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Bien que la méconnaissance des troubles cognitifs et comportementaux soit reconnue comme un facteur limitant la réinsertion socio-professionnelle des patients souffrant d’un traumatisme crânio-cérébral grave, peu d’études évoquent la question de la réhabilitation des troubles de la conscience et l’évaluation de l’efficacité et de la spécificité de la rééducation. Afin d’évaluer l’efficacité d’une intervention métacognitive sur la conscience des troubles cognitifs et comportementaux suite à un traumatisme crânio-cérébral grave, sept patients ont été confrontés à un protocole rééducatif de type cross-over designincluant un bilan neuropsychologique et des questionnaires comportementaux. Trois patients ont bénéficié d’une rééducation métacognitive tandis qu’une réadaptation sociale (capacités communicatives, interaction sociale) a été proposée à 4 autres patients ; la confrontation des deux procédures nous permettant d’interroger la question de la spécificité de l’intervention métacognitive. Bien qu’aucune influence de l’intervention n’ait été observée sur les mesures cognitives, un effet bénéfique des deux types de prise en charge a été relevé sur les difficultés comportementales. Les données obtenues suggèrent que les bénéfices de la rééducation sont similaires quelle que soit l’intervention proposée (métacognitive versus sociale), soulignant la nécessité de repenser l’approche rééducative en considérant l’individu dans son fonctionnement social.

The authors report the case of a three-year-old Mauretanian child who was referred to their ophthalmology department with a large exophthalmos combined with pansinusitis and a general inflammatory syndrome. The histological aspect of the lesion was highly suspect of tuberculosis and, although no bacteriological proof of the disease could be rendered, antibiotic treatment with a combination of INH, Ethambutol and Rifadine healed the lesion after one year.It is emphasized that, in developing countries, orbital tuberculosis is one of the possibilities in an inflammatory lesion.

A retrospective study was undertaken on 33 patients with bilateral retinoblastoma in whom one eye at least was classified as stage IV or V (Reese-Ellsworth classification). In most cases the other eye had been enucleated elsewhere.Conservative therapy consisted of primary chemotherapy (vincristine, actinomycin, cyclophosphamide) followed by external beam irradiation, six courses of chemotherapy and, if necessary, by cobalt-60 plaques, xenon arc photocoagulation or secondary enucleation. Ten patients were lost to follow-up, eight patients died or are currently being treated for recurrence, 15 patients are alive and free from disease and 42% of eyes at stage IV or V were saved.These results indicate that primary chemotherapy does not improve the final outcome of stage IV or V retinoblastoma, as compared with primary irradiation.

The authors have reviewed a series of 80 patients treated at the Curie Institute before 1965 for bilateral retinoblastoma. They present their cases of second non-ocular tumours in these patients and discuss their results and the possible factors influencing the percentage of second tumours in these patients.

The authors have reviewed the results of radioactive plaques in recurrent retinoblastoma after external beam radiation in 34 eyes. They give their results on ocular conservation and on the visual outcome and compare these results with other series previously published. They think radioactive plaques are an alternative to enucleation in recurrent retinoblastoma after external beam.

In a retrospective study of 105 retinoblastoma cases, the authors studied the clinical symptoms, survival and ocular conservations. The results are much better in case of early diagnosis. They discuss the therapeutic modalities in their institute and elsewhere.