Biomedical subjects

H Merle

Publications and source records attributed to H Merle.

At least 19 recordsLinked to original sources

PubMed2006

[Mycotic keratitis and endophthalmitis caused by unusual fungi: Lasiodiplodia theobromae].

We report a case of endophthalmitis caused by the fungus Lasiodiplodia theobromae. A 68-year-old man was referred to the hospital for right ocular pain since experiencing right ocular branch trauma 2 weeks before. The best-corrected acuity was limited to hand motion. Slit-lamp examination showed a large corneal abscess and an anterior chamber reaction. The patient underwent systemic and local antibiotic therapy, and corneal scraping for microbiological diagnosis. Sabouraud-chloramphenicol-gentamicin agar disclosed filamentous fungus, which was treated with oral itraconazole and topic amphotericin B. Molecular biology revealed Lasiodiplodia theobromae. Despite antimycotic drugs, severe panophthalmia occurred very quickly and led to evisceration. This case report describes Lasiodiplodia theobromae as the cause of keratomycosis and discusses risk factors and clinical features of fungal keratitis in order to improve prognosis by earlier treatment.

Aged↗

PubMed2006

[Leukemic infiltration of the optic nerve].

INTRODUCTION: We report a case of unilateral leukemic infiltration of the optic nerve caused by acute lymphoblastic leukemia. CASE REPORT: A 30-year-old woman with acute lymphoblastic leukemia beginning 3 months before was referred for left visual loss. The left fundus showed optic disc engorgement by infiltrating tumor, with numerous hemorrhages and exudates caused by optic nerve leukemic infiltration. CONCLUSION: Optic nerve leukemic infiltration is considered as central nervous system damage with severe prognosis. Treatment is based upon systemic and intrathecal chemotherapy and central nervous system radiation.

Adult↗

PubMed2005

Role of return migration in the emergence of multiple sclerosis in the French West Indies.

The emergence of multiple sclerosis in island societies has been investigated only in a few Caucasian populations living in temperate regions. The effect of human migration on the risk of developing this disease is still an open question because of possible genetic selection. We conducted an epidemiological study of the multiple sclerosis population in the French West Indies (Martinique and Guadeloupe), a population which includes large numbers of West Indians who have returned after emigrating to metropolitan France. Standardized incidence ratios (SIRs) for multiple sclerosis among migrants were calculated and their genetic characteristics were compared to those of non-migrants. The crude prevalence of multiple sclerosis was 14.8/10(5) on December 31, 1999 (95% CI: 11.9-17.7); and its crude mean annual incidence for the period July 1, 1999 to June 30, 2002 was 1.4/10(5) (95% CI: 1.0-1.8), confirming its emergence in the French West Indies. Recurrent neuromyelitis optica, which is virtually the only form of multiple sclerosis in black African populations in tropical regions, represented not >17.8% of these cases. During the 1,440,000 person-years of follow-up, 33 incidence cases were identified in migrants. Since the number of expected cases was 19.3, the overall SIR was 1.71 (95% CI: 1.19-2.38; P < 0.01) among migrants. The increase in the SIR was more marked if the stay was made before the age of 15 years (4.05, 95% CI: 2.17-6.83; P < 0.0001). European ancestry in the two migrating and non-migrating populations was similar. Martinique, which has a higher rate of return migration, has a higher prevalence of multiple sclerosis (21.0/10(5) versus 8.5/10(5)) and a higher incidence (2.0/10(5) versus 0.7/10(5)) than Guadeloupe. The emergence of the disease in the French West Indies is of environmental rather than genetic origin. It may be explained either through the introduction by migrants of precipitating environmental factors that operate in a critical way before the age of 15 years, and/or by the recent disappearance from the French West Indies of protective environmental factors acting before this age.

Adolescent↗

PubMed2005

[Melanocytoma of the optic disc. Three case studies].

PURPOSE: Melanocytoma is a rare benign tumor that usually occurs as a pigmented lesion in the optic nerve head. It seems to be more frequently encountered in the Black population. We report three cases of melanocytoma observed in Martinique, where 90% of the population is of African origin. OBSERVATIONS: The first and second cases were found on routine ophthalmic examination. These patients had a heavily pigmented lesion that obscured part or all of the optic disc with slight extension into the adjacent nerve fiber layer of the retina. The tumor's margins were finely fibrillated. Fluorescein angiography demonstrated a homogenous hypofluorescent black tumor obscuring the optic disc vessels, with no tumor vessels visible. There were no juxtapapillary choroid vascular abnormalities. The third case was discovered on visual field examination. This melanocytoma was accompanied by papillary edema. CONCLUSION: Only three cases of melanocytoma have been noted from 1994 to 2004 in 150,000 Caribbean patients examined in the University Hospital Center of Fort de France. The rarity of melanoma and the predisposition to melanocytoma are important epidemiologic factors in the etiologic search for pigmented tumor within the Black population. Yearly fundus examination is useful for monitoring growth and detecting malignant transformation.

Adult↗

PubMed2004

[Glaucoma screening in Martinique. Results in 813 hospital employees].

INTRODUCTION: Several US and Jamaican studies have shown that glaucoma is more severe in black populations than in Caucasian populations, which would lead to the assumption that the people of Martinique have a high glaucoma risk. METHODS: A prospective study was conducted in workers of Fort de France University Hospital with the occupational medicine unit. Intraocular pressure was measured with a pulse air tonometer (Topcon CT 60) and visual field abnormalities were detected with automated perimetry using Humphrey frequency doubling technology (FDT). Patients with known glaucoma or with intraocular pressure over 21 mmHg and/or a visual field abnormality were referred to ophthalmology examination to diagnose ocular hypertension, open-angle glaucoma or normal-pressure glaucoma. RESULTS: The occupational medicine unit examined 813 workers. The sex ratio was 0.36, mean age was 45.35+/-8.4 years (22-64 years), and mean ocular pressure was 12.1+/-2.62 mmHg (6-28 mmHg). Roughly 20% of workers had a family history of glaucoma. We found 22 patients with glaucoma (2.7%) (CI95: 1.6%-4%): 12 patients had open-angle glaucoma (1.5%) and 10 patients were diagnosed with normal-pressure glaucoma (1.3%). Glaucoma prevalence increased with age, reaching 8% in patients over 55 years of age. Of patients with normal-pressure glaucoma, 42.9% had a family history of glaucoma. CONCLUSION: Our results confirm previous data from the literature that found higher glaucoma prevalence in black people and in particular in the mixed-race population of Martinique. In addition to this ethnic feature, the insularity of Martinique could support glaucoma expression. Easy and fast to use, FDT associated with the pulse air tonometer provides early detection of glaucoma.

Adult↗

PubMed2004

[Cat-scratch disease neuroretinitis].

We report a case of cat-scratch disease neuroretinitis for which systemic and ocular investigations proved the responsibility of Bartonella henselae. An 11-year-old boy was referred to the hospital in November 2002 for severe visual loss in the left eye over the preceding 2 weeks. At the same time, he also developed a flu-like illness. The best corrected acuity in the left eye was counting fingers at 30 cm. Posterior segment examination on the left eye showed an optic disk edema with papillary and peripapillary hemorrhages and serous retinal detachment, mild vitreous inflammation, and two little perivascular white spots. The medical history was unremarkable except for a cat scratch on his left forearm 2 months before. Four weeks of antibiotic therapy including oral rifampin and doxycycline was used. Bartonella henselae immunoglobulin M were first detected with Bartonella henselae immunoglobulin G testing negative at this time. A 3-week serum showed immunoglobulin M seroreversion, while Bartonella henselae immunoglobulin G appeared. Other causes of optic disk edema with macular star were excluded by biological data. Bartonella antibodies to both Bartonella henselae and Bartonella clarridgeiae were detected in the cat. Ophthalmic follow-up showed progressive resorption of the neuroretinitis and the visual acuity increased to 5/10. The significance of this case report lies in the reminder that this pathology can be the cause of neuroretinitis; the prognosis can be improved by earlier treatment.

Bartonella henselae↗

PubMed2003

[Ciliary body melanoma in a black patient: a case report].

Uveal melanomas are rare in the black population. We report the case of an 81-year-old black man who presented a ciliary body melanoma of the left eye. Ophthalmological examination revealed a mass arising from the ciliary body and choroid. Diagnosis of ciliary body melanoma, made from clinical examination and ocular ultrasound, may be difficult in some cases due to its similarity to other eye tumors. Uveal melanomas mainly affect Caucasians but they are not unknown in blacks.

Aged↗

PubMed2003

[Hypophysis metastasis of a hypernephroma tumor revealed by a chiasma syndrome].

In a 45-year-old man with a hypernephroma tumor of the right kidney, a metastasis in the pituitary gland of this neoplasm was diagnosed 9 years after removal of this kidney. He complained of bitemporal hemianopsia and slight impairment of vision. A hypernephroma metastasis in the pituitary gland is very rare and few have been reported to date. In general, these metastases occur in cases with multiple metastasis to many organs, which suggests that the appearance of pituitary metastasis represents extensive disease. Many of these patients present diabetes insipidus. Visual defects are frequently associated. The Goldmann perimeter is important to detect visual field anomalies. MRI is the key radiological exam to localize the tumor. Surgery is the preferred treatment and should be undertaken quickly if visual function is affected. The histological exam should be made to confirm the diagnosis.

Biopsy↗

PubMed2002

[Evaluation of single-injection caruncular sub-Tenon's anesthesia].

INTRODUCTION: Because of its complications, particularly globe perforation, retrobulbar injection has been progressively replaced by peribulbar anesthesia. However, with peribulbar anesthesia, the excessive rate of imperfect blockade requires supplemental injection. We have been performing local anesthesia using caruncular sub-Tenon single injection for many years. This technique is evaluated. PATIENTS AND METHODS: A prospective study has been carried out on 183 eyes. Regional anesthesia was given by a caruncular sub-Tenon single injection. For each case, we studied akinesia, analgesia, pain before, during, and after surgery, the number of supplemental injections, eyeball orientation, and surgical conditions. RESULTS: A total motor blockade was obtained in 157 cases (85.8%) and total lid akinesia in 176 patients (96.2%). Eight patients (4.4%) needed a second injection. During surgery, 10 patients complained of pain (5.5%). We found 27 eyes (14.7%) were divergent and 12 (6.5%) were convergent. Surgical conditions were good or very good in 90% of cases. No complications due to the injection (perforation or lesion of the eyeball or the optic nerve) were noted. CONCLUSION: Single-injection caruncular sub-Tenon anesthesia is an alternative technique to classical peribulbar anesthesia. This technique is efficient, simple, easy to learn, reproducible, and seems to have a low rate of complications.

Aged↗

PubMed2001

MS and neuromyelitis optica in Martinique (French West Indies).

BACKGROUND AND OBJECTIVE: A population-based study is reported of MS in French Afro-Caribbeans (FAC) in Martinique. FAC are descendants of interracial mating that occurred between French Caucasians and black Africans in the 17th and the 18th centuries. METHODS: The authors surveyed the entire island of Martinique (area 1,128 km(2), population 357,000) between November 1997 and October 1999. RESULTS: Sixty-two patients (46 females, 16 males, ratio 2.9:1) were identified with definite or probable disease by the Poser criteria. Prevalence for all patients on December 31, 1998, was 17.4/10(5) (95% CI 13.1 to 21.7) and 14.3/10(5) (95% CI 10.4 to 18.2) for clinically definite cases (n = 51). Age range of patients on prevalence day was 17 to 73 years (mean +/- SD 39 +/- 11.3 years). Mean age at onset was 31.2 +/- 11 years. Overall, 9.7% had primary progressive disease and 19.4% had benign MS. A low proportion of definite and probable MS cases had oligoclonal bands in CSF (50.9%). Seventeen patients, 13 of whom were alive on prevalence day, had a relapsing form of neuromyelitis optica. CONCLUSION: The island of Martinique appears to have a low to medium prevalence of MS. MS was almost unknown in FAC in Martinique until the late 1970s. The apparent recent increase may be explained by improved recognition of patients, increased availability of MRI for diagnosis, increased disease awareness among physicians, increased survival of MS patients, or an actual increase in disease frequency.

Adolescent↗

PubMed2001

A description of human T-lymphotropic virus type I-related chronic interstitial keratitis in 20 patients.

OBJECTIVE: This study aimed to describe a syndrome that the authors call human T-lymphotropic virus type I-related chronic interstitial keratitis. METHODS: A consecutive series of 194 human T-lymphotropic virus type I-infected patients (divided into 119 patients with human T-lymphotropic virus type I-associated myelopathy/tropical spastic paraparesis and 75 asymptomatic human T-lymphotropic virus type I carriers) was systematically examined. RESULTS: Twenty patients (10.3%) had bilateral anterior stromal lesions made up of approximately 10 elevated, rounded or cloudy whitish opacities that were more or less confluent. The opacities were characteristically situated at the periphery of the anterior stroma, and the visual axis remained unaffected. The interstitial keratitis was chronic and unresponsive to topical administration of corticosteroids. It was mainly observed in patients affected by human T-lymphotropic virus type I-associated myelopathy/tropical spastic paraparesis among whom there were 18 cases (15.1%), as opposed to two cases (2.7%) in asymptomatic carriers. CONCLUSION: A new cause of interstitial keratitis is reported. Human T-lymphotropic virus type I infection may have a much broader spectrum of ocular manifestations than previously described. As with the other manifestations of human T-lymphotropic virus type I infection, corneal lesions could be linked to a lymphoplasmocytic infiltration of the stroma leading to corneal opacities.

Adult↗

PubMed2001

Patent foramen ovale closure in patients with transient ischemia attack/stroke.

Paradoxical embolism through a patent foramen ovale (PFO) has been recognized as a potential cause of transient ischemia attack (TIA) and stroke especially in younger patients. The therapeutic options are medical treatment (antiaggregation or anticoagulation) with an annual recurrence rate of 3% to 4% for stroke or TIA, surgical PFO closure, or catheter closure. Randomized studies are ongoing; however, the results will not be available soon. Since August 1994, we have attempted catheter closure of a PFO in 281 patients (age 17 to 79 years, mean 46.8 +/- 13.2) with paradoxical embolism. Of these, 184 patients had at least one embolic stroke, 112 patients at least one TIA, and 15 patients at least one peripheral embolism. The diameter of the PFO, measured with a balloon catheter, ranged from 3 mm to 24 mm with a mean of 10 +/- 3.5 mm. Implantation of the occluder was technically successful in all patients (two attempts in four patients). Seven different devices were used: 26 Sideris buttoned, 11 ASDOS, 19 Angel Wings, 98 PFO-Star, 37 Cardioseal-Starflex, 57 Amplatzer and, 33 Helex devices. One patient suffered from septicemia and subsequently died. In 2 patients, device embolization occurred during or after the procedure (1 Sideris, 1 PFO-Star; catheter retrieval successful). Thirty-seven patients had other minor complications without long-term sequelae: atrial fibrillation within the first weeks after implantation in five patients, asymptomatic thrombus on the device at routine transesophageal echocardiogram (TEE) in 7 patients (1 Angel Wings, 1 ASDOS, 1 CardioSeal, 4 PFO-Star), and device frame fracture in 25 patients (2 Sideris, 4 ASDOS, 1 Angel Wings, 1 CardioSeal, 17 PFO-Star). No complications occurred with the newer devices (Amplatzer and Helex). A residual shunt after 6 months was found in 5.5% of the patients who had completed their 6-month TEE follow-up. In two patients, a second occluder was implanted because of a residual shunt. During a follow-up period of 1 month to 71 months (mean 12 +/- 16 months, 268 patient years), a recurrence of an embolic event (seven TIA, two stroke) occurred in eight patients. None of these occurred with the newer devices (Amplatzer, Helex). Freedom from recurrence of the combined end point of TIA, ischemic stroke, and peripheral embolism was 95.7% (95% CI: 89.0%-98.4%) at 1 year and 94.1% (95% CI: 80.1-98.4%) at 3 years. Catheter PFO closure is a technically simple procedure. With the newer devices and increasing experience, the success rate has improved and the complication rate has decreased. The advantage of the procedure is that closing the defect means a causal treatment. However, catheter closure of PFO despite a very low morbidity has inherent potential risks like any other interventional procedure. Furthermore, selection of patients who definitely have PFO as the cause of their cerebral event has not been defined. For these reasons, further studies are warranted.

Adolescent↗

PubMed2001

[Diabetic retinopathy in Martinique: results of a cross-sectional survey based on 771 patients].

INTRODUCTION: Because of the gravity of diabetic retinopathy in Martinique, a cross-sectional survey was conducted between March and September 1996 to estimate the prevalence of this complication on this island. PATIENTS AND METHODS: Clinical data, obtained by examining and questioning 771 diabetic patients (recruited among the usual practice of the ophthalmologists), were analyzed using Epi-Info. RESULTS: Some form of diabetic retinopathy was present in 42%. of the patients and 8.3% presented proliferative retinopathy. A total of 78% of the patients presented a non-insulin-dependent diabetes mellitus, essentially women. Medical supervision of the diabetes and its ophthalmologic complications proved to be insufficient. Principal risk factors found for the prevalence and severity of diabetic retinopathy were a long duration of diabetes, insulin-dependent type diabetes among women and the whole population, age among men, mode of treatment (insulin), and hypertension. DISCUSSION: These results are higher than those usually reported in France. This can be explained by diet and racial factors: the population is mainly of African and Indian descent. Risk factors are the same as those already described in earlier studies. To improve these prevalences, strategies should include classic methods risk factors correction, patients education, increasing coordination between the different medical specialists), but should also take into account the particularities of this Caribbean population such as racial, economic, historical, and sociocultural factors.

Cross-Sectional Studies↗

PubMed2001

[Keratitis due to caterpillar of Pseudosphinx tetrio hairs].

A case of keratitis due to caterpillar hairs of the Pseudosphinx tetrio is reported. As he was clearing his garden without glasses or a protective headgear, the patient felt left ocular pain due to the projection of a caterpillar into the eye. On examination, there were numerous intrastromal caterpillar hairs involving the inferior temporal quadrant of the cornea. The small size of the hairs prevented removal with forceps. The patient was treated by extensive washing of the eyeball and topical application of anti-inflammatory drugs, cycloplegics and antibiotics. The caterpillar hairs gradually came off the cornea over a two-weeks period. The cornea remained free of any scar. Besides keratitis and conjunctivitis, caterpillar hairs are known to cause iris nodules, chronic uveitis, cataract, hyalitis, chorioretinitis, and orbital cellulitis.

Adult↗

PubMed2001

[Optical involvement in multiple sclerosis. Results of a cross-sectional study with 57 patients from Martinique].

INTRODUCTION: The optical disease observed concurrent with multiple sclerosis is poorly known in blacks because of the rare occurrence of this pathology in the black population. The few studies currently available suggest more severe problems in black subjects than in Caucasians. Martinique has subjects who are genetically close or even identical but who acquired multiple sclerosis in two very different endemic areas: some in Martinique and others in France. PATIENTS AND METHODS: We performed an ophthalmological transversal descriptive study in a population of 57 black multiple sclerosis patients living in Martinique, selected according to the Poser criteria. Patients were divided into two groups: an M group (26 cases) made up of patients who had never left Martinique or the West Indies and an FM group (31 patients) made up of patients who had lived at least one year in France between the ages of 5 and 15. RESULTS: At least one episode of retrobulbar optic neuritis was observed in 16 cases (61.5%) in the M group and in 11 cases (31.5%) in the FM group. The number of eyes with either one episode or more of retrobulbar optic neuritis or papillitis was higher in the M group, 26 cases (50%) than in the FM group, 14 cases (22.6%). Multiple sclerosis began by a disease of the optic nerve in 12 cases (46%) in the M group and in 7 cases (22.6%) in the FM group. The mean visual acuity is 20/30 in the M group and 20/20 in the FM group. The mean value of the p 100 wave was 131 ms in the M group and 113 ms in the FM group. DISCUSSION: Multiple sclerosis observed in the black population living in Martinique (M group) is characterized by frequent and severe visual problems. The visual phenotype of the FM group is quite similar to the visual phenotype of Caucasians. More than ethnic and genetic factors, the tropical area of acquisition should have an influence on the visual phenotype. For unknown reasons, the optical problems appear severe when multiple sclerosis is acquired in a low endemic area.

Adolescent↗

PubMed2001

[Lisch nodules: description of 2 clinical cases and their significance].

We report two cases of Lisch nodules in both eyes in two women. It was the only ocular manifestation of their Von Recklinghausen disease. The other general signs of their disease were cutaneous neurofibromas. Lisch nodules are melanocytic hamartomas consisting of melanocytic cells containing various quantities of pigment. They can be found in 90 to 100% of neurofibromatosis patients over 6 years of age. They are practically pathognomonic of type 1 neurofibromatosis and their finding is an important diagnostic argument. They must be distinguished from other iris nodules: nevus, melanoma, inflammatory nodules, and development anomalies.

Adult↗

PubMed2000

[Is there a delay in bathing the external eye in the treatment of ammonia eye burns? Comparison of two ophthalmic solutions: physiological serum and Diphotérine].

PURPOSE: An experimental animal study was conducted to analyze the delay for ocular bathing in the treatment of severe ocular ammonia burns. Two solutions of ocular wash, saline solution and Diphotérine were compared. MATERIAL: and methods: The study included 23 eyes of New Zealand albino rabbits that received for 1 minute 100 microl of 15.3% ammonium solution. Each eye was then washed with 250 of saline solution or 250ml Diphotérine after a delay of 1, 3, 5, 10 or 30 minutes. Effects were assessed on the basis of changes in anterior chamber pH, ammonia concentration in the anterior chamber, and cytopathology examination of the burned corneas. RESULTS: Ocular wash with Diphotérine in the first minutes following ocular burn induced an inflexion of the pH curve unlike ocular wash with saline solution. At 30 minutes, there was no inflexion of the pH curve and the ammonia concentration in the anterior chamber was low. Contrary to ocular wash using Diphotérine, stromal edema was seen at cytopathological analysis after washing with saline solution. CONCLUSIONS: This study provides evidence of the interest of ocular bathing in the first minutes following ocular burn by ammonia. The efficacy of external ocular washing with Diphotérine was proven by biochemical and cytopathological demonstrations. The importance of sequelae were related to the degree of initial stromal edema.

Ammonia↗

PubMed1999

Stent or angioplasty after recanalization of chronic coronary occlusions? (The SARECCO Trial).

This study tests whether stent implantation without anticoagulation after catheter recanalization of coronary occlusions can improve outcome compared with balloon angioplasty alone. One hundred ten patients were randomly assigned to angioplasty alone (no stent group) or stent implantation (stent group) after successful recanalization and balloon angioplasty. The type of stent and angioplasty technique utilized were decided by the operator. The acute procedural success in both groups was 100%. The acute minimal lumen diameter (MLD) was 1.85 +/- 0.44 mm in the no stent group versus 2.54 +/- 0.53 mm in the stent group (p <0.01). The diameter stenosis was 21 +/- 13% versus 3 +/- 14% (p <0.01). This was achieved not only by the stent implantation itself but primarily by a larger maximum balloon diameter in the stent group after stent implantation (3.32 +/- 0.55 mm vs 2.86 +/- 0.4 mm, p <0.05). After 4 months, the MLD was 1.15 +/- 0.73 mm in the no stent group versus 1.81 +/- 0.9 mm in the stent group (p <0.01). The diameter stenosis was 56 +/- 29% versus 34 +/- 28% (p <0.01). After 2 years, event-free survival was 26% in the no stent group and 52% in the stent group (p <0.05). Thus, acute and long-term procedural and angiographic success of stent implantation without anticoagulation after recanalization of total coronary occlusions is superior to that of balloon angioplasty alone. This beneficial effect is mainly the result of the larger balloon diameters, which may be used after stent implantation.

Angioplasty, Balloon↗