[Peripheral ulcerative keratitis]. / Les kératites à ulcères périphériques.

Peripheral ulcerative keratitis (PUK) is a disorder of the juxtalimbal cornea characterised by a crescent-shape destructive inflammation of corneal stroma. PUK can be associated with various ocular and systemic infectious and non infectious diseases. Different systemic autoimmune vasculitis that can prove potentially fatal may present as PUK. Potentially serious ocular complications of PUK exist. A careful clinical evaluation helps in timely diagnosis and prevention of complications.

Les kératites à ulcères périphériques (PUK) sont des maladies inflammatoires destructives du stroma cornéen juxta-limbique. Celles-ci peuvent être associées à de nombreuses pathologies systémiques ou oculaires, infectieuses ou non. Plusieurs vascularites auto-immunes connues, pouvant être éventuellement fatales, peuvent présenter un mode d'entrée clinique sous la forme d'une PUK. Il existe de nombreuses complications oculaires graves. Une évaluation clinique minutieuse aide à poser un diagnostic précoce et à prévenir certaines complications. Peripheral ulcerative keratitis.

[Painful Horner's syndrome revealing carotid artery dissection : about four cases]. / Claude Bernard-Horner douloureux, de la clinique au diagnostic de dissection carotidienne : à propos de quatre cas décrits par l'ophtalmologue.

We report four cases of painful Horner's syndrome due to carotid artery dissection. A lesion on oculosympathic pathway causes Horner's syndrome. A painful Horner's syndrome needs a prompt exploration by tomodensitometry or magnetic resonance imaging to exclude carotid artery dissection. Actually, carotid artery dissection leads to stroke or cerebral ischemic symptoms, mainly in the first two weeks. The treatment is based on anticoagulants or antiplatelet agents.

Nous rapportons quatre cas de dissections carotidiennes suspectées par la présence d'un syndrome de Claude Bernard-Horner douloureux. Ce syndrome est dû à une lésion au niveau de la voie oculosympathique. Lorsqu'il est accompagné de douleurs, une exploration par tomodensitométrie avec injection de produit de contraste, ou mieux, par résonance magnétique, est nécessaire afin d'exclure une dissection carotidienne. Etant donné la possible apparition d'un accident vasculaire ischémique endéans les deux premières semaines, un diagnostic précoce ainsi qu'un traitement par antiagrégant plaquettaire ou par anticoagulant sont primordiaux.

[Metabolic and cardiovascular consequences of suction-assisted lipectomy: Systematic review]. / Conséquences métaboliques et cardiovasculaires de la lipoaspiration : revue systématique de la littérature.

BACKGROUND: Suction-assisted lipectomy is one of the most frequent procedures in plastic surgery. The aim of this study was to investigate whether suction-assisted lipectomy causes changes in the carbohydrates and lipid metabolism and the potential effects on cardiovascular risk factors. METHODS: We interrogated five databases: Medline, American College of Physicians Journal Club Database, Cochrane central register of controlled trials, Cochrane database of systematic reviews, Database of abstracts of reviews of effects. A systematic review of the literature was performed in order to compare results of randomized controlled trials and observational studies concerning changes in weight, metabolism, endocrinology, inflammatory markers and cardiovascular risk factors after suction-assisted lipectomy. All articles were assessed by criteria from Oxford Center For Evidence Based Medicine (OCEBM). RESULTS: The search resulted in 40 articles: 12 experimental animal studies and 28 human studies. CONCLUSION: Different metabolic parameters are affected by suction-assited lipectomy. First, all articles point out a decrease of body weight after suction-assisted lipectomy. Weight lost only affects fat mass without any change of lean mass. The potential compensatory growth of visceral fat seems to be counteracted by physical activity. Then, resting energy expenditure seems to be stable or decrease after the surgery. This reduction is significantly related to the decrease of leptin levels and also seems to be counteracted by physical activity. About adipocytokines, leptin level decreases after suction-assisted lipectomy while results are contradictory about adiponectin and resistin levels. However adiponectin seems to tend to increase after surgery. Inflammatory markers seem to increase within first hours after surgery. Then they seem to decrease or remain at the preoperative levels. Fasting insulin level decreases and is linked to the aspirated volume. So insulin sensitivity seems to be improved. Concerning lipid profil, it tends to remain the same or to be improved by suction-assisted lipectomy. In conclusion, regarding all the literature, there is still debate about metabolic effect of suction-assisted lipectomy. Prospective clinical studies are needed to confirm or invalidate some hypotheses. These studies must consider some potential biases as physical activity, diet and medical treatment modifications (statins).