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In a retrospective analysis of 203 patients with non-Hodgkin lymphoma (NHL) treated between 1975 and 1985, the relationship between pathology, clinical presentation and course, was studied, using the Kiel classification. This classification was a much better predictor of prognosis than clinical stage and within the different pathology groups there was no significant difference between the stages concerning the survival rate. In the group with low grade malignancy this latter was positively associated with nodular architecture, bone marrow involvement and complete or partial response to therapy. In the high grade group, the survival was positively correlated to complete remission, but no plateau was seen in the survival curve. All extranodal sites had poor survival. For both grades, age (>60 years), systemic symptoms and biologic signs (Ann Arbor 'B' and 'b') were unfavorable prognostic factors.

A recent study (N. Eng. J. Med. 315 (1986), 1369), described a method of detecting malignant tumors by water-suppressed proton nuclear magnetic resonance (1 H NMR) study of plasma. We performed a similar study of the W 1/2, a mean of the full width at half height of the resonances of the methyl and methylene groups of the lipids of plasma lipoproteins which is inversely related to the spin-spin apparent relaxation time (T 2*). W 1/2 values were measured at a fixed baseline width of 310 Hz. The study was prospective and blinded and comprised 182 subjects consisting of 40 controls, 68 patients with untreated malignancies, 45 with malignant tumors undergoing therapy and 29 benign tumor patients. No differences were seen between any groups that could serve as a basis for a useful clinical test. The major difficulty in the determination of W 1/2 was due to interference of metabolite protons (particularly lactate) within the lipoprotein resonance signal. Triglyceride level was seen to correlate inversely with W 1/2 within malignant patient groups. These discrepant results may be related to differing triglyceride-rich very low density lipoprotein (VLDL) levels in the patient populations of each study. We conclude that the water-suppressed 1H NMR of plasma lipoproteins is not a valid measurement for assessing malignancy.

The authors report a case of laryngeal chemo-dectoma in a 53-year-old man who died from general dissemination with lymphatic and subcutaneous metastases. This functional neoplasm secreted calcitonin revealed by fluorescence and biochemical tests and perhaps adrenaline-like substances. Its cells looked like the light chief cells of the human carotid body; they contained secretory granules and lysosomal formations. Thirty similar cases had been previously reported. The superior laryngeal glomi and more occasionally the inferior ones were the seat of the these tumours which occurred with an equal frequency in both sexes. A hoarseness was often the unique symptom noticed during the several months or years preceding the first examination of this slow growing neoplasm. Nevertheless among the chemodectomas of the head and the neck region those arising in the larynx had the highest incidence of malignant evolution. Five of the patients presented a general dissemination, two had lymphatic metastases and one a local recurrence. The ultra-structural features and sometimes the rarely detected functional activity of these chemodectomas are those of apudomas whose cells might originate from the cephalic portion of the neural crests.RésuméLes auteurs rapportent un cas de chémodectome laryngé chez un homme de 53 ans décédé dans un tableau de dissémination générale avec métastases ganglionnaires lymphatiques et sous-cutanées. Ce néoplasme fonctionnel secrètait un taux élevé de calcitonine ainsi qu'en témoignent les dosages biochimiques et lˆétude en immunofluorescence. II élaborait aussi, semble-t-il, des substances proches de lˆadrénaline. Ses cellules qui ressemblaient aux cellules principales du glomus carotidien humain contenaient des grains de type neurosecrètoire et des formations lysosomiales. Trente cas semblables ont déjà été rapportés. Les glomi laryngés supérieurs et plus accessoirement les glomi inférieurs sont le siège de ces tumeurs qui surviennent avec une égale fréquence dans les deux sexes. Un enrouement est souvent le seul symptôme signalé pendant les mois voire les années précédant le premier examen de cette tumeur à croissance lente. Néanmoins, les chémodectomes laryngés se differencient des autres chémodectomes de la tete et du cou par un plus mauvais pronostic. Cinq des malades sont décédés dans un tableau de dissémination métastatique, deux étaient porteurs de métastases ganglionnaires lymphatiques et un autre a présenté une récidive locale. Les caractères ultrastructuraux et par-fois lˆactivité fonctionnelle incontestable de ces chémodectomes sont ceux dˆapudomes dont les cellules dériveraient dˆéléments ayant migré de la portion céphalique des cretes neurales jusqu'au larynx.ZusammenfassungDie Autoren berichten über einen Fall von Chemodectomus laryngum bei einem 53jährigen Mann, Gestorben mit generaler Dissemination sowohl wie mit lymphatischen und unterepidermischen Metastasen. Dieser funktionierende Neoplasmus produzierte groβe Mengen von Calcitonin, bestimmt durch biochemische Untersuchungen und bei Immunofluoreszens. Vielleicht produzierte er auch adrenalinähnliche Substanzen. Seine Zellen, die den Hauptzellen des Glomus caroticum glichen, waren mit neurosekretorischen Körnern und Lysosomen gefüllt. Dreißig gleiche Falle sind schon beschrieben worden. Diese Tumoren, die in beiden Geschlechtern vorkommen, sind in dem oberen Glomus laryngum und seltener in dem niederen anzutreffen. Heiserkeit ist gewöhnlich während Monate, sogar Jahre, das einzige Symptom dieser langsamwachsenden Tumoren. Jedoch unterscheiden sich die laryngischen Chemo-dectome von den anderen Kopf- oder Hals-Chemodecto-men bei einer schlechteren Prognose. Fünf Patienten sind mit einem Bild von metastatischer Dissemination gestorben, zwei trugen Lymphknotenmetastasen und ein Patient hatte lokales Rezidiv. Die Ultrastruktur sowie die zweifellose funktionale Aktivität dieser Chemodec-tome gleichen den Apudomen, in welchen die Zellen wahrscheinlich von der cephalischen Neuralleiste abstammen.

5-FV therapeutic monitoring was performed, in 26 patients with localized or disseminated epidermoïd tumour of various origin, during 64 chemotherapy cycles containing 5-FV 1000mg/m2in continuous infusion (J1–J5) and CDDP (100mg/m2J1 or 20mg/m2/j J1–J5). Blood samples were collected daily (8 a.m., 4 p.m.). 5-FV HPLC analysis used the method of Christophidis. Dose reduction of 5-FV was programmed according to the method of R. Fety using the J1–J2 and the J1–J5 5-FV area under the curve (AUC). An average of 2 cycles was administered.During the 1st cycle: J1–J2 5-FV AUC averaged 15751 μg 1−1h−1± 12309 (3902–56620) confirming the great interpatient variability. In 4 patients J1–J2 5-FV AUC 20000 μg 1−1h−1obliged to cancel chemotherapy at β. J1–J5 5-FV AUC averaged 46161 μg 1−1h−1±20020 (18380–90200). We observed a 5-FV accumulation process, characterised by an increase of daily 5-FV AUC in 18 patients. 5-FV dose reduction was scheduled in 27 cases and necessitated a further decrease during the chemotherapy cycle in 9 cases. 5-FV monitoring allowed a reduction in the toxicity which were less frequent for the cycles with J1–J2 5-FV AUC<20000μg 1−1h−1or J1–J5 5-FV AUC <30000μg 1−1h−1. Fourteen objective responses were obtained with 2 complete responses. J1–J5 5-FV AUC did not differ between responders and non responders.These time consuming techniques must find their role during more prolonged chemotherapy.