A familial disorder with low bone density and renal phosphate wasting.

Hereditary forms of renal phosphate wasting have been studied thoroughly in the past years. X-linked Hypophosphatemic rickets (XLH), autosomal dominant hypophosphatemic rickets/osteomalacia (ADHR) and autosomal recessive hypophosphatemic rickets (ARHR) are known genetic disorders in which a disturbance of phosphatonins is a causative factor in the pathogenesis. We describe a comparable but yet undescribed disorder in a family in which a 53 year old man presented with a spontaneous fracture after suffering for years with severe fatigue and musculoskeletal pains.

[Refractive surgery: techniques and reliability].

Refractive surgery modifies anatomic properties of the eye, in order to improve vision without the recourse to optical devices. It includes corneal surgery (radial keratotomy, excimer laser keratectomy), intraocular surgery (artificial lens implantation) and scleral surgery. The level of satisfaction of the patients who have benefit from this surgery is usually high, but is related to the selection of the subjects, which depends on the motivation and also on the default to be corrected.

[The ophthalmology department].

The main clinical activities developed during the first 25 year of the department are described. Topics of fundamental and also clinical research are briefly reviewed.

[Severe hypokalemia with paralysis in a patient with distal renal tubular acidosis as an initial expression of Sjögren's syndrome].

In a 33-year-old woman with a recent flaccid paralysis of the arms and legs, laboratory tests demonstrated a severe hypokalemia with hyperchloremic metabolic acidosis and abnormally acidified urine. The urinary anion gap was positive in the presence of acidosis, thus establishing the diagnosis of distal renal tubular acidosis. The patient made a full recovery after potassium and alkali replacement.

Corneal dystrophy and perceptive deafness (Harboyan syndrome): CDPD1 maps to 20p13.

The association of congenital corneal dystrophy with teenage onset perceptive hearing loss (Harboyan syndrome) has been reported in two sibships, one with consanguineous parents, which were consistent with autosomal recessive transmission. We have observed a Moroccan sibship where four girls and one boy were affected with this rare syndrome. The parents were first cousins once removed and unaffected.

Flow measurements in dialysis shunts: lack of agreement between conventional Doppler, CVI-Q, and ultrasound dilution.

Background: Measuring flow in dialysis shunts is recommended to predict imminent thrombosis. Multiple methods for measuring blood flow are in use. Numerous ultrasound protocols exist which determine volume flow using a conventional Doppler (CD) frequency shift analysis technique.

Reversible renal failure after treatment with omeprazole.

Omeprazole is a proton pump inhibitor widely used in the treatment of gastro-esophageal reflux disease and peptic ulcer disease. In a 73-year-old man we describe renal failure due to acute interstitial nephritis after use of omeprazol during 4 months. Unexpected renal failure without signs of hydronephrosis should always provoke awareness of drug reaction, omeprazole being one of the possible drugs.

[Placoid pigment epitheliopathy and cerebral vasculitis: a clinical case].

We report the case of a 21 year old man who has severe headache and blurred vision since 2 weeks. Ophthalmologic examination discloses typical lesions of acute posterior multifocal placoid pigment epitheliopathy and an homonymous right inferior quadrantanopsia. An inflammatory syndrome and a cerebrospinal fluid lymphocytosis are found.

[Primary herpetic infection after transfixing keratoplasty].

Purpose: To describe a case of herpes simplex virus primary infection after a corneal transplantation and to analyse different possible ways by which the infection could have been transmitted.

Methods: A corneal transplanted patient for a Fuchs dystrophy complains 10 days postoperatively of a flu-like syndrome with keratouveitis. Donor and recipient viral serologies and a polymerase chain reaction analysis of aqueous humor were performed.

[Acute pancreatitis, papillary coloboma and serous macular detachment].

A serous macular detachment in one eye with spontaneous flattening is seen twice during acute pancreatitis in a man aged thirty-four years who has a pancreatic malformation and an optic disc coloboma of this eye. Fluorescein angiography discloses the classic sequence of an optic disc pit complicated by maculopathy. Vascular leakage attributed to acute pancreatitis is also seen in the macula.

[The advantages and disadvantages of bifocal lenses].

The bifocal glasses present three main disadvantages: the jump of the image when the visual axis passes from the far vision glass to the reading segment, the prismatic effect on the near vision point that entails an apparent displacement of the fixed object as well as a degradation of the quality of its image, and the absence of intermediate vision in total presbyopia. Bifocals however keep their indications, even after the availability of the progressive glasses, by people accustomed with this kind of correction, and by others who are not supporting deformations in the lateral vision of the progressive glasses. Suggestions are made for choosing the model of bifocal which is the most appropriate in function of the different situations.

[Why and how to correct myopia?].

The myopia and its aggravation depend on genetic and environmental factors. Experiences performed on monkeys and chickens indicate that the quality of the image affects the growth on the ocular globe in the young animal by modifying biochemical conditions at the retinal level. If near work seems to be a factor associated to the myopia, the role of sustained accommodation on the evolution of the former is not evident.

'Oversaturation' of transferrin after intravenous ferric gluconate (Ferrlecit(R)) in haemodialysis patients.

Background: Chronic haemodialysis causes blood loss and iron-deficiency. This can be corrected with intravenous preparations, e.g.

[Peripheral ulcerative keratitis and a form of limited wegener's granulomatosis].

A man aged 68 years presents superior limbal infiltrates at his left eye two weeks before a marginal ulcer which quickly perforates. He has no systemic complaint. Clinical, biological, radiologic and histological evaluations disclose superior airways and lungs implications, an inflammatory syndrome, high ANCA (antineutrophiles cytoplamic antibodies) titer and vasculitis.

[Prevention of infections in the ophthalmology office].

Transmission of infectious agents from a patient to the following one in the medical office may result from infected collyria, from contact to the cornea by infected instruments or simply by the hands of the medical staff if some rules of hygiene are not respected. The prevention comprises the instillation without contact of the collyria, the adequate disinfection of instruments and the frequent hand washing. The disinfection of the tonometers and contact glasses aims particularly the elimination of viruses.

Pancreatic pseudocyst as a cause of upper gastrointestinal bleeding.

A 67-year-old man with a history of an attack of pancreatitis was repeatedly investigated for recurrent gastrointestinal bleeding necessitating blood transfusions. Routine investigations did not reveal the source of bleeding. Repeated angiograms also were not diagnostic.

[Fetal alcohol syndrome and bilateral uniform posterior haze of the cornea].

A boy aged 12 prematurely born presents several signs of fetal alcohol syndrome (FAS): mild mental retardation, staturoponderal delay, microcephaly, thin philtrum and vermillion of the upper lip. The ophthalmological aspects are: telecanthus, retinal vascular tortuosity, hypoplastic optic discs, hypermetropia, and an uniform, diffuse posterior haze on both corneas. This haze, which is not described till now as part of the syndrome, is not present in the other members of his family.

[Chorioretinal lymphoproliferative disorder induced by Epstein-Barr virus in lung transplantation].

The Epstein-Barr virus (EBV) is the causative factor of the posttransplant lymphoproliferative syndromes. Some ocular cases were described. We report the case of a lung-transplanted 59 year old man who presented a chorioretinal lymphoproliferative syndrome.

Bleeding into a liver cyst can be treated conservatively.

Objective: To report the case of a patient with haemorrhage in a large hepatic cyst.

Patient: A 66-year-old man, who presented with right shoulder pain and subsequent sudden abdominal pain. A large hepatic cyst containing blood was found at ultrasonography.

[Post-varicella acute retinal necrosis].

A man aged 43 in good health complaints of sudden blurred vision in his right eye, 12 days after a generalized chickenpox eruption. Examination shows an intraocular inflammation with retinal necrosis in temporal periphery. The serum antibodies against varicella-zoster are positive for the IgM and IgG, confirming a recent infection by varicella zoster.

Cholesterol-embolism: diagnosis by endoscopy.

A case report is presented, concerning a 68-year-old woman, with gastro-intestinal complaints, six weeks after an aortic arteriography. On gastroscopy a duodenal ulcer was found and multiple purple discolourations. Biopsies show that these discolourations were caused by cholesterol-emboli.

[Is treatment with corticotherapy or radiotherapy effective for involvement of ocular motility and for reduction of exophthalmos in Basedow's disease?].

It is acknowledged that high-dose corticotherapy, radiotherapy, or surgical decompression of the orbit are often efficient in dysthyroid optic neuropathy. Corticotherapy and radiotherapy are also given to patients with dysfunction of eye-muscle motility and/or proptosis in the absence of visual loss. The latter indication has been retrospectively evaluated in 13 patients.

[Primary orbital lymphoma within the context of Sjögren's syndrome secondary to rheumatoid arthritis].

We are describing the case of a seventy-four year old woman presenting a voluminous hard and painless tumor of the right lids, which has appeared half a year ago. Past medical history consists in a Sjögren's syndrome secondary to rheumatoid arthritis. The right eye is not visible and the left eye presents an important xerophthalmia and an opaque and vascularized cornea.

Inhalation trauma due to overheating in a microwave oven.

The microwave oven is a kitchen appliance that has become increasingly popular in recent years. In some instances the temperature in the microwave oven can become exceedingly high. A case is discussed of a patient with respiratory distress after inhalation of gas from an overheated microwave oven.

[Cryptococcal chorioretinitis and acquired immunodeficiency syndrome: apropos of a case].

A patient with acquired immune deficiency and antecedents of pancreatitis presented with headaches, fever, dyspnea and bilateral decrease of vision. A diagnosis of disseminated cryptococcosis was made by lumbar puncture, alveolar washing and elevated cryptococcal antigen in blood, urine and stool. Bilateral chorioretinitis with ischaemic maculopathy was responsible of the low vision and attributed to cryptococcal infection after vitreous puncture and isolation of yeast from the vitreous.