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Introduction Von Hippel–Lindau disease (VHL) is a syndrome of familial predisposition to the development of malignant and benign tumours, due to mutations in the VHL tumour suppressor gene. Pheochromocytoma is a tumour that develops in the adrenal gland, rare in pediatric age, and may be associated with genetic abnormalities including mutations in the VHL gene. Systematic screening of pheochromocytoma in children carrying a VHL mutation has been proposed. However, some VHL patients who have been screened may develop symptoms associated with pheochromocytoma despite screening. Here, we report on such a case. Clinical case A 13-year-old boy, known to be a carrier of a mutation of the VHL gene, undergoing annual screening, was admitted to our hospital for clinical symptoms related to a right adrenal pheochromocytoma discovered on abdominal imaging. After hemodynamic stabilisation, the pheochromocytoma was surgically resected. Histology confirmed the diagnosis of pheochromocytoma. The postoperative care was simple. The event-free period is currently 2 years. Discussion The present case has led us to reflect on the French and international screening strategies for pheochromocytoma in children carrying a mutation of the VHL gene. Between 2013 and 2018, six different recommendations were proposed for pheochromocytoma screening in secondary prevention for children with a VHL mutation, with variability regarding the age of onset and complementary examinations to be carried out. Despite the existence of these recommendations, our case demonstrates that a pheochromocytoma can develop by escaping well-performed screening. The role of early abdominal imaging should be redefined to improve the efficiency of screening. Conclusion The discovery of a pheochromocytoma in a child must be systematically investigated for an underlying genetic cause. In the particular case of children carrying a mutation of the VHL gene, annual abdominal imaging should be included in the pheochromocytoma screening protocol from the age of 5 years.

Summary Background Surgical site infections (SSIs) are the second most common healthcare-associated infection. Active SSI surveillance can help inform preventative measures and assess the impact of these measures. Aim We aimed to describe the evolution in trends over 14 years of prospective active SSI surveillance and implementations of SSI prevention measures in a French Teaching Hospital. Methods We monitored and included in the study all surgical procedures performed from 2003 to 2016 in eight surgical units. The semi-automated surveillance method consisted of weekly collection of SSI declaration forms (pre-filled with patient and procedure administrative data and microbiology laboratory data), filled-in by surgeons and then monitored by the infection control practitioners. Findings A total of 181,746 procedures were included in our analysis and 3270 SSIs recorded (global SSI rate 1.8%). The SSI rate decreased significantly from 3.0% in 2003 to 1.1% in 2016. This decrease was mainly in superficial SSIs and high infectious risk procedures. Higher SSI rates were observed for procedures associated with the usual risk factors. During this 14-year period, several evolutions in surgical practices occurred that might have contributed to this decrease. Conclusions With an overall decrease in SSI rate throughout the surveillance, our results revealed the benefits of an active and comprehensive hospital SSI surveillance programme for understanding the SSI rate trends, analysing local risk factors and assessing the effectiveness of prevention strategies. These findings also highlighted the importance of the collaboration between surgeons and infection control practitioners.

Objective: The objective of this study was to compare systemic exposure to tropicamide/phenylephrine following intracameral or topical administration before cataract surgery.Patients and methods: M ...

International audience; PURPOSE: To describe the glaucoma surgery offer in France in 2016. METHODS: We used the French National Health Care System database to identify all medical procedures carried out in 2016. The study investigated the entire population aged 30 years and older that had undergone glaucoma surgery, alone or combined with another surgery. We calculated the incidence of surgeries per 100 000 inhabitants 30 years of age and older performed by ophthalmologists carrying out at least 50 procedures annually, the number of surgeons doing these surgeries, the mean age of these practitioners, and the number of surgeons older than 55 years. RESULTS: In 2016, 16 854 glaucoma surgeries were performed in patients aged 30 years and older, for an incidence of 40.8 per 100 000 inhabitants aged 30 years and older. The most frequent procedure performed was trabeculectomy followed by non-penetrating deep sclerectomy (16.7 and 11.7, respectively, per 100 000 inhabitants 30 years of age and older). Private practice glaucoma surgery accounted for 47% of the activity of surgeons performing at least 50 surgeries per year and 60% of the total surgical activity. Of the private practice ophthalmologists performing at least 50 glaucoma surgery procedures per year, 58.5% were over 55 years of age, and 23.5% of public hospital ophthalmologists were over 55 years of age. CONCLUSIONS: This study demonstrates that surgeons performing glaucoma surgeries are often older. It is necessary to take note of the country's educational capacity to ensure that the number of ophthalmological surgeons remains adapted to demand.

Indexation en cours.; International audience; PURPOSE: Contact lens (CL)-related microbial keratitis (MK) has major public health implications, with about 300 million wearers worldwide, and certain potentially modifiable risk factors. This study aimed to identify the risk factors of CL-related MK. METHODS: A multicenter case-control study was conducted between 2014 and 2017. Cases presenting with CL-related MK were submitted to an anonymous 52-item questionnaire, which was also completed by healthy controls. Univariate followed by multivariate logistic regression analysis was performed. Risk factors for CL-related MK were given as odds ratio (OR) with 95% confidence interval and P-value. RESULTS: The study included a total of 2267 patients (1198 cases and 1069 controls). The MK risk factors for the daily disposable lenses group were exceeding the lens renewal period (OR = 9.16, P = 0.008) and occasionally wearing CL when sleeping (OR = 15.83, P = 0.035). The most important risk factors in the nondaily disposable lenses group were lens cleaning solution distributed by eye care brands (OR = 3.50, P < 0.001) and failure to renew lens cases (OR = 3.39, P = 0.001). Statistically and clinically significant variables were used to establish the MK risk equation for CL wearers, allowing an individual calculation of the risk of MK under lenses. CONCLUSIONS: The MK risk equation is a valuable tool for educating patients about the risks associated with wearing CL. It allows the patient to be informed about their overall risk of infection while detailing the precipitating elements of the infectious risk with the aim of modifying risk behavior.

Sclerosing angiomatoid nodular transformation (SANT) is a rare splenic lesion first described by Martel et al in 2004.1 As reported, SANT is a benign vascular lesion of the red pulp of the spleen, presenting under the microscope as angiomatoid nodules in a fibrosclerotic stroma. Although more than 200 cases have been reported in the English literature,2 only 8 cases have been found in children. SANT is most often suspected from imaging studies performed for another reason. Nevertheless, no signs are specific.3 This motivates surgery to remove the mass and confirm the diagnosis. The surgery could be done either by open, laparoscopic partial or total splenectomy.4 Herein, we reported two pediatric cases of SANT that were well treated by laparoscopic total and partial splenectomy. A 14-year-old girl was referred to our pediatric surgery department for further investigations of a solid tumor of the spleen. The mass was diagnosed by a routine ultrasonography (US) performed in the pediatric endocrinology department in the context of urinary tract infection and chronic asthenia. The patient’s medical and family history was unremarkable. On physical examination, she had good general condition without anorexia, fever or night sweats. Neither hepatosplenomegaly nor lymphadenopathies were found. The patient’s blood tests showed anemia (hemoglobin 85 g/L) and increased inflammatory markers [C reactive protein (CRP): 18 mg/L and erythrocytes sedimentation rate (ESR): 40 mm/hour]. Abdominal US imaging found a calcified heterogeneous vascularized central splenic mass with a maximal diameter of 7 cm (figure 1A). The US finding was confirmed by an MRI which showed a splenic vascular tissular lesion that had an iso-intense signal on T2 sequence and a progressive signal enhancement of the central portion after injection (figure 1B). Two weeks prior to surgery, she was vaccinated against Streptococcus pneumoniae , Haemophilus influenzae , and Neisseria meningitidis …

Background Although it is well documented that bloodborne viruses (BBVs), including human immunodeficiency virus (HIV), hepatitis C virus (HCV) and hepatitis B virus (HBV) have been transmitted from patients to healthcare workers (HCWs), there has also been reported transmission from HCWs to patients during the provision of health care. With remarkable progress in infection prevention, diagnosis tools, treatment regimens and major improvements in guideline development methodology, there was a need to develop an evidence-based guideline to replace the 1998 Canadian consensus document for managing HCWs infected with BBVs. Purpose This article summarizes the Canadian Guideline on the Prevention of Transmission of Bloodborne Viruses from Infected Healthcare Workers in Healthcare Settings. Methods A Guideline Development Task Group was established and key questions developed to inform the guideline content. Systematic reviews were conducted to evaluate the risk of HCW-to-patient transmission of HIV, HCV and HBV. Environmental scans were used to provide information on Expert Review Panels, disclosure of a HCW's serologic status and lookback investigations. Federal, provincial and territorial partners and key stakeholder organizations were consulted on the Guideline. Results The risk of HCW-to-patient BBV transmission was found to be negligible, except during exposure-prone procedures, where there is a risk that injury to the HCW may result in exposure of a patient's open tissues to the HCW's blood. Risk of ensuing transmission and the rate of transmission varied by BBV, and were lowest with HIV and highest with HBV. The Guideline provides key content, including recommendations regarding criteria to determine if a procedure is an exposure-prone procedure, management of HCWs infected with a BBV, including considerations for the HCW's fitness for practice, Expert Review Panels, HCW disclosure obligations and right to privacy and lookback investigations. Conclusion This new Guideline provides a pan-Canadian approach for managing HCWs infected with a BBV, with recommendations related to preventing HCW-to-patient transmission of BBVs during the provision of care.

Summary Purpose To evaluate the applicability of anterior segment optical coherence tomography (AS-OCT) for objective diagnosis of punctal stenosis. Methods We report the use of AS-OCT in 3 cases of epiphora related to punctal stenosis. We followed the methodology described in previous studies. The examination was performed by a single technician using a single Spectralis OCT with the AS-OCT module. Three patients with complaints of epiphora (mean age = 80 years) were examined. The external punctal diameter was measured on both infrared (IR) and OCT images. The internal diameter was measured on OCT images at a depth of 500 μm. The diagnosis was confirmed by clinical examination. Results The external punctal diameters were 159 μm in the right eye (Cases 1 and 2) and 195 μm in the left eye (case 2; mean: 171 μm). All measurements were lower than cadaveric measurements (200–500 μm), as well as previously described average diameters, thus confirming the diagnosis of punctal stenosis. The AS-OCT diameter correlated moderately with the punctal diameter estimate on the IR photos (mean: 183 μm). In addition, the mean internal diameter of the punctum at 500 μm (cases 1 and 2) was 58 μm, which is consistent with the mean diameter at 500 μm described in previous studies. Case 3 involved an 88-year-old man who complained of chronic epiphora. Slit lamp examination showed total punctal stenosis associated with cicatricial ectropion in the left eye due to a cutaneous tumor treated with radiotherapy. AS-OCT confirmed the presence of total punctual stenosis and the absence of associated canalicular stenosis. Limitations Our study is obviously limited by its small study population. The decision to resort to surgery was made by 2 different surgeons. There was thus no homogeneity in terms of stenosis. There is difficulty in everting the lid without applying pressure to the globe or changing the punctal or canalicular morphology. This maneuver was difficult in the postoperative setting after ectropion repair. Conclusion Our study shows that AS-OCT can be a rapid, non-invasive method in diagnosing punctal stenosis. Further studies are necessary to assess the use of AS-OCT in punctal stenosis.

Resume Introduction Les syndromes inflammatoires orbitaires regroupent une grande variete de processus intraorbitaires d’aspect inflammatoire tres differents dans leurs presentations cliniques et leurs pronostics. On prefere actuellement differencier les inflammations orbitaires, dites specifiques, pour lesquelles une etiologie a pu etre identifiee, des syndromes inflammatoires orbitaires idiopathiques (SIOI) pour lesquelles l’etiologie reste inconnue et l’histologie non specifique. Objectifs Le but de ce travail est de proposer une approche diagnostique efficace au clinicien devant prendre en charge une inflammation orbitaire non basedowienne. Materiel et methodes Il s’agit d’une etude retrospective et prospective regroupant 61 patients pris en charge pour une inflammation orbitaire non basedowienne entre mai 1999 et mai 2013 dans les services d’ophtalmologie des CHU de Nice et Limoges. Nous avons inclus 17 inflammations specifiques, 19 lymphomes orbitaires et 25 syndromes inflammatoires orbitaires idiopathiques. Les patients ont ete divises en deux groupes. Trente-six patients (groupe 1) ont beneficie d’une biopsie en premiere intention, alors que pour les vingt-cinq autres (groupe 2), le test therapeutique a ete initie d’emblee sans biopsie et nous avons ainsi pu comparer ces deux demarches en termes de rentabilite diagnostique et delai d’obtention d’une etiologie specifique. Resultats Nos resultats statistiques demontrent qu’une approche sans biopsie en 1 re intention conduit a un nombre de diagnostics specifiques statistiquement tres inferieur a celui obtenu par la demarche avec une biopsie en premiere intention. De la meme maniere, le risque de meconnaitre une inflammation specifique (d’ou traitement inadapte avec risque de sequelles fonctionnelles et risque vital de meconnaitre une pathologie lymphoproliferative) est tres nettement superieur dans le cas ou l’on ne realise pas de biopsie en 1 re intention. Enfin, le delai moyen entre la premiere consultation avec l’ophtalmologiste specialise et l’obtention d’un diagnostic specifique a ete de 1 mois avec la demarche 1 alors qu’avec la demarche 2, ce delai etait presque trois fois superieur avec une moyenne de 2,91 mois ( p Discussion Notre etude montre que la biopsie doit donc etre le point d’orgue de la prise en charge diagnostique. Le test therapeutique n’est effectue en 1 re intention qu’exclusivement dans les myosites ou dans les localisations ou la biopsie engage le pronostic fonctionnel. Il ne doit etre realise qu’apres la biopsie dans tous les autres cas. Bien sur dans tous les cas de rechute ou de recidive apres ce traitement, la biopsie doit etre realisee ou renouvelee. Conclusion La prise en charge diagnostique d’un processus inflammatoire orbitaire doit bien sur inclure des examens biologiques et une imagerie orbitaire precise, mais aussi une biopsie avec examen anatomopathologique en premiere intention de maniere systematique dans l’immense majorite des cas. Cette derniere doit etre renouvelee, au moins au moindre doute diagnostique ou devant toute recidive ou resistance au traitement.

The extension of blood vessels into the normally avascular stroma defines corneal neovascularization. Though this phenomenon, pathophysiological and clinical features are well characterized, therapeutic modalities have been hindered by a lack of safe, efficacious and non-controversial treatments. In this literature review, we focus on available therapeutic options in light of recent evidence provided by animal and clinical studies. First, this review will focus on pharmacological treatments that target angiogenesis. The low cost and market availability of bevacizumab make it the first anti-angiogenic therapy choice, and it has demonstrable efficacy in reducing corneal neovascularization when administered topically or subconjunctivally. However, novel anti-angiogenic molecules targeting the intracellular pathways of angiogenesis (siRNA, antisense oligonucleotides) provide a promising alternative. Laser therapy (direct photocoagulation or photo-dynamic therapy) and fine needle diathermy also find a place in the treatment of stabilized corneal neovascularization alone or in association with anti-angiogenic therapy. Additionally, ocular surface reconstruction using amniotic membrane graft or limbal stem cell transplantation is essential when corneal neovascularization is secondary to primary or acquired limbal deficiency.

Summary Aims The aims of this study were to evaluate the efficacy and safety of endoscopic treatment of primary obstructive megaureter in children, and to assess its long-term outcome. Methods Case files of 35 children who had endoscopic treatment of symptomatic primary obstructive megaureter between 2006 and 2016 were retrospectively analyzed. All children had ureterovesical junction dilatation with one or more ureteral dilators, and insertion of a JJ stent. An analysis of the case files and a comparison between pre- and postoperative ultrasound and scintigraphy findings were performed. Results The study population consisted of 22 boys and 13 girls aged between 2 months and 16 years. The follow-up period ranged from 8 months to 10 years. Twenty-one children (60%) were under 2 years at the time of treatment. The average duration of JJ stenting was 7 weeks (3–16 weeks). Thirty-four of 35 children (97%) were considered definitively cured, that is, asymptomatic with preserved renal function. Two children required open surgery for a failed endoscopic treatment procedure. Secondary reimplantation surgery was only necessary in one case (1/35) after technically satisfactory endoscopic treatment. Twelve of 35 children had a complication, including two Clavien III complications. Comparison of pre- and postoperative ultrasonography showed a significant decrease in ureteral diameter in 31 cases. Postoperative scintigraphy showed a significant improvement in the ureteral leaking curve in 20 children. Conclusion In our experience, endoscopic treatment of congenital obstructive megaureter in pediatrics seems to be safe and effective. It is proposed as a first-line treatment for children requiring an intervention, even for young children under 2 years.

BACKGROUND AND PURPOSE: Flow-diverting stents can be used to treat intracranial aneurysms that are not amenable to treatment with coils. We analyzed ophthalmic consequences due to coverage of the origin of the ophthalmic artery by flow-diverting stents for the treatment of internal carotid artery aneurysms. MATERIALS AND METHODS: From April 2009 to April 2013, the clinical and angiographic outcomes of all 28 patients treated for aneurysms with flow-diverting stents covering the origin of the ophthalmic artery were prospectively collected. The origin of the ophthalmic artery in relation to the target aneurysm was classified by using a 4-type classification. A complete ophthalmic examination was performed by a single ophthalmologist 48 hours before and 1 week after covering the ophthalmic artery. RESULTS: Ophthalmic artery patency was normal at the end of endovascular treatment in 24/28 cases (85.7%). With extensive ophthalmic examinations, 11 patients (39.3%) showed new ophthalmic complications. Patients with the ophthalmic artery originating from the aneurysm sac were at high risk for retinal emboli (4/5, 80%). Patients with the ophthalmic artery originating from the inner curve of the carotid siphon were at high risk for optic nerve ischemic atrophy (3/4, 75%). CONCLUSIONS: This prospective study shows that covering the ophthalmic artery with a flow-diverting stent is not without potential complications. Ophthalmic complications can occur but are often not diagnosed. The anatomic disposition of the ophthalmic artery in relation to the carotid siphon and aneurysm should be clearly understood because some configurations have a higher risk. When not required, covering of the ophthalmic artery by flow-diverting stents should be avoided.

Summary Introduction The purpose of this study is to analyse the 2-stage Muller's muscle flap technique for the treatment of orbital implant exposure and its results. Materials and methods This retrospective study reviewed all patients undergoing surgery using this technique in our university hospital over a 14-year period (1999–2012) in terms of success (no re-exposure of the implant) or failure. Results Nineteen patients were managed using this 2-stage procedure. Orbital implant exposure occurred 94.4 months (2–240) after implantation. The success rate was 68.4% (13/19) and failure rate 31.6% (6/19). Risk factors for exposure were enucleation for melanoma followed by radiation therapy, acrylic implant, and early exposure probably due to excessive suture tension. Discussion Implant exposure is the most common complication after evisceration, enucleation or socket surgery. Several techniques to repair exposures have been described. Two-stage Muller's muscle flap is an interesting option, especially for patients presenting defects larger than 4 mm 2 and without previous radiation therapy treatment. Conclusion The two-stage Muller's muscle flap procedure allows for an autologous vascularized pedicle flap from the ipsilateral upper eyelid. It is a reliable technique with a success rate of 68% in our study.

Summary Purpose The purpose of this study was to compare the safety and efficacy of a new cationic emulsion (CE) with a formulation of polyvinyl alcohol and povidone (PVA-P) for the treatment of mild to moderate dry eye disease. Methods This was a multicenter, open-label, comparative study. Patients were randomised to receive CE (Cationorm ® ) or PVA-P (Refresh ® ) (1:1). The following objective criteria were assessed to compare the two eye drops: tear Break-up Time (TBUT), Schirmer's test, lissamine green staining (Van Bijsterveld score), corneal fluorescein staining (Oxford scale) and oculopalpebral examination, on D7 and D28 (end of study). At these visits, ocular symptoms and safety were also assessed. Results Seventy-nine patients were randomised: CE: 44 patients; PVA-P: 35 patients. At D28, improvement was significantly better for TBUT [CE: 1.7 ± 2.4 s; PVA-P: 0.6 ± 1.8 s; P = 0.015] and for the Van Bijsterveld score [CE: −1.4 ± 1.2; PVA-P: −0.9 ± 1.2; P = 0.046] in the CE group. The same applied for the palpebral erythema score ( P = 0.023), overall efficacy assessed by the investigators ( P P = 0.021). Improvement was observed from D7. No difference was observed between the two treatments with regard to ocular safety. Conclusion These results suggest that in patients with mild to moderate dry eye, Cationorm ® , in addition to its moisturizing and lubricating properties, also helps stabilize the tear film due to its oily component. This study demonstrates the benefit of this new pharmaceutical form for the treatment of mild to moderate dry eye disease.

Spinal cord stimulator (SCS) implantation is an effective tool for reatment of various conditions that include complex regional pain yndrome, peripheral vascular disease, neuropathic pain, refracory angina, and failed back surgery syndrome (FBSS). SCSs are laced in the thoracic region to treat low back pain and lower xtremity radicular pain. Permanent SCS is indicated for chronic onmalignant pain of neuropathic origin with a positive trial [1]. omplications of SCS have been reported at 30–40%, with hardware elated problems, as in lead failure and migration, more common han infection [2]. Upper extremity paresthesia is an extremely rare ide effect of placing SCS lead in the low thoracic region. Only one ase of this phenomenon has been reported after temporary and ermanent SCS placement [3]. We report a case of permanent five ead SCS at T8–9 with affirmative coverage of low back and leg pain n an awake patient who experienced a five week delayed onset of pper extremity aberrant paresthesia. To our knowledge this is the nly report of this delayed phenomenon.

To determine the position of the lower loop of the ansa cervicalis (AC) compared to the inferior edge of the omohyoid muscle to guide minimally invasive surgery for the lateral oblique approach of parathyroid glands. Authors performed 36 anatomical dissections in the laboratory of anatomy (Laboratoire d’Anatomie Des Alpes Francaises) of the Grenoble medical school in 2012 on human cadavers. They independently measured the distance between the caudal extremity of the AC and the lower edge of the superior belly of the omohyoid muscle. Then, they controlled this measure on pictures. The study shows a majority of long AC (under the omohyoid muscle) in 66.7 % of cases. In addition, the AC was located on an average value of 0.1 cm below the lower edge of the omohyoid muscle (median −0.5 cm). Thus, two-thirds of AC are between 0 and −2 cm under the omohyoid muscle. Furthermore, the AC is generally non-symmetrical: there is a mean difference of 1.3 cm between the left and right AC. In this series, there are as many long AC on the right side as on the left side. These results are in contradiction with literature data. To preserve the ansa cervicalis and its phonatory functions, it is necessary for the surgeon to perform a systematic per operative identification of the AC because the position of the AC is mainly under the omohyoid muscle and because of an asymmetry. Per operative neurostimulation and/or magnified lenses might be helpful during the surgical approach.

Resume La neovascularisation corneenne se definit comme l’apparition de vaisseaux au sein du stroma corneen normalement avasculaire en reponse a une agression tissulaire aigue ou chronique. Elle est responsable d’un afflux de cellules immunitaires au sein du stroma qui diminue les chances de succes des greffes de cornees. Ainsi, le ciblage therapeutique des neovaisseaux constitue une piste recente de recherche visant a ameliorer le pronostic des greffes de cornees. L’etude de l’efficacite des molecules anti-angiogeniques sur les neovaisseaux suppose donc que l’on puisse quantifier de maniere objective l’importance de la neovascularisation avant puis apres l’administration des medicaments. Dans la premiere partie de cette revue de la litterature, nous presentons successivement les examens qui permettent de documenter les neovaisseaux corneens (photographies couleurs, angiographies du segment anterieur a la fluoresceine et au vert d’indocyanine, imagerie confocale in vivo). Nous abordons ensuite les methodes de classification et de quantification de la neovascularisation corneenne.

Corneal neovascularization is defined as the presence of vessels within the normally avascular corneal stroma. This physiopathological process is the consequence of local hyper-expression of pro-angiogenic factors in response to tissue damage. These new vessels (neovessels), initially immature and poorly developed, predispose the cornea to lipid exudation, inflammation, and scarring. Additionally, the influx of vascular cells into the stroma induces a loss of the cornea's immune privilege, resulting in a higher rate of graft rejection. In this literature review, we touch on epidemiological, physiopathological, and clinical aspects of corneal neovascularization, as well as secondary complications.

Permanent visual loss (PVL) is the most dreaded complication of giant cell arteritis (GCA). It results from anterior ischemic optic neuropathy or, less commonly, retinal artery occlusion. This complication still occurs in 14 to 20% of patients and is typically devastating and permanent, although it is highly preventable by an early diagnosis of giant cell arteritis and appropriate glucocorticoid treatment. Transient ischemic symptoms such as amaurosis fugax, episodes of blurred vision or diplopia may occur, either heralding visual loss or remaining isolated. In studies, the main predictors of PVL are jaw claudication, amaurosis fugax, lack of systemic "B" symptoms, a modestly increased ESR and a higher haemoglobin level. The evaluation of a GCA patient with PVL includes emergency fundoscopy completed by fluorescein angiography, immediate erythrocyte sedimentation rate, C-reactive protein, and complete blood count. Treatment is extremely urgent mainly because, if left untreated, GCA is associated with visual loss in the fellow eye within days in up to 50% of individuals. Treatment may begin with high-dose intravenous methylprednisolone, followed by oral prednisone administered at 1 mg/kg per day. Daily adjunctive aspirin orally may be added since it has been shown, in retrospective studies, to protect against stroke and visual loss. Although treatment duration of complicated GCA is not codified, an initial PVL deserves close monitoring of patient's systemic symptoms, ESR and CRP to avoid relapses due to a significant risk of late recurrence of visual loss during steroid tapering.

Resume Objectif Evaluer une methode de prise en charge precoce des desordres oculomoteurs entrainant une diplopie apres decompression orbitaire dans le cadre d’une orbitopathie dysthyroidienne. Patients et methodes Les dossiers de 51 patients ayant beneficie d’une decompression orbitaire (87 orbites) entre juillet 1998 et juin 2007 ont ete retrospectivement analyses. Les differentes explorations oculomotrices au cours de la prise en charge, l’incidence de la diplopie selon la methode de decompression employee, le type de chirurgie oculomotrice et les resultats sur la diplopie ont ete releves. Resultats Le taux de diplopie induite par la decompression etait de 34,2 %, sans difference statistiquement significative selon la methode employee. Quarante-neuf pour cent de la population presentait une diplopie postoperatoire. La prise en charge du strabisme a eu lieu en moyenne 10,9 semaines apres la decompression. Une diplopie a persiste chez deux patients (8 %). Conclusion La prise en charge precoce du strabisme apres decompression orbitaire et le reglage peroperatoire du recul musculaire semblent donner de bons resultats. Ils permettent une rehabilitation plus rapide des patients. Le choix adapte du type de decompression doit permettre d’ameliorer le resultat final.

Purpose To evaluate the efficacy and safety of a preservative-free cationic emulsion (CE) with a 0.18% hyaluronate sodium (HS) solution in patients with moderate to severe dry eye disease (DED) with keratitis or keratoconjunctivitis. Methods Eighty-five patients were randomized (1:1) in this multicenter, prospective, reference-controlled, parallel-group, investigator-masked study to receive CE (n = 44) or HS (n = 41). Clinical signs and symptoms were assessed over 3 months. The primary efficacy endpoint was noninferiority of CE to HS in change from baseline of ocular surface staining (OSS) score at 1 month. Results In the per protocol (PP) set and full analysis set (FAS), CE showed a similar and noninferior (pConclusions CE was similar to HS with regards to safety and efficacy for objective signs but was superior to HS in improving DED symptoms in patients with moderate to severe DED.

Alcoholic liver disease (ALD) is a major cause of morbidity and mortality worldwide. The spectrum of ALD ranges from fatty liver to alcoholic hepatitis and cirrhosis, which may eventually lead to the development of hepatocellular carcinoma. In developed countries as well as many developing nations, ALD is a major cause of end-stage liver disease that requires liver transplantation. The most effective therapy for ALD is alcohol abstinence; however, for individuals with severe forms of ALD and those in whom alcohol abstinence is not achievable, targeted therapies are absolutely necessary. In this context, advances of our understanding of the pathophysiology of ALD over the past two decades have contributed to the development of therapeutic modalities (e.g., pentoxifylline and corticosteroids) for the disease though the efficacy of the available treatments remains limited. This article is intended to succinctly review the recent experimental and clinical findings regarding the involvement of oxidative stress and redox signaling in the pathophysiology of ALD and the development of mechanistically-based antioxidant modalities to target the oxidative stress and redox signaling mechanisms of ALD. The biochemical and cellular sources of reactive oxygen and nitrogen species (ROS/RNS) and the dysregulated redox signaling pathways associated with alcohol consumption are particularly discussed to provide insight into the molecular basis of hepatic cell dysfunction and destruction as well as tissue remodeling underlying ALD.

Resume Objectif Evaluer l’interet de la plicature interlamellaire du muscle releveur de la paupiere superieure par mini incision (technique de Frueh) dans la chirurgie du ptosis. Patients et methodes Une etude retrospective a permis de comparer differents parametres dans un groupe de 98 ptosis seniles chez l’adulte entre la technique de Frueh et la technique classique de reamarrage de l’aponevrose par voie anterieure, et dans un groupe de 21 ptosis congenitaux isoles entre la technique de Frueh et la suspension au ligament de Whitnall. Le critere principal de notre etude a ete le nombre de reprises. Resultats Dans le groupe adulte, aucune difference statistiquement significative n’a ete retrouvee entre technique chirurgicale et nombre de reprises ( p = 0,82). Dans le groupe enfant, aucune correlation statistiquement significative n’a ete retrouvee entre technique chirurgicale et nombre de reprises ( p = 0,3). Discussion Chez l’adulte, la technique de Frueh presente une efficacite comparable a la technique de reference. Elle est significativement plus rapide que la technique classique par voie anterieure et permet l’obtention d’un meilleur aspect du contour de la paupiere superieure. Chez l’enfant, la technique de Frueh est une procedure de choix dans les ptosis minimes a moderes avec bonne action du releveur (ARPS). Concernant les ptosis severes avec mauvaise ARPS, son efficacite apparait limitee si on la compare aux techniques de reference et son utilisation en premiere intention semble donc plus discutable. Conclusion Ce travail confirme la technique de Frueh dans l’arsenal des techniques de reference de chirurgie du ptosis chez l’adulte et meme chez l’enfant.

Resume Introduction Les keratites infectieuses constituent une preoccupation majeure de sante pour les millions de porteurs de lentilles de contact, ainsi que pour leurs ophtalmologistes. Certains facteurs de risque infectieux sont bien connus (defaut d’hygiene, port permanent des lentilles…), d’autres sont seulement evoques, voire meconnus et gagneraient ainsi a etre demontres. Patients et methodes Une etude multicentrique prospective regroupant 12 centres hospitaliers universitaires francais (Besancon, Bordeaux, Dijon, Fort-de-France, Grenoble, Limoges, Lyon, Nancy, Nantes, Paris, Marseille et Strasbourg) comparant des patients souffrant d’une keratite infectieuse sous lentilles de contact (cas) a des porteurs sains de lentilles de contact (temoins) a l’aide d’un questionnaire standardise anonyme regroupant 51 items donnant des informations sur des facteurs de risques potentiels et developpe pour l’etude a ete debutee en juillet 2007. Resultats Deux cent cinquante-six cas et 113 temoins ont participe a cette etude. Une part importante des abces sous lentilles de contact est survenue sous lentilles cosmetiques (risque relatif [RR] : 16,5). Un delai de consultation chez l’ophtalmologiste superieur a un an (RR : 3,4) ou l’adaptation des lentilles par un non-ophtalmologiste (RR : 7,6) a entraine une augmentation du risque de survenue d’abces sous lentilles. Le non-respect des regles d’hygiene (lavage des mains : RR : 2,2 ; ou absence de rub and rinse : RR : 2,7) a aussi augmente le risque d’infection sous lentilles. Discussion Un questionnaire standardise, remis a tout patient presentant un abces de cornee sous lentilles de contact, semble etre un outil pertinent pour l’etude des facteurs de risque de keratite infectieuse sous lentilles de contact et l’education au bon maniement des lentilles de contact des porteurs.

Resume Introduction Les conjonctivites bacteriennes sont caracterisees par une hyperhemie et une secretion purulente d’un ou deux yeux. Ces signes cliniques apparaissent rapidement et sont contagieux. Cette etude vise a comparer, a la tobramycine, l’efficacite clinique (signes et symptomes) et la tolerance du collyre azithromycine. Patients et methodes Une etude multicentrique a ete menee chez 1043 patients atteints de conjonctivite bacterienne purulente. Les patients ont ete traites soit par azithromycine1,5 % deux fois par jour pendant 3 jours, soit par tobramycine 3 %, 1 goutte toutes les 2 heures pendant 2 jours puis 4 fois par jour pendant 5 jours. Le critere principal etait, pour l’œil le plus atteint, la guerison clinique 9 jours apres le debut du traitement (J9), definie par l’association des scores d’hyperhemie et de secretion egale a 0. Les principaux signes cliniques ont ete evalues a J0, J3 et J9. Resultats Quatre-vingt-sept virgule huit pour cent des patients sous azithromycine et 89,4 % sous tobramycine etaient gueris a J9. La guerison clinique sous azithromycine a ete non-inferieure celle de la tobramycine a J9: les secretions purulentes ont disparu chez 96,3 % des patients sous azithromycine et 95,1 % des patients sous tobramycine. L’azithromycine a ete bien toleree. Conclusion Le collyre azithromycine 1,5 % administre pendant 3 jours (soit 6 gouttes) montre une efficacite comparable a la tobramycine pendant 7 jours (soit 36 gouttes). Un nombre important de patients sous azithromycine presente une guerison precoce a J3 avec amelioration visible des signes evocateurs de la conjonctivite bacterienne purulente. Azyter® avec uniquement deux instillations pendant 3 jours facilite le traitement de la conjonctivite bacterienne.

Resume Objectifs Le but de cette etude etait d’evaluer l’efficacite du collyre Naabak® sur la composante inflammatoire de la secheresse oculaire. Patients et methodes Cette etude pilote de phase III, multicentrique, randomisee, en double insu, sur deux groupes paralleles a ete menee chez des adultes atteints de secheresse moderee. Les patients ont ete traites pendant trois mois avec un collyre de NAAGA (Naabak®) ou de chlorure de sodium 0,9 % (Larmabak®). Une goutte du traitement etait instillee 4 a 6 fois par jour pendant le premier mois, puis 3 a 4 fois par jour pendant les deux mois suivants. Deux visites de suivi a J28 et J84 ont permis une evaluation clinique et biologique des expressions de HLA-DR et MUC5AC sur les empreintes conjonctivales. Resultats Apres trois mois de traitement, une amelioration des symptomes de la surface oculaire et de l’inconfort global a ete notee a la fois chez les patients traites par Naabak® et ceux traites par Larmabak® plus marquee dans le premier groupe, mais sans difference significative. Les resultats des empreintes conjonctivales ont montre une diminution significativement plus importante de l’expression du marqueur inflammatoire HLA-DR dans le groupe des patients traites par Naabak®. Conclusion Cette etude confirme la propriete anti-inflammatoire du NAAGA dans le traitement du syndrome de l’œil sec, meme si l’efficacite clinique semble comparable a celle d’une solution de chlorure de sodium. Par consequent, le Naabak® pourrait avoir un interet therapeutique supplementaire chez les patients atteints de secheresse oculaire moderee en agissant sur la composante inflammatoire.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 37 - N° 8S1 - p. 334-342

Objectives To investigate the potential value of antenatally determined total fetal lung volume (TFLV) by magnetic resonance imaging (MRI) in the prediction of the postnatal survival in congenital diaphragmatic hernia (CDH). Methods We examined fetuses with isolated CDH, in which MRI was used at 22–38 weeks of gestation to measure TFLV and assess intrathoracic herniation of abdominal viscera, that were liveborn after 30 weeks of gestation and had postnatal follow-up until death or discharge from hospital. Regression analysis was used to investigate the effect on survival of gestational age at diagnosis, observed to expected (o/e) TFLV, intrathoracic herniation of the liver, side of CDH, gestational age at MRI, institution, year and gestational age at delivery. In 76 fetuses measurements of o/e TFLV and the lung area to head circumference ratio (LHR) were performed within 2 weeks of each other; in these cases o/e TFLV and o/e LHR were compared for their prediction of postnatal survival. Results In the 148 cases that fulfilled the entry criteria, multiple regression analysis demonstrated that significant predictors of survival were the presence or absence of intrathoracic herniation of the liver and o/e TFLV. The area under the receiver–operating characteristics curves for prediction of postnatal survival from o/e TFLV was 0.786 (standard error, 0.059; P < 0.001) and that from o/e LHR was 0.743 (standard error, 0.069; P = 0.001). Conclusions In the assessment of fetuses with CDH, MRI-based o/e TFLV is useful in the prediction of postnatal survival. Copyright  2008 ISUOG. Published by John Wiley & Sons, Ltd.

Menometrorrhagia is a frequent cause of medical consulting. After clinical examination showing the uterine origin of bleeding and excluding a cervical or vulvo-vaginal cause, ultrasonography is indicated. It is the first-line technique examination for the identification of an etiology: benign endometrium lesion (polyp, endometrium atrophy or hypertrophy) or malignant tumor, myometrial lesions (adenomyosis, leiomyoma), adnexal tumors, and first trimester pregnancy complication. Color Doppler sonography and hysterosonography are useful tools for ultrasound performance improvement. Ultrasound gives orientation for diagnosis and therapeutic strategy.

The role of Nrf2, a key regulator of antioxidant and cytoprotective genes, in tumorigenesis remains controversial. Here we showed that Nrf2 deficiency led to increased local tumor growth in mice following subcutaneous injection of B16-F10 melanoma cells, as indicated by increased proportion of animals with locally palpable tumor mass and time-dependent increases in tumor volume at the injection site. In vivo bioluminescence imaging also revealed increased growth of melanoma in Nrf2-null mice as compared with wild-type mice. By using a highly sensitive bioluminometric assay, we further found that Nrf2 deficiency resulted in a remarkable increase in lung metastasis of B16-F10 melanoma cells as compared with wild-type mice. Taken together, the results of this short communication for the first time demonstrated that Nrf2 deficiency promoted melanoma growth and lung metastasis following subcutaneous inoculation of B16-F10 cells in mice.

Resume Objectif Nous avons voulu mettre en evidence les differences en terme de restitution anatomique opposables a la voie abdominale et a la voie vaginale dans le traitement chirurgical du prolapsus genital. Nous avons compare les resultats anatomiques a court terme des sacropexies, sacrospinofixations et suspensions paravaginales. Patientes et methodes L'imagerie par resonance magnetique (IRM) a permis d'obtenir une comparaison reproductible et objective de la localisation des differents organes pelviens. Quarante-trois patientes ont beneficie d'une evaluation IRM en pre- et postoperatoire selon la position des organes par rapport a la ligne sous-pubosacrococcygienne. Nous avons note cystocele, hysterocele ou elytrocele lorsque la vessie, le col uterin, ou le cul-de-sac de Douglas descendait sous cette ligne lors d'efforts de poussee. Nous avons mesure les modifications de longueur et d'inclinaison laterale et anteroposterieure du vagin. Resultats Apres la cure chirurgicale on note que l'ensemble des organes pelviens est retrouve au-dessus de la ligne de reference IRM. En revanche, les vessies sont situees significativement moins hautes apres cure de prolapsus par voie vaginale. On ne retrouve pas de difference en ce qui concerne la localisation du fond vaginal en postoperatoire. Les longueurs et axes vaginaux sont comparables en pre- et postoperatoires. Discussion et conclusion Dans notre etude, la correction anatomique des prolapsus par voie abdominale ou par voie vaginale est comparable et satisfaisante a court terme, et la voie vaginale n'est pas responsable de diminution de la longueur ou de reorientation vaginale. Bien standardisee et evaluee a plus long terme, l'IRM pourra representer une aide objective et reproductible a la stadification des prolapsus.

Resume Les malformations arterio-veineuses intra-uterines sont une etiologie possible de metrorragies persistantes notamment en cas d’antecedent de fausses couches, de grossesse cornuale, de grossesse molaire ou de maladies trophoblastiques gravidiques. Nous rapportons 4 cas de patientes presentant une malformation arterio-veineuse intra-uterine. Le diagnostic de telles lesions fait appel a l’echographie Doppler en premiere intention. Ce diagnostic est par la suite confirme par angiographie. Le traitement de premiere intention est l’embolisation qui est la plupart du temps realisee dans le meme temps que l’angiographie. Ce traitement est rapide et definitif, permettant aux patientes d’avoir d’autres grossesses ulterieurement. Un suivi echographique, dont le rythme reste a definir, est necessaire afin de verifier la bonne involution de ce type de malformation vasculaire.

Granulocytic sarcoma in a 90-year-old patient Granulocytic sarcoma rarely involves the orbit. It is the local proliferation of immature myeloid cells and occurs most often in patients suffering from myelodysplastic syndromes. We report a case of granulocytic sarcoma that revealed acute myeloid leukemia in a patient suffering from chronic myelomonocytic leukemia. At the time of diagnosis, the lesion involved the nasal fossae, the ethmoidal sinus, and the orbit, with subperiosteal tumoral infiltration toward the skin. The treatment involved surgery and radiotherapy. The patient died 3 months later of complications of the hematological disease. This observation is original for the occurrence of granulocytic sarcoma during chronic and well-known leukemia, the age of onset, and the fatal outcome in just a few weeks. In this observation, the ophthalmologist revealed the acute nature of the myelodysplastic syndrome.

Ultrasonography is the method of choice for prenatal malformation screening, but it does not always provide sufficient informations to allow a correct diagnosis or an adequate abnormality evaluation. Fetal MRImaging (MRI) indications are increasing in order to complete sonographic findings. It has been initially used for evaluation of cerebral abnormalities, but it is more and more applied to other fetal areas. An adequate analysis of fetal chest and abdomen can be obtained with fast T2 and T1 weighted sequences. This allows an easy diagnosis of congenital diaphragmatic hernia and an evaluation of the consequences on pulmonary growth. Other pulmonary malformations can be also easily identified (cystic adenoid malformation, sequestration, bronchogenic cyst, tracheal or bronchial atresia). Therefore, fetal thoracic MRI contributes to a better understanding and evaluation of fetal thoracic malformations, which is particularly useful for their postnatal management.

Pulmonary tuberculosis is an endemic infection. Chest radiography is the mainstay in the evaluation of pulmonary tuberculosis. High resolution CT is required to detect fine lesions overlooked on chest radiographs, to define equivocal lesions, to determine disease activity in some cases and to evaluate complications or sequels. We review indications of chest radiograph and CT, the radiologic features of primary and post-primary tuberculosis, and outcome of tuberculous lesions.

Mitomycin C (MMC) has been described as having a positive effect in different types of dacryocystorhinostomy (DCR) surgery such as external DCR, endonasal and transcanalicular DCR. MMC, an antineoplastic antibiotic, acts as an alkylating agent by inhibiting DNA, RNA and protein synthesis. Topical use of MMC can modulate the scarring process, which is useful in glaucoma surgery and pterygium excision. In DCR, MMC is also useful because it reduces the scarring process and thus prevents the occlusion of the osteotomy site related to the fibroblast activity. An increase in the success rate for long-term results has been observed by different authors, resulting from a larger osteotomy size as well as a decrease in the density and cellularity of the mucosa. No complications have been seen with topical use of MMC.

Resume L'anatomie et la physiologie ovariennes sont utiles a connaitre pour comprendre la pathologie fonctionnelle de l'ovaire. Elle concerne principalement la femme en periode d'activite genitale. Cette pathologie est excessivement frequente, et implique l'absence de tout processus pathologique organique sous-jacent et la reversibilite potentielle des anomalies de facon spontanee ou sous l'effet d'une therapeutique medicale adaptee.

Resume Cet article etudie l’apport de l’echographie obstetricale a la surveillance du premier trimestre de la grossesse normale et pathologique. Deux periodes sont envisagees : avant et apres 11 semaines d’amenorrhee. Sont analyses plus particulierement : la clarte nucale et son apport au diagnostic des anomalies chromosomiques, la morphologie embryonnaire et le diagnostic des embryofœtopathies, les grossesses multiples et le diagnostic de chorionicite.

Resume Nous souhaitons discuter de l’importance de l’imagerie par resonance magnetique en complement de l’examen clinique dans le cadre du bilan pre- et postoperatoire dans l’etude du prolapsus uterovaginal et notamment du compartiment posterieur (rectocele, elytrocele). L’amelioration notable, obtenue en IRM (cliches statiques et dynamiques dans les 3 plans de l’espace) a permis une correlation clinicoradiologique plus precise sur l’exploration des prolapsus. Nous rapportons une observation clinique dans laquelle l’IRM pre- et postoperatoire peut apporter une evaluation plus fiable que le seul examen clinique.

Resume Buts. – A travers 8 cas d'endometrioses vesicales ou ureterales, nous analysons les symptomes permettant d'evoquer le diagnostic et nous etudions les possibilites therapeutiques. Materiels et methodes. – Nous avons recense retrospectivement les cas d'endometrioses vesicales et/ou ureterales sur une periode de 11 ans (novembre 1989–juillet 2000), ayant eu soit un geste ureteral chirurgical (reimplantation, suture sur sonde) soit un geste d'exerese vesicale. Resultats. – Sur 8 dossiers selectionnes, trois comportaient des atteintes vesicales et cinq des lesions ureterales. La seule complication postoperatoire etait un reflux vesico-ureteral apres reimplantation ureterale sur une vessie psoique. Aucune recidive constatee sur l'arbre urinaire. Conclusion. – Les lesions d'endometrioses ureterales ou vesicales symptomatiques justifient un traitement par resection chirurgicale. Les atteintes vesicales peuvent dans la majorite des cas etre traitees par cœliochirurgie lorsqu'elles sont isolees. Les lesions d'endometrioses ureterales mettent en jeu le pronostic fonctionnel renal. Dans un premier temps, une ureterolyse percœlioscopique ou un geste de dilatation par ureteroscopie, associee a un traitement medical, peut etre tentee sous couvert d'une surveillance rapprochee. En cas de persistance ou de recidive le geste d'exerese est indique.