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Query: UMLS:C0019829 (Hodgkin's disease)
 30,247 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

95 splenectomies carried out at the General Surgery Division of the Busto Arsizio Circolo Hospital between 1967 and 1977 are reported. After some brief historical notes, stress is laid on those forms of primary or secondary splenopathy which are receptive to surgical intervention. Splenectomies with surgical indication (traumatic ruptures during other operations for various conditions) are distinguished from those with medical indication: Cooley, Werlhoff, Hodgkin, hair cell leukaemia, Banti. The clinical, haematological and physiopathological aspects responsible for splenic change are considered for each individual disease on the basis of personal experience.
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PMID:[Splenectomy. Medical and surgical indications (observations on 95 cases)]. 57 14

During July 1976 to Demember 1977, 150 patients with Hodgkin's disease and 138 with non-Hodgkin's lymphoma were examined by computed tomography (CT). In 45 cases 50 repeat examinations were conducted. Concurrent laparotomy and lymphography were performed on 68 and 56 patients respectively. The overall incidence of false-positive CT examinations as confirmed by laparotomy was 7.4%. In 18 patients with non-Hodgkin's lymphoma in the abdomen there was good correlation between the two techniques. Of the 50 patients with Hodgkin's disease who underwent laparotomy, 17 had splenic disease and 14 minimally enlarged lymph nodes in 20 areas; CT, however, detected only four diseased spleens and five minimally enlarged lymph nodes. Nevertheless, CT often detected enlarged lymph nodes missed by lymphography and was 23% more efficient than lymphography in detecting unsuspected disease. CT also detected unsuspected disease in patients with relapse of lymphoma. CT may replace other non-invasive investigations of abdominal disease in patients with lymphoma and give a reliable guide to prognosis. It does not, however, eliminate the need for laparotomy in staging Hodgkin's disease.
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PMID:Computed tomography of abdomen in staging and clinical management of lymphoma. 73 36

The question was raised whether routine splenectomy might, by virtue of its effects on the receipt of subsequent chemotherapy, offer long-term benefits to patients with advanced Hodgkin disease. Therefore, we compared followup data from a group of patients who were receiving mechlorethamine hydrochloride, vincristine sulfate, procarbazine hydrochloride, and prednisone (MOPP regimen) and who had had splenectomies to a group of similarly treated, carefully matched control patients on the MOPP regimen who had not had splenectomies. Our results indicate no important difference in duration of survival or long-term remission status. There was only a suggestion that splenectomy in such patients may be followed by impaired resistance to subsequent infections. Therefore, although early splenectomy can be important in the assessment of splenic disease, it must not be considered to be a therapeutic procedure per se.
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PMID:Splenectomy, chemotherapy, and survival in Hodgkin disease. 84 52

Ninety-eight patients with clinically localised Hodgkin's disease underwent laparotomy and splenectomy to determine the extent of microscopic spread. In 68 patients the procedure was carried out for untreated disease apparently confined above the diaphragm. Abdominal disease cannot be confidently excluded on the basis of non-invasive investigation at presentation. Clinical assessment of splenic disease was unreliable unless gross splenomegaly was present. Pedal lymphography was accurate in assessing para-aortic and iliac disease but of no value in assessing other intra-abdominal lymph node involvement, including that of the mesenteric lymph node. Trephine bone marrow biopsy findings were normal in all patients before surgery, and only one patient was found to have diseased bone marrow by Stryker-saw biopsy at operation. Liver disease was identified at operation in nine patients, some of whom were asymptomatic with clinically undetectable splenic and nodal disease. Detailed clinical staging failed to detect disease in one-third of patients who underwent laparotomy. These studies show that if radiotherapy is to remain the treatment of choice for disease truly localised to lymph nodes a detailed staging procedure, including laparotomy and splenectomy, remains essential. The value of this potentially curative treatment is considerably diminished in the patient who has been inadequately staged.
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PMID:Intensive investigation in management of Hodgkin's disease. 100 Feb 27

Accurate staging is critical for the proper treatment of Hodgkin's disease. In the past 5 yr, 60 children with Hodgkin's disease were staged by celiotomy which included splenectomy and biopsy of liver, retroperitoneal lymph nodes, and bone. Fifty children underwent staging celiotomy at initial diagnosis (Group I). Ten others were staged surgically because of suspected reactivation of disease diagnosed and treated before current staging methods were employed (Group II). Forty-one of 50 children in Group I had Stage I or II disease, seven Stage III, and two Stage IV. As a result of operation, therapy was altered in seven children. Three had a higher stag e and four a lower stage than that suspected by clinical evaluation, including two with liver involvement. Of the two patients in Group II, celiotomy revealed unsuspected splenic disease in seven, including one with liver involvement. Celiotomy and splenectomy were well tolerated and no long-term complications have been noted (average follow-up 2 yr). Forty-nine of 50 children in Group I and six of ten in Group II are alive without disease. No cases of sepsis attributable to splenectomy have been observed.
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PMID:Experience with clinical and operative staging of Hodgkin's disease in children. 114 48

Treatment recommendations for patients with upper abdominal Stage IIIA Hodgkin's (III1A) disease have varied widely. The current study reports on a combined institutional retrospective review of 85 patients with surgically staged III1A Hodgkin's disease. Twenty-two patients received combined modality therapy (CMT), 36 patients were treated initially with total nodal irradiation (TNI), and 27 with mantle and para-aortic radiotherapy (MPA). Patients treated with CMT had an actuarial 8-year freedom from relapse (FFR) of 96% as compared to a FFR of 51% in TNI treated patients (p = 0.002), and a FFR of 54% in MPA treated patients (p = 0.004). Of the 11 relapses in MPA treated patients, 7 had a component of their failure in the untreated pelvic or inguinal nodes. The patients treated with CMT had an 8-year actuarial survival of 100% as compared to 79% in TNI treated patients (p = 0.055) and 78% in patients treated with MPA (p = 0.025). Histology and the number of splenic nodules were the most important prognostic variables. Patients with MC/LD histology and greater than or equal to 5 splenic nodules have a high risk of relapse (10/13) when treated with radiation alone (TNI or MPA). We recommend CMT for this group of patients. Patients with NS/LP histology and 1-4 splenic nodules represent a favorable subset of Stage III1A patients. Only 4/21 patients have relapsed and all 21 patients are currently alive without disease regardless of treatment. We currently feel that patients with Stage III1A Hodgkin's disease with NS/LP histology and splenic disease limited to 1-4 nodules are good candidates for MPA as an alternative to TNI or CMT.
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PMID:Treatment of patients with "minimal" stage IIIA Hodgkin's disease. 330 42

Hodgkin's disease may now be managed with several different regimens with the expectation of curing approximately 90 per cent of patients. Radiotherapy alone achieves this cure rate only in unilateral high cervical or inguinal stage 1 presentations. With all other presentations, radiotherapy requires the addition of chemotherapy to sustain the 90 per cent cure level. Combined modality regimens offer the patient the advantage of reduced doses of each modality in terms of number of Gy and courses of chemotherapy. The contribution of the staging laparotomy to combination therapy is now being questioned. This issue becomes pressing as imaging of the lymphatic system and commonly involved extranodal sites of disease is improved by computed tomography, magnetic resonance, and ultrasound technology. Only the spleen escapes adequate examination. The failure of imaging techniques to adequately determine the status of the spleen is compensated by the chemotherapy sensitivity of splenic disease, as often demonstrated in the treatment of patients with stage IV disease. Staging laparotomy for preadolescent children should be done on special indications, because splenectomy confers a life-long (50 years or more) threat of overwhelming infection despite administration of pneumococcal vaccine and the use of oral penicillin prophylaxis. The use of radiotherapy in a dose range that inhibits bone and dental development in immature, preadolescent children can no longer be condoned. Treatment with chemotherapy alone must be considered as the option for preadolescent and younger adolescent children. Radiotherapy in a low dose range (2000 to 2200 cGy) in combination with chemotherapy constitutes a possible alternative treatment. In combined therapy regimens, it appears unnecessary to deliver six full courses of chemotherapy because regimens using three or four courses have demonstrated effectiveness in adults with early stage disease. The selection of the chemotherapy regimen should be made with care so as to eliminate drugs causing sterility in the young male, ovarian dysfunction in females, and second malignant tumors including acute myeloid leukemia (AML). In addition, doxorubicin should be used only in noncardiotoxic cumulative doses. Pretreatment determinations of the cardiac ejection fraction provide some assurance of safety during doxorubicin therapy.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Hodgkin's disease in children. 332 75

The clinical records of 1,616 patients with previously untreated Hodgkin's disease were reviewed. Forty-nine of these patients (3%) presented with disease limited to sites below the diaphragm and underwent laparotomy as part of their staging evaluation. The clinical and histological characteristics of this group of patients with subdiaphragmatic Hodgkin's disease are compared with those who presented with supradiaphragmatic disease. Splenectomy in 47 patients revealed splenic involvement in 16 (39%), and bulky splenic involvement (more than five gross nodules) in ten (24%). The final pathological stage (PS) distribution was PS I = 8, PS II = 37, PS IV = 4. No clinical stage (CS) IA patients and only two of 20 patients with negative paraaortic nodes on lymphogram had splenic involvement in contrast to eight of nine CS IIB patients. Freedom from relapse and survival were similar to patients with equivalent stage supradiaphragmatic disease. Splenic involvement and bulky splenic involvement were associated with a significantly decreased survival. Twelve out of 44 PS IA to IIB patients relapsed. In eight of these 12 patients, relapse was limited to sites above the diaphragm and another two patients relapsed both above and below the diaphragm. Patients who received total lymphoid irradiation were less likely to relapse above the diaphragm than patients who received no supradiaphragmatic irradiation. We recommend that CS IA and IIA patients with subdiaphragmatic disease undergo staging laparotomy and receive supradiaphragmatic irradiation as part of their treatment. Laparotomy may not be necessary for CS IIB patients who are at high risk for splenic disease if chemotherapy is planned as part of their treatment program.
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PMID:Subdiaphragmatic Hodgkin's disease: laparotomy and treatment results in 49 patients. 359 9

From April 1972 to September 1979, 121 patients with Hodgkin's disease clinical stages IInA, IB, IIB or III successively received MOPP 6 courses in a first trial and 3 courses in a second trial, prior to extended field irradiation; 118 patients underwent surgical restaging prior to irradiation. Anatomical findings demonstrated that 3 courses of MOPP were as effective as 6 courses to treat occult splenic disease. Comparison between clinical and surgical restaging confirmed the reliability of clinical criteria of complete remission after chemotherapy. After extended field irradiation, actuarial survival and relapse-free survival at 4 years were the same whether the patients had received 6 or 3 courses of MOPP.
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PMID:[Hodgkin's disease: analysis of a reduction of chemotherapy]. 622 16

Between 1972 and 1979, 121 patients with Hodgkin's disease (clinical Stages IInA, IB, IIB, and III) were treated by two different, successive, therapeutic protocols. The first group received six MOPP (mechlorethamine, vincristine, procarbazine, prednisone) cycles before radiotherapy, whereas the second group received only three MOPP cycles before irradiation. A total of 118 patients underwent surgical restaging with splenectomy before irradiation. Clinical criteria used in defining complete remission were verified by surgical restaging. Three MOPPs were just as effective as six MOPPs when combined with radiotherapy in achieving complete remission and in treating occult splenic disease. Following extended-field irradiation, complete remission rates were 96% for three MOPPs versus 94% for six MOPPs. The actuarial survival rates, 4 years after therapy completion, were 89% for three MOPPs and 94% for six MOPPs, with a relapse-free survival rate of 88% and 96.6%, respectively.
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PMID:Combined modality in Hodgkin's disease. Comparison of six versus three courses of MOPP with clinical and surgical restaging. 638 1


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