A double-blind study of Grenz ray therapy in chronic eczema of the hands

The effect of Grenz ray therapy as an adjunct to topical therapy in chronic symmetrical eczema of the hands was assessed in 24 patients by randomly allocating active treatment to one hand while the other, which received simulated therapy, served as a control. Three Gy of Grenz rays were applied on six occasions at intervals of 1 week. There was a significantly better response to active treatment 5 and 10 weeks after the start of treatment compared with the untreated control.

Comparison of Grenz rays versus placebo in the treatment of chronic hand eczema

A double-blind trial was performed on 30 patients with bilateral symmetrical constitutional hand eczema, resistant to previous treatment. There was no difference in efficacy between Grenz rays in a total dose of 900 rad (9 Gy) given in three equal doses at 21-day intervals, and placebo therapy given in a similar treatment schedule.

Skin cancer caused by grenz rays

A 30-year-old woman developed chronic radiodermatitis and five squamous cell carcinomas within 7 years following a 16-year period of repeated grenz irradiations given to her psoriasis. The estimated cumulative dose of grenz radiation was approximately 3,000 rads (r) to each treated area. This case, illustrating a rather underestimated carcinogenic potential of grenz rays, is interpreted in light of the available literature on the subject. The technical bases of grenz ray therapy are also briefly reviewed.

Electron microscopic observations of Langerhans' cells in human epidermis irradiated with grenz rays

The effect of grenz rays on Langerhans' cells and epidermal morphology was studied at electron microscopic resolution in humans. Biopsies were obtained before and after grenz ray therapy (3 Gy X 3, 1 week interval) from 6 subjects. There was a pronounced reduction of the number of Langerhans' cells 24 hours after the final treatment. There appeared to be no consistent differences in keratinocyte morphology or changes of the intercellular space.

[An extremely long Abbé flap for simultaneous reconstruction of a defect of the upper lip and the columella]

X-ray treatment of a small haemangioma of the upper lip in a child led to severe health consequences, about 20 years later. Besides an extremely hypoplastic upper lip with whistle tip deformity, an exulcerated basal-cell carcinoma had developed upon the columella and the lower part of the nasal tip. The goal of the operation was to perform a radical excision of the tumor but also to obtain an aesthetically pleasing reconstruction of the upper lip and a simultaneous covering of the defect, resulting from the tumor excision on the columella and the nasal tip. To achieve this, we have chosen an Abbé-flap, with an extremely long cutaneous pedicle. While in Abbé-flaps the relation between muscular and cutaneous part usually is about 1:2, in this case it was about 1:5. With this flap it was possible to cover in one stage the defect in the upper lip, the columella and the nasal tip.

Polyvinylpyrrolidone (povidone) storage in RX-damaged skin following procaine-povidone intramuscular injections

A man, aged 67, has been treated in 1968 by X-rays for a basal-cell carcinoma of the back. The treatment was followed by an ulcerative radiodermatitis. 3 years later, the patient was treated by ten intramuscular injections of procaine-polyvinylpyrrolidone (or procaine-povidone) for sciatic neuralgia. An orange infiltration appeared progressively around the radiodermatitis. The area was excised in 1979 and polyvinylpyrrolidone (povidone) storage, responsible for the ring-shaped orange hue, could be demonstrated in the dermis and subcutaneous fat. Special stainings confirmed the presumed chemical nature of the deposits. 3 cases of povidone pseudotumours following procaine-povidone injections had been described previously. The preferential deposit of povidone in RX-damaged skin is discussed.

Occurrence of tumors and effects on longevity after limited x-irradiation in man

An analysis was made of survival times and causes of death of patients given local irradiation in small dosage during 1948--1960. The study involved 61 patients with peptic ulcers in whom hyperacidity was treated by partial gastrectomy and gastric irradiation, and their mortality was compared with that of 61 age- and sex-matched gastrectomized but nonirradiated control patients. For both groups the survival rates were related to "normal population" survival rates calculated from age-, sex- and year-specific mortality rates for the population of Victoria. Ten years after irradiation the relative survival rates of the irradiated and control groups began to diverge, due to more deaths than expected in the irradiated group. The irradiated group had a significantly increased number of deaths due to cancer, particularly carcinoma of the stomach, as well as an increase in deaths not caused by cancer. The mortality of the nonirradiated control patients was not significantly greater than that of the normal population.

Adverse effects of superficial X-ray therapy and recommendations for safe use in benign dermatoses

The danger of superficial radiotherapy for benign dermatoses has been exaggerated. It is safe if certain precautions are observed. The permissible life time maximum cumulative dose of conventional superficial X rays generated at 50 kV given to any area of skin is 1000 R, and of grenz rays, 5000 R.

Surgical and external ureteric trauma

This paper details the aetiology, presentation, diagnosis, prophylaxis, treatment, and results, of 84 surgical and external ureteric injuries. Although the incidence of surgical ureteric trauma was found to be low it was related to both the particular operation performed and certain faults in surgical technique. The series emphasizes the importance of prophylaxis, early diagnosis, and specific therapy. There were 94 operations carried out on the 84 ureters, resulting in 22 nephrectomies and 63 open repair procedures, of which 55 were regarded as successful and 8 as failures.

Acquired coarctation of the aorta--a long-term complication of irradiation

Images

Hypothyroidism after x irradiation to the neck: three case reports and a brief review of the literature

Three patients who developed hypothyroidism after x irradiation to the neck are presented. The first two cases demonstrate that patients can develop clinical and chemical hypothyroidism after a very short interval following radiotherapy. Hypothyroidism developed in the first patient in the absence of surgical manipulation of the neck, or a large iodine load 4 months after receiving 6800 rad of x-ray therapy to his neck for carcinoma of the larynx. The second patient developed hypothyroidism approximately 6 months after his radiotherapy for carcinoma of the esophagus. Both of these patients demonstrated high titers of serum antithyroid antibodies. A third patient with Hodgkin's disease did not manifest clinical symptoms and signs of hypothyroidism until 6 years after radiation therapy. These cases demonstrate the variability of onset of hypothyroidism after radiotherapy and emphasize the need for careful evaluation of thyroid function before and after neck irradiation.

Comparison of 99mTc and 123I for thyroid imaging

Thyroid images were obtained with 99mTc and 123I, using a scintillation camera and pinhole collimator, from 85 patients selected from over 1,000 patients predisposed to the development of thyroid neoplasms by prior radiotherapy. In 66 of 85 patients 99mTc and 123I gave essentially similar information, whereas in 19 patients some thyroid-image disparity was seen. In 11 of these 19, focal areas of increased 99mTc concentration were not seen with 123I. Radioiodide images showed slightly better contrast than the 99mTc images but required a longer imaging time and usually did not provide more information; in a few cases 99mTc showed abnormalities more readily. Regardless of which radionuclide was used, oblique views were needed to define some abnormalities. Currently 123I does not provide significant advantages over 99mTc for routine thyroid imaging. However, 123I is preferred in patients with very poor thyroid function and in those with suspected retrosternal thyroid tissue. In addition, areas of increased 99mTc concentration should also be studied with 123I.

Late effects of x irradiation in patients treated for metropathia haemorrhagica

We have previously reported on the causes of death among 2,068 patients treated with X irradiation for metropathia haemorrhagica at three Scottish radiotherapy centres between 1940 and 1960 (Doll and Smith, 1968). This cohort of women has now been followed up for a further seven years. 500 (24 per cent) women have now died, 78 (3-8 per cent) have emigrated and 25 (1-2 per cent) could not be traced. The numbers of deaths from different causes have been compared with the numbers expected in a population of similar age and sex exposed to the Scottish national mortality rates over the same period. An excess of deaths from leukaemia (seven observed, 2-3 expected) and of cancers of the heavily irradiated sites (59 observed, 40-1 expected) continues to be observed five or more years after treatment. There is no indication of any change in the excess death rate, due to cancers of sites in the radiation field, with time since treatment up to at least 20 years after the radiation exposure. Over the same period the number of deaths from cancer of the breast was below expectation (ten observed, 22-3 expected) and no increased mortality from coronary disease was seen (102 observed, 100-9 expected). The mean dose of radiation to the bone marrow has been determined for each woman ant it is estimated that the excess rate of leukaemia in the first 20 years after treatment is about 1-1 per million women per year per rad. This figure is in accord with the estimates derived from the survivors of the atomic bomb explosions in Hiroshima and Nagasaki and among patients with ankylosing spondylitis treated with X irradiation. However, the finding of no excess risk of leukemia among women treated with irradiation for cancer of the cervix (Hutchison, 1968) suggests that the simple assumption of a linear dose-response relationship for leukaemia is incorrect, at least when high doses of radiation are delivered to a small volume of marrow.

Follow-up study of patients treated by X-ray epilation for Tinea capitis; resurvey of post-treatment illness and mortality experience

This is the second follow-up study of 2,215 persons who during childhood between 1940 and 1959 had been given x-ray therapy for tinea capitis and of 1,395 persons well matched for age, sex, and race who were treated for the same disease during the same period without the use of x-ray therapy. The major finding of the study was an excess incidence in the irradiated cases of tumors of the head and neck including the skin, brain, thyroid, and parotid. However, between the groups there was no difference in death due to malignant neoplasms or any other cause. Among white patients, a 40% excess of treated psychiatric disorders was observed in the irradiated group, but there was no difference among blacks.

The tricho system: hypertrichosis, radiation, and cancer

Five women in their 6th to 8th decades were treated for facial hypertrichosis in Erie, Pennsylvania, 30 to 40 years ago. The epilations were performed with an X-ray device called "Tricho System," which was manufactured, sold, and proclaimed safe by its physician-inventor. The beauty shop operator who administered these treatments may or may not have received "instruction" by the company in the operation of the equipment. At varying intervals, each of the 5 women developed radiodermatitis and basal cell and/or squamous cell carcinoma at the sites of epilation. All presented to the plastic surgical service at the Hamot Medical Center in Erie, Pennsylvania. Two underwent massive radical resective surgery, 2 required extensive excision and resurfacing, and 1 refused resective surgery although she had had a previous surgical attempt 17 years earlier. Case histories are presented in detail. This series is representative of the epidemic nature of Tricho-System-induced disease.