Optical coherence tomography angiography findings in retinal cavernous hemangioma: New cases and review of the literature.

INTRODUCTION: Retinal cavernous hemangioma (RCH) is a rare retinal vascular disease characterized by grape-like clusters of saccular aneurysms, usually unilateral, asymptomatic and non-progressive. The diagnosis is made by multimodal imaging including conventional fluorescein angiography (FA). The recent introduction of swept source optical coherence tomography angiography (SS-OCTA) has allowed new insight into vascular diseases, allowing non-invasive, more precise visualization of retinal and choroidal blood flow, and represents a possible alternative to FA. METHODS: We herein describe two cases of RCH with multimodal imaging, including SS-OCTA, and compare our findings with those previously described. RESULTS: On OCTA, the presence of a draining vessel, a reduction in flow signal in the SCP and DCP, and a fluid level can be observed. CONCLUSION: These OCTA signs are in accordance with those described on conventional fluorescein angiography, allowing this invasive exam to be avoided in typical cases.

[Outpatient vitreoretinal surgery without next-day examination: Feasibility and acceptability]. / Chirurgie vitréo rétinienne en ambulatoire sans examen du lendemain : faisabilité et acceptabilité.

PURPOSE: To assess the feasibility and acceptability of outpatient care without next-day examination for patients undergoing retinal surgery. METHODS: Patients undergoing ambulatory vitreoretinal surgery between November 2013 and February 2016 at the Vienna medical center were included in this retrospective study. The age, comorbidities, indication, surgical technique and type of anesthesia used, symptoms, intraocular pressure and biomicroscopic examination data at the D0, D7 and M1 visits were recorded. Patient satisfaction with the outpatient treatment was collected by phone call in April 2016. RESULTS: Fifty-three surgeries on 49 patients (24 women, 25 men) with a mean age of 70 years (range, 39-91 years) were analyzed. The surgery was pars plana vitrectomy in all cases, with 26 cases of epiretinal membrane surgery, 7 vitreomacular traction syndrome, 4 vitreous hemorrhage, 6 macular hole, 4 dislocation of lens material, 5 retinal detachment and 1 macular retinoschisis in high myopia. The type of anesthesia was general in 64.1 % of cases (34) and local in 36.9 % of cases (19). Of the D0 examination data, 100 % were compatible with the patient being discharged to home. One patient consulted before the D7 exam for the occurrence of a subconjunctival hemorrhage. There were seven cases (13.2 %) of intraocular pressure elevation and two cases of vitreous hemorrhage (3.8 %) on the D7 examination data. Twenty-seven patients (55.1 %) were reached by phone and all of them were satisfied with their outpatient management. CONCLUSION: Outpatient treatment of patients without next-day examination for vitreoretinal surgery is possible and well accepted.

Complications and failures of the trapeziometacarpal Maia® prosthesis: A series of 156 cases.

When implanting the Maia® trapeziometacarpal prosthesis, surgeons will be faced with a variety of complications they must be able to recognize and anticipate. Their ability to deal with these complications and possibly even failures is governed by their knowledge of the right steps to take. The aim of this retrospective study was to assess the incidence of complications reported during implantation of the Maia® prosthesis, to describe their nature and potential predisposing factors, and to study failures and their outcomes. Between January 2008 and December 2012, 156 Maia® prosthetic joints were implanted in 139 patients at one center by one surgeon. Clinical and radiological parameters were analyzed before, during and after surgery. The implant characteristics were documented and the surgical technique used was analyzed. The overall postoperative complication rate was 35.9%. The most common complication (16%) was tendinopathy. Prosthesis dislocation (4.5%) and trapezoid loosening (2.6%) were the primary causes of failure. Eighteen patients required secondary surgical revision (11.5%) and the implant was removed in 12 cases (failure rate of 7.7%). Two factors were significantly correlated with the onset of complications, independent of their nature and irrespective of whether secondary surgical revision was required: a deformed thumb prior to surgery and the position of the trapezial cup. Mediocre trapezium bone quality was a statistically significant factor for secondary surgical revision. The survival rate of the Maia® prosthesis was 90.8% at 62months. These factors influence the onset of complications and must be taken into account in the pre-surgical workup in order to identify the best candidates for successful Maia® joint replacement. For the most part, the failure rate in our series was due to inappropriate surgical technique rather than an inherent defect in the prosthesis. A meticulous, precise surgical technique is therefore essential.

Diagnostic strategy for the assessment of axillary lymph node status in breast cancer.

The nodal status in breast cancer is a major prognostic factor in terms of survival. It also plays a role in the therapeutic decision-making process. Therefore, the evaluation of lymph node involvement in breast cancer is imperative in establishing a personalized treatment scheme. The sentinel lymph node procedure has proved successful for small breast tumors (T1-T2), limiting axillary lymphadenectomy and its side effects without changing overall survival. Even so, a substantial number of women must undergo axillary lymphadenectomy during a second surgery when the analysis of the sentinel node discloses major nodal involvement. Imaging can improve patient selection, especially those who appear eligible for immediate axillary lymphadenectomy. Ultrasound is able to depict morphological abnormalities in the lymph nodes such as cortical thickening, peripheral vascularization, hilar infiltration and loss of the kidney-shaped appearance of a normal node. When ultrasound is negative, the risk of massive nodal involvement is limited, thus allowing the oncologist to take an approach with the sentinel lymph node procedure. Magnetic resonance imaging (MRI) can also be useful in detecting pathological lymph nodes, particularly with diffusion-weighted MRI sequence.

Brain imaging in mitochondrial respiratory chain deficiency: combination of brain MRI features as a useful tool for genotype/phenotype correlations.

Mitochondrial diseases are characterised by a broad clinical and genetic heterogeneity that makes diagnosis difficult. Owing to the wide pattern of symptoms in mitochondrial disorders and the constantly growing number of disease genes, their genetic diagnosis is difficult and genotype/phenotype correlations remain elusive. Brain MRI appears as a useful tool for genotype/phenotype correlations. Here, we summarise the various combinations of MRI lesions observed in the most frequent mitochondrial respiratory chain deficiencies so as to direct molecular genetic test in patients at risk of such diseases. We believe that the combination of brain MRI features is of value to support respiratory chain deficiency and direct molecular genetic tests.

[Aspect of brain MRI in mitochondrial respiratory chain deficiency. A diagnostic algorithm of the most common mitochondrial genetic mutations]. / Aspect en IRM cérébrale des maladies mitochondriales. Algorithme décisionnel des maladies mitochondriales les plus fréquentes.

Mitochondrial diseases are due to deficiency of the respiratory chain and are characterized by a broad clinical and genetic heterogeneity that makes diagnosis difficult. Some clinical presentations are highly suggestive of given gene mutations, allowing rapid genetic diagnosis. However, owing to the wide pattern of symptoms in mitochondrial disorders and the constantly growing number of disease genes, their genetic diagnosis is frequently difficult and genotype/phenotype correlations remain elusive. For this reason, brain MRI appears as a useful tool for genotype/phenotype correlations. Here, we report the most frequent neuroradiological signs in mitochondrial respiratory chain deficiency and we propose a diagnostic algorithm based on neuroimaging features, so as to direct molecular genetic tests in patients at risk of mitochondrial respiratory chain deficiency. This algorithm is based on the careful analysis of five areas on brain MRI: (1) basal ganglia (hyperintensities on T2 or calcifications); (2) cerebellum (hyperintensities on T2 or atrophy); (3) brainstem (hyperintensities on T2 or atrophy); (4) white matter (leukoencephalopathy); (5) cortex (sub-tentorial atrophy); (6) stroke-like episodes. We believe that the combination of brain MRI features is of value to support respiratory chain deficiency and direct molecular genetic tests.

[Interference between cardiac pacemaker and electromagnetic anti-theft devices in stores]. / Interférences entre les stimulateurs cardiaques et les détecteurs de vol dans les magasins.

Electromagnetic anti-theft devices in shops comprise large diameter magnetic induction coils between which the shoppers pass. This study was undertaken with a simulator to assess the behaviour of different models of single and double-chamber pacemakers when exposed to 6 stereotyped and repetitive situations of 4 different electromagnetic anti-theft devices. Of the 35 pacemakers tested, 25 developed serious dysfunctions: 14 long-lasting inhibitions (over 3 seconds), 2 stimulations at maximal frequency, 2 electrical bradycardias and 2 permanent reprogramming. These dysfunctions due to electromagnetic interference are observed in old or modern, monopolar or bipolar pacemakers, and seem to be influenced by the amplitude and complexity of the signals emitted by the detectors. These observations justify a clear signalization warning pacemaker patients of a potential danger.