[Tracheal carcinoma infiltrating the thyroid gland and mimicking subacute thyroiditis. Contribution of Doppler to differential diagnosis]. / Carcinome trachéal envahissant la thyroïde et mimant une thyroïdite subaiguë. Apport du Doppler au diagnostic différentiel.

In the present case Color Coded Doppler showed a marked increase in vascularization in the right lobe of the thyroid with high systolic velocities (1 m/s). This sign was only doubtful compared with clinical, biological and isotopic data. Because of dramatic laryngeal dyspnea, surgery was conducted which allowed the final diagnosis of thyroid invasion by tracheal epidermoid carcinoma. This demonstrates the particular role of Color Coded Doppler in the management of inflammatory thyroid diseases.

[Retinal detachment after surgery of the anterior segment using the pars plana approach]. / Décollement de rétine après chirurgie du segment antérieur par la pars plana.

Anterior segment surgery via the pars plana was done on 114 eyes with the Klöti vitreous stripper between January, 1977 and December 31, 1982. In every case the posterior capsule was removed when present and anterior or total vitrectomy was performed. None of the 114 eyes had a history of retinal detachment prior to nor at the time of anterior segment surgery. There were 37 cases of trauma in this series. Follow-up varied from 1 to 66 months with 58% of cases having a follow-up of greater than one year. There was a 10.50% post-operative retinal detachment rate (12/114 eyes). Seven detachments occurred in the 37 traumatized eyes (19.10%) versus 5 detachments in 77 non-traumatized eyes (6.49%). Of the 12 detachments, 7 presented signs of severe proliferative vitreoretinopathy (PVR) while the remaining 5 detachments appeared to be uncomplicated. No detachment was related to an iatrogenic tear and no case of PVR seemed to be related to the sclerotomy site. Successful reattachment was achieved in 3 out of 4 uncomplicated cases and 3 out of 5 cases with PVR. Vitrectomy and posterior capsulectomy are often mandatory in anterior segment problems: pupillary membranes, secondary cataracts, lens ectopiae and dislocations, vitreous wick and vitreocorneal touch. In our opinion other indications for vitrectomy and posterior capsulectomy are congenital, juvenile and post-uveitis cataracts.(ABSTRACT TRUNCATED AT 250 WORDS)

[Peripheral vascular complications of beta-blocking agents]. / Les complications vasculaires périphériques des bêta-bloquants.

Beta-blocking agents may induce vascular syndromes related to environmental temperature, accentuation of arterial diseases, gangrene of the extremities. Incidence and severity are variable with beta-blocking agent's properties: cardioselectivity, intrinsic sympathomimetic activity, cardiac depression, and with the patient's disease. The risk of complication is greater with hypertension disease because of the reduction of arterial compliance and quantitative and qualitative alterations of adrenergic receptors.

[Pars plana lensectomy II - Short- and long-term complications]. / Broutage du cristallin par la pars plana II. Complications à court et moyen terme.

Pars plana lensectomies or membranulectomies were performed on 67 eyes with posterior capsule removal in every case, with follow-up of 60 eyes for more than 3 months (mean: 18 months). No peroperative or early postoperative complication was specifically related to the procedure employed. Irvine's syndromes and retinal detachments were the two most severe late complications. Four of the 5 Irvine's syndromes occurred after a membranulectomy and this encouraged systematic removal of the posterior capsule, knowing the risk of postoperative opacification; 3 of these 5 eyes, in fact, had a final visual acuity better than 6/10. Four of the 5 retinal detachments occurred after traumatic cataract removal, 2 of them associated with intraocular foreign body and 1 with penetrating injury. Retinal detachment prophylaxis in these high risk eyes should be based above all on systematic vitrectomy at the end of the lensectomy, and therefore the pars plana approach must be used. The pars plana approach for cataracts and membranules is effective and reasonably safe at the present time.

[Immune complexes and complement in leprosy (author's transl)]. / Les complexes immuns et le complément dans la lèpre.

The sera of 87 Senegalese patients with various forms of leprosy were investigated. Two of the most reliable methods were used to detect circulating immune complexes : the radiolabelled C1q binding test and the Raji cell binding technique. Several fractions of complement, including C3, C4, factor B and the C3d product of C3 were also assayed. A material having the properties of immune complexes was detected in lepromatous and reactional leprosy. In tuberculous leprosy, only the Raji cell binding technique gave positive results. C3 and C4 were normal or slightly raised, but C3d was increased in all forms of the disease. There was no significant correlation between C3d values and the results of immune complexes detection tests.

Les complexes immuns et le complément dans la lèpre / Immune complexes and complement in leprosy

The sera of 87 Senegalese patients with various forms of leprosy were investigated. Two of the most reliable methods were used to detect circulating immune complexes : the radiolabelled C1q binding test and the Raji cell binding technique. Several fractions of complement, including C3, C4, factor B and the C3d product of C3 were also assayed. A material having the properties of immune complexes was detected in lepromatous and reactional leprosy. In tuberculous leprosy, only the Raji cell binding technique gave positive results. C3 and C4 were normal or slightly raised, but C3d was increased in all forms of the disease. There was no significant correlation between C3d values and the results of immune complexes detection tests.

[Indentation of large retinal tears (author's transl)]. / Indentation des déchirures rétiniennes de grande taille.

According to us large retinal tears are between 20 degrees and 70 degrees in their largest dimension, which excludes true giant tears. Study of the data collected on 42 patients has shown us the following facts:--these retinal tears occur in phakic and often highly myopic eyes;--our global success rate is 73,8%;--tears smaller than 2 to 3 papillary diameters radially are on the whole easy to indent and failures are quite often related to a surgical fault;--tears wider than 3 papillary diameters radially are on the whole difficult to indent and failures are not always related to an obvious surgical fault, fishmouth phenomenon plays an important role;--in every case presence of blood in the vitreous seems to be unfavourable to the prognosis;--use of episcleral pockets solves must of times surgical problems related to fishmouth or tear dimension;--post operative intern limiting membrane retraction is frequent (10% vs 5,7% for all the retinal tears and detachments cured in the same period of time).

[Silicone sponges rejection (author's transl)]. / Le rejet des éponges de silicone. Etude étiologique et pronostique.

Out of 633 retinal tears or detachments treated by cryocoagulation and Lincoff sponges without scleral dissection, our rate of sponge rejection is 8 per cent (51 out of 633). Out of these 51 rejections we have 4 spontaneous expulsions and 45 surgical removals. In 2 cases we could preserve the buckle by medical treatment. The most pre-eminent causes are in decreasing frequency: --the peroperative sponge infection, mostly by staphylococcus epidermidis, --the existence of an anterior positioned sponge, more than a quadrant long, factor of bad mechanical tolerance, --several operations. The rate of anatomical success is of 86% in this group of 51 patients (80% if we only number successes at six months). We have had 8 recurrences after sponge removals (15%). Recurrences are due to sponge infection; they are mainly due to the reopening of the primitive lesions (6 times out of 8). Only 5 recurrences have been cured (62,5%). This result seems, however, better than the one reached by authors using scleral dissection techniques; according to us this is due to the relatively rare severe vitreous reactions when episcleral sponges' infection occurs.

[Retinal detachment and argon laser prophylactic treatment (author's transl)]. / Décollement de rétine et traitement prophylactique par le laser à argon.

We have studied 6 retinal detachments which hapened after a preventive photocoagulation with argon laser in 6 patients who had already had a severe retinal detachment on the other eye (2 anatomical success on 5 operated cases). This preventive photocoagulation was done on eyes which at the term were free of any retinal dehiscence. In this group of 6 we notice 2 giant tears (greater than 70 degrees) or 33% and 3 large tears (between 20 degrees and 70 degrees) or 33%. These high amounts do not correspond to what has been noticed before: - on the non photocoagulated fellow eyes (neither giant nor large tear) - on the whole lot of operated retinal detachments during the same period of time in our unit (2% of giant and 5,7% of large tears). We think that the responsability of laser in the development of these large lesions in predisposed eyes must be thought about. Studies on a larger scale will be necessary to have a more definite idea on this subject.

[Surgical treatment of retinoschisis (author's transl)]. / Le traitement chirurgical du rétinoschisis.

We have made a review of 20 retinoschisis without retinal detachment operated on 12 patients. There is no case of hereditary retinoschisis, the affection may occur at any age, and there is no preferential refractive error. Main surgical indications were macular involvement or impending involvement, and associated retinal tears. A good anatomical result has been obtained in 90% of our cases (18 out of 20) with 2/3 complete reattachments and 1/3 almost complete reattachments (with minimal and well sealed residual schisis). Association of cryocoagulation and indentation is more effective than cryocoagulation alone. On the functional point of view we have had 15% of improved visual acuities and 30% of worsened ones, thus surgical intervention implies macular risks that one must try to prevent by using procedures as atraumatic as possible.

[Drainage of subretinal fluid: technic and results]. / Le drainage du liquide sous-rétinien : techniques et résultats.

The drainage of subretinal fluid (S.R.F.) after choroidal diathermy offers a distinct advantage: important reduction of massive haemorrhages from the drainage site (4% vs 48% in the non diathermy group in our series). According to us it is not a decisive factor for the anatomical prognosis because complications of drainage in themselves seem to be a quite infrequent cause of anatomical failure. On the other hand we think that visual outcome is better in the diathermy group because of a diminution of macular haemorrhages.

[Prognosis of the retinal detachment in children (author's transl)]. / Pronostic du décollement de rétine de l'enfant.

Following features seem to characterize retinal detachments in children. High rate of difficult anatomical problems: invisible retinal breaks, macular or paramacular breaks, giant breaks or desinsertions (37% of our cases). High rate of severe traumatic macular lesions. Important delay in treatment with prolonged macular impairment. These facts explain the prognosis. Difficulties in the treatment of retinal breaks explain anatomical results (75% cure rate vs 78,6% for all the retinal detachments treated). In the same way they explain the high rate of multiple operations. Macular impairment and multiple operations explain visual results: 1/3 of the non amblyopic eyes recover a visual acuity comparable to the initial. So, the macular in children does not seem to have a special functional recuperation ability. Two supplementary facts may be mentioned. Delay in treatment has no adverse effect in anatomic prognosis. Non giant "simple" desinsertions expose to a noticeable risk of massive vitreous retraction.