Harry H. Bowing

Results Obtained in the Treatment of Carcinoma of the Cervix Uteri with Radium and Roentgen Rays from 1915 to 1924, Inclusive

IN this report we are compiling the results of treatment of carcinoma of the cervix with radium, considering only cases treated at least five years ago. All cases in which treatment with radium was employed at The Mayo Clinic for the ten-year period from 1915 through 1924 are included. This paper is supplementary to the report given in July of this year at the meeting of the American Radium Society (1); we are now adding our 1924 results. During the decade mentioned, 1,094 patients were treated, 1,001 (91.5 per cent) of whom have been traced. We have separated the cases into four major groups: operable, borderline, inoperable, and modified. The modified group includes all cases in which the lesions were modified by previous treatment before we first saw the patients; previous treatment may have been by operation, cautery, radium, roentgen ray, or other means. In the course of this ten-year period no treatment was applied in 167 cases, due to various reasons, such as recent treatment elsewhere or moribund ...

The Radium Treatment of Post-Operative Parotitis1

Although fortunately a rare complication, acute parotiti has for many years been recognized as a very serious post-operative infection. Because of the well-known association of epidemic parotitis with orchitis or oophoritis, operation on the genital organs was considered the type of surgery most likely to be followed by acute infection of the parotid glands. In 1878 and 1880, German authors reported cases following ovariotomy (2). Blair and Padgett discussed the history and etiology of the condition and gave their results; 14 cases of post-operative parotitis were cited, with seven deaths, a mortality of 50 per cent. Rankin and Palmer found 79 cases in a review of the literature, with 36 deaths, or a mortality of 46 per cent. Green, in 1935, cited the mortality in the combined American statistics as 58 per cent, individual reports varying from 25 to 60 per cent. The incidence of the complication is low, since it was found to occur following about one in 2,275 general operations (1). Rankin and Palmer, how...

Results of Treatment of Carcinoma of the Penis1

CARCINOMA of the penis is sufficiently rare to be of considerable interest with regard to its manifestations, mode of growth, and treatment. A survey of the literature on the subject in the past decade reveals an abundance of reports describing one or two cases. There are also excellent detailed studies of a larger series of cases contributed by Barringer and Dean (1), Dean (3, 4), Colby and Smith (2), Lewis (6), Pfahler and Widmann (7), Schreiner (8), Schreiner and Kress (9), and Howze (5). Many authorities report an incidence of from 1 to 3 per cent of penile carcinomas among all carcinomas in the male. During 1931, 3,505 patients with carcinoma were seen at The Mayo Clinic; 1,992 of these were men. Of these 1,992 men, six (or 0.301 per cent) had carcinoma of the penis. A total of 204 men in this series had carcinoma of the genito-urinary organs, and the six with penile carcinoma hence form 2.94 per cent of this group. Although this of course represents only the incidence for one year, it is probably a ...

Radium and X-ray Treatment of Advanced Carcinoma of the Breast Prior to Amputation1

FOUR cases of inoperable carcinoma of the breast will be discussed from the standpoint of the initial response, the gross and microscopic tissue changes, and the treatment. Two of the cases were massive inoperable carcinoma of the breast, the third was an operable primary growth with metastasis to the right and left axillary glands, and the fourth an easily operable primary growth with metastasis to axillary glands, and associated carcinoma of the fundus of the uterus, questionably operable. Report of Cases Case 1 (A406833). A woman, aged 48 years, came to the Clinic October 5, 1922, with a large pendulous right breast, massively infiltrated with carcinoma, especially in the upper half. The skin was attached but not discolored. Many axillary and supraclavicular glands were involved on the same side. The general condition of the patient was good. However, chronic rheumatic endocarditis, aortic and mitral regurgitation, and chronic myocarditis, with marked dilatation and hypertrophy were noted. The surgical...

Treatment of Malignant Tumors of the Rectum by Radium and Roentgen Rays

MALIGNANT tumors of the rectum are now most effectively dealt with by operation and by radium and roentgen-ray treatment: the best results will be secured by combining these procedures to meet the individual needs of the patient. Individual treatment is tedious in its application and demands the full co-operation of clinician, surgeon, radiologist, proctologist, pathologist and also of the patient. This paper deals chiefly with the problems confronting the radiologist in the management of these cases. To facilitate investigation, 127 cases observed in the Section on Radium Therapy at The Mayo Clinic during the years 1926 and 1927 were selected for study. Table I shows that 71.64 per cent of these cases ocproctoscopic examinations and from notes made at the time of the operation. In 115 of the 127 cases proctoscopic examination was made at the Clinic. Digital examination of the rectum, proctoscopic examination, and operative notes are important aids in helping the radiologist to decide whether or not the l...

The Treatment of Carcinoma of the Rectum by Irradiation

IT IS generally accepted that almost all malignant neoplastic diseases of the rectum are amenable to treatment by radium and roentgen ray. Most of the tumors are of the adenocarcinomatous type, and the degrees of malignancy vary. Among the remainder are colloid carcinoma, squamous-cell carcinoma, sarcoma, benign tumor (polyp) undergoing malignant degeneration, and so forth. If similar tumors are in suitable situation anatomically, for thorough irradiation, they respond favorably and thus a valuable therapeutic guide is furnished. The foregoing observation has aided materially in selecting patients for treatment as well as in anticipating the results. From the standpoint of the radiotherapist, these malignant neoplastic tumors of the rectum dorespond to treatment, but it is clinically impossible to state, at the time the patient is accepted for treatment, the degree of response that can be expected in a given case. This feature is not a problem peculiar to lesions of the rectum; it is, instead, a common fa...

Significant Cellular Changes Observed in Irradiated Tissue, Especially of Cancer of the Rectum1

FROM June, 1919, to June, 1924, forty-three cases of cancer of the rectum were resected at the Mayo Clinic, in which radium alone or in combination with roentgen rays was applied prior to operation. Thirty-four cases were treated as a pre-operative procedure, following a short interval after permanent colostomy. Nine cases were treated elsewhere, and in only one of these was a colostomy made prior to the irradiation. This small group of cases was studied for the special purpose of observing, if possible, those changes resulting from the application of the therapeutic rays of radium, and the X-ray. A similar study of cancer of the breast was made (2), which proved to be a substantiation of the work of Alter on irradiated cancer. MacCarty and Broders have reported data on cases of unirradiated cancer. It seems evident that cellular changes can be abundantly produced in malignant tissue, which reduce or inhibit the malignant process. Microscopically, the cellular changes in irradiated tissues seem to be iden...

Immediate and late results of intracavitary radium therapy for malignant lesions of the cervix.

Since its introduction, radiosurgery has been an important factor in the treatment of selected early, most borderline, and all late and recurring malignant lesions of the uterine cervix. When this method was first employed, the need was great. As the years passed, it has kept its position, and increase in its use has brought an ever-widening responsibility to the therapeutic radiologist. Intracavitary radium therapy as an initial method of treatment of malignant disease of the uterine cervix is worthy of sincere consideration by all discerning radiotherapists. Every patient with cancer of the cervix, except for those who are in the terminal phase of the disease, has a chance of cure or of survival for five years or longer at the time she first presents herself for consideration of treatment. The physician selecting and applying the initial therapy has the best opportunity of restoring the patient to health. Naturally, the method selected should be an adequate therapeutic procedure. Today, although the cau...

Malignant Disease of the Rectum and Rectosigmoid Treated with Radium1

It is our impression that treatment of polyps and polypoid malignant disease of the rectum is an ever-widening field for the radiologist. It is already a major field and we believe from past experience (1) that aggressive preoperative and planned postoperative treatment offer much promise for the future. Treatment of this condition demands co-operation of the patient, general practitioner, surgeon, proctologist, and radiologist. The proper treatment of carcinoma of the rectum is of major importance if the high incidence of this disease is considered. Teperson (5) stated recently, after a study of records of several thousand patients who received treatment, that 5 per cent of all malignant lesions of the body occur in the rectum and colon and that the majority of these lesions are within reach of the examining finger. Buie (3) reported that in ten years at the Mayo Clinic a positive diagnosis of malignant rectal lesions was made in 2,723 cases at proctologic examination. It is known that in this serious di...

Adenomyoma of the Rectovaginal Septum Treated with Radiologic Methods

THIS study is a review of 36 cases of adenomyoma of the rectovaginal septum, in which the patients were referred to the Section on Therapeutic Radiology, at the Mayo Clinic. The first case was observed in 1918, and the last three cases were observed in 1934. An adenomyoma is a tumor composed of glandular and muscular tissue. Considered from a general standpoint, this type of tumor may be found in many organs of the body, and when so situated, it usually is representative of the structure of the tissue from which it arises. This consideration deals in part with adenomyomas of the uterus, and specifically with adenomyomas found in the rectovaginal space. Lockyer, in 1913, presented a paper entitled “Adenomyoma in the Recto-uterine and Recto-vaginal Septa,” and he accordingly is accredited with having been the first to identify this phase of the disease. Keene and Kimbrough found that the earliest contribution to the subject, which dealt with adenomyomas of the uterus, was the report by Rokitansky, in 1860. ...