The Central Bright Spot Sign: A Potential New MR Imaging Sign for the Early Diagnosis of Anterior Ischemic Optic Neuropathy due to Giant Cell Arteritis.

BACKGROUND AND PURPOSE: A rapid identification of the etiology of anterior ischemic optic neuropathy is crucial because it determines therapeutic management. Our aim was to assess MR imaging to study the optic nerve head in patients referred with anterior ischemic optic neuropathy, due to either giant cell arteritis or the nonarteritic form of the disease, compared with healthy subjects. MATERIALS AND METHODS: Fifteen patients with giant cell arteritis-related anterior ischemic optic neuropathy and 15 patients with nonarteritic anterior ischemic optic neuropathy from 2 medical centers were prospectively included in our study between August 2015 and May 2016. Fifteen healthy subjects and patients had undergone contrast-enhanced, flow-compensated, 3D T1-weighted MR imaging. The bright spot sign was defined as optic nerve head enhancement with a 3-grade ranking system. Two radiologists and 1 ophthalmologist independently performed blinded evaluations of MR imaging sequences with this scale. Statistical analysis included interobserver agreement. RESULTS: MR imaging scores were significantly higher in patients with giant cell arteritis-related anterior ischemic optic neuropathy than in patients with nonarteritic anterior ischemic optic neuropathy (P ≤ .05). All patients with giant cell arteritis-related anterior ischemic optic neuropathy (15/15) and 7/15 patients with nonarteritic anterior ischemic optic neuropathy presented with the bright spot sign. No healthy subjects exhibited enhancement of the anterior part of the optic nerve. There was a significant relationship between the side of the bright spot and the side of the anterior ischemic optic neuropathy (P ≤ .001). Interreader agreement was good for observers (κ = 0.815). CONCLUSIONS: Here, we provide evidence of a new MR imaging sign that identifies the acute stage of giant cell arteritis-related anterior ischemic optic neuropathy; patients without this central bright spot sign always had a nonarteritic pathophysiology and therefore did not require emergency corticosteroid therapy.

[Adventitial cyst of the aorta]. / Kyste adventitiel de l'aorte.

The authors report a case of adventitial cyst of the abdominal aorta. This would seem to be the first time that a cyst has been reported in the literature with this localization. A 54 year old female patient was treated surgically for a suspected aneurysm of the abdominal aorta. Her antecedents included syphilis treated with bismuth. The condition began with a lumbago with no clearly defined etiology. An abdominal X-ray without preparation visualized a calcified abdominal tumor in a retroperitoneal position, apparently attached to the aorta. Arteriography showed that the tumor was excluded from the circulation. Surgical exploration of the aorta demonstrated a cystic tumor, which was resected. A review of the literature concerning the pathology of arterial cysts shows no previous cases of aortic cyst. On the other hand, references to identical anomalies of the iliac, femoral, popliteal and radial arteries provide grounds for discussion of the etiology of this aortic disease. The macroscopic data and histological studies suggest a phenomenon of cystic degeneration rather than a constitutional anomaly of the artery, or, in this particular case, an anomaly connected with syphilitic lesions.

[The abdomen in multiple-injured patients. Comparative study on 225 multiple-injured patients with and without abdominal lesions. Incidence of abdominal complications]. / L'abdomen du polytraumatisé. Etude comparative portant sur 225 polytraumatisés avec et sans lésions abdominales. Incidence des complications abdominales.

Of 225 patients with multiple injuries and a high lesional score, 100 presented traumatic abdominal lesions. Comparison of the two groups confirmed both the usefulness and validity of a traumatic index and the reliability of abdominal puncture-lavage. Abdominal complications were analyzed. Mortality in all multiple injury cases, with or without abdominal lesions, was identical in this series where emergency surgery was performed only for lesions affecting vital organs, the mean age of patients with abdominal lesion being significantly lower. An attitude to adopt when deciding whether surgery is necessary is proposed.

Anaesthetic management of patients with phaeochromocytoma. A review of 102 cases.

A total of 102 patients with phaeochromocytoma who underwent surgery by the same team between 1964 and 1976 were allocated to three groups according to the anaesthetic protocol used: (1) balanced anaesthesia and control of hypotension with noradrenaline; (2) anaesthesia with halothane and replacement of blood volume; (3) neuroleptanalgesia (droperidol and phenoperidine) and replacement of blood volume. None of the patients in any of the three groups received adrenergic inhibitors before anaesthesia. Comparison of the results in the three groups revealed that the major factor responsible for reduction of operative mortality to almost zero was control of hypotension by replacement of blood volume rather than by the use of noradrenaline following resection of the tumour, whereas the type of anaesthetic agent used was of secondary importance.