Can true monocular keratoconus occur?

Evidence increasingly supports keratoconus as an inherited, genetic disorder. If this is the case, it would be expected to express itself as a binocular condition even though variable expression of the gene may show differing levels in the two eyes. It is a common occurrence in specialist contact lens practices to see pseudo‐monocular keratoconus, that is, an overt clinical level of the condition in one eye and forme fruste keratoconus in the other. The advent of videokeratoscopy has shown almost every case of apparent monocular keratoconus to be different expressions of the condition in the two eyes. Nevertheless, rare cases of the condition are seen that appear to be truly monocular. Such a case is presented in which the condition has been present for more than 23 years. The age of the subject makes the future onset of keratoconus highly unlikely and videokeratoscopy does not show the presence of forme fruste in the ‘good’ eye. There is no history of monocular eye rubbing. Pachymetry shows the normal eye to be well within the range of normal corneal thickness, while the keratoconus in the other eye is sufficiently advanced to warrant corneal grafting. Thus, it is a case of true monocular keratoconus and represents an extreme example of variable gene expression.     

Médecin traitant et médecin correspondant: mécanisme et missions

Résumé: La loi du 13 août 2004 relative à l’assurance maladie a instauré un système de coordination des soins reposant sur une centralisation de la prise en charge par un médecin traitant choisi par le patient.Dans ce système en vigueur depuis le 1^er juillet 2005, le médecin traitant assure la coordination des soins et les soins de premier recours. Les médecins intervenant en concertation avec le médecin traitant, les médecins correspondants, assurent quant à eux le second recours au système de soins, et notamment les soins les plus spécialisés.Les patients qui ne désignent pas un médecin traitant seront financièrement pénalisés.D’un commun accord avec son patient, tout cancérologue peut exercer la fonction de médecin traitant.     

Atypical Shone's Complex Diagnosed at 70 Years Old: Presenting with Double-orifice Mitral Valve,Bicuspid Aortic Valve,and Aortic Coarctation

Atypical Shone''s complex is a rare congenital anomaly involving a left-sided obstructive lesion of two or three cardiovascular levels. A 70-year-old man with dyspnea on exertion was diagnosed with severe aortic stenosis (AS) with a bicuspid valve, complicated by severe aortic coarctation (CoA) and a double-orifice mitral valve. He underwent surgery for AS and CoA in one session. It is important to search for complicated malformations, even in cases of bicuspid aortic valve found in old age.     

Predictive performance of obesity indexes for the risk of high blood pressure in an adult population

Background and objectives

Comparisons of predictive performance of various anthropometric measures in high blood pressure have not been investigated. This study aimed at evaluating and comparing the predictive power of Body Mass Index (BMI), Body Adiposity index (BAI) and A Body Shape Index (ABSI) for predicting hypertension in adults.

La notion de structure en psychiatrie

The author explains the origins and the development of the notion of structure : Gestalttheory, structural linguistics, globalist neurology, social anthropology. He explains then the place and the functions of the notion of structure in contemporaneous psychiatry and in psychoanalysis.     

Long-term follow-up of cataract surgery in eyes filled with silicone oil

AIM:To evaluate the refractive and long-term outcome of eyes filled with silicone oil(SO)undergoing phacoemulsification cataract surgery(PCS).METHODS:This retrospective study evaluated patients with SO tamponade who were scheduled for PCS.RESULTS:Subjects(n=26)were followed for 29.5±13.9 mo after cataract surgery.The median spherical equivalent refraction(SER)was+5.3 D[interquartile range(IQR)+2.9 to+6.7]before PCS,and+3.4 D(IQR+2.0 to+4.4)after PCS.Within the follow-up period retinal reattachment after SO removal was achieved in 15 out of 26 eyes(57.7%).In 13 eyes assessment of refraction after SO-removal was possible,and showed a myopic shift of-4.6 D(IQR-2.9 to-7.3)in the SER.After SO removal,5 of the 13 eyes(38.5%)were within±1.0 D of the target refraction,while 9 out of the 13 eyes(69.2%)were within±2.0 D.CONCLUSION:In our study,the refraction after PCS for eyes filled with SO manifested low predictability,as did the myopic shift following SO removal.A significant percentage of the eyes that underwent SO administration required a long-term tamponade.     

Creating capabilities for societal participation in times of welfare state change? Experiences of people with disabilities in Finland

Societal participation is central for disability policies throughout the world. In a Finnish setting, it is firmly anchored in the welfare state's commitment to create equal capabilities, but it is also dependent on other prerequisites, such as an inclusive labour market. However, these commitments have become both increasingly important through efforts of strengthening the rights of people with disabilities as well as increasingly challenged by crumbling growth and recurrent austerity measures in social policy. This article explores societal participation of people with disabilities in Finland in times of the recent ratification process of the UN CRPD and welfare cuts, and investigates the subjective experiences of societal participation in a changing welfare state context. The data consists of 13 individual qualitative interviews among working-age people with different kinds of disabilities. The findings highlight the importance of state commitment for creating equal capabilities for societal participation and for removing barriers standing in its way. They also suggest that this commitment is becoming both strengthened by the UN CRPD and weakened by the economic crisis and austerity measures and that this may have an undermining effect upon capabilities for persons with disabilities to participate in society.     

Terra Firma forme dermatosis. Case series and review of the literature

Terra Firma forme dermatosis (TFFD) is an infrequently described disorder which features dirt‐like lesions that clear after rubbing with alcohol. We describe a series of four patients with the disorder, discuss differential diagnostic considerations and review the literature.