[Isolated hypertrophy of the superior oblique muscle in Basedow disease]. / Hypertrophie isoleé du muscle oblique supérieur d'origine basedowienne.

INTRODUCTION: Proptosis is the most common feature of Graves' ophthalmopathy. We report an exceptional case of proptosis in relation with an isolated enlargement of the superior oblique muscle in Graves' ophthalmopathy. OBSERVATION: After ocular contusion a 37 years old man presented a progressive right exophthalmos. On examination there was an unilateral proptosis with dilated conjunctival vessels, without any clinical signs of inflammation and no decreased vision. Ocular movements were full. On general examination signs of hyperthyroidism were present. CT-scan showed a superior oblique muscle enlargement with enlarged superior ophthalmic vein. Cerebral angiography excluded the diagnosis of a carotid-cavernous fistula. Dosage of thyroid hormone revealed hyperthyroidism. DISCUSSION: This case has a double interest: --Diagnostic: a CT-scan picture mimicking a carotido-cavernous fistula in this particular clinical context (history of ocular trauma, enlarged conjunctival vessels). --Isolated enlargement of superior oblique muscle in Graves' disease, which is exceptional in the literature.

[Diagnostic difficulties in pigmented tumor of the optic nerve head. A case report]. / Difficultés diagnostiques face à une tumeur papillaire pigmentée. A propos d'un cas.

Melanocytoma of the optic disc is a benign pigmented tumor located on the optic nerve head. Most cases are visually asymptomatic but in rare cases it can cause visual loss, which does not necessarily involve malignant transformation. We present a case of melanocytoma in a 49-year-old woman who presented with decreased vision in her left eye. The pigmented mass was in close continuity with the juxtapapillary adjacent choroid. Fluorescein angiography demonstrated hypofluorescence with adjacent disc edema. Ultrasonography disclosed a high internal reflectivity mass in the optic nerve head without retrobulbar extension. Magnetic resonance imaging (T1 weighted images) disclosed a hyperintense signal on the optic nerve head. The tumor was stationary for 20 months. This report emphasizes problems differentiating a melanocytoma from malignant melanoma of the optic nerve. Unusual features of melanocytoma (superior nasal location in the optic disc with an adjacent choroidal component, a decrease in visual acuity and disc edema surrounding the tumor) are discussed. Visual loss can be induced by optic neuropathy or retinal vascular obstruction. Melanocytomas grow very slowly over several years or remains stable, in contrast to malignant melanoma. In suspicious cases, close follow-up with serial fundus photographs is essential, although malignant transformation is exceptional.

[The eye and hepatitis C]. / Oeil et hépatite C.

Ocular diseases such as Sjögren's syndrome, Mooren's ulcer and acute retinal pigment epitheliitis have been associated with hepatitis C. We report the case of a 35-year-old male nurse with hepatitis C who developed Sjögren's syndrome which was confirmed by labial biopsy. The role of hepatitis C infection in Sjögren's syndrome was recently established, whereas in the two other diseases, its role remains obscure. Although the presence of the hepatitis C virus in the cornea is still incertain, hepatitis C serology in donor's is required before cornea transplantation can be undertaken.

[Outcome of Behçet disease in ophthalmological milieu in Morocco]. / Devenir de la maladie de Behçet en milieu ophtalmologique marocain.

We treated 123 patients with Behçet's disease during a period of 10 years (1984-1993). The ocular lesions include uveal lesions especially the posterior lesions and vascular retinal. Uveitis was total in 72% of cases. Periphlebitis occurred in 51% of cases, vein occlusion in 10% of cases, macular oedema in 16% and papillary oedema in 10%. Clinical course and prognosis were studied. The functional prognosis is poor as such lesions may lead to blindness, particularly due to papillary oedema maculopathy. The treatment used is based on immunosuppressive and corticoid steroid drugs.

[Inflammatory pseudotumor of the lacrimal gland. Apropos of 2 cases]. / Les pseudo-tumeurs inflammatoires de la glande lacrymale. A propos de 2 cas.

BACKGROUND: Inflammatory pseudotumors of the orbit are relatively common accounting for 12 to 15% of all orbital diseases. Lacrimal gland location is exceptional. CASE REPORTS: We report 2 patients aged 30 and 25 years who underwent surgery for an isodense tumor of the lacrimal gland. Immunohistochemistry revealed an inflammatory pseudotumoral process. Both patients are recurrence-free 2 years follow-up. DISCUSSION: Inflammatory pseudotumors of the orbit, particularly those located in the lacrimal gland still raise unresolved questions concerning the pathogenesis, diagnosis and treatment. CONCLUSION: Lacrimal gland localizations of inflammatory pseudotumors must be recognized due to difficulties in diagnosis and therapeutic management.

[Wolfram syndrome. Three case reports]. / Syndrome de Wolfram. A propos de 3 cas.

Wolfram syndrome is a rare disorder defined by the occurrence of diabete mellitus, diabete insipidus, optic atrophy and deafness; DIDMOAD is a commonly accepted acronym. We report 3 further cases: two girls and one boy. Their age ranged from 12 to 17 years. The diagnosis was based on the presence of juvenile diabete mellitus, bilateral optic atrophy, urologic signs, with urinary tract dilation; and deafness in two cases. The ophthalmic signs of Wolfram syndrome are progressive decrease in visual acuity, constriction of the peripheral visual field with or without central scotoma, color vision disturbances and bilateral optic disc atrophy. Diabetic retinopathy is a rare complication. The other clinical features are discussed so as to differentiate between Wolfram syndrome and other optic atrophies associated with diabete mellitus. We discuss of the pathogenic hypothesis including the mitochondrial dysfunction.

[Outcome of Behçet disease in ophthalmologic practice in Morocco]. / Devenir de la maladie de Behçet en milieu ophtalmologique marocain.

We treated 123 patients with Behçet's disease during a period of 10 years (1984-1993). The ocular lesions include uveal lesions especially the posterior lesions and vascular retinal. Uveitis was total in 72% of cases. Periphlebitis occurred in 51% of cases, vein occlusion in 10% of cases, macular oedema in 16% and papillary oedema in 10%. Clinical course and prognosis were studied. The functional prognosis is poor as such lesions may lead to blindness, particularly due to papillary oedema maculopathy. The treatment used is based on immunosuppressive and corticoid steroid drugs.

[Multilocular cyst of the kidney in a child. Value of MRI?]. / Kyste multiloculaire du rein chez un enfant. Intérêt de l'IRM?

We report one case of multilocular cyst of the kidney in one year and three months female infant who underwent echography, computed tomography and MRI before surgery. MR image accurately reflect the morphology of the tumor: the capsule is hypointense on T1-weighted images, the septa show moderate enhancement with intravenous contrast. Varied intensities from fluid in the visualised locules presumably represent different concentration of proteins. MR imaging features are highly suggestive but non pathognomonic of the disease. Positive diagnosis always require histology.

[Retinal vasculitis]. / Les vascularites retiniennes.

PURPOSE: The purpose of this study is to determine aetiologies of vasculitis of retina in Morocco. MATERIAL AND METHODS: This is a retrospective study on 108 cases of vasculitis of retina admitted in the ophthalmology department, for a 5-year period (1987-1993). Our patients had a complete ophthalmological examination : fluorescine angiography, colour vision, general examination and biological study. RESULTS: Many aetiologies have been found, predominantly Behcet's disease. The neovascularization of retina which complicates the vasculitis was detected in 30 % of our patients. A laser photocoagulation was performed on these cases, sometimes a vitrectomy was necessary when a haemorrhage of vitreous body occurred, complicating the neo-vessels of retina. The therapeutics received by our patients was based on the corticotherapy. An immunosuppression treatment was prescribed in most cases of Behcet's disease and in severe vasculitis. Outcome after treatment has been satisfactory, but many patients relapse very frequently, mainly those with Behcet's disease. CONCLUSION: Causes of vascular retinitis are variable, most of them are due to Behcet's disease.

[Uveitis and chronic intestinal inflammatory diseases: three case studies]. / Uvéites et maladies inflammatoires chroniques de l'intestin: à propos de 3 cas.

INTRODUCTION: The most frequent inflammatory chronic bowel diseases are Crohn disease and ulcerative colitis, which present extra intestinal manifestations, particularly, arthritis and ocular inflammation. Anterior uveitis is the main ocular manifestation and remains exclusively an inflammatory process. MATERIAL AND METHODS: [corrected] We report three cases of bilateral uveitis, with ulcerative colitis in two cases and Crohn disease in the last case. In the two first cases, uveitis occurred after 8 years of bowel disease which was stabilized by sulfasalazopyridine and 6 months after bowel surgery. In the third case, the patient was followed for Crohn disease for 3 years with anterior uveitis relapse concomitant to bowel relapse. RESULTS: In the two first cases, there was no recurrence after corticosteroids topical therapy. In the third case, topical and systemic corticosteroids provided adequate control of ocular inflammation, but the follow-up was marked by pupillary and inflammatory glaucoma, which required gonio-surgery. DISCUSSION: Anterior uveitis is the most frequent ocular manifestation in chronic inflammatory bowel disease: approximately 1.9-4.9% in Crohn disease and 1.6% in ulcerative colitis. The uveitis course is synchronous with bowel relapse and its treatment requires anti-inflammatory agents. Nevertheless, in severe relapse, recovery is obtained after the resection of the entire involved bowel segment.

[Langerhans-cell histiocytosis of the orbit. A case study]. / Histiocytose langerhansienne à localisation orbitaire. A propos d'un cas.

PURPOSE: Langerhans' cell histiocytosis is a rare disease representing less than 1% of orbital tumors. METHODS: We report a case of Langerhans cell histiocytosis with orbital involvement in a 9-year-old boy. He presented with an inflammatory swelling if the left lateral orbital wall. The computed tomographic scan revealed an orbital cellular mass with lytic bone lesion within the orbital roof and intracranial enlargement. RESULTS: The cytological study after a biopsy showed infiltrates of histiocytes derived from Langerhans cells. Diagnosis was confirmed by immunohistochemistry, which identified positive staining with anti-S100 and anti-CD1a antibodies. The rapidly expanding orbital tumor, posing a threat of ocular compression as well as intracranial spreading, was treated by chemotherapy (Vinblastine) combined with a steroid. CONCLUSION: A 2-year follow-up showed no evidence of recurrence or systemic involvement. According to this observation, the authors describe the clinicopathological and histological features of orbital involvement in Langerhans cell histiocytosis.

[Cholelithiasis after stomach resection?]. / Cholelithiasis nach Magenresektion?

The prevalence of all forms of cholelithiasis in patients suffering from peptic ulceration and following partial gastric resection has been examined on the basis of analysing 28 204 autopsies from 1953 to 1979. The review of the post-mortem reports proves considerable gallstone incidence of 30,84% in the above mentioned groups of patients. There was no statistic difference with regard to the prevalence of gallstone formation in the collective as a whole, in the ulcer group or the group with partial gastric resection. Our results obtained confirm the invalidity of the term "postresection-cholelithiasis."

[Transcranial Doppler ultrasound as monitoring during carotid operation]. / Transkranielle Dopplersonographie als Monitoring während der Carotisoperation.

We describe our method of transcranial Doppler (TCD) monitoring during carotid endarterectomy (CE) procedures. During a period of 35 months we performed 257 CE with TCD monitoring. Critical flow values during crossclamping of the internal carotid artery (ICA) and the necessity of insertion of an intraluminal shunt were taken in consideration with regard to the choice of surgical procedure: TEA (with or without patching) or eversion endarterectomy. The critical flow values were around 10-15 cm/s, no pulsatility signs were detected. Further advantages of the TCD monitoring are: detection of microemboli, control of the potential collateralisation of the external carotid artery and the control of efficacy and accurate positioning of the intraluminal shunt. We comment our results of cerebral monitoring and consider it as a useful tool for optimizing the postoperative results of carotid surgery.

[Posterolateral retroperitoneal approach and exclusion technique in therapy of infrarenal aortic aneurysm: initial experiences]. / Posterolateraler retroperitonealer Zugangsweg und Exklusionstechnik zur Therapie des infrarenalen Aortenaneurysmas: erste Erfahrungen.

Although the infrarenal aorta is a retroperitoneal structure, the surgical access has been transperitoneal especially when dealing with infrarenal aneurysms. After the opening of the sack a tube-or bifurcated graft is implanted. With the posterolateral retroperitoneal (RP) approach described by G.M. Williams in 1980 access to the aorta can be gained without opening the peritoneal cavity. With the non resective exclusion technique the intraoperative blood loss is minimized. This method is routinely used in Albany N.Y. for the treatment of infrarenal aneurysms. We describe here our first experiences with 44 RP excluded aortic aneurysms. Despite the small number of cases we can confirm the advantages described in the larger series of Sicard et al. and Leather and Shah: the RP approach and the exclusion technique can be routinely used for infrarenal aneurysms. It is associated with a smoother and shorter postoperative period (8 to 10 days).