Patients with lymphoma frequently develop neurologic abnormalities mainly due to nervous system infiltration but also direct drug toxicity. Moreover Guillain-Barré syndrome (GBS) remains a possible neuropathy, rarely described in non-Hodgkin's lymphoma. We describe a case of GBS in a patient with non-Hodgkin's high grade lymphoma. A 74-year old man with a newly diagnosed stage I high-grade lymphoma (precursor B-cell Burkitt like type according to the R.E.A.L. Classification) develop flaccid quadriparesis, 7 days after the end of the third course of CHOP treatment. The clinical course and neurological examination were consistent with GBS. The patient was in tumoral complete response. Despite appropriate treatment and a transfer in a reanimation unit, the patient died 3 days after the beginning of neurologic symptoms. The low number of cases described in the international literature doesn't permit to understand the association of this neurologic disease with non-Hodgkin's lymphoma. Collecting more data could lead interesting information to know the place of malignant hematological disease in the natural history of GBS.

Medical images are of great importance in radiotherapy, which became a privileged application field for image processing techniques. Moreover, because of the progression of the computers' performances, these techniques are also in full expansion. Today, the recent developments of the radiotherapy (3DCR, IMRT) offer a huge place to them. Effectively, they can potentially answer to the precision requirements of the modern radiotherapy, and may then contribute to improve the delivered treatments. The purpose of this article is to present the different image processing techniques that are currently used in radiotherapy (including image matching and segmentation) as they are described in the literature.

La radiothérapie est un domaine privilégié d’application des techniques de traitement des images de par l’utilisation importante de données issues de l’imagerie. Celles-ci sont de plus en pleine expansion du fait de la progression des performances informatiques. Actuellement, les développements récents de la radiothérapie (radiothérapie de conformation, radiothérapie conformationnelle avec modulation d’intensité) procurent une place majeure à ces techniques. En effet, elles contribuent à répondre aux conditions de précision exigées par la radiothérapie moderne et permettent d’envisager d’améliorer les traitements. L’objectif de cet article est de présenter les différentes techniques du traitement d’image utilisées aujourd’hui en radiothérapie (segmentation et recalage en particulier) au travers de la littérature.

Systemic metastases from ovarian carcinoma are frequent, but they seldom affect the central nervous system. We present here the case of a patient treated for an ovarian cancer by surgery and chemotherapy. Three months after the end of chemotherapy, the patient developed cerebral metastases from ovarian carcinoma (CMOC) treated by iterative surgery and and whole brain irradiation. As the frequency of solitary cerebral metastasis of ovarian cancer is higher than with other cancers, it is likely that they behave slightly differently. Literature analysis reveals an increase in the incidence of CMOC since the middle of the nineties. CMOC can occur during or after adjuvant chemotherapy and the best management strategies to better define determinants of survival for patients are not well known. It appears that a better outcome of CMOC may be obtained by an aggressive treatment, if possible, including surgery, radiotherapy, and chemotherapy. Taking into account the increase in the incidence of the CMOC and their early occurrence, some authors have proposed a prophylactic brain radiotherapy in patients who receive adjuvant chemotherapy.

Les métastases systémiques des cancers de l'ovaire sont fréquentes, mais elles atteignent rarement le système nerveux. Nous présentons ici le cas d’une patiente traitée pour un cancer de l’ovaire par l’association d’une chirurgie et d’une chimiothérapie. Trois mois après la fin de la chimiothérapie, des métastases cérébrales ont été mises en évidence : elles ont été traitées par chirurgie itérative et irradiation panencéphalique. Comme la fréquence des métastases cérébrales solitaires des cancers de l’ovaire est plus importante que dans d’autres cancers, il est probable qu’elles se comportent légèrement différemment. L’analyse des données de la littérature montre une augmentation de l’incidence des métastases cérébrales depuis le milieu des années 1990. Les métastases cérébrales des cancers de l’ovaire peuvent survenir pendant ou après la chimiothérapie adjuvante et la meilleure stratégie afin de définir les déterminants de la survie n’est pas bien connue. Le traitement agressif par chirurgie, lorsqu’il est possible, associé à la radiothérapie, peut être proposé en présence d’une à trois métastases cérébrales. Le traitement multimodal, lorsqu’il est possible, permet d’augmenter la durée de survie et d’améliorer le performance status. Compte tenu de l’augmentation de l’incidence des métastases cérébrales des cancers de l’ovaire et de leur apparition possible pendant ou au décours d’une chimiothérapie, certains auteurs ont proposé un traitement prophylactique cérébral par irradiation chez les patientes qui reçoivent une chimiothérapie adjuvante.

Introduction. - Multifocal osteonecrosis has a wide variety of etiologies, but in the cancer patient several risk factors could have a synergic effect (chemotherapy, radiotherapy, corticosteroid, metabolism disorder).Exegesis. - A patient with testicular seminoma receiving cisplatin-based chemotherapy and short-term corticosteroid developed multifocal osteonecrosis. Early diagnosis of osteonecrosis is important to prevent orthopedic complications.Conclusion. - Cisplatin could represent one of the possible etiologies of multifocal osteonecrosis, Magnetic resonance imaging has a high sensitivity and specificity in the diagnosis of osteonecrosis and should be used when this condition is suspected. (C) 2001 Editions scientifiques et medicales Elsevier SAS.

Wasting is a major complication of advanced head and neck cancer and the aim of this study was to compare nasogastric tube feeding (NG) and percutaneous fluoroscopic gastrostomy (PFG) in these patients. The goal of these two methods of nutritional support was to improve or maintain the initial nutritional status during treatment. A total of 90 patients, all stage IV oropharynx or hypopharynx tumor, were reviewed from a prospective databank. All these patients were treated by concomitant chemotherapy and twice-daily continuous radiotherapy with no acceleration. Fifty patients were managed by PFG, and the rest by NG. Mechanical failure, duration of feeding, complications, nutritonal evaluation and quality of life were analysed. Mechanical failure occurred in 32 of the 40 NG patients and in seven of the gastrostomy group. In the PFG group, 80% of patients conserved their nutritional support after the end of the radiotherapy, none patient in the NG group. In the PFG group, two presented a wound infection and six had aspiration pneumonia while in the NG group, 21 had aspiration pneumonia probably due to the NG tube (gastroesophageal reflux). The feeding methods were found to be equally effective at maintaining body weight and body mass index at time 1 (3 weeks) and at time 2 (6 weeks). Advantages were associated with PFG cosmesis, mobility and quality of life. PFG is a safe and effective method of providing enteral nutrition during treatment to patients with advanced head and neck cancer and offers important advantages over NG.

INTRODUCTION:Multifocal osteonecrosis has a wide variety of etiologies, but in the cancer patient several risk factors could have a synergic effect (chemotherapy, radiotherapy, corticosteroid, metabolism disorder).EXEGESIS:A patient with testicular seminoma receiving cisplatin-based chemotherapy and short-term corticosteroid developed multifocal osteonecrosis. Early diagnosis of osteonecrosis is important to prevent orthopedic complications.CONCLUSION:Cisplatin could represent one of the possible etiologies of multifocal osteonecrosis. Magnetic resonance imaging has a high sensitivity and specificity in the diagnosis of osteonecrosis and should be used when this condition is suspected.

Cervical sonography was performed in a 25-year-old man who was referred to our department because of the recent appearance of a left anterolateral cervical mass. This mass had the sonographic properties of air; it communicated with and extended the piriform sinus as well as deformed the left lamina of the thyroid cartilage. A preliminary diagosis of left pharyngocele was confirmed by CT. To our knowledge, this is the first sonographic description of such an abnormality. (C) 2000 John Wiley & Sons, Inc.