Affections héréditaires de la rétine dans le Nord -Pas-de-Calais. Dépistage hospitalier et prévalence

The authors present part of a research made on inherited retinal dystrophies recorded among the inhabitants of the Nord -Pas-de-Calais region. This retrospective study extending over a period of 18 years (from 1972 to 1989) and bearing on a population of nearly 4 million inhabitants has enabled us to try and assess the prevalence of each disease. The considerable amount of recorded cases (1 660 patients) corroborates the high frequency of these diseases together with their impact on the socio-economic life and on the health of the population. The distribution of the different forms of these diseases remains very close to the results found by other researchers in other countries.Les auteurs présentent une partie de la recherche entreprise sur les dystrophies rétiniennes héréditaires recensées parmi les habitants de la région du Nord -Pas-de-Calais. Cette étude rétrospective, menée sur 18 années (1972 à 1989) et sur une population proche de 4 millions d'habitants, permet de tenter une estimation de la prévalence pour chacune de ces affections. Le nombre considérable de cas dépistés (1 660 patients) confirme la fréquence et l'importance socio-économique et sanitaire de ces affections. La distribution des différentes formes reste très proche des résultats d'autres études menées en différents pays.Puech Bernard, Kostrubiec Benjamin, Hache Jean-Claude, François Pierre. Affections héréditaires de la rétine dans le Nord -Pas-de-Calais. Dépistage hospitalier et prévalence. In: Hommes et Terres du Nord, 1990/2. Géographie de la scolarité et de la santé. pp. 109-116

Combination of Hydroxychloroquine Plus Azithromycin As Potential Treatment for COVID-19 Patients: Safety Profile, Drug Interactions, and Management of Toxicity

International audienceThe coronavirus disease 2019 (COVID-19), caused by infection with severe acute respiratory syndrome coronavirus 2, has recently emerged worldwide. In this context, there is an urgent need to identify safe and effective therapeutic strategies for treatment of such highly contagious disease. We recently reported promising results of combining hydroxychloroquine and azithromycin as an early treatment option. Although ongoing clinical trials are challenging the efficacy of this combination, many clinicians claim the authorization to or have already begun to use it to treat COVID-19 patients worldwide. The aim of this article is to share pharmacology considerations contributing to the rationale of this combination, and to provide safety information to prevent toxicity and drug–drug interactions, based on available evidence

Genetic analysis of new French X-linked juvenile retinoschisis kindreds using microsatellite markers closely linked to the RS locus: further narrowing of the RS candidate region

International audienc

Partially reversible quadruple sectoranopia caused by vascular steal due to an arteriovenous malformation.

International audienceBACKGROUND: Lateral, homonymous upper and lower field blind sectors sparing a horizontal zone define quadruple sectoranopia. This rare campimetric deficit involves ischemia or infarction of parts of the lateral geniculate body supplied by the distal anterior choroidal artery. METHODS: A 41-year-old patient presented with a complaint of blurred vision. Visual acuity was 20/20 on both sides. Visual field showed a left quadruple sectoranopia. CT scan, MRI, MRA and conventional angiography showed a right cerebral arteriovenous malformation supplied partly by the right anterior choroidal artery. Partial retinal nerve fiber layer atrophy matched to the campimetric deficit proved that some degree of infarction involved the lateral geniculate body. RESULTS: The arteriovenous malformation was treated with stereotactic radiosurgery. Two years after treatment, the nidus had completely disappeared. The campimetric deficit began improving from 19 months onwards after stereotactic radiosurgery. Twenty-eight months after treatment, the superior defect had completely reversed. CONCLUSIONS: Quadruple sectoranopia involves ischemia or infarction of parts of the lateral geniculate body supplied by the distal anterior choroidal artery. Following radio-induced angioma thrombosis, blood was no longer shunted away from the right lateral geniculate body, whose viable areas resumed their activity. Accordingly, a partial campimetric recovery occurred

The effect on vision of associated treatments in patients taking vigabatrin: carbamazepine versus valproate.

International audiencePURPOSE: To evaluate the effect on visual function of a concomitant antiepileptic drug (AED) in patients treated with vigabatrin (VGB). METHODS: Sixty-four consecutive patients with a history of partial seizures currently treated with VGB with either carbamazepine (CBZ) or valproate (VPA) were examined with automated kinetic perimetry, static perimetry, electrooculogram (EOG), and electroretinogram (ERG). An original device based on kinetic perimetry was developed to quantify the area of perception for each isopter. RESULTS: Fifty-two patients were finally included. The results showed a significant difference in patients treated with VGB-VPA compared with patients treated with VGB-CBZ concerning the mean defect of static perimetry and the peripheral and midperipheral isopter (III 4e and III 1a Goldmann equivalent, respectively) in kinetic perimetry. EOG and ERG results did not differ significantly between the two groups. CONCLUSIONS: The visual impairment due to visual field constriction was more important in patients treated with VGB and VPA compared with patients treated with VGB and CBZ. The origin of this difference between the two associations could not be related to any particular retinal electrophysiologic abnormality

Retinal electrophysiological results in patients receiving lamotrigine monotherapy.

International audiencePURPOSE: To evaluate the effects on vision in patients receiving lamotrigine (LTG) monotherapy. METHODS: Twenty-four consecutive patients taking LTG for partial seizures were referred for a routine ophthalmologic examination including visual acuity testing, tonometry, slit lamp, and fundus examination. Automated kinetic perimetry, electrooculogram (EOG), and electroretinogram were performed after informed consent was obtained. RESULTS: In 18 patients finally included, the clinical ophthalmologic examination showed no abnormality. Four patients complained of blurring; among them, one patient had a visual field constriction in both eyes, which, however, was of unclear clinical significance (poor compliance) and a reduced light/dark ratio of the electrooculogram. One other patient with blurred vision had a reduced EOG, but the visual field was normal. Two patients had a reduced EOG but no visual symptoms. Considering the whole group of patients receiving LTG therapy, the light/dark ratio of the EOG was reduced in a dose-dependent fashion (p < 0.0001). The electroretinogram was normal in all patients. CONCLUSIONS: No irreversible visual field impairment in patients treated with LTG was encountered, although a dose-dependent retinal toxicity may have been present. The exact cellular mechanism of the electrophysiologic changes in patients taking LTG remain to be explained

Resolution of acute acquired comitant esotropia after suboccipital decompression for Chiari I malformation.

International audiencePURPOSE: To report a case of acute comitant esotropia successfully treated with suboccipital decompression in a 9-year-old male patient with Chiari I malformation. DESIGN: Interventional case report. METHODS: A 9-year-old male with Chiari I malformation had acute onset of diplopia, headache, and comitant esotropia. RESULTS: About 9 months after suboccipital decompression, diplopia resolved and there was near orthophoria on examination 15 months after surgery. CONCLUSION: In view of our case and after a review of literature, we advocate primary suboccipital decompression to treat acute comitant esotropia in patients with Chiari I malformation. A follow-up period of at least 1 year rather than 6 months seems necessary to assess surgery effects

Y a-t-il du sacré dans la nature ?

Si nous admirons la nature et aimons y méditer, si nous en reconnaissons la dignité et appelons à défendre son intégrité, si nous préférons la laisser faire plutôt que de chercher à nous y substituer, sacralisons-nous la nature ? Et cela nous place-t-il automatiquement dans une posture obscurantiste contraire au progrès scientifique et technique ? Ce volume regroupe les contributions des philosophes, théologiens, écologues et anthropologues réunis autour de ces questions en avril 2012, à la Sorbonne. La critique de la tendance religieuse, si controversée, de l'écologie contemporaine, passe ici par l'examen des raisons qui pourraient nous pousser à faire place à la notion de sacré, même si elle est relative et mouvante. Prendre au sérieux la re-sacralisation de la nature, tout en en refusant les manifestations les plus excentriques, c'est chercher quel sens théologique, psychologique, phénoménologique, éthique et même politique on peut donner à notre ancrage terrestre. Quand l'histoire naturelle et l'histoire humaine se rejoignent et se confondent, habiter la nature suppose de trouver le moyen de faire société avec elle tout en lui reconnaissant la liberté du sauvage, rétive à tout enfermement, même sous la forme de la sanctuarisation