Clinical, imaging and follow-up study of optic neuritis associated with myelin oligodendrocyte glycoprotein antibody: a multicentre study of 62 adult patients.

BACKGROUND AND PURPOSE: There are few clinico-radiological data on optic neuritis (ON) with myelin oligodendrocyte glycoprotein antibody (MOG-IgG). The objective was to characterize the clinico-radiological phenotype and outcome of patients with MOG-IgG-related ON. METHODS: The records of all adult patients admitted in three medical centres with MOG-IgG-associated ON who underwent orbital and brain magnetic resonance imaging (MRI) at the acute phase were reviewed. Spinal cord MRI within 1 month from the ON and all of the follow-up MRI were reviewed. RESULTS: Of 62 patients, 41.9% had bilateral ON and 66.2% optic disc swelling. On initial MRI, lesions were anterior (92%), extensive (63%) and associated with optic perineuritis (46.6%). Silent brain lesions were found in 51.8% of patients but were mainly non-specific (81%). Of 39 individuals with spinal MRI at onset, nine had abnormal findings (four were asymptomatic). Two symptomatic patients had longitudinally extensive myelitis with concurrent H-sign. At last follow-up, 5% of patients had visual acuity ≤0.1. Brain MRI remained unchanged in 41 patients (87%). CONCLUSIONS: Our study supports a mostly benign ophthalmological course of MOG-IgG-associated ON, despite initially longitudinally extensive lesions and development of optic nerve atrophy on orbital MRI. Spinal MRI could be of interest in detecting silent suggestive lesions.

[Study of a protocol of intra-articular analgesia after arthroscopy of the knee]. / Etude d'un protocole d'analgésie intra-articulaire après arthroscopie du genou.

The purpose of this study was to assess the analgesic effects of intra-articular injection of a morphine-bupivacaine combination following knee arthroscopy. 47 patients were evaluated. Knee arthroscopies were all performed under general anaesthesia, using propofol, alfentanil, isoflurane and nitrous oxide. Analgesic effects were evaluated by a visual analogic pain scale. Serum bupivacaine was measured during the first 8 postoperative hours. Analgesia was good in the immediate postoperative period, with minimal side effects. The serum bupivacaine levels were low. However the analgesic efficacy of intra-articular injection of morphine-bupivacaine should be corroborated through a double blind study.

[Cardio-thyrotoxicosis with arrhythmia disclosed by an embolic cerebrovascular accident]. / Cardiothyréose avec arythmie complète révélée par un accident vasculaire cérébral embolique.

We report a case of thyroid cardiomyopathy from an iodine overload in a patient admitted for a cerebrovascular accident. The diagnosis was suggested by a hyperkinetic circulatory status and confirmed by the increased circulating thyroid hormone concentrations. Treatment improved the haemodynamic status, however the patient died from a cerebral herniation.

[Chatergee syndrome and anesthesia. Apropos of a case]. / Syndrome de Chattergee et anesthésie. A propos d'un cas.

A combination of complete left bundle branch block (LBBB) and symmetrical negative T waves on the ECG characterizes the Chattergee syndrome. This pattern is infrequently and fortuitously detected in the absence of clinical symptoms. However, when appearing during general anaesthesia, it may lead to diagnostic difficulties to rule out a myocardial ischaemia. One case of this pattern was observed near the end of an otherwise non-complicated cholecystectomy in a ASA II 45 year old man, ECG abnormalities lasted for only a short time. Recovery and outcome were uneventful. Investigations were negative except for an early LBBB during the exercise test. Echocardiography and coronarography were normal. No therapy was given. In such perioperative cases, it is recommended to keep a very cautious attitude and to search for an incipient coronary disease which cannot be completely excluded in some cases.

[Conduction anesthesia and analgesia in emergency cases. From pain to its treatment]. / Anesthésie loco-régionale et analgésie en situation d'urgence. De la douleur à son traitement.

The study of pathophysiological and symptomatological characteristics of pain in emergency situations, and of its harmful consequences, shows that, in spite of a difficult context, analgesia is an essential part of the care to patients during the prehospital stage. Its prescription implies a good knowledge of analgesia techniques, including precise rules such as titration. The choice of analgesia must be the outcome of a rigorous step giving priority to the vital functions and associating several techniques. Regional anaesthesia is not very often used in prehospital emergency but rather in emergency units and in the surgical ward. Analgesia must be adapted, mainly to specific situations in emergency: children, old people, burned people with pain.

[Oxygen supply in war times. Current perspectives]. / L'alimentation en oxygène en temps de guerre. Perspectives actuelles.

The authors report their experience of the use of various sources of oxygen feeding in wartime: a classical feeding by liquid oxygen or by extractive oxygen cylinders; a new type of feeding by oxygen condensers or chemical oxygen. According to their practical experience, each source finds its role in wartime, this role being determined by war conditions.

[Diseases of the shipwrecked: apropos of 3 cases]. / Pathologie du naufragé: à propos de trois cas.

Three men (31, 34, 36 yr old) were rescued after they had drifted for 50 hours on their wrecked catamaran. While their apparent clinical condition was not worrying, besides multiple bruises, marked dehydration, epigastralgias, mild hypothermia in one patient and 50, severe biological disorders were present in all four: haemoconcentration, functional renal insufficiency, metabolic acidosis, severe rhabdomyolysis, hepatic cytolysis. After intravenous rehydration for 24 hr hydroelectrolytic and acid-base anomalies were corrected. Pathophysiology of shipwreck casualties is recalled. Initial management in ICU is necessary. Psychological and emotional aspects should not be underrated.

[Ambulatory colonoscopy under systemic general anesthesia. Our experience apropos of 500 cases]. / Colonoscopie sous anesthésie générale systématique en ambulatoire. Notre expérience à propos de 500 cas.

The authors report a retrospective study of 500 colonoscopies performed on outpatients under general anaesthesia. Anaesthesia protocol associated diluted propofol in continuous titrated infusion and alfentanil. The doses used were relatively low and no serious adverse effects were observed. Therefore this method appears to be appropriate for most outpatients undergoing a colonoscopy provided that usual security rules are respected.