Michael Hunter

Testicular seminoma. Results of the Yale University experience, 1964–1984

Eighty‐three testicular seminoma patients were treated with radiation therapy from 1964 through 1984. Seventy‐nine (95%) of the 83 patients had early disease that included 61 Stage I, 15 Stage IIA (pelvic or paraaortic lymph node involvement ≤ 5 cm), and 3 Stage IIB (pelvic or paraaortic lymph node involvement > 5 cm) patients. The 15‐year actuarial survival for this group of Stage I and II patients was 95% (±5%). Stage I patients were treated with a mean paraaortic/pelvic dose of 2924 cGy and only one patient developed recurrent disease. This recurrence was at the margin of the radiation field and probably represents a marginal miss. The Stage IIA patients were treated with slightly higher doses (mean, 3335 cGy) to the paraaortic/pelvic region and there were no recurrences. The three Stage IIB patients received tumor doses of 3245 cGy, 4090 cGy, and 4500 cGy, respectively, and there were no recurrences. Low dose prophylactic mediastinal and supraclavicular irradiation (mean, 2320 cGy) was used in 17 (94%) of the 18 Stage II patients and there were no mediastinal or supraclavicular recurrences. Four patients presented with advanced disease (one Stage III, three Stage IV) and the only disease‐free survivor was treated with cisplatinum‐based combination chemotherapy and radiation therapy. Three patients developed minor complications from the radiation therapy: one patient had persistent scrotal and leg edema and two patients treated with prophylactic mediastinal irradiation had chronic low leukocyte counts. Two of the 79 Stage I and II patients developed a second malignancy: one had bronchogenic carcinoma at the margin of a mediastinal field, and one had diffuse histiocytic lymphoma both in and out of the radiation therapy fields. The 15‐year actuarial probability of developing a second malignancy was 3.3%. Radiation therapy after operation is a successful treatment option for most patients with Stage I and II seminoma.

The Difficulty with “The Difficulties of Persuasion” (“Shuinan” 說難)

This chapter considers the place of “The Difficulties of Persuasion” (“Shuinan” 說難) both within the Han Feizi corpus and in early Chinese intellectual history generally. In contrast to those who have read it as evidence of the amorality or even the immorality of the Han Feizi author(s), I argue that the “Difficulties of Persuasion” should be read as Sima Qian 司馬遷 read the text in the early Western Han, i.e. as advice by a righteous persuader for righteous persuaders. In addition to considering the place of “persuasion” (shui 說) in the Han Feizi corpus, I also compare the text’s advice to persuaders with other writings on persuasion known from early China and ancient Greece.