[Stereotactic radiosurgery. Preliminary experience of a team of Lyon]. / La radiothérapie stéréotaxique multifaisceaux. Expérience préliminaire d'une équipe lyonnaise.

Radiosurgery (RS) is a new technique that is being developed worldwide to treat a variety of central nervous system (CNS) diseases. We report preliminary results concerning the first 35 patients treated at our institution between October 1989 and December 1990. These patients presented with pituitary adenomas (PA: 12 patients), primary CNS tumors with different histologies (11 patients), arteriovenous malformations (AVM: 6 patients), acoustic neurinomas (3 patients) and CNS metastases (3 patients). All patients were treated with a linear accelerator and received a single dose of 20 Gy delivered on the 70% isodose curve localized stereotactically by mean of either a CT scan or angiography. Preliminary results with a median follow-up of 26 months were as follows. AVM had totally disappeared in 3 patients after 12 and 17 months, and remained stable in 3 at 6 and 26 months. In 3 PA patients, the adenoma was partially regressed on the CT scan and, in 2 patients, the visual field was moderately improved; none experienced clinical improvement due to hormonal hypersecretion. One patient with neurinoma experienced clinical improvement, but the CT scan remained unchanged in the 3 patients. Of the patients with primary or secondary tumors, 8 exhibited a reduced lesion diameter on the CT scan, but 3 died later of progressive disease. Complications were not rare. In 7 patients, delayed reactions were observed: one case of cerebral edema reversed under corticotherapy; and 6 cases of neurological impairment due to brain necrosis, reversed in only one. RS appears to be an interesting approach for the treatment of deeply located AVM and for small acoustic neurinomas.(ABSTRACT TRUNCATED AT 250 WORDS)

[Ideal treatment of malaria attack: more questions than answers? Experience of a department of infectious diseases]. / Traitement idéal de l'accès palustre: plus de questions que de réponses? Expérience d'un service de maladies infectieuses.

The number of cases of malaria imported to western Europe from tropical areas is steadily growing, due to the increased number of people traveling to endemic regions and to the spread of Plasmodium strains resistant to chemoprophylaxis. This has prompted the WHO to frequently update its guidelines concerning preventive therapy. We report on 143 consecutive cases of benign attacks of malaria in patients returning primarily from western and central Africa. Plasmodium falciparum was responsible for 80% of the cases. Forty-one percent of the patients had followed their preventive regimen correctly; mefloquine failed in 3 of them. Three early relapses were observed after curative treatment, including 2 patients who had received intravenous quinine for more than 5 days. Because P. falciparum infection is potentially lethal, we suggest that the treatment of malaria attacks be optimized, by systematically dosing serum quinine levels, in order to adjust the administered doses, and, as a first-line therapy, by prescribing a combination of drugs to patients at high risk of resistance.