Prise en charge des troubles oculomoteurs après effraction iatrogène de l'orbite au cours d'interventions sinusiennes endoscopiques [Management of motility disorders secondary to iatrogenic orbital fracture during endoscopic sinus surgery.]

PURPOSE: Orbital wall fracture may occur during endoscopic sinus surgery, resulting in oculomotor disorders. We report the management of four cases presenting with this surgical complication. METHODS: A non-comparative observational retrospective study was carried out on four patients presenting with diplopia after endoscopic ethmoidal sinus surgery. All patients underwent full ophthalmologic and orthoptic examination as well as orbital imaging. RESULTS: All four patients presented with diplopia secondary to a medial rectus lesion confirmed by orbital imaging. A large horizontal deviation as well as limitation of adduction was present in all cases. Surgical management consisted of conventional recession-resection procedures in three cases and muscle transposition in one patient. A useful field of binocular single vision was restored in two of the four patients. CONCLUSION: Orbital injury may occur during endoscopic sinus surgery and cause diplopia, usually secondary to medial rectus involvement due to the proximity of this muscle to the lamina papyracea of the ethmoid bone. Surgical management is based on orbital imaging, duration of the lesion, evaluation of anterior segment vasculature, results of forced duction testing and intraoperative findings. In most cases, treatment is aimed at the symptoms rather than the cause, and the functional prognosis remains guarded.

Pseudogynes (=sécrétergates) et répartition des individus à l'intérieur d'une fourmilière de Formica lugubris Zett (Hymenoptera, Formicidae)

Following the discovery of numerous pseudogynes (= secretergates) in a polycalic colony ofFormica lugubris Zett, the author describes the qualitative and quantitative aspects of the distribution of individuals inside the nest. Workers are distributed in three clusters, the first (21 %) could consist of foragers, living in the upper part of the nest, and is distinguished by a low percentage of secretergates (1 %). The two others contain mainly domestic workers. Queens inhabit two areas (intermediate and deep). The percentage of secretergates increases with depth in the nest. Measurements of normal workers and secretergates show that the latter are significantly smaller.

Evaluation du dispositif d'urgences sociales EMUS

Le concept EMUS (équipe mobile d'urgences sociales) trouve son origine dans la réunion consacrée à l'urgence sociale qui s'est tenue en fin d'année 2009 et dans le rapport sur la création de l'équipe mobile d'urgence établi en été 2010 à la suite de cette réunion. Le Département de la santé et de l'action sociale (DSAS) a mandaté l'IUMSP pour effectuer une évaluation accompagnante du projet dans sa phase pilote pour: Accompagner le projet par des bilans intermédiaires dans le but d'effectuer des ajustements du projet ; Mesurer l'impact du projet ; Évaluer le dispositif en place ; Évaluer le fonctionnement du dispositif ; Évaluer ses interventions. Les résultats de cette évaluation sont présentés dans le présent rapport. Des résultats intermédiaires (quantitatifs et qualitatifs) ont également été présentés au comité de pilotage de l'évaluation sous forme orale (présentations PowerPoint suivies d'une discussion), et cela à deux reprises (septembre 2012 et juin 2013). Une synthèse de ces résultats intermédiaires peut être consultée à l'annexe 8.1

Effect of vitamin D on Epstein-Barr (EBV)-specific CD8+T cells in patients with early multiple sclerosis (MS)

Background: Infection with EBV and a lack in vitamin D may be important environmental triggers of MS. 1,25-(OH)2D3 mediates a shift of antigen presenting cells (APC) and CD4+ T cells to a less inflammatory profile. Although CD8+ T cells do express the vitamin D receptor, a direct effect of 1,25(OH)2D3 on these cells has not been demonstrated until now. Since CD8+ T cells are important immune mediators of the inflammatory response in MS, we examined whether vitamin D directly affects the CD8+ T cell response, and more specifically if it modulates the EBV-specific CD8+ T cell response. Material and Methods: To explore whether the vitamin D status may influence the pattern of the EBV-specific CD8+ T cell response, PBMC of 10 patients with early MS and 10 healthy controls (HC) were stimulated with a pool of immunodominant 8-10 mer peptide epitopes known to elicit CD8+ T cell responses. PBMC were stimulated with this EBV CD8 peptide pool, medium (negative control) or anti- CD3/anti-CD28 beads (positive control). The following assays were performed: ELISPOT to assess the secretion of IFN-gamma by T cells in general; cytometric beads array (CBA) and ELISA to determine whichcytokines were released by EBV-specific CD8+ T cells after six days of culture; and intracellular cytokine staining assay to determine by which subtype of T cells secreted given cytokines. To examine whether vitamin D could directly modulate CD8+ T cell immune responses, we depleted CD4+ T cells using negative selection. Results: We found that pre-treatment of vitamin D had an antiinflammatory action on both EBV-specific CD8+ T cells and on CD3/ CD28-stimulated T cells: secretion of pro-inflammatory cytokines (IFNgamma and TNF-alpha) was decreased, whereas secretion of antiinflammatory cytokines (IL-5 and TGF-beta) was increased. At baseline, CD8+ T cells of early MS patients showed a higher secretion of TNFalpha and lower secretion of IL-5. Addition of vitamin D did not restore the same levels of both cytokines as compared to HC. Vitamin D-pretreated CD8+T cells exhibited a decreased secretion of IFN-gamma and TNF-alpha, even after depletion of CD4+ T cells from culture. Conclusion: Vitamin D has a direct anti-inflammatory effect on CD8+ T cells independently from CD4+ T cells. CD8+ T cells of patients with earlyMS are less responsive to the inflammatory effect of vitamin D than HC, pointing toward an intrinsic dysregulation of CD8+ T cells. The modulation of EBV-specific CD8+T cells by vitaminDsuggests that there may be interplay between these twomajor environmental factors of MS. This study was supported by a grant from the Swiss National Foundation (PP00P3-124893), and by an unrestricted research grant from Bayer to RDP.

Anti-N-Methyl-D-Aspartate (NMDA) Receptor Encephalitis Mimicking a Primary Psychiatric Disorder in an Adolescent.

Anti-N-methyl-d-aspartate (anti-NMDA) receptor encephalitis likely has a wider clinical spectrum than previously recognized. This article reports a previously healthy 16-year-old girl who was diagnosed with anti-NMDA receptor encephalitis 3 months after onset of severe depression with psychotic features. She had no neurological manifestations, and cerebral magnetic resonance imaging (MRI) was normal. Slow background on electroencephalogram and an oligoclonal band in the cerebrospinal fluid prompted the search for anti-NMDA receptor antibodies. She markedly improved over time but remained with mild neuropsychological sequelae after a trial of late immunotherapy. Only a high index of suspicion enables recognition of the milder forms of the disease masquerading as primary psychiatric disorders.

La voix-over du Roman d'un tricheur et sa postérité dans Providence. A propos de la résurgence de pratiques "bonimentorielles".

Partant de la réception internationale du film Le Roman d'un tricheur de Sacha Guitry dans laquelle la voix du cinéaste est fréquemment rapprochée de celle du "bonimenteur" de l'époque muette, cette étude examine les particularités de ce film en termes de positionnement du narrateur over par rapport aux images et par rapport au spectateur. Une filiation est posée entre ce film et Providence de Resnais au niveau des manifestations de l'oralité: là aussi, le narrateur occupe la place d'instigateur du monde filmique et de spectateur des images qu'il commente.