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Aim: To analyze microcirculatory abnormalities, central avascular area and capillary density in OCT-angiography in retinal venous occlusions (RVO)., Methods: This is a descriptive study of 35 patients (35 eyes) with RVO who consulted at the  ophthalmology department of Farhat Hached Hospital in Sousse between January 2014 and July 2018. The diagnosis of retinal venous occlusion was established on clinical examination, fundus photography and fluorescein angiography. All patients underwent OCT-angiography and OCT B-scan., Results: Our study includes a total of 35 patients (35 eyes). Of these patients, 20 (57.1%) had branch retinal vein occlusion and 15 (42.8%) had central retinal vein occlusion. The loss or rarefaction of the capillary plexus concerned the deep capillary plexus (DCP) more than the superficial one (SCP). This rarefaction was observed in 25 eyes (71.42%) in both DCP and SCP. The widening of the central avascular zone and the rupture of the peri-foveolar anastomotic mesh were better or as visible as fluorescein angiography. Vascular tortuosity was easy to analyze and was more evident in the SCP than the DCP. Twenty-six (74.28%) patients had vascular tortuosity in DCP and 30 patients (85.71%) had this vascular tortuosity in SCP. Capillary dilatation and microaneurysms were better visible in the DCP than the SCP. These vascular abnormalities were found in 26 cases (74.28%) in the DCP and in 17 cases (48.57%) in the SCP., Conclusions: OCT-A is a non-invasive examination that allows very precise analysis and follow-up of both macular edema and superficial and deep capillary plexus architecture during retinal vein occlusions.

This study examined the effect of emotion on the judgment of durations of several minutes compared with that of durations of a few seconds. Three experiments were performed on the temporal judgment of emotional stimuli lasting from 2 s to 6 min (Experiment 1) or from 2 to 6 min (Experiment 2 and 3). These involved emotional sounds (Experiment 1 and 2) or virtual reality emotional films (Experiment 3). The results showed an increase in the lengthening of the perceived duration as the level of arousal and negative valence of the emotional stimuli increased, both for the long durations of several minutes and for the shorter durations. However, the magnitude of the time distortion tended to decrease as the length of the duration increased because the affects experienced by the participants lost their intensity over time. Nonetheless, when the exposure to emotional stimuli was limited and the stimuli were sufficiently arousing, as in Experiments 2 and 3, people overestimated time across durations ranging from seconds to minutes., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: Venous thromboembolism (VTE) is a well-established complication of trauma. Recent studies suggest that pulmonary embolism (PE) may occur very early, and even immediately, after injury. The aim of this study is to analyze the incidence, risk factors and prognosis of early PE among ICU trauma patients., Patients and Methods: We conducted a twenty-month-long prospective cohort study, including all trauma patients with a confirmed PE diagnosis admitted to our ICU between January 1st, 2017 and August 31st, 2018. Early post traumatic PE was defined as pulmonary embolism diagnosed within the first 72 hrs of injury. All the patients who were included were systematically screened for early PE on day 3., Results: During the study period, 365 trauma patients were admitted. The diagnosis of post-traumatic PE was confirmed in 66 patients (18%). In our study, 27 patients (41.5%) developed a PE within 72 hrs of trauma. According to our analysis, the factors associated with the development of early post-traumatic PE in multivariate analysis were obesity (P=0.049; OR=4.04), high SOFA score (P=0.003; OR=1.67), and the use of surgical procedures (P=0.033; OR=4.87). Furthermore, sepsis and ventilator-acquired pneumonia were associated with late PE (P=0.019; OR=5.87). Overall, the mortality rate was at 19.7%. Yet, the patients who were diagnosed with early PE had a higher mortality rate compared to the late PE group (33% vs. 10.2%, respectively). We found that the only independent predictive factor of mortality among the patients with early post-traumatic PE included in this study was the APACHEII score on ICU admission (P=0.011; OR=1.44)., Conclusion: Our study cohort showed that many of the post-traumatic PEs occur early in the post-traumatic period. To the best of our knowledge, this is the first prospective study conducted in an ICU to apply a systematic screening protocol for post-traumatic PE diagnosis. Further studies with larger patient populations are required to create more accurate predictive models., Competing Interests: None., (AJCD Copyright © 2020.)

Competing Interests: There are no conflicts of interest.

Purpose: to evaluate the current rate of pulmonary embolism (PE) in our medico-surgical intensive care unit (ICU), to identify risk factors, and to determine the outcome of PE in ICU., Methods: We performed a prospective cohort study of consecutive patients requiring intensive care admission during a one-year period. We included, in this prospective study, all the patients with confirmed PE admitted in ICU with more than 18 years of age, and expected to stay in ICU for more than 48 hours. Only the patients who had a clinical suspicion (unexplained hypoxemia and/or shock) for PE underwent diagnostic studies., Results: During the study period, 842 patients were admitted in our ICU. One hundred and two patients were excluded. The diagnosis of PE was confirmed in 75 patients (10.1%). In our study, all patients (100%) had received some forms of pharmaceutical prophylaxis (PP) during ICU stay. The median time from ICU admission to diagnosis of PE was 6 days. The diagnosis of PE was made by spiral CT in 74 patients (98.7%), and by echocardiography in 1 case (1.3%). The mean ICU stay was 26.3 ± 26.5 days (median: 20 days). During their ICU stay, 73 patients (97.3%) developed one, or more, organ failure. Respiratory failure was the most observed (97.3%). Moreover, 38 patients (50.6%) developed nosocomial infections and 29 (38.6%) died. The multivariate analysis showed that the risk factors associated with mortality were the presence of shock the day of PE diagnosis and the presence of right ventricular dilatation on echocardiography., Conclusion: Our findings confirm that subjects in the ICU are at high risk of PE, due to a high number of risk-factors. PE was associated with higher ICU mortality and a significantly higher ICU LOS. Our results invite to revise the preventive strategies of deep venous thrombosis and PE in patients requiring ICU admission., (© 2019 John Wiley & Sons Ltd.)

The neck, being not protected by skeleton, is vulnerable to external trauma and injury which can involve blood vessels, muscles, nerves, and trachea. Carotid injuries can be potentially life-threatening by hemorrhage and stroke. We present a case of a 26-year-old manual worker who presented a neck injury caused by a metallic projectile. The injury involved the right common carotid artery with an internal jugular vein fistula, and tracheal damage. The patient was managed with surgical repair of the tracheal lesion, reconstruction of the carotid section using a PTFE graft bypass, and ligation of the internal jugular vein. In the immediate postoperative period, the patient presented with no neurological deficits, but he did develop a pulmonary infection that resolved with antibiotic therapy. The follow-up is now 3months. The patient is doing well without any neurological disorder., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

Posterior reversible encephalopathy syndrome (PRES) is an acute central nervous system disorder characterized by reversible brain vasogenic edema. We report here a new case of a nine-year-old boy with B-cell acute lymphoblastic leukemia (B-ALL) who developed PRES secondary to induction chemotherapy including dexamethasone (dexamethasone®), vincristine (oncovin(®)), daunorubicin (adriblastine(®)) and intrathecal injection. Cerebral magnetic resonance imaging (MRI) showed high signal intensity on T2 at cortical and sub cortical region of parieto-frontal and parieto-occipital lobes. The patient was put under sodium valproate (depakine(®)) and we decided to continue dexamethasone (dexamethasone(®)) and daunorubicin (adriblastine(®)) injection. The MRI, after four weeks, was normal. So, we resumed vincristine (oncovin(®)) and we started L-asparaginase injections. Then, the outcome was favorable. The treatment of PRES is based on the withdrawal of the triggering factor to avoid the risk of irreversible lesions. But, due to the severity of leukemia the discontinuation of chemotherapy is difficult because of the risk of disease progression.

Introduction: Malignant teratomas can be either immature teratomas or they can develop after treatment of other malignant germ cell tumors with chemotherapy or radiotherapy. Spontaneous malignant transformation of mature teratomas is very rare., Observation: We report the case of a patient complaining of atypical chest pain. Chest plain radiography showed a right anterior mediastinal mass. Computed tomography revealed a heterogeneous mediastinal mass with fat areas and calcification. There were hilar and mediastinal lymph nodes as well as lung parenchymal nodules. CT-guided and then surgical biopsies confirmed the diagnosis of a mature teratoma, which had degenerated into a digestive adenocarcinoma., Conclusion: Spontaneous malignant transformation of mature mediastinal teratoma is very rare. The diagnosis of malignant transformation is based on radiological examinations, laboratory tests and histological studies., (Copyright © 2013. Published by Elsevier Masson SAS.)