[Isolated occlusion of a cilioretinal artery]. / Occlusion isolée d'une artère cilio-rétinienne.

PURPOSE: Isolated cilioretinal artery occlusion is uncommon but has characteristic features. Based on a case report and a review of the literature, we present the clinical findings and angiographic particularities of this syndrome and discuss controversial pathophysiological data. CASE REPORT AND METHOD: A 56-year-old man had sudden visual loss in the right eye estimated at 3/10 P10. Fundus examination showed areas of retinal interpapillomacular infarction due to cilioretinal artery occlusion. Fluorescein angiography demonstrated delayed filling and emptying of this artery. Left fundus examination was normal. RESULTS: Systemic examinations revealed severe hypertension (240/130) rapidly controlled with a two-drug regimen. The clinical course was good with normalization of fundus and angiography, and visual recovery to 8/10 P3 with a small absolute paracentral scotoma. DISCUSSION: The few cases described would offer an explanation of the low prevalence of cilioretinal arteries and the more frequent association with central retina venous obstruction which can mask arterial occlusion. A relative reversible occlusion explains the generally good prognosis especially if the capillary network is not affected by the occluded artery as was observed in our case. CONCLUSION: Although diagnosis of isolated cilioretinal artery occlusion is made without difficulty, the underlying pathogenic mechanism remains difficult to explain due to the various phenomena revealed by the increased arterial pressure.

[Posterior fractures-dislocations of the upper end of the humerus. Apropos of a series of 11 cases]. / Les fractures-luxations postérieures de l'extrémit

e supérieure de l'hujérus. A propos d'une série de 11 observations

[Associated homolateral fractures of the neck and shaft of the femur]. / Fractures associées homolatérales du col et de la diaphyse fémorale

The authors have reviewed 25 cases of associated fractures of neck and shaft of the same femur. Some were treated conservatively, others were operated on. They conclude that the best treatment should be surgical on both foci. They recommend nailing of the shaft, the nail being introduced in the anterior aspect of the greater trochanter, and screwing of the neck, the screws being located behind the nail. In cases of low diaphyseal fractures plating was used. However a high rate of non-unions was noted in such cases.

[Blind nailing of trochanteric fractures using the Ender method (author's transl)]. / L'enclouage à foyer fermé des fractures trochantériennes par clous élastiques de Ender, introduits par voie supra condylienne interne: bilan clinique de 204 interventions.

After trochanteric fractures, the rate of survival of old patients was best when treated by the Ender method: 15% died during 3 months following the fracture. The procedure is uneasy and an excellent radiologic technique is necessary. The position of the proximal end of the first nail in the femoral head is most important. Excessive external rotation was frequent, but little desabling. Secondary displacement of the nails toward the distal end occurred in 25% of the cases and was difficult to avoid but remained moderate. The procedure is indicated in old people with porotic bones. It should not be done in subtrochanteric fractures.

[Recent fractures of the humeral diaphysis. Apropos of a continuous series of 200 cases, of which 107 were treated with a hanging cast alone. (Arterial intra-osseous vascularization of the humerus)]. / Fractures récentes de la diaphyse humérale. A propos d'une série continue de 200 observations dont 107 traitées uniquement par le plâtre pendant (Etude de la vascularisation artérielle intra-osseuse de l'humérus)

Were reviewed 200 fractures of humeral diaphysis, two cases have been excluded because they were incomplete; 175 patients out of 200 have been reexamined a long time after; 23 have not been reexamined but held a sufficient follow up. Most of the transversal fracture were met among young adults (56 per 100 traffic accidents). The intraosseous vascularisation was studied elucidating partly the greatest frequency of pseudarthrosis in the part 1/3 middle-1/3 inferior especially after exaggerated periostal elevation. Among 107 cases treated by hanging cast were noted 4 pseudarthrosis, 12 shoulder's stiffnesses. Traction or external fixation were rarely useful (comminuted fractures, burns). Surgical procedures were rarely necessary because this type of fracture usually united with good result after conservative treatment. The outcomes of 40 osteosynthesis were examined and non-unions were noted. Vascular (4 out of 200) and nervous (29 out of 200) complications were also noted.

[Combination of methylmethacrylate (acrylic cement) and antibiotics. Bacteriologic and mechanical study]. / Association méthacrylate de méthyle (ciment acrylique) et antibiotiques. Etude bactériologique et mécanique.

The authors report the results of a study about the association of acrylic cement with antibiotics. Three cements have been tested: Simplex, CMW, Palacos, with 14 different antibiotics. A series of experiments has been carried out in three phases: a macroscopic study of the polymerisation of the mixture; in vitro bacteriological studies; and mechanical studies (trials of resistance to traction, flexion, shock measuring the modulus of elasticity and hardness). In vivo bacteriological testings have been carried out on 10 patients. It has come out from this study that the polymerisation of cement, usually does not destroy antibiotics which remain active and that the mechanical properties of cement are modified in sundry manners. All additions of tested antibiotics modifie mechanical properties by about 25 p. 100 but some additions seem to be preferable. Improvements must still be made and confirmed by this type of research.

[Lumbar venography in the diagnosis of disc herniation (author's transl)]. / Apport de la phlébographie lombaire dans le diagnostic des hernies discales.

The authors have performed lumbar venography on 120 occasions in patients with low back pain. In 58 patients in whom the herniated disc was confirmed, the result of venography was positive and the localisation was precise in 67 cases. It is concluded that the method is safe, reliable and allows precision in diagnosis to allow better selection for surgical treatment. The examination is particularly useful in recurrent sciatica, fractures of the lumbar spine, recent or old, and in spinal stenosis. It may be associated with discography when the result is not clear cut.

[Fracture of the odontoid process (author's transl)]. / Fractures de l'apophyse odontoïde (dens) de l'axis. 102 cas dont 73 fractures récentes.

102 cases of fractures of the odontoid process have been seen by the author - 73 recent cases and 29 old ones. It was important to distinguish basal fractures (29 cases), which all united after conservative treatment by reduction and skull traction for six weeks followed by a plaster cast for six to eight weeks, and fractures of the body (44 cases). 41 body fractures were treated conservatively, of which 6 died and only 20 united. The authors consider that treatment by skull traction must always be tried. An eventual indication for surgery can be made at about the 20th day if displacement is found to be present in spite of treatment. Fusion in these cases must be limited to C1-C2. It is best obtained by a combination of wiring and grafting.

[Ocular phototoxicity and altitude among mountain guides]. / Phototoxicité oculaire et altitude chez des guides de haute montagne.

PURPOSE: This study aimed to evaluate ocular phototoxicity in mountaineer guides who experience overexposure to ultraviolet related to the altitude at which they work, as well as light reflection on snow. MATERIALS AND METHODS: Ninety-six guides and 90 controls living in plains, over 50 years old, underwent complete examinations. They responded to a questionnaire assessing altitude exposure and protective eyewear. We compared the two groups and performed a logistic regression within the guide group so as to identify risk and protective factors. RESULTS: Guides develop more ocular surface diseases. They exhibit more anterior cortical cataract (P<0.01) and cataract surgery (P=0.01). Only 61.5% of guides had a normal ocular fundus versus 81.1% in control group (P<0.01). They exhibit more drusen (27.2% vs. 15.6%, P<0.01). Among the guide group, exposure at an altitude above 3000 m is risk factor for anterior cortical cataract (OR=1.16, P<0.01). Wearing ski masks (OR=0.50, P=0.04) or photochromic lenses (OR=0.53, P=0.03) reduces this risk. Exposure to snow increases the risk of maculopathy (OR=1.9, P<0.01). Wearing a hat reduces this risk (OR=0.40, P=0.02) and the risk of cataract formation (OR=0.46, P=0.04). CONCLUSIONS: Guides develop more ocular surface diseases, anterior cortical lens opacities and drusen. These results underscore the potential deleterious role of ultraviolet radiation and the importance of light reflection on snow. The best ocular protection includes sunglasses and a hat with a visor or brim.

[Comparison between Lenstar LS 900 non-contact biometry and OcuScan RXP contact biometry for task delegation]. / Comparaison de la biométrie sans contact cornéen par LENSTAR LS 900 et de la biométrie contact par OCUSCAN RXP dans le cadre de la délégation de tâches.

INTRODUCTION: Non-contact biometers have many advantages including the delegation of tasks to orthoptists. This study analyses the reliability of measurements comparing contact and non-contacts techniques. PATIENTS AND METHODS: Comparative measurements were taken on 86 eyes of 45 patients (mean age: 74 years; 44.4 % males) in preoperative phacoemulsification by three orthoptists with experience in this task. Each patient had non-contact measurements (Lenstar LS 900, Haag-Streit) and contact measurements (corneal biometry and ultrasound pachymetry with OcuScan RXP, Alcon) and a keratometry refractometer (TONOREF II, Nidek). The axial length data, pachymetry, power of the intraocular lens (SRK/T formula), anterior chamber depth, and the average keratometry were analyzed by paired comparisons. RESULTS: The non-contact biometer was ineffective in 5.8 % of cases (Parkinson's disease, two cases; dense posterior subcapsular cataracts, three cases). The non-contact pachymetry was statistically significantly higher (546.4 µm vs. 538.6 µm; p<0.001). The axial length was significantly longer for the non-contact measurement (23.21 mm vs. 23.05 mm; p<0.0001). In 25.9 % of patients, this difference was greater than or equal to 0.3mm and affected the power of the implant chosen. The anterior chamber depth measured on non-contact biometry was statistically greater (3.33 mm vs. 3.03 mm; p<0.0001). However, there was no significant difference regarding the average keratometry (43.82 D vs. 43.78 D; p=0327). CONCLUSION: Besides the infectious benefit for patients, absence of cleaning and decontamination of biometric probes, non-contact measurements using Lenstar are an example of a safe activity that can be delegated to assistants. This technique has been used to optimize the refractive outcome of 25.9 % of our patients undergoing refractive cataract surgery.

[Susac syndrome: variable onset modes and disease courses: two case reports]. / Syndrome de SUSAC. Modes d'entrée et évolutions variables: à propos de deux cas.

INTRODUCTION: Susac syndrome is a rare microangiopathy of unknown etiology, which involves the clinical triad of encephalopathy, visual loss, and hearing loss. Several onset and progression patterns are possible. OBSERVATION: Case 1: a 43-year-old woman developed subacute encephalopathy, which had not been diagnosed and had been evolving for 2 months, as well as left sensorineural hearing loss. The fundus exam found central artery branch occlusion in the left retina. The treatment was based on corticosteroids combined with cyclophosphamide and immunoglobulins. Angiographic monitoring revealed persistent asymptomatic arterial alterations despite positive neurological progression. Case 2: a 27-year-old woman presented visual loss in the right eye after recurrent neurological episodes. The triad was completed by deafness in the right ear. Treatment with corticosteroids led to favorable neurological progression and stabilized the ophthalmologic symptoms. DISCUSSION: This syndrome preferentially affects young women. The nearly constant neurological symptoms can differ. Branch occlusions are frequently bilateral and often come with the appearance of vasculitis. Deafness is bilateral, asymmetrical, and of endocochlear origin. Brain MRI shows lesions of the corpus callosum that are distinctive of the syndrome. The disease mainly evolves in a monocyclic way, self-limited in time, and it rarely becomes chronic. Treatment, which has not been codified to date, is based on corticosteroids and, in severe cases, immunosuppressive drugs. Other therapies have not proved to be effective. CONCLUSION: The diagnosis is based on the triad of neurological, ophthalmic, and ENT damage, but sometimes it can be difficult to formulate because of the chronology of symptom onset. Neurological damage, the first manifestation, will help make therapeutic decisions.