[Metabolic imaging for supratentorial oligodendrogliomas]. / Les oligodendrogliomes supra-tentoriels: imagerie métabolique.

Metabolic imaging with positron emission tomography (PET) provides, in neuro-oncology, information complementary to that provided by anatomic imaging obtained with CT-scanner or MRI. Only a few publications have yet reported its use in oligodendroglial tumors. These findings and partial results obtained in ongoing work, suggest some preliminary conclusions: 11C-MET (L-methyl-methionine) is a more appropriate tracer than 18F-FDG (fluoro-deoxy-glucose), in terms of both specificity and sensitivity, for the assessment of patients with this category of tumor. PET/MET allows differentiation between grade II and grade III oligodendrogliomas; better targeting for stereotactic biopsy; more accurate assessment of the post-operative residual tumor; identification of progression from low-grade to anaplastic grade during the disease course; differentiation between recurrence and a post-radiation processes. PET/MET allows, to some extent, prediction of response to radiotherapy; and, probably, to chemotherapy.

Burst-fractures and cementoplasty.

Percutaneous acrylic cement vertebroplasty is known for its pain-relieving effect in spinal tumors and recently in osteoporotic vertebral collapse. To our knowledge no study has been published reporting the treatment of acute high energy post-traumatic fracture (mainly single burst fracture) by vertebroplasty. Our purpose was to evaluate the technical feasibility of the cement injection at this acute phase, assess its the impact on the pain and monitor spinal stability, by quantifying potential kyphosis modification. Twelve patients with relative contraindication of the orthopaedic treatment were treated by early injection after the trauma for an A type fracture of the Magerl classification, without neurological sign. Patients surveys revealed a significant pain reduction within the first day. Half of them reduced the kyphosis angle, and the anterior height vertebral body significantly improved after the vertebroplasty. The mean reduction in the kyphosis angle was 8. No complication occurred except one extravertebral asymptomatic leak, with secondary increase of the kyphosis. Vertebroplasty performed in reduction position may allow a complete stabilization without pain and furthermore can reduce the kyphosis angle.

Increased expression of transforming growth factor-beta after cerebral ischemia in the baboon: an endogenous marker of neuronal stress?

There has been an increasing interest in recent years in the evaluation of the neuronal and glial responses to ischemic insult. Some cytokines, including transforming growth factor-beta (TGF-beta), that are overexpressed after experimental stroke in rodents are thought to be implicated in the neuronal processes that lead to necrosis. Thus, such cytokines could predict tissue fate after stroke in humans, although data are currently sparse for gyrencephalic species. The current study addressed the expression pattern of TGF-beta1 in a nonhuman primate model of middle cerebral artery occlusion. Focal permanent ischemia was induced for 1 or 7 days in 6 baboons and the following investigations were undertaken: cerebral oxygen metabolism (CMRO2) positron emission tomography studies, magnetic resonance imaging, postmortem histology, and reverse transcription-polymerase chain reaction. The aim of the current study was to correlate the expression of TGF-beta1 to the underlying metabolic and histologic state of the threatened cerebral parenchyma. The authors evidenced increased TGF-beta1 mRNA levels (up to 25-fold) in those regions displaying a moderate (20% to 49%) reduction in CMRO2. The current findings suggest that the greatly enhanced expression of TGF-beta1 in the penumbral zones that surround tissue destined to infarction may represent a robust index of potentially salvageable brain. The current investigation, in the nonhuman primate, strengthens the authors' hypothesis, derived from rodent models, that TGF-beta1 may be involved in the physiopathology of human stroke.

[Krouamania causing an acute subdural hematoma of arterial origin]. / Hématome sous-dural aigu d'origine artériolaire et krouamanie.

We report a case of arteriolar subdural hematoma caused by Jedba assimilated to Krouamania. We discuss the pathophysiological mechanism of subdural bleeding, the clinical symptoms, the characteristics of such hematomas and the therapeutical management.

[Unilateral endonasal approach to hypophyseal adenomas]. / Abord endonasal unilatéral des adénomes hypophysaires.

The endonasal approach for transsphenoidal hypophysectomy is a simple technique for exposing the floor of the sella turcica. In our institution we have operated 162 patients (64 microadenomas and 98 macroadenomas), over a ten-year period, by using that approach. The floor of the sella turcica is exposed through an incision performed posteriorly to the nostril at the junction of cartilaginous and bony septum. Postoperative rhinological complications are less frequently observed after unilateral endonasal approach than after sublabial one, and it is more comfortable for the patient. The morbidity of unilateral endonasal transsphenoidal approach is comparable to that of other series.

[Psychoneuroses of paternity. Puerperal psychoneuroses in man]. / Les psychonévroses de la paternité. Psychonévroses puerpérales chez l'homme.

Psychotic, neurotic and psychosomatic disturbances, directly promoted by fatherhood condition, seem more frequent than the small number of publications about this subject allow to suppose. Twenty original observations are expounded and discussed; they allow the importance of basic psychological ground; it is necessary to differentiate distinctly between initial paternity disturbances, among immature patients, inducing total disorder, and multiple paternity perturbations where anxiety and culpability feeling prevail. Regarding these disturbances and the sociological phenomenon of the "couvade", the real puerperality in men is investigated in connection with the personal and relational structure of the individual.