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178 R a d i u m
Radium is applied bv tying unfiltered emanation tubes in the end
of an ordinary rubber finger cot. and packing it centrally or toward any
wall depending on the needs of the case. As a rule about 35 to 40 millicuries
are used for periods varying from 4S to 60 hours. This dosage,
of course, produces an intense caustic effect, but we believe that nothing
less will suffice. In 6 to 10 weeks slough and destroyed bone are gradually
cast off. As may be inferred, we place our main reliance on the
destructive qualities of radium, and not on cauterization or curettage.
Postoperative Treatment. During the weeks following the operation,
constant attention is given to the radiated area. Frequent irrigations
are absolutely necessary on the part of the patient, because when
the radium slough commences to form a very disagreeable odor is given
off. I-oose string)' necrotic tissue and fragments of destroyed bone
should be gently removed. If a large sequestrum forms, many weeks
may elapse before it loosens and separates. While in place, it is a constant
source of annoyance, because of pain and suppurative discharge.
Excessive granulation tissue may form about it, giving the false picture
of a recurrence. After the effect of the operative treatment subsides,
careful observation is made for possible neoplastic nodules that
have not completely regressed. If any such areas arc present, and they
appear to be enlarging, emanation tubes or filtered needles are applied.
But caution should be used in order not to treat unnecessarily, because
it is our experience that regression may continue, even though outward
radium effects have disappeared.
This series of cases from the Memorial Hospital records comprises
24 carcinomata of the antrum. Of these 12 were in females and 12 in
males.
The age incidence is as follows:
Decade
Cases
Fourth 3
Fifth 10
Sixth 5
Seventh 4
Eighth 2
Before being referred to the hospital 11 cases were surgically treated
for wrongly diagnosed empyema. Five sought the attention of a dentist
who extracted teeth for the relief of pain. Two cases were operated
on intranasal'y one or more times for obstruction. One patient had a
complete resection of the upper jaw with a large recurrence.
Cervical nodes were present only three times. In one case on account
of patient's poor general condition, emanation tubes were inserted
and no attempt made to do a complete neck dissection. In all
except four instances, roentgenographs examination revealed the destruction
of one or more of the walls of the antrum. It may. therefore,
be concluded that the cases taken as a group were far advanced.
The results of treatment are briefly as follows:
Four cases were unimproved. These were hopelessly advanced.
All were in poor general condition, and died before the results of radiation
could be determined.
Four cases are showing a satisfactory response to the operative
treatment.
Eight cases were improved locally and generally, although they were