A new method of visual exploration analysis

The term visual field corresponds to the angular field of view that is seen by the eyes when they are fixed on a point straight-ahead. In neurological patients--e.g. stroke, trauma, or tumour patients--visual field function can be restricted, depending on lesion site and size. In contrast, the term "functional visual field" describes the area of visual field responsiveness under more ordinary viewing conditions. The visual exploration, i.e. the capacity to explore and analyze our visual world, is dependent on the integrity of the visual system and the oculomotor system which has to move the fovea from one object of interest to the next. In this paper, we present a new method to assess the functional visual field, conceptualized as the area that a patient actively scans with eye movements to detect predefined targets placed on everyday scenes. This method allows us to compare three levels of visual field function: (a) the spatial distribution of successful search (hits, i.e. which targets did the patient find?), (b) the spatial distribution of fixations (i.e. where did the patient preferentially search for targets?), and (c) the retinotopic level (i.e. the visual field assessed by perimetry). By integrating these three levels, one can evaluate functional outcomes of visual field disorders. Of particular importance is the question of how a patient compensates for a visual field loss with appropriate eye movements. A further clinical application of this method is the comparison of pre- with post-treatment data. Patients with visual field disorders usually undergo specific exploration trainings, aimed at enhancing the number and amplitude of saccades towards the region of the visual field deficit. The first experiences and clinical application with this method are presented here.     

Painful oculomotor palsy: a diagnostic approach

We review the question of diagnosis of painful and relatively isolated ophthalmoplegia due to diseases affecting the ocular motor nerves. For each clinical setting, we provide an overview of the main causes and a practical way to approach the diagnosis. As vascular malformations should always be kept in mind in patients with painful ophthalmoplegia, emergency neuroradiological investigations may be needed. However, the etiological scope is wide and the rationale for choosing the more appropriate examination and its optimal timing depends exclusively on the clinical evaluation. Despite advances in investigation techniques, diagnosis may remain difficult or even unresolved in a certain number of patients. We discuss successively paralysis of the third, sixth and fourth nerve, paralysis of several ocular motor nerves, recurrent ophthalmoplegia and ischaemic ocular motor palsies, which are the most frequent cause.     

A clinical, neurophysiological and molecular study of 12 patients from 4 families with spinal and bulbar muscular atrophy

INTRODUCTION: Spinal and bulbar muscular atrophy (SBMA) is an X-linked, late-onset neuro-endocrine disorder resulting from an expansion of a CAG repeat in the androgen receptor gene. Material and method. We report the detailed phenotypic study in a series of 12 SBMA patients evaluated in four kindreds. RESULTS: Clinical phenotypic spectrum varied considerably, ranging from childhood-onset weakness and atrophy mimicking limb-girdle myopathy in patients with 53 CAG repeats to isolated hyperCKemia in an adult with 42 CAG repeats. All male patients had gynecomastia. Two female carriers presented with paresthesias and hand action tremor. Homozygous deletions of SMN1 and SMN2 genes were not found in any patients. CONCLUSION: This report demonstrates that SBMA may present with a wider clinical spectrum than previously described and suggests that clinical phenotype severity in SBMA is partially linked to the number of CAG repeats. It also suggests that SMN1 and SMN2 genes do not act as modifying genes in SBMA.     

Optic neuritis in cat scratch disease

Ocular and neuro-ophthalmic manifestations of cat scratch disease are not uncommon. The association of anterior optic neuritis with retinal lesions suggests neuroretinitis, which is highly suggestive of cat scratch disease. A new case is described.     

Pituitary apoplexy

Pituitary apoplexy is a life threatening condition caused by sudden hemorrhage or infarction of the pituitary gland. Most patients present with headaches and neuro-ophthalmologic symptoms and signs, often associated with altered mental status.     

Acute myocardial infarction complicating primary antiphospholipid syndrome after aspirin and steroids withdrawal

A 24-year-old woman, with known antiphospholid antibodies (APS), presented with an acute myocardial infarction (AMI) that occurred three months after delivery. No risk factors for arteriosclerosis and no past history of arterial/venous thrombosis were noted. During pregnancy, aspirin prophylaxis was prescribed and followed by steroids after caesarian section. Steroids withdrawal was followed by AMI. Immediate coronary angiography revealed thrombotic occlusion of the left descending coronary artery; PTCA was successfully performed. She was discharged with an antiplatelet and anticoagulant regimen. No recurrent coronary event occurred during follow-up.     

Acute myocardial infarction: what is new?

Current recommendations on the management of acute myocardial infarction and the use of thrombolysis are reviewed.     

Intervention psycho-éducative pour diminuer la fatigue à la suite d’un cancer du sein: fondements, description du contenu et démarche évaluative

Résumé:   À la fin des traitements médicaux initiaux pour un cancer du sein, la fatigue est le symptôme le plus fréquemment rapporté. Plusieurs facteurs associés au maintien de la fatigue sont connus et certains sont modifiables. Des approches thérapeutiques non pharmacologiques, telles que la modification de certains comportements, sont maintenant recommandées. Le premier but de cet article est de résumer les données provenant des écrits scientifiques qui permettent de mieux comprendre la fatigue secondaire au cancer, la trajectoire évolutive de ce phénomène, les principaux facteurs associés et les pistes dintervention les plus intéressantes. Le second but est de décrire le contenu dune intervention psycho-éducative destinée à des femmes qui ont terminé leurs traitements initiaux pour un cancer du sein ainsi que de décrire la démarche évaluative en cours. Lintervention inclut la gestion de stress et lexercice physique. Cette intervention est présentée sous forme de manuel et peut être administrée selon différents formats et par différents intervenants. Une étude en cours teste le format de groupe, animé par deux infirmières. Les résultats viendront sous peu documenter lefficacité de cette intervention qui pourrait être offerte dans le cadre dun programme de prévention secondaire.Travaux réalisés grâce à une subvention du FRSQ.     

«Cancers du sein»

Résumé: Cet article présente les conclusions d’un groupe de travail appliquant la méthodologie ANAES en ce qui concerne:1. Le traitement de l’aisselle.2. La prise en charge des patientes présentant une tumeur surexprimant HER2.3. L’hormonothérapie adjuvante.4. La chimiothérapie adjuvante.Groupe de travail Liste de médecins référents invités en regard du sujet choisi et répartis sur l’ensemble du territoire français. Fabrice ANDRE (Villejuif) Emmanuel BARRANGER (Paris) Jacques BONNETERRE (Lille) Patricia DE CREMOUX (Paris) Philippe CHOLLET (Clermont-Ferrand) Krishna CLOUGH (Paris) Bruno CUTULI (Reims) Marc DEBLED (Bordeaux) Thierry DELOZIER (Caen) Francette ETTORE (Nice) Pierre FUMOLEAU (Dijon) Jean-Paul GUASTALLA (Lyon) Jean-Marc GUINEBRETIERE (St-Cloud) Michel HERY (Monaco) Louis MAURIAC (Bordeaux) Sylvie MENARD (Milan) Jean-Baptiste MERIC (Paris) Frédérique PENAULT-LLORCA (Clermont-Ferrand) Thierry PETIT (Strasbourg) Henri ROCHE (Toulouse) Jean-Philippe SPANO (Paris) Marc SPIELMANN (Villejuif) Serge UZAN (Paris) Patrice VIENS (Marseille)Groupe de lecture Emmanuel ACHILLE (Strasbourg) Lydie AIMARD (Marseille) Thierry ALTWEGG (Dijon) Eric-Charles ANTOINE (Paris) Bernard ASSELAIN (Paris) François BERTUCCI (Marseille) Laurent CALS (Toulon) Mario CAMPONE (Nantes) Yvan COSCAS (Paris) Paul-Henri COTTU (Paris) Bruno COUDERT (Dijon) Adel COURDI (Nice) Philippe DALIVOUST (Marseille) Véronique DIERAS (Paris) Nadine DOHOLOU (Bordeaux) Marc ESPIE (Paris) Thomas FACCHINI (Reims) Jean-Marc FERRERO (Nice) Joseph GLIGOROV (Paris) Anne-Claire HARDY-BESSARD (Saint-Brieuc) Pierre KERBRAT (Rennes) Anne LESUR (Nancy) Alain LORTHOLARY (Nantes) Jean-Pierre LOTZ (Paris) Elisabeth LUPORSI (Vandœuvre-lès-Nancy) Catherine MAESTRO (Nice) Jean-Pierre MARTIN (Lyon) Jean-Louis MISSET (Paris) Alain MONNIER (Montbéliard) Jean-Marc NABHOLTZ (Paris) Hervé NAMAN (Mougins) Moise NAMER (Nice) Claude NOS (Paris) Raoult PAYAN (Grenoble) Pascal PIEDBOIS (Créteil) Jean-Yves PIERGA (Paris) Xavier PIVOT (Besançon) Pierre POUILLART (Paris) Isabelle RAY-COCQUARD (Lyon) Jacques ROUESSE (St-Cloud) Daniel SERIN (Avignon) Hélène SIMON (Brest) Eric TESSIER (Mougins) Véronique TRILLET-LENOIR (Lyon) Michèle TUBIANA-HULIN (St-Cloud) Jean-Louis WENDLING (Toulon) Laurent ZELEK (Créteil)La présente recommandation a été réalisée avec le soutien des partenaires suivants: – Amgen – AstraZeneca – Chiron – Janssen-Cilag/OBF – Lilly – Novartis – Pfizer – Sanofi-Aventis – Roche     

Acute myocardial infarction management in a hospital center with emergency ambulance service and intensive care unit,without cardiac catheterization laboratory

OBJECTIVES: We report our experience about acute myocardial infarction management in a small hospital with no possibility of coronarography. MATERIALS AND METHODS: In 1998, 60 patients were hospitalized for acute myocardial infarction < 10 days. We studied characteristics of patients, the management of myocardial infarction, the mortality. RESULTS: Our population consisted of 83% of men and 17% of women with a mean age of 63.5 and 74 years respectively. An out-hospital doctor was first warned by 60% of patients. For hospitalization, the emergency ambulance service (SMUR) was used in 45% of cases, out-hospital doctors using these means of transport in 36% of cases. The global time of intervention was 18h30. The mean time for patients managed in the first sixth hours was 2h10. A thrombolysis was applied for 35% of patients (15% in prehospital that is to say 32% of "SMUR patients", and 20% in hospital). A transfer to the neighbouring university hospital for primary or rescue coronary angioplasty was decide for 41% of patients. A total of 77% of our patients underwent a coronarography. The global mortality at 10 days was 13.3% (< 75 years: 10.6%; > 75 years: 23%). CONCLUSIONS: A low volume centre and with no possibility of coronarography can manage the acute phase of myocardial infarction with results closed to those of the literature.