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A retrospective evaluation of the data of all patients with Hodgkin's disease (collective of Freiburg) treated between 1964 and 1977 was made in order to find out if there was an increased risk of infection after a diagnostic laparotomy with splenectomy (LS). Among a total number of 592 patients, 277 had been submitted to LS (since 1969). 185 patients had a total remission, 130 of them after primary LS, 34 after secondary LS, and 21 without any treatment of the spleen. An inquiry conducted by means of a questionnaire showed no differences between the compared groups as to the frequency of not septic infections such as pulmonary tuberculosis, angina tonsillaris, pyodermia, sinusitis, complications in wound healing, urinary tract infections, and infections of the intestine. However, there was a significant increase of unspecific pneumonias and herpes zoster manifestations after (long-term observation) secondary LS. There were no differences regarding the frequency of febrile and not febrile colds, but after LS, the colds had a longer and more severe course.--The analysis of the cause of death in the 277 patients who died showed a lethal septicaemia in seven cases. All these patients had been submitted to LS. In three of these patients, a recurrence was proved or could not be excluded, four presented as total remission with respect to Hodgkin's disease.--These results and the communications of literature permit to conclude that the iatrogenic asplenia represents an additional immunological risk. They suggest a further reduction of the indication for LS, the criteria of which are discussed.

A correlation between the NAD metabolism and DNA synthesis, that means cell proliferation, was observed in the course of experimental studies using mouse tissues. The present studies revealed a similar correlation also in splenic tissues of patients with Hodgkin's disease. The enzymatic activities of NAD-pyrophosphorylase and NAD-glycohydrolase were measured in detail in isolated cell nuclei. NAD-pyrophosphorylase activity was particularly increased in patients with Hodgkin's disease. A decrease of enzymatic activity was seen following radiation therapy, and especially 24 hours after local irradiation of the spleen with 200 rd(60Co). These studies are in accordance with former results obtained in mice.

The post-therapeutic pregnancy data of 122/244 women aged until 40 years who had been treated primarily in Freiburg i. Br. for Hodgkin's disease between 1949 and 1981 were obtained by an inquiry based on questionnaires. All of the 122 patients of the questionnaire group were in remission. 39 out of them (32%) became pregnant one or more times; 38/94 (40%) of these had been irradiated down to the promontory and 1/17 (6%) had been submitted to an irradiation including the pelvis with ovariopexy. The resulting 63 post-therapeutic pregnancies leaded to 41 normal births (65%), three premature infants (5%), two viable children suffering from malformations (3%) and five spontaneous abortions (8%). An interruption was performed in twelve cases (19%). There were no significant divergences from distributions of normal populations with regard to the percentages of normal births and negative variants, even under consideration of comparable literature reports. Neither in the questionnaire group nor in the group of 122 patients whose gynecologic data could only be evaluated by means of the medical records available, there was any indication suggesting an increased risk of morbidity or mortality.

Phytohemagglutinin-stimulated DNA-synthesis of lymphocytes was measured in 35 patients with Hodgkin's disease in continuous remission 1 to 8 years after intensive high-energy radiotherapy. In comparison to a normal control group we found there was no significant difference between the values of patients in complete remission and healthy subjects. We conclude that the extremely suppressed lymphocytic reactivity as measured by DNA-synthesis during irradiation may again reach normal values one or two years after radiotherapy.

From 1948 through 1977, 151 patients with an epipharyngeal tumor underwent radiation therapy at our department. A retrospective analysis was made reviewing treatment results and prognostic features. The 5-year survival rate of the total group amounted to 39%, the 10-year survival to 27%. Tumor stage and histology were confirmed as the preponderant factors in prognostication. Stage T1--2 cases had a 5-year survival rate of 57%, which decreased to 46% if unilateral lymph node metastases had occurred, and down to 17% in case of bilateral metastasition to the lymph nodes. Of stage T3--4 patients, 45% survived during 5 years. Lymphoepithelial carcinoma, with a 5-year survival rate of 54%, had a better prognosis than squamous cell carcinoma (47%), transitional cell carcinoma (30%) and reticulum cell sarcoma (30%). A review of the results other authors have obtained since 1956 with combinations of surgical and irradiation methods gives evidence that the efficiency of techniques confined to local or regional treatment has reached its limits. At present, further improvement may be achieved mainly by means of systematically applied adjuvant chemotherapy complementary to the general thérapeutic concept.

Esophago-gastro-duodenoscopies with multiple mucosa biopsies were performed before and after irradiation of the mantle field or the spleen pedicle in 13 patients with Hodgkin's disease in stage I and II. For the irradiation the photons of a 4 MeV linear accelerator were applied with focal doses of 40 to 44 Gy. Contrast simulator radiographs were made in order to verify the position within the irradiation field of the organs from which biopsies were taken. In 0/10 patients examined before the irradiation, 0/5 patients examined less than 15 weeks after the irradiation, and 0/12 patients examined 15 weeks or later after the irradiation, histomorphologic investigation of the mucosa of the esophagus showed no pathologic findings. With the same intervals of examination related to irradiation, the gastric mucosa showed a pathologic histomorphology in 1/13, 7/9, and 5/9 patients, respectively, and the duodenal mucosa in 0/13, 5/9, and 2/9 patients, respectively. With the exception of one ulcer in the duodenal bulb the histopathologic findings as well as the macroscopic findings were neither significant nor characteristic, i.e. not radiospecific. Most of these findings were inflammatory alterations of the mucosa, erosions, and capillarectasies.