Venous territories of the brain.

The venous return of the cerebral hemispheres is ensured by two systems. The first, superficial system, reaches the peripheral dural sinuses, i.e. the superior sagittal sinus, the lateral sinus and the cavernous sinus. The second, deep system, corresponds to Galen's vein. Anatomical and angiographic data from the literature enable the usual drainage territory to be defined for each of these collecting vessels. However, the variability of the superficial sylvian vein and the importance of cortical anastomotic vessels make impossible to delimit precisely the territory of each peripheral sinus. The functional role played by numerous centro-peripheral anastomoses is more difficult to assert in each individual. It is therefore probable that in the cerebral hemispheres there is a deep territory balancing the superficial territories.

[Diagnostic strategy for a thyroid nodule]. / Stratégie diagnostique devant un nodule thyroïdien.

Solitary thyroid nodules present as localized tumefactions of the thyroid gland readily detectable clinically. They are frequent (2-5% of the general population) and due to a variety of causes, each requiring a specific treatment; hence the need for a systematized diagnostic approach. On scintigraphic grounds, one can distinguish between "warm" or "extinctive" nodules (10% and 20% of the cases respectively), which are a priori benign, and "cold" nodules (70%), which in 1 out of 10 cases correspond to a differentiated epithelioma with excellent post-operative prognosis. Three methodological data call for comments: (1) the images supplied by technetium may differ from those supplied by radioactive iodine, which remains the reference radioisotope; (2) there is no clinical criterion of malignancy, but fluid-containing nodules are almost invariably benign; (3) needle cytology is the best means of selecting nodules for surgery and histology which is the only reliable diagnostic examination. We therefore propose, albeit with due caution, a diagnostic approach based on the sequence scintigraphy-needle exploration and cytology and aimed at limiting surgery to purely therapeutic purposes.

[Mental anorexia: gonadotrophic response to clomifene citrate. Sixteen cases]. / Anorexie mentale: réponse gonadotrope au citrate de clomifène. Seize observations

Sixteen patients with anorexia nervosa and secondary amenorrhoea received clomiphene citrate, eight before any other treatment (200 mg of clomiphene citrate per day for four days) and eight others after partial or total correction of weight loss (50 mg of clomiphene citrate per day for five days). Menstruation occurred in four patients of the second group. An elevation of plasma LH was demonstrated in 4 cases in the first group and 7 of the second group. Variation in FSH was not always parallel with LH. The authors discuss the physiopathological mechanism of gonadotrophic insufficiency in anorexia nervosa and define the role of clomiphene citrate in the treatment of this disorder.

[A case of oncocytic adenoma of the pituitary gland with galactorrhea and hyperprolactinemia]. / Un cas d'adénome oncocytaire de l'hypophyse avec galactorrhée et hyperprolactinémie

A tumor of hypophysis, with suprasellar expansion, was removed surgically in a 68 years old woman with panhypopituitarism and galactorrhea. Light and electron microscopy studies have shown an oncocytoma. One year after pituitary ablation and cobaltherapy, the patient had normal pituitary functions and galactorrhea had disappeared. Since the prolactin cells were outside the adenoma and the prolactin secretion became normal after surgery, we can assume that galactorrhea was presumably due to the compression of the pituitary stalk by oncocytoma.