Use of voriconazole to successfully treat disseminated Trichosporon asahii infection in a patient with acute myeloid leukaemia.

Trichosporon spp. is an emerging fungal pathogen in immunocompromised hosts, and disseminated infection is often fatal in neutropenic patients. Reported here is a case of disseminated infection in a neutropenic patient with acute leukaemia. After failure of amphotericin B and fluconazole therapy, the course of infection dramatically improved with voriconazole treatment. A literature search revealed 69 additional cases of disseminated Trichosporon spp. infections in neutropenic patients, and these are also reviewed. Clinical symptoms that suggest infection include fever, disseminated papulopustular cutaneous lesions and pulmonary involvement. Despite treatment with antifungal agents (amphotericin B, fluconazole), 78% of patients died. Voriconazole may represent a promising therapy for this life-threatening infection.

[Review of ophthalmologic complications in hereditary bullous epidermolysis. Apropos of 40 cases]. / Revue des complications ophtalmologiques des épidermolyses bulleuses héréditaires. A propos de 40 cas.

INTRODUCTION: We assessed the frequency of ophthalmologic signs in inherited epidermolysis bullosa and evaluated follow-up. PATIENTS AND METHODS: Forty patients were studied retrospectively. Of the 40 patients, 38 had dystrophic and 2 had junctional epidermolysis bullosa. A complete ocular examination was performed in all cases and repeated if necessary (8 times). RESULTS: Ocular complications were found in 75% of the patients. Corneal anomalies associated or not with refractive anomalies were present. The best corrected visual acuity was less than 3/10 in 20% of the cases. Only 15% had lid modifications. DISCUSSION: In our series, 75% of the cases had ocular anomalies, similar to other series in the literature. Corneal problems dominated. CONCLUSION: Ocular lesions in inherited epidermolysis bullosa are often found and require initial ocular examination. Corneal lesions also need to be followed with optical correction to optimize functional prognosis.

[Micro-endoscopy of the lacrimal apparatus combined with Erbium YAG laser: an anatomical study. New methods of imaging]. / Micro-endoscopie des voies lacrymales combinée au laser YAG Erbium: étude anatomique. Nouvelles méthodes d'imagerie.

PURPOSE: To study the anatomic structure and the endoscopic aspect of the lacrimal drainage system and to evaluate the efficacy of the Erbium laser with microendoscope in lacrimal obstruction. METHODS: Twenty lacrimal ducts from ten fresh cadaver heads were used to lead a special rigid probe of 1.1. mm diameter (Endognost Schwind). This probe combined a flexible endoscopic probe of 500 mu, an Erbium laser fiber of 375 mu and an irrigation. The probe was introduced through the inferior canaliculus. Progressing in the lacrimal system, all the images were analysed. Then, we used the laser fiber to open the lacrimal sac mucosa and the lacrimal bone. RESULTS: The anatomo-endoscopic analysis was performed using endoscopic data. We appreciated essentially the walls of valves and sinuses that appeared only functional when increasing the irrigation flow. The laser could easily open the mucosa and the lacrimal bone but not the maxilla. DISCUSSION: The small size of the cannula allows to use the system for the diagnosis of lacrimal obstructions. The combined laser allows to treat at same time canalicular obstructions and lower obstructions. CONCLUSION: The endocanalicular study of the lacrimal drainage system can diagnose the type of obstruction and can treat it. A clinical study is requested to confirm these results.

[Anterior uveitis in HIV-infected patients. 3 cases in patients treated with an antiprotease]. / Uvéite antérieure chez des patients infectés par le VIH. 3 cas chez des patients traités par une antiprotéase.

OBJECTIVES: Uveitis is an ocular manifestation rarely observed in HIV-infected patients. We observed three cases of anterior uveitis without progressive retinitis in HIV patients receiving antiprotease treatment. CASE REPORT: The first patient developed a first episode of uveitis during ritonavir therapy. Two other episodes occurred with indinavir. The second patient developed uveitis when treated with indinavir. In the third patient, the first episode developed with indinavir and a second with a ritonavir-saquinavir combination. Uveitis was unilateral in 4 episodes. Clinical manifestations were red irritable eyes and, in 2 episodes, reduced visual acuity. The antiprotease was interrupted in 4 of the 6 episodes and clinical course was rapidly favorable. DISCUSSION: Pure anterior uveitis should suggest drug induction in HIV infected patients; rifabutin is often the cause. Infectious causes predominate in case of total uveitis associating choroid and retinal involvement. Cytomegalovirus, herpes zoster, syphilis, and toxoplasmosis have been incriminated. Antiproteases would appear to be a new cause of anterior uveitis in HIV-infected patients.

In utero eyeball development study by magnetic resonance imaging.

The aim of this study was to measure fetal ocular development and to determine a growth curve by means of measurements in utero. Fetal ocular development was recorded by analysis of the results of magnetic resonance imaging (MRI). An anatomic study allowed definition of the best contrasted MRI sequences for calculation of the ocular surface. Biometric analysis of the values of the ocular surface in the neuro-ocular plane in 35 fetuses allowed establishment of a linear model of ocular growth curve in utero. Evaluation of ocular development may allow the detection and confirmation of malformational ocular anomalies such as microphthalmia.

[Rosacea with ocular involvement in a child]. / Rosacée de l'enfant avec atteinte oculaire.

INTRODUCTION: Rosacea ia an uncommon facial eruption in children. We report a case of rosacea associated with a specific episcleritis. CASE REPORT: A 10-year-old girl consulted for an erythematous papular and pustular eruption of the mid face of 1 month duration. The child complained that she had had a red painful right eye for 6 months. There was no argument for acne, periorificial granulomatous dermititis or for sarcoidosis. The ophthalmological examination gave the diagnosis of ocular and cutaneous rosacea. Oral antibiotics followed by erythromycin gave favorable results for both skin and ocular lesions. DISCUSSION: Ocular involvement is a frequent complication of rosacea in adults. It is exceptional in children in whom rosacea is in itself rare. The presence of blepharitis, keratoconjunctivitis or episcleritis may suggest the diagnosis in a child with a mid facial eruption. As in the adult, skin and ocular rosacea responds well to prolonged oral antibiotics. The choice of the antibiotic depends on the age of the child. Cyclins are not authorized in children under the age of 8 years.

The pterygoid venous plexuses.

The pterygoid venous plexuses are closely adjacent to the lateral pterygoid m. and occupy a considerable part of the infratemporal fossa (ITF). We have conducted a study after injection of colored latex in 10 unemblamed subjects in order to define the arrangement of the venous network and to assess the frequency of the different types of plexuses found. In all the subjects symmetry was noted between the right and left plexuses, with predominance of the venous layer in the upper part of the ITF. The pattern most often encountered was plexiform and complex. The development of these plexuses follows that of the masticatory muscles, whose contraction promotes drainage and represents an alternative venous pathway for drainage of the cranial cavity.

[Cytomegalovirus retinitis in children with AIDS acquired through materno-fetal transmission]. / Rétinites à cytomégalovirus chez l'enfant atteint de SIDA de transmission materno-foetale.

PURPOSE: To describe the clinical feature and the outcome of CMV retinitis in children with vertically transmitted HIV infection. RESULTS: Five case-reports of cytomegalovirus retinopathy are described. These children from eight month-old to seven and a half year-old (median age at diagnosis 52 months) had been perinatally contaminated by the human immuno-deficiency virus. The ophthalmic signs included only a red eye for one patient. The clinical signs were similar to the adult's retinopathy. At the opposite the differences were emphasized like the clinical onset with a delayed diagnosis. Mean follow-up since diagnosis is 8 months with 3 patients still alive. CONCLUSION: CMV retinitis in vertically transmitted AIDS can occur early in childhood and must be checked systematically in the patients with low CD 4 count because of the usual asymptomatic onset.

Computation of eyeball growth by magnetic resonance imaging (26.11.93).

The computation of eyeball growth has a wide field of applications in orbital and ocular pathology. An anatomic and MRI study to compute eyeball growth has been done. The anatomic study was made to determine the best MRI parameters to calculate the ocular surface; then this surface was computed by MRI in the neuro-ocular plane in fetuses and children aged from 0 to 13 years. The curve of eyeball growth shows rapid growth in utero and until 18 months, followed by a phase of slower growth. This method allows measurement in two dimensions, which we find complementary to ultrasound in the antenatal search for certain congenital malformations.

Anatomic study of the orbital septum (22.10.93).

The orbital septum separates the intraorbital fat from the palpebral part of the orbicularis oculi m. An anatomic study after injection of colorant into the intraorbital fat allows definition of a fibroadipose layer anterior to the orbital septum. This consists of radial fibers and extraorbital fatty lobules. The septum is derived embryologically from the mesenchyme of the second arch, but the structure of the anterior layer remains controversial. The septum has an important mechanical function in containing the orbital fat and is involved in orbital movements. A knowledge of these different layers facilitates surgical approaches and helps to define the anatomic landmarks in palpebral surgery for conditions such as ptosis and in blepharoplasty.

[Acute uveitis in reversal reactions]. / Uvéites aiguës au cours des réactions de réversion.

Two cases of acute uveitis have been reported in reversal reactions in lepromatous patients treated with anti-hansenian multidrug therapy with daily rifampicin. This type of eye damage has seldom been reported in reversal reactions.

[Terson's syndrome. Apropos of 7 cases]. / Le syndrome de Terson. A propos de 7 cas.

We studied seven cases of Terson's syndrome, in association with bleeding in the subarachnoid space caused by rupture of vascular malformation or cranial traumatism. The association of rapid increase of intracranial pressure with subarachnoid hemorrhage could explain the development of a Terson's syndrome. The retinal hemorrhages associated with the vitreous hemorrhage are variable in morphology and topography. Pars plana vitrectomy has been performed in eight eyes with most often good results.

[Demonstration of a correlation between the degree of pigmentation and the power of inactivation of isoniazid in man]. / Mise en évidence d'une corrélation entre le degré de pigmentation et la puissance d'inactivation de l'isoniazide chez l'homme.

In a group of 153 white subjects treated for tubercle, individual determinations were made of: a) The power of inactivation of isoniazid. b) The degree of pigmentation (iris, skin, hair) assessed by a weighted pigmented index of the iris. A statistical study of the results shows the clear existence of a narrow positive correlation between these two characters, such that the more pigmented a subject is, the greater is the chance of rapid inactivation of isoniazid. An attempt at a biochemical explanation is proposed. The results in the world literature (Japanese, Swedish, American) are in keeping with these observations. Thus, weakly pigmented tuberculous patients are potentially a new group at risk from anti-TB drugs.

Power of isoniazid acetylation and pigmentation; first experimental tests in the rabbit: comparison with clinical data.

A positive correlation has been observed clinically at the Centre Edouard Rist, Paris, between the degree of pigmentation and the power of isoniazid acetylation in so-called "caucasians". The investigation was based on a relatively small sample of 153 observations, but sufficient to allow a significant statistical analysis. Comparing the results with data published in the literature, it may be assumed that this relationship between the power of acetylation and pigmentation would be applicable to all human beings. The rabbit, having as in man a bi-modal distribution of the power of acetylation, was used for further research of this correlation in that animal. The results of this research in rabbits may be compared with those in man, but further studies are required in view of the interest of this comparison and of the possible consequences of the relationship of pigmentation and the degree of acetylation of isoniazid in human therapeutics.

[Subclinical alcoholic optic neuritis without vitamin deficiency]. / Névrites optiques alcooliques infra-cliniques sans carences vitaminiques.

Vitamin B1, Folic acid Vitamin B12, whole blood Lead level, and plasma Zinc level were determined in 82 patients admitted to an alcoholism rehabilitation program. Each patient was examined for an optic neuritis. Thirty-two of the patients had sub-clinical abnormalities suggestive of optic neuritis like dyschromatopsias and/or field visual defects. No differences were found in the blood levels of Vitamin B1, Folic acid, and Vitamin B12 between the 32% affected and the 68% unaffected subjects. Moreover vitamins blood levels were found to be within the limits of normal values in both groups. A negative correlation between whole blood Lead levels and plasma Zinc levels was found. When an optic neuritis occurs the lead level tends to be higher and the Zinc lower. Abnormalities of the more usual alcoholism tests: gamma glutamyl Transpeptidase (gamma GT), mean red cell volume (V.G.M.) and glutamic Oxaloacetic transferase (T.G.O.), were more pronounced in alcoholics with optic neuritis.