Seventy-eight patients with locally recurrent or disseminated lung cancer were treated with cyclophosphamide therapy. Only eight patients showed objective tumor regression. Five of the objective responses occurred in patients with small cell anaplastic carcinoma and three in patients with squamous carcinoma. No objective responses were seen in adenocarcinoma or alveolar cell carcinoma. An additional 26 patients manifested a stable or subjectively improved status during therapy. Hemorrhagic cystitis was seen in six of 36 patients receiving the drug orally but in none of those receiving monthly intravenous courses. Hematologic toxicity was acceptable though there was one death from sepsis associated with leukopenia. There was no evidence that life was prolonged by this drug. Because there seemed to be frequent subjective benefit, we recommend that symptomatic patients with recurrent or disseminated lung cancer receive monthly intravenous courses of cyclophosphamide as palliative therapy.
The surgical treatment of incapacitating angina pectoris is now possible through the use of a combined approach. Direct and indirect myocardial revascularization is combined with resection of ventricular aneurysms or akinetic areas. During the past 20 months, 44 patients have been operated upon. The procedures performed were: 1) single internal mammary artery implants (12 patients); 2) double internal mammary artery implants (18 patients); 3) aortocoronary vein bypass graft (14 patients, 12 to the right coronary and two to the anterior descending arteries). Twelve of these patients had a combined internal mammary artery implantation and three a ventricular aneurysmectomy. Two patients who did not obtain complete relief after indirect myocardial revascularization had one year later a carotid sinus nerve stimulator implanted and they are able to control their angina. Vein grafts have the advantage of relieving angina immediately, and, when possible, are the procedure of choice. The hospital mortality has been 9 percent. The operative techniques are described. The surgical treatment of incapacitating angina pectoris is now possible through the use of a combined approach. Direct and indirect myocardial revascularization is combined with resection of ventricular aneurysms or akinetic areas. During the past 20 months, 44 patients have been operated upon. The procedures performed were: 1) single internal mammary artery implants (12 patients); 2) double internal mammary artery implants (18 patients); 3) aortocoronary vein bypass graft (14 patients, 12 to the right coronary and two to the anterior descending arteries). Twelve of these patients had a combined internal mammary artery implantation and three a ventricular aneurysmectomy. Two patients who did not obtain complete relief after indirect myocardial revascularization had one year later a carotid sinus nerve stimulator implanted and they are able to control their angina. Vein grafts have the advantage of relieving angina immediately, and, when possible, are the procedure of choice. The hospital mortality has been 9 percent. The operative techniques are described.
A family group of eight members is described of which seven members have or had histologically proved Hamman-Rich syndrome. From the onset of symptoms, the age range is from four months to 39 years. The case data of a mother, daughter, and granddaughter with proved disease are presented. The latter two members are alive and well at the present time, being maintained on low doses of steroids. One of these patients was 3% years old when the diagnosis was confirmed by lung biopsy. She probably represents one of the youngest living patients with Hamman-Rich syndrome. Two brothers of this group had coexistent pulmonary fibrosis and bronchogenic cancer; an association in the familial disease not previously recorded, though isolated cases have been reported. It is now firmly established that Hamman-Rich syndrome can occur as a distinct familial entity that is transmitted as an autosomal dominant trait
Esophageal perforations occurred in 33 (0.4 percent) of 8,038 patients who underwent peroral gastrointestinal endoscopic procedures at the Mayo Clinic from 1961 through 1967. Esophagoscopy was the procedure most often responsible. Perforations of the cervical portion of the esophagus were more common, but less serious than perforations of the thoraco-abdominal portion. Cervical perforations resulted from technical problems related to the endoscopic procedure or from unfavorable physical characteristics of the patient. Thoraco-abdominal perforations occurred at the site of benign or malignant esophageal strictures and were caused by excessive dilation, dilation without a satisfactory guide, or bougienage or biopsy beyond visual range. The most helpful diagnostic tests were roentgenographic examinations of the neck or thorax, including contrast studies of the esophagus. Results were best when treatment was initiated promptly and pursued aggressively, with use of antibiotics, surgical drainage, and elimination of esophageal obstruction.
A case report of a retroesophageal right subclavian artery causing dysphagia in an adult is presented. The necessity of reestablishing a pulsatile flow in the right subclavian artery to prevent the subclavian steal syndrome is emphasized.
The block of the anterior subdivision of the left bundle branch (LABS) delays the activation process in the anterosuperior portions of the interventricular septum and of the free left ventricular wall by about 20 msec. The main electrocardiographic signs are: left ÂQRSF deviation, delayed intrinsicoid deflection and slurred R wave in aVL, terminal slurred R wave in aVR, and slurred S waves in the left precordial leads. The vectorcardiogram is modified in the portion between 30 and 80 msec., and this portion is directed upward, backward, and to the left. There is counterclockwise rotation in the frontal and horizontal planes and the terminal portion of the curve is slurred. When LASB is associated with right bundle branch block (RBBB), the left ÂQRSF deviation and the delayed intrinsicoid deflection as well as the slurred R wave in aVL persist. In the VCG, the R loop presents the same situation and rotation mentioned above in the frontal and horizontal planes, and it is slurred in the intermediate portion. The S loop is above the X axis in the frontal plane.
A clinical surface electrocardiogram (ECG) in which ventricular reciprocal rhythm occurred occasionally three times and probably seven times in succession together with paroxysmal ventricular tachycardia and ventricular extrasystoles in competition with sinus rhythm causing incomplete A-V dissociation is described.An ECG tracing of ventricular reciprocal rhythm occurring in succession has never been reported previously as far as can be ascertained from published reports
Nonrandomized data exploring pancreas stereotactic body radiation therapy (SBRT) has demonstrated excellent local control rates and low toxicity. Before commencing a randomized trial investigating pancreas SBRT, standardization of prescription dose, dose constraints, simulation technique, and clinical target volume delineation are required.Specialists in radiation oncology, medical oncology, hepatobiliary surgery, and gastroenterology attended 2 consecutive Australasian Gastrointestinal Trials Group workshops in 2017 and 2018. Sample cases were discussed during workshop contact with specifically invited international speakers highly experienced in pancreas SBRT. Furthermore, sample cases were contoured and planned between workshop contact to finalize dose constraints and clinical target volume delineation.Over 2 separate workshops, consensus was reached on dose and simulation technique. The working group recommended a dose prescription of 40 Gy in 5 fractions. Treatment delivery during end-expiratory breath hold with triple-phase contrast enhanced computed tomography was recommended. In addition, dose constraints, stepwise contouring guidelines, and an anatomic atlas for pancreatic SBRT were developed.Pancreas SBRT is emerging as a promising treatment modality requiring prospective evaluation in randomized studies. This work attempts to standardize dose, simulation technique, and volume delineation to support the delivery of high quality SBRT in a multicenter study.
Experimental bronchography with heavy metal tantalum was performed in ten greyhound dogs. The method is simple, produces excellent bronchographic pictures and does not produce pathologic changes.
The Editorial Board is pleased to announce the appointment of Dr. Charles G. Roland as Department Editor of our new section, "Medical History." Dr. Roland was born and raised in Canada and received his M.D. from the University of Manitoba in 1958. He was a Senior Editor of the Journal of the American Medical Association from 1964 to March, 1969, when he was named Head, Section of Publications at the Mayo Clinic. He is a member of the editorial boards of Diseases of the Chest, Postgraduate Medical Journal and the American Medical Writers Association Bulletin. He is a co-author of the book, Scientific Writing, and has published widely in the realm of medical history. On August 18, 1969, Dr. Roland became Chairman of a newly created Department of the Medical Library and of Publications, Mayo Foundation Library. The new department will include the Mayo Medical Library and the Section of Publications. Dr. Roland is this year's President of the American Medical Writers Association.
The study of historiography is undergoing a revolution akin to that which took place in the history of political thought in the 1960s, and the work of J.G.A. Pocock is central to both. Pocock's continuing exploration, in Barbarism and Religion (1999-), of the intellectual contexts of Gibbon's History of the Decline and Fall of the Roman Empire, is central to this enterprise, and this essay situates the origins of his own work within a pre-‘Cambridge School’ Cambridge and its experience of what might be called the Butterfieldian moment. That was marked by a desire to treat religion seriously as a driving force in history; and the same concern is applied here to further understanding an eighteenth-century controversy in which history and religion were dramatically involved, and which profoundly affected Gibbon's own historical and religious views. The work of Conyers Middleton and John Jortin is critically examined from this perspective. These preludes to Gibbon lead to a series of postludes examining the particular contexts in which Victorian and twentieth-century historians and writers, from Henry Hart Milman to Evelyn Waugh, variously appreciated and interpreted Gibbon. The whole is to be seen as a reflexive engagement with Pocock's vitally illuminating studies in eighteenth-century historiography.
