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C C Shullenberger

Publications and source records attributed to C C Shullenberger.

12 recordsLinked to original sources

Electrocardiographic changes after adriamycin chemotherapy.

The electrocardiograms of 146 patients with metastatic carcinoma of the breast were reviewed before, during, and after the patients received Adriamycin (Doxorubicin) chemotherapy (AD). The most significant electrocardiographic change occurred in the amplitude of the QRS voltage. Seven patients developed cardiomyopathy after AD and showed a significant decrease in QRS voltage. This decrease, however, was more severe at the onset of congestive heart failure that at conclusion of Adriamycin. In 35 patients with pleural effusion, there was an inverse relation between the extent of the effusion and the amplitude of QRS voltage in the absence of congestive heart failure. These results indicate that 1) the sudden and relatively severe decrease in QRS voltage with the onset of CHF limits the value of this ECG criterion for predicting early Adriamycin toxicity, and 2) caution should be exercised in the interpretation of QRS voltage changes in patients with significant pleural effusion.

Breast Neoplasms

Regional pulmonary function in scimitar syndrome.

Analysis of regional pulmonary function distribution using radioactive 133xenon gas and eight scintillation detectors was performed in a patient with scimitar syndrome. Zonal ventilation per unit of lung volume within the slightly hypoplastic right lung was normal. The pulmonary blood flow to the lower right zone was significantly reduced due to aberrant systemic arterial supply to the right lower lobe. The 133xenon technique provides a simple nontraumatic method of evaluating the functional integrity of the right lung in this cardiopulmonary syndrome.

Adult

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

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

Hodgkin's disease.

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B-Lymphocytes

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

Regional pulmonary function before and after pneumonectomy using 133xenon.

Regional pulmonary function studies using 133xenon gas, spirometry, and arterial blood gas levels were performed before and 1 to 47 months after pneumonectomy for bronchogenic carcinoma in 27 patients. The mean loss in forced vital capacity was more after right pneumonectomy (44.9 percent of preoperative value) than after left lung resection (41.4 percent). There was no significant change in regional pulmonary function distribution within the remaining lung in 24 patients. Two patients developed significant changes in regional pulmonary blood flow; one had hepatic cirrhosis, and the other sustained a myocardial infarction after pneumonectomy. The third patient with significant apical hyperperfusion before pneumonectomy gradually developed abnormal distribution of ventilation concomitant with electrocardiographic evidence of cor pulmonale within two years after pneumonectomy. The mean ventilation of the apical zones was significantly lower than the mean of 14 healthy subjects. This finding and the higher incidence of ventilatory defects were related to old age and heavy smoking. Seven patients with marked reduction of pulmonary blood flow to the tumor-bearing lung (9 to 33 percent of cardiac output) had technically successful pneumonectomy. A formula and nomogram were developed to estimate the prognostically significant forced expiratory volume in one second after pneumonectomy from the preoperative studies.

Age Factors

A clinicopathological study of stages I and II non-Hodgkin's lymphomata using the Lukes-Collins classification.

A series of 226 patients with Stages I and II non-Hodgkin's lymphomata, treated with intensive irradiation to the involved regions, were studied using the Lukes-Collins classification. A statistically significant difference was found in the length of survival of patients with the follicular and the diffuse types of lymphoma. A difference in survival was also observed among those with the 3 subtypes of follicular lymphomata. The extent to which the follicular pattern could be recognized and whether or not lymphoma cells were confined to the follicular structures likewise had a bearing upon the survival of patients with follicular lymphomata. In this series, no significant difference in survival was found between the histological types of diffuse lymphoma. The relationship of the methods of staging to survival in this series, and the findings at staging laparotomy in other series suggest that the lymphangiogram is less valuable for detecting intra-abdominal disease in the non-Hodgkin's lymphomata than in Hodgkin's disease, probably because of the high incidence of involvement of mesenteric lymph nodes in the non-Hodgkin's lymphomata.

Abdominal Neoplasms

Growth of permanent lymphoid cell cultures from human source: tenth anniversary.

The authors developed 52 permanent lymphoid cell cultures from various human sources, mainly from neoplastic lymphoproliferative disease. These cultures are reviewed against the background of similar cultures obtained in several other laboratories. The peculiar features of these cultures are: 1) the phenomenon of lymphoblastoid transformation; 2) the production of both globulins and mediators of delayed hypersensitivity; 3) the presence of herpes type virus as related to etiology or autoimmunity; and 4) cytotoxicity and other assays for the demonstration of tumor-specific antigens.

Animals