[Survey by SFRO, SNRO and AFPPE about the evolution of the radiation therapist profession in France]. / Enquête SFRO­SNRO­AFPPE sur l'évolution du métier de manipulateur exerçant en radiothérapie en France.

PURPOSE: As part of the multidisciplinary team, radiation therapists are in charge of elements of treatment preparation and delivery of radiotherapy to cancer patients. Helping scientific and technological improvements, more and more patients with cancer were treated with radiotherapy including hypofractionnated radiotherapy, that explain the increase of demands on services. The professional impacted by this increase of demands are radiation oncologists and medical physicists. The opportunity to push forward the radiation therapist's competencies appears with the possibility to shift them some tasks. In this context, a first work was performed with objectives to have an overview of the tasks shifted to radiation therapists in France, the tasks that they could perform but also to evaluate some criteria of job satisfaction. MATERIAL AND METHODS: The committee of "new status and value of status" including six radiation oncologists (the French society of radiation oncology [SFRO] et national union of radiation oncologists [SNRO]) and six radiation therapists committee members of the French association of radiation therapists (AFPPE), built a questionnaire including three parts: demographic characteristics, tasks shifted and job satisfaction criteria. In total, the questionnaire included 19 questions and 24 items assessed with a four point-Likert scale (ranging from "completely disagree" to "completely agree"). This survey, formatting with google form, was tested by the committee members and the final version was sent to the SFRO, AFPPE and SNRO members, before being disseminated on the social networks. RESULTS: From November 18th 2022 to December 31st 2022, 492 responses were received (response rate=18.3%): 55 % of the respondents had at least 11 years of experience in radiotherapy. The respondents worked in different type of health facilities (36 % in specialized cancer centres, 19.5 % in private centers, 17.5% in university and general hospital, 10.2% in general hospital). More than » of the respondents had a teaching lecturer activity, 20% had a management team activity and a research activity for 18%. Less than 10% of the respondents had another degree than that of radiation therapist: university degree (n=27), degree in dosimetry (n=11) and master (n=3). More than 76% would like to be trained and to have access to the advanced practice, more than 50% would like expend competencies with a university degree, 30% with a master and 67% would like to participate in research. Forty-two percent of the respondents were involved in a task shifting (excluding decree relating to acts and activities carried out by radiation therapists) and among the radiation therapists non-involved, 63% would be interested in being. Regarding job satisfaction, 53% of the respondents were satisfied with their job and their salary and 68% believed that their job occupation is in line with their professional aspirations. More than 2/3 of the respondents described a significant workload and mental load, 53% thought to have time for their patient care and 70% felt some organisational difficulties. CONCLUSION: This survey shows: (i) A significant involvement of radiation therapists in the task shifting; (ii) A very strong demand for career development, in particular with existing degrees or to be created degree such as advanced practice; and (iii) The need to reinforce a job satisfaction for almost the half of the respondents, linked to a workload, a mental load and some organisational difficulties.

[Interprofessional recommendations on behalf of Société française de radiothérapie oncologique for the prevention, protection and management of cyberattacks in radiation oncology]. / Prévention, protection, et gestion des cyberattaques en oncologie radiothérapie : recommandations interprofessionnelles au nom de la Société française de radiothérapie oncologique.

Cybersecurity is currently a major issue. Large hospitals are no longer the only main targets of attacks, but all healthcare organizations and establishments, without distinction of size or activities. The information system is defined as all the resources needed to collect images, store and process them with general distribution of multiple information within an organization. Systems are therefore crucial for the functioning of a medical department. Radiation oncology is one of the specialties most dependent on digital resources, for imaging, data transfer, dosimetry, treatment and so on.. Radiation oncology departments are therefore a prime target for ransomware attacks, which have increased significantly in recent years. Cybersecurity can be likened to a viral or bacterial attack. It is based on the two usual pillars of antimicrobial protection : hygiene and prophylaxis. In this article, we will detail by analogy the three classic levels of prevention of a bacillary attack: "primary prevention", which acts upstream of the infection; "secondary prevention", which acts at an early stage of its evolution; and "tertiary prevention", which acts on complications and risks of recurrence. This article is the result of an interprofessional group on behalf of SFRO, the French society of radiation oncology, with the aim of helping all teams to implement safety adapted to the specificities of a radiation oncology department in France.

[Radiation therapists shortage in France: Organizational consequences and difficulties in deploying new missions and/or tasks delegation]. / Métier de manipulateur en radiothérapie en tension en France : conséquences organisationnelles et difficultés à déployer de nouvelles missions et/ou délégation de tâches.

PURPOSE: Radiation therapists shortage has been evaluated at national level in France, specifically in oncology radiotherapy, in terms of: (i) organizational adaptations, (ii) impact on patients care, and (iii) difficulties in deploying new missions and/or tasks delegation. MATERIALS AND METHODS: French professional organisations representing radiation therapists - SFRO, SNRO and AFPPE - sent their members a national survey (ten questions on 32 items). RESULTS: From 18 November 2022 to 31 December 2022, 55 responses were received (response rate: 31%) from radiotherapy managers or department heads; 51% had a structure comprising three to five treatment rooms (receiving 500 to 1000 patients per year [36%], or 1500 to 2000 patients per year [33%]). Activities performed were intensity-modulated radiotherapy (100%), stereotaxic radiotherapy (85%), brachytherapy (40%), adaptive radiotherapy (34%). These structures described consequences in closing machine time for 25% of them (reduction of the hourly volume greater than 10% in 57%) with the following consequences in the last 6 months: (i) an extension of the period of medical care (78%), a closing of one or more accelerators (50%) and the development of moderate hypofractionation scheme or extreme hypofractionation (50%). In current functioning, linear accelerators can deliver treatments with a team of two radiation therapists per room for a short day (43%) or two to four radiation therapists per room teams for a long day (40%). During the last 6 months, there has been a 10% increase in linear accelerators operating with a single team. (ii) regarding treatment planning: 16.4% reported a decrease in the opening amplitude (less than 20% in 44% of cases, from 20 to 50% in 33 % of cases). The initial scheduling of appointments for radiotherapy sessions was carried out by radiation therapists in 84% of the departments in current functioning (0.1 to 1 FTE dedicated to this activity in 62% of the departments). Over the last 6 months, there has been a clear reduction in the number of dedicated FTEs: [FTE=0.1 to 1]=-8%; [FTE=0]=+7%. (ii) Regarding tasks delegation (excluding the decree on acts and activities carried out by the radiation therapist): organ at risk delineation is partially performed by radiation therapist in 26% of the centres; caregiver support time in 78% (56% totally or 22% partially). This activity has been reduced by 42%. Seventy-five percent of departments want to develop new techniques, patient-centered approaches (44%), implement task delegation (organ at risk delineation: 58%; weekly consultations: 67%; positioning imaging validation: 71%), and 78% of departments are interested in developing advanced radiotherapy practice. However, the number of radiation therapists is considered insufficient in their implementation in 76% of cases (one to two FTE missing for 72% of structures). CONCLUSION: This survey shows a significant impact of radiation therapist shortage in radiotherapy oncology care (treatment delays, access to caregiver support time, workload on treatment teams), and represents a major obstacle to the development of radiotherapy structures.

Neuropsychologic and adaptive functioning in adolescents and young adults shunted for congenital hydrocephalus.

The major aim of this study was to assess whether the syndrome of nonverbal learning disabilities described in hydrocephalic children is observed in adulthood. Eleven adults shunted for congenital hydrocephalus related to spina bifida and eight adults shunted for hydrocephalus related to aqueductal stenosis were administered an extensive neuropsychologic battery to investigate discrepancies between verbal and visuospatial cognition, verbal and visuospatial long-term memory, and psycho-social adaptive abilities. The results showed no discrepancies between Wechsler Performance IQ or Verbal IQ in either hydrocephalic group. Nevertheless, the subjects with spina bifida appeared more cognitively impaired than the subjects with aqueductal stenosis, who performed normally on the Wechsler Adult Intelligence Scale-Revised. Memory assessment using Signoret's Memory Battery revealed no discrepancy between verbal and visuospatial memory in the hydrocephalic group. Nevertheless, the subjects with spina bifida had poorer verbal and visuospatial memory performance than the subjects with aqueductal stenosis. There were no differences on the Vineland Adaptive Behavioral Scale between subjects with spina bifida and those with aqueductal stenosis in autonomy, socialization, and daily living skills. These results suggest that shunted congenital hydrocephalus is not characterized by nonverbal learning disabilities syndrome in adolescence or in adulthood.

A new concept in Dorello's canal microanatomy: the petroclival venous confluence.

The so-called Dorello's canal was studied in 32 specimens (16 human cadaver heads) injected with colored latex and fixed in formalin (28 specimens) or studied with microscopic and ultrastructural methods (four specimens). To avoid the differences usually encountered in the description of this area, the authors preferred to consider a larger space that they have named the petroclival venous confluence (PVC). It was located between two dural layers: inner (or cerebral) and outer (or osteoperiosteal). The PVC was quadrangular on transverse section. The posterior petroclinoid fold and the axial plane below the dural foramen of the abducent nerve (sixth cranial nerve) limited the PVC at the top and bottom, respectively. Its anteroinferior limit was the posterosuperior aspect of the upper clivus and outer layer of the dura mater. Its anterior limit was the vertical plane containing the posterior petroclinoid fold, and its posterior limit was the inner layer of the dura. The PVC was limited laterally by the medial aspect of the petrous bone apex and medially by the virtual sagittal plane extending the medial limit of the inferior petrosal sinus upward. The PVC was a venous space bordered by endothelium and continuous with the cavernous sinus, the basal sinus of the clivus, and the inferior petrosal sinus. There were trabeculations between the two dural layers. The petrosphenoidal ligament of Gruber may be regarded as a larger trabeculation, and it divided the PVC into a superior and an inferior compartment. The abducent nerve generally ran through the inferior compartment, where it was fixed to the surrounding dura mater. This nerve was only separated from venous blood by a meningeal sheath of varying thinness lined with endothelium. The clinical implications of these findings are discussed.

Spinal cord compression resulting from Burkitt's lymphoma in children.

We report seven cases of spinal cord compression resulting from Burkitt lymphoma in boys aged 15 years and below. This became manifest clinically as acute or rapidly progressive spinal cord compression. All the patients showed total paraplegia with a sensory loss at thoracic level and sphincter disturbances. Four patients were operated on, the operation permitting exeresis of an epidural tumor. In three cases surgery was followed by chemotherapy. One patient was treated exclusively with chemotherapy. Owing to the effectiveness of chemotherapy, surgery should be considered only in cases of rapid deterioration or for diagnostic purposes.

[Intracavernous invagination of pituitary macro-adenomas]. / L'invagination intra-caverneuse des macro-adénomes hypophysaires.

Depending on authors, intra-cavernous invasion by a pituitary adenoma is found in 9% to 40% of cases. In the light of our own experience, we think that such an invasion is probably much less frequent than usually evoked on CT-scan and MRI. In our study, it was confirmed in only one case over 125 (0.80%), though radiological data suspected an intra-cavernous invasion 17 times. An anatomical study on 20 cadavers showed that 30% of normal pituitary glands present with a lateral expansion into one or both cavernous sinuses (CS). These natural invaginations were already evoked by Harris and Rhoton in 1976. They can resemble an intra-cavernous extension or invasion on MRI views, moreover when an adenoma increases the volume of this expansion, and in the absence of any rupture of the medial wall of the CS. The medial wall of the CS is, in fact, constituted by a dural pouch which close-fits the pituitary gland and its expansions; it invaginates more or less in the CS, depending on the importance of the pituitary lateral expansion. In case of a large adenoma, the finger-glove lateral distension of the pouch disappears progressively during the tumoral removal. Finally the dura returns to its normal place back, at the end of the procedure. This concept of invagination of the CS medial wall, as opposed to that of invasion and therefore of rupture of the dural plane, explains the wide range of figures concerning the frequency of intracavernous invasion by pituitary adenomas, in the literature. These figures are all the more variable as there is no absolute criteria of intra-cavernous invasion on CT-scan nor MRI views. In the same way, no clinical criteria can be retained to assume the existence of such an invasion. So, an ophthalmoplegia seems to be usually linked to a compression of occulomotors nerves; it recovers in a large majority of cases, after the adenoma is removed. In conclusion we emphasize the necessity of interpreting with great care radiological imaging when it evokes' a possible intra-cavernous invasion of a pituitary adenoma. The indication of an eventual radiotherapy should be retained with as much care as possible, since complete removal of an adenoma and its lateral expansion(s) is almost always feasible through a trans-sphenoidal route.

Study of unilateral hemisphere performance in children with developmental dysphasia.

Hemisphere specialization for language was studied in 10 children with expressive developmental dysphasia (DD) (mean age 10 years 4 months) submitted to a dichotic listening task (in a word free-recall task and forced-attention task) and a finger tapping/vocalization dual-task paradigm. A nonsense shape dichaptic task was also introduced to control right hemispheric processing. Performances of dysphasic children were compared to those obtained from 15 normal children. The results showed that controls had a right ear advantage in free-recall (words) dichotic listening task and a significant right ear advantage in forced-right-attention task, with a change in ear asymmetry as a consequence of instruction. In the dysphasic group we observed a significant right ear advantage in the free-recall dichotic listening task and no change in ear asymmetry during forced right or forced left condition. Results in time sharing paradigm and nonsense dichaptic task are more difficult to interpret, because there was no interaction between group and condition. These results cannot support a complete left hemisphere dysfunction in developmental dysphasia.

[Spinal cord compression due to thoracic spinal chondroma. A study of 2 case and a review of the literature]. / Compression médullaire par chondrome rachidien thoracique. Etude de 2 cas et revue de la littérature.

We report two cases of thoracic spine chondroma in two girls aged 14 and 12 years. The lesion was revealed by signs of spinal cord compression and affected T1 and T7 respectively. Chondroma is a benign bone tumour, fairly frequent in the extremities but very rare in the spine. It accounts for 2.8% of benign bone tumours and 12% of all bone tumors. 3.6% to 4% of chondroma are located in the spine. Out of 51 cases reported in the literature 21 had been revealed by spinal cord compression, with an age range of 5 to 76 years. In all cases of spinal cord compression magnetic resonance imaging (MRI) is necessary as first-line examination, but CT scans are still useful in the diagnosis and post-operative follow-up of spinal chondroma because of the osteo-cartilaginous nature of these tumors. The purpose of this study was to report two new cases of spinal cord compression by thoracic spine chondroma and to review the literature.

Sleep EEG and developmental dysphasia: lack of a consistent relationship with paroxysmal EEG activity during sleep.

In order to clarify the relationship between developmental dysphasia and EEG abnormalities, paroxysmal activities during sleep were studied in a series of 24 children with expressive developmental dysphasia (mean age 8 years) and compared to a control group of 39 children (mean age 9 years). The children of both groups were selected excluding cases with prior history of neurological disease or epilepsy. In the control group, 37 children had normal sleep EEG while 2 children had paroxysmal abnormalities. In the dysphasic group, epileptic abnormalities were observed in 9 cases, rare in 4 cases and frequent in 5 cases (density: 2.5 to 66.2% of total sleep time). Nevertheless, paroxysmal abnormalities did not reach the frequency described in the Landau-Kleffner syndrome, and it is unlikely that EEG abnormalities could have produced dysphasia.

[Ethical problems raised by the current French practice of therapeutic abortions. Part I: prospective study for 24 months at the University Hospital of Tours (76 cases)]. / Problèmes éthiques soulevés par les pratiques françaises actuelles de l'interruption médicale de grossesse. 1re Partie: Etude prospective sur 24 mois au CHU de Tours (76 cas).

OBJECTIVE: Determine the circumstances and conditions concerning ethical problems raised by medical abortions treated in a University hospital. METHODS: Prospective study for 2 years (1 Sept 1991--31 Aug 1993) conducted with a consulting Committee for the antenatal diagnosis and fetal medicine at the University Hospital at Tours. Each discussion of the medical file for proposed medical abortions, the conditions leading to the decision and the ethical recommendations formulated were registered as well as the outcome of the pregnancy and for the infant. RESULTS: There were 76 cases raising ethical problems. They were divided into 3 categories of recommendations: medical abortion (55 cases), abstention with acceptation of possible fetal death in utero (11 cases), conservation of the pregnancy (10 cases). CONCLUSION: A practical attitude could usually be decided after discussion between parents and physicians. A few cases of disagreement were observed which led to uncertainty [correction of incertainty] and diverging opinions concerning the diagnosis and prognosis for the fetal pathology.

[Post-traumatic transient cortical blindness]. / Cécité corticale transitoire post-traumatique.

BACKGROUND: Transient cortical blindness is a rare complication of mild head trauma in children. This spectacular manifestation always has a benign outcome. CASE REPORT: A five-year-old girl was admitted for bilateral blindness immediately following a fall with frontal head injury. Neurological examinations and ophthalmological investigations showed no abnormalities. The electroencephalogram showed slow waves in the left occipital area. The blindness resolved completely within 3 hours. CONCLUSION: This bilateral blindness was similar to that of the 40 cases reported since 1964, including a rapid and benign outcome. Its mechanism is not clear, although some suggest a cerebral vasospasm. Our patient's mother has a history of migraine.

[Late recurrence of supra- and infra-tentorial medulloblastoma]. / Rechute tardive sus- et sous-tentorielle d'un médulloblastome.

BACKGROUND: The vital outcome for treated medulloblastoma in children is generally positive provided there is no evidence of recurrence 18 months after initial surgery and radiotherapy. Late recurrences have, however, been reported. CASE REPORT: A medulloblastoma in the posterior fossa of a 10 year-old-boy was treated by almost complete surgical excision, radiotherapy and chemotherapy. One year later, the CT scan was normal but, 4 years after surgery, it showed supra-and infratentorial tumors. Progressive hydrocephaly required a ventriculoperitoneal shunt. 9 years after the initial surgery, progressive neurological degradation and the presence of cells in the CSF were treated by several courses of chemotherapy, with subsequent improvement of the neurological condition. This boy is in a stabilized condition 11 years after the discovery of the tumor. CONCLUSION: The first symptomatic recurrence of medulloblastoma was late, more than seven years after surgery. This recurrence was supra-and infratentorial and responded to non intensive chemotherapy.

[Tuberculous abscess of the cerebellum]. / Abcès tuberculeux du cervelet.

Cerebral tuberculous abscess is exceptional. We report on the case of a H.I.V. positive 29 year-old man suffering from high intracranial pressure together with a cerebellar syndrome. The CT scan revealed a voluminous abscess of the left cerebellar hemisphere. Anatomical and pathological examination of the extracted mass showed a tuberculous abscess. 16 months after surgery and antituberculous treatment, the patient's symptoms have disappeared and he has resumed his professional activities. Though controversial, a pathogenic continuum between a tuberculoma and a tuberculous abscess may be assumed to exist. The A.I.D.S. pandemic reactivates the tuberculous foci, increases the risks of contagion reduced the effectiveness of treatment, and justifies a systematic search for the bacillus of Koch, after puncture, in any cerebral abscess.

[Pituitary abscess, treated by medication]. / Abcès hypophysaire traité médicalement.

Pituitary abscesses are rare. The case reported here concerns a 28-year old African. Gradual development of diplopia over 6 months was the first clinical manifestation. Three months later this development had reached a more severe and infectious context, with complete right ophthalmoplegia, meningitis and coma (GCS = 9). CT scan showed an image in favour of a pituitary abscess with suprasellar extension, associated with thrombophlebitis of the cavernous sinus. An antibiotic therapy consisting of cefotaxime and metronidazole administered for 1 month, and netilmicin for 15 days succeeded in controlling the infectious syndrome. This resulted in cure of visual disorders, reduction in size of the CT scan image and reconstruction of the pituitary sella which had been destroyed. The diagnosis of pituitary abscess should be made when confronted with an infectious syndrome (unexplained fever, repeated meningitis). CT does not recognize the nature of the hypophyseal mass it shows: necrosis of a pituitary adenoma, giant aneurysm or craniopharyngioma may mimic local infection. Surgery confirms the diagnosis and is regarded as the best treatment. The patient's life is threatened when meningitis is present, and the functional prognosis is poor when recovery from visual disorders is compromised due to late diagnosis. In this paper a comparative analysis of the clinical course of the disease and therapeutic data in our patient is presented and compared with other reported cases.

Cognitive functions in Duchenne muscular dystrophy: a reappraisal and comparison with spinal muscular atrophy.

In order to clarify cognitive functions in Duchenne muscular dystrophy (DMD), we performed a new controlled neuropsychological study. IQ (WISC-R), verbal skills (fluency, confrontation naming and syntax comprehension) and memory abilities (BEM) were studied in two matched groups; 24 DMD children and 17 spinal muscular atrophy (SMA) children aged 12-16 yr. A significant difference appeared between the DMD and SMA patients: only in the DMD group were there significant disabilities in certain specific functions and normal scores in others. Despite similar education, the DMD children more often had significantly greater learning disabilities. There were more DMD left-handers. Verbal IQ was significantly low whereas performance IQ was at a normal level. DMD children also performed poorly in reading tasks and in some memory functions such as story recall and verbal recognition. Specific cognitive disabilities in certain DMD children, not seen in SMA children, suggest a relationship with a DMD genetic disorder.

Acute measles encephalitis of the delayed type: neuroradiological and immunological findings.

A case of delayed acute measles encephalitis in an immunosuppressed child is reported. Detailed immunological studies have shown defective humoral immunity (defective IgA, IgG2 and IgG3) and decreased natural killer activity. Neuroradiological examination by magnetic resonance imaging revealed several high signal lesions on T2-weighted images in the gray matter without clinical or pathological correlation. The implications of these findings are discussed.

Disseminated cerebral histiocytosis X responding to vinblastine therapy: a case report.

A case of intracranial histiocytosis X with multiple parenchymal brain lesions is described. Despite severe neuroradiological findings, and involvement of a node and vertebra on presentation, the child is doing well clinically, with outpatient chemotherapy, 36 months after diagnosis. The prognosis of cerebral involvement in such atypical cases should probably be reevaluated. Therapeutic problems are discussed.