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Biomedical subjects

P Denis

Publications and source records attributed to P Denis.

At least 37 records · Page 2Linked to original sources
PubMed2005

Long term effect on IOP of a stainless steel glaucoma drainage implant (Ex-PRESS) in combined surgery with phacoemulsification.

AIM: To evaluate the efficacy and safety of a stainless steel miniature glaucoma drainage device (Ex-PRESS R50) for the surgical treatment of primary open angle glaucoma (POAG) and cataract when combined with phacoemulsification. METHODS: Clinical, prospective, multicentre, single treatment arm, non-randomised, non-masked study. The Ex-PRESS device was implanted at the limbus under a conjunctival flap. Phacoemulsification cataract extraction and in the bag IOL implantation were performed through clear cornea temporally. PRIMARY OUTCOME: IOP change; secondary outcomes: side effects and VA changes. RESULTS: 26 eyes of 25 patients were implanted with the device. The mean (SD) follow up was 23.9 (10.4) months and the mean age was 75.1 (7.1) years. 17/26 eyes have more than 3 years of follow up. One case was discontinued because of device removal, one because of death, and three were lost to follow up. EFFICACY: preoperative IOP was 21 (4) mm Hg; at 1, 2, and 3 years IOP was 15.3 (3.1) mm Hg (35% reduction), 16.6 (2.7) mm Hg (29% reduction), and 16 (2.6) mm Hg (22% reduction) respectively. Kaplan-Meyer determined overall success rate (IOP < or = 21 mm Hg at the last visit with or without medications) as 76.9%. The number of antiglaucoma medications was reduced by 95% at year 1. Only six patients (23%) were taking IOP lowering treatment at their last visit, five with one medication and one with two medications. Side effects: early postoperative complications were clinically mild and included six cases of hypotony (IOP <5 mm Hg), three cases of hyphaema (<2 mm) with no clinically significant further effects. Long term complications were two cases (7.7%) of device rotation (one treated by reposition) and three cases (11.5%) of conjunctival erosion at 2 and 3 years. CONCLUSIONS: The Ex-PRESS implant, combined with phacoemulsification cataract extraction, is clinically safe and effective, maintaining in the long term a large reduction in IOP and in the number of antiglaucoma medications.

Aged↗
PubMed2005

Direct costs of glaucoma and severity of the disease: a multinational long term study of resource utilisation in Europe.

BACKGROUND: Resource utilisation and direct costs associated with glaucoma progression in Europe are unknown. As population progressively ages, the economic impact of the disease will increase. METHODS: From a total of 1655 consecutive cases, the records of 194 patients were selected and stratified by disease severity. Record selection was based on diagnoses of primary open angle glaucoma, glaucoma suspect, ocular hypertension, or normal tension glaucoma; 5 years minimum follow up were required. Glaucoma severity was assessed using a six stage glaucoma staging system based on static threshold visual field parameters. Resource utilisation data were abstracted from the charts and unit costs were applied to estimate direct costs to the payer. Resource utilisation and estimated direct cost of treatment, per person year, were calculated. RESULTS: A statistically significant increasing linear trend (p = 0.018) in direct cost as disease severity worsened was demonstrated. The direct cost of treatment increased by an estimated 86 for each incremental step ranging from 455 euro per person year for stage 0 to 969 euro per person year for stage 4 disease. Medication costs ranged from 42% to 56% of total direct cost for all stages of disease. CONCLUSIONS: These results demonstrate for the first time in Europe that resource utilisation and direct medical costs of glaucoma management increase with worsening disease severity. Based on these findings, managing glaucoma and effectively delaying disease progression would be expected to significantly reduce the economic burden of this disease. These data are relevant to general practitioners and healthcare administrators who have a direct influence on the distribution of resources.

Adult↗
PubMed2005

[Glaucoma in the young patient. Therapeutic problems].

Achieving an adequate intraocular pressure (IOP) is critical to the successful management of children affected with juvenile glaucoma, in whom medical therapy is often insufficient to control IOP. Anti-glaucoma eyedrops are usually not approved for use in children but, however, are frequently used in pediatrics. Although ocular hypotensive eyedrops may be well tolerated in young patients, their chronic use is often problematic because of systemic side effects or noncompliance. Glaucoma filtering surgery with adjunctive antifibrosis therapy (particularly with mitomycin C), aqueous shunt surgery and cyclodestructive procedures are currently undertaken in patients with juvenile glaucoma. Filtration surgery is usually less successful in patients with juvenile glaucoma: the higher failure rate stems from the excessive wound healing response in younger patients, resulting in subconjunctival fibrosis.

Adolescent↗
PubMed2004

[Buphthalmia secondary to congenital pigmented epithelial iris cyst].

We report the case of a 2-day-old child with buphthalmia caused by a congenital pigmented epithelial iris cyst. The use of ultrasound biomicroscopy (UBM) and high-resolution echography (20MHz) specified the diagnosis before general anesthesia for complete examination and treatment. Surgery can control intraocular pressure and the opening of the visual axis; there is, however, relative amblyopia. This case confirms the advantage of UBM in examining tumors of the anterior segment. The early diagnosis, facilitated by use of the UBM, provided quick and well-adapted treatment.

Cysts↗
PubMed2004

[Glaucoma in the melanoderm patient].

Much less marginal in France than believed, glaucoma in the melanoderm patient comes early in life, with a more aggressive progression leading to blindness twice as often as in the Caucasian patient. Generally open-angle glaucoma, it may be related to anatomical ocular characteristics of the Black population. Its management is not very different from that of glaucoma in the Caucasian patient.

Adult↗
PubMed2004

[Purtscher retinopathy in acute alcoholic pancreatitis. A case report].

Purtscher retinopathy is a retinal vasculopathy most commonly caused by head or chest trauma. The most frequent signs include white ischemic infarcts (cotton-wool spots) and retinal hemorrhages (intraretinal, preretinal, or flame). The signs of ischemic vasculopathy predominate in the interpapillomacular zone. We report a case of a 31-year-old woman with sudden bilateral loss of vision caused by Purtscher retinopathy in acute alcoholic pancreatitis.

Acute Disease↗
PubMed2004

Results of 24-h manometric recording of colonic motor activity with endoluminal instillation of bisacodyl in patients with severe chronic slow transit constipation.

The aims of this study were to assess the prevalence of manometric colonic abnormalities and to evaluate the motor effect of intraluminal bisacodyl in a cohort of refractory constipated patients. Twenty-four hour colonic motility recordings were performed in 40 patients referred for a severe intractable chronic constipation. At the end of each recording session the motor effects of the endoluminal instillation of 10 mg bisacodyl were assessed. These patients were compared with 20 healthy subjects. The number of high-amplitude propagating contractions (HAPC) was significantly decreased in patients with slow transit constipation (12 +/- 11.6 vs 1 +/- 8.6, P < 0.001). Based on manometric patterns four groups of patients were isolated. Ten patients had no spontaneous HAPC, no food-induced colonic motor response and significantly lower colonic activity in transverse colon (374 +/- 1220 vs 3249 +/- 3458, P < 0.05). Five patients had significantly increased sigmoid segmental motility (20298 +/- 6364 vs 88780 +/- 3643, P < 0.001) and eight patients had significantly lower number of HAPC without other manometric abnormalities while 17 patients had normal colonic motility recordings. Endoluminal bisacodyl was able to induce HAPCs in all groups of patients. Patients with severe slow transit refractory constipation represented a heterogeneous group and endoluminal bisacodyl was able to promote a propagated motor activity in a majority of patients even in those suspected of having an inert colon.

Adult↗
PubMed2004

[The neuroanatomical and physiological bases of variations in intraocular pressure].

Intraocular pressure displays a distinct circadian rhythm in animals and humans, with an increase at night and a decrease during the daytime. In animals, the IOP rhythm has been reported to be synchronized by environmental light and to persist in constant darkness, demonstrating a circadian component controlled by an endogenous pacemaker. The structures involved in the rhythmic regulation of intraocular pressure include the suprachiasmatic nucleus, which controls the activity of sympathetic and parasympathetic ocular innervation. These effectors are responsible for controlling the production (beta-adrenergic system) and the outflow (alpha1-adrenergic, parasympathetic system, prostaglandin) of aqueous humor. The production of aqueous humor is under adrenergic control (alpha1- and beta-receptors). Many neuropeptides such as vasoactive intestinal peptide, substance P, and the atrial natriuretic peptide are also involved in the regulation of intraocular pressure. A better understanding of the circadian regulation of intraocular pressure is needed for an appropriate treatment of ocular hypertension and glaucoma.

Afferent Pathways↗
PubMed2004

[Effect of intraocular pressure and arterial blood pressure variations on glaucoma progression].

PURPOSE: The purpose of this paper is to collect data describing the implication of intraocular pressure (IOP) and arterial blood pressure in the progression of glaucoma. METHOD: The literature selection for this Article was based on MEDLINE searches covering the last 20 Years and relevant Articles. Topics covered were ambulatory blood pressure monitoring, IOP fluctuations, arterial hypotension, and glaucoma. RESULTS: Hypoperfusion of the optic nerve head is among the significant factors relating to glaucoma damage. The physiological decrease in nocturnal blood pressure is more pronounced in some glaucoma patients, particularly in those presenting normal pressure glaucoma or with progressive visual field loss. Normal human subjects have a circadian variation in their IOP and these fluctuations are related to the sleep-wake cycle. In glaucoma patients, unappreciated IOP fluctuations may explain many cases of glaucoma progression. DISCUSSION AND CONCLUSION: Eyes with advanced glaucomatous optic neuropathy were associated with more marked alterations in the optic nerve vascular supply circulation than eyes with less nerve damage. Numerous findings suggest that circadian IOP variations and arterial blood pressure may play a role in the progression of glaucoma.

Blood Pressure↗
PubMed2004

[Circadian rhythm variations of intraocular pressure and therapeutic decisions: interpretation of clinical trial results based on a statistical model].

Therapeutic decisions (treatment initiation, continuation, change, combination, etc.) based on intraocular pressure (IOP) monitoring require knowledge of both circadian IOP fluctuations and the pharmacological circadian rhythm of the active ingredients. A simple model was applied to data from two clinical trials to estimate the consequences of circadian IOP fluctuations on (1) ocular hypertension diagnosis, (2) therapeutic adjustments, and (3) the daily cumulative effect of marginally low therapeutic differences. A grid for clinical interpretation of the average IOP differences is presented. The probability of an IOP that exceeds the target value for the diagnosis or therapy varied to a large extent throughout the day. IOP was higher in the morning than in the evening. The IOP variance (measured by standard deviation) was an important factor in decision-making, regardless of the IOP value itself. Regular IOP monitoring over the entire day allowed minimization of the time spent above a target value. IOP differences that seemed low when expressed in average values in therapeutic trials could have clinically significant consequences in the practitioner's decisions. The data presented suggest that ocular hypertension diagnosis and therapeutic decisions should be made early in the morning, at least for most patients. In any case, the time of the measurement should be considered in the therapeutic approach.

Biotransformation↗
PubMed2003

Molecular analysis of the capsid coding region of a virulent encephalomyocarditis virus isolate after serial cell passages and assessment of its virulence.

EMCV has been recognized as a worldwide-shared pathogen in many host species with natural differences of virulence among strains. Differences of virulence were also demonstrated experimentally after serial passages of particular EMCV strains in cell culture. In order to evaluate the genetic variability of the CCR of an highly virulent Belgian EMCV isolate after 210 passages in cell culture, this region has been molecularly characterised by RT-PCR and sequencing. The analyses enlightened the stability of the isolate as only 3 mutations appeared within the CCR and this was observed between passage 200 and 210. One of the mutations is adjacent to the amino acid described as the differentiation amino acid between diabetogenic and non-diabetogenic variants of EMCV. An experimental inoculation of pigs with the passage 210 of the virus enlightened its attenuation and the challenged pigs were protected against the wild-type virus. Results confirm the ability of EMCV to become attenuated after passages in cell culture.

Animals↗
PubMed2003

[Cataracts in glaucoma patients].

Combined glaucoma and cataract surgery has gained increasing success over the past decade, because of technological advances and modifications in surgical techniques. Extracapsular cataract extraction has been progressively replaced by phacoemulsification through a clear corneal incision with foldable lens implants. Nonpenetrating glaucoma surgery, which has the potential to reduce intraocular pressure while reducing the risk of postoperative hypotony and associated local complications, has been recently proposed as a safe and effective solution for combined surgery in glaucoma patients. Useful modifications in surgical technique also include the use of combined phacotrabeculectomy or phacosclerectomy with antimetabolite supplementation, particularly mitomycin C.

Cataract↗
PubMed2003

[I have tested it for you....the Smartlens].

The SmartLens tonometer (ODC, Zurich, Switzerland) is a contact lens that allows continuous measurement of intraocular pressure (IOP), in addition to estimating pulse amplitude. IOP measurements taken with the Smartlens tonometer showed a good correlation with Goldmann tonometry. Nevertheless, there was a mean difference of 3.5 mmHg (p<0.01) in intraocular pressure between the two methods, with a significant overestimation by Smartlens tonometry compared with Goldmann tonometry in normal individuals. Preliminary results demonstrated that IOP measurements are not statistically affected by the thinning of the cornea induced by LASIK surgery.

Contact Lenses↗
PubMed2003

[Glaucoma and quality of life].

Glaucoma is a serious ocular disorder potentially leading to blindness. Measuring the quality of life of patients with glaucoma is important because it makes it possible to evaluate the impact of the disease and its treatment on the patient's everyday life. Hitherto, this was done using generic scales, or those developed for other diseases; but no scale suitable for glaucoma was available. The recently developed GlauQOL scale is now available. We present the short version of this questionnaire adapted to individual use within an ophthalmology consultation setting.

Glaucoma↗
PubMed2002

The role of remote gut inflammation in duodenojejunal dysmotility.

The aim of this prospective study was to determine the role of remote inflammation of the gut on duodenojejunal motor status by comparing patients with acute cholecystitis (AC) to those with biliary colic (BC). Thirty-six gallstone patients (11 AC and 25 BC) were explored. Manometric recordings were performed during fasting and after a 750-kcal meal and ended by an intravenous injection of 100 mg trimebutine. Patient data were compared to those of 20 healthy controls. Phases III were more frequently absent in AC patients than in BC patients (P < 0.01) and controls (P < 0.05). When phase III characteristics were similar between the AC and BC group, the phase III amplitude was lower in both groups than in controls (P < 0.0001). After the meal, the mean motor index in the jejunum expressed by the area under the curve (AUC) per 30-min period was higher in the AC group than in BC group and controls (P < 0.05). Specific motor phenomena were observed after the meal. In particular, propagating clusters of contractions (PCCs) were more frequent in AC patients than in BC (P < 0.05) and controls (P < 0.01). A lack of the expected decrease in the AUC during recording occurred with the same frequency in the AC and BC groups but was more frequent in patients than in controls (P < 0.05). In 8/11 patients in the AC group with duodenojejunal tracings before and 3 months after surgery, preoperative motor disturbances disappeared in 5/8 patients and improved in 3/8 patients. The higher frequency of duodenojejunal motor disturbances especially after a meal in patients with AC and their disappearance in most of the patients after removal of the infected gallbladder suggest that remote inflammation of the gut affects duodenojejunal motility.

Acute Disease↗