INTRODUCTION : Une cellulite orbitaire est une inflammation aigue du contenu orbitaire, d’origine infectieuse. C’est une urgence diagnostique et thérapeutique. Les auteurs rapportent un cas de cellulite orbitaire révélant une tumeur maligne du sinus maxillaire. OBSERVATION : Il s’agissait d’une patiente âgée de 20 ans, consultant pour une protrusion du globe oculaire gauche, évoluant depuis 15 jours avec une notion d’épistaxis intermittente. L’examen ophtalmologique objectivait à l’œil gauche : une acuité visuelle chiffrée à 3/10, une tuméfaction palpébrale, un chémosis, une ophtalmoplégie incomplète, un tonus oculaire à 33 mm Hg. La TDM orbito-cérébrale demandée en urgence, montrait une pansinusite gauche compliquée d’une cellulite grade 5 de Chandler. Un traitement antibiotique avait été instauré. L’examen ORL dans le cadre d’un bilan étiologique retrouvait une lésion bourgeonnante développée au dépend du sinus maxillaire dont la biopsie avec examen anatomopathologique était en faveur d’un rhabdomyosarcome de type alvéolaire. CONCLUSION : Le bilan étiologique d’une cellulite orbitaire permet de ne pas méconnaitre une cause sinusienne telle qu’une tumeur maligne. Ce bilan doit comprendre un examen clinique approfondi, une imagerie orbito-crânienne, voire un examen anatomopathologique.

Purpose.-To study the topography of retinal breaks and their agreement with Lincoff's rules. Materials and Methods.-We performed a retrospective descriptive study of patients with recent rhegmatogenous retinal detachments followed on the ophthalmology service of Abass Ndao Hospital from January 2006 through December 2016. Patients with no prior retinal treatment were included. Results.-Over 11 years, we reviewed 97 patients with 107 eyes with retinal detachments. The mean age of our patients was 51.7 years, range 23-79 years. There were 69 male patients, for a male:female ratio of 2.46. Refraction revealed that 38.1% of patients were myopes. Fourteen percent (14%) of patients had experienced trauma to the eye with the detachment. The right eye was involved in 54.6% of patients. The onset was insidious in 54.6% of cases and sudden in 23.7% of cases. All patients had decreased visual acuity, associated with a scotoma in 26.8% of cases. Visual acuity was decreased to light perception through 7/10. In 64.9% of cases, Lincoff's rules were observed. Discussion.-Lincoff's rules are still relevant for localization of the breaks in retinal detachments. Conclusion. Diagnosis of a retinal detachment is an essential step, since it determines the treatment. Lincoff's rules still have a role in finding the retinal break in retinal detachments. (C) 2019 Elsevier Masson SAS. All rights reserved.

PURPOSE:To appreciate the epidemiological characteristics and to show the therapeutic aspects of the giant retinal tears. PATIENTS AND METHODS:We conducted a retrospective study from January 2014 to June 2017 on subjects with giant retinal tears. Patients with media opacities limiting examination were excluded. RESULTS:We identified 17 cases of giant retinal tears. The frequency of detachments related to a giant retinal tear was 17% compared to all retinal tears. The mean age was 50.75 years with a sex ratio (M/F) of 6.5. We found three cases of high myopia, one case of hyperopia and four trauma cases. All patients had a decrease in visual acuity. The average time to consultation was four weeks. The mean intraocular pressure was 8mmHg. The tear was found in the left eye in eight cases and in the right eye in five cases; two cases were bilateral. We performed intraocular surgery in five eyes and laser in four eyes. We achieved anatomical reattachment and functional improvement in all operated patients. COMMENTS AND CONCLUSION:The prognosis of a giant retinal tear remains guarded, especially if patients are seen and treated late. Laser photocoagulation of giant tears remains effective, especially in cases of early diagnosis.

La prise en charge des cancers du côlon des patients âgés est caractérisée par une proportion importante d’abstention thérapeutique. Nous avons recherché si la mise en place de la réunion de concertation pluridisciplinaire (RCP) a modifié les pratiques. Nous avons comparé la prise en charge de tous les patients consécutifs âgés de 75 ans et plus, opéré d’un adénocarcinome colique entre 1995 et 2000 avant la mise en place de la RCP (période 1) et entre 2001 et 2005 après la mise en place de la RCP (période 2). La sélection des patients a été réalisée par la revue du fichier du service d’anatomopathologie confronté au bilan d’extension réalisé pour chaque patient opéré. Quatre vingt seize patients de 75 ans et plus ont eu une résection d’un adénocarcinome colique pendant la période 1 et 104 pendant la période 2. Parmi ceux-ci, il y avait 40 cancers de stade II et 23 de stade III pendant la période 1 (âge médian : 80, extrêmes : 75 - 94), 44 de stade II et 29 de stade III pendant la période 2 (âge médian : 82 ans, extrêmes : 75 - 95). Pendant la période 2 : 64 % des dossiers ont été discuté en RCP en péri-opératoire (54 % des dossiers de stade II et 79 % des dossiers de stade III). Le taux de présentation des dossiers en RCP a significativement augmenté avec le temps (55 % de Janvier 2001 à Mai 2003 vs 79 % de Juin 2003 à Décembre 2005, p = 0,05). La proportion de chimiothérapie adjuvante après résection d’un cancer de stade II pendant la période 1 et la période 2 était de 5 % et 7 % et pour les stades III de 26 % et de 41 % respectivement (p = 0,3). Pendant la période 2 la proportion de décision de chimiothérapie dans les stade III était de 52 % en cas de soumission du dossier à la RCP et de 0 % en l’absence de discussion pluridisciplinaire. Pour les stade III, 40 % des patients de 75-79 ans ont été traités par chimiothérapie adjuvante vs 15 % des patients âgés de 80 ans et plus (p = 0,03). Une évolution de la prescription de chimiothérapie était constaté selon la période : pendant la période 1, 6/ 9 patients âgés 75 à 79 ans et 0/14 patients âgés de 80 ans et plus, ont reçu une chimiothérapie adjuvante. Pendant la période 2, 6/9 patients âgés de 75 à 79 ans et 6/20 des patients âgés de 80 ans et plus, ont reçu une chimiothérapie adjuvante, mais aucun après 85 ans. L’instauration d’une RCP a permis de poser un plus grand nombre d’indication de chimiothérapie adjuvante. La proportion de patients âgés discutée en RCP augmente avec le temps. Le grand âge reste néanmoins associé à une non-prescription de chimiothérapie adjuvante. Le bénéfice d’une chimiothérapie adjuvante chez des patients âgés de plus de 80 ans reste à établir. L’établissement de critères de sélection des patients âgés devant bénéficier d’une chimiothérapie adjuvante est souhaitable.

Environ 15 % des adénocarcinomes colorectaux présentent une instabilité des microsatellites (IMS). Ces tumeurs ont un meilleur pronostic que celles sans IMS. La fréquence des tumeurs avec IMS augmente avec l'âge par un mécanisme d'hyperméthylation du promoteur du gène hMLH1. Cependant, la prévalence exacte de l'IMS et ses potentielles implications cliniques ne sont pas connues après l'âge de 75 ans. Tous les patients consécutifs ayant une détermination du statut IMS ont été inclus dans deux centres entre 2005 et 2008. La détermination du statut IMS a été réalisée par l'analyse de 5 marqueurs quasi-monomorphes (BAT26, BAT25, NR21, NR22, NR24). L'instabilité d'au moins 3 marqueurs étant requise pour porter le diagnostic d'IMS. La prévalence de l'IMS a été comparée entre les patients de moins de 75 ans et de 75 ans et plus. Les patients présentant un syndrome HNPCC avec mutation identifiée ont été exclus de l'étude. 754 patients ont été inclus dont 272 (36 %) patients âgés de 75 ans ou plus (âge médian 82 ans, extrêmes 75 à 101 ans). Il y avait 425 hommes et 329 femmes. La proportion de femmes était de 38 % avant 75 ans et de 53 % à partir de 75 ans (p < 0,0001). Sur l'ensemble de la population une IMS dans la tumeur primitive a été mise en évidence dans 105 (13,9 %) cas. La proportion d'IMS était de 19,4 % à partir de l'âge de 75 ans et de 10,7 % avant 75 ans (p = 0,0017). Chez les patients de 75 ans et plus la proportion des IMS était significativement plus élevé chez les femmes que chez les hommes (27 vs 10,2 %, p = 0,003). Chez les patients de moins de 75 ans il n'y avait pas de différence de prévalence de l'IMS entre les hommes et les femmes (12,5 vs 9,7 %, p = 0,4). Parmi 80 patients dont les tumeurs présentait une IMS et pour lesquels la mutation V600E de BRAF a été recherchée il y avait une différence significative en fonction de l'âge (11,4 % avant 75 ans vs 72,2 % après 75 ans, p < 0,001). Dans le groupe des 36 patients étudiés de 75 ans et plus il n'y a pas de différence de prévalence de la mutation V600E en fonction du sexe (78 % chez les femmes et 70 % chez les hommes, p > 0,9). Parmi les 21 patients dont les tumeurs présentaient une IMS et pour lesquels des résultats d'immunomarquage hMLH1 et hMSH2 étaient disponibles, il y avait une extinction de l'expression d'hMLH1 et de hMSH2 chez 8/10 et 1/10 des patients de 75 ans et plus et chez 6/11 et 1/11 des patients de moins de 75 ans. La prévalence de l'IMS dans les adénocarcinomes colorectaux est significativement plus élevée après l'âge de 75 ans. Dans cette tranche d'âge, l'IMS est significativement plus fréquente chez les femmes. Cette variation ne semble pas liée à une hyperméthylation différente du promoteur de hMLH1. La valeur pronostique de l'IMS dans cette tranche d'âge est en cours d'évaluation.

Three dietary CP concentrations (11.5, 13.0, and 14.5% of DM) and 3 supplemental urea levels (100, 50, and 0% of supplemental N) were used in a completely randomized block design experiment conducted at 2 locations to determine N and P balance and serum urea N (SUN) concentrations of feedlot cattle. Crossbred steers [British and British x Continental; initial BW = 315.0 +/- 3.2 kg at location 1 (n = 27) and initial BW = 353.2 +/- 8.4 kg at location 2 (n = 27)] were used in 3 nutrient balance sampling periods (SP) at the beginning, middle, and end of the feeding period (154 d in location 1 and 159 d in location 2). Fecal N (g/d; P = 0.03), urinary N (g/d; P < 0.01), urinary urea N (UUN; g/d; P < 0.01), apparent N absorption (g/d; P < 0.01), and SUN concentration (mg/dL; P < 0.01) increased linearly as dietary CP concentration increased. Nitrogen retention (g/d) was not affected (P = 0.61) by dietary CP concentration. Phosphorus intake (g/d; P = 0.02), fecal P (g/d; P = 0.04), and urinary P (g/d; P = 0.01) increased linearly as dietary CP increased, reflecting changes in diet composition with increasing CP concentrations. As dietary urea levels increased, urinary N (g/d; P = 0.04), UUN (g/d; P = 0.01), and apparent N absorption (g/d; P = 0.04) increased linearly, but P intake (g/d; P = 0.10) and urinary P (g/d; P = 0.02) decreased linearly. No interactions were observed between SP and dietary treatments for most variables. Evaluation of SP means, however, showed that as days on feed increased, fecal N (g/d; P = 0.01), urinary N (g/d; P < 0.01), UUN (g/d; P < 0.01), apparent absorption of N (g/d; P < 0.01), SUN (mg/dL; P < 0.01), and urinary P (g/d; P < 0.01) increased linearly, whereas retained N (g/d) decreased linearly (P < 0.01) with increasing days on feed. These data suggest that changes in dietary CP and urea levels, as well as stage of the feeding period, markedly alter N and P utilization by feedlot cattle.

OBJECTIVE:With personal results and a review of the literature, we report the eventual interest of surgical staging in malignant ovarian germ cell tumours.PATIENTS AND METHODS:This was a retrospective study of 36 patients (21.5-[8-61]) with malignant ovarian germ cell tumours between January 1984 and December 2004. There were 4 groups: no 1--dysgerminoma only, no 2--immature teratoma, no 3--malignant ovarian germ cell tumours with secretion. All the patients had a minimal follow up of 18 months after treatment. We reported conservative or non-conservative surgery, if surgical staging was made and description of eventual neoadjuvant or adjuvant chemotherapies and finally the recurrences and deaths.RESULTS:Stages of FIGO were: group 1--IA n=2, IC n=2, IIB n=1, IIIA n=2, IIIC n=3; group 2--IA n=3 (G1, G2, G2), IC n=1 (G3); group 3--IA n=8, IC n=4, IIA n=1, IIIA n=1, IIIB n=3, IIIC n=5. Three patients had neoadjuvant chemotherapy. All the patients had cytoreductive surgery (conservative surgery n=31) with staging in 15 cases. Twenty-six patients had adjuvant chemotherapy. Five years global survival was 92%.DISCUSSION AND CONCLUSION:Surgery in a young patient with malignant ovarian germ cells tumours must be conservative (adnexectomy) (preserving fertility and because of good prognostic). In case of stage IA with part of dysgerminoma and/or immature teratoma and/or embryonal carcinoma certified by surgical staging, strict follow up could be organized (clinic, radiology, AFP, HCG). In case of more than stage IA, chemotherapy is indicated after conservative surgery and surgical staging.

African green monkeys (AGMs) persistently infected with SIVagm do not develop AIDS, although their plasma viremia levels can reach those reported for pathogenic HIV-1 and SIVmac infections. In contrast, the viral burden in lymph nodes in SIVagm-infected AGMs is generally lower in comparison with HIV/SIVmac pathogenic infections, at least during the chronic phase of SIVagm infection. We searched for the primary targets of viral replication, which might account for the high viremias in SIVagm-infected AGMs. We evaluated for the first time during primary infection SIVagm dissemination in various lymphoid and non-lymphoid tissues. Sixteen distinct organs at a time point corresponding to maximal virus production were analyzed for viral RNA and DNA load. At days 8 and 9 p.i., viral RNA could be detected in a wide range of tissues, such as jejunum, spleen, mesenteric lymph nodes, thymus and lung. Quantification of viral DNA and RNA as well as of productively infected cells revealed that viral replication during this early phase takes place mainly in secondary lymphoid organs and in the gut (5 x 10(4)-5 x 10(8) RNA copies/10(6) cells). By 4 years p.i., RNA copy numbers were below detection level in thymus and lung. Secondary lymphoid organs displayed 6 x 10(2)-2 x 10(6) RNA copies/10(6) cells, while some tissue fragments of ileum and jejunum still showed high viral loads (up to 10(9) copies/10(6) cells). Altogether, these results indicate a rapid dissemination of SIVagm into lymphoid tissues, including the small intestine. The latter, despite showing marked regional variations, most likely contributes significantly to the high levels of viremia observed during SIVagm infection.

Atmospheric emissions of ammonia, as well as other gases and particulates are a growing concern of livestock producers, the general public and regulators. The concentration and form (rapidly degradable in the rumen vs. slowly degradable in the rumen) of protein in beef cattle diets may affect urinary and fecal excretion of nitrogen and thus may affect ammonia emissions from beef cattle feedyards. To determine the effects of dietary protein concentration and degradability on potential ammonia emissions, 54 steers were randomly assigned to 9 dietary treatments in a 3 x 3 factorial arrangement of treatments. Treatments consisted of three dietary crude protein concentrations (11.5, 13, and 14.5%) and three supplemental urea:cottonseed meat ratios (100:0, 50:50, and 0:100 of supplemental N). Steers were confined to tie stalls and feces and urine excreted were collected and frozen. One percent of daily urine and feces excretion were mixed and added to polyethylene chambers containing 1,550 g of soil. Chambers were sealed and ammonia emissions were trapped in an acid solution for seven days using a vacuum system. Results suggest that as the protein concentration in the diet increases from 11.5 to 13%, potential daily ammonia emissions increased 60 to 225%, due primarily to increased urinary N excretion. As days on feed increased, in vitro ammonia emissions also increased. Potential daily ammonia emissions must be balanced with possible effects on animal performance to determine optimal protein concentrations and forms.

We previously reported data on the dynamics of acute SIVagm infection in AGMs showing remarkable similarities with viral replication patterns observed in peripheral blood during the first two weeks of pathogenic SIVmac infection. We therefore compared these early events occuring in peripheral blood of infected AGMs with those taking place in the lymph nodes of distinct anatomical sites (cervical, axillary, inguinal and mesenteric lymph nodes). The lymph node RNA and DNA viral load patterns were similar to those in blood with peaks ranging from 5.10(4)-1.10(8) RNA copies/10(6)LNC and 10(3)-6.10(4) DNA copies/10(6)LNC between day 7 and day 14 followed by rapid and significant decreases as early as 21 days post-infection. The lymph node architecture and the FDC network was conserved during the course of infection, and neither follicular hyperplasia nor CD8(+) cell infiltration into LN germinal centers were detected in acute and chronic phases of infection.

This massive infiltration of subcutaneous fascias with local necrosis, microabcess, and local thrombosis of small vessels is not always due to Streptococcus pyogenes. Nevertheless, this microorganism has a major role with the toxic shock-like syndrome it can induce, even in healthy subjects, lethal in 60 % of cases despite available sophisticated therapeutic means. Diabetes mellitus appears as a lethality risk factor during necrotizing fasciitis. For some cases, several microorganisms have been identified through microbiology. Nevertheless, since the mid-eighties, many authors have also suspected new virulence of Streptococcus pyogenes. Early debridement has been the only successful therapy since 1924, date of the first case described by Meleney.

The authors studied the prevalence and risk determinants for human immunodeficiency virus type 1 (HIV-1) and type 2 (HIV-2) in female prostitutes from Dakar (1985-1990), Ziguinchor (1987-1990), and Kaolack (1987-1990), Senegal, West Africa. Each cohort showed a distinct distribution of HIVs: 10.0% HIV-2 and 4.1% HIV-1 in Dakar, 38.1% HIV-2 and 0.4% HIV-1 in Ziguinchor, and 27.4% HIV-2 and 1.3% HIV-1 in Kaolack. In 1,275 female prostitutes from Dakar, increase years of sexual activity and a history of scarification were associated with HIV-2 seropositivity. In contrast, HIV-1 seroprevalence was associated with a shorter duration of prostitution and a history of hospitalization. In 278 female prostitutes from Ziguinchor, HIV-2 seroprevalence was associated with women of Guinea-Bissau nationality and increased years of sexual activity. In 157 female prostitutes from Kaolack, HIV-2 seroprevalence was associated with increased years of sexual activity and a history of never using condoms. The authors also studied the risk determinants for HIV-2 in the 1,280 Senegalese prostitutes pooled from all three sites. Controlling for ethnic group, women from Ziguinchor and Kaolack were more likely to be HIV-2 seropositive as compared with women from the Dakar site. Increased years of sexual activity were associated with HIV-2 seropositivity, while a history of excision and BCG vaccinations decreased the risk of HIV-2 infection.