[The Dunbar's syndrome: renaissance of a controversial disease pattern]. / Dunbar-Syndrom - Renaissance eines kontrovers diskutierten Krankheitsbildes.

HISTORY AND ADMISSION FINDINGS: A 79-year-old woman (BMI 23) presented with postprandial, occasionally epigastric, occasionally diffuse abdominal pain. INVESTIGATIONS: No pathologic findings in the physical examination and in the chemical analysis.Continuative examinations: Gastroscopy revealed a mild, nonreactive gastritis which was alleged not to be the cause of the symptoms. In ultrasonography arteriosclerotic lesions were seen, which led to the differential diagnosis of compensated angina abdominalis. On that assumption a CT-angiography was performed, which revealed a typical focal narrowing of the celiac axis about 1,5 cm distal of its origin in combination with hypertrophic collaterals between the celiac axis and the upper mesenteric artery. DIAGNOSIS, TREATMENT AND COURSE: In view of all findings, the diagnosis of Dunbar's syndrome was established. Since the symptoms were moderate, no further therapy was carried out. CONCLUSION: Dunbar's syndrome is caused by deep crossing of the median arcuate ligament resulting in compression of the proximal celiac axis resulting in a characteristic hooked appearance. Since a good collateralisation between the celiac axis and the superior mesenteric artery can be found, only about one percent of patients display symptoms (postprandial pain, sometimes weight loss). Typical patients are 20-40 year-old women. Although the diagnosis can be difficult and symptoms are rare, the Dunbar's syndrome, if typical morphologic findings an epigastric postprandial pain are present, is a relevant differential diagnosis.

[Treatment of hypermetropia using the Holmium laser--laser thermokeratoplasty (LTK)]. / Le traitement de l'hypermétropie à l'aide du laser Holmium--laser thermokeratoplastie (LTK).

The results of two year follow-up after Holmium LTK are presented. The choice of the technique was justified based on experimental, technical and anatomo-pathological data as well as on the property of the corneal collagen fibers to shrink at a temperature of 60-70 degrees C. Although the immediate results were encouraging, we found an important regression after two years follow-up, resulting in a final correction of maximally 1.5 D, independent on the degree of hypermetropia to be treated. These results were obtained with the "contact" method, which is in our experience slightly superior to the "non-contact" technique. The question is whether the regression will continue with time or will stabilize and remain at 1.5 D of hyperopic correction.

[Pseudokeratoconus: a topical finding?]. / Le pseudokératocone: une decouverte topographique?

Two patients candidates for radial keratotomy showed a borderline keratoconus which was unsuspected before and revealed by corneal topography. This pathology constitutes a contrindication to refractive surgery.

Emergence of cross-resistant herpes simplex virus following topical drug therapy in rabbit keratitis.

The acquisition of drug resistance in vivo was investigated by 7 serial passages (from P0 to P7) of herpes simplex virus (HSV-1) in rabbit cornea treated with either IUdR (idoxuridine), IDC (idoxycytidine), ACV (acyclovir), TFT (trifluridine), or Ara A (adenine arabinoside). Therapeutic failure was acquired gradually: at P3 for IUdR, at P4 for ACV and at P5 for TFT. At P7, viral thymidine kinase (TK) activity was reduced to 5.6% of the parental strain for IUdR, to 7.5% for ACV and to 4.6% for TFT treatment. No signs of clinical unresponsiveness occurred with IDC or Ara A. The in vitro determination of antiviral drug sensitivity performed by the dye-uptake assay on HSV isolates at each passage showed a correlation between the increase in the 50% effective dose (ED50) and the increase of ulcer area grade at each passage under antiviral drug (p less than 0.1). Both IUdR- and TFT-resistant HSV1 developed cross-resistances to TK dependent drugs. However ACV-resistant HSV1 did not show cross-resistance to other antiviral TK dependent drugs. The acquisition of the cross-resistances is discussed, and the practical implications in case of therapeutic failures are suggested.

[A new type of negative anterior chamber lens in high myopia]. / Lentille de chambre antérieure négative d'un nouveau type dans la myopie élevée.

We performed 12 implantations of a new type of intraocular lens in high myopia. The optical performance of this new lens, which has been polished along the peripheral rim to reduce its thickness is excellent. After 8 to 23 months, the endothelial cell counts are good.

[4-incision keratotomy: Saint Andrew's cross or the Greek cross?]. / Kératotomie à 4 incisions: croix de Saint-André ou croix grecque?

For low to moderate myopes (-1.50 to -4.50) having a four-incisions keratotomy, the authors compare the disposition of the cuts: like a "x" in one eye or like a "+" in the opposite eye. Visual acuity, pre- and postoperative keratometry and the evaluation of astigmatism are necessary to establish the efficacity of these "crosses".