[French neurosurgical practice in Neuro-Oncology (national survey--part I)]. / Neurochirurgie et neuro-oncologie: état des lieux (I). Généralités, plan cancer, enquête nationale.

OBJECTIVE: The aim of this work is to summarize the elements of the "Cancer Plan" applicable to neurosurgical practice, and to give the results of a national inquiry concerning the daily practice of Neuro-Oncology from the neurosurgical point of view. METHOD: The Neuro-Oncology Group of the French Society of Neurosurgery has submitted a questionnaire to every department of Neurosurgery in France. RESULTS: The response rate of the public centers was 96.5%. Moreover, responses were available from 7 private centers. The results are detailed in the text. CONCLUSION: This national survey highlights the interest and implication of French neurosurgeons in the field of Neuro-Oncology. But also, to be in accordance with the guidelines for good clinical practice, the importance of developing official neuro-oncological networks in order to offer the best access to clinical and fundamental data and hence optimise patient's care. The publication of the "Cancer Plan", the creation of a National Neuro-Oncology Group, and the results of this survey (actual multidisciplinary approach, better information and transparency, individualized care of the patients), are in the line with updating our daily practice, even though discrepancies remain among centers. French neurosurgeons must continue along the same path, but at the same time there is a need for additional help to definitely reach a truly, and homogeneous, optimized care of neuro-oncological patients.

[Diagnosis of Conn's adenoma. Comparative study of x-ray computed tomography and scintigraphy using 19-noriodocholesterol]. / Diagnostic d'adénome de Conn. Etude comparative de la tomodensitométrie et de la scintigraphie au 19-noriodocholestérol.

OBJECTIVE: In order to differentiate an aldosterone producing adenoma (APA) and a bilateral adrenal hyperplasia (BAH) in case of primary hyperaldosteronism, an adrenal CT-scan is usually used as first line exploration. The contribution of adrenal 19-noriodocholesterol (NP59)-scintigraphy is controversial. PATIENTS AND METHODS: We describe 17 cases of primary hyperaldosteronism referred to surgery for suspected APA. The value of abdominal CT-scan and of adrenal scintigraphy was studied. RESULTS: After unilateral adrenalectomy, 15 cases with confirmed APA were cured and 2 cases with an unilateral hyperplastic macro nodule showed persistence of the disease. The pathologic findings were concordant with CT-scan in 76% (13/17) and with scintigraphy in 88% (15/17). Similar sensitivity was found for CT-scan and scintigraphy (86% and 88%) with 2 false negative results with both techniques. False positive results were observed only with CT-scan (2 cases) suggesting that scintigraphy has a better specificity. No case was misdiagnosed by both techniques. CONCLUSION: These results suggest that NP59-scintigraphy is complementary to adrenal CT-scan for the recognition of APA and is particularly useful in case of a unilateral hyperplastic macro nodule mimicking an APA.

[Value and limits of exercise radionuclide ventriculography in chronic aortic insufficiency. Apropos of 47 operated cases]. / Intérêts et limites de la ventriculographie radio-isotopique d'effort dans l'insuffisance aortique chronique. A propos de 47 cas opérés.

The role of exercise radionuclide angiography in the therapeutic strategy of chronic aortic insufficiency remains controversial. In order to assess the value of this technique, 47 patients with pure chronic aortic insufficiency were evaluated before and one year after valve replacement. The preoperative EF decreases or does not increase on exercise (51.9% vs 48 +/- 10%; p < 0.001) in the majority of patients (78%), whereas, after surgery, the EF tends to increase on exercise (55 +/- 11% vs 57 +/- 11%; NS). Despite optimal surgical correction, 16 of the surviving 46 patients still had left ventricular dysfunction at one year after surgery. The preoperative parameters correlating with this dysfunction were, in order, resting radionuclide EF (r = 0.65; p = 0.0001) and the echocardiographic parameters: left ventricular endosystolic dimension, fractional shortening, and the radius/thickness ratio. The preoperative exercise radionuclide parameters did not correlate with postoperative left ventricular dysfunction. In patients without postoperative left ventricular dysfunction, the EF increased on exercise, contrary to the other group. The exercise EF remains valuable for retrospective evaluation of surgical benefit. The exercise radionuclide EF does not reflect myocardial contractile reserve alone but also the conditions of left ventricular load. This study confirms the superiority of the resting radionuclide EF and echocardiographic parameters over exercise radionuclide EF for the prediction of postoperative left ventricular dysfunction.

A human monoclonal antibody obtained from EBV-transformed B cells with specificity for myosin.

We describe the preparation of a stable human lymphoblastoid cell line obtained during ex vivo studies in which peripheral blood lymphocytes of a Glanzmann's thrombasthenia patient were transformed with Epstein-Barr virus. Somatic hybrids secreted an IgM monoclonal antibody (B7) that reacted with the myosin heavy chain of human platelets by immunoblotting. Flow cytometry showed that B7 barely recognized unstimulated intact platelets, but bound abundantly after permeabilization of fixed cells with Triton X-100. The reactivity of the antibody on thin sections of human myocardium and aorta was studied by immunohistochemistry. B7 specifically stained myosin of myocytes, but there was no labelling of aortic smooth muscle cells. The epitope was conserved in cardiac or skeletal myosin prepared from pig or rabbit. Measurement of the dissociation constant in a competitive ELISA showed that B7 bound with high affinity (10(-8) M). Purified Fab fragments retained their ability to bind to myosin, suggesting that B7 may be useful in the imaging of myocardial necrosis after myocardial infarction, myocarditis, cardiac drug toxicosis or graft rejection. This work also shows that EBV transformation of B cells may uncover naturally occurring autoantibodies which under normal circumstances are inhibited by the immune surveillance system.

Shunt failure in adult hydrocephalus: flow-controlled shunt versus differential pressure shunts--a cooperative study in 289 patients.

BACKGROUND: In order to assess the efficiency of flow-controlled shunts in reducing shunt failure in the treatment of adult hydrocephalus (with a special focus on overdrainage complications), a series of 289 patients was analyzed through a retrospective and comparative study performed in three neurosurgical departments. METHODS: A group of 142 adult patients suffering from hydrocephalus were operated on using a conventional differential pressure (DP) shunt and compared with a group of 147 adult patients operated on using flow-controlled (FC) system (Orbis-Sigma, Cordis). Only the first complication, which required a surgical revision within the first 2 years after shunt implantation, was taken into account for each patient and analyzed using life-table methods. RESULTS: The actuarial risk of shunt infection in the two groups is respectively 8.3% and 10.9% at 1 year (nonsignificant difference). The actuarial risk of mechanical complications at 1 year is 38% for the DP patients and 10% for the FC patients (p = 0.0001); this difference is largely due to a decrease of complications related to overdrainage phenomenon (14/142 subdural collections were observed in the DP group versus 1/147 in the FC group) (p = 0.0001). CONCLUSION: The conclusion of this cooperative and retrospective study is that the use of a flow-controlled system decreases the risk of mechanical complications related to the hydrodynamic properties of the shunts used in the treatment of adult hydrocephalus, especially those related to overdrainage.

[Stereotaxic biopsies of pineal tumors. Comments on their risk and implication apropos of 370 cases]. / Les biopsies stéréotaxiques des tumeurs de la région pinéale. Réflexions sur leur risque et leur rendement à propos de 370 cas.

370 stereotactic biopsies of pineal region tumors, from 15 neurosurgical centers in France have been reviewed with the goal to evaluate the mortality/morbidity rates and diagnostic yield of this procedure. The impact of neuroradiological means of localisation, the probe trajectory, the type of biopsy instrument, the time of shunting are discussed in order to maximize the diagnostic yield and minimize the mortality/morbidity rates. Stereotactic biopsy contribution, as compared to other diagnostic methods, in pineal region tumors was evaluated. The mortality rate was 1.3 % (5 patients of 370), 3 patients suffered severe neurological complication. In relation to the large number of patients in this study, we can assess that the mortality rate of stereotactic biopsy in this region doesn't significantly exceed that of stereotactic brain tumor biopsies in general.

[MRI of the heart: morphological and functional aspects]. / IRM du coeur: aspects morphologiques et fonctionnels.

The performances of cardiac magnetic resonance imaging have been recently improved by the possibility of obtaining functional information by means of gradient echo sequences. Cavity volumetry and wall thickness and mass measurements are now possible. Ultrarapid sequences are useful for the analysis of myocardial perfusion and methods for measuring blood flow and temporal labelling of the ventricular wall open up new prospects for functional evaluation of the heart. In clinical practice, MRI can be useful for the exploration of cardiac parietal and intracavitary masses, constrictive pericarditis, hypertrophic and restrictive cardiomyopathy and cardiac malformations. Assessment of valvular and coronary heart disease is based on new techniques and is currently under evaluation.

[Complementary value of the isoprenaline test and high-amplification ECG in the diagnosis of arrhythmogenic dysplasia of the right ventricle]. / Valeur complémentaire du test à l'isoprénaline et de l'ECG à haute amplification dans le diagnostic de la dysplasie arythmogène du ventricule droit.

Arrhythmogenic dysplasia of the right ventricle is a common cause of ventricular arrhythmia. It is important to reach a diagnosis, due to the risk of sudden death, particularly as this may be the first sign of the disease. Diagnosis is based on the angiographic demonstration of a morphological or structural abnormality of the right ventricle, and non-invasive tests are relatively insensitive. From a case investigated in 1984, the authors carried out a prospective determination of the diagnostic value of the isoprenaline test in 61 patients suffering from arrhythmogenic dysplasia of the right dysplasia confirmed by angiography. High concentrations (8-30 micrograms/min) of isoprenaline were continuously infused over a period of 3 minutes, regardless of the heart rate achieved. In a control group of 50 subjects with no myocardial disorder, isoprenaline induced monomorphic wave-burst arrhythmia in only one patient (2%). In the subjects affected by right ventricular arrhythmogenic dysplasia, isoprenaline induced one or more episodes of wave-burst ventricular arrhythmia in 52 patients (85%): one triplet in four patients, several episodes of wave-burst arrhythmia in 31 patients and prolonged ventricular tachycardia in 17 patients. Polymorphic arrhythmia occurred in 80% of cases, but left lag forms predominated. High-amplification ECG demonstrated late potentials in 66% of cases, i.e. in 80 and 62% of patients with and without prolonged VT respectively. The isoprenaline test or high-amplification ECG gave abnormal results in 58 of the 61 patients, with a cumulative sensitivity of 95 percent.

[Neurinoma of the oculomotor nerves. Apropos of 2 cases]. / Neurinomes des nerfs oculomoteurs. A propos de deux observations.

The authors report two cases of neurinomas of the oculomotor nerves: one neurinoma of the oculomotor nerve and one of the abducens nerve. The study of 30 cases in the previous literature points out the major striking features of these tumors. Both headaches and oculo-motor palsies are the most regular clinical features. They are not typically suggestive. Therefore the diagnosis is difficult among all the tumors of cavernous sinus and surrounding structures. C.T. scan and M.R.I. with the clinical history should readily allow pre-operative diagnosis. These data are insufficient to distinguish the affected nerve. The surgical treatment is not always complete due to the tumor infiltration into the cavernous sinus.

[Macronodule associated with bilateral adrenal hyperplasia. A rare misleading cause of primary aldosteronism (two cases)]. / Macronodule associé à une hyperplasie bilatérale des surrénales. Une cause rare et trompeuse d'hyperaldostéronisme primaire (2 cas).

Aldosterone-producing adrenal adenoma and bilateral hyperplasia are the two predominant subtypes of primary aldosteronism. Their recognition is based essentially on adrenal CT scan and on measurements of plasma aldosterone and 18-hydroxycorticosterone (18-OHB) concentrations in response to postural testing. We report 2 cases of primary aldosteronism associated with a unilateral hyperplastic macronodule resembling an aldosterone-producing adenoma on CT scan. Plasma aldosterone and 18-OHB concentrations were consistent with this diagnosis in one patient. In the light of these two cases and of those previously published, the investigations needed for the etiological diagnosis of primary aldosteronism are discussed.

[Treatment of chronic hydrocephalus in adults by flow-regulated shunt. Apropos of a series of 46 patients]. / Traitement de l'hydrocéphalie chronique de l'adulte par dérivation à débit régulé. A propos d'une série de 46 patients.

46 patients, 24 males and 22 females (mean age: 68.3 years), with chronic hydrocephalus were operated on by a variable-resistance, flow-regulated shunt. The selecting criteria before surgery were essentially clinical (association of gait disturbances, dementia and urinary incontinence, positive lumbar puncture withdrawal test) in consideration with the retrospective and cooperative study of this series. Hydrocephalus had an etiology in 23 cases (50%): 4 cases of trauma (8%), 9 cases of tumors (20%), 9 cases of subarachnoid haemorrhage (20%) and 1 case of infection (2%). The average follow-up is 17 months (median: 12 months). 20 patients (43.5%) have an excellent result (normal life), 16 patients (34.8%) have a good result (residual symptomatology compatible with a self-governing life), 5 patients (10.9%) have a poor result (residual symptomatology non compatible with a self-governing life), 2 patients (4.3%) have a bad result (unchanged symptomatology). 3 patients died after the surgical procedure. 3 patients had an infectious complication of their shunt (actuarial risk of infectious complication at one year and a half: 7%). 2 patients presented a non infectious complication, one chronic subdural hematoma and one bad insertion of the proximal catheter (actuarial risk of mechanical complication at one year and a half: 4.4%).

[Cell proliferation in human cerebral tumors. In vivo study of 45 cases by incorporation of 5-iododesoxyuridine]. / La prolifération cellulaire des tumeurs cérébrales humaines. Etude in vivo de 45 cas par incorporation de 5-iododésoxyuridine.

A method to study the proliferation of human brain tumors, is presented. Non radioactive 5-Iododeoxyuridine (2.4 gr) infused over a 24 hours period is detected in situ on histologic section by an immunological technique (peroxidase-anti-peroxidase) using a specific anti-Iododeoxyuridine antibody. This exploration utilised in 45 patients is easy, reliable and harmless. All cells which enter in S phase of cellular cycle during the infusion are labelled. So the cellular kinetics of all the brain tumor cells (malignant cells, inflammatory stroma reaction cells, reactive astrocytes, endothelial and muscular cells of the vessels) are detected on the same histological section, as well as all the others proliferative cells of the body (leukocytes, primitive tumor of the metastatic brain localisation...) if multiples biopsies are done. 8 of 9 gliomas of low histological malignancy (grade I and II) have a slow cellular kinetic. The 23 astrocytomas of different histological malignancy (grade III and IV) have variable proliferative speed (7 very fast, 8 fast and 8 slow). Only the large cells of the pinealoma are very proliferative, the lymphoid stroma is quiescent. The 5 metastasis have a slow to very fast kinetic without correlation with the cellular differentiation except in one case (important differentiation and slow cellular proliferation). The 5 lymphoma cells kinetics are well correlated with the histologic differentiation (3 large cells poor differentiated lymphomas and very fast kinetic, 2 better differentiated and slower proliferation). The 2 meningiomas proliferate slowly. The biochemical and histopathological grounds of the presented method and the limits of quantification are discussed. This method is compared with this using Bromodeoxyuridine. The correlation between proliferation and histologic malignancy is analysed. The use of cytokinetic results for therapeutic and prognosis need further statistical anatomoclinical studies.

Mucoceles of the sphenoidal sinus. Report of six cases and review of the literature.

Six personal cases of mucocele of the sphenoidal sinus are reported, and 124 cases from the literature are reviewed. Sphenoidal sinus mucocele is a benign and rare lesion which has long been unrecognized. Clinical features include fronto-orbital pain, oculomotor palsies, loss of visual acuity, exophthalmos and anosmia. Our series is of particular interest since four of our six patients presented with endocrine disorders. Recent advances in neuroradiological methods should rapidly lead to the correct diagnosis. Treatment consists of aspiration and drainage of the mucocele via a trans-sphenoidal approach. The results are good, and ophthalmoplegia usually subsides. In our experience, endocrine disorders do not always respond to treatment. The prognosis of sphenoidal sinus mucocele depends on the preoperative duration of the loss of visual acuity.

[Extradural intracavernous epidermoid cyst. Apropos of 2 cases]. / Kyste épidermoïde intra-caverneux extra-dural. A propos de deux observations.

The authors report two cases of intracranial, extradural, intracavernous epidermoid cyst. In one case the cyst was ruptured into the subarachnoid space and in the substance of the temporal lobe. The two cysts had to be subtotally resected because of dense adherences with the internal carotid artery. In both cases the post-operative periods were uneventful.

Magnetic resonance imaging of an anomalous origin of the left coronary artery from the pulmonary artery.

This report describes a 34-year-old woman with an anomalous origin of the left coronary artery from the pulmonary artery. The angiographic pattern was clearly demonstrated by magnetic resonance imaging (MRI) performed before surgery. This case suggests that MRI could play an important role in the pre-operative assessment of coronary anomalies.

Bronchogenic carcinoma staging: CT versus MR imaging. Assessment with surgery.

One hundred and twenty patients with bronchogenic carcinoma were prospectively studied by both computed tomography (CT) and magnetic resonance imaging (MRI) during the 2 weeks preceding thoracotomy or mediastinoscopy. MRI scans included contiguous axial and coronal slices. Results of CT and MRI studies were compared with the surgical and pathological findings on the basis of the TNM classification. Although no significant difference was found between the two imaging methods for the evaluation of tumour extent, MRI appears to be a valuable imaging technique for left upper lobe and apical neoplasms. Comparison between the two techniques for mediastinal node evaluation showed that sensitivity of MRI is superior to CT in the left paratracheal, aortopulmonary and subcarinal node areas.

[Contribution and limits of x-ray computed tomography and magnetic resonance imaging in evaluating the extent of primary cancers of the bronchi]. / Apports et limites de la TDM et de l'IRM dans le bilan d'extension des cancers primitifs des bronches.

The authors report the contribution and the limits of CT and MRI in the thoracic and extrathoracic staging of bronchogenic carcinoma. From data of a personal study and of the literature, findings and performances of CT and MRI are reported and compared for the evaluation of mediastinal and parietal extension and in the detection of nodes and metastases. Their respective places and indications are underlined.

[Malignant lymphoma of the heart. Contribution of modern technics of medical imaging]. / Lymphome malin de localisation cardiaque. Apport des techniques modernes d'imagerie médicale.

Although rarely encountered, tumours of the heart are now more easily and frequently diagnosed owing to the availability of non-invasive imaging methods, notably echocardiography. With echocardiography the cardiac extension of the tumour is perfectly visualized, but its connections with the mediastinum are less readily accessible. The case presented here of a female patients with a malignant lymphoma involving the heart (right ventricle and atrium, pericardium) and the mediastinum illustrates the complementary nature of echocardiography, computerized tomography and magnetic resonance imaging.

Detection of anomalous systemic venous return and intraatrial baffle leakage by radionuclide angiocardiography.

The case presented here is a 27-year-old patient who was born with common atrium and left superior vena cava (LSVC). Construction of interatrial septum and intraatrial baffle with pericardium was performed 16 years ago. Radionuclide angiocardiography (RAC) showed that a substantial amount of blood flow from the LSVC was directed to the inferior vena cava through the hemiazygos vein (HAV). It also detected a baffle leak and a left to right shunt at the atrial level. Subsequent RAC after reoperation initially showed insignificant flow through the atrial baffle, major flow through the HAV, and no shunt. Repeat RAC one year after surgery showed increased flow through the baffle and diminished flow through the HAV, without a satisfying explanation. This case illustrates the value of RAC in detecting various types of cardiovascular abnormality and subtle hemodynamic changes.