obtained with a truly psychosomatic approach using well-coordinated team work between stomatologists and psychotherapists might have a theoretical basis.

Seasonal rhythm of semen characteristics of a Brazilian breed ("Mangalarga") stallion.

An attempt has been made to define semen seasonality in a horse in the Southern Hemisphere. Repeated measurements of three variables in the semen were made for 36 months (Jan/90-Dec/92) in a 21-year old "Mangalarga" stallion living under natural photoperiod and temperature conditions in a farm situated in São José do Rio Pardo, São Paulo, Brazil (latitude 21 degrees) 36'S; longitude 46 degrees 53' W). The horse fed on natural pasture and a nutritionally balanced feed twice a day (11:00 and 17:00 h). Water and mineral supplement were available ad libitum. Semen was collected almost daily by an artificial vagina and showed annual changes in volume of ejaculate, sperm motility, and sperm concentration. Spectral and rhythmometric analyses of the semen data were performed according to the fast Fourier transform (FFT) and cosinor techniques (tau = 365 days). Statistically significant annual rhythms for semen volume, motility, and concentration of sperm were present. Acrophases occurred in the spring (October) for ejaculate volume and in autumn (May) for sperm concentration and motility.

Mesothelioma in rats following intrapleural injection of chrysotile and phosphorylated chrysotile (chrysophosphate).

Pathological effects of asbestos are probably dependent on the size and surface properties of the fibers. Surface-modified chrysotile fibers were injected into the pleural cavity of rats to investigate the potency of the fiber to induce mesothelioma. Chrysotile fibers were modified by a phosphorylation process, resulting in the presence of phosphorus at the fiber surface. Phosphorylated samples were characterized by enhanced durability and reduced affinity for biological macromolecules. Five samples were tested: 1 untreated and 4 phosphorylated. ChrP1, ChrP2 and ChrP3 corresponded to phosphorylated samples obtained by first, second and third passages through an Alpine classifier; Pm was defibrillated ChrP1. The number of fibers per microgram and the size distribution were determined by transmission electron microscopy and classified in 4 size groups. Groups of 35 rats were inoculated with 20 mg of fibers suspended in 0.9% NaCl solution. No mesothelioma was found in the saline controls. All fiber samples were proficient in producing mesothelioma; the percentages were different between groups and untreated chrysotile but not significantly so. The differences may be explained on the basis of the number of fibers injected which were greater than 8 microns in length and less than 0.25 microns in diameter. The findings of a proficiency of long fibers to produce mesothelioma, previously reported by others for glass fibers, could be applied to chrysotile.

Yawning: a possible confounding variable in EMG biofeedback studies.

An elderly hemiplegic patient participating in an EMG biofeedback training program was observed to produce a synergistic flexion movement of the plegic (determined by functional evaluations) upper limb while yawning. In the course of the training sessions the electrical activity of the anterior deltoid (the target muscle) was recorded during yawning. These peak EMG values were greatly facilitated in comparison with the session mean peak values obtained during an attempted maximum voluntary isometric contraction (shoulder flexion) of the same limb (e.g., Trial 1: 85.00 vs. 4.33 microV). The possibility of yawning as a confounding variable in EMG biofeedback studies is presented and discussed.