Treatment of rosacea and demodicosis with benzyl benzoate: effects of different doses on Demodex density and clinical symptoms.

BACKGROUND: Patients with rosacea or demodicosis have high facial skin Demodex densities (Dds). Topical ivermectin, benzyl benzoate (BB) and crotamiton have been shown to decrease Dds in vivo, but there are few data on the clinical and acaricidal effects of BB among patients with rosacea. OBJECTIVE: To evaluate the impact of topical BB (+crotamiton) treatment on Dds and clinical symptoms of rosacea and demodicosis, and compare three BB treatment regimens. METHODS: In this retrospective observational study, 394 patients (117 with rosacea, 277 with demodicosis) were included. Three BB (+crotamiton) treatment regimens were compared: 12% once daily, 12% twice daily and 20% once daily. Dds were measured using two consecutive standardized skin surface biopsies [superficial (SSSB1) and deep (SSSB2)] before treatment and at the first follow-up. Symptoms were evaluated using investigator global assessment. Treatment was considered effective if the Dd had normalized (SSSB1 ≤ 5 D/cm2 AND SSSB2 ≤ 10 D/cm²) or symptoms had cleared and curative if the Dd had normalized and symptoms had cleared. RESULTS: At an average of 2.7 months after treatment start, the total Dd (SSSB1 + 2) had decreased by 72.4 ± 2.6% from the initial value across the whole cohort. Dds had normalized in 139 patients (35%), and symptoms had cleared in 122 (31%). Treatment was effective in 183 (46%) patients and curative in 78 (20%). Compliance was good: 77% of patients correctly followed treatment instructions. Results were similar in patients with rosacea and those with demodicosis. The 12% once-daily regimen was less effective than the other doses and had poorer compliance than the 12% twice-daily regimen. CONCLUSION: Topical treatment with BB (+crotamiton) may be an effective treatment for rosacea and demodicosis, indirectly supporting a key role of the mite in the pathophysiology of rosacea. The two higher dose regimens were more effective than the lower dose.

Erythematotelangiectatic rosacea may be associated with a subclinical stage of demodicosis: a case-control study.

BACKGROUND: Facial densities of Demodex mites have been observed to be greater in patients with demodicosis and papulopustular rosacea than in healthy control patients. In patients with erythematotelangiectatic rosacea (ETR), this density has been observed to be similar to or greater than that of healthy controls. Erythema and telangiectasia, characteristics of ETR, are often observed among patients with pityriasis folliculorum, a discreet demodicosis, suggesting a possible link between these conditions. OBJECTIVES: To compare the facial Demodex densities of patients with clinical ETR and patients with healthy skin, demodicosis, rosacea with papulopustules, and other facial dermatoses. METHODS: In this retrospective study, we recorded Demodex densities measured using two consecutive standardized skin surface biopsies (SSSB1 and SSSB2) in 23 patients with ETR, 20 healthy control patients, 590 patients with demodicosis, 254 with rosacea with papulopustules and 180 with other facial dermatoses. RESULTS: Patients with ETR had higher Demodex densities (D cm-2 ) than did the healthy controls (mean ± SEM; SSSB1: 15·7 ± 6·3 vs. 1·8 ± 1·1 D cm-2 , P = 0·042; SSSB2: 38·0 ± 13·7 vs. 5·1 ± 2·1 D cm-2 , P = 0·026) and patients with other dermatoses (SSSB1: 0·4 ± 0·1 D cm-2 , P = 0·004; SSSB2: 1·3 ± 0·3 D cm-2 , P = 0·004), but lower densities than patients with demodicosis (SSSB1: 82·7 ± 4·2 D cm-2 , P = 0·008; SSSB2: 172·2 ± 7·7 D cm-2 , P = 0·001) or rosacea with papulopustules (SSSB1: 86·6 ± 7·3 D cm-2 , P = 0·027; SSSB2: 197·0 ± 12·1 D cm-2 , P = 0·002). CONCLUSIONS: ETR may be associated with nonvisible Demodex proliferation, possibly corresponding to a subclinical stage of demodicosis. Dermatologists should be aware of this potential association and look for subclinical demodicosis in patients with ETR, so that topical acaricidal treatment can be offered if Demodex density is high.

Papulopustular rosacea and rosacea-like demodicosis: two phenotypes of the same disease?

BACKGROUND: Papulopustular rosacea and rosacea-like demodicosis have numerous similarities, but they are generally considered as two distinct entities, mainly because the causal role of the Demodex mite in the development of rosacea is not yet widely accepted. Several clinical characteristics are traditionally considered to differentiate the two conditions; for example, papulopustular rosacea is typically characterized by central facial papulopustules and persistent erythema, whereas small superficial papulopustules and follicular scales rather suggest rosacea-like demodicosis. However, none of these characteristics is exclusive to either entity. OBJECTIVE: To explore differences in Demodex densities according to clinical characteristics traditionally associated with these two conditions. METHODS: Retrospective, observational, case-control study of 242 patients with central face papulopustules. Demodex densities were measured on two consecutive standardized skin surface biopsies. RESULTS: In the whole cohort, Demodex densities were greater in patients with persistent erythema than in those without. In 132 patients without recent treatment or other facial dermatoses, 120 (91%) had persistent erythema, 119 (90%) small superficial papulopustules and 124 (94%) follicular scales; 116 (88%) simultaneously had clinical characteristics traditionally associated with both papulopustular rosacea and rosacea-like demodicosis. Higher Demodex densities were linked to the presence of follicular scales, but not to papulopustules size, nor to the presence/absence of persistent erythema. CONCLUSION: Our observations highlight the difficulty differentiating between these entities and suggest that rosacea-like demodicosis and papulopustular rosacea should no longer be considered as two separate entities, but rather as two phenotypes of the same disease.

Value of the "spine sign" on lateral chest views.

OBJECTIVE: To determine the performance of the spine sign in detecting lower chest abnormalities in the lateral view. METHODS: This retrospective study included 200 patients who had undergone lateral view and CT scans of the chest within 1 week. Two radiologists independently read the lateral views, and a third radiologist, blinded to the aim of the study, read the scans. The spine sign was considered as positive if the progressive increase in lucency of the vertebral bodies was altered. Interreader agreement was calculated through k-statistics. Sensitivity, specificity, positive- and negative-predictive values, and accuracy were calculated compared with CT. RESULTS: Agreements between readers ranged from 0.12 to 0.68. Positive spine sign could appear in two ways: absent or inversed progressive increase in lucency of the vertebral bodies. Sensitivity, specificity, positive- and negative-predictive values, and accuracy were, respectively, 60% and 70%; 64% and 84%; 91% and 97%; 19% and 29%; and 61% and 72% for each reader (p-value ranging from 0.026 to 0.196). Abnormalities most frequently associated with positive spine sign were plate-like atelectasis, ground-glass opacity, pleural effusion and consolidation. CONCLUSION: The spine sign can present as an absent or inversed progressive increase in lucency of the vertebral bodies. It has a moderate sensitivity but a good positive-predictive value, so it can be useful especially when it appears as inversed progressive increase in lucency of the vertebral bodies to detect various abnormalities usually identifiable on chest radiographs. ADVANCES IN KNOWLEDGE: On lateral chest radiographs, the spine sign is useful to detect lower chest abnormalities and is related to various underlying abnormalities and is, per se, non-specific.

Tuning of automatic exposure control strength in lumbar spine CT.

OBJECTIVE: To investigate the impact of tuning the automatic exposure control (AEC) strength curve (specific to Care Dose 4D®; Siemens Healthcare, Forchheim, Germany) from "average" to "strong" on image quality, radiation dose and operator dependency during lumbar spine CT examinations. METHODS: Two hospitals (H1, H2), both using the same scanners, were considered for two time periods (P1 and P2). During P1, the AEC curve was "average" and radiographers had to select one of two protocols according to the body mass index (BMI): "standard" if BMI <30.0 kg m(-2) (120 kV-330 mAs) or "large" if BMI >30.0 kg m(-2) (140 kV-280 mAs). During P2, the AEC curve was changed to "strong", and all acquisitions were obtained with one protocol (120 kV and 270 mAs). Image quality was scored and patients' diameters calculated for both periods. RESULTS: 497 examinations were analysed. There was no significant difference in mean diameters according to hospitals and periods (p > 0.801) and in quality scores between periods (p > 0.172). There was a significant difference between hospitals regarding how often the "large" protocol was assigned [13 (10%)/132 patients in H1 vs 37 (28%)/133 in H2] (p < 0.001). During P1, volume CT dose index (CTDIvol) was higher in H2 (+13%; p = 0.050). In both hospitals, CTDIvol was reduced between periods (-19.2% in H1 and -29.4% in H2; p < 0.001). CONCLUSION: An operator dependency in protocol selection, unexplained by patient diameters or highlighted by image quality scores, has been observed. Tuning the AEC curve from average to strong enables suppression of the operator dependency in protocol selection and related dose increase, while preserving image quality. ADVANCES IN KNOWLEDGE: CT acquisition protocols based on weight are responsible for biases in protocol selection. Using an appropriate AEC strength curve reduces the number of protocols to one. Operator dependency of protocol selection is thereby eliminated.

Reduced z-axis coverage in multidetector-row CT pulmonary angiography decreases radiation dose and diagnostic accuracy of alternative diseases.

OBJECTIVE: To investigate the effect of a two-third reduction of the scanned length (i.e. 10 cm) on diagnosis of both pulmonary embolism (PE) and alternative diseases. METHODS: 247 consecutive patients suspected of acute PE had a CT pulmonary angiography (CTPA) of the thorax (standard length, L). Based on this acquisition, a second set of images was created to obtain a scan length of 10 cm caudally to the aortic arch (l). Images were anonymized, randomized and interpreted by two independent readers. The quality of enhancement, the presence of PE and the possible alternative and/or complementary diagnoses were recorded. A McNemar exact test investigated differences in discrepancies between readers and between scan lengths. RESULTS: 57 (23%) patients had an acute PE. Among l sets, PE was missed by both readers in one (1.8%) patient, because the unique clot was localized in a subsegmental artery out of the 10-cm range. There were discrepancies between L and l sets in 9 (3.6%) and 11 (4.5%) patients, by Readers 1 and 2 (p=0.820), respectively. Discrepancies between the readers of L sets and those between both sets were not different regardless of the reader (p>0.99). There were discrepancies between both sets for alternative and/or complementary diagnoses in 43 (17.2%) patients. CONCLUSION: Although its performance in diagnosing PE is maintained, CTPA should not be restricted to a range of 10 cm centred over the pulmonary hilum, because alternative and/or complementary diagnoses could be missed. ADVANCES IN KNOWLEDGE: (1) A 10-cm CTPA acquisition reduces the radiation dose by two-thirds as compared with a standard one, but does not impair the accuracy for the diagnosis of PE. (2) Significant alternative diagnoses are missed in 17.2% of patients when reducing the acquisition height to 10 cm.

Optimised z-axis coverage at multidetector-row CT in adults suspected of acute appendicitis.

OBJECTIVE: To compare diagnostic performances of two reduced z-axis coverages to full coverage of the abdomen and pelvis for the diagnosis of acute appendicitis and alternative diseases at unenhanced CT. METHODS: This study included 152 adults suspected of appendicitis who were enrolled in two ethical committee-approved previous prospective trials. Based on scans covering the entire abdomen and pelvis (set L), two additional sets of images were generated, each with reduced z-axis coverages: (1) from the top of the iliac crests to the pubis (set S) and (2) from the diaphragmatic crus to the pubis (set M). Two readers independently coded the visualisation of the appendix, measured its diameter and proposed a diagnosis (appendicitis or alternative). Final diagnosis was based on surgical findings or clinical follow-up. Fisher exact and McNemar tests and logistic regression were used. RESULTS: 46 patients had a definite diagnosis of appendicitis and 53 of alternative diseases. The frequency of appendix visualisation was lower for set S than set L for both readers (89% and 84% vs 95% and 91% by Readers A and B, respectively; p=0.021 and 0.022). The probability of giving a correct diagnosis was lower for set S (68%) than set L (78%; odds ratio, 0.611; p=0.008) for both readers, without significant difference between sets L and M (77%, p=0.771); z-axis coverage being reduced by 25% for set M. CONCLUSION: Coverage from diaphragmatic crus to pubis, but not focused on pelvis only, can be recommended in adults suspected of appendicitis. ADVANCES IN KNOWLEDGE: In suspected appendicitis, CT-coverage can be reduced from diaphragmatic crus to pubis.

White matter abnormalities are related to microstructural changes in preterm neonates at term-equivalent age: a diffusion tensor imaging and probabilistic tractography study.

BACKGROUND AND PURPOSE: Preterm infants have a high risk of brain injury and neurodevelopmental impairment, often associated with WMA on conventional MR imaging. DTI can provide insight into white matter microstructure. The aim of this study was to investigate the association between WMA on conventional MR imaging and DTI parameters in specific fibers in preterm neonates at term-equivalent age. MATERIALS AND METHODS: Seventy preterm neonates (39 boys and 31 girls) were included in the study. WMA were classified as no, mild, moderate, or severe. Probabilistic tractography provided tract volumes, FA, MD, λ(//), and λ(⊥) in the CST, SLF, TRs, and corpus callosum. Data were compared by using MANOVA, and adjustment for multiple comparisons was performed. RESULTS: Important associations were found between WMA and microstructural changes. Compared with neonates with no WMA (n = 41), those with mild WMA (n = 27) had significantly increased λ(⊥) and MD in the left ATR, the left sensory STR, the bilateral motor STR, and for λ(⊥) also in the right CST; FA decreased significantly in the left sensory STR. Diminished tract volumes and altered diffusion indices were also observed in the 2 neonates with moderate WMA. CONCLUSIONS: Altered DTI indices in specific tracts, with λ(⊥) as most prominent, are associated with mild WMA in preterm neonates at term-equivalent age.

Gender differences in language and motor-related fibers in a population of healthy preterm neonates at term-equivalent age: a diffusion tensor and probabilistic tractography study.

BACKGROUND AND PURPOSE: Sex differences in white matter structure are controversial. In this MR imaging study, we aimed to investigate possible sex differences in language and motor-related tracts in healthy preterm neonates by using DTI and probabilistic tractography. MATERIALS AND METHODS: Thirty-eight preterm neonates (19 boys and 19 girls, age-matched), healthy at term-equivalent age and at 12 months were included. TBV was measured individually. Probabilistic tractography provided tract volumes, relative tract volumes (volume normalized to TBV), FA, MD, and λ(⊥) in the SLF, in the TRs, and in the CSTs. Data were compared by using independent t tests, and Bonferroni corrections were performed to adjust for multiple comparisons. RESULTS: We showed that healthy preterm boys had larger TBV than girls. However, girls had statistically significantly larger relative tract volumes than boys bilaterally in the parieto-temporal SLF, and in the left CST. Moreover, in the left parieto-temporal SLF, a trend toward lower MD and λ(⊥) was observed in females. CONCLUSIONS: Structural sex differences were found in preterm neonates at term-equivalent age in both sides of the parieto-temporal SLF and in the left CST. Further studies are necessary to investigate whether these structural differences are related to later sex differences in language skills and handedness or to the effect of prematurity.

Homoeopathic remedies in dermatology: a systematic review of controlled clinical trials.

BACKGROUND: Homoeopathic therapies are routinely used for the management of skin diseases. However, there is a lack of evidence-based data on their effectiveness. OBJECTIVES: To assess the evidence for the efficacy of homoeopathic treatments in dermatology. METHODS: We designed a systematic review of the controlled clinical trials (January 1962-April 2011) investigating homoeopathic therapies for the treatment of cutaneous diseases. We collected data from MEDLINE, PubMed, Current Contents, HomInform (Glasgow), reference lists, specialist textbooks and contacts with homoeopathic manufacturers. There was no restriction on language. Subsets were defined according to treated skin disease/condition. For each subset, two reviewers extracted data for information on study quality, type of remedy, population and outcomes. RESULTS: After an extensive search, we isolated a very limited number of trials investigating homoeopathic treatments for cutaneous diseases. Overall, of the 12 trials with interpretable results, nine trials indicated no positive effects of homoeopathy. The three trials showing a positive effect were of low methodological quality. CONCLUSIONS: Reviewed trials of homoeopathic treatments for cutaneous diseases were highly variable in methods and quality. We did not find sufficient evidence from these studies that homoeopathy is clearly efficacious for any single dermatological condition.

Species specific thyroid signal transduction: conserved physiology, divergent mechanisms.

In the literature, data obtained in signal transduction from various species thyroids and cells lines are often integrated in a common model. We investigate qualitatively and systematically, using the same protocol, the control by TSH of the two main functions of the thyrocytes, the synthesis and the secretion of thyroid hormones. In all species investigated, the TSH receptor activates both. In some species, including humans, rats and mice, the TSH receptor activates both the cAMP and phospholipase C-PIP2 cascades, in others (e.g. dog) it only stimulates the first. The cAMP pathway activates the limiting step in thyroid hormones synthesis, the generation of H(2)O(2), in dog, rat and mice but not in human, pig, horse and beef. Thus although the physiological result of TSH action is the same in all species, the signaling pathways used are different. Other distinctions in signaling are observed such as the relative effects of one cascade on the other.

Correlations between clinical presentations of adult trigger digits and histologic aspects of the A1 pulley.

PURPOSE: We aimed to report by light microscopy the normal histology of the A1 pulley, describe the histologic abnormalities of A1 pulleys in trigger digits, and look for possible correlations between these findings and the severity of the disease. METHODS: In a series of 104 trigger digits operated on in 80 adult patients, the A1 pulleys were removed and histologically studied. The findings were compared with 55 normal A1 pulleys obtained from fresh-frozen cadaveric specimens. RESULTS: The normal A1 pulley was composed of 3 layers: layer I, an inner, avascular, concave unicellular or bicellular gliding layer containing cartilage-like cells; layer II, a middle layer, also avascular, characterized by spindle-shaped fibroblasts; and layer III, an outer, richly vascularized layer, continuous with the membranous tendons sheath. We used a 3-grade classification, increasing in severity, to describe the histologic abnormalities observed in trigger digit A1 pulleys. Mild abnormalities (grade 1) were those with a fibrocartilaginous gliding surface almost intact. The margin between the fibrocartilaginous and membranous portions of the pulley was well delineated. In moderate abnormalities (grade 2), the avascular fibrocartilaginous gliding surface appeared fissured and thinner. The inner layer (I) was interrupted and replaced by fibrous tissue, with fissures that did not cross through the middle layer (II). A mild vascular network hyperplasia was observed in the outer layer (III), which began to invade the fibrocartilage. In severe abnormalities (grade 3), the fibrocartilaginous gliding surface was thin, discontinuous, or even completely destroyed. The vascular network hyperplasia became excessive and reached the synovial space of the flexor tendon sheath. The histologic features were correlated with the severity of the clinical symptoms (p < .001). CONCLUSIONS: The histologic abnormalities observed in the A1 pulley of trigger digits are characteristic and not related to inflammation. As the trigger digit worsens, the gliding surface begins to wear and is gradually replaced by a secondary invasive hyperplasia from the outer layer. These abnormalities could be caused by a modification or an increase of the mechanical stresses along the flexor tendons.

Intraductal optical coherence tomography during endoscopic retrograde cholangiopancreatography for investigation of biliary strictures.

BACKGROUND AND STUDY AIMS: Optical coherence tomography (OCT) uses infrared light reflectance to produce high-resolution cross-sectional tissue images. The aim of this study was to demonstrate the feasibility of biliary intraductal OCT during endoscopic retrograde cholangiopancreatography (ERCP) and to assess the potential of the method to detect malignant biliary strictures. PATIENTS AND METHODS: Thirty-seven patients with biliary strictures were studied during therapeutic ERCP. Malignant strictures were defined as those that demonstrated malignant cells in brushing and/or biopsy specimens, and/or endoscopic ultrasound-guided fine-needle aspiration and/or surgery. Strictures that did not have malignant cells in resected specimens and were without clinical/radiological evidence of disease progression for at least a 12-month follow-up period were considered as benign. Two OCT criteria for malignancy were considered: unrecognizable layer architecture; and presence of large, nonreflective areas compatible with tumor vessels. Sensitivity and specificity for brushings/biopsies as well as OCT criteria were calculated. RESULTS: Nineteen patients had malignant and 16 had benign strictures. In two patients, OCT assessment could not be performed due to tight strictures. Malignancy was confirmed by biliary brushings/biopsies in 12/19 (63 %) patients. OCT revealed that two malignancy criteria were encountered in 10/19 (53 %) and at least one criterion in 15/19 (79 %) patients with malignant strictures. No patient with benign stricture met both criteria and 5/16 met one criterion (31 %). Combining brushings/biopsy with the observation of at least one OCT criterion resulted in the diagnosis of malignancy in 16/19 (84 %) patients. CONCLUSIONS: OCT may improve the sensitivity and diagnostic accuracy of biliary brushings/biopsies alone.

Transverse maxillary stability assisted by a transpalatal device: a retrospective pilot study of 9 cases.

This retrospective pilot study assessed the transverse stability of an original surgical approach in nine patients with moderate transverse maxillary deficiency associated with a sagittal and/or vertical skeletal anomaly. During the one-stage surgical procedure, bi- or three-dimensional anomalies were corrected. Maxillary expansion was guided by a transpalatal bone-anchored device (TPD). Expansion measurements were made 1-2 months before surgery, 6 and at least 12 months after surgery. The transverse occlusion was corrected in all cases. After 12 months the gingival landmarks revealed an expansion range from -0.83 to +2.92 mm for the cuspids, +1.66 to +6.23 mm for the bicuspids and from +2.68 to +4.80 mm for the molars. For the occlusal landmarks, expansion ranged from -2.01 to +3.15 mm (cuspids), from +1.11 to +7.13 mm (bicuspids) and from +2.70 to +6.26 mm (molars). Cuspid expansion was significantly smaller than that of bicuspids and molars. This more posterior expansion was achieved through the surgical procedure. The transverse stability obtained with the aid of the bone-anchored TPD was satisfying. This preliminary study supports the principle of an original surgical approach, called 'Le Fort I--TPD', which combines a Le Fort I osteotomy with a controlled maxillary expansion.

Effects of physical environment on the evolution of Kashin-Beck disease in Tibet.

In previous studies we observed a proximo-distal gradient of lesion frequencies along the limb, with the distal joints being the most often affected. This suggests an associated effect of environmental factors on the most exposed joints. On a population of 820 children (mean age 13 years) of endemic areas distributed in groups of healthy and severity stages I to III of KBD (Kashin-Beck disease), the effects of different working activities were studied. Heavy work like that of a ploughman were compared to light physical work, e.g. school children, and exposure to cold and history of frostbite were also considered. The most severe stages, II and III, were present in 72% of the ploughman vs. 29% of the schoolchildren, 70% of the shepherds vs. 30% (p < 0.001) of the schoolchildren, and in 65% of the shepherds working in winter vs. 40% of those working in the other seasons (p < 0.001). In the group with history of frostbite, 58% present the severest stages vs. 40% without (p < 0.001). The results confirm a highly significant relation between microtrauma and cold and the severity of the KBD alterations.

Relationship between the extent of deep venous thrombosis and the extent of acute pulmonary embolism as assessed by CT angiography.

The aim of our study is to investigate prospectively the quantitative relationship between deep venous thrombosis (DVT) and acute pulmonary embolism (PE). 110 patients clinically suspected of having venous thromboembolic disease underwent combined CT pulmonary angiography (CTPA) and venography of lower limb veins. 44 patients presented with clinical signs of DVT and positive ultrasonography or ascending venography, but no clinical sign of PE (Group 1). 66 patients presented with clinical signs of PE and positive CTPA (Group 2). Clot load in lower limb veins and pulmonary arteries were scored by two independent readers, each using two separate systems for DVT and two for PE. 27 (61%) patients in Group 1 also had PE, and 55 (83%) patients in Group 2 also had DVT. Correlations between PE and DVT scores were weak but statistically significant in Group 2 (r(s) ranging from 0.470-0.520; p< or =0.001), but only some were significant in Group 1 (r(s) ranging from 0.253-0.318; p-values ranging from 0.035-0.097). In conclusion, although PE occurs in a majority of patients with DVT, and vice versa, the amount/burden of clot load in one condition does not necessarily indicate - or indicates only weakly - the degree of burden in the other condition.

CPAP with algorithm-based versus titrated pressure: A randomized study.

BACKGROUND: Our goal was to evaluate whether an algorithm-prescribed pressure is effective in sleep apnea-hypopnea syndrome (SAHS) patients requiring continuous positive airway pressure (CPAP). METHODS: SAHS patients with an apnea-hypopnea index (AHI)>20/h were selected for a parallel group randomized study including an in-sleep laboratory acute phase and a domiciliary chronic phase. After baseline polysomnography, patients had a second night polysomnography either with CPAP at the algorithm-calculated pressure, followed by home treatment at this pressure without any correction or adjustment (calculation group), or with auto-CPAP titration, followed by home treatment at the pressure judged to be optimal from the auto-titration (titration group). The primary outcome was the change in Epworth sleepiness scale (ESS) at 6 months. RESULTS: The calculated pressure (mean (SD)) was 7.0 (1.4) in the calculation group (n=33), while the optimal pressure was 7.0 (2.2)cmH(2)O in the titration group (n=36). During the 6-month treatment at home, the ESS decreased from 8.3 (4.9) to 5.4 (4.0) in the calculation group (n=20) and from 8.7 (5.4) to 6.4 (5.4) in the titration group (n=20) (between-group difference not significant). CONCLUSION: In these SAHS patients with moderate sleepiness treated with CPAP, we found no difference in effectiveness between an algorithm-based pressure and an auto-titrated pressure.

Effect of topical corneal anaesthesia on ocular response analyzer parameters: pilot study.

PURPOSE: The effect of topical corneal anaesthesia on corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated intraocular pressure (IOPg), and corneal compensated IOP (IOPcc) was measured by ocular response analyzer (ORA). DESIGN: Observational, cross-sectional study. METHOD: We examined both eyes of 23 healthy volunteers. Patients with external eye disease, previous refractive surgery, contact lenses or topical medication were excluded. ORA parameters were first measured in both eyes. Oxybuprocaïne 0.4% eye drop was instilled in the right eyes (RE) and physiologic saline in the left eyes (LE) as a control to rule out the lubrication effect. After 2 min, the ORA measurements were performed again. Goldmann applanation tonometry (GAT) was finally done. Data are expressed as mean +/- standard deviation (SD). The medians of the four CH, CRF, IOPg, and IOPcc values measured before and after instillation were compared by using Wilcoxon signed ranks tests for RE and LE. RESULTS: The mean age was 39.5 +/- 11.6 years. The mean GAT was 13.1 +/- 2.5 mmHg for RE and 12.8 +/- 2.5 mmHg for LE. In the RE, the respective values for the two sequences were IOPcc = 15.6 +/- 2.6 mmHg and 15 +/- 2.8 mmHg (P = 0.036); IOPg = 15.3 +/- 3.3 mmHg and 15.4 +/- 3.5 mmHg (P = 0.806); CH = 11 +/- 1.3 mmHg and 11.1 +/- 1.4 mmHg (P = 0.563); CRF = 11.1 +/- 1.8 mmHg and 10.9 +/- 1.9 mmHg (P = 0.053). In the LE, the respective values for the two sequences were IOPcc = 15.4 +/- 2.6 mmHg and 15.6 +/- 2.8 mmHg (P = 0.903); IOPg = 15.5 +/- 3.5 mmHg and 15.4 +/- 3.4 mmHg (P = 0.208); CH = 10.8 +/- 1.4 mmHg and 10.7 +/- 1.7 mmHg (P = 0.494); CRF = 10.7 +/- 1.8 mmHg and 10.7 +/- 2.2 mmHg (P = 0.626). CONCLUSION: Two minutes after instillation, topical corneal anaesthetic slightly decreases IOPcc and also-but not statistically significantly-CRF. We did not find any statistical significant difference in CH or IOPg before and after topical corneal anaesthesia. Further investigation with more patients should be advised.

[Correlation between corneal hysteresis, corneal resistance factor, and ocular pulse amplitude in healthy subjects]. / Corrélation entre hystérèse cornéenne, facteur de résistance cornéen et amplitude de pulsation oculaire chez les sujets sains.

PURPOSE: The Ocular Response Analyzer (ORA) measures corneal biomechanical properties: corneal hysteresis (CH) and the corneal resistance factor (CRF). The Pascal Dynamic Contour Tonometer (PDCT) measures the ocular pulse amplitude (OPA), which represents the systolic-diastolic variation in intraocular pressure (IOP). Both ORA and OPA values are lower in glaucoma patients than in normal patients. Our purpose was to assess whether there is a correlation between CH, CRF, and OPA values in healthy subjects. DESIGN AND PARTICIPANTS: Prospective observational study including 81 eyes of 41 healthy adult volunteers. Patients with ocular eye disease, previous refractive or intraocular surgery, contact lenses, or topical or general medications were excluded. METHODS: Patients underwent four ORA, three OPA, and two Goldmann Applanation Tonometry (GAT) measurements. For each device, the mean of all measurements were considered for this study. The statistical analysis by Spearman rank correlations was performed for right (RE), left (LE), and both eyes. The correlation between the two eyes of each subject was taken into account and canonical correlations were calculated using the SAS statistical software to improve the power of the analysis. RESULTS: The mean age was 43.6 +/- 14.6 years. The mean central corneal thickness was 545 +/- 32 microm for RE, 553 +/- 34 microm for LE, and 550 +/- 32 microm for both eyes. The mean IOPGAT values for RE, LE, and both eyes were, respectively 14.3 +/- 2.9 mmHg, 14.0 +/- 2.9 mmHg, and 14.2 +/- 2.9 mmHg. Spearman correlations were not statistically significant for separated RE and LE analysis. For both eyes, these correlations were rS=0.210, p=0.193 for OPA/CH and rS=0.388, p=0.013 for OPA/CRF. The Spearman correlation was statistically significant for OPA/CRF. This result was confirmed by canonical correlations (p=0.002) and in addition, CH was statistically correlated to OPA in the latter analysis (p=0.010). CONCLUSION: A statistically significant correlation was found between corneal biomechanical property values as measured by ORA and ocular pulse amplitude values as measured by PDCT in healthy subjects.