Radiation induced malignant peripheral nerve sheath tumour of the second cervical nerve.

We report a 44-year-old with progressive quadriparesis due to a dumbbell malignant peripheral nerve sheath tumour (MPNST) of the second cervical nerve, 17 years after whole brain radiotherapy for a pineal germinoma. To our knowledge this is the first case of radiation induced high cervical MPNST arising from a benign neurofibroma.

[Dropped Head Syndrome after whiplash injury in a patient treated for a Hodgkin's lymphoma by mantle field radiotherapy]. / Syndrome de la tête tombante après traumatisme cervical dans le cadre d'un lymphome de Hodgkin irradié en mantelet.

The authors report a case of Dropped Head Syndrome with an unusually rapid onset after an accident in a patient with a history of Hodgkin's lymphoma cured by chemotherapy and mantle field radiotherapy and compare this case to the rare published cases of chronic Dropped Head Syndrome occurring after this type of treatment. A 56-year-old man was treated at the age 36 years for supra-diaphragmatic Hodgkin's lymphoma by chemotherapy and mantle field radiotherapy according to a standard technique and standard doses (40Gy, 20 fractions, 27 days). Seventeen years after the end of treatment, he experienced a violent whiplash injury, rapidly followed by a Dropped Head Syndrome, similar to the cases of chronic Dropped Head Syndrome already described in the context of Hodgkin's lymphoma (permanent flexion of the head, only reduced in the supine position). Physical and neurophysiological examination, electromyogram, and magnetic resonance imaging confirmed the diagnosis of Dropped Head Syndrome. Very few treatment options are available for the major disability related to Dropped Head Syndrome. This type of subacute onset of Dropped Head Syndrome has not been previously described. The good results of radiation therapy after chemotherapy allow a dose reduction to 30Gy in the involved regions. This, together with recent progress in treatment planning, should allow eradication of these complications.

Radiofrecuencia en la cefalea cervicogénica. Experoencia clínica / No disponible

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The effect of cervical X-irradiation on activity index of thyrocytes and plasma TSH: a pre-clinical model for radiation-induced thyroid damage.

Because radiotherapy in the head and neck region is necessary in the treatment of childhood cancer, possibilities to prevent damage to the thyroid gland must be explored. We developed a model in which radiation-induced effects can be investigated in a way that these effects can be quantified, using thyroid dysmorphology and plasma TSH. Thirty-five Wistar rats, 5 weeks old, were X-irradiated on the cervical region, with a single dose varying from 0 to 20 Gy. After 6 weeks, TSH, T4 and T3 were determined, and thyroid glands were processed for histological examination by two independent pathologists. A histological classification scale was developed, using follicular size, colloid density and cell height of thyrocytes to measure hyperplasia and hypertrophy. By the sum of these scores, a cell-activity index was calculated, which was related to plasma TSH concentration. Numbers of PAS-positive droplets and epithelial desquamation were also counted. Inter-observer reliability was assessed. Good to very good reliability was found for scores of follicular size, colloid density and cell height. Significant increase of cell-activity index was found after 10, 15 and 20 Gy. The plasma TSH concentration was positively correlated to the cell-activity index, increasing with radiation-doses up to 15 Gy. The number of desquamated cells was significantly increased after radiation doses >10 Gy, with moderate reliability. In conclusion, this model using cell-activity index of thyrocytes together with plasma thyrotropin concentrations and desquamation of cells can be used for interpretation and future (pre-clinical) studies of prevention of radiation-induced thyroid damage.

[The question of radiation exposure of the cervical spine in analgesic roentgen irradiation of therapy-resistant humero-scapular periarthritis associated with local cervical syndrome and/or cervicobrachial syndrome]. / Zur Frage der Mitbestrahlung der Halswirbelsäule bei der Röntgen-Schmerzbestrahlung der therapieresistenten Periarthritis humeroscapularis mit lokalem Zervikalsyndrom und/oder Zervikobrachialsyndrom.

An improvement is achieved by palliative X-ray irradiation in about 70% out of 47 patients with scapulohumeral periarthritis and local cervical syndrome and/or cervicobrachial syndrome which was hitherto resistant to medicomechanical treatment. Higher rates of success (84%) can be achieved if the patients present an identical symptomatology, but less severe alterations of the vertebral column, even if the vertebral column is not irradiated. In case of severe alterations of the vertebral column, the success of palliative irradiation is diminished, even if the cervical vertebral column is additionally irradiated.

[Late paralyses of peripheral nerves after radiotherapy]. / Spätparesen peripherer Nerven nach Strahlentherapie.

On the basis of eleven observations in 10 patients carried out by the authors-nine cases of paresis of the brachial plexus, one case of paresis of the accessory nerve and one of femoral nerve--the problems of late paresis due to the irradiation of peripheral nerves are discussed. The development of these nerve lesions are primarily caused by radiation-induced fibroses and vasculopathies in the environment of the nerves. Several series of radiation appear to increase the risk of radiogenic pareses. With the frequently preferred application of megavolt therapy, a further increase in radiogenic nerve lesions may result.