Dural sinus thrombosis in children with cancer

Dural sinus thrombosis (DST) has been reported in association with cancer in both adults and children. We describe the seven patients seen with this complication in our centre between 1981 and 1995. Diagnosis was confirmed by either cerebral CT scanning, MRI or angiography. Median age was 13 years (range 8-15). Six patients were boys. Six children were being treated for non-Hodgkin lymphoma and one for neuroblastoma. Presenting symptoms were seizures and transient neurologic deficit, often preceded by headaches. The probable cause of DST was found in two cases. Tumour localisation in the central nervous system (CNS) probably caused DST in one patient who was treated for ki 1 lymphoma. Dehydration in combination with a poor general condition seemed to be the cause of DST in the patient with neuroblastoma. In five children with stage III or IV non-Hodgkin lymphoma (three lymphoblastic lymphoma; two Burkitt's lymphoma), etiology remained unknown. In these children, DST occurred early in the course of therapy. The median interval between start of chemotherapy and onset of symptoms was 19 days (range 8-40). No child had received L-asparaginase. Prognosis was favourable, with symptoms completely disappearing without therapy within 1 to 5 days. The incidence of DST in patients with advanced stage non-Hodgkin lymphoma during induction and consolidation was calculated to be below 3%. We conclude that DST is rarely diagnosed in children with cancer. Occurrence during the initial phase of therapy for non-Hodgkin lymphoma is associated with a benign prognosis.     

Treatment of intracranial ependymomas of children: review of a 15-year experience

PURPOSE: There are still major controversies in the optimal management of children with intracranial ependymomas. To assess the impact of tumor site, histology, and treatment, the outcome of children treated at the Institut Gustave Roussy was reviewed retrospectively. METHODS AND MATERIALS: Between 1975 and 1989, 80 children aged 4 months to 15.8 years were seen at the Institut Gustave Roussy for postoperative management of an intracranial ependymoma. Location of tumor was infratentorial in 63 cases and supratentorial in 17. Surgical treatment consisted of complete resection in 38, incomplete resection in 38 and biopsy only in 4. Postoperative irradiation was done in 65 patients and chemotherapy in 33. Surviving patients have been followed from 12-197 months with a median of 54 months. RESULTS: The 5-year actuarial survival and event-free survival are 56% and 38%, respectively. Thirty-four patients relapsed from 3-72 months after diagnosis (median 25 months). In 20 patients, the only site of failure was the original tumor site. Three patients failed locally and at distance, while 10 others failed only at distance. Survival at 5 years was significantly better for patients who had complete resection of the tumor (75% vs. 41%, p = 0.001) and for those who received radiation therapy (63% vs. 23%, p = 0.003). Event-free survival at 5 years was superior in patients with complete resection of the tumor (51% vs. 26%, p = 0.002) and in patients who received radiation therapy (45% vs. 0%, p < 0.001). Sex and tumor site had no impact on survival or event-free survival. There was no difference in survival, event-free survival, or pattern of failure between patients treated with local field, whole brain or craniospinal irradiation, while severe longterm sequelae were noted predominantly in the latter two groups. CONCLUSION: Considering that failures were predominantly local and that there was no apparent benefit from prophylactic irradiation, we recommend local field irradiation with doses above 50.0 Gy for all children with intracranial ependymomas, without meningeal dissemination at diagnosis. Special considerations are necessary for children < 3 years of age.     

Fibrodysplasia ossificans progressiva and synovial chondromatosis

Central nervous system vasculitis in Crohn's disease. A 36-years old man was referred to the hospital because of severe headache, vertigo and right sided combined motor-sensory hemiparesis. There was a history of Crohn's disease with an acute exacerbation only two months ago. Magnetic resonance imaging detected a vascular lesion of the left brainstem and serologic investigations revealed circulating immunocomplexes and p-antineutrophil cytoplasmic autoantibodies (p-ANCA). Further investigations care no evidence of arteriosclerotic cerebrovascular disease. These findings therefore suggest that cerebral vasculitis secondary to Crohn's disease was the underlying cause of this focal neurologic deficit.     

Reconstruction of the long bones of the legs in children via free vascularized transplant of the fibula after resection for sarcoma

Nineteen children were operated on between 1985 and 1994. All the patients presented a sarcoma of long bones: osteosarcoma: 12 and Ewing's sarcoma: 7. They were operated on: resection and reconstruction of the long bones with a free vascularised fibula. Pre and post-operative chemotherapy was used. The average follow-up was 3 years (between 10 years and 1 year). The mean bone defect was 20 cm (between 32 and 11 cm). Boys were more frequently encountered [12]. Average age was 9.5 years. The pathological bone was: femur: 14, tibia: 4, humerus 1. The approach needs usually two incisions for femoral bone: the internal incision allows us to prepare the recipient vessels: deep femoral vessels in 11 cases. In 18 cases, union occurred in less than 14 months. One case of pseudarthrosis occurred. Immediate follow-up was simple in 17 cases. Infection was observed in 2 cases. Secondly, the most frequent complications were: fracture of the fibula: 6 cases, vicious cal: 2 cases; delayed union: 6 cases; stiffness: 2 cases. One patient died later from pulmonary metastasis. Solid osteosynthesis of the member and of the free vascularised fibula permit to shorten these delays. Success depends on two criteria: the graft thickening of the fibula and union of the fibula at both ends. The micro vascular anastomoses must be excellent. Twelve children had bone union with only one operation. In the 6 cases of delayed union, secondary bone grafts give consolidation. The comparison of this technique with standard treatment showed an evident superiority of the free vascularised fibula transplant in extensive defects of bone. The fibula is a life bone which permits rapid union with a short hospitalization, a quick recovery and an early return to school. Free vascularised fibula permit to ameliorate the quality of survival.     

Crseharacterization of land surface thermal structure from NOAA-AVHRR data over a northern ecosystem

This paper focuses on the estimation and analysis of surface thermal parameters (emissivities and surface temperatures) in a nordic environment (Québec, Canada). The land cover in this region varies from boreal forest in the south to tundra in the north. The thermal parameters are estimated from two variants of a new model that combines the radiances of the short wave infrared (SWIR) spectral band [advanced very high resolution radiometer (AVHRR) channel 3: 3.55–3.93 μm] and the thermal bands (AVHRR channel 4: 10.5–11.5 μm; and AVHRR channel 5: 11.5–12.5 μm). The study, carried out for images acquired on different dates, reveals that, in most situations, the two approaches allow the separation of emissivities and surface temperatures. Analysis of the variations of the estimated emissivities in relation to surface patterns shows that they are slightly variable in spectral bands 4, and 5, with values generally greater than 0.95. Variations are more important in the SWIR channel, where values less than 0.90 appear, especially in urban areas. In general, surface emissivities increase with the density of the vegetation cover. Moreover, for densely vegetated areas, SWIR surface reflectivities, which can be derived from emissivities, appear to be well correlated with the reflectivities of the AVHRR visible channel. As with emissivities, variations of the estimated land surface temperatures (LST) in relation to vegetation density, characterized by the normalized difference vegetation index (NDVI), were considered. The relations between the two parameters (LST and NDVI) show essentially two opposite directions of linear variations (positive and negative correlations). In the light of the main results obtained, the synergistic use of the different spectral regions (visible, near, mid-, and thermal infrareds) could be very useful in the parameterization of boreal ecosystems.     

Ischio-vertebral dysplasia: a distinct entity

A total of 20 isolates of Blastocystis were characterized using a single set of polymerase chain reaction (PCR) primers. The amplification product revealed five types of pattern. All four isolates from Singapore yielded PCR products quite different from those of the local isolates. However, most of the local isolates showed a major product at either 280 or 500 bp, or both. We also suspected that the amplification product detected at 280 bp might be an indicator of the pathogenicity of this parasite. One isolate (M12) obtained from a monkey showed patterns similar to those of human isolates (10203 and KP1) and probably belongs to the same strain. The results indicate that the intraspecific or interstrain variations in these 20 Blastocystis isolates belong to 5 different patterns. The differences among isolates of the same strain revealed by the presence or absence of certain amplification products showed further intrastrain variations in this parasite.     

"Cirrhotic's lund". A new radiological entity? 182 CASES (AUTHOR'S TRANSL)

The authors studied the chest X-rays of 182 patients with alcoholic cirrhosis. They eliminated the abnormal films of patients with severe clinical or biological changes. After double reading, they isolated ten cases in which chest X-ray revealed changes in the pulmonary interstitium. The question as to the nature of this interstitial pneumopathy is posed.