Topical anesthesia versus topical and subconjunctival anesthesia combined in diabetic retinopathy photocoagulation.

PURPOSE: comparison between two anesthetic techniques on the ability to reduce pain during panretinal photocoagulation (PRP) treatment. METHODS: Observational retrospective single center study. Medical charts of patients who underwent PRP for proliferative diabetic retinopathy were revised. Patients were included if they had the first eye treated with oxybuprocaine hydrochloride drops, and in case of severe pain, the fellow eye received topical anesthesia in combination with 2% subconjunctival lidocaine. The groups were compared for pain perception using an analog visual scale (VAS), number of laser spots, number of interruptions, and laser session duration. RESULTS: Forty-two eyes of 21 patients (mean age: 58.3 ± 7.6 years) were analyzed. The mean number of laser spots was significantly higher under combined anesthesia (+84.2 ± 155.9 spots, p = 0.01), with a reduced time for laser execution (-2.5 ± 3.12, p = 0.0008). The use of combined anesthesia significantly decreased the number of interruptions (-40.8%, p < 0.0001) into a single session. On the pain grading scale, the pain perception was significantly lower in the combined anesthesia group (p < 0.0001). In eyes receiving topical anesthesia the treatment was stopped for pain in 5 eyes (23.8%), while 5 eyes under combined anesthesia presented subconjunctival hemorrhage (23.8%). CONCLUSION: Using combined anesthesia in patients subjected to PRP appeared to reduce pain perception limiting the treatment duration and the interruptions for pain without significant complications. Further studies on a larger scale would be desirable to replicate such findings and standardize the analgesic procedures in ophthalmology.

IgM monoclonal gammopathy-associated neuropathies with different IgM specificity.

BACKGROUND AND PURPOSE: Antibodies directed against myelin-associated glycoprotein (MAG) are believed to be the most frequent biologic marker of the neuropathies associated with IgM monoclonal gammopathy of undetermined significance (MGUS). The objective of this study was to examine the prevalence of antiganglioside and/or sulfatide-positive patients and their clinical findings, including therapeutic response, compared to anti-MAG-positive or seronegative patients. METHODS: We prospectively followed 46 patients with MGUS who were diagnosed in our tertiary referral centers for polyneuropathy since 1997. All patients underwent nerve conduction studies and were tested for anti-MAG, gangliosides, and sulfatide antibodies. All the anagraphic and clinical data (including symptoms, disability scale, therapy, secondary malignancy development) were recorded in a database and compared between three patients' groups (anti-MAG-positive; antiganglioside/sulfatide-positive; no reactivity). RESULTS: Anti-MAG reactivity was present in 17 (37%) patients; other 17 patients (37%) had antiganglioside/sulfatide reactivity and 12 (26%) had no reactivity. Patients with antiganglioside/sulfatide positivity, although heterogeneous by a clinical and neurophysiological point of view, had the most severe neuropathic manifestations and a higher disability score at nadir (P < 0.001). These patients had a better response to both intravenous immunoglobulin therapy and rituximab. CONCLUSIONS: Our results suggest that antiganglioside/sulfatide-positive patients form a relevant portion of patients with MGUS-associated polyneuropathy seen in tertiary care centers and should be considered in future studies on treatment response.

Clinicopathological findings in five cats with paw calcification.

This retrospective study describes the clinicopathological findings in five cats with soft tissue mineralisation of interdigital spaces and footpads. Paw disease was the reason for veterinary consultation in three out of five cats. All cats had laboratory findings suggestive of renal failure and high solubility product [calciumxphosphorus]. In all cases, cytological examination of paw lesions was suggestive of calcinosis. The results of our study agree with two previous case reports of paw calcification in the cat, suggesting a metastatic pathogenesis and a correlation between paw mineralisation and renal failure.

[Estimation of the efficacy of three strains of mumps vaccines during an epidemic of mumps in the Geneva canton (Switzerland)]. / Estimation de l'efficacité de trois souches vaccinales ourliennes au cours d'une épidémie d'oreillons dans le canton de Genève (Suisse).

BACKGROUND: The number of mumps cases reported in Switzerland markedly increased from 1993 to 1995 although vaccination coverage against mumps had risen steadily since the national MMR immunization program was launched in 1987. In 1991, an estimated 80% of children 27 to 36 month-old were immunized against mumps. The purpose of the present study was to assess the hypothesis that the epidemic was the consequence of a low vaccine efficacy of the Rubini strain--a mumps vaccine strain that has been widely used in Switzerland. METHODS: Vaccine efficacy was assessed by measuring secondary attack rates among immunized and nonimmunized children 16 year-old or younger who wre family contacts of cases. RESULTS: From February 1993 to April 1996, Geneva pediatricians reported 283 primary cases of mumps and 63 secondary cases. Estimate of vaccine efficacy was equal to 6.3% (95% CI: -45.9; 39.8) for the Rubini strain, as compared to 73.1% (95% CI: 41.8; 87.6) for the Urabe Am 9 strain, and 61.6% (95% CI: 0.0; 85.4) for the Jeryl Lynn strain, two vaccine strains of mumps that had also been used in Geneva. CONCLUSION: Our study supports the hypothesis that the Rubini vaccine strain of mumps does not confer sufficient long-lasting protection against mumps.

[Presentation of the document "Model type of a plan for prevention at the canton level," drafted by a study group of the Swiss Society for Social and Preventive Medicine]. / Présentation du document "Modèle-type d'un plan cantonal de prévention", rédigé par le groupe de travial de la SSMSP.

This article presents the preliminary work of a group charged to develop a model for a prevention plan on the level of the cantons. The document should advise them as to how to develop a comprehensive prevention plan. This work has been stimulated by the reaction of the Conference of Cantonal Health Ministers to the "Concept 1986" of the Swiss Society for Social and Preventive Medicine.

[Comparison of the efficacy of various strains of mumps vaccine: a school survey]. / Comparaison de l'efficacité de différentes souches de vaccin ourlien: une enquête en milieu scolaire.

BACKGROUND: Since the beginning of the program of immunization of children against measles, mumps and rubella (MMR) in 1987, various outbreaks of mumps have occurred in Switzerland, with a significant proportion of cases in immunized children. Previous studies have suggested a possible lack of efficacy of the Rubini vaccine strain, which has been much used in this country. METHODS: Incidence study of secondary cases of mumps in the schools of Geneva, between March 18th and June 30th 1994. STUDY POPULATION: During the study period, mumps outbreaks have been observed in 10 school classes. After exclusion of the 10 primary cases, the study population comprised 195 children aged 4 to 12 years. RESULTS: Raw estimation of vaccine efficacy against mumps was 72.5%. Whereas both the Urabe and Jeryl-Lynn strains showed a significant efficacy, the Rubini strain didn't show any significant protective effect. After adjustment by Poisson regressions for the confounding effect of age, efficacy rates and 95% confidence limits were 75.8% (35.6%, 90.9%) for Urabe; 64.7% (10.6%, 86.0%) for Jeryl-Lynn; and 12.4% (-102%, 62.1%) für Rubini. CONCLUSION: This study didn't show any protective effect of the Rubini vaccine strain. Furthermore, it demonstrated a statistically significant protective effect of the Urabe and Jeryl-Lynn strains, compared to the Rubini strains. In this conditions the use of the Rubini strain should be restricted to situations of confirmed contra-indications to the other vaccinal strains, as long as its protective efficacy is not clearly demonstrated.

[Vaccination against influenza in Switzerland]. / Vaccination contre la grippe en Suisse.

Influenza is still an important cause of morbidity and mortality in our country. The yearly vaccination of the population at risk is always the best method of prevention and for the limitation of health care costs. Today the protection of elderly people and health care professionals by vaccination is not sufficient. Development of information programs, sensibilisation and motivation of the community on a national basis and in line with the health care insurers are necessary. The vaccine's reimbursement since 1996 following the respective legal change will certainly help to promote vaccination against influenza. On the other hand, the competition of different vaccines introduced in Switzerland in the last years will additionally support the penetration of information and vaccination.

[Vaccination coverage of 2-year-old children in Geneva]. / Couverture vaccinale des enfants de 2 ans à Genève.

OBJECTIVE: To measure the immunization uptake among 2 year-old children living in Geneva. METHODS: Review of the vaccination cards, systematically checked because of the compulsory vaccination against diphtheria, during the year in 1991. RESULTS: 3937 immunization cards were reviewed, ie. 93.6% of the children in the given age group. Immunization uptake rates were, for diphtheria and tetanus (3 doses) 96.8%; pertussis (3 doses) 96.1%; poliomyelitis (3 doses) 96.6%. For measles, mumps and rubella vaccine (MMR) (1 dose), 78.4%. For the Haemophilus influenzae b vaccine, recently introduced: 68.5%. The uptake rate for MMR was lower among children of swiss origin (75.5%) than among children of other nationalities (84.6%, p < 0.0001). The highest rates were found among children coming from southern Europe and Latin America. CONCLUSIONS: From the point of view of the community risk, immunization uptake rates for diphtheria, tetanus, pertussis and poliomyelitis can be considered satisfactory. For MMR vaccine, the rate was higher than 2 years earlier, but still insufficient, compared to the level which could block the transmission of the target diseases in the population. The persistence of such a low rate of immunization uptake will not prevent the occurrence of epidemics in the population.

Development of health activities in Switzerland.

A survey in five Swiss cantons has indicated several kinds of difficulty that will have to be overcome if strategies for the prevention of illness and the promotion of health are to be satisfactorily developed and implemented.

Public health importance and risk factors for cercarial dermatitis associated with swimming in Lake Leman at Geneva, Switzerland.

Fifteen cohorts of healthy bathers were recruited at four Lake Leman beaches between 3 July and 23 August 1996 to assess the public health importance of cercarial dermatitis in Geneva, Switzerland. Telephone follow-up interviews were carried out after 2-7 days. Overall, 153 bathers out of 555 reported probable cercarial dermatitis at follow-up. Median daily attack rate was 27.7% (2.2-57.7%). Of the cases, 11.1% noticed more than 30 skin lesions, 19.6% described severe itching, 50.3% used a drug treatment, 3.9% visited a doctor and 15% claimed they would reduce their bathing activities. History of cercarial dermatitis, time spent in the water, hour of the day, barometric pressure and maximum daily atmospheric temperature predicted disease occurrence in multivariate analysis. While a benign disease, cercarial dermatitis may have a negative impact on the local water recreation industry. The identification of risk factors for the disease may help produce better preventive recommendations for the bathers.

Acute hemorrhagic leukoencephalopathy: clinical and CT diagnosis and histopathological confirmation in an elderly patient.

With the aid of CT acute hemorrhagic leukoencephalopathy (AHL) was diagnosed before death in a 65 year old woman. On the histopathological evidence, which is very similar to that for experimental allergic encephalomyelitis (EAE), AHL is considered to be a highly acute variant of parainfective encephalomyelitis.

Risk factors for tuberculosis among HIV-infected patients in Switzerland. Swiss HIV Cohort Study.

The aim of this study was to determine the risk factors associated with tuberculosis among human immunodeficiency virus (HIV)-infected persons living in Switzerland, a country with low prevalence of tuberculous infection. We performed a nested case-control study and logistic regression. Cases (n = 239) were patients participating in the Swiss-HIV Cohort study (n = 7,103), diagnosed with bacteriologically confirmed tuberculosis. The rest of the cohort population was used as control. Patients from industrialized countries had a risk of tuberculosis similar to those from Switzerland (adjusted odds ratio (OR) 1.1; 95% confidence interval (95% CI) 0.7-1.5); whereas the risk among patients from Eastern Europe (OR 2.8, 95% CI 1.9-3.7), Brazil (OR 10.6; 95% CI 9.6-11.5), and Africa (OR 3.0; 95% CI 2.4-3.6) was markedly higher. Immune suppression, as indicated by low CD4 + cell count, was an independent risk factor for tuberculosis (OR 7.8; 95% CI 7.3-8.3 for patients with CD4 + < 50 cells.mm-3 compared to those with CD4 + > 500 cells.mm-3). Age, sex and HIV-transmission category did not appear to increase the risk of tuberculosis after adjustment for other patient characteristics. In conclusion, in countries of low prevalence of Mycobacterium tuberculosis infection, to originate from a country with high prevalence of tuberculosis infection and to have advanced immunodeficiency are significant risk factors for tuberculosis. They may be used to complement the tuberculin skin test in targeting patients for preventive chemotherapy.

A case-control study of the efficacy of a non-randomized breast cancer screening program in Florence (Italy).

In a rural area near Florence a population-based screening program for breast cancer was started in 1970, offering a mammography test every 2.5 years to all women between 40 and 70 years of age. In order to evaluate the efficacy of this program a case-control study has been carried out comparing the screening history of all women who died from breast cancer in this area in the years 1977-1984, and who had been diagnosed after the start of the program, with that of a matched group of living controls. The case-control study showed that the overall O.R. of dying from breast cancer in the study period for "screened" versus "never-screened" women was 0.53 (95% C.I. = 0.29-0.95). After evaluation of other variables as potential confounders the adjusted O.R. estimates were respectively 0.57 (95% C.I. = 0.35-0.92) and 0.32 (95% C.I. = 0.20-0.52) for women screened only once or at least twice. No significant protective effect was shown for women below the age of 50 years.

Human heart rate variability and sleep stages.

With the aim of better understanding the dynamic changes in sympatho-vagal tone occurring during the night, human heart rate variability (HRV) during the various sleep stages was evaluated by means of autoregressive spectral analysis. Each recording consisted of an electroencephalogram, an electrooculogram, and electromyogram, and electrocardiogram, and a spirometry trace. All of the data were sampled and stored in digital form. Sleep was analysed visually, but HRV was analysed off-line by means of original software using Burg's algorithm to calculate the LF/HF ratio (LF: 0.04-0.12 Hz; HF: 0.15-0.35 Hz) for each sleep stage. Seven healthy subjects (four males; mean age 35 years) were enrolled in the study. Our findings show a progressive and significant reduction in the LF/HF ratio through sleep stages S1-S4, as a result of an increase in the HF component; this indicates the prevalence of parasympathetic activity during slow-wave sleep. During wakefulness, S1 and REM, the LF/HF values were similar and close to 1.