The effects of ultrafractionated X-ray therapy in malignant lymphomas.

To improve the therapeutic methods in malignant lymphomas a new irradiation schedule is suggested i.e., ultrafractionated radiotherapy in small daily doses spaced out over a long period of time until the tumor dose of 3,500 R is reached. This treatment was used in 26 patients with malignant lymphomas--most of whom in stages III and IV--as well as in patients with recurrences that no longer responded to chemotherapy. Total remissions were obtained as well as an improvement of survival : 18 of the 16 patients are still in life and 8 of these have already been followed up for more than 5 years. The tumor dose per field did not exceed 2,000 R in the patients under concomitant chemotherapy. Ultrafractionated X-ray was very well tolerated by patients with altered general condition and even by those with recurrences or previous irradiation sequelae.

Study of mediastinal and lung involvements in Hodgkin's disease.

Clinical, biological, radiological and radioisotope investigations in 224 patients with Hodgkin's disease revealed a great frequency (100 cases, i.e. 44%) of mediastinal and pleuro-pulmonary involvements, most of them in advanced stages of the disease. The predominant histologic types in these cases were mixed cellularity or nodular sclerosis. Evolution and prognosis were improved by combination chemotherapy in COOP courses; X-ray therapy was associated after drug therapy only if absolutely necessary, on limited areas.

Relationships between lymphography and the histologic nodal and splenic types in Hodgkin's disease. Considerations on clinical evolution.

Trying to establish the eventual interrelations of the initial histologic nodal type and the splenic one, the general lymphographic picture, the histologic nodal type and spleen involvement, lymphographic and histologic examinations were carried out in 151 patients with Hodgkin's disease. Lympographies were performed in 139 cases, and splenectomy (followed by splenic, hepatic and abdominal lymph node biopsies) in 32. Lymphocyte depletion was found in 72.7% of the patients with lymph node obstruction diagnosed lymphographically. Splenic involvement was more frequent in cases with pathologic lymphographic picture and histologic aspects of lymphocyte predominance or nodular sclerosis. In patients with initial nodal histologic types of nodular sclerosis or lymphocyte depletion, the splenic histopathologic types were the same, but they got more severe in cases with lymphocyte predominance or mixed cellularity. Splenic biopsy might be unconclusive after protracted cytostatic treatment or splenic X-ray therapy. In the authors' opinion, early routine splenectomy is rather more advisable than differentiated splenectomy.

Significance of T and B lymphocytes in different chronic internal diseases with immune processes.

The T and B lymphocytes were determined by the rosette test in the peripheral blood of 100 patients with internal chronic diseases with immune processes such as: chronic hepatitis, systemic lupus erythematosus, myasthenia gravis, chronic lymphocytic leukemia and lymphosarcoma. The values obtained were compared with those in 10 controls. The mean per cent values of the T lymphocytes in the controls were 33 (29-38%) and of the B lymphocytes 25.2 (16-43%). In the patients investigated the values varied, namely: in chronic hepatitis and systemic lupus erythematosus the T lymphocytes were generally low while the B lymphocytes were moderately high. In myasthenia gravis both T and B lymphocytes were below the control values. In chronic lymphocytic leukemias and lymphosarcomas the per cent values of the T lymphocytes were generally low while those of the B lymphocytes were high. The significance of these results for the immunologic implications of the lymphocyte populations is discussed and an attempt is made to correlate these data with the nucleologram variations.

Lymphographic aspects of the barrier function of lymph nodes in Hodgkin's disease.

The persistence of Lipiodol in various lymph node groups was followed up by systematic lymphographic control. Assuming a certain relationship between the barrier function of the lymph nodes and the persistence of their image on the film the authors have tried to find out whether the duration of Lipiodol persistence may be a test for the estimation of prognosis in Hodgkin's disease. The observation of such cases has shown that Lipiodol is retained for a longer period in the external iliac and lombo-aortic lymph nodes as well as in the pathologic ones, except those with lymphocyte depletion, whereas it is very rapidly eliminated from the inguinal nodes. These findings seem to prove that Hodgkin's disease is more severe in patients in whom the barrier function of the lymph nodes is defective i.e. unable to retain the foreign substances introduced in the organism. These conclusions should be further verified by comparison with other clinical and biologic factors.