[Breast infections]. / Infections du sein.

Breast infections such as mastitis and breast abscesses are frequent. They are usually caused by the same microorganisms as those that cause other soft tissue infections. For a simple mastitis, a treatment with antibiotics alone is usually sufficient, whereas drainage is necessary when an abscess is present. While ultrasound-assisted puncture and aspiration is the best approach for breast abscesses of less than 3 cm, surgery is recommended for more extended infection. Infections of breast implants have to be treated applying a mixed surgical-medical approach with removal of the implant (usually in one stage exchange) and antibiotics adapted to the microorganism identified.

Pseudophakic ametropia managed with a phakic posterior chamber intraocular lens.

We report the use of a phakic posterior chamber intraocular lens (IOL) to correct pseudophakic ametropia. Two eyes of 2 patients developed ametropia after unilateral phacoemulsification and IOL implantation. The manifest refraction was -6.00 -0.50 x 50 in the first patient and +4.50 -1.00 x 15 in the second. Both patients were bothered by the induced anisometropia and had posterior chamber phakic IOL implantation in the pseudophakic eye. Postoperatively, uncorrected visual acuity improved from 20/400 to 20/30 in the first patient and from 20/200 to 20/40 in the second patient. The manifest refraction was -0.50 -0.75 x 55 and +1.50 -1.50 x 30, respectively. No complications were noted. Implantation of a phakic posterior chamber IOL may be an alternative to currently available methods of managing pseudophakic ametropia.

[Indocyanine green angiography in "multiple evanescent white dot syndrome" (MEWDS)]. / L'angiographie au vert d'indocyanine dans le "multiple evanescent white dot syndrome" (MEWDS).

PURPOSE: Multiple evanescent white dot syndrome (MEWDS) is a benign acquired chorioretinal disorder occurring mostly in young adults. Its pathophysiology is unknown. To describe the results of indocyanine green angiography (ICGA) in MEWDS. PATIENTS AND METHODS: Four patients with MEWDS were investigated by ICGA. RESULTS: In all cases, ICGA revealed numerous choroidal hypofluorescent lesions that largely outnumbered the lesions visible with either fundoscopy or fluorescein angiography. Three cases showed a blind spot enlargement on perimetry associated with the presence of a large peripapillary hypofluorescent zone on ICGA. Three cases showed macular granularity on fundoscopy correlating with a significant subfoveal hypfluorescent lesion on ICGA. Evolution was always favorable with disappearance of the hypofluorescent choroidal lesions. CONCLUSIONS: Our results confirm that MEWDS is primarily a choroidal disorder. The blind spot enlargement and the macular granularity, frequently detected in MEWDS, result from larger peripapillary and subfoveal choroidal lesions.

[Indocyanine green angiography in posterior uveitis]. / Angiographie au vert d'indocyanine dans les uvéites postérieures.

BACKGROUND: Indocyanine-green (ICG) angiography gives additional information in posterior inflammatory conditions by enabling to analyse the choroid. It may become a useful work-up procedure in inflammatory diseases predominantly involving the choroid. Our purpose was to analyse ICG findings and correlate them to fluorescein angiographic and clinical findings in posterior uveitis. PATIENTS AND METHODS: In patients with posterior uveitis involving the choroid, ICG angiography is performed routinely in addition to the usual uveitis work-up. We report on the ICG angiography features found in sarcoidoses (6 cases), birdshot chorioretinopathy (4 cases), multiple evanescent white dot syndrome (MEWDS, 2 cases), Vogt-Koyanagi-Harada disease (2 cases) and multifocal choroiditis (2 cases). RESULTS: The hypofluorescent lesions characteristic for choroidal lesions were seen in all 5 analyzed entities. They corresponded either to active inflammatory lesions or to atrophic areas of the choroid. To distinguish between these 2 situations correlation between clinical findings, fluorescein angiography and ICG angiography was necessary. Except for multifocal choroidits where hypofluorescent areas corresponded essentially to atrophic areas, ICG angiography showed inflammatory choroidal lesions not seen clinically or by fluorescein angiography. ICG hyperfluorescence in the late phase of angiography seemed to be a sign for recent or acute inflammatory involvement. CONCLUSION: ICG angiography was helpful to assess choroidal involvement and disease progression in 4 of the posterior inflammatory disorders examined and will probably prove useful in the work-up of most posterior uveitis involving the choroid.

[Short and long-term advantages and disadvantages of prolene monofilament sutures in penetrating keratoplasty]. / Avantages et inconvénients à court et long terme des sutures au monofilament de Prolène dans les kératoplasties perforantes.

The authors have studied the short and long-term advantages and inconveniences of Prolene monofilament sutures employed in perforating keratoplastic surgery. Contrary to Nylon, Prolene has the advantage of no structural or tensional modifications, postoperative measurements of corneal astigmatism thus remaining more stable with the time. Accordingly, where very little or no astigmatism is noted, the slight or no change in corneal refraction with time is an obvious advantage ot the patient. However, the use of Prolene in the beginning can cause some problems with continuous suture tension, either excessive or insufficient, which can result in serious complications. With training, these difficulties can be overcome and excellent results obtained.

[Long-term results of congenital glaucoma microsurgery--retrospective study]. / Résultats à long terme de la microchirurgie du glaucome congénital--étude rétrospective.

Medium and long term results of trabeculotomy and goniotomy operations for primary congenital glaucomas treated in Lausanne between 1965 and 1990 were studied retrospectively. Parameters evaluated were intraocular pressure (IOP) and final visual acuity (VA). Data on IOP were available for 38 eyes. 66% underwent trabeculotomy and/or goniotomy (first group) the others needed further surgical or medical treatment (second group). IOP was equal or inferior to 19 mmHg in 88% of the first group and 62% of the second group at the end of the study (mean follow-up 13.1 years). Data on VA were available for 32 eyes. In the first group, 65% showed a VA of more than 0.5 compared to 33% for the second group. Therefore, we can consider trabeculotomy and goniotomy as early operations as advisable in first intention treatment of primary congenital glaucoma.

Ocular penetration of cyclosporin A. III: The human eye.

The distribution of cyclosporin A (CsA) in the blood, saliva, tears, aqueous humour, vitreous, and cerebrospinal fluid has been studied after oral treatment with 5 mg/kg/day of CsA or application of 2% CsA eye drops in olive oil solution. After oral treatment all patients had high CsA levels in blood. Measurable levels of CsA were also found in the saliva and tears. Patients without any intraocular inflammation or patients with mild uveitis did not have any detectable CsA in the aqueous humour. However, patients with severe uveitis had significant levels of CsA in the aqueous humour and in the vitreous. No CsA was found in the cerebrospinal fluid of two patients with central nervous system manifestations of Behçet's disease. After local treatment with 2% CsA eye drops no detectable levels of CsA were found in the blood, the saliva, the aqueous humour, or the vitreous even in patients with severe uveitis.

[3 years' clinical experience with IOGEL lenses]. / Drei Jahre klinische Erfahrung mit IOGEL-Linsen.

A total of 63 IOGEL PC-12 and 12 IOGEL 1103 intraocular lenses have been implanted at Lausanne and Basle University Eye Hospitals, and followed up for up to 3 years. In general, the functional and anatomic results are good. From a comparison of the behavior of IOGEL lenses implanted in the sulcus and capsular bag it is concluded that given a suitable surgical technique the IOGEL 1103 lens with implantation in the capsular bag may be recommended.

Treatment of endogenous uveitis with cyclosporine A.

Thirty patients suffering from severe sight-threatening bilateral chronic endogenous uveitis were treated with initial dosages of 10 mg/kg/d of CsA. After 1 month of therapy, all patients but one demonstrated a rapid decrease of the intraocular inflammatory processes along with an arrest of the deterioration of vision. After 1 year (or more) of treatment, most patients still show the same visual acuity achieved after 1 month. During the 3-year span of this study, attempts at tapering off the CsA dosage to less than 5 mg/kg/d induced a temporary flare-up in 20 of the 24 patients followed without interruption for more than 6 months. Nonetheless, control of the intraocular inflammation was finally achieved by 5 mg CsA/kg/d or less in 14 of the 25 patients. In six of these 14 patients the CsA dosage was further tapered to total discontinuation. Two of the six patients showed a rapid reactivation of the intraocular inflammatory processes with a profound decrease in vision within 1 and 3 weeks, respectively. In four patients, control of the intraocular inflammation and preservation of good visual acuity have been observed for a period of up to 18 months.

Evaluation of conventional therapy versus cyclosporine A in Behçet's syndrome.

When ocular structures are affected in Behçet's syndrome, a rapid loss of vision has been the rule regardless of the type of treatment--corticosteroids, Leukeran, Imuran, colchicine. The objectives of the present study were to compare, in a masked manner, conventional treatment (corticosteroids/Leukeran) to treatment with CsA. Forty patients suffering from Behçet's syndrome with active ocular inflammatory reactions were included in the study. These were randomly assigned to conventional or CsA regimens and were regularly examined by a multidisciplinary group of physicians. The unmasked internist modulated the treatment and recorded systemic manifestations. The masked ophthalmologists recorded the ocular findings without knowledge of the assigned type of treatment. An analysis of the results 3 years after initiation of the study shows that CsA is more effective than conventional therapy in decreasing the active ocular inflammatory processes and arresting the deterioration of visual acuity. Regarding the extraocular symptoms, however, conventional therapy is superior to CsA, especially for the control of skin lesions and arthritis. Side effects were recorded in a much higher incidence among patients receiving CsA. However, tight and constant control of the CsA dosage as performed in this study has, so far, prevented clinical and biochemical nephrotoxic manifestations in patients assigned to this treatment.

Metastatic Serratia marcescens endophthalmitis.

Metastatic endophthalmitis in a ten-day-old baby who underwent colostomy for an unperforated anus and developed septicemia to Serratia marcescens is described. Although rapid isolation of the agent enabled efficacious specific antibiotic treatment and systemic eradication of the infective agent, the ocular condition continued to deteriorate. Because of the total loss of visual functions and the fear of possible development of sympathetic ophthalmia, enucleation rather than vitrectomy or evisceration was performed. Histopathologic examination of the globe revealed massive infiltrates within the choroid and optic nerve with total destruction of the retinal architecture. The child recovered immediately after surgery and was discharged a week later.

The development of synapses in striate cortex of man.

Synaptic density in human striate cortex was determined at various ages, utilizing a computer assisted method. Simultaneous measurement of total volume of striate cortex made it possible to estimate total number of synapses. Synaptogenesis in human striate cortex was found to be most rapid between ages 2-4 months, a time which also is critical for the development of function in visual cortex of the infant. Synapse elimination occurred subsequently with loss of about 40% of synapses between ages 8 months and 11 years. Synapse numbers were stable in adults, except for a slightly lower value in a single brain at age 71 years. Analysis by individual cortical layers showed similar age related changes in all strata of striate cortex, except for somewhat later synaptogenesis in cortical layers V and VI. Total volume of striate cortex reached adult size remarkably early, at about age 4 months. The findings support the hypothesis that exuberant synaptic connections are an anatomical substrate for plasticity in developing cerebral cortex.

The effect of liquid silicone on the rabbit retina. Histologic and ultrastructural study.

Silicone oil was injected into 23 rabbit eyes, which had undergone vitrectomy and which were then examined in the electron microscope six weeks later. Retinal lesions were observed in the outer plexiform layer. They consisted mainly of a subtotal disappearance of the processes of horizontal and bipolar cells and of the synaptic terminals of the photoreceptors. The lesions were seen only in areas of the retina that had been in permanent contact with the oil bubble. They did not depend on the purity of the silicone oil injected.

Structural development of the lateral geniculate nucleus and visual cortex in monkey and man.

This study concerns the development of the primary visual pathway of the primate. The lateral geniculate nucleus (LGN) is the principal thalamic relay to the visual cortex (area 17), and its neurons have similar morphological characteristics in both monkey and man, as identified by Golgi impregnation. The commonest neuron is the multipolar with a radiate or tufted dendritic tree; next is the bipolar neuron with two or three diametrically opposed dendritic trunks. Less frequent are neurons with beaded dendrites and others with fine, axon-like dendritic processes, possibly interneurons. The dendritic tree of all neurons remains generally within a lamina, but some dendrites cross interlaminar zones. LGN neurons are identifiable before birth and differ from their adult form by the presence of immature features, especially numerous dendritic and somatic spines, most frequent at birth in monkeys and at about 4 months postnatally in man. They disappear almost completely by 3 months in monkeys and 9 months in man. The human LGN has reached its 'adult' volume by this age. Two stages in the development of the human area 17 can be defined. The first is marked by a rapid growth to its 'adult' volume by about 4 months, and by intense synaptogenesis beginning in the foetus and reaching a maximum around 8 months. The second stage is one of stabilization in the volume of area 17 and loss of synapses to reach 'adult' synaptic density around 11 years, at about 60% of the maximum values.

[Morphological development of the primary visual pathway in the child]. / Développement morphologique de la voie visuelle primaire chez l'enfant.

This study concerns the development of the human primary visual pathway. The lateral geniculate nucleus (LGN), the principle thalamic relay to the visual cortex (area 17), has a population of neurons similar to that of the monkey, as identified by Golgi impregnation. Commonest neuron is the multipolar with a radiate or tufted dendritic tree, followed by the bipolar neuron with two or three diametrically opposed dendritic trunks and, more rarely, neurons with beaded dendrites and those with fine, axon-like dendritic processes, possibly interneurons. The dendritic tree of all neurons remains generally within a lamina, but some dendrites cross interlaminar zones. These zones contain neurons whose dendrites enter adjacent laminae. LGN neurons are identifiable at birth, and even earlier, and differ from their adult form by the presence of immature features (growth cones and numerous dendritic and somatic spines), most frequent at four months but disappearing completely by nine months post-natally, when the LGN has reached its "adult" volume. Two stages in the development of area 17 can be defined. The first is marked by rapid growth to its "adult" volume at about four months, and by intense synaptogenesis beginning in the foetus and reaching a maximum around eight months. The second stage is one of stabilization of volume of area 17 and loss of synapses to reach "adult" synaptic density around 11 years, at about 60 p. cent of maximum values. The formation of transitory morphological features in the first year coincides with a period of visual plasticity in the infant. Our observations can be correlated with clinical evaluations of visual activity during the preverbal stage, a period of great importance in the establishment of visual acuity, of stereopsis, and of oculomotor function, all very sensitive to the numerous forms of visual deprivation.

Synaptogenesis in human visual cortex--evidence for synapse elimination during normal development.

Age-related changes in synaptic density in human visual cortical area 17 (striate cortex) were determined, based on counts in material prepared for electron microscopy with the phosphotungstic acid method. The results were correlated with measurements of the volume of striate cortex from celloidin sections. Two periods were defined, one of rapid synapse production which ends at about postnatal age 8 months, and a subsequent longer period of synapse elimination which extends past age 3 years. Exuberant synaptic connections during early childhood may impart to the immature cerebral cortex plasticity which is lost in the adult.