The authors report a case of acute myeloid leukemia in a thirty-four-year-old man who had been under lithium carbonate for the last six months for manic-depressive psychosis. One year after treatment with cytosine-arabinoside, 6-thioguanine and daunorubicin, the patient is still in complete remission. In the medical literature we found seven additional reports of acute or chronic myeloid leukemia after lithium therapy. Lithium was found to enhance granulopoiesis. Our findings suggest that lithium may initiate or promote leukemia.

Eleven infants were treated at the Institut Gustave-Roussy between 1967 and 1980 for a yolk sac tumor localized to vagina. All the children had high serum alpha-foetoprotein levels. The average age was 10 months and the first symptoms were vaginal hemorrhages. The volume of the tumor and tumoral extension, as well as the biopsy, were appreciated by vaginal examination under general anesthesia. Treatment fluctuated during these years; 7/11 children were cured and since 1977, 6/8 (average follow-up 3 1/2 years) with the following therapeutic schedule: primary chemotherapy reducing the tumoral volume, and either partial colpectomy or curietherapy or both. So, these 6 girls were cured with a conservative treatment, preserving uterus and vagina. Two of them had moderate sequelae due to curietherapy.

A new subcutaneous flap technic, derived from the chinese forearm flap has been demonstrated. It has been used to cover large cutaneous defects of the hand, especially when the extensor tendons were exposed. An excellent functional repair has been obtained in a single procedure avoiding large scar formation usually seen on the forearm after classical chinese fasciocutaneous flap.

From 1975 to 1979, 173 children with neuroblastoma were treated according to the same protocol at the Institut Gustave-Roussy. They were classified according to the site of the primary tumor (abdominal: 122; thoracic: 29; others: 22) and according to TNM staging (stage I: 8; stage II: 24; stage III: 35; stage IV: 99; stage V: 2). Depending on stage and age, treatment consisted of surgery and radiotherapy associated with cyclic multiagent chemotherapy (vincristine, Adriamycin, cyclophosphamide). It resulted in a significant improvement of prognosis in stage III patients, especially those with abdominal tumors. In the latter group, prognosis depended mainly on the possibilities of resection of the tumors. Therefore, making these tumors operable remains the major goal of therapy in such patients. Radiotherapy is quite efficient in sterilizing the small post-surgical residual tumors. Prognosis in children over 1 year of age with metastases still remains very poor, even though the quality of the survival is improved.

Two cases of Burkitt's tumor treated in the Pediatric Hospital, Owendo, Libreville are discussed. The tumors were of the maxillofacial type, and remission by chemotherapy was obtained for a period of between 6 to 8 months. After this length of time, and in spite of spectacular local results, metastases developed and led to a fatal outcome. Cyclophosphamide chemotherapy is effective locally, but does not prevent recurrence.

The authors report protocols and results observed with various palliative chemotherapy, used successively against epidermoid carcinomas of head and neck area. This study was followed up during the last ten years by a group of physicians working in 8 specialized oncological centers. The poor prognosis and efficiency of antimitotic drugs in head and neck carcinomas require analyse of a great number of patients files. The cooperative work of several teams allows for more rapidly significant results. Each protocol was closed after a two year period. The protocols were dropped one after another, in order to provide a greater efficiency and a lower toxicity. It was possible to confirm the limited efficiency of "heavy" protocols and the most useful association. The members of this group now pursue a randomised study comparing the results obtained with cis-platyl used alone or in addition to three other drugs. The aim of this study is to assess which is more efficient and less toxic.

Published reports have shown that there is an increased incidence of second malignancies, particularly sarcomas, following high dose radiotherapy in cancer treatment. However, this increased risk is very small and is relatively negligible when one considers the beneficial effects of radiotherapy in cancer treatment. This incidence of radiation induced cancer appears to be higher in certain groups of patients, such as children and patients with Hodgkin's disease. In view of scarcity of published data, controlled surveys remain necessary for the quantitative assessment of the cancer risk in various sub-groups of irradiated patients.

Peripheral lymphocyte chromosomes were analyzed in 55 consecutive patients with complete remission after treatment for Hodgkin's disease. In 8 patients, observed metaphases were too few in number. The other 47 patients, 29 men and 18 women, had been off all therapy for 53 months (median 41, ext. 1 to 250 months). The mean interval since the diagnosis was 78 months (median: 73 months) and the mean age at the time of chromosome analysis was 38 years (median: 34, ext. 10-78 years). No patient had either a preleukemic syndrome or leukemia. In contrast to karyotypes in normal controls and previously untreated patients, abnormal cells, hypodiploid, hyperdiploid and tetradiploid cells were more frequent. But neither monosomy 5 or 7 nor trisomy 8 were observed. Intrachromosomal rearrangements (gaps, breaks...) were significantly more frequent (12% vs 5% in untreated patients) particularly on chromosomes 1 and 2. Interchromosomal rearrangements were also numerous (1,25%) but no cells showed any specific translocation for malignant hemopathy. Chromosomal aberrations do not seem closely associated with treatments but influenced by the post-diagnosis interval and the factors present at the time of primary treatment.

In past years, health authorities have exempted anti-neoplastic agents from undergoing carcinogenesis tests. However, in view of increasing knowledge of this therapeutic family and of patients' increased life expectancy, toxicologists are having to reconsider the problem from both ethical and scientific points of view. Analysis of data has established a correlation between mutagenic activity of these molecules, carcinogenic activity in the animal and carcinogenic activity in man. For this reason, studies in laboratory animals are of interest at the present time. Assessment of the carcinogenic activity of anti-neoplastic agents in animals must take into account the chemical structure of the drug. The experiments to be carried out are: either in vitro, short term tests aimed to detect genotoxic drugs by mutagenesis tests, or limited in vivo tests, in order to determine the promoting or initiating character of these drugs. However, the obtention of negative results with the latter tests does not exclude the necessity of long term tests. Whatever the results obtained during these experiments, the decision to stop or to continue the development of an anti-neoplastic agent does not belong exclusively to the toxicologist, who can assess the risk, but not the potential benefice.

In a retrospective study of 1 094 patients treated for Hodgkin's disease between 1963 and 1976, we have observed 65 malignant complications including 28 granulosis acute leukemias and 37 solid tumors. The actuarial 10 year risk of developing acute leukemia is 4.7 per cent; and 5.4 per cent for solid tumors. These figures vary according to the medications received. They are more important in the case of polychemotherapy, particularly for acute leukemia, thus confirming the specific role of alkyl agents. While the course of solid tumors does not seem to differ from that of identical primitive tumors; on the other hand, induced leukemia seems to have a more perjorative prognosis than spontaneous leukemia and they are often announced by cytopenia. The overall risk of developing secondary cancer is multiplied by 2.4 compared to the normal population; that of developing acute leukemia is multiplied by 9.3. In order to reduce this risk, active non alkyl agents of limited duration must be advocated. Irradiation fields must also be reduced.

We report the second case of Hodgkin's disease associated with thrombotic thrombocytopenic purpura (TTP). Although the two diseases coexisted originally, TTP was diagnosed alone at first. Because of the very rare occurrence of this association the diagnosis of TTP is discussed according to the accepted criteria and taking into account the haematological complications which can reveal or be observed in Hodgkin's disease. No evident relationship between the two diseases can be suggested. But immunologic disorders observed in the two cases suggests that their coexistence is not necessarily accidental. The evolution of these two diseases is particularly good.

Sixty patients treated for Hodgkin's disease by radio + chemotherapy and remaining in complete remission with a median follow-up of 26 months answered a questionnaire dealing with their quality of life during and after treatment. Their main request was to be better informed about their disease, treatment and its side effects. Therapeutic toxicity is mainly due to chemotherapy and is digestive in nature (nausea and vomiting) symptoms. The majority of patients complained of disturbances in their personal and professional lives. It is concluded that more complete knowledge of all patients' disorders may help doctors to improve treatment planning in order that the patient's quality of life be less disturbed.

It is reported the first observation of cardiogenic shock without delay, in a leukemic patient during a first injection of Rubidazone (22050 RP) which is recognized so far, as one of the least cardiotoxic anthracyclines. It has been concluded: --anthracyclines, beside the risk of a progressive cardiomyopathy which is related to the dose and very well known, can induce immediate cardiac injuries, which cannot be predicted yet; --the perfect myocardial protector is still to be discovered; --in this case, beta-adrenergic stimulators appeared to be able to control the cardiotoxic effect of Rubidazone; --the last fact could be considered in the decision to maintain the treatment when such an injury occurs during a chemotherapy or when it seems absolutely necessary to use such a drug.

A 62 year old patient with CLL treated by alkylating drugs for more than three years, underwent acute leukaemia (AL). The clinical particularities of the onset and course of this AL, the cytological, cytoenzymological and ultrastructural characteristics of the blasts are discussed in order to find a relation between the two hemopathies. A possible drug-induced etiology of this AL is proposed.

Five cases are reported of embryonal carcinoma with a vitelline structure more or less predominating. The presentation was of an anterior mediastinal tumour occurring in young men and in three cases there was mediastinal obstruction. The clinical examination, in particular testicular examination, was negative. In each case the level of the alpha-fetoprotein was greater than 1,000 micrograms/l, even post-operatively. The alpha-fetoprotein and HCG-beta should be measured systematically in all cases of anterior mediastinal tumour occurring in young subjects, and would enable a more frequent identification of tumours with difficult histology. The serum levels reflected the changes noted clinically and radiologically. Polychemotherapy bases around cis platinum led to a significant but transitory regression of the tumours. Radiotherapy was ineffective. Surgery was never totally curative.