[First- and second-line hospital management of ophthalmologic emergencies: Clinical pathway study of 1360 patients]. / Prise en charge des urgences ophtalmologiques en premier et second recours hospitaliers : analyse du parcours de 1360 patients.

The general practitioner (GP) might offer a good alternative for the management of certain ophthalmologic emergencies in his or her practice, given the increasing demand for ophthalmological care and difficulties with access to ophthalmologists. The main objective of the study was to describe ophthalmological complaints and their management in general emergency departments compared to ophthalmological emergency departments in order to assess which pathologies can be treated by the GP. This was a single-center retrospective study at the University Hospital of Reims, based on consultation data from the general and ophthalmological emergency departments for all adult patients presenting for an ophthalmological problem in September 2019 and September 2020. Consultations where patients were brought back following a first emergency consultation and consultations for another non-ophthalmological reason were excluded. Out of 1360 consultations recorded, 16% of patients had initially consulted their GP. The 4 most frequent diagnoses were: "ocular trauma," "conjunctivitis," "eye pain" and "visual impairment." A prescription for medication was issued in 77% of cases, 37% of which were for antibiotics. Only 29% of consultations carried out in general emergency departments led to a request for a complementary ophthalmology consultation. The GP might therefore be able to manage certain ophthalmological emergencies in his or her practice as a first line and refer certain ophthalmologic emergencies. However, the training of GPs in this specialty must be reinforced in collaboration with ophthalmologists.

Analysis of CA-125 levels in the sera of patients with non-ovarian carcinomas and non-malignant diseases.

CA-125 is known as a marker of ovarian carcinoma; it is useful in monitoring response to treatment and it is even said to be a means of detecting ovarian carcinomas. We have studied the serum levels of CA-125 in 260 patients with advanced carcinomas (excluding ovarian cancer) and in 120 patients with non-malignant diseases (excluding gynaecological diseases). Our cut-off value was 20 IU/ml. Sensitivity was 0.53 and Specificity only 0.38; sensitivity was high in lung cancer (0.56), in breast cancer (0.46) and in cancer of the stomach (0.91). Five percent of the cancer patients had values higher than 233.5 IU/ml. Sensitivity was correlated with the presence of a metastatic disease (p less than 0.001). A second assay was obtained in 163 cases; a concordance between the variation of the serum level and the clinical evolution was found in 65% cases. A high rate of false positive values was found in cases of acute pneumonia (0.74) and of gastro-intestinal diseases (0.41). In view of these results, the optimal threshold value was set at 65 IU/ml. CA-125 appears to be a useful marker in the monitoring of advanced non-ovarian carcinomas.

[CA-125 in non-ovarian benign and malignant pathology: study on 380 patients]. / Le CA-125 en pathologie bénigne et maligne non ovarienne: étude portant sur 380 patients.

CA-125, a serum marker of epithelial ovarian cancer, was studied by a radioimmunometric method: the sensitivity and specificity of the assay was studied in 260 patients with non ovarian carcinomas and 120 patients with non malignant diseases. The ideal threshold value has been discussed. Levels higher than 20 UI/ml (cut-off value) have been found in 53% of cases. Sensitivity falls to 25% if the cut-off value is 65 UI/ml. The serum levels correlated well with the existence of a metastatic disease (P less than 0.001). A second assay allowed to study in 163 cases the correlation between the variations of the serum level and the clinical evolution; a good correlation was found except in case of stable disease. High levels have also been found in patients with benign diseases, most of all in cases of pneumonia and severe liver cirrhosis.