Benefits of Ophdiat, a telemedical network to screen for diabetic retinopathy: A retrospective study in five reference hospital centres

AimOne objective of Ophdiat^®, a telemedical network using digital non-mydriatic cameras in Île-de-France, is to develop a comprehensive screening programme that provides access to annual fundus examinations to all diabetic patients. The aim of this study was to evaluate the benefits of this programme in a hospital setting.MethodsA retrospective analysis of 500 case reports of diabetic patients hospitalized before and after Ophdiat^® setup was performed in five reference hospital centres. At each centre, 100 case reports (50 before, 50 after) of patients aged greater than 18 years, hospitalized for their annual check-up, with no known diabetic retinopathy (DR) before hospitalization and with the last fundus examination performed greater than 11 months previously, were randomly selected. The primary endpoint was the proportion of patients whose fundus examinations were performed during hospitalization; secondary endpoints were the number of cases of DR found and the time taken by ophthalmologists to make the diagnosis.ResultsThe mean proportion of patients with fundus examinations was 50.4% and 72.4% before and after, respectively, Ophdiat^® (P < 0.01). The prevalence of DR was 11.1% before and 12.7% after (not significant). The mean time taken by an ophthalmologist per diagnosis of DR was 0.90 half-day before and 0.32 half-day after Ophdiat^®.ConclusionThis evaluation shows that Ophdiat^®, combined with the availability of modern and effective devices, has improved DR screening in diabetology departments in hospitals. Additional human resources would certainly ensure more effective use of the system.     

Efficacité de la nitroglycérine en nébuliseur

The effects of a nitroglycerine spray (Nitrolingual Spray 0,4, G-Pohl-Boskamp) were studied in 14 patients, 6 of whom (Group I) has resting pulmonary capillary pressures (PCP) greater than 18 mm Hg and 8 (Group II) with PCP less than 18 mm Hg. The following parameters were studied before and 5, 10, 30, 60 and 120 minutes after administration : systemic blood pressure (BP), pulmonary artery pressure (PAP), right atrial pressure (RAP), pulmonary capillary pressure, cardiac index (CI) and systolic work index (SWI). In 5 other cases the ejection fraction (EF) was measured by scintigraphy with Technetium 99 labelled red blood cells. In group I, a fall in PCP (p < 0,05) (maximal variation : − 26,6 p. 100) ; RAP (− 30 p. 100) and PAP (− 17,4 p. 100) was recorded after the fifth minute. CI (+ 10,8 p. 100) and SWI (+ 14,6 p. 100) increased up to the 30th minute (p < 0,05).In Group II, no change in CI or SWI was recorded, but PCP (− 37 p. 100) PAP (− 27,9 p. 100), RAP (− 45 p. 100) fell significantly from the 5th up to zhe 30th minute (p < 0,05). The heart rate was unchanged in both groups. The EF increased significantly (+ 17,5 p. 100, p < 0,05) from the 5th minute. In comparison, isosorbide dinitrate (sublingual 5 mg, 5 patients) had no demonstrable effect (RAP − 29 p. 100, PAP − 14,7 p. 100, PCP − 26,9 p. 100) was more delayed (p < 0,05) than the nitroglycerine spray.The action of nitroglycerine spray is marked, rapid and effective. It is limited in time, hardly lasting longer than 30 minutes.     

Apport de la radiologie au diagnostic étiologique des hypertensions artérielles d'origine surrénalienne

Radiological investigation of adrenal causes of hypertension includes the widely accepted adrenal arteriography and venography, and also the new techniques of echotomography and computerised axial tomography.The choice of investigations is determined by the patients'clinical and biological profiles.In all cases, the initial investigation should be computerised axial tomography or, according to some authors, echotomography.When pheochromocytoma is suspected, adrenal arteriography should be requested as most pheochromocytomas are hypervascular.On the other hand, patients with suspected primary hyperaldosteronism should undergo adrenal venography. It is the only technique currently capable of diagnosing a very small adrenoma by either the angiography or the very selective blood sampling that may be performed at the same time.     

Auto-anticorps anti-érythrocytaires et anémies hémolytiques auto-immunes. Étude de 80 observations. Aspects particuliers au sujet âgé

The following observations were drawn from the study of 80 patients with anti-erythrocyte auto antibodies (AEAA) :

- The average age was about 62 years with a maximal incidence in the 65–75 year range. There was a female predominance which increased after the age of 65 ;

- In 20 p. 100 cases, the majority being elderly patients, anti-erythrocytic auto immunisation seemed to be idiopathic. The aetiologies in the remaining cases comprised malignant haemoreticulopathies, connective tissue diseases, liver disorders, microorganism infection and treatment with alpha-methyldopa ;

- Anti-erythrocyte auto immunisation does not always cause haemolytic anaemia. In 66 p. 100 of patients with AEAA there were no clinical or biological signs of haemolysis ;

- The association of other immunological abnormalities (anti-organ antibodies, positive rheumatoid factor, hypergammaglobulinaemia…) and AEAA is common and seems to reflect a complex disorder of the immune system. This also applies in patients in whom the immunological type of AEAA changes during the course of the disease ;

- These observations lead to the discussion as to the possible relationship between auto immunity and the ageing process.