In an attempt to reduce some of the delayed sequelae associated with combined modality therapy in Hodgkin's disease, we randomly tested stages IIB, IIIA, and IIIB MOPP (mechlorethamine, vincristine, procarbazine, and prednisone) v ABVD (Adriamycin, bleomycin, vinblastine, and dacarbazine). In 232 previously untreated patients, three cycles of either combination preceded and followed extensive irradiation. The complete remission rate was 80.7% following MOPP and 92.4% following ABVD (P less than .02). The 7-year results indicated that ABVD was superior to MOPP in terms of freedom from progression (80.8% v 62.8%; P less than .002), relapse-free survival (87.7% v 77.2%; P = .06), and overall survival (77.4% v 67.9%; P = .03). Moreover, the comparative iatrogenic morbidity showed that irreversible gonadal dysfunction as well as acute leukemia occurred only in patients subjected to MOPP, while cardiopulmonary studies failed to document significant laboratory differences between the two treatment groups. Present findings indicate that ABVD followed by extensive irradiation represents a valid therapeutic alternative to the widely used alkylating agent-containing regimens plus radiotherapy.
The introduction of unipolar lead cardiography has renewed interest in the cardiographic diagnosis of biventricular hypertrophy or strain. East and Bain (1948) stated that this diagnosis could often be made with the help of unipolar leads, but recent studies by Garouso et al. (1949), Soulie et al. (1949), Rosenman et al. (1950),and .Levine and Phillips (1951) do not entirely support this view. The following investigation was undertaken to determine the frequency of cardiographic findings in this condition and, if possible, to establish reliable criteria for the diagnosis. CASE MATERIAL AND METHODS Three groups were studied: Group I-26 patients with isolated right ventricular hypertrophy; Group II-30 patients with isolated left ventricular hypertrophy; and Group 111-51 patients with right and left ventricular hypertrophy. Autopsy confirmation was obtained in all cases and unipolar as well as standard bipolar leads were recorded in all, using a Vector photographic machine and a Sanborn " Visocardiette " direct-writing instrument. Unipolar limb and chest leads were recorded by the technique of Goldberger (1947) (1 cm.=15 mv. for limb leads. 1 cm.=1 mv. for chest leads). The standard limb leads have been omitted from the analysis since they did not contribute any information not obtainable from a study of the unipolar leads. All age groups were represented. Cases of ischoemic heart disease, cardiac infarction, or cardiac aneurysm were excluded. Right bundle branch block was present in 3 cases in Group III, and left bundle branch block in 4 cases in Group II and 4 cases in Group III; these cases were excluded from the analysis of cardiographic signs, but were retained in the series as a whole. kTIOLOGY AND PATHOLOGICAL CRITERIA OF VENTRICULAR HYPERTROPHY All the common causes of heart disease were found, the most frequent being: in Group I pulmonary heart disease; in Group II, hypertension; and in Group III, combined aortic and mitral valve lesions, and pulmonary heart disease associated with systemic hypertension. Three degrees of hypertrophy were recognized. For the right ventricle, a thickness of the wall of 5 to 7 mm. was denoted by +, 8 to 10 mm. by ++, and more than 10 mm. by +++; for the left ventricle, 15 to 18 mm. was denoted by +, 19 to 24 mm. by + +, and more than 24 mm. by + + +. In the few cases in which the wall was not measured in millimetres, an assessment was made in keeping with the above criteria, and based on the weight of the heart. Measurements were made at the outflow tract region of the right ventricle, the maximum muscle thickness being recorded, in both ventricles. CARDIOGRAPHIC CRITERIA OF VENTRICULAR HYPERTROPHY The features of isolated hypertrophy of the left or right ventricle respectively which were studied have been based on criteria used in this department and on work by Goldberger (1947), Sokolow and Lyon (1949), and Myers (1948 and 1950). The findings indicative of hypertrophy of both ventricles in Group III were derived from these criteria.
The role of chronic cardiopulmonary disease as a risk factor for immediate and late mortality was evaluated retrospectively in a consecutive series of 116 patients who had had resections for stage Ia non-oat-cell lung cancers. The presence of chronic cardiopulmonary disease was diagnosed on the clinical history and preoperative assessment of lung and heart function by traditional means. Patients with chronic cardiopulmonary disease showed a lower five-year survival rate than controls-35% versus 53% (p < 0.08). The difference increased and became significant if besides having cardiopulmonary disease the patient was over 60 years of age or had had a pneumonectomy-30% versus 52% (p < 0025). A higher operative mortality was the main reason for the lower observed survival. Nevertheless, survival of patients at risk exceeded 30% in each subgroup, being 33% for patients over 60 undergoing pneumonectomy. In our series the benefits of resection of lung cancer in patients with impaired cardiopulmonary function were greater than the risks of perioperative and later death even in the groups with a poorer prognosis.
Two cases of 5-fluorouracil cardiotoxicity, resulting in one patient in myocardial infarction, are described. A review of the literature confirms that cardiotoxicity is a rare but genuine complication of 5-fluorouracil treatment; the cardiotoxic effect seems to range from mild angina without persistent electrocardiographic changes to severe myocardial infarction. No factors predictive of this complication were identified. The authors therefore feel it is advisable to stop 5-fluorouracil treatment when precordial pain occurs, even if the ECG (after angina) is normal, since angina can in some cases result in myocardial infarction.
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