Search PubMed⌕ Search

Biomedical subjects

L M Fuller

Publications and source records attributed to L M Fuller.

At least 91 records · Page 5Linked to original sources
PubMed1982

Collaborative clinical trial for stage I and II Hodgkin's disease: significance of mediastinal and nonmediastinal disease in laparotomy- and non-laparotomy-staged patients.

In this study, 460 eligible patients with stage I and II Hodgkin's disease were randomized to treatment with involved field (IF) and extended field (EF) radiotherapy. Lymphangiogram was a requisite of the study. One hundred and seventy-seven patients were staged by laparotomy. The value of EF radiotherapy in improving survival over a 10-year followup was studied. This effect was considered separately for patents staged by laparotomy, for patients staged by lymphangiogram alone, and for patients with and without initial mediastinal involvement. A substantial benefit was seen for the subgroup staged by lymphangiogram alone and without mediastinal disease, with 10-year survival rates of 80% for EF and 56% for IF. For all other groups staged by laparotomy or having mediastinal presentations 10-year survival rates were essentially the same, differing by less than ten percentage points for IF and EF regimens. The advantage of EF treatment in lymphangiogram-staged nonmediastinal disease was realized only when the extended fields included the abdominal para-aortic area.

Hodgkin Disease↗
PubMed1981

Reassessment of prognostic factors in stage IIIA and IIIB Hodgkin's disease treated with MOPP and radiotherapy.

Prognostic factors have been re-evaluated for 88 patients with Stage III Hodgkin's disease to see if they have remained significant on a long-term basis. Treatment had consisted of two cycles of MOPP followed by radiotherapy to the mantle, abdomen, and pelvis; all patients had achieved complete remission. Case material was grouped according to the presence of absence of mediastinal disease. Five-year survivals for Stage IIIA and IIIB patients were 85 and 80%; corresponding disease-free survivals were 76 and 73%. Significant prognostic factors include age, histopathology, and extent of abdominal disease, but the relative importance of these factors differs for the mediastinal and nonmediastinal patients. Modifications of current treatment policy for both mediastinal and nonmediastinal patients are discussed in relation to the prognostic factors.

Adult↗
PubMed1981

Use of intravenous liposoluble contrast material for the examination of the liver and spleen in lymphoma.

An experimental contrast material has been developed that, after intravenous injection, selectively opacifies the spleen and liver on computed tomography (CT). The contrast material contains iodinated ester of poppy seed oil in an emulsified form. Clinical trials were recently initiated to test the value of this contrast agent in Hodgkin's and non-Hodgkin's lymphomas. We present here two of our initial patients in whom we found lesions in the spleen or liver following the infusion of the experimental contrast material that were not visualized on the precontrast and urographic contrast material enhanced CT scans.

Adult↗
PubMed1981

Treatment of stage I and II mediastinal Hodgkin disease. A comparison of involved fields, extended fields, and involved fields followed by MOPP in patients staged by laparotomy.

Three treatment programs for Stage I and II mediastinal Hodgkin disease (established by laparotomy) were compared. Involved-field radiotherapy + MOPP gave a disease-free survival rate of 97%, significantly different from 62% and 55% for involved and extended fields, respectively. Corresponding survival figures of 97%, 88%, and 84% were not significantly different statistically due to salvage with radiotherapy and/or chemotherapy. Among patients given radiotherapy alone, the survival figure of 94% for limited mediastinal disease was significantly better than 63% for extensive mediastinal and hilar disease; corresponding disease-free figures of 72% and 35% were also significantly different. Constitutional symptoms were an important prognostic factor in disease-free survival following the use of involved fields; hilar disease was important only with large mediastinal masses. Most relapses were intrathoracic; MOPP alone salvaged only 47%. Treatment of Stage I and II Hodgkin disease should be based on symptoms, extent of mediastinal disease, and hilar involvement.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1980

Laparotomy findings in lymphangiogram-staged I and non-Hodgkin's lymphomas.

Ninety patients with Stage I or II, including extranodal (E), presentations of non-Hodkin's lymphoma were investigated by laparotomy, either for the definitive staging of patients with peripheral presentations or for diagnosis of abdominal disease. Sixty-eight patients had staging laparotomies after extensive work-up, which included lymphangiography and bone marrow biopsy. The remaining 22 patients had laparotomies for diagnosis of abdominal symptoms or for management of unrelated surgical problems, with lyphoma being found incidentally. The incidence of positive abdominal findings in the 68 patients who had staging laparotomies depended on histologic subtype. In nodular lymphoma patients, abdominal disease was found in 17 of 28 (61%) and in diffuse lymphoma patients, in 9 of 40 (22.5%). For patients with nodular lymphomas upstaged by laparotomy, the positive findings tended to cluster around an axis consisting of the celiac, porta-hepatic, para-aortic, and root of the mesentery lymph nodes. In addition, 64% of these patients had splenic involvement. For the diffuse lymphoma upstaged by laparotomy, the distribution of positive findings was similar to that of the nodular lymphoma group; however, only 1 patient had splenic involvement. By contrast, in approximately half of the diffuse lymphoma patients who had laparotomies for diagnosis, the gastrointestinal tract was found to be involved in addition to the previously cited lymph nodes.

Abdominal Neoplasms↗
PubMed1980

Evaluation of the significance of prognostic factors in stage III Hodgkin's disease treated with MOPP and radiotherapy.

One hundred consecutive Stage IIIA and IIIB Hodgkin's disease patients were treated between July 1969 and September 1976, on a combined chemotherapy-radiotherapy program consisting of two courses of MOPP followed by radiotherapy to the mantle, abdomen, and pelvis. Eighty-eight patients completed radiotherapy to all disease sites. At the time of this analysis, the mean follow-up period for the 100 patients was 45 months; 70 patients had been followed three to seven years. Projected five-year survival and disease-free survival figures for the 100 patients were 80% and 68% respectively; corresponding results for the 88 patients were 90% and 78%. To determine whether any of the following prognostic factors influenced results for either the 100 or the 88 patients, survival curves were calculated for age, sex, constitutional symptoms, histopathology, method of staging, and status of the mediastinum. Other than age, none of these factors influenced survival significantly. However, disease-free survival figures were influenced adversely by mediastinal disease as well as age.

Adult↗
PubMed1980

Laparotomy staged I and II non-Hodgkin's lymphomas: preliminary results of radiotherapy and adjunctive chemotherapy.

Fifty-three non-Hodgkin's lymphoma patients staged I, IE, II, and IIE after laparotomy, received involved field radiotherapy with or without adjunctive chemotherapy. These cases have been analyzed for survival, disease-free survival, sites of relapse, and subsequent management. For nodular lymphoma patients, the five-year survival figure was 87%. While this represents only modest improvement over survival figures for patients staged I and II by lymphangiography, results for patients with upper torso disease were significantly better. Although there was a definite incidence of relapse, early failures common in the lymphangiogram series, were not seen in this study. Of the total group of 14 patients, 4 relapsed after a minimum complete remission period of 20 months. The five-year survival figure for all presentations of stages I and II diffuse histiocytic lymphoma was 85%. This represents a substantial improvement over the corresponding figure of 36% for patients staged clinically after lymphangiography. The improvement in results is credited to more precise staging of patients with peripheral presentations, the use of adjunctive multiple-agent chemotherapy for abdominal and mediastinal presentations, and more effective treatment for relapse. To date, too few patients with peripheral presentations have been treated to determine the value of adjunctive chemotherapy for nodular or diffuse histiocytic patients.

Aged↗
PubMed1977

Malignant lymphomas of the thyroid: a clinical pathologic study of 35 patients including ultrastructural observations.

The clinical and pathologic findings for 35 patients with malignant lymphoma presenting in the thyroid are reviewed. The lymphomas tended to occur in females with a median age of 65 years and clinically were manifested by a mass in the neck. The majority of patients were euthyroid and thyroid scans demonstrated cold nodules. In none of the patients was there clinical suspicion of lymphoma prior to surgery. Thirty-four of the cases were histiocytic lymphomas; the one exception; a patient with nodular poorly differentiated lymphocytic lymphoma, had histiocytic lymphoma in a subsequent biopsy of the soft tissues of the neck. Although classified as histiocytic, the lymphomas had the histologic and ultrastructural features of transformed lymphocytes or immunoblasts. Lending possible additional credence to the immunoblastic nature of these lymphomas was the histologic documentation of chronic lymphocytic thyroiditis in all 27 cases where residual thyroid parenchyma remained. This relationship suggests possible evolution of thyroid lymphomas from chronic lymphocytic thyroiditis and probably is analogous to the malignant lymphomas developing in other altered immune states, including Sjogren's syndrome. In the current study the overall 5-year survival was 54%. Patients under age 65, without local soft tissue extension or regional lymph node involvement, and with stage I disease survived the longest; a nodular histologic pattern also appeared to favorably influence the prognosis. Improved staging procedures and newer modes of therapy appear essential, particularly for those patients with clinical stage II disease and with local extension to soft tissues.

Adult↗
PubMed1977

New assessment of the prognostic significance of histopathology in Hodgkin's disease for laparotomy-negative stage I and stage II patients.

This paper describes preliminary radiotherapy results in 90 patients with Stage I and II Hodgkin's disease who were evaluated by laparotomy, including splenectomy, and liver and bone marrow biopsies. As a result of selection by laparotomy, the estimated five-year survival rate for these patients was 96%. No statistically significant differences were detected in the disease-free survival for patients with mixed cellularity, nodular sclerosis, and lymphocytic predominance disease. Since only one patient with lymphocytic depletion was in this series, no statement can be made regarding this rare histopathology. Patterns of new disease differed for Stage I and II patients. The major difference was that patients with nodular sclerosing Stage II presentations involving the mediastinum were at considerable risk of developing subsequent disease in the pulmonary parenchyma or the pleura. This finding, together with the demonstration that a histologic diagnosis of mixed cellularity did not carry an inferior prognosis, indicates the need for reassessment of the appropriateness of applying treatment programs based on results of lymphangiographically staged patients to Stage I and II patients evaluated by laparotomy.

Adolescent↗
PubMed1977

Team approach to management of non-Hodgkin's lymphomas: past and present.

A detailed review of our results of radiotherapy for stage I and II non-Hodgkin's lymphomas has been presented as background for our current multidisciplinary approach which uses multiple-agent chemotherapy, radiotherapy, and immunotherapy for nodular and diffuse stage I, II, and III lymphomas of the poorly differnetiated lymphocytic, mixed, and histiocytic varieties. Optimum management is based on coordinated efforts of medicine, radiotherapy, pathology, diagnostic radiology, and surgery. In stage I, II, and III disease, routine staging procedures include lymphangiography, bilateral iliac crest needle biopsies of the bone marrow, and percutaneous needle biopsies of the liver. Staging laparotomy is considered essential to our present program for stage I, IE, II and IIE disease. In our opinion, staging laparotomy is not indicated in stage II or IIIE disease. Although very preliminary, results for these programs are encouraging. This paper presents the concept of team management and a specific plan for its implementation.

BCG Vaccine↗
PubMed1976

Survival and complications of radiotherapy following involved and extended field therapy of Hodgkin's disease, stages I and II. A collaborative study.

A collaborative trial with random assignment to involved field or extended field radiotherapy for localized Hodgkin's disease was begun in 1967. Case accession was completed in 1973, with 224 eligible patients assigned to involved field and 243 to extended field. With a median follow-up time of 27 months no significant survival difference is found between involved and extended field regimens for the total patient group or for most subgroups defined by age, sex, histology, stage, class, and use of laparotomy for staging. A single exception is an improved survival in the involved field group for female patients. Survival free of distant extension shows a similar lack of treatment effect, but survival free of any extension, local or distant, shows a significant benefit from extended field treatment. Complications of radiotherapy are significantly increased following extended field treatment. Survival following local extension is similar to survival following periods free of any extension.

Adolescent↗
PubMed1976

Radiation-related myocardial injury. Management of two cases.

Pericardial effusion and trifascicular block developed 5 years following mediastinal irradiation for Hodgkin's disease in a 19-year-old patient. Another 24-year-old patients had an acute myocardial infarction followed by severe angina pectoris 5 years following mediastinal irradiation for the same disease. A pericardial window and a permanent demand pacemaker were used in the first case; an aorto-coronary vein grafting was utilized in the second patient. Both patients responded to treatment and are well. Five other previously reported cases of myocardial injury that occurred 2 months to 8 years following mediastinal irradiation in young patients were reviewed. To our knowledge, successful surgical treatment of this disease entity has not been reported before. Close, long-term follow-up of patients who have received mediastinal irradiation should be helpful in the early recognition and successful management of these serious cardiac complications. The systematic clinical and radiographic surveilance of these patients should be supplemented by a routine 12-lead electrocardiogram.

Adult↗
PubMed1975

Influence of staging celiotomy in localized presentations of Hodgkin's disease.

Staging celiotomy was performed in 139 previously untreated patients with lymphogram negative Stage I and II Hodgkin's disease. Sixteen additional patients received definitive radiotherapy for symptomatic relief of upper torso disease prior to abdominal exploration. The overall incidence of positive abdominal findings for these two groups was 34.5% and 31.2%, respectively. Further analysis of the 139 previously untreated cases revealed notable differences in incidence of positive abdominal findings for stage, presentation, and specific histology. Stage I patients with upper cervical or inguinal presentations or a lymphocytic predominance classification had negative celiotomies, as contrasted with a 43% incidence of positive abdominal findings in patients with supraclavicular presentations. In Stage II disease, the incidence of positive findings was related to the status of the mediastinum. For mediastinal presentations, the incidence was 33.3%, as compared to 48% for nonmediastinal presentations. To date, the number of relapses in celiotomy Stage I and II patients has been low regardless of whether or not prophylactic irradiation was administered to the major lymph-node-bearing regions of the upper and lower torso. Of 9 patients with progression, extranodal spread occurred as the first evidence of new disease in 4 patients. The implication of this finding is considered in a discussion on the influence of staging celiotomy in the management of Stage I and II patients with Hodgkin's disease.

Abdominal Neoplasms↗