[Unsuccessful surgery of Cushing's disease. Role and efficacy of fractionated stereotactic radiotherapy]. / Echec après chirurgie de la maladie de Cushing: rôle et résultats de la radiothérapie stéréotaxique fractionnée (RSF).

BACKGROUND AND PURPOSE: To optimize and reduce the toxicity of pituitary adenoma irradiation, we evaluated the feasibility and effectiveness of fractionated stereotactic radiotherapy (FSR) in 51 patients with functional adenoma; 12 of them had Cushing's disease. PATIENTS AND METHODS: Eleven females and one male, median age: 49 years, 8 of them relapsed and 4 had persistent hormonal secretion after surgery. The delivered dose was 50 grays (Gy) (5 x 1.8 Gy/week) using 5 convergent micro-beams scanning in arc therapy mode. The median planned target volume (PTV) receiving 90 to 100% of the total dose was 2,1 cm(3). We used relocatable non-invasive stereotactic device Brain Lab, and adapted Linac for stereotactic radiotherapy. RESULTS: Nine out of twelve patients (75%) presented with complete remission after a median time of 29 months, 3/12 patients with partial remission. Actuarial probability to have hormonal persistent secretion was 88% at on year, 44% from 3 to 5 years, 22% at 7 years, and 11% to 0% after 7 years. The 12-corticotroph adenomas were significantly (p=0.007) more radiosensitive than 39 non-corticotroph adenomas. Toxicity was significantly lower for corticotrope adenoma, with no radio-induced pituitary deficiency and no neurological or optic injury. CONCLUSIONS: Combined surgery and FSR appears to be safe and effective for treatment of pituitary adenomas. However, long-term follow-up is required to determine the impact in terms of tumor response and hormone deficiency. The focused treated volume obtained by FSR seems more suitable for these benign tumours than standard radiotherapy. In addition to this conformal approach, the use of standard fractionation reduced the risk of severe damage to the optic chiasma, which is sometimes observed after radiosurgery and is inherent in single fraction radiotherapy.

[Retro-ocular hydatid cyst. Apropos of a case surgically treated by the trans-facial approach]. / Kyste hydatique rétro-oculaire. A propos d'un cas opéré par voie transfaciale.

The authors report the case of a woman presenting with a hydatid cyst of the left orbit and stress the clinical, CT scan and laboratory findings. They suggest a medico-surgical treatment protocol.

Modifications of collagens in the course of inflammatory tracheal stenoses.

A comparison was made between the biochemical and histological properties of collagens contained in samples of normal tracheas obtained at autopsy or of stenosed tracheas obtained during surgery. The amounts of total collagen solubilized by pepsin was increased seven times in the pathological samples, and the proportion of cartilage type II collagen decreased by about one half, being replaced by type I collagen, whose ratio was increased five times. Microscopic studies confirmed that cartilage underwent a degenerative process and was progressively infiltrated by fibrils of interstitial collagen.

[Wegener's granulomatosis with atypical beginning (author's transl)]. / Granulomatose de Wegener à début atypique.

The authors report a case of Wegener's disease starting in the sub-maxillary region and spreading to the auricular region. The diagnosis was evoked by the correlation between the granulomatous lesions observed in the sub-maxillary region and on the tympanic membrane; there was also renal failure of rapid onset. A remission of five months has been obtained by treatment with corticosteroids and immunodepressant agents. Around this case the authors collected 267 cases from the literature and point out the rarity of the auricular form and the exceptional nature of the sub-maxillary localization of this disease.