Biomedical subjects
Publications and source records attributed to E Lacombe.
Keratoprosthesis is the last solution available to the corneal blind patient unsuitable for corneal graft. Keratoprosthesis by anterior fixation requires repeated operations and results are therefore variable. The concept of keratoprosthesis by posterior fixation is presented. This theoretically reduces the risk of expulsion. Only one operation is required and this reduces complications. Initial results, described here, are encouraging.
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Corneal dysplasia has been recently reported. Clinically, it is characterized by a progressive epithelial corneal opacity with pearly or greyish white coloration. Its topography may be either next to either far from the limbus. The recurrences are frequent after surgical treatment. Histologically, many aspects are described. Morphological changes affecting the cells and/or the architecture of the modified epithelium, may vary from light dysplasia to true carcinoma in situ. Some peculiar clinical conditions may coexist with corneal dysplasia, which may also be isolated. Three clinical cases are reported, with detailed pathological data. The signification of the use of the term "dysplasia" and the histogenesis are discussed, and the conclusions for treatment are drawn.
After reviewing the anatomical, pathological and clinical features of pterygium, the authors describe the various surgical techniques. Simple resection, resection combined with oral and mucous membrane or conjunctival graft, derivation autoplasty, central or peripheral lamellar keratoplasty. 102 cases are presented, operated by the various techniques. A statistical study of successes and recurrences, considering the evolution stages and the follow up, is presented. Operative indications are outlined: simple resection in very wild cases, conjunctival autoplasty in intermediate cases, actually the most frequent, lamellar keratoplasty, in so called "malignant" pterygium or recurrent pterygium.
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In 1939, R. Turpin and al. described cases of hereditary and congenital corneal opacities in three generations of one family. The members of this family have since been followed-up regularly by the author, examination of the corneas of the grandmother and the grand'daughter made by electron microscopy, the morphology compared, and an attempt made to establish the progression of the lesion. It so happened that at the same time, witschel and al. published (June, 1978) the results of their examination of the American members of the same family. Their conclusions were the same, in that this familial congenital dystrophy of the cornea is mainly stromal and differs therefore from familial congenital endothelial dystrophies. The author's analysis is complementary to theirs.
Lens extraction by the posterior route with the phakotribe keeps the complete anterior segment intact. The approach causes no inconvenience to the globe. An account of 18 months experience. The method enables extraction of the most delicate cataracts without subsequent procedures. Vision can be restored rapidly by a contact lens. However the indications must be well evaluated in experimental hands. This technique may be indicated in cataracts in children whether they are congenital or traumatic as well as in traumatic cataracts in adults.
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Prompted by evidence suggesting preserved red cell deformability in cardiac surgical patients pretreated with pharmacologic dosages of methylprednisolone, we performed in vitro experiments to examine the ability of similar levels of methylprednisolone and hydrocortisone to modify erythrocyte membrane changes produced by metabolic depletion or membrane-active compounds. Variables measured included cell morphology, blood biscosity, membrane deformability, osmotic fragility, red cell cholesterol, and glycolytic intermediates. In incubated samples, methylprednisolone partially prevented the transition of discs to echinocytes, the rise in whole blood viscosity, the decrease in membrane deformability, and the loss of red cell cholesterol which accompany ATP depletion, but it had no apparent effect on red cell glycolysis. The drug also inhibited esterification of cholesterol in cell-free serum. In unimcubated samples to which lysolecithin was added, methylprednisolone partially prevented and reversed morphologic and rheologic responses without affecting membrane cholesterol. Hydrocortisone demonstrated similar properties. Possible mechanisms for these actions are discussed. The concept is advanced that preserved blood fluidity may contribute to the beneficial responses to these drugs in certain clinical conditions.
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Plasma from a patient with Waldenstrom's macroglobulinemia was observed to gel upon exposure to room air, yet to remain in solution indefinitely at 4 degrees C if sealed. Three studies were carried out which showed this change not to be due primarily to decreases in carbon dioxide tension or temperature, but to variations in the concentration of hydrogen ions within or just above physiologic levels. In purified material (IgM) a marked increase in viscosity occurred between pH 7.5 and 8.0, followed by precipitation between pH 8.0 and 9.7, and by reversible dissolution between pH 9.7 and 10.0. The analytical and clinical consequences of these solubility changes are discussed.
We have performed 40 keratoplasties in 35 eyes presenting with corneal wounds. These injuries follow accidents of which the most frequent are:--metallic foreign bodies;--windscreen. The following results have been obtained after these grafts;--49 p. 100 success;--51 p. 100 failure. In fact 51 p. 100 of the eyes did not benefit from a satisfactory functional result despite the fact that the graft remained clear in 63 p. 100. Our failures are due to two principle complications: cataract and its subsequent surgical management in 28 out of 35 cases, and detachment of the retina in 3 out of 35 cases. The remaining failures are related to the usual complications of other keratoplasties. These keratoplasties are special since a contussion of the posterior pole is often associated with the corneal wound. The indications for these grafts cannot wait until an accurate assessment of the state of the posterior segment is possible, and this is why these grafts are special and why there should be reservations on the prediction of the final visual result. Keratoplasty however remains the only hope for visual recovery and in children the only means of preventing the development of definite amblyopia. Nevertheless in children the prognosis remains the most pessmistic (4 failures out of 5 cases in children under 10).
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