Induction of hepatic aryl hydrocarbon hydroxylase in C57BL mice by ionizing radiation.

Inbred strains of C57BL mice were exposed to either 100, 500, or 1000 rads of whole-body irradiation. Another group of mice were given injections of 3-methylcholanthrene only, and a control group had no treatment. Forty-eight hr after treatment, the animals were killed and hepatic aryl hydrocarbon hydroxylase (AHH) activity was measured by spectrophotofluorometer. A comparison of hepatic AHH activity in treated and nontreated groups of mice showed that each treated group had a significantly increased AHH induction compared with the control group. Although radiation appeared to have a dose-related effect on AHH induction, the increase with dose level was not statistically significant.

Tumor burden assessment and its implication for a prognostic model in advanced diffuse large-cell lymphoma.

Previously untreated adult patients who presented with advanced diffuse large-cell lymphoma (DLCL) at diagnosis were studied to identify possible prognostic factors. One hundred five patients were seen between 1974 and 1981; 45 patients were stage III and 60 patients were stage IV. All patients received cyclophosphamide, doxorubicin, vincristine, prednisone, and bleomycin (CHOP-Bleo). Stage III patients also received radiation therapy alternated with chemotherapy. Overall survival was 50% at 5 years and 43% at 8 years. Seventy-four patients achieved a complete remission (CR) and 37 are alive and disease-free with a median follow-up of 72 months. There was no difference in clinical outcome between stage III and stage IV. However, a proportional hazards model identified lactic dehydrogenase (LDH) level and tumor burden, among all clinical factors studied, as independent risk factors for survival. These two factors were also important for achievement of remission and relapse-free survival. Three distinct patient risk groups were identified with 5-year survival rates of 87%, 48%, and 20%, respectively. The measure of tumor burden proposed herein, along with LDH level, can be used for developing treatment programs, and for meaningful comparison of different treatment regimens, as well as assessment of prognosis.

The adjuvant role of two cycles of MOPP and low-dose lung irradiation in stage IA through IIB Hodgkin's disease: preliminary results.

Fifty-eight laparotomy-staged I and II patients with upper torso presentations of Hodgkin's disease and 8 patients with lymphangiogram-staged lower torso disease were treated with radiotherapy alone or with 2 cycles of MOPP and radiotherapy. Patients with upper torso disease with either no mediastinal or only small mediastinal disease without hilar involvement and with no "B" symptoms were treated with mantle radiotherapy alone. Patients with large mediastinal masses or hilar disease were treated with 2 cycles of MOPP followed by definitive mantle irradiation and low dose lung irradiation. Those for whom "B" symptoms were the only adverse prognostic feature received 2 cycles of MOPP and mantle radiotherapy. Patients with lower torso disease were treated with radiotherapy alone if the disease was limited to the pelvis. Those with more extensive disease received 2 cycles of MOPP prior to radiotherapy. The 4-year survival for all 66 patients was 97%. The corresponding disease-free and freedom from second relapse figures were 77% and 92%. Survival for the patients with unfavorable presentations who received 2 cycles of MOPP and radiotherapy was 100%. It was 92% for the group with favorable presentations who were treated with radiotherapy only.

Outcomes of high-dose unilateral kidney irradiation in patients with gastric lymphoma.

PURPOSE: To review the long-term clinical effects of unilateral kidney irradiation on overall renal function and blood pressure in patients with gastric lymphoma. METHODS AND MATERIALS: In the study were 27 patients with Stage I or II gastric lymphoma who had undergone irradiation of at least 24 Gy to > or = 1/3 of the left kidney. They include 16 women and 11 men, aged 31 to 77, with a mean age of 57.6 years (median 56). Fifteen patients had Stage I and 12 had Stage II disease. In 13 patients the whole kidney had been irradiated, and 14 had had partial kidney irradiation, at doses ranging between 24 and 40.5 Gy. All patients received combined chemotherapy with various drugs: all patients received corticosteroids, and five received cis-platinum. Their follow-up ranged between 0.7 and 7.8 years (mean 3.4 years). Data on possible effects of the treatment on blood pressure, renal function as assessed by blood urea and creatinine, and kidney shrinkage as seen by serial computed tomography scanning were collected on all patients. RESULTS: Three patients had persistent, mild elevations of urea and creatinine levels, which did not require special treatment. All three also received cis-platinum. Ipsilateral kidney shrinkage was evident in most patients. In 19 patients the craniocaudal measurement of the kidney shrank by > or = 1.6 cm. Shrinkage in other dimensions was also evident. The degree of atrophy was related to the volume of kidney irradiated. Only two patients developed hypertension, both at a low level of 150/90; one patient had had 40 Gy to the whole kidney, the other 40 Gy to half the kidney. Neither patient had elevated urea or creatinine. CONCLUSIONS: Notwithstanding the shrinkage to the irradiated part of the kidney, the treatment did not lead to clinically significant hypertension or renal dysfunction. The administration of cis-platinum to patients with gastric lymphoma that requires kidney irradiation should be further evaluated.

Hodgkin's disease: correlation of clinical characteristics with probabilities for negative lymphangiogram vs. negative laparotomy findings in patients with Stage I supradiaphragmatic presentations vs. those in patients with Stage II.

PURPOSE: At a time both when late complications and second malignancies have become a growing concern and when staging laparotomy has been largely abandoned and comparative studies for staging Hodgkin's disease by state of the art computed tomography (CT) vs. lymphangiography have revealed minimal differences in results for these procedures, our purpose for undertaking this study was twofold. Our initial reason was to determine and compare probabilities for negative abdominal findings for patients with Stage I presentations with those for patients with Stage II as determined by lymphangiography and subsequently by laparotomy for those patients who had negative lymphangiograms. Our second reason, being an extension of the first, was to create a resource that can be used in conjunction with other information for arriving at appropriate treatment decisions including giving either more or particularly less than standard institutional therapy and especially with respect to the abdomen. METHODS AND MATERIALS: Data on 714 patients with prelymphangiogram Stage I-II upper torso presentations of Hodgkin's disease were entered prospectively in our database between 1968 and 1987. Twenty-eight with lymphocyte predominant disease, who had both negative lymphangiogram and negative laparotomy findings and 17 with questionable diagnoses of lymphocyte-depleted or unclassified disease were excluded from subsequent analyses of 669 patients with nodular sclerosis (NS) and mixed cellularity (MC) diagnoses. RESULTS: Stage I: in final logistic models, negative lymphangiogram findings were associated strongly with a combination of no constitutional symptoms and nodular sclerosis histology, whereas negative laparotomy findings correlated strongly with a combination of no constitutional symptoms and female sex. Predicted probabilities depended on the ratios of favorable to unfavorable characteristics. Stage II: in final logistic models, negative lymphangiogram findings were associated strongly with a combination of no constitutional symptoms, nodular sclerosis histology, age <40 years, and <4 involved sites, whereas negative laparotomy findings correlated strongly with a combination of <4 involved sites and mediastinal disease. Predicted probabilities again depended on the ratios of favorable to unfavorable characteristics. CONCLUSION: This study demonstrated that probabilities for negative abdominal findings for patients with supradiaphragmatic presentations of NS and MC Hodgkin's disease depended on: 1) whether the disease presented as Stage I or as Stage II; 2) whether staging was limited to a lymphangiogram or whether it included a laparotomy; and 3) or whether the clinical features associated with the presenting stage and methods of staging were favorable or unfavorable.

Hemodynamic changes in chronic obstructive pulmonary disease.

Right cardiac catheterization was performed in 136 patients with chronic obstructive pulmonary disease. Forty-three of these patients had a second study a mean of 25 months later (range, 18 to 38 months). The changes in hemodynamic data over a period of 25 months were small. The cardiac index decreased 6%, and the mean pulmonary arterial pressure increased 7%. The changes were similar in patients with and those without emphysema.

Thoracoscopy: technique and results in eighteen patients with pleural effusion.

Eighteen patients with pleural effusion were examined. Nine patients had malignant neoplasm and in one the pleura was diffusely involved. Nine patients had pleural effusion of inflammatory origin. One of these was due to tuberculosis, one to trichinosis and the other seven were nonspecific. Thoracotomy in three of these seven failed to add additional information. All patients tolerated pneumothorax well with equilibration of pleural space and atmospheric pressure.

Dosimeter placement in the Rando phantom.

Each section of the Alderson Rando phantom contains a tissue-equivalent plastic coating layer approximately 2 mm thick, applied to both faces. This compensates for material removed in the sawing process. Conventional use of thermoluminescent dosimeters positions them totally or partially within the coating layer. Analysis shows that, in the lung region, dosimeters placed in this layer received a dose averaging 39% lower than those placed at midsection. Where bony structures interfere, some dosimeters in the coating layer received an 18% higher dose than those at midsection. Therefore, positioning dosimeters at the center of a section is recommended.

Thoracic lymphoma.

Mediastinal adenopathy is a common manifestation of HD in a usually predictable pattern involving anterior and middle mediastinal nodes with or without disease in the hili. Hilar adenopathy is uncommon without detectable mediastinal disease and the lung is virtually never involved alone. In NHL the pattern of disease is more unpredictable. Lung manifestations include direct extension from involved nodes, nodules with or without cavitation, atelectasis secondary to endobronchial or nodal obstruction and rarely an interstitial pattern. Pleural effusions are not uncommon, but solid pleural masses are less frequent. Invasion of the pericardium is not often seen, although masses are commonly seen along the pericardium. Invasion of the chest wall occurs particularly with involvement of internal mammary nodes. Occasionally, posterior nodes will invade the adjacent vertebrae and spinal canal. The chest wall may be invaded by enlarged axillary nodes. Isolated chest wall soft-tissue masses are not common and are usually a manifestation of NHL, especially large cell lymphoma. Although the chest radiograph should detect most intrathoracic disease. CT has been found a necessary adjunct in patients with HD for accurate staging and therapy, especially if radiotherapy is planned. CT has been found helpful in NHL for staging, especially for the pleura and chest wall. MR imaging has not been found to contribute additional useful information except in selected cases.

Bronchogenic carcinoma in breast carcinoma patients.

Forty-eight female patients who developed bronchogenic carcinoma synchronously with or after the occurrence of breast carcinoma are reported. The object of the study was to review the radiographic findings for possible clues to the diagnosis of bronchogenic carcinoma and to ascertain the histologic diagnoses observed. In 40 patients on whom films were available, the original radiographs before surgery for bronchogenic carcinoma were examined. The clinical records of the 48 patients were also reviewed. Histologic diagnosis of primary bronchogenic carcinoma was required. A solitary pulmonary lesion in a patient with breast carcinoma, a cavitated lesion, or a lesion that failed to respond to appropriate therapy for metastatic breast carcinoma suggested the diagnosis of bronchogenic carcinoma. An increase in the frequency of small cell carcinoma and a decrease in the frequency of adenocarcinoma was seen in bronchogenic carcinomas developing 5 years or more after radiation therapy for breast carcinoma. It was concluded that the benefits of radiation therapy in selected patients far outweighed the risk of bronchogenic carcinoma.

Effects of geometric and screen-film unsharpness in conventional and 350-kVp chest radiography.

Clinical comparison of 350- and conventional 120-kVp techniques indicates that small linear structures, such as small pulmonary blood vessels, are shown better at 120 kVp, due in part to two factors affecting image unsharpness: geometric and screen-film unsharpness. The combined effects of geometric (Ug) and screen-film unsharpness were evaluated for both kVp levels. The total-system modulation transfer function (MTFUg X MTFscreen-film) demonstrates differences in unsharpness under two conditions: (a) when the same screen-film system is used with different magnifications (i.e., extreme planes in the chest) and (b) when different screen-film systems are used for magnification of the midplane of the chest.

Effect of irradiation on testicular cells of opossum.

Five months old male opossums were exposed to 5000 rd wholebody 60Co gamma-radiation. Testes tissues from animals sacrificed at 16, 40 and 90 hours post-irradiation and from nonirradiated animales were used for enzymatic and histological studies. Electrophoretic pattern of lactate dehydrogenase and glucose-6-phosphate dehydrogenase was slightly disturbed in early hours in irradiated animals, but it did not persist beyond 40 hours postirradiation. Histological study indicates 31% survival of type A spermatogonia suggesting high radioresistance of testes tissue in comparison to other animals.