[Perivenular whitening in central retinal vein occlusion demonstrated by "en-face" OCT]. / Mise en évidence du blanc périveinulaire, par OCT « en-face ¼, dans le cadre d'une OVCR.

We report the case of a patient with a central vein occlusion associated with perivenular whitening. The "en-face" spectral domain OCT precisely demonstrated the ischemic area. This case underscores the utility of the "en-face" mode in the follow-up CRVO.

[Ethmoidal mucocele after transpalpebral bony orbital decompression]. / Mucocèle ethmoïdale après décompression orbitaire osseuse transpalpébrale.

We report a case of a late ethmoidal mucocele occurring after transpalpebral bony orbital decompression. A 39-year-old man presented with a recurrence of a right-sided proptosis without signs of orbital inflammation. The patient had undergone bilateral transpalpebral bony orbital decompression for dysthyroid orbitopathy 2 years prior. Orbital CT scan showed a large mucocele in the supero-lateral right ethmoidal sinus with lateral extension to the medial rectus. The patient was therefore referred to an ear, nose and throat (ENT) surgeon, who performed an anterior ethmoidectomy with marsupialization and drainage of the mucocele via an endoscopic approach. A complete postoperative resolution of proptosis was observed without recurrence of the mucocele to date, approximately 6 months postoperative. Sinus complications occurring after orbital decompression may include sinusitis, hematoma, imploding antrum syndrome and mucoceles. Recurrent proptosis secondary to an ethmoidal mucocele is a rare event after bony orbital decompression surgery, with only two cases reported in the international literature. Management requires ophthalmologic diagnosis and collaboration between the ophthalmologist and otorhinolaryngologist.

[Small-incision, minimal dissection procedure (Frueh's procedure) in correction of involutional and congenital ptosis: A retrospective study of 119 cases]. / Plicature interlamellaire du muscle releveur de la paupière supérieure par mini incision (technique de Frueh) dans la chirurgie du ptosis : étude rétrospective sur 119 cas.

PURPOSE: To evaluate the efficacy and efficiency of the new small anterior incision, small-incision dissection procedure (Frueh's procedure) for the correction of involutional and congenital blepharoptosis. PATIENTS AND METHODS: This was a retrospective study to compare different parameters between Frueh's procedure and the traditional aponeurotic anterior approach in a group of 98 involutional blepharoptosis patients and between Frueh's procedure and Whitnall's sling in a group of 21 congenital blepharoptosis patients. The main criterion was recurrence requiring reintervention. RESULTS: In the adult's group, the rate of reoperation was not significantly different for the two surgical procedures (p=0.82). In the children's group, the rate of reoperation was not significantly different for the two surgical procedures (p=0.3). DISCUSSION: In adults, compared with the traditional aponeurotic approach, Frueh's procedure for blepharoptosis correction is equally efficacious in correcting eyelid height, superior in producing desirable eyelid contour, and much quicker to perform. In children, Frueh's procedure is a good technique for mild and moderate blepharoptosis with a good levator function. However, Frueh's procedure in severe blepharoptosis with low levator function seems not to be as efficient as the traditional surgical techniques. CONCLUSION: This study confirms Frueh's procedure as a reference for the treatment of adults and children with blepharoptosis.

[Retinal nerve fiber layer in OCT 3: prospective study of 53 normal children]. / Évaluation de l'épaisseur de la couche des fibres nerveuses rétiniennes en OCT 3 : étude prospective sur 53 enfants normaux.

PURPOSE: To measure the peripapillary retinal nerve fiber layer thickness (RNFL thickness) in normal children using optical coherence tomography (OCT) and evaluate the effects of several factors on RNFL thickness, in order to complete results of other studies on this topic. MATERIAL AND METHOD: One hundred and four eyes of 53 normal children were investigated using OCT (Stratus OCT 3, Carl Zeiss Meditec, Dublin, CA, USA) measuring the RNFL thickness. These 28 boys and 25 girls had a mean age of 9.68±3.02 years (range, 4-15 years) and a mean refraction in spherical equivalent of +1.79±2.11 diopters (range, -3.50-5.75). The effects of age, sex, and refraction on RNFL thickness were statistically analyzed with the SPSS Package (version 15, Chicago, IL, USA). RESULTS: RNFL thickness was 104.33±10.22 µm (range, 85.87-145.82). RNFL thickness was greatest inferiorly (132.99±16.36 µm) and superiorly (130.72±19.51 µm), thinner nasally (79.01±18.48 µm), and thinnest temporally (73.79±12.61 µm). In univariate regression analysis, age had no significant effect on refraction and RNFL thickness. In univariate and multivariate analysis, refraction had a significant effect only on temporal (p<0.001) RNFL thickness. CONCLUSION: OCT can be used to measure RNFL thickness in children. This study confirms normal children's RNFL thickness data, which can be useful to the clinician in evaluating and treating optic nerve disorders in children.

[Papillary retinal nerve fiber layer thickness measurement using optical coherence tomography in children with ocular hypertension and juvenile glaucoma]. / Mesure de l'épaisseur de la couche des fibres nerveuses rétinienne péripapillaires par tomographie à cohérence optique chez les enfants hypertones et glaucomateux.

PURPOSE: To compare retinal nerve fiber layer (RNFL) measurements taken with OCT in normal, ocular hypertensive, and glaucomatous eyes of children 4-18 years old. MATERIALS AND METHODS: The study included 181 eyes: 106 normal, 37 with ocular hypertension, and 38 with juvenile glaucoma. Diagnostic groups were classified based on intraocular pressure, optic nerve head appearance, visual field examination, and central corneal thickness measurement. RNFL measurements were taken using the Zeiss Stratus OCT. RESULTS: The RNLF average thickness was 94.2 + or -13.2 microm in glaucomatous eyes, 105.4 + or - 6.8 microm in ocular hypertensive eyes, and 104.8 + or - 10.3 microm in normal eyes. RNFL average thickness, inferior thickness, and superior thickness showed statistically significant differences between normal and glaucomatous eyes (p<0.01) and between glaucomatous [corrected] and ocular hypertensive eyes (p<0.01). There was no difference found between normal and ocular hypertensive eye. CONCLUSION: OCT has already shown its diagnostic efficiency in adult glaucoma. This study shows that OCT is useful in childhood glaucoma diagnosis, helping to differentiate between ocular hypertension and beginning juvenile glaucoma.

[Transverse maxillary deficiency: interest in the management of chronic nasal obstruction]. / Disjonction intermaxillaire : intérêt dans la prise en charge de l'obstruction nasale chronique.

OBJECTIVES: To describe the surgical orthodontic technique of correcting transverse maxillary deficiency associated with nasal obstruction and malocclusion. SURGICAL PROCEDURE: The surgical-orthodontic correction of transverse maxillary deficiency consists in an incomplete Le Fort I procedure, without down-fracture, associated with a sagittal palatal osteotomy. This procedure is called SARE (Surgically Assisted Rapid Expansion). A pre-fabricated orthodontic appliance is cemented to premolars and molars prior to the surgical procedure. The patient activates the appliance allowing a 1 mm widening a day up to 10 mm. A stabilisation phase is mandatory to avoid early relapse of the correction. This phase involves ossification of the midline osteotomy site. RESULTS: A 22 year old female consulted for a chronic nasal obstruction. Previous treatments, medical and surgical (septoplasty) did not improve her symptoms. She presented with a typical transverse maxillary hypoplasia. She underwent a surgery with the technique described above. Nasal patency improvement was noted on the first post-operative day. This was confirmed by comparing pre and post-operative rhinomanometry. An orthodontic treatment followed for several months to stabilize the result. DISCUSSION AND CONCLUSION: Main advantages of this surgical intervention are to correct both the dental malocclusion and the nasal obstruction by widening the nasal floor and the maxillary arch. Post-operative period is mostly uneventful. It can take up to six months to achieve a good result that is why a strong collaboration has to exist between the surgeon, the orthodontist and the patient.

[Orbital pseudotumors and Riedel's thyroiditis: case report]. / Pseudo-tumeurs orbitaires et thyroïdite de Riedel: à propos d'un cas.

INTRODUCTION: We report a case of a patient with orbital pseudotumors associated with Riedel's thyroiditis. This association of unknown etiology may be related to idiopathic multifocal fibrosclerosis that includes retroperitoneal fibrosis, mediastinal fibrosis, sclerosing cholangitis, Riedel's thyroiditis, and orbital pseudotumors. CASE REPORT: A 44-year-old woman was referred for a bilateral inflammatory malignant exophthalmos with progressive optical neuropathy (bilateral visual acuity<1/20). Imaging studies demonstrated bilateral exophthalmos (grade III) with compression of the both optic nerves by extensive tumoral infiltration. The general work-up showed a compressive goiter, with the histopathologic examination establishing the diagnosis of Riedel's thyroiditis. Orbital biopsy and antithyroid antibody testing were not contributive. Systemic corticosteroid associated with total thyroidectomy resulted in regression of the symptoms within 3 months. DISCUSSION: The coexistence of bilateral orbital pseudotumor and Riedel's thyroiditis is the most common situation found for idiopathic multifocal fibrosclerosis. We discuss the differential diagnosis with thyroid-associated orbitopathy and orbital lymphoma. This observation is original because the diagnosis was reached by ophthalmic manifestation. The ophthalmologist should be able to identify this pathology to optimize the diagnostic and the therapeutic strategy. CONCLUSION: In case of exophthalmos, a complete assessment should be made, including radiological and histopathological orbital and thyroid work-up.

[Paraganglioma of the cerebellopontine angle: report of two cases]. / Paragangliomes de l'angle ponto-cérébelleux: à propos de deux cas.

Paragangliomas of the cerebellopontine angle are exceptional tumours. We report two cases of paragangliomas of the cerebellopontine angle. To our knowledge, including these two cases, only five cases have been reported in the international literature. The emerging field of genetic study of these tumours will prove critical for their diagnosis and prognosis. The presence of paraganglioma in this area is explained by an abnormal embryologic migration of paraganglionic cells into the cerebellopontine angle, associated with tumorogenesis. These tumors can be associated with others cervico-facial tumours and to genomic abnormalities. The preoperative diagnosis of these tumours is very difficult, with clinical signs like hearing loss, vertigo and tinnitus are very ambiguous. Radiologic assessment of the cerebellopontine angle is also vague. The final diagnosis is only made possible peroperatively and by the post-operative histopathologic study. ENT and neurosurgeons should be awarded of the possible existence of paragangliomas of the cerebellopontine angle, and the necessity of a systemic and genetic assessment.

Placebo control study of acute smokeless tobacco abstinence in young adult men.

Tobacco use can lead to dependence, as indicated by withdrawal symptomatology during abstinence. In smokers, nicotine-free cigarettes suppress tobacco withdrawal, suggesting that non-nicotine stimuli may be relevant to tobacco dependence. This study examined non-nicotine factors in smokeless tobacco (SLT) withdrawal. SLT users used their own brand of SLT, nicotine-free SLT, or no SLT hourly in 3 approximately 4.5-hr sessions. Participant-rated measures of craving and desire to use SLT were elevated in the abstinence condition relative to the own-brand and nicotine-free conditions. Heart rate was significantly elevated in sessions in which participants' own brand was administered relative to the nicotine-free and abstinence conditions. These results support the notion that stimuli associated with tobacco use may have some withdrawal suppressing qualities, at least in the short term.

Heat and water respiratory exchanges: comparison between mouth and nose breathing in humans.

The temperatures (TI, TE) of inspired and expired gas and the mass of expired water (MEH2O) have been measured in four subjects at rest during mouth and nose breathing of dry air at room temperature. TI and TE were measured by copper-constantan thermocouples, MEH2O by freezing and ventilatory parameters by total body plethysmography. During mouth breathing, temperatures are significantly higher (TI = 28.1 degrees C, TE = 31.5 degrees C) and the amount of expired water larger (MEH2O = 27.8 mg dm-3 BTPS) than during nose breathing (TI = 24.8 degrees C; TE = 29.6 degrees C; MEH2O = 26.6 mg dm-3 BTPS). From these experimental data the appropriate computations show clearly that in humans, while either nose or mouth breathing, the expired air is not water saturated; the latent heat exchanges represent the larger part of the respiratory heat exchanges; the counter current expiratory heat recovery is imperfect; in terms of heat and water respiratory exchanges, no large difference exists between the oral and nasal routes. This last point is confirmed by the calculation of a difference less than 10% in the total respiratory heat losses between mouth and nose breathing.

Respiratory water loss as a function of ventilatory or environmental factors.

Since expired gas is not water-saturated (Ferrus et al., 1980, Respir. Physiol. 39: 367-381), its water content should depend on biological or environmental factors other than expired gas temperature. In order to verify this hypothesis, multiple linear regression relationships between MEH2O, the mass of water expired per litre of BTPS ventilated gas and respiratory frequency (f) or period (TR), tidal volume (VT), ventilation (V), temperature of inspired gas (TI), density of inspired gas mixture (rho I), partial pressure of water in inspired gas (PIH2O) were computed from 345 experiments performed on 7 subjects. This analysis shows that MEH2O is positively and significantly correlated to TI (0.22 mg . dm-3 . degrees C-1), to PIH2O (0.14 mg . dm-3 . Torr-1), and to TR (0.87 mg . dm3 . s-1). MEH2O is negatively and significantly correlated to f (-0.27 mg . dm-3(cy . min-1)-1) to rho I (-0.06 mg . dm-3(g . dm-3)-1) and to V (-0.09 mg . dm-3(dm3 . min-1)-1). There is no statistical correlation between MEH2O and VT. It is concluded that the respiratory water loss depends to a large degree on respiratory or environmental conditions. This dependence supports the previously published results suggesting that expired gas is not water saturated.