[Oligodendrogliomas: historical background of classifications]. / Oligodendrogliomes: historique des classifications.

The story of the classifications for gliomas is related to the development of the techniques used for cytological and histological examination of brain parenchyma. After a review of these techniques and the progressive discovery of the central nervous system cell types, the main classifications are presented. The first classification is due to Bailey and Cushing in 1926. It was based on histoembryogenetic theory. Then Kernohan introduced, in 1938, the concept of anaplasia. The WHO classification was published in 1979, then revised in 1993 and 2000. It took into account some data from both previous systems and introduced gradually the notion of histological criteria of malignancy. More recently; molecular genetics data and clinical evolution were retained. The Sainte-Anne classification for oligodendrogliomas is based on both histological and imaging data. It includes the notion of spatial histological structure of oligodendrogliomas. Contrast enhancement is closely related to endotheliocapillary hyperplasia. Gliomas classifications are changing and confusions can be made because of lack of reproductibility and misinterpretations of samples.

[Reappraisal of the Sainte-Anne Hospital classification of oligodendrogliomas in view of retrospective studies]. / Classification des oligodendrogliomes de l'hôpital Sainte-Anne. Mise au point à l'usage des études rétrospectives.

PURPOSE: Definition of homogeneous tumor groups of oligodendrogliomas or oligo-astrocytomas is a basic condition for an adequate evaluation and comparison of the results of treatments in patients from various institutions. However, increasing discordances are observed in the histological diagnosis of these tumors. The main goal of this study is to assess whether, for retrospective studies, MRI data may serve as a common basis for encompassing asymmetry in diagnosis established according to the WHO or Ste-Anne (SA) classification. PATIENTS AND METHODS: This study included 251 adult patients in whom a SA grade A or B oligodendroglioma or oligo-astrocytoma was newly diagnosed at our institution from 1984 to 2003. Routine histological preparations and post-contrast preoperative MRI/CT-scan were simultaneously reviewed in order to assess the impact on survival of the following features: presence or absence of a polymorphous or gemistocytic astrocytic component, of necrosis and of contrast enhancement (CH); endothelial hyperplasia (EH) assessed as absent, present minor (HE+) or (HE++) when conform to the threshold of HE defined in the SA grading system of oligodendrogliomas. The tumors were graded A: no CH and no EH; in B: CH and /or HE++, and A/B: EH + but no CE. RESULTS: 70.1% of the tumors were classified as "pure" oligodendroglioma, 19.5% as "polymorphous oligo-astroastrocytoma" and 10.3% as "gemistocytic oligo-astrocytoma". In grade A, or B tumors, the presence of a polymorphous or a gemistocytic component had no significant influence on survival; however respectively 53% and 65% of these tumours versus 32% of "pure" oligodendrogliomas were grade B at the time of diagnosis. In either histological subtypes, survival was not significantly different when HE was absent or minor (HE+). After regrouping of the histological subtypes and of the tumors with HE+ or absent, the series included 153 oligodendrogliomas grade A and 98 grade B. Survival in patients with grade A versus grade B tumors was respectively 142 versus 52 months (p<0.0001). In grade B tumors, necrosis had no significant influence on survival. Ring-shaped contrast enhancement surrounding large foci of necrosis was observed in only 4 cases. In tumors with or without CE, patient survival was respectively 148 versus 40 months (p<0.0001). On post contrast MRI done in 235 patients, only 7 tumors (3%) were grade A/B (EH++ but no CH). CONCLUSIONS: From these results and our previous observation that, according to the SA classification of gliomas, only oligodendrogliomas or oligo-astrocytomas may not show CE, we propose that for retrospective studies: 1) tumors diagnosed according to the Ste-Anne classification as oligodendroglioma or oligo-astrocytoma be regrouped in a unique category, 2) independent of their histological type and grade according to the WHO, gliomas that do not show CE be regrouped with SA oligodendrogliomas grade A, 3) concerning gliomas that show CE on MRI: oligodendrogliomas or oligo-astrocytomas WHO grade II or III, as well as WHO secondary glioblastomas or glioblastomas with an oligodendroglial component, be regrouped with SA oligodendrogliomas grade B; however tumors that show ring-like CE surrounding large foci of necrosis and finger-like "peritumoral" edema should be excluded or analysed separately.

[Results of the Sainte-Anne - Lyons series of 318 oligodendroglioma in adults]. / Résultats de la série Sainte-Anne - Lyon de 318 oligodendrogliomes intracrâniens de l'adulte.

INTRODUCTION: Incidence of cerebral oligodendrogliomas is increasing because of better recognition made possible by improved classifications. We studied a homogeneous series using the Sainte-Anne grading scale in order to better understanding the history of these tumors with or without treatment and to assess prognosis and associated factors. PATIENTS AND METHODS: A retrospective series of 318 adult patients with oligodendroglioma (OLG) treated at Hôpital Sainte-Anne, Paris (SA) and Hôpital Neurologique, Lyons (L) between 1984 and 2003 was analyzed: 182 grade A OLG (SA + L), 136 grade B among which a homogenous series of 98 (SA) were included. For grade A: age at diagnosis ranged from 21 to 70 (mean: 41), sex ratio was 1.28. For grade B: age at diagnosis ranged from 12 to 75 (mean: 45.5), sex-ratio was 1.58. The main first symptoms were: epilepsy (A: 91.5%; B: 76%), intracranial hypertension (A: 7.9%; B: 14.6%), neurological deficit (A: 5.1%; B: 17.7%). The most frequent locations were: frontal, insular and central for both A and B. Mean size was 55 mm for grade A, 62 mm for B. Calcifications were found in 20% of A, 48.5% of B. No tumor was enhanced on imaging (CT/MRI) in grade A, all but 7 in grade B. All patients underwent surgery either for biopsy (A: 47.2%; B: 53%), or removal which was partial (A: 26.4% vs B: 19.4%) or extended (A: 36.3% vs B: 37.8%). Fifty-six patients underwent 2 procedures and 12 three procedures. Radiotherapy was performed in 76.9% of grade A, and 91% of B patients, in the immediate postoperative period for 71% A and 82.7% B. Chemotherapy was delivered for 36% of grade A (in the event of transformation to grade B or failure of radiotherapy) and 67.5% of B patients. Among grade A tumors, 38% transformed into grade B within a mean delay of 51 months with a mean follow-up of 78 months. RESULTS: Median survival was 136 months for grade A and 52 for grade B. Survival at 5, 10 and 15 was 75.5%, 51% and 22.4% for grade A vs 45.2%, 31.3% and 0% for grade B respectively. In univariate and multivariate analysis, grade A survival was associated with age at diagnosis, tumor size, large removal and response to radiotherapy. Grade B survival was associated with age at diagnosis, wide removal and sharply defined limits of the tumor on imaging. CONCLUSIONS: Analysis of both published data and this series underlines many prognostic parameters. It shows that OLG are heterogeneous tumors even in each grade (A and B). Treatment should consequently progress towards more targeted procedures for patients mainly with postoperative radiotherapy and chemotherapy.

Vascular endothelial growth factor expression in oligodendrogliomas: a correlative study with Sainte-Anne malignancy grade, growth fraction and patient survival.

Microangiogenesis is a delayed but crucial event in the malignant progression of oligodendrogliomas. Accord-ingly, in the new Sainte-Anne grading system of oligodendrogliomas, endothelial hyperplasia and contrast enhancement, both being indicators of microangiogenesis, are key criteria for the distinction of grade A from grade B tumours. Vascular endothelial growth factor (VEGF) is a potent angiogenic factor: a strong correlation between VEGF expression, Sainte-Anne malignancy grade and patient outcome might thus be expected. In order to assess this hypothesis, VEGF immunostaining was performed in a series of 34 oligodendrogliomas that included 11 grade B and 23 grade A, of which nine became grade B during the study period (mean clinical and imaging follow-up: 41 months). VEGF expression correlated strongly with Sainte-Anne tumour grade (P < 0.001), and inversely with patient survival (P < 0.001) and recurrence-free survival (P = 0.002). One hundred per cent of grade B but only 17% of grade A were VEGF-positive. By contrast, the MIB-1 labelling index did not correlate with VEGF expression, total survival or recurrence-free survival. In accordance with the grading system, this study showed that, in oligodendrogliomas, VEGF expression and microangiogenesis are progression-related phenomena that confer on these tumours a growth advantage by presumably reducing hypoxia-induced apoptotic cell death. These findings might have important implications in the future for the indication and timing of anti-angiogenic therapies.

Oligodendrogliomas. Part II: A new grading system based on morphological and imaging criteria.

This second part of our study of 'pure' oligodendrogliomas focuses on survival data analysis. In order to identify potentially useful prognostic factors and to assess the effectiveness of a new grading system, the 79 patients in the previously analyzed series for whom adequate follow-up could be obtained (52%) were entered in the present analysis. Statistical analysis demonstrated that contrast enhancement and endothelial hyperplasia had powerful and similar influence on survival. Median survival with and without contrast enhancement were: 3 versus 11 years, and with or without endothelial hyperplasia were: 3.5 versus 11 years. Conversely, the degree of nuclear atypia and presence or absence of mitosis or necrosis were not correlated with survival. These findings allowed us to devise a simple grading system which discriminates two malignancy grades as follows: absence of endothelial hyperplasia and of contrast enhancement = Grade A, presence of endothelial hyperplasia and/or of contrast enhancement = Grade B. Of the 79 oligodendrogliomas in this study, 59 tumors were categorized as grade A and 20 as grade B. Median survival were: 11 years in grade A and 3.5 years in grade B. Five-year and 8-year survival rates were: 89% and 60% in grade A and: 33% and 15% in grade B. Double blind grading between two independent observers was concordant in 96% of the cases. Application of this simple efficient and reproducible grading scheme should permit reliable comparison of retrospective or prospective therapeutic data emanating from various institutions.

A fluorophotometric study of corneal endothelium after trabeculectomy using different concentrations of Mitomycin-C.

The aim of the study was to determine the corneal endothelial permeability coefficient (Pac) in subjects after trabeculectomies using different concentrations of Mitomycin-C (MMC). MMC, a highly toxic drug, is not without drawbacks and complications such as corneal damage. To ascertain a possible relationship between a level of endothelial permeability (Pac) and concentrations of MMC used, we performed, in a prospective study, trabeculectomies in cases of primary open-angle glaucoma (POAG), younger than 50 years, with either concentrations of 0.5 mg/ml of MMC (group 1: 11 eyes) or 0.2 mg/ml of MMC (group 2: 10 eyes). Group 3 consisted of 8 patients after a typical trabeculectomy without MMC and served as a control group (8 eyes). In all groups, before surgery and again 1, 3 and 6 months after surgery, corneal endothelial permeability (Pac) was determined by using anterior segment fluorophotometry (Fluorotron Master). The thickness of the cornea (CT) was measured with a DGH Technology ultrasonic pachymeter. One month after surgery the mean values of Pac were statistically significantly higher in groups 1 and 2 (group 1: 4.78 x 10(-4) cm/min, group 2: 4.67 x 10(-4) cm/min) in comparison with the control group (group 3: 3.37 x 10(-4) cm/min), but the differences between groups 1 and 2 were not statistically significant (p = 0.05). Six months after operation the mean values of Pac in all groups were normalized. In eyes that underwent trabeculectomy with MMC, higher concentrations of MMC were likely to have a transient adverse effect on corneal endothelial permeability. In light of the resulting toxic intraocular effect of MMC, the damage in the function of the corneal endothelial barrier is greater with greater concentrations of MMC.

[Axial and para-axial fluorophotometry in optic neuropathies]. / Osiowa i paraosiowa fluorofotometria w neuropatiach nerwu wzrokowego.

PURPOSE: To investigate optic neuropathies, with normal results in fluorescein fundus angiography, by axial and paraaxial fluorophotometry (a type of topographic vitreous fluorophotometry) in order to determine differences examined in the amount of fluorescein leakage in macular and optic disc. MATERIAL AND METHODS: We studied 12 eyes with unilateral idiopathic retrobulbar inflammatory optic neuropathy and 4 eyes with unilateral posterior ischaemic optic neuropathy during the acute phase: control group consisted of 5 healthy eyes. After 3-4 months, in final stage of optic neuropathies, in which primary atrophy of optic disc developed (6 eyes), fluorophotometric examinations were repeated. All cases of control group underwent axial and paraaxial fluorophotometry. Complete ophthalmic, physical and neurological examinations were performed. RESULTS: The mean fluorophotometric values of PVPR (posterior vitreous penetratio-ratio) for f-scans (foveal) were lower than for t-scans (PVPRf < PVPRt) in all neuropathies during the acute phase but all values of PVPR were higher than in control eyes. In late phase of the neuropathies in which primary atrophy of optic disc developed we found a trend: PVPRt < PVPRf, but all values of PVPR were lower than in control eyes. We noticed increased permeability of the blood-ocular barrier and difference between fluorophotometric readings for optic disc directions (t-paraaxial scans) and for foveal directions (f-axial scans) in optic neuropathies during the acute phase, when the findings on ophthalmoscopic and fluorescein fundus angiography were normal.

[Nephrologic analysis of 94 women with diagnosed "primary" gestosis]. / Oddalna ocena nefrologiczna 94 kobiet z rozpznana gestoza "pierwotna".

Among 94 women with diagnosed "primary" gestosis during pregnancy, 67 patients demonstrated (3-6 months after delivery) chronic glomerulonephritis (25 women) or chronic pyelonephritis (28 women) or hypertension caused by others than nephrologic reasons. "Primary" gestosis was diagnosed correctly only in 29% cases. The most often reason of "secondary" gestosis was undiagnosed chronic nephropathy before and during pregnancy. Obtained results confirm other data informing that "primary" gestosis is a rare phenomenon.

[Fluorometric estimation of corneal endothelium functions in emmetropic and myopic eyes in pseudophakia]. / Ocena fluorofotometryczna funkcji sródblonka rogówki oka normowzrocznego i krótkowzrocznego w pseudofakii.

The aim of the study was to calculate the corneal endothelial permeability (Pac) before, one week, and one month after planned extracapsular cataract extraction and intraocular posterior chamber lens implantation in two groups with axial myopes (8 eyes) and normal eyes (6 eyes): in patients aged 60-75 years. Patients with minimal endothelial disorders have been found to have abnormal endothelial permeabilities. Each operated eye was submitted to fluorophotometry of the anterior segment with measurement of corneal endothelial permeability (Fluorotron Master, Coherent), the day before surgery, 1 week and 1 month afterwards. The measuring of cornea thickness measurement and endothelial cell counting was done by specular microscopy with pachymeter. Corneal permeability clearly increased 1 week after surgery in both groups; 1 months after surgery Pac was normalized in both groups, except for all pseudophakic myopic eyes (axial length: 25-27 mm) with longer surgical procedures (> 20 min), those associated with a greater increase in corneal endothelial permeability. No changes in corneal thickness and endothelial cell density were noted as a result of surgery. Myopic eye with longer surgical procedures was found as a risk factor for an increase in corneal endothelial permeability.

Corneal endothelial permeability in protection glaucoma filter bleb with tissue plasminogen activator.

After glaucoma filtering surgery subconjunctival injection of human recombinant tissue plasminogen activator may promote the function of glaucoma filter bleb and increase outflow facility. It can also increase postoperative complications, such as corneal damage. The aim of our research was to determine corneal endothelial permeability (Pac) in subjects with glaucoma filter bleb protected by a plasminogen activator (Actilyse, Boehringer) when haemorrhagic clots obstructing a glaucoma filtering site had occurred. Two weeks, three months and six months after goniotrephining with scleral cover, in groups with and without subconjunctival injection of 25 mg human tissue plasminogen activator, Pac was calculated. In both groups, no significant differences in the level of Pac measured by fluorophotometry were found.

[Influence of steroidal and nonsteroidal anti-inflammatory drugs on post-operative blood-aqueous barrier in pseudophakia]. / Wplyw sterydowych i niesterydowych leków przeciwzapalnych na pooperacyjna bariere krew-ciecz wodnista w pseudofakii.

Fluorophotometric evaluation of the tightness of blood-aqueous barrier was made in 2 groups of patients who underwent cataract surgery with IOLs implantation. The first group was treated with nonsteroidal (Naclof, Tolectin) and the second with steroidal (Dexamethasone, Hydrocortisone) anti-inflammatory drugs. Fluorophotometry of the anterior segment of the eye was performed for the quantitative examination of the inflammatory reaction. The leakage of fluorescein through the blood-aqueous barrier was evaluated and compared with the fellow, non-operated eye. The individual leakage coefficient, calculated according to Sanders, was lower in the group of patients treated with nonsteroidal drugs but the differences were not statistically significant. The results suggest that nonsteroidal drugs could be as efficient or even more efficient in the treatment of inflammatory reaction after cataract surgery with IOLs implantation.

Axial and para-axial fluorophotometry in diabetic macular edema.

The vitreous fluorophotometric examinations were used in nonproliferative diabetic retinopathy to recognize early diabetic macular edema. Thanks to additional fixation light, axial and para-axial fluorophotometry in patients with nonproliferative diabetic retinopathy was achieved (Fluorotron Master, Coherent). The angle of deviation from the foveal scan (f) was 10 degrees in temporal (t) and nasal (n) directions. In case of non clinically significant macular edema, the posterior vitreous penetration ratio (PVPR) in the foveal scan (f) was significantly higher (p < 0.05) than in the other results (trend PVPRt < PVPRf > PVPRn).

[Blood-retinal barrier and visual field in retinitis pigmentosa]. / Bariera krew-siatkówka i pole widzenia w zwyrodnieniu barwnikowym siatkówki.

The aim of the research was to determine, with new-generation fluorometer (Fluorotron Master), the factor of fluorescein leakage into the vitreous and to reveal, with the static perimeter (Humphrey's), the quantitative parameter of the visual field in retinal pigmentary dystrophy. The factor of fluorescein leakage into the vitreous was almost ten times higher in retinal pigmentary dystrophy and it indicated the damage of blood-retina barrier. The correlation between the factor of fluorescein leakage into the vitreous and the degree of visual field defect has not been found.

Axial and para-axial fluorophotometry in glaucoma simplex.

In this fluorophotometric study, in 25 eyes with middle advanced stages of glaucoma simplex (visual field defects ranged from 500 dB to 800 dB) and treated with topical antiglaucomatous agents, the posterior vitreous penetration ratio (PVPR) was compared with that from normal subjects. Vitreous fluorophotometry (Fluorotron Master, Coherent) was used to measure posterior vitreous fluorescein concentration. Due to additional fixation light in horizontal plane, three scans were taken along the following directions: temporal (t), foveal (f), nasal (n). The angle of deviation from the foveal scan was 15 degrees in each direction. The average values of posterior vitreous penetration ratio in group of patients with glaucoma were higher in comparison with those in healthy subjects. In both groups the PVPR was significantly lower in nasal (n) scan (optic disc area) in comparison with temporal (t) or foveal (f) scans (p < 0.05).

[Measurement of lens transparency in workers at risk of developing of glassblower's cataract]. / Pomiar przezroczystosci soczewek u osób narazonych na wystapienie zacmy hutniczej.

The authors evaluated the transparency of lenses in persons on a stand predisposing to the formation of a glassblower cataract as well as in office clerks. They used for their measurements a fluorophotometer (Fluorotron Master) and an opacity lensmeter. In a group of 40 ironmasters they found a considerable fall in light transparency through the lens and a significant increase of the lens autofluorescence in comparison with a group of office clerks. The quantitative measurement of lens transparency by means of a fluorotron and a opacity lensmeter creates the possibility of an earlier detection of a ++pre-cataract condition.

[Eclampsia in the late postpartum. Contribution of x-ray computed tomography and magnetic resonance imaging]. / Eclampsie du post-partum tardif. Apport du scanner X et de l'imagerie par résonance magnétique.

A 28-year-old woman developed late post-partum eclampsia. CT scan showed focal cortical hypodensities and diffuse and bilateral hypodensity of the hemispheric white matter. These lesions were hypointense on T1-weighted sequences and hyperintense on T2-weighted sequences. The CT and MRI abnormalities resolved completely within a few weeks. These changes are similar to those which occur with the more common prepartum eclampsia.

[Diagnostic value of the captopril test in patients with arterial hypertension]. / Wartosc diagnostyczna testu kaptoprylowego u chorych z nadcisnieniem tetniczym.

In 30 patients with renovascular hypertension, 50 with hypertension in a course of arteries, 71 hypertensive subjects with coexisting parenchymal nephropathy and in 63 with primary hypertension the captopril test was performed after 8 hours night rest and within high sodium diet. Positive test result was stated in 76.67% of patients with renovascular hypertension, in 70.59% of patients with arteritis, in 53.52% of patients with hypertension and coexisting parenchymal nephropathy and in 63.49% of patients with primary hypertension. Significant correlation between increase of plasma renin activity and blood pressure decrease after captopril administration was only stated in patients with renovascular hypertension and in those with arteritis. Results of performed studies impaired the captopril test value in diagnostics of renin-dependent hypertension.

[Effect of the method of treatment on mean survival time of patients with glial brain tumors]. / Wplyw sposobu leczenia na sredni czas przezycia chorych z glejopochodnymi guzami mózgu.

In the years 1976-1981 54 patients were treated for malignant glial tumours confirmed by histological examination. The purpose of the reported analysis was a comparison of the mean survival time and the mean time of survival without evidence of recurrence in 3 groups of patients. In group I of 13 patients not treated surgically but receiving only conservative management the mean survival time was 7.4 weeks. In group II treated surgically but without other therapy this time was 29.2 weeks. In group III in which the patients were operated on and treated with chemotherapy and radiotherapy this time was 58.9 weeks. The differences between the groups were statistically significant. Similarly, the mean survival time without recurrence was significantly longer in the group receiving comprehensive treatment than in the group treated only surgically (46.5 vs 18.0 weeks).