[DRESS syndrome with bilateral panuveitis, elevated intraocular pressure, and HHV-6 reactivation: a case report]. / DRESS syndrome associé à une pan-uvéite bilatérale: à propos d'un cas.

INTRODUCTION: DRESS syndrome (drug rash or reaction with eosinophilia and systemic symptoms) is a rare but life-threatening drug hypersensitivity syndrome with a potential viral cofactor. The syndrome is characterized by rash, fever, hematological disorders (eosinophilia, lymphocytosis), and systemic symptoms (adenopathy, multiorgan involvement). CASE REPORT: We report the first description of acute bilateral panuveitis with elevated intraocular pressure associated with anticonvulsant-induced DRESS syndrome, hypogammaglobulinemia, and HHV-6 reactivation in a 63-year-old-woman. Complete general and ophthalmological recovery was obtained 4 weeks after the end of anticonvulsant drug exposure without corticosteroid prescription, with the patient remaining free of disease after 6 months. DISCUSSION: Our data suggest that uveitis may be one of multivisceral involvements described in drug hypersensitivity syndrome. The data also suggest that HHV-6 may play a role in the complex pathogenesis of DRESS as well as in the development of immune inflammatory disorders such as bilateral panuveitis with elevated intraocular pressure and alteration of retinal and choroidal circulation in this patient.

Seismic reflection images of the Moho underlying melt sills at the East Pacific Rise.

The determination of melt distribution in the crust and the nature of the crust-mantle boundary (the 'Moho') is fundamental to the understanding of crustal accretion processes at oceanic spreading centres. Upper-crustal magma chambers have been imaged beneath fast- and intermediate-spreading centres but it has been difficult to image structures beneath these magma sills. Using three-dimensional seismic reflection images, here we report the presence of Moho reflections beneath a crustal magma chamber at the 9 degrees 03' N overlapping spreading centre, East Pacific Rise. Our observations highlight the formation of the Moho at zero-aged crust. Over a distance of less than 7 km along the ridge crest, a rapid increase in two-way travel time of seismic waves between the magma chamber and Moho reflections is observed, which we suggest is due to a melt anomaly in the lower crust. The amplitude versus offset variation of reflections from the magma chamber shows a coincident region of higher melt fraction overlying this anomalous region, supporting the conclusion of additional melt at depth.

[Long-term effects of iterative diving on visual field, color vision and contrast sensitivity in professional divers]. / Retentissement à long terme de la plongée sous-marine sur le champ visuel, la vision des couleurs et la sensibilité au contraste du plongeur professionnel.

PURPOSE: To assess long-term functional effects of iterative diving, we studied visual field, color vision, and contrast sensitivity in 21 French Navy professional divers and 21 controls. PATIENTS AND METHODS: This retrospective study investigated a population of 21 divers and 21 controls. All subjects were male. The inclusion criterion for divers was a total number of dives greater or equal to 1,000. Exclusion criteria for the two groups were glaucoma, ocular hypertension, smoking, and vasospastic risks. Additional exclusion criteria for controls were any history of diving practice and of hyperbaric oxygen therapy. The visual field was examined with a Humphrey Central 30-2 threshold test. Moreover, we explored spatial contrast sensitivity using Metrovision Moniteur Ophtalmologique "STAT" program and color vision with desaturated 15 hue test. RESULTS: None of the divers had any loss of spatial contrast sensitivity. There was a high frequency of yellow-blue axis color vision defects (45.2%) in the diver group. Regarding visual field, corrected pattern standard deviation was significantly higher in divers (p<0.01). CONCLUSION: These findings suggest that iterative diving may cause subclinical functional effects on vision. Further studies will be needed to determine the exact setting of this repercussion upon macula and/or the optic nerve.

[Orbital myositis associated with ulcerative colitis]. / Myosite orbitaire et rectocolite ulcéro-hémorragique.

We report a rare case of a 32-year-old Caucasian man who presented with a 2-month history of progressive proptosis in his left eye with no visual impairment nor diplopia. He had suffered from ulcerative colitis for 3 years before presentation. Computed tomography and magnetic resonance imaging scans demonstrated mild proptosis and isolated enlargement of the left superior rectus muscle. Laboratory examination results showed no evidence of other ocular or systemic disease. He was treated with a short course of systemic steroids. His intestinal and eye conditions quickly improved over the following weeks. After a 1-year follow up, the orbital myositis remains unchanged and the digestive condition is satisfactory with a long-term mesalazine therapy. To our knowledge fewer than 10 cases of orbital myositis associated with ulcerative colitis have been reported in the literature. We present and discuss a new case with a concomitant evolution between these two disorders.

Dairy management practices associated with incidence rate of clinical mastitis in low somatic cell score herds in France.

An epidemiological prospective study was carried out in French dairy herds with Holstein, Montbéliarde, or Normande cows and with low herd somatic cell scores. The objective was to identify dairy management practices associated with herd incidence rate of clinical mastitis. The studied herds were selected on a national basis, clinical cases were recorded through a standardized system, and a stable dairy management system existed. In the surveyed herds, mean milk yield was 7420 kg/cow per yr and mean milk somatic cell score was 2.04 (132,000 cells/mL). Overdispersion Poisson models were performed to investigate risk factors for mastitis incidence rate. From the final model, the herds with the following characteristics had lower incidence rates of clinical mastitis: 1) culling of cows with more than 3 cases of clinical mastitis within a lactation; 2) more than 2 person-years assigned to dairy herd management; 3) balanced concentrate in the cow basal diet. Moreover, herds with the following characteristics had higher incidence rates of clinical mastitis: 1) milking cows loose-housed in a straw yard; 2) no mastitis therapy performed when a single clot was observed in the milk; 3) clusters rinsed using water or soapy water after milking a cow with high somatic cell count; 4) 305-d milk yield >7435 kg; 5) herd located in the South region; 6) herd located in the North region; 7) cows with at least 1 nonfunctional quarter; and 8) premilking holding area with a slippery surface. The underlying mechanisms of some highlighted risk factors, such as milk production level and dietary management practices, should be investigated more thoroughly through international collaboration.

[Onset of Leber's hereditary optic neuropathy in association with borreliosis]. / Révélation d'une neuropathie optique héréditaire de Leber dans un contexte de borréliose.

INTRODUCTION: The diagnosis of Lyme disease in the presence of an acute optical neuritis always raises a difficult diagnostic problem. We present a case of Lyme-associated Leber's hereditary optic neuropathy (LHON). OBSERVATION: A 17-year-old Eurasian young man presented with left-eye visual impairment for 1 month. This loss of vision acuity in the left eye is related to an optic neuropathy. Mitochondrial DNA testing showed a G to A substitution at position 11778 confirming a diagnosis of LHON. The family history disclosed a case of LHON in a maternal cousin. The mother's family is Asian. Besides, serum examination of anti-Borrelia antibodies was performed and was positive against Borrelia burgdorferi garinii. The patient history indicated that he had been possessing a dog and was living in an endemic area of Lyme disease. But he did not recall receiving a tick bite nor having any erythema chronicum migrans. Initial examination showed bilateral green-red axis colour vision defects which made us fear bilateralisation of the optic neuropathy, which occurred 2 months later (that is 3 months after the onset of symptoms on the left eye). An antibiotic treatment by ceftriaxone was administered for 4 weeks all in all; and a long term ubidecarenone therapy was established. At present, after a 1-year follow up, the eyes' conditions remains unchanged. CONCLUSION: To our knowledge, this would be the first case reporting such an association, in which we can discuss the fortuitous character or the role of the infectious factor in the developing of the mitochondrial pathology. This observation also raises the problem of the positive diagnosis of Lyme disease when tick bite and erythema are absent or underestimated.

Management practices from questionnaire surveys in herds with very low somatic cell score through a national mastitis program in France.

French dairy herds (n = 534) were enrolled in the National 'Zero Mastitis Objective' Program to highlight management practices characterizing very low somatic cell score (SCS) herds. The herds studied were stratified into 2 groups. The first group (LOW) included herds within the first 5 percentiles and the second group (MED) herds within the 50 to 55 percentiles of herds on the basis of mean SCS for the 36 mo preceding the program. Potential explanatory variables, collected through questionnaire surveys, were analyzed using multistep logistic regression models. Twenty-six variables were significant factors in the final models, in which 18 were considered as primary factors for very low SCS. The probability for a herd belonging to the LOW group was associated with: (1) regular use of teat spraying; (2) herdsman precise in his techniques; (3) less than 1 person-year used at activities other than dairy herd; (4) teat dipping after mammary infusion at dry off; (5) heifers kept in a calving pen around parturition; (6) cows locked in feed-line lockups after milking; (7) dry cows with prepartum Ca restriction; (8) heifers on a nondamp pasture; (9) cows culled when at least one damaged teat; (10) heifers at pasture not drinking water from a river; and (11) disinfecting teat ends with alcohol before intramammary infusion at dry off. The probability for a herd belonging to the MED group was associated with: (1) milking cows housed in a straw yard; (2) checking heifers for mastitis only beginning at 2-wk prepartum; (3) no mastitis treatment when at least one clot was observed in milk at successive milkings; (4) distance of herdsman's house to cowshed >300 m; (5) only dirty teats washed before milking; (6) free access of cows from pasture to cowshed during bad weather; and (7) more than 18% of spring calvings. The variables associated with very low SCS should be applied as part of a thorough mastitis-control program adapted to each herd.

[Abducens nerve palsy in spontaneous intracranial hypotension]. / Paralysie du nerf abducens secondaire à une hypotension intracrânienne spontanée.

Described by Schaltenbrand (1940), spontaneous intracranial hypotension is an unusual syndrome, sometimes revealed by an abducens nerve palsy motivating the patient to consult emergency ophthalmology services. The Authors report the case of a 50-Year-old Turkish woman who presented with diplopia due to a left abducens nerve palsy. These symptoms were associated with headache and nausea. Brain magnetic resonance imaging demonstrated diffuse pachymeningeal enhancement with gadolinium. A lumbar puncture showed low spinal fluid pressure (6 cm H2O), leading to the diagnosis of palsy by spontaneous intracranial hypotension. First, a classic treatment was prescribed with no result: increased water intake, corticoid therapy, and rest. Then a blood patch consisting of an injection of autologous blood by lumbar puncture between the third and fourth lumbar vertebrae to plug the spontaneous leak of spinal fluid, with success. A review of the literature provides information on the physiopathological mechanism, the clinical and imaging symptoms, and the treatment.

[Subhyaloid hemorrhage following a Valsalva maneuver]. / Hémorragie rétrohyaloïdienne secondaire à une manoeuvre de Valsalva.

The authors present a case of a 48-year-old man complaining of a temporal nasal scotoma without visual impairment, occurring after sneezing. The perception of scotoma is explained by a retrohyaloidal hemorrhage sparing the optical axis. The hemorrhage, resulting from the break of two superior temporal veins, disappeared within 8 months without after effects. The authors explain the responsible mechanisms and analyze the different cases published in the literature.

[Postoperative visual improvement in spheno-orbital meningioma: a case report]. / Récupération fonctionnelle après chirurgie d'exérèse d'un méningiome sphéno-orbitaire. A propos d'une observation.

A 59-year-old woman complained of right eye proptosis and visual impairment (20/100) lasting 2 months. CT and MRI scans disclosed a right spheno-orbital meningioma ranging over the optic foramen and cavernous sinus. Histopathology revealed transitional meningioma. Visual acuity (20/25), visual field, and proptosis were improved after surgery at the time of the ophthalmologic examination 6 months later. We present an additional case and review the available literature concerning postoperative visual outcome.

[Uncomplicated orbital varix: a difficult therapeutic problem]. / Varice intraorbitaire non compliquée: un problème thérapeutique difficile.

The authors describe a case of right orbital varix discovered in a 34-year-old female. She was referred by her ophthalmologist because she was experiencing a functional disorder with esthetic consequences. With physical effort, she had intermittent exophthalmia and moderate diplopia. The symptoms disappeared with rest. The diagnosis was made by NMR examination before and after the Vasalva maneuver. Because of the patient's excellent visual acuity, we did not propose a therapeutic solution.

Evidence from three-dimensional seismic reflectivity images for enhanced melt supply beneath mid-ocean-ridge discontinuities

Quantifying the melt distribution and crustal structure across ridge-axis discontinuities is essential for understanding the relationship between magmatic, tectonic and petrologic segmentation of mid-ocean-ridge spreading centres. The geometry and continuity of magma bodies beneath features such as overlapping spreading centres can strongly influence the composition of erupted lavas and may give insight into the underlying pattern of mantle flow. Here we present three-dimensional images of seismic reflectivity beneath a mid-ocean ridge to investigate the nature of melt distribution across a ridge-axis discontinuity. Reflectivity slices through the 9 degrees 03' N overlapping spreading centre on East Pacific Rise suggest that it has a robust magma supply, with melt bodies underlying both limbs and ponding of melt beneath large areas of the overlap basin. The geometry of melt distribution beneath this offset is inconsistent with large-scale, crustal redistribution of melt away from centres of upwelling. The complex distribution of melt seems instead to be caused by a combination of vertical melt transport from the underlying mantle and subsequent focusing of melt beneath a magma freezing boundary in the mid-crust.

Off-axis crustal thickness across and along the east pacific rise within the MELT area

Wide-angle seismic data along the Mantle Electromagnetic and Tomography (MELT) arrays show that the thickness of 0.5- to 1. 5-million-year-old crust of the Nazca Plate is not resolvably different from that of the Pacific Plate, despite an asymmetry in depth and gravity across this portion of the East Pacific Rise. Crustal thickness on similarly aged crust on the Nazca plate near a magmatically robust part of the East Pacific Rise at 17 degrees15'S is slightly thinner (5.1 to 5.7 kilometers) than at the 15 degrees55'S overlapping spreading center (5.8 to 6.3 kilometers). This small north-south off-axis crustal thickness difference may reflect along-axis temporal variations in magma supply, whereas the across-axis asymmetry in depth and gravity must be caused by density variations in the underlying mantle.

Does sweeping of the membranes reduce the need for formal induction of labour? A randomised controlled trial.

OBJECTIVE: 1. To evaluate the effectiveness of sweeping of the membranes to reduce the need for a formal induction of labour; 2. to evaluate the side effects of this intervention. DESIGN: A randomised controlled clinical trial. SETTING: Three tertiary care hospitals of the province of Quebec, Canada. POPULATION: Two hundred women for whom non-urgent induction of labour was medically indicated. METHODS: Women were randomly allocated to sweeping of membranes, or vaginal examination for Bishop scoring only. MAIN OUTCOME MEASURES: 1. Cumulative incidence and relative risk of induction of labour by either oxytocin, prostaglandins or amniotomy; 2. women's discomfort and side effects attributable to sweeping of the membranes. RESULTS: Women allocated to sweeping of the membranes required formal induction of labour less frequently than women in the control group, but this difference was not statistically significant (49% vs 60%, RR 0.83, 95% CI 0.64-1.07). Pain during vaginal examination and other side effects were more frequently reported by women allocated to the sweeping group. CONCLUSIONS: The observed reduction in the need for formal induction of labour is smaller than in previous studies. Side effects and discomfort associated with sweeping of the membranes must be taken into account when counselling women who require induction of labour.

[A case of conjunctival raspberry tumor of viral origin]. / Une tumeur framboisée conjonctivale d'origine virale.

We describe the clinical and histopathological findings of a conjunctival papilloma due to papillomavirus. The therapeutic method applied was excision plus cryotherapy. These lesions are known to recur, and papillomavirus DNA sequences are present in several cases of conjunctival dysplasia and carcinoma. Using biological molecular methods (in situ hybridization, Southern blot hybridization, and particularly polymerase chain reaction), more than 60 Human Papillomavirus have currently been reported. This new detection techniques improve the possibility of findings HPV infection, and increase the interest for this virus extremely widely distributed in man.

[Trabeculectomy with mitomycin C. Study apropos of 30 cases]. / Trabéculectomie avec mitomycine C. Etude à propos de 30 cas.

UNLABELLED: Standard trabeculectomy with adjunct Mitomycin C application was performed in 30 eyes of 26 patients with refractory glaucoma to study the efficacy and safety of this technique. The results were analyzed for each aetiology and number of ocular risk factors for failure of filtering procedure and compared with those of other series, including those using 5-fluorouracil. METHODS: The surgical procedure was similar to that described by Cairns, except that a fornix-based conjunctival flap was used. A 0.4 mg/ml solution of Mitomycin C was applied at the filtration site for three minutes. The mean follow-up was 6.4 months; the thirty eyes were followed for 4 to 11 months. RESULTS: At 6 months, the intraocular pressure was less than 21 mmHg in 65.2% of cases without postoperative glaucoma medication, and the overall success rate was 86.9%. No remarkable complications occurred. CONCLUSION: Intraoperative Mitomycin C may be a helpful adjunct in achieving low final intraocular pressure after trabeculectomy in high-risk glaucoma filtering surgery, and Mitomycin C may be a viable alternative to postoperative 5-Fluorouracil. But further studies regarding late complications due to mitomycin are required.

[Macular complications of synthetic antimalarials. Apropos of a case]. / Complications maculaires des antipaludéens de synthèse. A propos d'une observation.

The clinico-pathological findings in a 17-year-old girl with an "oeil de boeuf" maculopathy are reported together with the aetiological elements involved (hereditary or toxic maculopathy). The case was a second stage typical maculopathy due to antimalarial drugs. These patients were particularly susceptible, probably because of impaired renal function, since the total dose absorbed (140 g. chloroquine) was low. Ophthalmologic monitoring is required to prevent intoxication. Clinical examination, angiography and automatic perimetry and contrast sensitivity test are needed to detect the first effect of toxicity.

[Combined cataract-glaucoma operations. Extracapsular extraction and trabeculectomy versus phacoemulsification and trabeculectomy]. / Interventions combinées cataracte-glaucome. ECCE et trabéculectomie versus phacoémulsification et trabéculectomie.

This retrospective study was conducted to evaluate the results of Combined Surgery of Cataract and Glaucoma (triple procedure). The procedure of combined surgery were trabeculectomy and extracapsular extraction (14 eyes) versus trabeculectomy and phacoemulsification (15 eyes). The follow-up of both groups was at least 9 months and up to 16 months (mean: 12 months). The mean decrease of IOP was 12.4 mmHg and 8.9 mm Hg in the first and second group respectively. Instillation of Beta-blockers twelve months after surgery were more frequent in the first group (64.3%) than in the second (26.7%). Finally, the IOP values one year after surgery were equivalent in both groups (less than 19 mmHg in 93% of cases). The mean features to emphasize the delay of recuperation of the best corrected visual acuity: one month for phacotrabeculectomy, and three months for extracapsular with trabeculectomy. The frequency of complications was low in both groups. We observed more hyphemas but less secondary cataracts in the phacotrabeculectomy group. Phacotrabeculectomy could become a reference procedure for combined glaucoma and cataract surgery.