Robert E. Fricke

Radium therapy in carcinoma of the female urethra.

Carcinoma of the female urethra is an uncommon but important disease. Its uncommonness is indicated by the small number of cases appearing in the literature. In 1933, Counseller and Paterson (1) found only 124 cases reported. To this number they added 12. In 1935 Menville and Counseller (2) estimated that a total of 149 cases had been published. Sparks and Parsons (3), in 1937, reviewed 119 cases and found references to 49 others. Nichol (4) stated that up to 1940 reports of 262 examples were available for study in the literature. The disease is important because, as is true of all carcinomas, if it is not discovered and adequately treated early, the outcome will be fatal. Review of Literature The principal articles reviewing large numbers of cases have already been mentioned. Further reference to them will be brief. Most authors mention the first case of carcinoma of the female urethra reported in 1833 by Mme. Boivin (5). In an early report by Shaw (6), in 1923, the methods of treatment were discussed. A...

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...

Radium Treatment of Granular or Hypertrophied Lateral Pharyngeal Tonsillar Bands1

Chronic pharyngitis is a painful and disabling affliction. The symptoms, findings and pathologic changes are fully described in textbooks on otolaryngology (7). The lymph follicles covering the entire pharynx and the nasopharynx undergo hypertrophy and the lymphoid cells around the ducts of the glands produce red, raised patches which are seen easily on inspection. This condition is the so-called granular pharyngitis. When the lateral pharyngeal tonsillar bands are hypertrophied, the infection usually is termed “lateral pharyngitis.” As Schenck (12) has pointed out, elimination of all infected tissue in Waldeyers ring cannot be accomplished by operative procedures alone. When operation is resorted to, compensatory hypertrophy subsequently occurs. Lillie stated that the faucial or palatine tonsil is the only one that can be completely removed surgically. After the operation there is a tendency, in some instances, for the lateral pharyngeal bands or the tonsillar plaque in the lateral pharyngeal wall to un...

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 ...

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...

Radon Ointment Treatment of Irradiation Ulcers1

Large irradiation ulcers with accompanying necrosis, infection, and sloughing, and often eventual malignant changes, have long been a serious therapeutic problem. Treatments designed for ordinary deep burns are not effective; the ulceration produced by atrophy of the skin and vascular obliteration is extremely indolent. Probably the only effective treatment has been excision and skin grafting. Because of the usual infection and malignant changes, along with the reduced blood supply, satisfactory results have not been frequent. Fortunately, fewer of these extensive ulcerations are now seen than formerly. Better understanding of the biologic effects of irradiation and the more accurate determination of dosage have contributed to this improvement. The tissues of some patients, however, prove abnormally sensitive to roentgen and gamma rays. Furthermore, to arrest many deep-seated cancers, irradiation has to be pushed to the limits of tissue tolerance. Instances of slowly developing, severe injuries from irrad...

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...

Treatment of Carcinoma of the Breast

IN THE Fall of 1925 two patients with cancer of the breast were referred to me by Dr. A. B. Glascock, of Baltimore. The difference in response to radiation therapy and in the progress of the disease in the two cases presents certain points of interest. Case 1. Mrs. J. R. R., aged 70, was admitted September 28, 1925, with a deeply ulcerated growth of the right breast, the whole mass measuring 9 x 14 cms. (Fig. 1). The growth was bathed in a very foul discharge. There were several skin implants near the main lesion. The growth had commenced three years previously. For the past two years electrical treatments (nature unknown) had been given by a doctor in New York City, without effect on the lesion. No metastatic glands were detected. Tissue examination showed adenocarcinoma. The Wassermann was negative and the X-ray of the chest was clear. The patient had lost 26 pounds in the last two and a half years; her weight was now 92 pounds. The prognosis in this case was very bad. We hoped for palliation over a few...

Further Observations on the Radium Treatment of Postoperative Parotitis1

Acute parotitis has always been recognized as a serious condition. It has been the object of extensive research and much capable experimentation; many excellent statistical studies have been reported. One of the first reports of acute parotitis appeared in the Lancet in 1829 (11). In this case the disease progressed to gangrene in spite of incision and drainage. In 1834 Brodie, in a clinical lecture, distinguished acute parotitis from epidemic parotitis, or mumps, and stressed the seriousness of the condition; he mentioned that when it appears as the termination of some other disease it usually indicates approaching dissolution. The disease was first accurately studied from a pathologic standpoint by Virchow, in 1858 (7). Acute postoperative parotitis was recognized in 1878, when Munde reported a case following ovariotomy. In 1880 Moeriche reported that the disease occurred in 5 of 200 patients in whom ovariotomy was performed (2). The old well known association between the parotid and genital organs, as ...