[Selective laser trabeculoplasty: results after a first and a second session, overall comparison and results for three indications]. / Trabéculoplastie au laser sélective: résultats après première et deuxième séances, comparaison globale puis dans trois indications.

PURPOSE: To compare the results obtained with SLT trabeculoplasty after an initial treatment (SLT-1) and after a second treatment (SLT-2). Subgroup analysis according to trabecular pigmentation and the existence of a high myopia. MATERIALS AND METHODS: Retrospective study of 77 patients, 152 SLT sessions performed in the Ophthalmology Department of Clermont-Ferrand University Medical Center, 118 SLT-1, 34 SLT-2. Three comparable groups of patients were assembled: group 1 (glaucoma patients with normal or subnormal trabecular pigmentation), group 2 (glaucoma patients with high myopia), and group 3 (glaucoma patients with significant trabecular pigmentation). The results were compared between groups, for SLT-1 and SLT-2. RESULTS: Intraocular pressure lowering was consistent with data reported in the literature. Comparison of the results of SLT-1 versus SLT-2 did not find any significant difference in terms of IOP change. However, after SLT-2, the IOP response appears significantly greater (P=0.03) in the group with significant trabecular pigmentation compared to the non-myopic group with normal trabecular pigmentation. DISCUSSION: Our results are consistent with the literature for efficacy, tolerance and reproducibility of SLT. No reduction in SLT efficacy was observed after a second session. Trabecular pigmentation is not a predictor of the response after the first session. In the case of retreatment (SLT-2), the differences observed lead to the hypothesis that it may be appropriate to perform at least two SLT treatments in patients with significant trabecular pigmentation in order to obtain maximal effect. Myopia, a variable not previously studied, does not seem to influence SLT outcomes. CONCLUSION: Trabecular pigmentation and the presence of myopia do not appear to be predictive of a successful first treatment. However, our study leads us to suggest the hypothesis that the maximal response of SLT in patients with significant trabecular pigmentation is not obtained until after at least two sessions. This observation opens an interesting perspective on the therapeutic strategy to adopt in the case of pigmentary glaucoma.

[Case report of a 2-year-old child with palpebral rhabdomyosarcoma]. / Rhabdomyosarcome palpébral chez un enfant âgé de deux ans.

Rhabdomyosarcoma is an extremely virulent rare tumor whose early diagnosis considerably improves survival and visual prognosis. We report the case of a 2-year-old child with levator palpebrae superioris muscle rhabdomyosarcoma revealed by a sudden and isolated blepharoptosis. Initially, clinical and imaging investigations did not show any abnormality but a painful tumor with some hematoma quickly developed, so the investigations were repeated. The CT-scan showed an extra-conal tumor that had developed at the superior part of the orbit. Histology confirmed the diagnosis of embryonic rhabdomyosarcoma. Because of its results, treatment consisting of chemotherapy associating ifosfamide, vincristine, actinomycin and orbital radiotherapy of 40 Gy with a local addition of 10 Gy were administrated with successful results after a 3-year-follow-up.

Assessment of topographic brachial plexus nerves variations at the axilla using ultrasonography.

BACKGROUND: The aim of this study was to describe topographic variations in the arrangement of the four main brachial plexus nerves at the junction of the axilla and the upper part of the arm. METHODS: In 153 patients undergoing upper arm surgery using axillary block, we studied nerve arrangements with a three-step approach, combining: (A) cross-sectional ultrasound imaging using a 12 MHz linear ultrasound probe; (B) distal shift of the ultrasound scanhead from the axilla to the elbow joint following the paths of individual nerves; and (C) identifying the distal motor response to electrical nerve stimulation of each nerve. These results were then converted into a 12-section pie chart with the axillary artery (AA) as the axis. RESULTS: The order of the nerves around the AA was median, ulnar, radial, and musculocutaneous in all cases. The most frequent arrangement was observed in 65% of the patients. Five less frequent variations were observed in 4-20% of the patients, with four other variations seen in <2% of the patients. In 78% of the cases, the four nerves were seen separately using static ultrasound imaging. The musculocutaneous nerve was close to the artery in 18% of the patients. CONCLUSIONS: Topographic variations of the four main nerves at the axilla were found to be numerous, the most frequent arrangement being seen in less than two-thirds of the patients. Four separate nerves were seen on static ultrasound imaging at this sectional level of the axilla in only 78% of the cases.

[Interferon-related retinopathy in a man with chronic hepatitis C]. / Rétinopathie à interferon alpha 2b et ribavirine chez un patient atteint d'une hépatite C chronique.

A 50-year-old diabetic man receiving insulin, and suffering from chronic hepatitis C treated with interferon alfa and ribavirin presented with an acute peripheral scotoma and retinopathy associated with interferon therapy. When the treatment was interrupted, all the clinical symptoms and the test abnormalities returned to normal. If the association of interferon alpha and ribavirin increase the incidence of retinopathy, diabetes, and hypertension are also risk factors. Therapeutic abstention and monitoring are usual in the absence of visual acuity changes. However, in certain cases, such as in this patient, ceasing treatment as a matter of urgency avoids serious visual aftereffects. However, because of the incidence on the liver disease, this treatment interruption requires having clearly ruled out all other differential diagnoses.

[An optic nerve glioma in a 4-month-old child]. / Gliome du nerf optique chez un enfant de 4 mois.

The optic nerve glioma is a relatively rare pathology in children and only a few cases have been described in infants. This paper reports the symptoms of this exceptional case in a 4-month-old child and reviews the differential diagnoses at this age. Finally, we discuss the diagnosis and therapeutic possibilities.

[Solitary plasmacytoma simulating pituitary adenoma]. / Plasmocytome solitaire simulant un adénome hypophysaire.

A case of solitary plasmocytoma of the sphenoid is reported, masquerading as pituitary adenoma. At the time of surgery, the patient had no findings of multiple myeloma. The tumor was removed by trans-sphenoidal route and radiotherapy delivered. The post-operative course was uneventful, and two years later, there is no sign of recurrency or extension of multiple myeloma.

[Choice of a central analgesic for anesthesia with spontaneous respiration]. / Choix d'un analgésique central pour l'anesthésie avec respiration spontanée.

The ventilatory effects of tramadol (T) and nefopam (N) are evaluated in anesthetized patients with enflurane in a closed circuit breathing system and compared with the effects of pentazocine (P). The following parameters tidal volume (VT), minute ventilation (V), CO2 (capnometry) occlusion pressure (OP), ventilatory response to hypercarbia are recorded after 30 minutes of anaesthesia, before and after repeated injections of the analgesics, P: 15 mg, N: 40 mg, T: 100 mg are injected I.V., and analgesics administration is repeated at 30 minutes interval, so that the patients receive a total P dose of 30 mg, a total N dose of 60 mg and a total T dose of 200 mg. The administration of 15 mg of P induces a change in VT (-24%), ventilatory frequency (-40%), OP (-18) OP only returns to basal values after a second dose. The ventilatory response to hypercarbie is indeed satisfying (increase of 61% in V). After N and T, ventilatory frequency is not disturbed. V increases of 16% and 11% respectively after the first injection, and of 31% and 2% after the second injection. OP increases by 39% and 56% respectively after the first injection and gets better over time with nefopam (+ 58%), 30 mg of P. 20 mg of N and 100 mg of T are equivalent for analgesia.(ABSTRACT TRUNCATED AT 250 WORDS)

[Anesthesia programmed by enflurane]. / Anesthésie programmée à l'enflurane.

A microcomputer type 6502 is the central unity of a volatile anaesthetic injector for use in a closed circuit breathing system. Estimated calculations for quantity of anaesthetic liquid are done in agreement with the formula of J.W. Severinghaus and H. Lowe. Clinical assay is realised with enflurane. The syringe efficacy is controlled by permanent recorder of halogenate concentration in upper airways Fi-FA: infrared analysor cosma Rubis 3000).