Castleman disease of the parapharyngeal space: Diagnosis and management.

INTRODUCTION: Castleman's disease (CD) is a rare and benign disease often identified in the mediastinum with few cases in the head and neck area. Parapharyngeal Castleman's disease was rarely reported in the literature. The aim of our work was to discuss the management of this particular location of CD. It was about a case report that has been reported in line with the SCARE 2020 criteria (Agha et al., 2020 [1]). CASE PRESENTATION: We report the case of a 53-year-old female patient who presented a left parotid tumefaction. Radiological investigations showed a parapharyngeal mass that was surgically removed. Definitive pathologic report concluded to Castleman's disease. She presented, one year later, a retropharyngeal recurrence, which was treated by radiotherapy with good response. CLINICAL DISCUSSION AND CONCLUSION: Castleman's disease located in parapharyngeal spaces is an entity that was rarely reported in the literature. Surgical excision is the golden standard treatment. Radiotherapy is also an effective treatment that can be offered for unresectable cases or recurrences of Castleman's disease.

Evaluación de resultado del tratamiento quirúrgico en el glaucoma avanzado / The outcome of surgical treatment in advanced glaucoma

Introducción Existe incertidumbre con respecto a los resultados de la cirugía de glaucoma para pacientes con glaucoma avanzado, ya que puede estar asociada con el fenómeno de «wipe out». El objetivo de este estudio fue evaluar el resultado del tratamiento quirúrgico en el glaucoma avanzado. Métodos Este estudio retrospectivo incluyó 67 ojos de 49 pacientes con glaucoma en etapa terminal en los que se realizó una cirugía de glaucoma. Se revisaron los registros clínicos antes y después de la cirugía. El período de seguimiento fue de 14,4meses. Resultados a edad media fue de 50,2años y la proporción de sexos fue de 0,75. Todos los pacientes tenían un campo visual tubular con persistencia de una isla central. El valor medio de la desviación media en perimetría automatizada fue de 18,94dB±4,7. La presión intraocular (PIO) media antes de la cirugía fue de 27,16mmHg±8,9 Después de la operación la tasa de éxito general fue del 93% (PIO <18mmHg con agudeza visual estable). La PIO media fue de 14,25mmHg±4,12 (p<0,001). No hubo cambios significativos en la agudeza visual media. El valor medio de la desviación media fue de 18,83±4,69 (p=0,07). No se observó ningún fenómeno de wipe out. Las complicaciones postoperatorias tempranas fueron hipotonía, hifema e hipertonía y fueron transitorias, sin causar pérdida visual. Las complicaciones a largo plazo fueron la fibrosis tardía de la ampolla de filtración y la progresión de la catarata. Conclusión La cirugía de glaucoma tuvo efectos beneficiosos en la mayoría de los pacientes con glaucoma avanzado. La PIO postoperatoria estuvo en general controlada y la agudeza visual se preservó sin ningún caso de wipe out (AU)

Introduction There is uncertainty regarding the outcomes of glaucoma surgery for patients with advanced glaucoma, because it may be associated with the «wipe out» phenomenon.The aim of this study was to evaluate the outcome of surgical treatment in advanced glaucoma. Methods This retrospective study included 67eyes of 49 patients with end-stage glaucoma in which glaucoma surgery was carried out. The clinical records prior to and after surgery were reviewed. Follow up period was 14.4months. Result The mean age was 50.2years and the sex ratio was 0.75. All the patients had a tubular visual field with persistence of a central island. The mean value of the mean deviation on automated perimetry was 18.94dB±4.7. The mean intraocular pressure (IOP) before surgery was 27.16mmHg±8.9. Postoperatively the overall success rate was 93% (IOP <18mmHg with stable visual acuity). The mean IOP was 14.25mmHg±4.12 (P<.001). There was no significant change in the mean visual acuity. The mean value of the mean deviation was 18.83±4.69 (P=.07). No occurrence of wipe-out phenomenon was noted. The early postoperative complications were hypotony, hyphema and ocular hypertension and they were transient without causing any visual loss. Long term complications were late bleb fibrosis and progression of cataract. Conclusion Glaucoma surgery had beneficial effects in the majority of patients with advanced glaucoma. Postoperative IOP was in general under control and visual acuity was preserved without any cases of wipe-out (AU)

[Ocular manifestations of Behçet's disease]. / Les manifestations oculaires au cours de la maladie de Behçet.

INTRODUCTION: Behçet's disease is a systemic inflammatory disease. Ocular involvement is an important diagnostic criterion, and this disease may be associated with severe visual loss. PURPOSE: The goal of this study was to specify the epidemiological, clinical and therapeutic features of ocular involvement in patients with Behçet's disease and to identify risk factors for poor visual outcomes. METHODS: A retrospective study was performed in 93 patients diagnosed with ocular Behçet's disease over a period of 9 years. Epidemiological, clinical, and therapeutic data was obtained from medical records and analyzed retrospectively. Poor visual outcome was defined as visual acuity limited to light perception without projection or no light perception. RESULTS: The male:female ratio was 1.9. The mean age was 34.5 years. Ocular involvement was the presenting sign in 4%, bilateral in 61% and active in 68.8%. Uveitis was the most common presentation (57%), dominated by panuveitis, followed by retinal vasculitis (51.6%) and papilledema (10.7%). Maculopathy (26.8%) and cataract (18.2%) were the most common complications. Twenty patients (21.5%) had no light perception or light perception without projection. Treatment was based on corticosteroids in combination with immunosuppressive therapy (Azathioprine) in 55.9% of cases. Our study indicates a significant association of male gender and panuveitis with a poor visual outcome. CONCLUSION: Ocular involvement in Behçet's disease is frequent and serious, which may lead to blindness. Male gender and panuveitis were predictors of poor visual prognosis.

The outcome of surgical treatment in advanced glaucoma. / Evaluación de resultado del tratamiento quirúrgico en el glaucoma avanzado.

INTRODUCTION: There is uncertainty regarding the outcomes of glaucoma surgery for patients with advanced glaucoma, because it may be associated with the «wipe out¼ phenomenon. The aim of this study was to evaluate the outcome of surgical treatment in advanced glaucoma. METHODS: This retrospective study included 67eyes of 49 patients with end-stage glaucoma in which glaucoma surgery was carried out. The clinical records prior to and after surgery were reviewed. Follow up period was 14.4months. RESULTS: The mean age was 50.2years and the sex ratio was 0.75. All the patients had a tubular visual field with persistence of a central island. The mean value of the mean deviation on automated perimetry was 18.94dB±4.7. The mean intraocular pressure (IOP) before surgery was 27.16mmHg±8.9. Postoperatively the overall success rate was 93% (IOP <18mmHg with stable visual acuity). The mean IOP was 14.25mmHg±4.12 (P<.001). There was no significant change in the mean visual acuity. The mean value of the mean deviation was 18.83±4.69 (P=.07). No occurrence of wipe-out phenomenon was noted. The early postoperative complications were hypotony, hyphema and ocular hypertension and they were transient without causing any visual loss. Long term complications were late bleb fibrosis and progression of cataract. CONCLUSION: Glaucoma surgery had beneficial effects in the majority of patients with advanced glaucoma. Postoperative IOP was in general under control and visual acuity was preserved without any cases of wipe-out.

[Ocular manifestations of Crohn's disease]. / Les manifestations oculaires au cours de la maladie de Crohn.

PURPOSE: The objectives of our study were to describe the ocular manifestations of Crohn's disease and to identify risk factors for ocular involvement. METHODS: We prospectively collected 71 cases of Crohn's disease. All patients underwent a complete ophthalmic examination. Two groups were identified according to the presence (group 1) or not (group 2) of ocular involvement related to Crohn's disease. Various parameters were compared between the 2 groups. RESULTS: The average age was 38±12 years. The M/F gender ratio was 1.7. Group 1 included 27 patients (38%). Among the ocular manifestations observed, we noted anterior uveitis in 10 cases (37%), scleritis in 2 cases (7.4%), episcleritis in 8 cases (29.6%), dry eye syndrome in 7 cases (25.9%), corneal infiltrates in 7 cases (25.9%), lid ulcer in one patient (3.7%), vein occlusion with capillary leakage in two patients (7.4%) and a serous retinal detachment in one patient (3.7%). Conjunctivitis was considered a coincidental ocular finding; it was seen in 8 cases (15 eyes). Colonic or ileocolic localisation and the activity of the bowel disease were identified as independent risk factors for ocular involvement in Crohn's disease (the adjusted odds ratios were 5.21 and 6.8, respectively). CONCLUSION: Ocular manifestations of Crohn's disease are polymorphic. Colonic or ileocolic localisation, as well as the activity of the bowel disease, have been identified as risk factors for ocular involvement.

[Sickle cell retinopathy in children: Report of 42 cases]. / La rétinopathie drépanocytaire chez l'enfant : à propos de 42 cas.

We aimed to describe the epidemiological, etiological and clinical features, treatment and clinical course of sickle cell retinopathy in children and to determine the risk factors for serious involvement. METHODS: This was a retrospective study including all children diagnosed with sickle cell retinopathy. Epidemiological, clinical and therapeutic characteristics, as well as clinical course, were analysed retrospectively by chart review. Two groups were defined: Group 1 (Goldberg stage 1 and 2); Group 2 (Goldberg stage 3, 4 and 5). In order to identify factors independently associated with severe sickle cell retinopathy, we conducted a logistic regression analysis in descending order. RESULTS: The frequency of sickle cell retinopathy was 14.48%. Forty-two patients (84 eyes) were included; among them 23 boys and 19 girls, aged 10 to 17 with a mean age of 14±1.98 years. Twenty patients were of genotype SS, 11 patients of genotype SC, 8 Sß and 3 SO Arab. The three patients in group 2 were all of SS genotype. The majority of patients (32) had an HbF level of less than 15%. All our patients had sickle cell retinopathy distributed as follows: 62% at stage 1; 31% at stage 2; 5% at stage 3 and 2% at stage 4. Multivariate analysis revealed a single risk factor independently linked to severe involvement - an HbF level<15%. CONCLUSION: Retinopathy is a frequent complication of sickle cell disease which may lead to blindness. The HbF level is negatively correlated with severe involvement.

[Orbital cellulitis in children: Report of 60 cases]. / Les cellulites orbitaires chez l'enfant : à propos de 60 cas.

The goal of this study was to describe the epidemiological, etiological, clinical and therapeutic features and clinical course of orbital cellulitis in children, and to assess the risk factors for retroseptal involvement. METHODS: This was a retrospective study including 60 children (67 eyes) diagnosed with orbital cellulitis. Two groups were defined according to the clinical form: pre- or retroseptal. RESULTS: We studied 29 cases (34 eyes) of preseptal cellulitis and 31 cases (33 eyes) of retroseptal cellulitis. The mean age was 4 years. The male: female ratio was 1.3. The prescription of anti-inflammatory drugs and antibiotics prior to hospitalization was noted in respectively four and 10 patients. Eyelid edema was the principal sign (100% of cases); exophthalmia was noted in 19 eyes, ptosis in 27 eyes and chemosis in 10 eyes. Oculomotor disorders were present in 4 eyes. The mean C-reactive protein level was 53.15±27mg/l in preseptal cellulitis and 92.09±21mg/l in the retro-septal cases. Orbital computed tomography was performed in 31 patients and MRI in 5 patients. The pathway of entry of the orbital infection was primarily from the sinuses (23 cases). All of our patients had received broad spectrum intravenous antibiotic therapy. Three children had a cavernous sinus thrombosis and had been treated with anticoagulant therapy. Surgical drainage was performed in five patients. The course was favorable and without sequelae for all the patients. Two independent risk factors for retroseptal involvement were identified: the prescription of anti-inflammatory drugs prior to hospitalization, and sinus involvement. CONCLUSION: Orbital cellulitis in children is a serious infection and requires close collaboration between the ophthalmologist, otolaryngologist, and pediatrician in order to be diagnosed and treated early so as to improve the prognosis for vision and life.

Vertebral metastases from intracranial meningioma.

Meningioma rarely gives rise to metastases outside the brain and meninges. We report here a case of a patient who was treated for anaplastic brain meningioma with surgery and fractionated radiation therapy without any recurrence until 5 years after the operation, when she developed vertebral metastases.

[Laryngotracheobronchial foreign body in children: predictive factors of respiratory sequelae]. / Le corps étranger laryngo-trachéo-bronchique chez l'enfant : facteurs prédictifs des séquelles respiratoires.

BACKGROUND: Inhalation of laryngotracheobronchial foreign body in children is a serious accident that may compromise the prognosis of the child and the respiratory function in the long term. AIM: identify the predictive factors of respiratory sequelae of laryngotracheobronchial foreign body inhalation. METHODS: This retrospective study was conducted in the children hospital of Tunis during a period of nine years (2000 - 2008). In all statistical tests, the significance level was set at 0.05. RESULTS: 60 children were included in the study. The average age was 24.9 +/- 3.4 months. 2 / 3 of the children were boys. The foreign body was plant in 80% of cases. The penetration syndrome was reported in 83.7% of cases. The average time of stay of foreign body was 14 days. The chest radiograph was abnormal in 77.4% of cases. Endoscopic extraction was performed in 59 cases and a pneumectomy was conducted in one child. 30 children were followed for an average of 23 months. 18 children had not respiratory sequelae (clinical, radiological and scintigraphic). 10 children had respiratory sequelae (clinical and radiological and/or scintigraphic) at the last follow-up and four patients developed bronchial dilatation. Respiratory sequelae were correlated with the stay period of the foreign body exceeding 84H. Neither age, nor sex, nor the nature of foreign body or its location, nor the presence of radiological opacity at the initial radiograph, were predictive factors of respiratory sequelae. CONCLUSION: The inhalation of foreign body is a serious accident affecting essentially male infants. Clinical, radiological and scintigraphic follow up is mandatory.

[Mesenchymal tumors of the digestive tract, immunohistochemistry contribution]. / Les tumeurs mésenchymateuses du tube digestif, apport de l'immunohistochimie.

UNLABELLED: Mesenchymal tumors of the digestive tract are rare and display variable morphological appearances. Thanks to immunohistochemistry and molecular biology, these tumors are now better classified and dominated by stromal tumors. AIMS: the aim of this article is to study morphological characteristics of mesenchymal tumors of the digestive tract and to insist on immunohistochemistry contribution to diagnosis, especially the c-Kit. MATERIALS AND METHODS: this is a retrospective study of 40 mesenchymal tumors of the digestive tract diagnosed before the event of c-Kit, from 1985 to 1999 in the pathology laboratory of F. Hached hospital in Sousse. Immunohistochemical studies were performed on these tumors with the following antibodies: c-Kit, CD34, smooth muscle actin and S-100 protein. RESULTS: after immunostaining, the tumors were reclassified as the following: 33 stromal tumors, 4 leiomyosarcomas, 1 leiomyoma, 1 schwannoma and 1 desmoid tumor. CONCLUSION: mesenchymal tumors of the digestive tract are dominated by stromal tumors. The latter are defined usually by a spindle cell proliferation, often expressing the c-Kit protein which must be used in all mesenchymal tumors of the digestive tract.