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Resume A mesure que l’esperance de vie augmente, du fait des pathologies liees a l’âge et de l’immunosenescence, des situations d’immunosuppression peuvent se produire et se compliquer d’infections particulieres comme celles a mycobacteries. Outre la tuberculose infectieuse, des especes apparentees plus rares comme les infections a Nocardia , peuvent se manifester. Nous rapportons un cas de nocardiose cerebrale chez un patient âge avec un syndrome myeloproliferatif traite par hydroxycarbamide. Dans ce domaine, la gestion therapeutique est compliquee de par la nature iatrogene des medicaments requis. A ce jour, aucune evaluation, ni aucune recommandation n’ont ete faites pour le traitement de la nocardiose dans la population geriatrique.

Resume Les donneurs pediatriques d’organes sont rares et principalement la consequence de mort encephalique (ME) de causes non naturelles. Ces circonstances, plus souvent traumatiques accidentelles ou non, orientent potentiellement les deces dans un processus d’obstacle medicolegal (OML), compliquant les demarches de coordination de prelevement d’organes (PMO). Pour esperer faire participer ces jeunes defunts au pool des donneurs potentiels d’organe, les soignants doivent faire preuve d’une cooperation etroite avec les equipes medicojudiciaires, en preservant notamment les preuves utiles a la recherche de la verite. Ils doivent aussi apporter au medecin legiste (ML) le maximum d’informations medicales sur les lesions observees cliniquement ou radiologiquement en pre- et peroperatoire du PMO. En reponse, les procureurs seront souvent plus attentifs envers ces medecins reanimateurs et ces professionnels de la coordination de prelevement d’organes (CPO), qui les sollicitent pour une autorisation officielle de PMO. Ils pourront suggerer des que possible un « accord de principe » si l’enquete judiciaire le permet et si le ML requis ne s’y oppose pas. Ulterieurement, si la demarche evolue favorablement vers un accord parental, une « autorisation officielle » pourra etre fournie a la CPO qui en fera la demande. Cette collaboration etroite entre les professionnels de sante et les equipes medicojudiciaires, a contribue a mettre en place tous ces principes permettant un recensement superieur des enfants en ME, avec un meilleur taux de prelevement parmi la cohorte presentee de 22 enfants de moins de 3 ans identifies par la CPO.

Introduction Les ondes de chocs extracorporelles (OCE) focales font partie de l’arsenal therapeutique des tendinopathies achilleennes. Elles reposent sur le principe de cavitation au sein du tendon par des ondes sonores afin de creer une microvascularisation locale avec appel de facteurs de croissance et ainsi favoriser la cicatrisation tendineuse. Les donnees de la litterature mettent en evidence une efficacite chez plus de 80 % des patients [1] . Nous avons cherche a determiner s’il existait des facteurs predictifs de reponse aux OCE. Patients et methodes Une etude retrospective monocentrique a ete realisee au centre Lyon Choc entre le 1er janvier 2016 et le 31 decembre 2019. Les patients ont ete traites avec un appareil Dornier delivrant des ondes de choc focales. Le protocole de traitement etait similaire avec un minimum de deux seances espacees de 15 jours d’intervalle. La realisation de seances supplementaires a ete laissee a l’appreciation du medecin et du patient selon l’efficacite clinique. L’intensite des OCE a ete determinee selon la tolerance du patient et son morphotype. L’efficacite a ete recueillie par auto-evaluation a chaque seance. Resultats Au total, 465 patients ont ete traites pour une tendinopathie achilleenne pendant cette periode. L’âge moyen est de 61,5 ans avec un sex-ratio masculin a 54 %. Parmi ces 465 patients, 90 (19,4 %) n’ont retire aucun benefice avant la derniere seance d’OCE et 111 (23,9 %) en ont ressenti une amelioration de 75 % ou plus. En comparant ces 2 groupes, il n’a pas ete note pas de difference significative dans la maniere de realiser les seances avec un nombre de seances (2,94 vs 3,38), une intensite (6,15 vs 6,61) et une energie totale similaire (15 752 mJ vs 15 376 mJ). L’âge n’apparait pas comme un facteur predictif de reponse egalement (55,9 ans vs 58,9 ans). Le groupe « non repondeur » etait par contre plus feminin (52,3 % vs 37,8 % ; p = 0,044) et avait une duree d’evolution plus courte (10 mois vs 18 mois ; p = 0,027). Discussion Une fois de plus les OCE focales apparaissent comme un traitement efficace des tendinopathies achilleennes avec 80,6 % de patients repondeurs dans cette etude. Le sexe feminin apparait comme un facteur de mauvaise reponse. L’evolution plus longue comme facteur de bon pronostic apparait plus surprenante de prime abord. Le mecanisme physiopathologique des OCE explique probablement ces bons resultats en relancant le processus de cicatrisation qu’aurait perdu des tendons plus destructures par une longue evolution. Les principales forces de cette etude sont le nombre important de patients traites et il s’agit a notre connaissance de la seule etude recherchant des facteurs predictifs dans cette localisation. La principale limite tient a l’absence d’imagerie realisee avant et apres la realisation des OCE. Conclusion Le sexe masculin et une duree d’evolution plus longue apparaissent dans cette etude comme des facteurs de bonne reponse aux OCE pour les tendinopathies achilleennes. La facon de realiser les seances (intensite, nombre de choc et energie totale delivree) n’influent pas sur la reponse au traitement.

International audience; Ivabradine is a bradycardic drug used worldwide in the treatment of chronic stable angina and chronic heart failure. We presented here a case of a 61-year-old woman who was admitted to emergency department for overdose. She presented with drowsiness, bradycardia (45bpm) and a low blood pressure (116/21mmHg). She died ten hours after admission from multiple organ failure. Ivabradine was quantified in different matrices sampled during autopsy using a method on LC-MS/MS (TSQ Vantage Thermo Fisher Scientific®), after a double liquid-liquid extraction with a mixture of hexane/ethyl acetate (1/1; v/v) and then chloroform/isopropanol (80/20; v/v). Chromatographic separation was achieved using a Hypersyl gold PFP column (200×2.1mm, 1.9μm) and an acetonitrile/formiate 2mM, 0.1% formic acid buffer gradient. Method was fully validated on whole blood. The mean overall recovery was 90%. Linearity was validated in the 5-500ng/mL range, with intra and inter-day precision lower than 14.3%. The ivabradine concentration found in patient post-mortem blood was 1210ng/mL. Ivabradine was also quantified in different viscera like lung (2910ng/g), kidney (1510ng/g), liver (1050ng/g), heart (900ng/g), and brain (110ng/g). The vitreous humor concentration was 760ng/mL. Pregabalin and zopiclone were also found in blood at 50μg/mL and 206ng/mL, respectively. This case seems to be the first report of a fatal intoxication involving ivabradine and the first published concentrations in organs.

EBMPracticeNet is a Belgian website of guidelines translated and adapted from the Finnish EBM guidelines. During the experimentation of the EBMPracticeNet website in France, physicians globally got an accurate answer and found the information provided by the website reliable and useful for practice. They perceived its ergonomics as good and wished to continue using it. Improvements should focus on the indexation and adaptation of the guidelines, and on physicians' training.

Resume Introduction La prise en charge des patients presbytes est un enjeu medical, chirurgical et economique. Nous nous sommes demandes quelle procedure entre une technique de Presbylasik appelee Supracor Regular et une chirurgie endoculaire de remplacement de cristallin clair par un implant trifocal diffractif offrirait les meilleurs resultats (en termes d’acuite visuelle et de satisfaction) a nos patients hypermetropes presbytes entre 55 et 70 ans. L’objectif etait d’evaluer l’efficacite et la securite des deux techniques (a une semaine et a trois mois) ainsi que la qualite de vie des patients operes. Materiel et methodes Cette etude retrospective a inclus 21 patients hypermetropes presbytes, d’âge moyen de 60,9 ans, ayant beneficie d’une chirurgie refractive a l’hopital d’instruction des armees–Percy (Clamart) entre juin 2011 et mars 2014 ; 13 patients ont eu le traitement corneen par Supracor (realise avec un laser femtoseconde IntraLase FS60 (AMO, Etats-Unis) et un laser excimer Technolas 217P (Technolas Perfect Vision, GmbH) selon l’algorithme Zyoptix Tissue-Saving (ajuste par un nomogramme et le mode Supracor Regular), et 8 patients ont beneficie d’une chirurgie de cristallin clair Prelex (presbyopic lens exchange) par phacoemulsification bimanuelle avec mise en place d’implants intraoculaires trifocaux diffractifs Finevison Micro F, PhysIOL*. Resultats L’acuite visuelle binoculaire sans correction dans le groupe Supracor est de 0,03 (−0,2–0,1) LogMar en vision de loin et 0,23 (0,06–0,36) en vision de pres a j7 et de 0,031 (−0,2–0,1) en VL et 0,166 (0,06–0,36) en VP a 3 mois. Dans le groupe Prelex, a j7, l’AVSC binoculaire est de 0,025 (0–0,1) en VL et 0,165 (0,06–0,18) en VP et a m3 de 0 (−0,1–0,1) en VL et 0,105 (0,06–0,18) en VP. Quatre patients du groupe Supracor restent dependants de lunettes en vision de pres versus 0 dans le groupe Prelex. Sept patients sur 11 du groupe Supracor et 100 % des patients Prelex sont pleinement satisfaits. La presence de halos lumineux est retrouvee dans les deux techniques. Le taux de reprise est plus important dans le groupe Supracor, mais la reprise est plus lourde dans le groupe Prelex. Conclusion Les deux procedures chirurgicales sont efficaces et sures pour la prise en charge des patients hypermetropes et presbytes. Cependant, pour les patients âges de plus de 55 ans, la chirurgie cristallinienne semble etre la plus appropriee.

Background: Trying to predict the very early death after a CGA is difficult in elderly metastatic cancers. Last year, we presented a clinical score to predict this risk in 815 elderly cancer patients (Boulahssass et al 9511 ASCO 2015). The aim of this new study is the next step by developing a score to estimate the risk of early death at 100 days in metastatic cancers (MC) in order to have the collective wisdom not to overtreat this population.100 days is nearly 3 months, if patients are going to die within 3 months, it’s maybe necessary to provide them best supportive care alone.

Resume Objectif Evaluer l’efficacite et la satisfaction des patients hypermetropes presbytes operes par presbylasik centre (multifocalite centree sur la vision de pres) de type Supracor (Technolas Perfect Vision). Materiel et methodes Il s’agit d’une etude retrospective realisee a l’HIA Percy entre septembre 2011 et septembre 2013. Cinquante-neuf yeux de 29 patients ont ete inclus, et ont beneficie de presbylasik. Les criteres de surveillance etaient l’acuite visuelle binoculaire sans correction en vision de loin (VL) et en vision de pres (VP), l’aberrometrie, le bombement corneen central evalue par topographie corneenne ( bump ), et la satisfaction des patients (questionnaire). Resultats L’acuite visuelle binoculaire sans correction moyenne retrouvee etait de 0,09 logmar en VL, 0,22 en VP le lendemain de l’intervention, de 0,04 logmar en VL et 0,17 en VP a 1 mois postoperatoire, de 0,15 logmar en VL et 0,19 en VP a 3 mois postoperatoires, et de −0,02 logmar en VL et 0,18 en VP a 6 mois postoperatoires. Le bump moyen retrouve etait de 2,56 ± 0,9 dioptries. Il existait significativement plus d’aberrations optiques de haut degre dans les 5 mm centraux en postoperatoire ( p Conclusion Le presbylasik Supracor est une solution de choix pour affranchir en verres correcteurs les patients hypermetropes presbytes.

Objective To present a fatal intoxication involving Ivabradine. Case history A 61-year-old woman was admitted to hospital for voluntary intoxication. At admission, the patient presented drowsiness. Few hours later she suffered a cardiac arrest followed by a successful resuscitation but she died 10 hours after admission. Autopsy and reference toxicological analysis were performed. Methods HPLC-DAD, GC-MS and LC-MS/MS screening were performed. Quantification was achieved by LC-MS/MS (TSQ Vantage ThermoFischer®), after a double liquid/liquid extraction under alkaline condition [hexane/ethyl acetate (1/1, v/v) followed by Chloroform/Isopropanol (80/20, v/v)]. Chromatographic separation was achieved using a Hypersyl gold PFP column and a classic acetonitrile/formiate2 mM, 0.1% formic acid buffer gradient. IS used was morphine D3. Results The method was fully validated in whole blood. Calibration curves were linear from 5 to 500 ng/mL. The LOQ was 5 ng/mL and the intra- and inter-assays bias were all acceptable ( Table 1 . Due to high concentrations, samples were diluted 1:2 and 1:10. Midazolam, atropine and atracurium metabolite (laudanosine) were identified at therapeutic concentrations. Pregabalin, zopiclone and N-desmethylzopiclone were found at 50 μg/mL (therapeutic range: 2–8 μg/mL), 206 ng/mL (therapeutic range: 10–50 ng/mL) and 400 ng/mL. Discussion Midazolam, atropine and atracurium were administered during hospitalization, while ivabradine, zopiclone and pregabalin were part of her chronic treatment. Ivabradine is indicated in the management of stable angina pectoralis and symptomatic chronic heart failure. It selectively and specifically inhibits the pacemaker current I(f) thereby slowing heart rates with a dose dependent activity. There are few data about therapeutic concentrations; they appear to be around 10 ng/mL, with a Cmax of 22 ng/mL. Three non-fatal Ivabradine intoxications were reported in which peripheral blood concentrations were 119 ng/mL [1] , 375 ng/mL [2] and 525 ng/mL [3] . The concentration in our case is much higher and probably played a major role in the occurrence of the death. Conclusion We describe here the first case of a fatal intoxication involving Ivabradine; we furthermore provide postmortem concentrations in organs.

Resume Introduction Les pistolets Airsoft sont devenus d’utilisation courante en France depuis que le decret du 24 mars 1999 autorise les personnes majeures a utiliser une arme d’une energie inferieure a 2 J. L’objectif de ce travail etait de rechercher le lien entre le contexte de survenue des accidents ophtalmologiques par billes de pistolets Airsoft et les consequences cliniques observees, pour en deduire les elements efficaces de prevention. Methodes Analyse retrospective de cas de patients victimes d’accidents ophtalmologiques lies a un traumatisme par bille de pistolet Airsoft entre septembre 2009 et aout 2010 dans deux centres hospitaliers du Nord de la France. Resultats Six patients dont l’âge moyen est de 12,6 ± 3,2 ans ont ete inclus. Les lesions les plus frequemment rencontrees sont l’ulcere de cornee, l’hyphema et le traumatisme irien. Des sequelles fonctionnelles existent dans la moitie des cas et un acte chirurgical a ete necessaire dans un tiers des cas. Le tir est direct dans tous les cas. Dans 83 % des cas, l’accident a eu lieu en jouant dans ou autour de la maison. Une fois sur deux, l’arme a ete gagnee dans un stand de foire ou achetee en boutique generaliste, et dans aucun de ces cas, les patients ne possedaient de lunettes de protection. Conclusion Le fort attrait que represente l’Airsoft pour les mineurs nous « incite » a proposer plusieurs mesures pratiques pour ameliorer leur protection, la principale etant l’interdiction de mise en vente de ces pistolets en dehors des magasins specialises.

Purpose To evaluate a diffractif trifocal toric intraocular lens (IOL) comparated with a trifocal IOL and a monofocal toric IOL. Methods This retrospective comparative study included patients with visually significant cataract or presbyopia who were scheduled for lensectomy and implantation of IOL. They were included in 3 groups according to the IOL implanted: multifocal group, multifocal toric group and toric group. At 1 month postoperatively, visual acuity (VA) at long and near distance, and refractive outcomes were examined. Results 70 eyes of 45 patients were included. 21 eyes in the multifocal group, 22 in the multifocal toric group, and 27 in the toric group. The mean age of patients was 70.7 years +/− 10.6 (range 52–91 years). Postoperatively, the mean refractive astigmatism decreased to 0.71D, 0.77D and 0.72D respectively in the 3 groups. The distance uncorrected VA was 0.13logMar +/− 0.11 for multifocal group, 0.13logMar +/− 0.16 for multifocal toric group and 0.12logMar +/− 0.11 for toric group. There were no statistically differences between the 3 groups for the uncorrected distance VA, and between multifocal group and multifocal toric group for the uncorrected near VA. Conclusions Diffractif trifocal toric IOL provided useful VA at any distance. The addition of a toric surface to the aspheric diffractive multifocal IOL resulted in a comparable visual performance.

Introduction: The number of nonagenarians people in the world is steadily growing. Decision making about those patients concerning cancer treatment is difficult due to the lack of recommendations. Comprehensive Geriatric Assessment (CGA) is a help for clinicians to take a decision concerning this treatment. UCOG PACA-Est Cohort is a large multicenter prospective cohort of geriatric patients with cancer. The aim of our study is to describe the population of patient age over 90 years old in the UCOG PACA-Est cohort.Methods: All patients included in the cohort have benefited from a standardized CGA before the treatment decision. The CGA included (not exhaustive): MMSE, ADL, IADL, gait speed, one-leg standing, Charlson comorbidity index (CCI). Characteristics of cancer, social and demographic data were also collected. During a 100-days follow up, the rate of death, and targeted CGA interventions were collected.Results: On the 860 patients of the cohort, there were 101 nonagenarians with a mean age of 92 years (SD 2y). There were 65% of women and 20% of the patients had a metastatic cancer. The nonagenarians were significantly (p 90y (OR=4,3 [1,5-11,9], p=0,005). After the CGA, the initial cancer treatment plan was modified for 32% of nonagenarians, versus 20% for the rest of the cohort (OR=1,89 [1,2-3],p=0,006).The targeted geriatric interventions were not significantly different except for physiotherapy’s and pain’s care (OR= 1,5 [1-2,3],p=0,046 and OR=2,2 [1,1-4,3], p=0,02). The rate of death at 100-days follow up was more important for nonagenarians (OR= 1,8 [1,1-2,8], p=0,013).Conclusion: The study suggests a high vulnerability for nonagenarians patients with cancer. In spite of the altered cognitive status and the loss of autonomy, the targeted geriatric interventions differ only for physiotherapy’s care and pain’s care. The study shows the influence of the geriatrician in the decision making of the oncologist. It also confirms the importance of a CGA in very old people.

International audience; Physical gels formed by amphiphilic molecules, namely in this study Methyl-4,6-O-benzylidene-α-D-mannopyranoside, can be form either in polar and protic liquid like water or in organic apolar solvent such as toluene. The solvent, that influences the supramolecular organisation of the gelators, plays an important role in the stability and formation of the gel phase. Gelator-solvent interactions govern not only the assembly but also the solvent diffusion in the material. We present here measurements of neutron scattering (Time of Flight and Neutron Spin Echo) characterising this microscopic behaviour. In addition, we show that Transient Grating spectroscopy provides valuable information through the characterisation of the longitudinal acoustic wave propagating in the system. Opposite effects on the speed of sound in the gels are observed for the two solvents investigated, being relevant of the interactions between the gelators and the surrounding liquid.

We studied the effectiveness of lansoprazole and ranitidine in promoting gastric ulcer healing in a multicentre double-blind trial, by comparing the proportion of healed ulcers after 4 and 8 weeks of treatment. One hundred and fifty-eight patients were randomly given either ranitidine (150 mg each morning and at bedtime) or lansoprazole (30 mg each morning and placebo at bedtime). One hundred and twenty-eight patients completed the trial (62 taking lansoprazole, 66 taking ranitidine). Fifty-one (80%) of those treated with lansoprazole and forty-two (62%) of those treated with ranitidine had healed ulcers at 4 weeks (P < 0.05). Sixty-one (98%) patients who received lansoprazole and 57 (86%) who received ranitidine had healed ulcers at 8 weeks (P < 0.05). The observed differences were not significant in the intention-to-treat analysis. No serious adverse event was reported with lansoprazole.

Purpose To evaluate the effect of oral eplerenone on subretinal fluid (SRF), visual acuity, and choroidal thickness in patients with chronic central serous chorioretinopathy (CSCR). Methods Retrospective review of all patients monitored for a minimum of 3 months with chronic CSCR lasting more than 3 months who were treated with oral eplerenone with four physicians retina practice. Visual acuity, dilated funduscopic examination, and spectral-domain ocular coherence tomography (SD-OCT) with enhanced depth imaging (EDI) were obtained at each visit. The primary outcome measure was the reduction in subretinal fluid (SRF) following initiation of therapy. Protocol was oral eplerenone 25 mg daily first week and 50 mg daily during 9 weeks. Results 4 eyes of 4 patients were treated. At 3 months, all eyes had decreased SRF height on OCT and all eyes had improved their visual acuity. Mean SRF height decreased from 390 µm to 285 µm and mean visual acuity enhanced from logMAR 0.20 to 0.08 No significant side effect occurred. Only one eye showed reccurence after eplerenone was discontinued. Conclusions Oral eplerenone appeared to be a safe and reliable treatment with significant anatomic and visual improvements in eyes with chronic CSCR.

Purpose SUPRACOR™, performed with the Technolas Excimer Workstation 217P (Bausch + Lomb Technolas), creates a small zone of high refractive power in the central cornea, the « bump », to facilitate near focus. The aim of this study is to evaluate the influence of corneal biomechanics on this « bump ». Methods This retrospective study included 46 eyes of 23 patients. The Supracor ablation pattern was applied, to create hyperprolate shape resulting about 2 D near addition. The periphery was treated with hyperopic ablation in a 6 mm zone, using 9.5 mm suction ring, under 120 µm flap created by the IntraLase FS60 femtosecond laser (AMP, USA). Every patient underwent a corneal topography (Pentacam, Oculus, Germany) before and 1 month after surgery to evaluate the importance of the “bump”, and a biomechanical evaluation with the Ocular Response Analyser (ORA, Reichert, NY). CH (Corneal Hysteresis) and CRF (Corneal Resistance Factor) were evaluated. Spearman's rank correlation coefficient was used to analyze the relationship between the parameters of the ORA and the « bump ». Results The mean patient age was 55.5 ± 3.94, ranging from 50 to 62 years. Pre-operative spherical equivalent were 1.57 ± 0.77 D. Mean corneal thickness was 548 ± 44 µm. CH and CRF were respectively 10.53 ± 1.63 mmHg and 10.90 ± 2.12 mmHg. Mean “bump” was 2.25 ± 0.98 D, ranging from 0.50 to 4.64 D. A correlation was found between the CH and the bump (r = 0.34; p = 0.022) and also between the pachymetry and the bump (r = 0.45; p = 0.004). A strong correlation was found between corneal thickness and the CH (r = 0.62; p = 0.001). Conclusions In this study, the “bump” is correlated with the corneal thickness and the CH. The corneal thickness appears to be sufficient to predict the “bump” in hyperopic patients undergoing Supracor. These results should be confirmed in a larger sample of patients.

Objectifs La sonde vesicale a demeure (SVD) est surutilisee chez la personne âgee (PA). Cela peut entrainer de nombreuses complications, notamment infectieuses, associees a une alteration de la qualite de vie et de l’autonomie. Le but de l’etude est d’analyser le taux de succes, a 6 mois, des alternatives therapeutiques (AT) a la SVD, proposees a l’issu d’une reunion multidisciplinaire uro-geriatrique. Methodes Une evaluation standardisee uro-geriatrique est realisee chez toutes les PA de plus de 70 ans, porteuses d’une SVD avec echec de desondage. A l’issu de cette evaluation, une AT au SVD est proposee au sein d’une reunion multidisciplinaire. Le taux de succes des AT (defini par un desondage avec succes) est recueilli a 7 jours, 1, 3, et 6 mois. Le taux de deces est egalement collecte. Resultats Soixante et un patients ont ete inclus avec un âge moyen de 87 ans (SD 6,5) (cf. Tableau 1 ). Une AT au SVD etait realisee dans 62 % ( n = 38) des cas, dont 23 desondages, 7 implantations de stents uretrales et 8 photo-vaporisations de prostate. Le taux de succes etait de 92,1 % a 7 jours, puis de 100 % a 1, 3 et 6 mois. Le taux de deces total a 1, 3 et 6 mois etait de 6,6 % ( n = 4), 21,3 % ( n = 13), 36 % ( n = 22). A 6 mois, le taux de deces dans le groupe SVD etait plus important (65 % vs 18,4 %, p = 0,01). En analyse univariee, les facteurs predictifs de deces a 6 mois etaient les comorbidites neurologiques (OR : 4,3 [1,2–14,9], p = 0,023), une forte dependance (ADL p = 0,009) et la SVD (OR : 5,5 [1,8–17], p = 0,003). En analyse multivariee, une forte dependance (OR : 4,4 [1,4–14,5], p = 0,014). Conclusion Avec une AT dans 62 % des cas et un taux de succes de 100 % a 6 mois, l’analyse multidisciplinaire semble permettre une prise en charge personnalisee et efficace des PA en echec de desondage. Des etudes complementaires seront realisees pour determiner l’impact de la SVD sur la qualite de vie et le risque de deces des PA les plus dependants.

Introduction La sonde vesicale a demeure (SVD) est surutilisee chez la personne âgee (PA), entrainant un risque infectieux. Des alternatives therapeutiques existent, avec parmi elles, la chirurgie prostatique. Il n’existe pas de recommandations etablies sur la prise en charge peri-operatoire des chirurgies urologiques de la PA porteuse d’une SVD prenant en compte l’emergence de souches resistantes. L’objectif de notre etude est d’etudier l’efficacite d’un protocole d’antibiotherapie prophylactique peri-operatoire, cible, a spectre restreint, dans le cadre d’une chirurgie urologique prostatique chez la PA avec une SVD. Materiels et methodes Toutes les PA > 70 ans, d’un centre de geriatrique de reference, porteuses de SVD avec echec de desondage, beneficiaient d’au moins une evaluation multidisciplinaire entre le 1iermars et le 1iernovembre 2016. En cas de chirurgie prostatique, un protocole d’antibiotherapie prophylactique etait realise selon l’ECBU realise dans les 10 jours precedant la chirurgie :en cas d’Enterobacterie, un traitement par pivmecillinam ou en cas d’allergie par fosfomycine ;en cas d’enterocoque un traitement par amoxicilline ou en cas d’allergie par linezolide ; en cas de Pseudomonas aeruginosa, un traitement par ciprofloxacine. En cas de resistance ou d’ECBU polymicrobien, le protocole recommandait un avis specialise. En cas d’ECBU negatif, l’abstention therapeutique etait indiquee.L’antibiotherapie etait effectuee pour une duree totale de 5 jours. L’efficacite etait definie par l’absence d’infections urinaires symptomatiques dans les 30 jours suivant l’intervention. Resultats Parmi les 65 patients evalues,14 ont beneficie du protocole antibiotique etabli. On retrouvait 100 % d’hommes avec un âge moyen de 84 ans (73–94).6 ont beneficie d’une chirurgie d’incontinentation par implantation de stent et 8 d’une photovaporisation transuretrale de prostate. Plus de 2/3 des patients ( n = 10) ont recu une antibiotherapie dans les 6 mois precedant le geste chirurgical.4 ECBU etaient steriles. Les principaux germes retrouves,en cas d’ECBU positives, etaient Klebsiella pneumonia (4), Enterococcus faecalis (3) et Escherichia coli (3). Un avis d’expert a ete pris devant 2 ECBU poly microbiennes. L’efficacite du protocole etait de 93 % ( n = 13).1 patient, avec ECBU sterile initial a presente en post-operatoire un sepsis severe urinaire. Conclusion Le protocole d’antibioprophylaxie etabli montre une efficacite dans 93 % des cas, en permettant un usage restreint des antibiotiques associes a une duree d’exposition courte. Les resultats seront a confirmer sur un echantillon de patients plus important.

Intrastromal corneal rings and corneal collagen crosslinking for progressive keratoconus: comparison of two sequences

Purpose Flap wrinkles can be seen in 0,2-4% of LASIK cases. Our purpose is to evaluate flap folds through 7 femto-second cases and make a review of the literature on the epidemiology. Methods Retrospective monocentric review of 822 eyes who had flap created with the IntraLase FS60 femtosecond laser one month follow up were included between January 2012-January 2014 in the Ophthalmology and Refractive Surgery Unit, Percy Military Hospital. Patients had an exhaustive examination with uncorrected (UDVA) and corrected distance visual acuities, spherical equivalent and mean keratometry (Km) were compared preoperatively and postoperatively. Flap thickness were measured with SD-OCT and optical aberrations on Zyoptix Wavefront System. Results 7 folds of 6 patients were observed (0.85% of LASIK procedures), 4 were horizontal, 1 vertical and 2 oblique. No trauma was found. All the folds involved the visual axis. Their UDVA was +0,2 logMAR (from +0,4 to 0). Mean spherical equivalent decreased from -4,9 D to -0,43 D, mean Km changed from 43 D to 39.75 D. Postoperative optical aberrations measured at 4.57 µm (+/- 2). Mean thickness measured to 120µm (+/- 8). The main causes are early trauma, flap desiccation and contraction, intraoperative misalignment, flap thinness, large photo-ablation of myopia and cuts with microkeratome. The folds concern throughout its thickness and are the result of hyper-hydration of proteoglycans, resulting in irregularity of Bowman's membrane and flap deformation. Conclusion Flap folds are a potentially sight-threatening complication. Rigorous surgical technique, education and post-operative follow-up would reduce their frequency, identify and treat them quickly to increase visual performance.

Purpose INTRODUCTION : The surgical laser treatment of refractive disorders is becoming more and more prevalent. Preoperative evaluation means are multiple and all seem promising in the detection of infraclinic keratoconus. Our purpose was to compare the different scores. SETTING : Review of cases, ophthalmology and refractive surgery unit, Percy Military Hospital, Clamart, France. Methods MATHERIAL AND METHODS : Retrospective monocentric observational study, conducted between november 2013 and may 2014. Each patient benefited from an exhaustive corneal topography assessment : Pentacam® and a Belin/Ambrosio ehancement (P/B), Orbscan® and SCORE analyzer by Gatinel & Saad (O/S), and an Ocular Response Analyzer (ORA). A systematic analysis of the following was conducted : the thinnest point of pachymetry (TP), the value of maximum posterior elevation (MPE), the I-S ratio (IS), the maximum keratometry (K max), the presence of SRAX, and the enantiomorphism. Results RESULTS : 36 myopic patients, recused from laser refractive surgery, were included, or 72 eyes. Suspect cases added up to 31 patients for P/B, 32 for O/S, and 27 for ORA (or respectively 52, 55 and 40 eyes). There were 9 cases of discordance between the different scores. The averages were respectively : 502 +/- 47 µm for P, 26.81 +/- 7.46µm for MPE, 0.78 +/- 0.55 for IS, 44.6 +/- 1.8D for K-max. Conclusion CONCLUSION : Each of the exams and indices studied led us to detect infraclinic keratoconus, but in discordant cases, a more detailed analysis of the topographic map remains essential.

Purpose To analyze the efficacity and satisfaction of treatment by hyperopic presbyopia with a new in situ keratomileusis (LASIK) procedure, Supracor( Technolas Perfect Vision). Methods This retrospective study included 58 eyes of 29 patients treated with a new central multifocal presbyLASIK with a micromonovision using the Technolas 217P excimer laser between september 2011 to september 2013. Mean patient age was 55 years (range 47 to 62 years). The mean preoperative spherical equivalent refraction was +1.3D. The main outcome measure were uncorrected distance visual acuity (UDVA) and uncorrected reading ability, aberrometry, the bump and the satisfaction of the patients. Results The mean binocular UDVA was 0.09 logMAR-/+0.15 for distance vision and 0.22 logMAR+/-0.11 for near vision the day postoperatively , 0.04 logMAR+/-0.14 for distance vision and 0.17 logMAR+/-0.12 for near vision at 1 months , 0.15 logMAR+/-0.23 and 0.19logMAR+/-0.18 respectively at 3 months and -0.02 logMAR+/-0.06 and 0.18 logMAR +/-0.11 respectively at 6 months. The mean bump was 2.56+/-0.9D. The median total RMS increased from 0.30µm +/-0.07 preoperatively to 0.46µm+/-0.14 postoperatively (p

The management of presbyopic patients is a medical, surgical and economic issue. We wondered which procedure, whether a Presbylasik technique called Regular Supracor or the intraocular surgery of clear lens replacement by a trifocal diffractive lens (presbyopic lens exchange [Prelex]), provided the best results (in visual acuity and satisfaction) for our hyperopic and presbyopic patients between 55 and 70. The aim of this study was to compare the safety and efficacy of the two techniques (at one week and three months) and to assess patients' quality of life.This study is a retrospective monocentric clinical trial conducted between June 2011 and March 2014, on 21 hyperopic presbyopic patients (mean age 60.9 years), in the "hôpital d'instruction des armées-Percy" (Clamart); 13 patients underwent the corneal treatment of Presbylasik (with the Intralase FS60 femtosecond laser [AMO, USA] and the Technolas 217P excimer laser [Technolas Perfect Vision, GmbH] following the Zyoptix Tissue-Saving algorithm adjusted with a nomogram and the Regular Supracor mode), and 8 patients underwent clear lens extraction (Prelex), through bimanual phacoemulsification and implantation of diffractive trifocal intraocular lenses (Finevision Micro F, PhysIOL(*)).Mean uncorrected binocular distance and near vision visual acuity in the Supracor group were respectively 0.03 (-0.2-0.1) LogMar and 0.23 (0.06-0.36) one week postoperatively and 0.031 (-0.2-0.1) and 0,166 (0.06-0.36) three months postoperatively. In the Prelex group, the mean uncorrected one week binocular VA was 0.025 (0-0.1) for distance vision and 0.165 (0.06-0.18) for near distance and the three months visual acuity was 0 (-0.1-0.1) and 0.105 (0.06-0.18) for distance and near vision. All Prelex patients were spectacle-free at all distances, whereas 4 Supracor patients required spectacles for near vision postoperatively. Seven of 11 patients in the Supracor group and 100% of the Prelex patients were completely satisfied. Both groups experienced halos, but patients reported more halos in the Prelex group (75%). One eye required intraocular lens exchange and four eyes (16.7%) required a new corneal procedure in the Supracor group.Both surgeries are safe and effective modalities in the management of hyperopic and presbyopic patients. However, the Prelex procedure seems to be more appropriate for patients over 55 years of age.

The aims of this study were to measure the amount of starch from partially resistant starches (retrograded and complexed high-amylose cornstarches) escaping small-intestinal digestion in healthy humans by use of an intubation method and to compare these data with data obtained by indirect in vitro methods. Experiments were carried out in vivo in 6 healthy humans by using ileal intubation and stool analysis and in vitro by using 3 different methods for analyzing resistant starch. In intubated subjects, 51 +/- 2% of the retrograded and 21 +/- 2% of the complexed starch was delivered to the ileum and was fermented almost completely in the colon. In vitro estimates of the absorption of resistant starch were much lower. We conclude that technologically modified starches may substantially increase the amount of carbohydrate available for colonic fermentation in humans, but that in vitro measurements of resistant starch are inaccurate for predicting malabsorption in healthy humans.

To evaluate efficacy and patient satisfaction of presbyopic hyperopes treated with centered PresbyLASIK (multifocality centered on near vision) by the SUPRACOR technique (Technolas Perfect Vision).This is a retrospective study carried out at Percy Army Teaching Hospital from September 2011 through September 2013. Fifty-nine eyes of 29 patients were included and underwent PresbyLASIK. Study parameters included uncorrected binocular distance (DVA) and near (NVA) visual acuity, aberrometry, central corneal curvature by corneal topography (bump), and patient satisfaction (questionnaire).Mean uncorrected binocular visual acuity was found to be 0.09 logmar for DVA and 0.22 for NVA on post-operative day one, 0.04 logmar for DVA and 0.17 for NVA at 1 month post-operatively, 0.15 logmar for DVA and 0.19 for NVA at 3 months post-operatively, and -0.02 logmar for DVA and 0.18 for NVA at 6 months post-operatively. Mean central corneal curvature was found to be 2.56±0.9 diopters. There were significantly more higher-order aberrations in the central 5mm post-operatively (P0.01). Among the patients undergoing bilateral SUPRACOR LASIK, 79% were entirely satisfied with the surgery, and all patients would recommend the procedure to their family and friends. Eighty-six percent of these patients acheived total spectacle independence at distance and near.SUPRACOR PresbyLASIK is a method of choice in overcoming spectacle dependence in presbyopic hyperopes.

Purpose The objective of this study was to appreciate the reproducibility of the thickness of Lasik corneal flaps made by the IntraLase FS60 laser femtosecond (IntraLase, AMO USA). Methods It was a retrospective, randomized, double-blind study.Twenty eight eyes were included in the study. Every flap was program to measure 120 µm. The flaps were measured by Spectral Domain OCT (Heidelberg), one month after surgery in five points on a horizontal line through the center of the pupil (center, 1mm and 2 mm from the center pupil in nasal and temporal) The scheduled and the obtained thicknesses were compared in each point. Results Double reading by two different doctors showed no significant difference in the thickness flap measurements (p

Purpose In keratoconus treatment, Ferrera® rings nomogram integrates the Q factor defining corneal asphericity. Our study deals with the effect of the implantation of Ferrerra rings on the Q factor Methods This retrospective and monocentric study involves forty eyes of thirty-one patients suffering from keratoconus implanted with Ferrara® rings, with an uncorrected visual activity (UCVA), a best spectacle-corrected visual acuity (BSCVA) and a videokerato-topography, before and six months after surgery. The items followed are the UCVA, the BSCA, the average (Kmean) and maximum keratometry (Kmax) and the Q factor in the central 20° (Q20) and 40° (Q40). The analyse of the visual acuity (more or less than a line) enables to differentiate two groups of “good” and “bad” responders. The statistical tests are a Wilcoxon signed rank for pre and post operative comparisons, a Wilcoxon-Mann Whithey for group comparisons, and a Spearsman for correlations. Results The average age of patients is 32,8 years with 83,1% of male gender. Twelve eyes were implanted with two rings and twenty-eight with one. We find an average gain of 3.6 lines for UCVA, 1.1 lines for BSCVA and a decrease in Kmean of 1,4 dioptry. Q20 and Q40 are meaningly improved after surgery, but there is no significant difference between the studied groups. Lastly, before surgery, BSCVA is correlated to Q20, and Kmax to Q40. After surgery, UCVA is correlated to Q20 and Kmax to Q20. But the Kmax variation and the UCVA or BSCVA gains are not correlated. Conclusion Including the Q factor in the nomogram establishing ring’s choice improves the keratometric field but not the visual outcome.

Miscanthus is a perennial C4-grass that has received much interest as a potential of impact on the local agroecosytem. In this context, laboratory experiments were conducted to investigate the potential colonization of this new exotic plant species by three of the main aphid pest species of common crops in Picardie, northern France. In host preference experiments, the two polyphagous aphid species studied, Aphis fabae (Scop) and Myzus persicae (Sulzer), exhibited an xclusive preference for their host plant, whereas the cereal specialist Rhopalosiphum padi (L.) showed no preference between its host plant and miscanthus. When assessed by electrical penetration graph technique, plant tissue probing activity by all three species always was characterized by pathway phases including potential drops that are typically associated to the transmission of noncirculative viruses. Phloem ingestion was observed in 5% of the polyphagous aphid individuals tested and in 20% of the R. padi tested. Aphids kept in clip-cages on miscanthus had a low survival rate and were unable to reproduce. These results demonstrate that miscanthus is not a suitable host for these three main aphid pest species but could act as a potential host for some viruses transmitted in a noncirculative manner and also in a circulative nonpropagative manner. The use of miscanthus as a barrier crop to limit the flow of aphid vectors and their phytoviruses is discussed.

The bioavailability of an aqueous solution of 1-deamino-8-D-arginine vasopressin (dDAVP), with and without an enzyme inhibitor, was studied in six healthy, male volunteers aged 19-34 years, followed for 8 h after each drug administration.For i.v. administration the subjects received 4 micrograms dDAVP. For intestinal administration 500 micrograms dDAVP was administered directly, in two separate sessions, in the first part of the duodenum via a triple-lumen channel tube. In one session a solution of isotonic polyethylene glycol (PEG) was given as a continuous enteral perfusion. In the other session a solution of PEG and aprotinin was administered enterally at the constant rate of 5 ml.min-1 for 4 h. Plasma dDAVP was measured using a specific, sensitive radioimmunoassay and intestinal juice was collected for measurement of lipase, chymotrypsin and pH every 30 min for 5 h.The intestinal chymotrypsin activity was decreased after perfusion of aprotinin while the lipase activity was not modified. After i.v. administration, the half-life of elimination of dDAVP was 1.56 h and plasma clearance 1.24 ml.min.kg-1. The mean bioavailability after duodenal administration of dDAVP+ aprotinin was 0.46% compared with 0.09% after duodenal administration of dDAVP alone. The bioavailability of dDAVP after direct duodenal administration of an aqueous solution was similar to that after swallowing a tablet in a previous study and increased 5 times when given together with a perfusion of an enzyme inhibitor.