Dermatological adverse effects of anti-glaucoma eye drops: a review.

Many patients are treated for glaucoma. Like other drugs, anti-glaucoma eye drops may induce dermatological adverse effects. We aim to review the dermatological adverse effects secondary to the active agents in anti-glaucoma eye drops through a literature review. In January 2020, we queried PubMed using the following MeSH terms: glaucoma/drug therapy or glaucoma, open angle/drug therapy cross-referenced with parasympathomimetics/adverse effects or adrenergic agonists/adverse effects or carbonic anhydrase inhibitors/adverse effects or prostaglandins F, synthetic/adverse effects or adrenergic beta antagonists/adverse effects or ophthalmic solutions/adverse effects. The initial search identified 1128 studies, of which 49 were excluded for being in a foreign language, 15 for not involving eye drops, 968 for not focusing on adverse dermatological effects, and 11 for insufficient documentation or redundancy. After adding 38 linked studies, we finally analyzed 123 studies. The ocular and periocular dermatological adverse effects of eye drops are contact dermatitis, hyperpigmentation, prostaglandin analog periorbitopathy, mucous membrane pemphigoid, eyelash depigmentation, skin hypertrichosis, and rare cases of melanoma and skin depigmentation. The reported distant dermatological adverse effects are psoriasis, excessive sweating, lichen planus, alopecia, toxic epidermal necrolysis, erythema multiforme, erythroderma, subacute cutaneous lupus erythematosus, nail pigmentation, and bullous pemphigoid. Most of the cutaneous adverse effects of anti-glaucoma eye drops are ocular and periocular and induced by prostaglandin analogs. Distant adverse effects are rare and sometimes questionable but should be kept in mind, especially mucous membrane pemphigoid, which could lead to blindness. The role of preservatives, such as benzalkonium chloride, should also be considered.

[Aggressiveness and violence in daily ophthalmology practice: Descriptive analysis of a survey sent to residents and assistants in Grand Est and Bourgogne-Franche-Comté]. / Agressivité et violence au cours de l'exercice professionnel en ophtalmologie : analyse descriptive d'un questionnaire adressé aux internes et assistants des régions Grand Est, Bourgogne-Franche-Comté.

INTRODUCTION: The goal of this study was to estimate the prevalence of workplace violence in a population of young ophthalmologists in France and to characterize these situations. METHODS: We conducted an epidemiological descriptive, cross-sectional, multi-center study based on an anonymous questionnaire. We submitted a questionnaire to all ophthalmology residents and fellows (n=157) in the Grand Est and Bourgogne-Franche-Comté regions between December 2020 and March 2021. RESULTS: The overall response rate was 76.4% (n=120, 55% female and 45% male) of whom 81.6% reported having faced aggression at least once. For 50.9% of participants, aggression had occurred several times per year. These situations occurred during the first year of residency in 64.3% of cases. They mainly consisted of verbal aggression (98.8%) by a patient or their relatives (43.7% and 29.8%). The main complaints voiced by these individuals concerned the wait time (40%) and the feeling of lack of competence or improper medical care (26.8%). Fifty-seven percent of people who faced these situations thought about it for at least a week, and 20.4% of those exposed felt anxiety at work after the incident. CONCLUSION: We found high prevalence of verbal aggression in professional ophthalmology practice. Although these situations were mainly verbal aggression without significant consequences, they sometimes lead to anxiety in the aftermath. We should prepare medical students to manage them, through appropriate theoretical and practical training, such as medical simulation described in this article.

[Management of ocular toxoplasmosis in France: Results of a modified Delphi study]. / Prise en charge de la toxoplasmose oculaire en France : résultats d'une étude Delphi modifiée.

OBJECTIVE: To evaluate diagnostic and therapeutic practices and then establish a consensus on the management of ocular toxoplasmosis in France through a Delphi study. MATERIALS AND METHODS: Twenty-three French experts in ocular toxoplasmosis were invited to respond to a modified Delphi study conducted online, in the form of two questionnaires, in an attempt to establish a consensus on the diagnosis and management of this pathology. The threshold for identical responses to reach consensus was set at 70 %. RESULTS: The responses of 19 experts out of the 23 selected were obtained on the first questionnaire and 16 experts on the second. The main elements agreed upon by the experts were to treat patients with a decrease in visual acuity or an infectious focus within the posterior pole, to treat peripheral lesions only in the presence of significant inflammation, the prescription of first-line treatment with pyrimethamine-azithromycin, the use of corticosteroid therapy after a period of 24 to 48hours, the prophylaxis of frequent recurrences (more than 2 episodes per year) with trimethoprim-sulfamethoxazole as well as the implementation of prophylactic treatment of recurrences in immunocompromised patients. On the other hand, no consensus emerged with regard to the examinations to be carried out for the etiological diagnosis (anterior chamber paracentesis, fluorescein angiography, serology, etc.), second-line treatment (in the case of failure of first-line treatment), or treatment of peripheral foci. CONCLUSION: This study lays the foundations for possible randomized scientific studies to be conducted to clarify the management of ocular toxoplasmosis, on the one hand to confirm consensual clinical practices and on the other hand to guide practices for which no formal consensus has been demonstrated.

[Oral chemotherapy (sonigegib) of extensive basal cell carcinoma, about 4 cases]. / Traitement par chimiothérapie orale (sonidegib) de carcinomes basocellulaires étendus, à propos de 4 cas.

Basal cell carcinoma (BCC) is the most frequent cutaneous carcinoma. Its incidence is constantly increasing, primarily due to sun exposure during the two first decades of life. The lower lid and medial canthus are the most common locations. In the majority of cases, surgery with sufficient margins is the first-line treatment. In the case of inoperable tumors (extensive lesions, poor general health, high surgical morbidity, unacceptable cosmetic sequelae), oral chemotherapy can be suggested. We report the follow-up of 4 patients with advanced non-metastatic basal cell carcinoma (BCC) treated with oral chemotherapy (sonigegib). All patients were female with a mean age of 80years. The first patient had an infiltrative BCC of the right lower lid with orbital invasion, the second a nodular BCC of the right inferior lid with massive cutaneous and orbital invasion extending to the controlateral medial canthal angle, the third an advanced infiltrative BCC invading both orbits and nasal cavities, and the fourth, an infiltrative BCC with extension to the ipsilateral skin of the face. The diagnosis of BCC was confirmed by multiple biopsies in our four patients prior to starting chemotherapy. Because of the locally advanced lesions, surgery was contraindicated in all cases, chemotherapy was undertaken (sonidegib 200mg daily), and ophthalmological and dermatological examinations were performed every 3months. In all 4 patients, the outcome was very favorable, with one clear regression in tumor size and infiltration and 3 partial regressions. Many side effects were noted, including nausea, muscle cramping, dysgeusia resulting in significant weight loss, and malnutrition in the elderly patients. The treatment had to be discontinued after 11months in the patient with total macroscopic regression because of major side effects. The treatment is still underway for the other patients and will be continued as long as a clinical benefit is observed. The treatment will be discontinued if intolerable side effects develop. Oral chemotherapy (sonidegib) is an effective alternative treatment when surgery cannot be realized, especially in the case of extensive infiltrative non-metastatic BCC.

[Retained lens fragments after cataract surgery: Comparison of same-day versus delayed vitrectomy]. / Vitrectomie pour luxation postérieure de fragments cristalliniens après chirurgie de la cataracte : étude comparative.

PURPOSE: To evaluate and to compare functional outcomes and complication rates of the same-day versus delayed pars plana vitrectomy (PPV) for intravitreal retained lens fragments after cataract surgery. METHODS: Retrospective comparative series of 135 eyes with retained lens fragments that underwent PPV between August 2014 and July 2016. Sixty-two eyes received same-day PPV (group 1) and seventy-three eyes underwent delayed PPV (group 2). Outcome measures included best-corrected visual acuity (BCVA) at 6 months and postoperative complications. RESULTS: The mean time to PPV in group 2 was 4.3±5.3 days. Mean axial length, lens fragment size and surgical technique were comparable in both groups. At 6 months, BCVA was 0.27±0.40 logMAR in group 1, and 0.35±0.30 logMAR in group 2, with no significant difference (P=0.205). Fifty-one (82.2%) eyes in group 1 and 53 (72.6%) eyes in group 2 achieved BCVA of+0.30 logMAR (20/40) or better (P=0.183). The most common complications were macular edema, elevated intraocular pressure>25mmHg, and retinal detachment occurring respectively in 10 (16.1%) eyes, 4 (6.4%) eyes and one eye (1.6%) in group 1 and 11 (15.0%) eyes, 5 (6.8%) eyes and 2 (2.7%) eyes in group 2. Overall, the complication rate was similar in both groups (P=1). CONCLUSION: Our study shows that visual acuity outcomes and complication rates were similar regardless of timing of the PPV. The optimal timing of surgery remains a multifactorial decision involving patient preferences, transportation, surgeon availability and severity of the initial presentation.

Study of retinal structure and function in patients with major depressive disorder, bipolar disorder or schizophrenia: A review of the literature.

Major depressive disorder, bipolar disorder and schizophrenia are currently among the most common psychiatric disorders, known to constitute a serious public health issue in terms of morbidity, mortality and functional handicap. Their pathophysiology is still unclear, but there is now increasing evidence supporting the existence of abnormalities of neurotransmission. As the retina is an extension of the central nervous system, it may be an interesting site of study which might provide a better understanding of the pathophysiology of psychiatric disorders. Several studies have demonstrated retinal abnormalities, with abnormal cone and rod responses on electroretinography (ERG), suggesting a process of functional neuronal loss, structurally supported by a decrease in the retinal nerve fiber layer thickness (RNFL) on optical coherence tomography (OCT), which suggests involvement of the molecular signal pathways of neurotransmission. These tests could be useful tools for diagnosing and monitoring psychiatric disorders. This article is an overview of the literature on retinal abnormalities observed in patients with major depressive disorder, bipolar disorder or schizophrenia, and discusses how they could be pathophysiologic markers.

[Retinal investigations in patients with major depressive disorder, bipolar disorder or schizophrenia: A review of the literature]. / Étude de la structure et de la fonction rétinienne chez les patients atteints de trouble dépressif sévère, de trouble bipolaire ou de schizophrénie : une revue de la littérature.

Major depressive disorder, bipolar disorder and schizophrenia are currently among the most common psychiatric disorders, known to constitute a serious public health issue in terms of morbidity, mortality and functional handicap. Their pathophysiology is still unclear, but there is now increasing evidence supporting the existence of abnormalities of neurotransmission. As the retina is an extension of the central nervous system, it may be an interesting site of study which might provide a better understanding of the pathophysiology of psychiatric disorders. Several studies have demonstrated retinal abnormalities, with abnormal cone and rod responses on electroretinography (ERG), suggesting a process of functional neuronal loss, structurally supported by a decrease in the retinal nerve fiber layer thickness (RNFL) on optical coherence tomography (OCT), which suggests involvement of the molecular signal pathways of neurotransmission. These tests could be useful tools for diagnosing and monitoring psychiatric disorders. This article is an overview of the literature on retinal abnormalities observed in patients with major depressive disorder, bipolar disorder or schizophrenia, and discusses how they could be pathophysiologic markers.

[Treatment of hematomas in age related macular degeneration by vitrectomy and subretinal injection of r-tPA: Preliminary results (French translation of the article)]. / Traitement des hématomes de la dégénérescence maculaire liée à l'âge par vitrectomie et injection sous-rétinienne de rt-PA : résultats préliminaires.

PURPOSE: To evaluate anatomical and functional outcomes of surgical displacement of macular hemorrhages complicating exsudative age-related macular degeneration (AMD) after vitrectomy, subretinal rtPA (recombinant tissue plasminogen activator) injection, intravitreal bevacizumab injection and gaz tamponade. METHODS: Retrospective case series, including 26 patients with submacular hemorrhage, who underwent a surgical displacement within 15 days after the onset of symptoms. Optical coherence tomography (OCT) was carried out to measure the diameter of the hemorrhage and to specify the relation with retinal pigment epithelium. Anatomical success was defined as a total displacement of the hemorrhage away from the fovea at first postoperative visit. Visual acuity improvement was measured at 1 and 6 months and at final postoperative visit. RESULTS: The procedure resulted in hemorrhage displacement away from the fovea in 20 eyes (81%). Visual acuity significantly improved by 5,8 (±7,2) lines (P=0.0003) at 1 month postoperatively, 7,4 (±6,7) lines (P=0.0004) at 6 months and 7,4 (±7,4) lines (P=0.0002) at final postoperative visit (16,5±19,8 months). There was an inverse correlation between hemorrhage diameter and final acuity improvement (Pearson correlation coefficient P=-0.60 (IC 95% [-0.81; -0.26]; P=0.002)). CONCLUSION: Vitrectomy with subretinal rtPA injection was found to be effective for the displacement of AMD hemorrhage in 81 % of the patients. Mean final visual acuity improved by more than 7 lines.

[Treatment of noninfectious intermediate uveitis, posterior uveitis, or panuveitis]. / Traitement des uvéites intermédiaires, postérieures et panuvéites non infectieuses.

Controlling long-term inflammation during non-infectious intermediate, posterior or panuveitis while limiting side effects remains challenging. There is no standardized pre-therapeutic evaluation providing diagnostic certainty, but some simple tests allow us to identifiy the main etiologies. The ophthalmologist identifies the type of uveitis, and the internist completes the investigations according to the ophthalmologist's findings. Fundus photographs, optical coherence tomography, and fluorescein and indocyanine green angiography should be considered during diagnosis and follow-up. Ocular complications of uveitis are numerous. They require close monitoring and specific medical and sometimes surgical management. The growing number of available drugs makes it possible to optimize the management of these conditions with varied etiologies and presentations. Currently, systemic corticosteroids remain the mainstay of therapy, and other alternatives are considered in the case of poor tolerance, steroid resistance or dependence. The choice of a systemic, periocular or intravitreal treatment depends on several factors: chronicity or recurrence of uveitis, duration, bilaterality, association with a systemic inflammatory disease, the presence of contraindications to certain treatments, and also socioeconomic constraints. It is of the utmost importance to find the best compromise allowing tight control of ocular inflammation by means of adapted systemic and/or local treatment while avoiding the main complications.

Treatment of hematomas in age related macular degeneration by vitrectomy and subretinal injection of r-tPA: Preliminary results.

INTRODUCTION: Macular subretinal hematoma is a complication of age related macular degeneration (AMD) responsible for a severe change in vision. We evaluated anatomic and functional results of surgical treatment of hematoma by vitrectomy, subretinal injection of r-tPA (recombinant tissue plasminogen activator), intravitreal bevacizumab injection and air tamponade. METHODS: Retrospective case series including 26 patients with submacular hemorrhage who underwent vitrectomy within 15 days after the onset of symptoms. Optical coherence tomography (OCT) was performed to measure the diameter of the hemorrhage and specify the location in relation to the retinal pigment epithelium. Anatomical success was defined as a total displacement of the hemorrhage out of the fovea at the first postoperative visit. Visual acuity improvement was measured at 1 and 6 months and at final postoperative visit. RESULTS: The procedure resulted in hemorrhage displacement away from the fovea in 20 eyes (81%). Visual acuity significantly improved by 5.8 (±7.2) lines (P=0.0003) at 1 month postoperatively, 7.4 (±6.7) lines (P=0.0004) at 6 months and 7.4 (±7.4) lines (P=0.0002) at the final postoperative visit (16.5±19.8 months). There was an inverse correlation between hemorrhage diameter and final acuity improvement (Pearson correlation coefficient ρ=-0.60 (IC 95% [-0.81; -0.26]; P=0.002)). CONCLUSION: Vitrectomy with subretinal r-tPA injection was found to be effective for the displacement of AMD hemorrhage in 81% of the patients. Mean final visual acuity improved by more than 7 lines, confirming the efficacy and functional benefit of surgical displacement.

[Epidemiologic and etiologic patterns of uveitis in a University Hospital]. / Caractéristiques épidémiologiques et étiologiques des uvéites dans un centre hospitalier universitaire.

INTRODUCTION: The purpose of this study was to describe the epidemiologic characteristics of adult uveitis evaluated at the regional center of excellence specializing in systemic and autoimmune disease in the Nancy university medical center. The secondary objectives were to describe the progression over time of the various etiologies and to identify local specificities. MATERIALS AND METHODS: We performed a retrospective epidemiological study of patients diagnosed with uveitis. All patients were referred to the regional center of excellence of the Nancy university medical center between January 1, 2005 and December 31, 2016. Patients under 18 years of age, patients with a first episode of acute anterior uveitis, as well as patients for whom the etiological diagnosis was made by the ophthalmologist with no need of internal medicine referral, were excluded. Age, gender, laterality, site of inflammation, clinical signs, etiology (infectious, non-infectious or idiopathic, as well as diagnosis), and date of first consultation were recorded. RESULTS: Six hundred and ninetypatients were included, with 59 % women and a mean age of 49 years. The uveitis was unilateral in 53 % of cases. Panuveitis was the most common form (52 %, N=358), followed by recurrent anterior uveitis (30 %, N=205), posterior uveitis (16 %, N=107), and intermediate uveitis (3 %, N=20). Non-infectious etiologies accounted for 35 % of all uveitis (the most common being HLA-B27 uveitis, sarcoidosis, ankylosing spondylitis and Behçet's disease) and infectious etiologies for 13 % (tuberculosis, toxoplasmosis and Lyme disease were the most frequent). The uveitis was idiopathic in 52 %. A trend toward improvement in diagnostic yield was observed : 53 % of uveitides were considered idiopathic prior to 2011 compared to 50 % after 2011 (P<0,01). CONCLUSION: We identified a majority of panuveitis, which is explained by our inclusion criteria. Fifty-two percent of our series remained idiopathic, with an improvement in the diagnostic yield over time. This could be related to both repeated etiological assessments and better diagnostic performance. The study of this large cohort of patients improved our knowledge of the characteristics of uveitis in our center.

[EyeSi surgical simulator: Construct validity of capsulorhexis, phacoemulsification and irrigation and aspiration modules]. / Simulateur de chirurgie de cataracte EyeSi : validité de construction des modules capsulorhexis, phacoémulsification et aspiration des masses cristalliniennes.

PURPOSE: To compare performance on the EyeSi surgical simulator in 3 training modules by users with different levels of experience in ophthalmology. METHODS: We included 18 surgeons (6 residents with no cataract experience, 6 residents with little experience (1 to 10 cases) and 6 experienced cataract surgeons (over 500 cases). Three modules were selected (capsulorhexis, phacoemulsification-cracking and irrigation and aspiration). All subjects completed 12 levels of increasing difficulty twice, and the results of the second trial were analyzed according to the surgeon's experience. RESULTS: For the capsulorhexis module, experienced surgeons achieved higher total scores than the other 2 groups in exercise 1 (P=0.0102). For the phaco-cracking module, experienced surgeons achieved higher total scores in exercise 8 (P=0.0495) and a tendency toward significance in exercises 3 (P=0.0934) and 5 (P=0.0938). Participants with greater experience had lower total task time in exercises 1 (P=0.0444), 4 (P=0.06) and 5 (P=0.0189). CONCLUSION: Experienced surgeons outperformed residents with regard to overall score in 4 exercises of the capsulorhexis and phaco-cracking modules. Our results confirm previously demonstrated construct validity for these modules on the EyeSi simulator. These findings will help in the development of relevant training programs that could potentially be applied to the standard ophthalmological curriculum.

[Epidemiology of patients with eye-related emergencies in a university hospital: A cross-sectional study identifying factors associated with true emergency]. / Caractéristiques des patients examinés en urgence par un ophtalmologiste dans un CHU : résultats d'une étude transversale analytique identifiant des facteurs associés au caractère de véritable urgence.

PURPOSE: To describe epidemiological characteristics of outpatients examined by university medical center ophthalmologists in emergency rooms (ER), and to determine factors associated with true emergencies. METHODS: A monocentric cross-sectional study including all patients examined by an ophthalmologist in the ER of in the university hospital of Nancy over a two-month period was conducted. Demographics and medical characteristics were assessed. The visits were categorized by ophthalmologists as true emergencies or not. RESULTS: Among the 1,308 patients included, the median (IQR) age was 49 (32-64) years, and 56 % were males. The main reasons for seeking care were eye redness (32.6 %), eye pain (30.0 %), eye trauma (26.1 %), and visual loss (23.3 %). Nearly 40 % of the consultations were judged as not truly emergent. Factors significantly associated with true emergencies were: age under 60, male gender, some reasons for seeking care (visual loss, eye redness, eye pain), and a period of less than 3 days between symptom occurrence and the ER visit. CONCLUSION: The proportion of non-emergent ER visits was relatively high, and factors associated with true emergencies have been identified in our study. Standardized protocols may be useful to help emergency physicians and nurses to determine when to refer a patient to an ophthalmologist.

[Outpatient management without day 1 clinical follow-up of patients undergoing uncomplicated filtering surgery]. / Prise en charge ambulatoire sans contrôle clinique à j1 de patients opérés d'une chirurgie filtrante non compliquée en peropératoire.

INTRODUCTION: Although the general increase in ambulatory surgery allows for a 20% reduction in costs of hospitalization, the necessity of a day 1 postoperative visit remains the main problem for elderly patients or those who reside at considerable distance. For these reasons, in 2014, we decided to only see patients with uncomplicated filtering surgery at D5 and D21 and to replace the D1 visit with a telephone call. The primary goal of our study was to analyze a population of patients undergoing uncomplicated filtering surgery who were not seen at D1 and to describe the frequency of postoperative complications, intraocular pressure results and therapeutic management at D5 and D21. PATIENTS AND METHODS: This was a retrospective monocentric study in the department of ophthalmology. All patients (naïve of surgical treatment for glaucoma) underwent surgery for primary open-angle glaucoma in an ambulatory surgery unit between May 2014 and July 2016. A nurse made a phone call to the patients at day 1 and they responded to a standardized questionnaire. Depending upon their responses, the patients were seen quickly (<24hr) or on the systematic schedule at day 5 and day 21. RESULTS: One hundred and forty-four eyes (126 patients) were included in our study. The mean preoperative IOP was 20.4±6.4mmHg. After the phone call, only five patients were examined before the first planned follow-up at day 5. For 3 of them, the examination revealed the presence of a hyphema, and their topical medication was changed. The other two patients had no treatment modifications. At day 5, the mean IOP was 10.6±5.9mmHg. Thirty-two eyes (22.2%) required a change in their medication at day 5. The mean IOP at day 21 was 12.9±4.6mmHg. Our success rate (IOP<21mmHg with no topical medication) at day 21 was 95.6%. DISCUSSION: The guidelines for filtering glaucoma surgery recommend examining the patient at day 1 (or at least before day 3), day 8, day 15 and day 30 or more frequently according to the case. We replaced the day 1 visit with a telephone call. We did not note a substantial rate of complications due to the elimination of the D1 visit. The criteria of success of filtering glaucoma surgery vary in the literature, but our success rate at D21 seems to be similar that in the literature and may suggest that the day 1 visit is not necessary if the surgery for primary open angle glaucoma is uncomplicated.

Analysis of tissue chimerism in nude mouse brain and abdominal xenograft models of human glioblastoma multiforme: what does it tell us about the models and about glioblastoma biology and therapy?

In situ hybridization coupled to immunohistochemistry for antigens of interest allows unequivocal identification of tumor cells from reactive stroma cells and normal adjacent structures in human glioblastoma multiforme grafts transplanted into nude mice. With this methodology, we have explored the development of glioblastoma multiforme solid grafts transplanted into nude mouse brains or flanks. The brain transplants closely resembled the human situation, particularly in relation to differentiation and growth patterns. The morphological features of peritumoral reactive gliosis were similar to those observed in humans. A mouse glial stroma within the main tumor masses was also demonstrated. Kinetic studies showed that the compartment of isolated tumor cells that infiltrated host brains and the reactive gliosis constituted two cycling cell populations. Despite VEGF protein expression by tumor cells and some reactive astrocytes, the abnormally permeable microvascular beds were not hyperplastic. The observation of a non-infiltrative pattern of growth when grafts were established in host flanks demonstrated that the organ-specific environment plays a determining role in the growth and invasive properties of glioblastoma. The phylogenetic distance between man and mouse and the recipient immunoincompetence should not impose serious limitations on the use of this model for studying malignant glioma biology and therapy in vivo.

Models for neuro-oncological preclinical studies: solid orthotopic and heterotopic grafts of human gliomas into nude mice.

To study the optimum therapeutic modalities for treating human malignant brain tumors in vivo without ethical limitations, a model of heterotopic and another of orthotopic xenografting into nude mice were developed. For the first implantation, 11 human high-grade gliomas and 4 low-grade tumors were microsurgically grafted on epigastric vessels. The 11 high-grade gliomas, but no low-grade tumors, were established into nude mice. Afterwards, all these mouse-adapted gliomas which grafted into other nude mice developed. Introduction of a microcatheter into the femoral artery or vein permitted infusion for magnetic resonance imaging (MRI) and treatment. A bladder catheter setting and electrode implantation allowed urine sampling and ECG or EEG recording. Thus, the most important parameters of chemo- and radiotherapy to destroy a maximum number of malignant cells or to inhibit their divisions and the hosts reactions to treatment can be studied. The human gliomas transplanted onto the mouse brain infiltrated the host brain at great distances from the tumor, as in human patients. So, this second implantation constitutes a representative model of the evolution of human gliomas, and allows the study of malignant cell migration in the brain before, during and after treatment determined with the heterotopic model and to appreciate the tolerance of the colonized brain to these treatments. Echography and MRI allowed us to follow the macroscopic evolution with or without treatment of the malignant brain tumors transplanted onto mouse brains. It should now be possible to undertake the same clinical studies on patients after appropriate consideration of ethical and scientific constraints.

Severity of diabetic retinopathy is linked to lipoprotein (a) in type 1 diabetic patients.

To determine the relationship between plasma Lp(a) concentration and the risk of developing diabetic retinopathy, 341 Type 1 diabetic patients underwent an annual retinal fluorescein angiography and were assigned to one of 3 groups according to the stage of their diabetic retinopathy: no retinopathy (NR), non-proliferative diabetic retinopathy (N-PDR), or proliferative diabetic retinopathy (PDR). One hundred and twenty-three Type 1 diabetic patients had no retinopathy, 188 had N-PDR and 30 had PDR. The ages of the three groups and the duration of diabetes were significantly different. Hypertension, microalbuminuria and diabetic nephropathy were more frequent in PDR than in NR or N-PDR (p < 0.0001). Plasma HbA1c was higher in PDR than in NR or N-PDR (p < 0.01). Type 1 patients who had been diabetic for at least 20 years included 30 NR, 108 N-PDR and 24 PDR. Type 1 diabetic patients with PDR had microalbuminuria and macroproteinuria more frequently than other patients (p < 0.0001 and 0.01, respectively). Type 1 diabetic patients with PDR had the highest median plasma Lp(a) and the highest frequency of Lp(a) above 30 mg/dl (p < 0.05). Multivariate analysis carried out in Type 1 diabetic patients with a duration of diabetes of at least 20 years showed that microproteinuria, HbA1c and Lp(a) accounted significantly for 21% of variance in retinal status. Lp(a) above 30 mg/dl was related to the risk of developing PDR (OR = 8.40, p < 0.05). Lipoprotein(a) appears to be associated with the severity of diabetic retinopathy in Type 1 diabetic patients, and particular attention should be paid to those with Lp(a) above 30 mg/dl and pre-proliferative retinopathy.

What has become of our idiopathic inflammatory pseudo-tumors of the orbit?

OBJECTIVE. We looked for the development of specific systemic disease or malignant lymphoma in patients whose initial diagnosis was idiopathic inflammatory pseudo-tumor of the orbit (IOPT). PATIENTS AND METHODS. IOPT was diagnosed in 24 patients on the basis of imaging findings and surgical biopsies (70%). Nineteen of these 24 patients (10 men and 9 women, age range 19- 83 years) were reassessed 1-12 years after the initial diagnosis. RESULTS. The initial diagnosis described diffuse inflammation (33%), dacryoadenitis (20%) or myositis (47%). At reassessment, 4 patients had developed a specific disease: generalized lymphoma, Wegener's disease, necrotizing vasculitis, and Crohn's disease. All four were recognized within one year of the IOPT diagnosis. A biopsy was obtained in these four patients and was not contributive. One case of non-specific granulomatous proliferation was found 6 years after the initial diagnosis. One case of orbital meningioma occurred 10 years after radiotherapy of the orbit and could not be attributed to a definite cause. The other patients had a common non-specific clinical course; recurrent inflammation required corticosteroid therapy in 55% and complementary external radiotherapy of the orbit in 22%. DISCUSSION AND CONCLUSION. Specific diseases that developed after an initial diagnosis of inflammatory pseudo-tumor of the orbit occurred early and appeared more often in diffuse forms, suggesting the need for more extensive histopathological diagnostic procedures. The clinical course tended to be more quiescent in patients who passed the critical period of the first year.

[Gyrate atrophy and craniopharyngioma: a case report]. / Atrophie gyrée et craniopharyngiome: à propos d'un cas.

We report the case of a 13-year-old girl who developed a craniopharyngioma and a gyrate atrophy. No genetic link between these two diseases has ever been reported. This case recalls the characteristic features of gyrate atrophy.