Radical treatment of Hodgkin disease with radiation therapy: results of a 15-year clinical trial. The 1985 Erskine lecture

In 1970, the University of Minnesota Hospitals instituted a policy for treatment of patients with stage I, II, and IIIA Hodgkin disease that required complete staging including laparotomy and extended field or total nodal radiation. Evaluation of the results of this policy in 1974 led to modifications of treatment based on analysis of disease recurrences. Since 1974, patients with large mediastinal masses or hilar disease have been treated with whole-lung or half-lung radiation. In addition, patients with stage IIIA disease with positive spleens were treated with liver irradiation. Sixty-five patients with Hodgkin disease treated with extended or total nodal fields and 126 patients treated with the radical radiation approach are evaluated. The use of this treatment modification has changed the prognostic factors and produced an improvement in recurrence-free survival that is statistically significant. The authors suggest that radical radiation therapy is the treatment of choice in patients with stage IA, IIA, or IIIA Hodgkin disease.     

Calcification in untreated mediastinal lymphoma

Calcification was demonstrated radiographically within newly diagnosed lymphoma of the mediastinum in two patients. These patients and those in other isolated reports show that radiographic examinations may, rarely, reveal calcification in lymphomatous tissue prior to treatment.     

Physics of thin-section MR imaging at low field strength

Thin-section magnetic resonance imaging at low field strengths requires analysis of the relative merits of data collection techniques for direct three-dimensional versus multisection two-dimensional imaging. This analysis was done with specific emphasis on shortened relaxation times and the use of reduced magnetic field gradients. Three-dimensional Fourier transform techniques can provide thin-section images of good diagnostic quality when combined with partial flip-angle gradient-reversal techniques.     

Structure-biodegradability relationships in pyrethroid insecticides

The metabolism of 20 pyrethroids has been examined to evaluate the contribution of detoxification in their selective action between insects and mammals. The studies utilized living houseflies, mice, or rats, or esterase and oxidase systems derived from these organisms. Pyrethroid-hydrolyzing esterases cleave the primary alcoholtrans- substituted-cyclopropanecarboxylates much faster than the correspondingcis-isomers but are ineffective in hydrolyzing secondary alcohol esters. Microsomal enzymes oxidize the (+)-trans-chrysanthemate moiety at thetrans-methyl group of the isobutenyl substituent and at one of the gem-dimethyl groups whereas the (+)-cis-isomer is attacked at either of the isobutenyl methyl groups. Products isomerized at C₃ of the cyclopropane are also detected but only after ester cleavage and oxidation of an isobutenyl methyl group. Each alcohol moiety has its own unique sites for oxidation involving pentadienyl, allyl, benzylic methylene, and aromatic substituents. An enhancement of insecticidal activity is expected on replacement of the biodegradable groupings with substituents relatively resistant to metabolism but this may also increase the mammalian toxicity.Presented at Third International Congress of Pesticide Chemistry (IUPAC), Helsinki, Finland, July 3–9, 1974.     

Measurement of pressure in the lower esophageal sphincter

Ten healthy human lower esophageal sphincters (LES) were studied with two separate perfused catheter systems, identical in all respects save their external diameters (3.2 and 7 mm for small and large assemblies respectively). Maximum resting pressures, whether recorded by station withdrawal or by slow continous pull-through, were significantly higher with the larger assembly. Residual pressures during postdeglutitive relaxation were similar with the two systems. These observations serve to emphasize that LES pressures recorded with perfused catheters are in fact measurements of the resistance to stretch of sphincteric smooth muscle.     

Second-screening mammography: one versus two views per breast

To compare the advantages of one-view versus two-view second-screening (follow-up) mammography, oblique and craniocaudal projection mammograms from 1,000 consecutive asymptomatic women who had prior normal baseline studies were reviewed retrospectively, first with only the oblique images, then with the oblique and craniocaudal views. In women with dense breasts, one-view (oblique only) readings resulted in abnormal interpretations four times more frequently (53 cases, 5.3%) than two-view readings (13 cases, 1.3%). The induced cost from these abnormal interpretations would have more than offset the small savings in operating expense associated with one-view screening. In contrast, four times fewer abnormal one-view interpretations (13 cases, 1.3%) were made in women with primarily fatty breasts, in whom superimposition of dense tissue on images is not as frequently a problem. In these women, considering only cost, it may be reasonable to obtain a single mediolateral oblique projection for follow-up screening mammography. However, the issue of whether to implement such an approach remains unresolved, because the sensitivity of one-view versus two-view second screening in the detection of breast cancer has not yet been determined.     

Pattern of psychiatric morbidity and alcohol dependence in patients with alcoholic liver disease

Fifty-six male patients with alcoholic liver disease were evaluated for the presence and severity of alcohol dependence and psychiatric illness using a severity of alcohol dependence questionnaire and research diagnostic criteria, respectively. Forty-three (76.7%) patients were found to be dependent; 26 (46.4%) moderately, and 17 (30.3%) severely. Patients with alcoholic hepatitis were significantly (P less than 0.05) more often found to be dependent than patients with alcoholic cirrhosis. Psychiatric morbidity was observed in 42 (75%) of the patients with alcoholic liver disease and 15 (26.7%) of the nonalcoholic cirrhotics. The difference was highly significant (P less than 0.01). The commonest disorders in patients with alcoholic liver disease were neuroses (33.0%), followed by affective disorders (26.8%). It was, however, not possible to ascertain whether psychiatric disorders antedated alcoholism or were secondary to it. Detection of moderate to severe dependence on alcohol and psychiatric morbidity in about three-fourths of the patients with alcoholic liver disease warrants an increased awareness and a multidisciplinary approach for the management of these patients.