understanding and tackling poverty and vulnerability in mountain livelihoods in the hindu kush himalaya

This chapter critically reviews the existing knowledge on livelihoods, poverty, and vulnerability in the Hindu Kush Himalaya (HKH). Development in mountain areas and the practices of people in these areas are uniquely conditioned by distinct characteristics that we term "mountain specificities". Some of these specificities—such as inaccessibility, fragility, and marginality—constrain development. Others—such as abundant biological diversity, ecological niches, and adaptation mechanisms—present development opportunities for mountain people

Pars plana vitrectomy for disturbing primary vitreous floaters: clinical outcome and patient satisfaction

Item does not contain fulltextBACKGROUND: Primary vitreous floaters can be highly bothersome in some patients. In the case of persistently bothersome floaters, pars plana vitrectomy may be the most effective treatment. The aim of this study is to evaluate the incidence of complications, and patient satisfaction, after pars plana vitrectomy for disabling primary vitreous opacities. METHODS: We included a total of 110 eyes that underwent pars plana vitrectomy between February 1998 and August 2010. Fifty-seven eyes (51.8%) underwent 20-gauge vitrectomy, whereas 53 eyes (48.2%) underwent 23-gauge vitrectomy. In a retrospective manner, we assessed intraoperative and postoperative complications. There was a considerable range of time between surgery and questionnaire (range: 4-136 months). Patient satisfaction was assessed by a questionnaire based on a modified NEI VFQ-25 questionnaire. RESULTS: A retinal detachment occurred in 10.9% of cases, and the incidence did not differ significantly between the 20-gauge and 23-gauge vitrectomy groups. In 4.5% of the eyes, a retinal detachment developed within the first 3 months, and 6.4% occurred later in the postoperative period. Cystoid macular edema occurred in 5.5%, and an epiretinal membrane was seen postoperatively in 3.6% of cases. Development of glaucoma requiring glaucoma surgery, a macular hole, and postoperative scotoma, each occurred in 0.9% of cases. No cases of endophthalmitis occurred. Eighty-five percent of patients were satisfied or very satisfied with the results of the vitrectomy. Eighty-four percent of all patients were completely cured from their troublesome vitreous floaters, and an additional 9.3% of patients were less troubled by vitreous floaters. Ten patients (9.3%) were dissatisfied, and six of these patients (5.6%) had a serious complication that resulted in permanent visual loss. CONCLUSIONS: Pars plana vitrectomy is an effective approach to treat primary vitreous floaters, resulting in a high rate of patient satisfaction. Postoperative complications may be more frequent than previously reported, so patients should be well-informed about the complication rate before reaching informed consent about this surgical intervention. Additional preventive measures should be considered to reduce this complication rate

Aniridic glaucoma: diagnosis and treatment

Aniridia is a bilateral iris aplasia/hypoplasia, associated with other ocular anomalies arising during the childhood: nystagmus, photophobia, amblyopia, keratopathies, cataract and lens luxation, glaucoma, fovea and optic nerve hypoplasia. In 6-75 % of cases aniridia is accompanied by a dysgenetic secondary glaucoma caused by an iridogoniodysgenesis for abnormal migration of neural crest neuroectodermal cells, and a higher vulnerability of the optic nerve head for possible microstructural alterations in lamina cribrosa. Congenital glaucoma associated with aniridia is uncommon. The poor young patient collaboration for several clinical and instrumental analyses entails in many cases the need of examinations under general anesthesia. Medical therapy represents the first step, whereas low-responsive patients may undergo laser treatments (transscleral diode laser cyclophotocoagulation or cyclocryotherapy) and/or surgery (trabeculectomy with or without antimetabolites). Refractory cases, frequently with an early onset, require glaucoma drainage devices (Molteno implant, Ahmed valve, or Baerveldt tube shunt). A prophylactic goniotomy can be performed with a long-term effectiveness in reducing risks of aniridic glaucoma onset or progression. \ua9 Springer International Publishing Switzerland 2015. All rights are reserved

Foramen magnum meningiomas: detailed surgical approaches and technical aspects at Lariboisière Hospital and review of the literature.

Foramen magnum meningiomas are challenging tumors, requiring special considerations because of the vicinity of the medulla oblongata, the lower cranial nerves, and the vertebral artery. After detailing the relevant anatomy of the foramen magnum area, we will explain our classification system based on the compartment of development, the dural insertion, and the relation to the vertebral artery. The compartment of development is most of the time intradural and less frequently extradural or both intraextradural. Intradurally, foramen magnum meningiomas are classified posterior, lateral, and anterior if their insertion is, respectively, posterior to the dentate ligament, anterior to the dentate ligament, and anterior to the dentate ligament with extension over the midline. This classification system helps to define the best surgical approach and the lateral extent of drilling needed and anticipate the relation with the lower cranial nerves. In our department, three basic surgical approaches were used: the posterior midline, the postero-lateral, and the antero-lateral approaches. We will explain in detail our surgical technique. Finally, a review of the literature is provided to allow comparison with the treatment options advocated by other skull base surgeons.Journal ArticleReviewinfo:eu-repo/semantics/publishe