Hugh F. Hare

Cancer of the Thyroid in Children

ASURVEY of 15,000 thyroid operations performed at the Lahey Clinic shows that 258 cases, or 1.7 per cent, were diagnosed as primary malignancy of the thyroid gland. Six of the cases were in children under fourteen years of age, the youngest in this group being six years, the oldest thirteen. Three of the six have been previously reported by Cattell (1). A review and the subsequent course of these cases is given, in addition to the report of three new cases. There is considerable discrepancy among experienced pathologists regarding the proper classification of thyroid malignancy. We are accustomed to and use Dr. Shields Warrens classification. While it does not reach Dr. Warrens ideal, it is a satisfactory working classification from the clinical point of view.

Roentgenologic diagnosis of pituitary tumors.

Heretofore the roentgenologic diagnosis of pituitary tumors has been limited to those growths far enough advanced to cause the typical appearance which has come to be associated with sellar changes in this type of lesion. The diagnosis of early lesions has not been made, owing largely to the difficulty in distinguishing between the normal sella and the sella with borderline enlargement. This problem has been complicated by the fact that on routine measurement 10 to 20 per cent of the acidophilic tumors do not show enlargement, and that the basophilic tumors thus far studied, with rare exceptions, have been microscopic in size. Changes in these latter cases are limited to the alterations of calcium architecture in the cranial vault. The chromophobe tumors, occurring more frequently than the others, have produced changes in all cases thus far diagnosed. In a number of cases of enlarged sella there has been no clinical evidence of the disease. The problem has been further complicated by many borderline enlar...

Carcinoma of the Thyroid in Children

The purpose of this paper is to review 5 cases of thyroid cancer in children followed for more than ten years. These cases were first reported by one of us (1) (H.F.H.) in February 1937. At that time, 6 patients had been studied, 5 of whom were then alive and are still living and well ten years later. Cancer of the thyroid in children is a rare disease. We have seen a total of 6 histologically proved cases in addition to the 6 cases originally reported. Some of these patients were seen only in consultation and were not treated at the Clinic. Langmann and Bruch (2) reviewed the literature in 1938 and found a total of 20 cases of cancer of the thyroid in children, to which they added one of their own. Seventeen of these patients were living, the longest survival being nine years after diagnosis and operation. These writers concluded that thyroid cancer in children runs a more benign course than the same condition in adults. This is in accordance with our experience and the observations of others. Since the ...

TWO-MILLLION-VOLT X-RAY THERAPY OF HODGKIN'S DISEASE

We have used X rays produced a t two million volts for the treatment of lymphoma since 19451 .I Several physical and clinical advantages result from the use of this higher-energy radiation in local and regionalized cases. The relatively greater penetration, as indicated by its half-value layer (HVL) of 12.5 mm. copper, allows the administration of sufficient radiation to the deeper tumor-bearing regions. Untoward skin effects are almost completely avoided both because of this penetration and because of the fact these highenergy rays achieve their maximum ionization just below the radiosensitive skin? The threshold skin erythema dose with 2-million-volt X radiation is about 3000 r when delivered by the divided-dose technique, as compared with less than 1000 r for conventional deep-therapy rays. In addition, megavolt rays are known to be less strongly absorbed by bone and other high-atomicnumbered components and thus have a lesser effect on the blood-forming organs for the same soft-tissue dose. The Van de Graaff electrostatic X ray source used in this work is a constantpotential unit delivering 80 r/min., measured a t 1 meter. The usual treatment distance of 125 cm. allowed a portal 35 cm. x 35 cm. in size and made possible the treatment of most regions with a single field carefully shaped so as to shield normal structures such as the eyes, teeth, lungs, or genitalia. The focal spot on these units is usually under 3 mm. in diameter and results in a sharply defined X-ray beam. These factors have allowed us to treat most of our lymphoma cases through two portals, one anterior and one posterior, with minimum tumor doses from 2400 r to 3000 r delivered to the primary lesion and the adjacent lymphatics, regardless of the location. Conventional deeptherapy equipment cannot readily provide portals of the dimensions desirable for lymphoma therapy and may elicit excessive skin and systemic reaction if adequate deep irradiation is delivered to such large fields. The histological classification of lymphomas used in this study and the number of cases treated are shown in FIGURE 1. This report covers four series of cases followed for a period of three to five years for all types of lymphoma (FIGURE 2). The 64 cases reported using the 2-million-electron-volt (Mev) X ray were treated a t Massachusetts Institute of Technology (M.I.T.), between 1950 and 1952 and were patients for whom one of us (H. F. H.) cared as a staff member of the Lahey Clinic, Boston, Mass. Another group of 181 cases was composed of patients also treated by H. F. H. between 1939 and 1942; 200-kilovolt-peak (kvp) X rays were used. The third series of 63 cases was treated with 200-kvp and 400-kvp therapy a t Los Angeles Tumor Institute, * Fellow of the Los Angeles Tumor Institute.

Radiation treatment of benign and inflammatory conditions.

The radiation treatment of benign and inflammatory conditions occupies an important place in modern therapeutics. The number of lesions found to respond well to radiation therapy has gradually increased over a period of years until at present nearly half of the cases seen in the radiotherapy department are treated for benign or inflammatory conditions. This excludes the use of radiation in dermatology, where its efficacy has been well demonstrated and it is widely employed. The list of non-malignant lesions successfully treated is a long one, too long, in fact, to be presented in an editorial. If, however, we exclude the group in which there is only a small percentage of good results, along with those conditions about which there is lack of agreement as to the value of the treatment, we are still left with an impressive number of lesions which respond satisfactorily, and with which we should all be familiar. Radiation treatment for non-malignant conditions is well tolerated and gives a fair percentage of ...

Two-million-volt radiation.

Supervoltage radiation in the form of two-million-volt roentgen rays, when the quality of radiation delivered is comparable to the quality of the radium beam, has given us our first opportunity to study and evaluate what might be accomplished by a radium bomb of a magnitude of 5,000 gm., providing that much radium were available in the world. In addition to having a quality equivalent to radium-bomb radiation, supervoltage roentgen radiation has several advantages, even if radium were ever found in quantities sufficient for bombs of this magnitude. To begin with, it allows complete shielding for those working with it, without danger of even small amounts of radiation reaching personnel. Radiation delivered by this means, moreover, is developed from a point source, which means that a small tumor can be treated with a sharply defined field. The ease of maneuverability of the equipment is such that treatment may be delivered through ports of special size and shape without endangering either patient or person...

Roentgen Changes in the Cranial Vault Accompanying Diseases Resulting from Metabolic Disturbances1

DISEASES associated with metabolic disturbances frequently produce changes in the osseous system which, with improved roentgen technic and increasing experience, are more frequently recognized and successfully diagnosed than previously. Naturally, the degree of bony change and the ease with which it is demonstrated roentgenologically depend upon the stage of the disease and whether it is localized or generalized. It is becoming increasingly apparent to roentgenologists that there are more diseases which affect the osseous system than was previously realized and that a definite diagnosis from the roentgenogram alone is not warranted. The various metabolic disturbances which may lead to changes in the cranial vault are given in Table I, with some of the laboratory findings. Hyperparathyroidism.—The symptoms and signs of hyperparathyroidism are now generally recognized. It is a progressive disease associated with weakness, backache, progressive round back, and ease of fatigue. Loss of height is common, due t...

The George W. Holmes Annual Lecture

On May 16, 1945, Dr. George Winslow Holmes delivered the annual oration of the New England Roentgen Ray Society. Immediately following his lecture, it was proposed, and unanimously approved by the Society, that this lecture be designated the first George W. Holmes Annual Lecture and that each year some outstanding scientist, regardless of specialty, be invited to deliver, at the closing session of the Society, the annual Holmes Lecture. In creation of this lecture the respect and love of all members of the Society for Dr. Holmes played equal parts. Many members of the group received their training in radiology under his tutelage at the Massachusetts General Hospital, while others have been trained by his intellectual sons and grandsons. Quite apart from this, the respect in which he is held by all members of the Society has increased during the years not only for his ability as a radiologist, but for his zeal and quality in the practice of medicine. He has, furthermore, a quality difficult to describe in ...

The Endocrine Glands and Cancer

Patients with advanced malignant growths should be, and in most cases are, treated palliatively with roentgen rays or radium. The alleviation of symptoms when these agents are properly employed, in appropriate dosage, is too well known to require comment, yet it is striking how often we see what is considered a cancerocidal dose administered to a hopelessly incurable patient. We must, unfortunately, consider three out of every four cases referred to us as incurable. In most instances it is obvious which patients have early and sufficiently localized lesions to receive cancerocidal quantities of radiation. In such cases even a severe reaction is a small price to pay for eradication of the neoplasm. In the hopeless cases, however, the radiation reactions are without such compensation and are frequently so severe that the patient suffers more from the treatment than from the disease. This is well exemplified in the treatment of prostatic cancer, either with platinum radium needles or radon seeds, when the im...

The Bone Changes in Primary Hypogonadism

THIS report is based on observations made on nine cases of primary prepuberal hypogonadism. By this term we refer to that condition in which puberty has not taken place (absence of secondary sex characteristics), in which there is every evidence clinically of normal pituitary function, and in which there is no evidence of other endocrine disorders. When the usual and normal physiologic changes caused by a particular gland fail to appear, it is, therefore, natural to assume that the gland is deficient. It must not be forgotten, however, that such changes are produced not only by the activity of the hormone in question but also by the ability of the end organ to react to that hormone. Furthermore, if there is evidence of activity of a certain gland, as determined by biological tests which even now are relatively crude, the product of that gland may fail to produce a reaction in the end organ because the hormone may be present in an inactive form. A clear conception of these principles should simplify diagno...