Solitary cerebral metastasis from a papillary carcinoma of the thyroid.

A woman aged 52 was treated with radioactive iodine for a papillary carcinoma of the thyroid. Four years later she developed signs and symptoms of an intracranial space occupying lesion. A computed tomographic scan showed a mass in the right posterior frontal region.

Total lymphoid irradiation preceding bone marrow transplantation for chronic myeloid leukaemia.

Between August 1985 and October 1987 we treated 35 patients with chronic myeloid leukaemia (CML) by high dose chemotherapy, total body irradiation (TBI) (1000 or 1200 cGy, n = 31) and total lymphoid irradiation (TLI) (800 or 600 cGy, n = 35) preceding allogeneic bone marrow transplantation (BMT). Both TBI and TLI were given at 200 cGy/fraction. Twenty-three patients had HLA-identical sibling donors, nine patients had HLA-matched but unrelated donors, and three partially HLA-mismatched donors.

The use of radioactive iodine in thyroid carcinoma.

The use of radioactive iodine (131I) for the treatment of primary carcinoma of the thyroid and as an alternative to a surgical thyroidectomy in the management of patients with metastatic disease is described. The rationale for using 131I to ablate normal thyroid tissue after a surgical thyroidectomy is considered in relation to the natural history of papillary and follicular tumours and in recognition of the results of such a policy in some recently reported series. It is concluded that 131I ablation is indicated in patients with follicular tumours: and in patients with papillary tumours if they are over the age of 40 or if the tumour contains a substantial follicular component.

Oedema of the neck after ablation of the thyroid with radioactive iodine.

Six out of 30 patients who underwent thyroid ablation with 131I during the period 1975-85 developed acute oedema of the neck within 48 h of the therapeutic dose. The condition was painless and responded well to treatment with corticosteroids. The early onset and absence of pain distinguish this complication from radiation thyroiditis.

Bone marrow transplantation for patients with chronic myeloid leukaemia: T-cell depletion with Campath-1 reduces the incidence of graft-versus-host disease but may increase the risk of leukaemic relapse.

Between December 1983 and November 1985 we treated 39 patients with chronic myeloid leukaemia by chemoradiotherapy and transplantation from HLA-identical sibling donors using bone marrow that had been depleted of T cells ex vivo with the rat monoclonal antibody Campath-1. Twenty-eight of the patients were in the chronic phase (good-risk group) and 11 patients were in more advanced phases of the disease (accelerated phase or blastic transformation; poor-risk group). Of the patients of good risk 23 (82%) survive; the median duration of follow-up is 461 (range 111-776) days; of the 11 patients of poor risk four survive; the median duration of follow-up is 280 (range 189-658) days.

Long-term results from graded low dose radioactive iodine therapy for thyrotoxicosis.

An analysis has been made of the results of treatment in a series of 261 consecutive patients given graded low dose radioactive iodine therapy for thyrotoxicosis. Of these patients, 140 (54%) became euthyroid after a single dose of 131I and a further 50 (19%) achieved a remission after supplementary treatment with an antithyroid drug; 45 patients (17%) required further treatment with 131I which was invariably curative. The incidence of hypothyroidism was 10% at 1 year.

Bone marrow transplantation for patients with chronic myeloid leukemia.

Between February 1981 and December 1984 we treated 52 patients with chronic myeloid leukemia in the chronic phase and 18 patients with more advanced disease by high-dose chemoradiotherapy followed by allogeneic bone marrow transplantation using marrow cells from HLA-identical sibling donors. In addition, the 40 patients who had not previously undergone splenectomy received radiotherapy to the spleen. To prevent graft versus host disease, cyclosporine was given either alone or in conjunction with donor marrow depleted of T cells.

Spinal extradural angiosarcoma occurring after treatment for Hodgkin's disease.

An extradural angiosarcoma was found invading the L3 and L4 nerve roots. An angiosarcoma has not previously been reported in this situation. The tumour was diagnosed eighteen years after the patient presented with Hodgkin's disease and was possibly induced by the treatment given for this disease.

Fractionation of whole body irradiation before bone marrow transplantation for patients with leukaemia.

Thirty patients in various stages of acute leukaemia or chronic granulocytic leukaemia (CGL) were treated with cytotoxic drugs followed by whole body irradiation (TBI) administered in 200 cGy fractions twice daily to a total of 1000 or 1200 cGy. The immediate toxicity of fractionated TBI administered in this way was negligible and patients required only minor premedication and little treatment subsequently for complications attributable to TBI. Fourteen (47%) patients have died, ten of the 12 transplanted with active disease, and four of the 18 subjected to transplantation in remission of acute leukaemia or in chronic phase of CGL.

Marrow transplantation for patients in the chronic phase of chronic granulocytic leukaemia.

In 1979 two patients with Philadelphia (Ph1)-chromosome-positive chronic granulocytic leukaemia (CGL) were treated with chemoradiotherapy and transplantation of bone marrow from their respective identical twins. Subsequently twelve patients with Ph1-positive CGL in chronic phase were treated with chemoradiotherapy followed by transplantation of bone marrow from their HLA-identical sibs. Two of the fourteen patients have died of complications of the transplant procedure; twelve patients are alive and well.

Carbon monoxide diffusing capacity in polycythaemia rubra vera.

The diffusing capacity of the lung, or transfer factor, for carbon monoxide (TLCO) was measured in 12 patients with polycythaemia rubra vera. This was significantly raised (mean 152% predicted, SEM +/- 14%) and remained so even after correction to a standard haemoglobin concentration of 14 . 6 g/dl (mean 139% predicted, SEM +/- 13%).

Adult T-cell lymphoma-leukaemia in Blacks from the West Indies.

Six Black patients (five born in the West Indies and one in Guyana), aged 21-55 years, had adult T-cell lymphoma-leukaemia diagnosed in the U.K. This disorder is rare in Europe and the U.

Splenic irradiation in B-prolymphocytic leukaemia.

Twelve patients with B-cell prolymphocytic leukaemia (PLL) were treated with splenic irradiation at a weekly dose of 100 cGy to a maximum total dose of 1000 cGy. There was no morbidity associated with this treatment. SEven patients responded.

Buffy coat autografts for patients with chronic granulocytic leukaemia in transformation.

We have treated 20 patients with chronic granulocytic leukaemia (CGL) in transformation with cytotoxic drugs or with cytotoxic drugs and whole-body irradiation followed by transfusion of autologous blood cells collected at diagnosis and stored in liquid nitrogen. The mean number of nucleated cells autografted was 25.1 X 10(8)/kg (range: 12.

Autonomous erythropoietin induced erythrocytosis.

Erythrocytosis in a young Sinhalese man is described. The patient was known to have had a raised Hb and PCV for at least 10 years. Subsequent investigations failed to support the diagnosis of polycythaemia vera or to reveal a cause for secondary polycythaemia.