[Anatomic variations in the ethmoid sinus in patients undergoing dacryocystorhinostomy at the Hassan II de Fès Medical Center (study of 215 patients)]. / Variations anatomiques du sinus ethmoïdal des patients opérés de dacryocystorhinostomie au centre hospitalier Hassan II de FES (étude de 215 patients).

INTRODUCTION: Although several studies have tried to identify the causes of failure of dacryocystorhinostomy (DCR) surgery, the ethmoid sinus remains an underestimated and little described source of failure. OBJECTIVE: To study anatomical relationship between the ethmoidal sinus, particularly the "Agger nasi" cell, with the lacrimal fossa in the North African population, little described in the literature. This study is based on the results of preoperative analysis of dacryo-computed tomography. PATIENTS AND METHODS: Analysis of preoperative computed tomography images of patients undergoing dacryocystorhinostomy over a 7-year period from January 2011 to December 2017. Anatomical relationships were studied according to the following classification: type I: No ethmoid cells located anteriorly to the posterior lacrimal crest on transverse images; type II: ethmoidal cells extending anteriorly to the posterior lacrimal crest, but not reaching the anterior edge of the lacrimal bone; Type III: ethmoidal cells located anterior to the lacrimal bone suture. RESULTS: Two hundred and fifteen preoperative computed tomography images were analyzed. The morphology of the ethmoid sinus was classified as type 1 in 33.5%, type 2 in 42.32% and type 3 in 24.18%. Computed tomography analysis was symmetrical in 87.5% and asymmetrical in 12.5%. CONCLUSION: During dacryocystorhinostomy, the surgeon must take into consideration type III, which can be present in 25% of cases. In the case of surgical failure, a dacryo-CT must be performed to rule out such anterior positioning of the ethmoid cells.

Malignant transformation of a mature retroperitoneal teratoma into adenocarcinoma.

Retroperitoneal mature teratoma is a rare congenital tumor, far behind ovarian and testicular localizations. Malignant transformation of teratomas is extremely uncommon. We report a case of a 23-year-old female, who presented with chronic pelvic heaviness, abdominopelvic ultrasound revealed a cystic mass in the right iliac fossa, initially considered as a functional ovarian cyst. Given the persistence of the patient's symptoms a pelvic MRI was requested. It showed a right retro-colic cystic unilocular with parietal nodule. The two ovaries showed normal appearance. A retroperitoneal teratoma was suggested given the retroperitoneal topography of the mass, and the presence of a tissular parietal nodule. She underwent surgery and the diagnosis was confirmed after histological study.

Atypical manifestation of a fistula between a hydatid cyst of a liver and a gallbladder: A case report.

The hydatid cyst of the liver is the most common location of hydatid disease. Complications in this form are dominated by superinfection of the cyst and rupture into the bile ducts or the peritoneal cavity. We report the case of a 54-year-old female patient with a hydatid cyst of the liver complicated by a rupture in the gallbladder revealed by urinary symptoms.

[Impact of the SARS-CoV-2 pandemic on diabetic macular edema and prognostic factors]. / Impact de la pandémie du SARS-CoV-2 sur l'œdème maculaire diabétique et facteurs pronostiques.

PURPOSE: To assess functional and anatomical consequences of the delay in intravitreal injections for diabetic macular edema (DME) patients during the corona virus pandemic lockdown in Morocco as well as to evaluate factors associated with disease progression. PATIENTS AND METHODS: This cross-sectional study included DME patients who did not complete their scheduled intravitreal bevacizumab injections during the Lockdown period (March 20, 2020 to May 20, 2020). Data recorded included age, duration of diabetes, number of previous intravitreal injections, best-corrected visual acuity, and central macular thickness before and after the lockdown. RESULTS: One hundred and fifty four eyes of 104 patients were analyzed. 57.8% were male. The mean age was 59.4±9.04 years. The mean duration of delay of intravitreal injections was 57.3±6.7 days. The mean number of intravitreal bevacizumab injections received before the lockdown was 2.29±2.1. Worsening of visual acuity was noted in 44.8% of patients and was associated with a lower number of intravitreal injections performed prior to the lockdown (P=0.001) and with glycemic imbalance (P=0.04). An increase in central macular thickness was noted in 26.6% of patients and was associated with a lower number of intravitreal injections (P=0.038). CONCLUSION: The delay in intravitreal injections during the lockdown had negative effects on visual acuity and central macular thickness in eyes with DME. Prolonged delay in intravitreal anti-VEGF injections in diabetic patients should be avoided.

[Hemifacial spasm. Etiology and management]. / Spasmes hémifaciaux. Étiologies et conduite à tenir.

INTRODUCTION: Hemifacial spasm (HFS) is an involuntary contracture of the facial muscles innervated by the ipsilateral facial nerve. We studied the etiology of these HFS. MATERIALS AND METHODS: This retrospective study included 233 patients with HFS who came to the ophthalmologist for quarterly botulinum neurotoxin A injection. Of these, we analyzed the 198 patients for whom MRI scans were performed. We recorded patient clinical data and clarified the etiology of their HFS. RESULTS: The 198 patients (62.6% women) had a mean age of 55.7±14years. An etiology was found in 52.5% of cases. In 34.5% of HFS, MRI revealed vascular compression where the facial nerve emerged from the brainstem. We specify the arteries involved. Brain tumors accounted for 1.5% of cases. MRI was normal in 64.5% of cases. In these secondary cases of HFS, we found 8.5% peripheral facial palsy, 4% post-traumatic HFS and 4% secondary to an eye injury. Stress was found in 17% of patients. DISCUSSION AND CONCLUSION: This study illustrates the need for MRI with attention to the posterior fossa in the work-up of HFS in order to identify primary HFS associated with vascular compression of the facial nerve and to rule out a rare but serious posterior fossa tumor. The treatment of HFS is based on quarterly injections of botulinum neurotoxin/A (NTBo/A), the three brands of which have market approval. The injection pattern and frequency is customized according to the results. In cases of insufficient response to injections of NTBo/A, neurosurgical microvascular decompression may be considered for cases of primary HFS.

Air bubbles in the brain: retrograde venous gas embolism in the cavernous sinus.

We present a rare case of cavernous sinuses air embolism occurring after peripheral venous catheterization. This 44-year-old lady followed for idiopathic thrombocytopenic purpura was referred to our service for vomiting and critical headaches after blood transfusion for her thrombocytopenia. Having been submitted to a brain computed tomography, this later showed air bubbles in bilateral cavernous sinuses related to cavernous sinuses gas embolism. This condition, which remains purely unusual could be fatal, where the ultimate importance that the radiologists and clinicians to be fully aware of.

[Best conditions to perform TAVI procedures]. / Les bonnes conditions pour réaliser des TAVI.

Well conditions to perform TAVI procedures are guided by ministry regulation and dedicated to centers with both on-site a cath-lab and cardiac surgery. Heart Team decision is mandatory to select patient for TAVI and local anesthesia is recommended. Conditions changes would be discuss according to increased procedures number related to indications evolution.

[Prognostic factors for idiopathic macular hole surgery: Report of 107 eyes (Approach by univariate statistical analysis)]. / Les facteurs pronostiques de la chirurgie des trous maculaires idiopathiques : à propos de 107 yeux (Approche par analyse univariée).

PURPOSE: To identify prognostic factors influencing the success of idiopathic macular hole surgery, including initial visual acuity, hole size and stage, and type of gas used for tamponade. PATIENTS AND METHODS: Retrospective single-center descriptive analysis of all patients with an idiopathic macular hole operated by the same surgeon, treated in the ophthalmology department of Mulhouse hospital, between January 2004 and July 2014. Patients whose functional and anatomical results could be confounded by the coexistence of other ocular pathologies and patients with secondary macular holes were excluded. RESULTS: We included and followed 107 eyes of 104 patients for at least 6 months. Initial closure after the first surgery was obtained in 92 eyes (85.98 %), allowing 2 groups to be defined, the cases of success and failure. Initial visual acuity, hole size, stage according to Gass, Gaudric and IVTS classifications, and presence or absence of a PVD, were statistically significant prognostic factors (P<0.05) CONCLUSION: Our univariate statistical analysis identified multiple prognostic factors. These factors may predict success and the choice of surgical technique, including whether to peel the internal limiting membrane, the choice of gas for tamponade, and postoperative positioning.

Ameliorating effects of Nigella sativa oil on aggravation of inflammation, oxidative stress and cytotoxicity induced by smokeless tobacco extract in an allergic asthma model in Wistar rats.

BACKGROUND: The comparison of smokeless tobacco (ST) exposure versus Ovalbumin (Ova) sensitized rats or asthmatic patients has hardly been studied in the literature. Thus, the present study aims to investigate the aggravation of inflammation, exacerbation of asthma, oxidative stress and cytotoxicity induced by ST. METHODS: ST was given at the dose of 40mg/kg in an allergic asthma model in Wistar rats. Furthermore, the effects of oral administration of Nigella sativa oil (NSO), at a dose of 4mL/kg/day, were investigated. RESULTS: The obtained results showed that ST clearly enhanced lung inflammation through interleukin-4 (IL-4) and Nitric oxide (NO) increased production. Actually, ST was found to intensify the oxidative stress state induced by Ova-challenge in rats, which was proven not only by augmenting lipid peroxidation and protein oxidation, but also by altering the non-enzymatic and enzymatic antioxidant status. Furthermore, the aggravation of inflammation and oxidative stress was obviously demonstrated by the histopathological changes observed in lung. In contrast, NSO administration has shown anti-inflammatory effects by reducing IL-4 and NO production, restoring the antioxidant status, reducing lipid peroxidation and improving the histopathological alterations by both protein oxidation and NSO treatment. CONCLUSIONS: Our data have proven that severe concurrent exposure to allergen and ST increases airway inflammation and oxidative stress in previously sensitized rats. They also suggest that the oral NSO treatment could be a promising treatment for asthma.

[Management of high-risk pulmonary embolism with pulmonary artery trunk mobile thrombus]. / Gestion d'une embolie pulmonaire à haut risque avec thrombus mobile du tronc artériel pulmonaire.

The presence of a right intraventricular thrombus is a marker of severity of pulmonary embolism (PE), and is associated with high mortality. We report the case of a young patient with a PE postoperative of patellar tendon surgery. The cardiac echocardiography at its admission revealed a voluminous mobile thrombus of 1.7cm diameter located on the pulmonary trunk. Systemic thrombolysis was performed because of respiratory deterioration allowing a rapid disappearance of the thrombus and recovery. Our case emphasizes the value of a complete ultrasound analysis centered on the pulmonary trunk in the case of intermediate-risk PE. No recommendation exists on the management of these right ventricular thrombi, thrombolysis appearing to be the first-line treatment.

[Treatment of choroidal noevascularization secondary to angioid streaks with bevacizumab and response: Experience of the ophthalmology department of Hassan II university hospital]. / Traitement par bévacizumab et évolution des néovaisseaux choroïdiens compliquant les stries angioïdes : expérience du service d'ophtalmologie du CHU Hassan II.

PURPOSE: To evaluate the efficacy of intravitreal bevacizumab in the treatment of choroidal neovascularization (CNV) secondary to angioid streaks. METHODS: We conducted a prospective study in the ophthalmology department of Hassan II university hospital in Fez, including 12 eyes of 7 patients with CNV associated with angioid streaks. We injected 8 eyes with bevacizumab 1.25mg; best corrected visual acuity (BCVA), fundus examination, fluorescein angiography and optical coherence tomography were performed and analyzed for all patients before and after treatment. The goal of the study was to determine the percentage of patients with stabilization or improvement in BCVA and decreased central macular thickness. RESULTS: Visual acuity on admission was <1/10 in 75% of patients. We injected 8 eyes with anti-VEGF, whereas abstention was appropriate for 4 eyes with disciform scarring. The average number of bevacizumab injections was 4.3±1.3 over a mean follow-up of 14.57 months±5.3. After treatment, BCVA was <1/10 in 12.5% of cases, between 1/10 and 5/10 in 50% of cases, and in 37.5% of patients, it was ≥5/10. Mean central macular thickness decreased from 424.25±137.03µm on admission to 255.75 microns±50.14 post-treatment (P=0.005). CONCLUSION: Intravitreal bevacizumab is a promising and effective treatment option for the management of CNV associated with angioid streaks, with the requirement however of early treatment and extended follow-up.