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El presente artículo es una aproximación reflexiva a lo que supone e implica la destreza escrita en el aula tanto para los profesores como para los estudiantes. Se aborda la distinción entre “expresión escrita” y “composición escrita”, y se defiende la necesidad de equilibrar ambos modos de hacer en el aula para, poco a poco, conseguir de los estudiantes el máximo de eficacia con los textos escritos. Por último, se incide en la importancia de entretejer necesidades, motivación, responsabilidad y “emociones”.

Introduction: Adverse effects in the nasolabial region should be anticipated after Le Fort I osteotomy. Intraoperative factors such as the extent of surgical dissection, type of closure and perinasal soft tissue reconstruction seem to influence soft tissue response. Attempts to control these changes have been made over the years and several techniques have been proposed., Materials and Methods: The authors present a minimally invasive alternative surgical technique to control alar base widening as well as lip shortening., (© EDP Sciences, SFODF, 2017.)

Introduction: Dirofilariasis is a disease rarely seen in humans, occurring commonly in noncarnivorous mammals. The microfilariae are transmitted by a mosquito vector. Ocular dirofilariasis is rarely described in the ophthalmic literature., Case Report: An 81-year-old woman living in the north of France had a history of sudden pain and swelling of the left orbit. On slit lamp examination, a white worm was seen under the superior bulbar conjunctiva. Excision of the subconjunctival worm was adequate treatment and was important for parasite identification., Discussion: Dirofilariasis is broad-based and is more common in Italy. Cases in France are found in the south. Ocular symptoms are frequently subconjunctival, but many cases of orbital involvement are found. Treatment is only surgical; systemic medication is not necessary., Conclusion: Ocular dirofilariasis is exceptional. Case reports in ophthalmic literature are rare. This parasite infection is probably underdiagnosed.

Objective: Assess cerebrovascular CO2 reactivity changes using transcranial Doppler sonography (TCD) after oral premedication associating clonidine (2 micrograms.kg-1) and flunitrazepam (70 micrograms.kg-1) in patients scheduled for carotid stenosis surgery., Study Design: Prospective study, not randomized, the patient being his own "control"., Patients and Methods: Thirteen patients undergoing carotid endarterectomy under cervical plexus block were included. The monitoring included: automated arterial pressure cuff, ECG, radial artery catheter, TCD with probe secured in temporal window. The study of the cerebrovascular CO2 reactivity was performed with TCD recording on the side of operation, on the day before, and on the day of carotid endarterectomy, 90 min after the premedication, immediately before surgery. To change PaCO2, four ventilatory states were successively performed: (1) normoventilation, (2) hyperventilation, (3) hypoventilation, (4) "breath-holding test". At each state, it was noted: HR, MAP, PaCO2, mean blood flow velocity in the middle cerebral artery (Vm-MCA), resistance index of Pourcelot (RI), cerebrovascular reactivity (slope Vm-MCA/PaCO2). The results (+/- SEM) were analyzed by Wilcoxon test or t test., Results: After premedication, cerebrovascular CO2 reactivity decreased (0.043 +/- 0.019 vs 0.034 +/- 0.013; p < 0.05) without modification of RI (0.578 +/- 0.291 vs 0.612 +/- 0.025; NS). No complication during carotid clamping was reported., Conclusion: Inclusion of clonidine in premedication before carotid stenosis surgery must be questioned because a decrease of cerebrovascular CO2 reactivity could be deleterious in case of intraoperative stroke.

The aims of intravascular ultrasound (IVUS) are visualization of the arterial wall, characterization of the arterial plaque, measurement of vessel diameter and endoluminal procedure assessment. The main sources of errors are: limitation of resolution, distortion of images due to non uniform angular velocity of mechanical type transducers, overestimation or underestimation of cross sectional area secondary to eccentric position or non coaxial orientation of the catheter. Awareness of these problems may prevent misinterpretations. Combined balloon imaging catheters, forward-looking sector scanners and ultrasound imaging guide wires may be achieve by miniaturization of transducers. Three dimensional imaging, blood flow quantification, local elasticity of tissues may be achieve by new softwares.

We report the successful treatment of an aneurysm of the pancreatoduodenal artery which ruptured into the duodenum in a 78-year-old patient. The pancreatoduodenal arcades were excluded by aorto-mesenteric bypass and ligature of the gastroduodenal artery. Aneurysm are rarely located in pancreatoduodenal artery. Surgical repair is often difficult due to the close relations with the pancreatic parenchyma. Arteriography is essential to guide the operation.

We study the elimination of two viscoelastic substances from the vitreous cavity: the Hydroxypropyl Methylcellulose and the Sodium Hyaluronate that are potentially vitreous substitutes. We performed gas-vitrectomy in 116 eyes of 58 rabbits. Three days after surgery we performed gas-viscoelastic substance exchange. We analyzed the concentration of Hydroxypropyl Methylcellulose and Sodium Hyaluronate with diphenylamine reaction at different periods: zero, 1 week, 2 weeks, 1 month till 6 months. In both cases the elimination is fast so that 1 week after the intravitreal injection remains only 60.1% of the Hydroxypropyl Methylcellulose and 100% of Sodium Hyaluronate, and two weeks after 38.5% of Hydroxypropyl Methylcellulose and 62.5% of Sodium Hyaluronate. We conclude that both substances have a short half life-time specially in the case of the Hydroxypropyl Methylcellulose.

According to Powers et collaborators the hypothesis that intramyocardial vessels may be collapsed in artificially ventilated patient with added PEEP, could be arisen. So, myocardial ischemia may explain why in some of those ones there appear signs of left ventricular failure. To test whether this reasoning was correct we measured LVEDP in normal dogs submitted to increasing levels of PEEP up to 40 cm H2O. Our results seem to point towards the following conclusions: a) In normal dogs, Starling relation is not altered and remains within the same hypercontractility pattern. b) As PEEP increases, ventricular function remains within the same curve up to 30 cm H2O and jumps to a higher contractility curve at 40 cm H2O of PEEP. All of this would suggest that under our experimental conditions it does not seem reasonable to assume the existence of left ventricular failure due to PEEP influence.

Since 1966 maniac-depressive illness has been divided into bipolar disorder (BP) and unipolar disorder (UP). Both groups are still in the process of subtyping (bipolar I,II,III and the tentative subtyping of unipolar group by Winokur). When affective disorder begins with depressive episodes is it possible to predict future mania and anticipate BP diagnosis? Are they variables of good predicting value for bipolarization? The issue is of importance since handicap, evolution, prognosis, treatment are somewhat different for UP and BP. Several studies indicate some possible predictors of bipolarization: pharmacological mania, bipolar familial antecedents, postpartum first episode, hypersomnia and psychomotor retardation, psychotic depression, etc. Special attention is given to switch to mania during antidepressant treatment.

A case of severe thrombocytopenia (27 x 10(3)/mm3) of early onset during unfractionated heparin (Héparine sodique Rovi) treatment is reported in a 75 year-old man suffering from a deep vein thrombosis of the right calf. It was not associated with thromboembolic or haemorrhagic complications. A serum heparin-dependent aggregating factor was not detected. Substitution of low molecular weight heparin (Choay Laboratory, CY 222, PM 4 500, 25 000 U anti-Xa/ml) for unfractionated heparin resulted in a progressive normalisation of the platelet count and improvement of the venous thrombosis.