[Tests and imaging of the lymphatic system]. / Explorations et imagerie du système lymphatique.

Methods for lymphatic imaging are numerous and can be roughly classified as anatomic or functional studies. Direct or indirect lymphographies provide useful informations in case of lymphostasis. Contrast lymphangiography is the only anatomical method giving precise informations either on lymphatic ducts or lymph nodes. Nevertheless this invasive method is no more indicated in cases of limb edemas. Indirect lymphographies study the spontaneous lymphatic drainage of inert particles injected into the dermis. The blue dye test is the most simple and the oldest indirect lymphography used in the positive diagnosis of a lymphostasis. It has been replaced with the indirect radionuclide lymphography which give more reliable informations. Fluorescence microlymphoangiography is an atraumatic method which permits the visualization of skin lymphatics. Indirect lymphangiography with contrast medium give reliable informations on the status of the initial lymphatics and is the best imaging method to differentiate between lipedema and lymphedema. Indirect radionuclide lymphoscintigraphy is a safe, non invasive and physiological method for the assessment of the limb lymphatic system used for morphological studies and objective measurement of the peripheral lymphatic function necessary to assess the lymphatic variation under therapy (decongestive physiotherapy, surgery, drugs).

[The importance of lymphography in melanoma]. / Intérêt de la lymphographie dans les mélanomes.

It is a pity that, in view of its important prognostic value and for technical reasons, or because of problems of interpretation, lymphography should no longer be part of a routine work-up for diagnosing melanoma. Indeed, bipedal lymphography can accurately reveal the extent of node invasion in case of palpable adenopathy. It provides for the monitoring of the retroperitoneal lymph nodes after inguinal curettage has been accomplished. This method may reveal metastases at the subclinical stage. Axillary lymphography is especially valuable in case of palpable adenopathy. It has prognostic value in case of positive isotopic-clinical node involvement. Above all, however, it enables discarding the diagnosis of any secondary invasion, and preventing otherwise systematic axillary node curettage in 41% of cases. Lastly, if findings are normal, it affords a means for long-term follow-up.

[Lymphography of the upper limb in malignant melanoma]. / La lymphographie du membre supérieur dans les mélanomes malins.

Owing to its technical difficulty and to an imperfect knowledge of its semiology, lymphography of the upper limb is rarely used. However, experience makes it easy to perform and of considerable value and reliability for diagnostic purposes. Its main advantage in patients with palpable lymphadenopathy is that lymph node excision can be avoided in many cases provided the subjects are regularly followed up.

MOPP chemotherapy plus irradiation for Hodgkin's disease, stages IA to IIIB. Long-term results of the prospective trial H72 (1972-1976, 334 patients).

From April 1972 to December 1976, 334 patients with Hodgkin's disease, CS IA-IIIB, were prospectively treated with combined chemotherapy and radiation. The 166 stages IA and II2A were clinically staged only; the 168 other patients were randomized to clinical or pathological staging. All patients received 3 or 6 cycles of MOPP followed by Mantle field with or without mediastinal irradiation and/or inverted Y or lumbo-aortic field according to initial stage, presentation and protocol. At completion of therapy, 317 patients were in complete remission. Twenty-six patients relapsed and 43 died including 5 with leukemia and 6 with infection. Overall 12-year survival and relapse-free rates are 86.6 +/- 3.08 per cent and 91.5 +/- 3.2 per cent respectively (IA: 95.3 and 95.3 per cent; IIA: 87.8 and 92.1 per cent; IIIA: 83.3 and 100 per cent; IB, IIB: 81.7 and 89.2 per cent; IIIB: 67.8 and 73.7 per cent). The randomized comparison between clinical staging plus 6 cycles of MOPP and laparotomy staging plus 3 cycles of MOPP in final stage II3+A, IB, IIB patients showed no significant 12-year survival differences (90.8 versus 85.6 per cent). With this combined modality treatment policy, high survival rates are obtained using only 3 cycles of MOPP and radiotherapy in CS IA, II2A and in PS II3+, IB, IIB. Laparotomy staging may be unnecessary if 6 cycles of MOPP are employed before irradiation in CS IIA, IB, IIB disease and if 3 cycles of MOPP are followed by irradiation in CSIA and II2A disease. Mediastinal irradiation can be avoided in patients with supradiaphragmatic disease without mediastinal involvement.

Prognostic value of lymphograms in chronic lymphatic leukemia.

Chronic lymphatic leukemia (CLL) is a disease with a prognosis that has previously been difficult to assess. In recent years, this problem has largely been overcome by various classifications based on clinical and hematologic findings. This article presents the results of a study designed to show the value of lymphograms in assessing the prognosis. These results show that prognosis is associated with lymph node structure, as assessed by lymphography. Lymphography, as an investigation is superior to scanning or echography, since these give information merely on nodal size. It is proposed that lymphograms should be used for assessing the gravity of the disease and help in the choice of therapy.

Non-Hodgkin's lymphoma occurring after Hodgkin's disease. Four new cases and a review of the literature.

This article describes four cases of non-Hodgkin's lymphomas occurring after successful treatment of Hodgkin's disease (HD). The clinical symptoms consisted of digestive disorders, and the histology confirmed an intestinal involvement in these four patients. In all cases patients had diffuse large cell types (intermediate or high grade). The respective role of HD treatment (combination chemotherapy in 3 of 4 patients with irradiation in 3 of 4 patients) and of other pathogenic hypotheses, are discussed.

[The advantages of lymphography in malignant melanoma (author's transl)]. / Intérêt de la lymphographie dans les mélanomes malins.

The authors report the results of their observations on 27 cases of malignant melanoma having undergone lymphography. They insist on the absence of risk of this examination causing diffusion of the primary tumour and the advantages of lymphography in this particular cases: clinically palpable metastatic adenopathy and high risk malignant melanoma without palpable adenopathy.

[Therapeutic strategy in nonseminomatous cancer of the testis]. / Stratégie thérapeutique des cancers non séminomateux du testicule.

The prognosis of non-seminomatous carcinoma of the testis has been revolutionized by the introduction of chemotherapy for both advanced and localised forms of the disease. In the last 15 years, 41 cancers of this type (13 Stage I, 16 Stage II and 12 Stage III) have been treated in our Department. All Stage I cancers received postoperative chemotherapy comprising Velbé, Thiotepa, Rufocromomycine and Methotrexate and all are in remission with an average follow-up period of 8 years. Five Stage II had this protocol, the II others had 3 cycles of PVB (a pulmonary recurrence in one case was treated with 3 further cycles of PVB +/- Adriamycin) and curative surgery. This survival is 100 p. 100 with a follow-up ranging from I to II years. Six patients had post-chemotherapy surgery which was always negative. The combination used in Stage I was also used in 8 Stage III patients; there were 7 failures despite falling back on PVB in 4 cases; the 8th case in still is remission after years' follow-up. The PVB protocol was used recently in 4 other cases with 2 complete remissions, one death in remission during thoracotomy (shocking) and one death from aplasia after the first cycle. This gives a 24 p. 100 5 year survival but only a third of Stage III patients had PVB from the outset. A review of the literature and our own experience suggest that curage and chemotherapy are no longer indicated in Stage I; curage is only proposed after 3 cycles of PVB in Stage II cases with a poor prognosis; 4 to 6 cycles of PVB are recommended in Stage III with secondary surgery if indicated. Maintenance therapy does not seem to be necessary.