ADOLESCENT AND SENILE KYPHOSIS
Authors: C. Lambrinudi
Journal: BMJ (1934)

MEIBRCTSRA --~~~~~~~~~~~~~~~~~~~~~~~~M EDICAL JOURNAL from this, there would not appear to be any considerable difficulty, £or with reasonable care the heart and lungs are not likely to suffer from ill effects.On general grounds one would expect that such a method ought to produce more satisfactory results than any of those hitherto employed, since the growth with which we are dealing is certainly radio-sensitive, and the only real danger is that by too energetic a dose we may produce sloughing of the tissues and perforation.Combination with internal radiation from a tube or from seeds would seem to be a rational method, but so far it has not been developed. Deep X RaysResults of great interest have recently been obtained by Levett using deep x rays, the radiation consisting of very hard rays and being limited to a narrow field, including seven inches of the oesophageal wall.It is still too early to speak with any certainty of the results secured, but in a few cases at least it would seem that complete healing had been obtained without secondary stenosis.Hitherto the disadvantage of x-ray treatment in these cases has been the intensely depressing effect upon the patient, due apparently to the effects of the x rays upon the surrounding structures, and perhaps to the absorption of products so formed.So severe have been these effects that radiologists of the brilliant achievement of Coutard have entirely abandoned the method.If, however, these secondary effects could be avoided by skilful adjustment of the apparatus, the method would appear to have definite possibilities, and it is certainly one which should be explored to the full.Another method which we are at present ourselves investigating is the application of radon to the outer surface of the oesophagus after exposure by transthoracic exploration.It is a very remarkable fact that even in elderly subjects the lower half of the^oesophagus can be fully exposed by the transthoracic route apparently without risk and with only trivial inconvenience to the, patient, far less in fact than is associated with an ordinary laparotomy.Theoretically, if a growth of the oesophagus could be surrounded by a group of radon seeds there is little doubt that the growth would entirely disappear and that healing of the mucosa would occur.'The mechanical problems involved are, however, difficult to solve, and in spite of a few encouraging examples we can still only regard the method as in the experimental stage. ConclusionsIt will be seen, then, that for the present we regard the relief of dysphagia as the one object to aim at in the treat- ment of carcinoma of the oesophagus, and we consider the introduction of a spiral tube as the method most likely to achieve this in practice.Our personal experience of the method now extends over some fifteen years, and includes upwards of 300 cases, whilst the method is in general use by many other surgeons.We consider, how- ever, that every attempt should be made to develop the method of'radiation both by radium and by x rays, since although both of -these are still in the experi- mental stage they are probably the only methods to which we can look -for any real prospect of curing the disease.