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To assess the potential benefit of the MXM auditory brainstem implant for patients with neurofibromatosis type 2.Retrospective case review.Tertiary referral centers.Fourteen patients with neurofibromatosis type 2 and bilateral acoustic neuromas underwent implantation with the MXM auditory brainstem implant during surgery to remove the second-side tumor.There were no complications related to the auditory brainstem implantation. Auditory sensations were present for 12 of 14 patients (86%). Global results indicated an improved quality of life for the patients receiving auditory sensations, in part because of their auditory orientation within the environment. Eighty-nine percent of patients tested with an open-set sentence test demonstrated enhancement of speech understanding as a result of lip-reading improvement when auditory brainstem implant sound was combined with lip-reading. A few patients (36%) had some speech understanding in sound-only mode. One patient was able to have limited phone conversations.These results indicate that significant auditory benefit can be derived from the MXM auditory brainstem implant.

The authors report on their experience with the trans-sinusal frontal approach in removing olfactory groove meningiomas. Six tumors were operated on by the trans-sinusal frontal approach, using a bicoronal incision; two tumors developed on one side, and there were four bilateral olfactosellar tumors. Osteotomy of the anterior wall of the frontal sinus was performed with an oscillating saw without any burr hole. The posterior wall of the sinus was resected and the tumor was attacked through a real subfrontal route along the plane of the anterior skull base. Ethmoidal blood supply was controlled at the initial stages of the operation, allowing avascular tumor debulking. Olfactory nerves, invaded by the tumor, were removed along with the tumor. Tumor extensions toward the sella and the optic canals were removed without brain retraction, opening of the Sylvian fissure, or dissection of the carotid arteries. All patients made a good neurologic recovery; intellectual impairment disappeared within 1 month, and visual acuity normalized within 2 weeks. Olfactory nets were preserved on the contralateral side in unilateral tumors. The trans-sinusal frontal approach is technically easy and safe to achieve. Osteotomy and replacement of the anterior wall of the frontal sinus are rapidly performed. When the frontal sinus is small, imageguided surgery allows precise deliniation of its limits and the free bone flap, including the calvarial outer layer, tangentially cut from one supraorbital canal to the other. The cosmetic result is perfect, as the normal contour of the forehead is maintained without any scar or visible burr hole. The trans-sinusal frontal approach gives access to the orbital roofs and to the central anterior skull base from the crista galli to the tuberculum sellae and the anterior clinoid processes. The trans-sinusal frontal approach represents an alternative to conventional craniotomies for tumors developed in the central anterior skull base, especially for olfactory groove meningiomas, whatever their size.

Neurofibromatosis type 2 (NF2) is a monogenic dominantly inherited disease that predisposes to the development of tumors of the nervous system, particularly meningiomas and schwannomas. The gene which, when altered, causes NF2, is localized on chromosome 22 and has recently been identified. The NF2 gene is also the site of somatic mutation in tumors, suggesting that it might have a tumor suppressor activity. We here report a screening method for the detection of point mutations in NF2 which takes advantage of denaturing gradient gel electrophoresis (DGGE). This method efficiently screens 95% of the coding sequence and 90% of intron/exon junctions. When applied to 91 unrelated NF2 patients, it enabled the identification of 32 germ-line mutations. Since mutations are found in only one third of the patients, it is expected that mutations or deletions affecting the promoter and/or intronic regions of the NF2 gene occur frequently. The characterized mutations are preferentially located within the 5' half of the gene. Most of them are predicted to lead to the synthesis of a truncated protein. A search for genotype/phenotype correlations showed that, at least in this series of patients, mild manifestations of the disease were associated with mutations which preserve the C-terminal end of the protein.

The authors have reviewed hearing results obtained in 99 patients operated on via the suboccipital approach for acoustic neurinoma, who were not deaf prior to surgery (pure tone average less than 70 dB). Tumor size was less than 10 mm in four cases, 10 to 19 mm in 26 cases, 20 to 29 mm in 39 cases, and 30 mm or greater in 30 cases. Removal was macroscopically complete in 92 cases and incomplete in seven, including four cases with bilateral acoustic neurofibromatosis. Hearing was preserved in 29 patients (29.3%), of whom 23 had neurinomas smaller than 30 mm and six had tumors exceeding 30 mm in size. Postoperative hearing was good in eight cases (four with neurinomas less than 20 mm and four with neurinomas greater than 20 mm), serviceable in four cases (three with neurinomas less than 20 mm and one with a tumor greater than 30 mm), and poor in 17 cases (eight with neurinomas less than 20 mm and nine with tumors greater than 20 mm). Fifty-seven patients underwent intraoperative brain-stem auditory evoked potential monitoring: the rate of hearing preservation was found to be higher in this group than in the 42 without monitoring (p less than 0.05). A statistical study using stepwise regression analysis showed that the two preoperative factors most significantly associated with postoperative hearing preservation are a good auditory level for low frequencies measured by pure tone audiometry and a small-sized tumor. Overall results indicate that, even if hearing is more easily preserved when the neurinoma is small and the preoperative auditory condition is good, the surgeon should try to save hearing in all patients who have preserved hearing before surgery.

(1992). Weltwirtschaftlicher Strukturwandel—Herausforderungen an die Schweizer Raumordnungspolitik. disP - The Planning Review: Vol. 28, No. 111, pp. 13-17.

Among the patients showing evidence of cerebral metastases without previously known cancer history, lung cancer has been found 37 times as the primary tumor in our institution. There were 34 men and three women and all but two were heavy smokers. Only one presented at diagnosis with thoracic symptoms but the chest radiograph was abnormal in 34. The histologic type of the primary tumor was obtained in 32 cases as a result of thoracic investigations and in five cases from metastatic tumor tissue. The primary tumor appeared to be non-small cell lung carcinoma in 26 cases and small cell lung carcinoma in 11 cases. These results show that patients treated with surgery (20 cases) have a better survival (median 10 months versus 4.5) than the others, and among surgically treated patients only those treated with bifocal resection (eight patients) are long-term survivors. Also, in four of six patients, objective regression of the neurologic symptoms was seen after radiation therapy alone. Central nervous system relapse was seen in 12 patients, but in none of the patients treated with postoperative radiation therapy. Conventional chemotherapy (11 patients) induced objective responses only in the small cell type and proved to be too toxic when used simultaneously with radiation therapy in inoperable patients.

Ependymomas are the most frequent spinal cord tumors in adult patients. Although magnetic resonance imaging can be a highly accurate diagnostic tool, it does not always provide accurate differentiation between ependymomas and astrocytomas. This is why the authors recommend surgical resection and histological evaluation in all intraspinal cord tumors. It cannot be said that a tumor is unresectable without first attempting to remove it. Complete removal should be accomplished whenever possible, and patients should undergo operation before they become neurologically impaired. Quality of life depends on preoperative neurological status. Postoperative radiotherapy should be avoided in all low-grade ependymomas even after partial removal. Radiotherapy may be used to treat anaplastic ependymomas, which are quite rare in the spinal cord. Patients with low-grade ependymomas must be followed for years and undergo reoperation if necessary. In our experience treating 93 spinal cord ependymomas, complete removal was achieved in 86 patients and only one patient underwent reoperation 18 years later for tumor recurrence. The gold standard in treatment protocol is gross-total resection without adjunctive radiation therapy. Good long-term outcomes have been achieved by using this strategy.

Object. Pituitary adenomas are usually benign tumors; however, some behave aggressively and metastasize. Until now, no specific marker of aggressive behavior or malignancy has been found. The polysialylated neural cell adhesion molecule (NCAM), which is highly expressed in embryonic tissues such as the brain and pituitary, is detected in some neuronal and neuroendocrine tumors. Because polysialylation has been implicated in the regulation of cell growth and migration, polysialylated NCAM expression has been considered as a prognostic marker in such tumors. Methods. In the present study, the authors analyzed polysialylated NCAM expression in 82 pituitary tumors from humans: 49 secreting adenomas, 32 nonfunctioning adenomas, and one growth hormone and prolactin—secreting carcinoma associated with acromegaly and spinal and liver metastases. Based on immunohistochemical analyses, the tumors were classified as somatotropic (22 tumors), prolactinoma (14 tumors), corticotropic (17 tumors), and gonadotropic or so-called null cell adenomas (28 tumors). Assessment of polysialylated NCAM was performed using three different methods (immunohistochemical analysis, Western blot analysis, and enzyme-linked immunosorbent assay) with a specific mouse monoclonal immunoglobulin M (Men B) that recognizes polysialic acid on NCAM. Tumoral NCAM expression was also evaluated with the aid of immunohistochemical analysis. Using this method, NCAM and polysialylated NCAM were studied in six healthy pituitaries. In addition, corrrelations were investigated using three statistical methods (chi-square test, nonparametric Mann—Whitney U-test, and principal component analysis) to compare tumoral polysialylated NCAM expression and seven parameters (tumor size and type, intrasphenoidal or cavernous sinus invasion, Ki-67 index, mitoses, and patient age and sex). Neural cell adhesion molecules were expressed in the healthy anterior pituitary and in all tumors. In contrast, polysialylated NCAM was not found in the healthy pituitary gland, but was expressed in 46.3% of typical pituitary tumors and in 85% of the tumors selected as highly aggressive, including one carcinoma and three tumors with histological characteristics that raised suspicion of malignancy. There was no significant correlation between polysialylated NCAM expression and tumor size, tumor type, Ki-67 index, mitoses, or patient age and sex. In contrast, the expression of polysialylated NCAM, which was sensitive to endoneuraminidase-N treatment, was strongly correlated with tumor invasion (p < 0.0001). Conclusions. In pituitary tumors in humans, expression of polysialylated NCAM is strongly related to tumor invasion and confirms the clinical diagnosis of aggressiveness.

✓ Myxopapillary ependymomas represent the most frequent type of ependymomas found at the conus medullaris—cauda equina-terminal filum level. They are neuroectodermal tumors mainly observed during the fourth decade of life. Pediatric cases have been rarely described at an age range of 10 to 13 years. Myxopapillary ependymomas are typically solitary tumors involving the terminal filum. Simultaneous discovery of two tumors located both on the terminal filum has been reported once. The pathogenesis of this focal ependymoma located at the same embryological level, on the terminal filum, is uncertain; it may represent one end of a spectrum, the other end being the giant ependymoma of the terminal filum.

Median and tibial nerves somatosensory evoked potentials (SEPs) were recorded in 20 patients with intramedullary cervical spinal cord tumours. The longitudinal extent of the tumour was determined by magnetic resonance imaging (MRI) and the surgeon's intraoperative observations. Somatosensory evoked potentials to median or tibial nerve stimulation were abnormal in 85% of patients. Three groups were identified on the basis of the median nerve SEP findings: Group I (20% of cases) with normal SEPs responses; Group II (30% of cases) with impaired cervical dorsal horn postsynaptic activity (abnormal N13 potential) but preserved dorsal columns transmission up to the cortex (normal P14 and N20 potentials); Group III (50% of cases) where the dorsal horn activity and dorsal columns transmission were both impaired. The isolated abolition of the N13 potential observed in Group II reflects a functional dissociation between segmental dorsal horn and dorsal columns structures and should prompt myelographic investigations. Postoperative follow-up suggests that absent N13, P14 and N20 potentials before surgery carry an ominous functional prognosis. However, postoperative recovery of the N13 potential was found to occur in a few cases, suggesting that these tumours do not necessarily produce irreversible damage to the cervical dorsal horn neurons. Thus SEPs proved to have a high sensitivity in detecting cervical spinal cord dysfunction in intramedullary tumours, provided that a selective recording of the N13 potential is performed using a cervical-supraglottal derivation.

Fischer Georges. Elaboration et aperçu de l'accord américano-soviétique sur les euromissiles. In: Annuaire français de droit international, volume 33, 1987. pp. 33-68.

Fischer Georges. La troisième Conférence d'examen du Traité sur la non-prolifération. In: Annuaire français de droit international, volume 31, 1985. pp. 254-271.

Fischer Georges. La non reconnaissance du Transkei. In: Annuaire français de droit international, volume 22, 1976. pp. 63-76.

Fischer Georges. Le Canal de Panama, passé, présent, avenir. In: Annuaire français de droit international, volume 23, 1977. pp. 745-790.

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✓ Bypasses of the sagittal sinus, 2.5 mm in diameter, were carried out in 25 dogs with venous (13 cases) and arterial (12 cases) autogenous grafts, by classical microtechniques. Animals were sacrificed 10 to 75 days after the operation, average 40 days. The patency rate was 54% in the venous autograft group; in all cases, thrombosis occurred early and was due to technical factors. The immediate postoperative patency rate was 100% in the arterial graft group, but this type of graft showed a tendency to progressive occlusion because of extensive fibrosis of the arterial wall; thus the patency rate was 75% at the time of autopsy. This preliminary work demonstrates the technical feasibility of bypass procedure which could be used for sagittal sinus repair.

Fifteen patients with recalcitrant cerebrospinal fluid (CSF) fistula underwent the insertion of a lumboperitoneal shunt. The shunt consists of a two-piece Silastic tube and has been used in a population of 150 patients with communicating hydrocephalus, persistent postoperative meningocele, and benign intracranial hypertension. The spinal catheter is introduced subcutaneously and no flushing device is used. We studied three groups: 9 patients had a history of head trauma, and 7 of these had undergone one or several ineffective direct approaches to the dural leak. Four patients presented with a presumably congenital fistula. Two patients had persistent rhinorrhea due to previous intracranial procedures. Indium-111 cisternography was performed in 10 patients before lumboperitonel (LP) shunting and failed in 2 of those to document the site of leakage. Twelve patients showed cessation of rhinorrhea after LP shunting. In 4 of these, shunt-related complications responded to shunt removal with no further recurrence of rhinorrhea. Two patients underwent revision of the shunt. In 3 patients, the LP shunt failed to control the CSF leak and further intracranial procedures were indicated. The LP shunt provides and attractive and technically simple solution when direct methods of treatment have failed. Additionally, LP shunting should be considered as a primary mode of treatment in elderly patients or when impairment of CSF dynamics is documented by radionuclide cisternography and computed tomographic scanning. When an LP shunt is ineffective, shunt function should be checked by isotopic studies before additional surgery is performed. (Neurosurgery 16:44–47, 1985)

Fischer Georges. Note additionnelle sur la coopération régionale en Asie du Sud. In: Annuaire français de droit international, volume 31, 1985. pp. 204-209.

The Food and Agriculture Program at the Institute of Applied Systems Analysis has over a number of years developed a large global model system with the purpose of studying agricultural policy issues. This article reports on preliminary findings of the economic and welfare effects of a general introduction of free trade. At free trade world market prices rise by 20 to 25 percent, as the downward pressure on these prices of protection is released. This triggers economic gains, particularly for developing countries and lowly protected developed countries, and a considerable expansion of world trade, particularly in animal products. Globa! welfare improves, but the poorest layers of the population in developing countries may suffer from the higher prices., Le Programme Alimentaire et Agricole de l'Institut International d'Analyse des Systèmes Appliqués a développé un vaste système global de modèles destinés à étudier les problèmes de la politique agricole. Cet article décrit les résultats préliminaires d'une analyse basée sur ce système tentant de tirer les conséquences économiques de bien-être d'un régime de libre-échange. Il conduit à une hausse des prix agricoles mondiaux de l'ordre de 20 à 25% due à la disparition de l'effet dépressif du protectionnisme. Cette hausse de prix^ favorise surtout l'économie des pays en développement ainsi que les pays développés faiblement protégés. ïïîe stimule une expansion du commerce international, en particulier pour les produits animaux. Le bien-être mondial s'améliore, mais certaines couches de la population la plus pauvre des pays en développement risquent de souffrir de la hausse des prix des denrées de base., Fischer G., Frohberg K., Gulbrandsen O. L'agriculture dans un régime de libre-échange. In: Économie rurale. N°164, 1984. pp. 29-33.

Fischer Georges. La Conférence d'examen du Traité sur la dénucléarisation des fonds marins. In: Annuaire français de droit international, volume 23, 1977. pp. 809-819.

Fischer Georges. Le bombardement par Israël d'un réacteur nucléaire irakien. In: Annuaire français de droit international, volume 27, 1981. pp. 147-167.

Fischer Georges. L'indépendance de la Guinée et les accords franco-guinéens. In: Annuaire français de droit international, volume 4, 1958. pp. 711-722.

Fischer Georges. Les accords sur la limitation des armes stratégiques. In: Annuaire français de droit international, volume 18, 1972. pp. 9-84.

Fischer Georges. Henri Laugier. 1888-1973. In: Politique étrangère, n°1 - 1973 - 38ᵉannée. pp. 99-102.

Lande Adolphe, Fischer Georges. La codification du droit international des stupéfiants. In: Annuaire français de droit international, volume 2, 1956. pp. 557-571.

Fischer Georges. Agence internationale pour l'énergie atomique. In: Annuaire français de droit international, volume 2, 1956. pp. 616-634.

Dans notre monde, sans doute divers et diversifie, certains exaltent au-dela du raisonnable les differences pretendument irreductibles entre nations, l'authenticite et le passe historique specifique de tel peuple ou groupe de peuples du Tiers Monde. Or, en examinant la naissance et l'evolution des mouvements nationaux dans les pays coloniaux ou semi-coloniaux, on se rend compte des points communs qui existent entre les ideologies et les methodes d'action de ces divers mouvements, ou, en tout cas, du nombre tres limite de modeles qu'ils presentent. Les differences s'expliquent autant sinon plus par les roles respectifs des couches sociales, par la nature des liens avec la metropole ou le centre que par la specificite culturelle ou historique. Le reveil national est a la fois emprunt et refus et souvent refus parce que emprunt. L'influence des methodes occidentales, de la pensee occidentale, est patente. Meme aupres de ceux qui se sont voulus les plus authentiques, les plus proches de l'âme nationale, cette influence s'est profondement fait sentir. Sans aller jusqu'a qualifier Gandhi, comme le fait Gunnar Myrdal, de liberal-radical de l'ere post-victorienne (i), on ne peut evoquer cette grande figure sans constater la marque que lui ont imprimee les idees ou — plus directement — la personnalite et les conseils de certains Occidentaux : Andrews, Chesterton, Max Muller, Polak, Ruskin, Sonia Schlesin, Thoreau, Tolstoi (pour ne mentionner que ceux-la). La religion joue un role ambigu mais certain dans le reveil national de nombreux peuples du Tiers Monde (et auparavant, de l'Europe orientale). On serait tente de dire que ce role correspond precisement a ce qui, dans le mouvement rationaliste, est refus. Mais les attitudes religieuses baignent elles aussi dans une realite sociologique, subissent les influences exterieures et s'y adaptent, se fondent sur les interpretations nouvelles et changeantes des doctrines anciennes (2).

Fischer Georges. Le Traité américano-soviétique relatif à la limitation des essais souterrains d'armes nucléaires. In: Annuaire français de droit international, volume 20, 1974. pp. 153-172.

Fischer Georges. La non-prolifération des armes nucléaires. In: Annuaire français de droit international, volume 13, 1967. pp. 47-98.

Socini Roberto, Fischer Georges. La tutelle italienne sur la Somalie. In: Annuaire français de droit international, volume 2, 1956. pp. 571-581.

Fischer Georges. Le mode de règlement des différends adopté par l'Accord international sur le blé. In: Annuaire français de droit international, volume 1, 1955. pp. 208-211.

Fischer Georges. Le caractère tripartite de l'Organisation. In: Annuaire français de droit international, volume 1, 1955. pp. 376-382.

Fischer Georges. Le nouveau statut du Sikkim. In: Annuaire français de droit international, volume 20, 1974. pp. 201-214.

Fischer Georges. La coopération internationale en matière d'utilisation pacifique de l'énergie atomique. In: Annuaire français de droit international, volume 1, 1955. pp. 228-257.

Chaumont Charles, Fischer Georges. Explication juridique d'une définition de l'agression. In: Annuaire français de droit international, volume 2, 1956. pp. 521-529.

Fischer Georges. La Nigeria en marche vers l'indépendance. In: Annuaire français de droit international, volume 5, 1959. pp. 205-219.

Fischer Georges. La souveraineté sur les ressources naturelles. In: Annuaire français de droit international, volume 8, 1962. pp. 516-528.

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Fischer Georges. Les relations entre les Etats-Unis et la République de Panama. In: Annuaire français de droit international, volume 1, 1955. pp. 85-98.

Fischer Georges. Accord instituant l'Organisation. In: Annuaire français de droit international, volume 1, 1955. pp. 406-423.

Fischer Georges. L'assistance technique de la France aux nouveaux Etats. In: Annuaire français de droit international, volume 3, 1957. pp. 92-118.

Fischer Georges. Les compétences du Secrétaire général. In: Annuaire français de droit international, volume 1, 1955. pp. 345-348.

Fischer Georges. Accord relatif au siège. In: Annuaire français de droit international, volume 1, 1955. pp. 393-406.

Fischer Georges. Quelques réflexions sur la position de la France à l'ONU. In: Politique étrangère, n°6 - 1955 - 20ᵉannée. pp. 707-718.

Drago Roland, Fischer Georges. Pondération dans les organisations internationales. In: Annuaire français de droit international, volume 2, 1956. pp. 529-547.