Radical Course Research Articles

Father Patrick Lavelle: The Rise and Fall of an Irish Nationalist, 1825–1886

This is a study of Father Patrick Lavelle, one of the most radical members of the post- Famine Irish Catholic Church. Lavelle, who came from a comfortable tenant-farming background in Mayo, pursued his clerical studies in Maynooth and from an early stage displayed an aggressive and uncompromising manner. His confrontations with John Miley at the Irish College, Paris; Bishop Thomas Plunket in Partry, Cardinal Paul Cullen, John O'Connor Power and others gained him a reputation as a pugnacious and zealous opponent. However, the more gentler side of his nature was revealed when he met Sir Arthur Guinness in Cong in the 1870s.While Lavelle is commonly regarded as a tenacious radical, it is often overlooked that he laboured relentlessly for his poor, oppressed parishioners of Partry against the twin dangers of Evangelicalism and famine. His pastoral duties were similar to those of other clerics in the west of Ireland and highlight the importance of the priest in the survival of their congregations. Lavelle's fame is normally associated with the Fenian movement, in which he defended the right of Irish people to rebel against tyrannical government. This policy brought him into conflict with Paul Cullen who continuously endeavoured to have Lavelle suspended by the Vatican. Lavelle argued that the Fenian organisation had never been specifically named by the Church. He was able to pursue his radical course in Britain and Ireland because of John MacHale's protection. It is argued that Lavelle espoused militant nationalism because of the demise of constitutional nationalism, a position adopted by many other Irishmen. Once it became clear that the Fenians could not deliver on the national question, Lavelle and others reverted to parliamentary agitation and the Home Rule party. During this period Lavelle's fame declined, symbolising the clergy's fading power in Irish politics in the 1870s and the rise of the Catholic urban middle classes. Nevertheless, Lavelle has to be regarded as the link between the radical pre-Famine Irish Church and the socially aware clerics of the post-Land League Church.

A 20-year review of haemangiopericytoma in Auckland, New Zealand

The records of all patients registered with a histological diagnosis of haemangiopericytoma in Auckland between 1970 and 1990 were reviewed retrospectively, with the aim of determining the natural history of the disease and the response to various treatment modalities. A total of 24 patients were identified, having a median age of 45 years. Twenty-one patients (87.5%) underwent surgery; the remaining three were deemed to be unfit for surgery. Seven patients (29%) were treated with surgery alone; nine (37.5%) received a radical course of radiotherapy and three (12.5%) received palliative radiation therapy for pain relief and/or dyspnoea. Five patients (21%) received chemotherapy during the course of their disease. Eight of the 24 patients (33%) were alive and disease free, 13 (54%) having died and three (13%) being lost to follow-up. Seven patients (29%) died as a result of metastatic disease. Three of the seven (43%) who were treated with surgery alone are known to be alive and disease free. The three patients who had received palliative radiotherapy, died within 2 months of completing the latter treatment. Five of the nine patients (56%) receiving a course of radical radiotherapy are alive and disease free at present. No local recurrence was noted following surgical excision and postoperative radical radiotherapy, whilst eight (67%) of those initially treated by excision alone developed recurrent disease. None of the patients treated with chemotherapy obtained significant palliation. Results suggest that adequate surgical excision followed by postoperative radiotherapy is effective in controlling haemangiopericytoma and that metastatic disease is at present invariably fatal. The role of chemotherapy needs further investigation.

Thwarting the Guatemalan Coup

Thwarting the Guatemalan Coup Francisco Villagrán de León (bio) When President Jorge Serrano suspended Guatemala's constitution, dissolved Congress, and dismissed the courts on 25 May 1993, he must have expected public frustration with Congress, the 30-year-old leftist insurgency, and the generally poor social conditions to translate into overwhelming popular support for his actions. In all likelihood, he was hoping to pull off a presidential autogolpe similar to the one that Alberto Fujimori had accomplished in Peru a year earlier. What Serrano experienced instead was, fortunately, something quite unexpected. After an initial 48 hours of shocked paralysis, the groups and institutions that make up Guatemalan civil society began to mobilize, disjointedly at first, but more and more efficiently as time went on. In less than two weeks, the coup was reversed. Through the efforts of its civil society, and with critical international support, Guatemala turned what threatened to be another setback for Latin American democracy into an impressive victory for democratic rule. A look at how this occurred provides insight into the depth of democratic commitment among the large sectors of civil society that [End Page 117] firmly refused any return to the authoritarian past. It also underlines the importance of the principle of constitutionality as a rallying point for different social sectors and as the political-philosophical beacon that lit the way to a peaceful and legitimate resolution of the crisis. Only President Serrano himself knows why he thought he could succeed in such a radical course of action. There had been earlier signs that he was tempted by the idea of dictatorial rule. He had complained bitterly about a hostile press and had threatened on more than one occasion to place curbs on freedom of speech. He had repeatedly attacked congressional gridlock and had criticized the business community and other sectors for their lack of support and understanding. In the months leading up to the coup, Serrano had increasingly isolated himself from contacts with those sectors, as well as from many of his personal friends and political allies. On the international front, Serrano and his representatives had maintained a distinctly low profile during the constitutional crises in Haiti and Peru, declining to join in denunciations and calls for strong collective action. In addition, Serrano was the only Latin American leader to offer public support to Venezuela's President Carlos Andrés Pérez during his agonizing fall from power. But if Serrano had been flirting with the idea of dictatorship for at least a year, why did he choose May 25 to make his dictatorial gamble? His party had made a solid showing in municipal elections earlier that month—although in the context of record-low voter turnout—and he may have felt a newfound confidence. At the time, he faced tough upcoming negotiations with Congress over a budget increase for the Supreme Court and a new energy tax bill—negotiations that would require even greater illegal payoffs than were already standard. During the previous week, there had been student demonstrations in which a demonstrator was shot and killed in front of Congress, apparently by a congressman's bodyguard. In addition, word had gotten out that charges of Serrano's own corruption—which apparently exceeded that of any of his predecessors—were going to be investigated by the auditor general's office. Finally, in mid-May Serrano had privately expressed frustration with Guatemala's stagnating peace talks, and had said he was looking for a way to back out of them. He may have seen the coup as a way to put the peace talks on the back burner, as well as to regain his standing with Guatemala's military. All these developments were symptoms of an overall crisis of governance, brought on by Serrano's autocratic leadership style and his inability to use negotiation and compromise to build consensus around his policies. During the past year, his administration had been drifting from crisis to crisis, wrangling with important groups ranging from human rights and labor organizations to the business community, professional groups (such as the bar association), and the media. Serrano [End Page 118] managed to avert the collapse of his administration only...

Protracted Lhermitte's Sign Following Head and Neck Irradiation

Lhermitte's sign is a rare complication of head and neck irradiation involving the delivery of dose to the cervical spinal cord. Although uncommon, symptoms of lightning-like electric sensations spreading into both arms, down the dorsal spine, and into both legs on neck flexion following head and neck irradiation, causes great concern in both the patient and the physician. This spontaneously reversible phenomenon is important for the otolaryngologist and radiation oncologist to recognize and discuss. A particularly severe and protracted case of Lhermitte's sign involving a patient recently completing a radical course of radiation for nasopharyngeal carcinoma is described in detail, including a review of the literature surrounding the cause and management of this condition.

Christ All in All: The Recovery of the Gospel for North American Evangelism

The ministry of evangelism in North America is at a point of unacceptable enculturation, both in congregational practice and in theological reflection and education. A radical course correction is required so that the gospel can be reclaimed with a Christocentric emphasis rather than one that is anthropocentric and ecclesiocentric. A hermeneutical method for such an approach is suggested in the form of four questions: (1.) What is the gospel? (2.) What is our context? (3.) What makes the gospel good news in this context? (4.) How does contextual response to the gospel further illumine its good news?

Radiation therapy for aggressive fibromatosis. The Experience at the University of Florida.

Twenty-nine patients (thirty sites) who had histologically confirmed aggressive fibromatosis were treated with radical courses of radiation at the University of Florida between March 1975 and February 1986. The minimum length of follow-up was two years; 76 per cent of the patients were followed for more than five years. Twenty-seven sites received doses of at least 5000 centigrays (one centigray equals one rad). Twelve patients were treated twice a day. Fourteen sites were treated with radiation postoperatively for known or presumed microscopic quantities of residual aggressive fibromatosis; in eleven, the disease was locally controlled. Sixteen sites were treated postoperatively for known grossly apparent residual disease; in fourteen, the disease was locally controlled. Over-all, aggressive fibromatosis was controlled in twenty-five (83 per cent) of the thirty sites. The six-year actuarial rate of local control was 79 per cent. The five local recurrences occurred at four, eleven, thirty-four, sixty-one, and sixty-eight months after the initiation of radiation therapy. Two of the five failures occurred in the high-dose radiation field in patients who were treated for grossly apparent disease. The remaining three failures occurred at the margin of the irradiated field in patients who were treated for assumed microscopic quantities of residual disease. There was no apparent difference in local control between patients who were treated for primary (previously untreated) aggressive fibromatosis and those who were treated after one or more recurrences. Comparison of the results of radiation therapy with published data on operative treatment shows that local control substantially improves with postoperative radiation therapy when operative margins are less than wide.(ABSTRACT TRUNCATED AT 250 WORDS)

Bladder cancer: Long-term follow-up results of patients treated with radical radiation

Carcinoma of the bladder is commonly treated for cure with external beam radiation. Whilst short-term results are associated with a good chance of disease control there is little information about the long-term results of such therapy. We present a retrospective review of the Princess Margaret Hospital experience in treating transitional cell carcinoma of the bladder and emphasis on the long-term follow-up of patients treated with radiotherapy (XRT). Between 1972 and 1980, 355 patients were treated with a radical course of external beam radiation. The overall survival was 20% at 10 years and the cause-specific survival was 32%. Radiation treatment resulted in a long-term bladder preservation in at least 25% of patients. The majority of long-term survivors without evidence of relapse were patients with T 1 (solitary tumours), T 2 and T 3a tumours. This subgroup represents patients with disease favourable for treatment with radiation. Factors affecting response to the XRT and survival included T stage and tumour bulk. Radiation complications were frequent and were usually associated with local disease recurrence.

Radical external beam radiotherapy for localised carcinoma of the prostate using a hypofractionation technique

The survival of 232 patients with apparently localized carcinoma of the prostate is reported, who were treated between October 1964 and October 1984 by a radical course of external beam radiotherapy using a hypofractionation technique. Assessment was made in a retrospective analysis, noting influence of age, stage of disease at presentation, initial histology, dose of radiotherapy given and any subsequent treatment required, recorded up to October 1986. From this it will be seen that the development of a six fraction regime, given over a period of three weeks leads to comparable results to other reported series, whether assessed as a local response or by survival curves, and to the economical use of scarce resources, but even more important, is less wearing for patients than daily fractionation, with early and late morbidity being within acceptable limits.

Three-dimensional motion analysis of an improved head immobilization system for simulation, CT, MRI, and PET imaging

A mask/marker immobilization system for the routine radiation therapy treatment of head and neck disease is described, utilizing a commercially available thermoplastic mesh, indexed and mounted to a rigid frame attached to the therapy couch. Designed to permit CT, MRI, and PET diagnostic scans of the patient to be performed in the simulation and treatment position employing the same mask, the system has been tested in order to demonstrate the reproducibility of immobilization throughout a radical course of irradiation. Three-dimensional analysis of patient position over an 8-week course of daily radiation treatment has been performed for nine patients from digitization of anatomic points identified on orthogonal radiographs. Studies employing weekly simulation indicate that patient treatment position movement can be restricted to 2 mm over the course of treatment. This easily constructed system permits rapid mask formation to be performed on the treatment simulator, resulting in an immobilization device comparable to masks produced with vacuum-forming techniques. Details of motion analysis and central axis CT, MRI, and PET markers are offered.

Bladder cancer: Long-term follow-up results of patients treated with radical radiation

Carcinoma of the bladder is commonly treated for cure with external beam radiation. Whilst short-term results are associated with a good chance of disease control there is little information about the long-term results of such therapy. We present a retrospective review of the Princess Margaret Hospital experience in treating transitional cell carcinoma of the bladder and emphasis on the long-term follow-up of patients treated with radiotherapy (XRT). Between 1972 and 1980, 355 patients were treated with a radical course of external beam radiation. The overall survival was 20% at 10 years and the cause-specific survival was 32%. Radiation treatment resulted in a long-term bladder preservation in at least 25% of patients. The majority of long-term survivors without evidence of relapse were patients with T1 (solitary tumours), T2 and T3a tumours. This subgroup represents patients with disease favourable for treatment with radiation. Factors affecting response to the XRT and survival included T stage and tumour bulk. Radiation complications were frequent and were usually associated with local disease recurrence.

Twice-a-day radiotherapy for T3 squamous cell carcinoma of the glottic larynx.

Between March 1978 and April 1986, 21 previously untreated patients with T3 squamous cell carcinoma of the true vocal cord received radical courses of twice-a-day radiotherapy (120 cGy twice daily) to total doses of 7,440-7,680 cGy. The rate of local control at the primary site was 67% after radiotherapy. The ultimate control rate after salvage surgery was 83%. Five-year absolute and cause-specific survival rates were 59% and 81%, respectively. It is concluded that radiotherapy is a rational approach for many patients with T3 glottic cancer.

Bilateral stage Ib glottic carcinoma: results of radiation therapy.

Bilateral early carcinoma of the true vocal cords (stage T1bN0M0) makes up about 15% of all stage I carcinomas. Twenty-four patients with stage Ib glottic carcinoma (18 with involvement of the anterior commissure and six without) received a radical course of radiation therapy with the median dose of 6,600 rad (66 Gy) in 33 fractions calculated at midpoint. In 19 patients (80%) radiation therapy alone produced complete local control of the disease. In the five patients in whom treatment failed, the recurrent tumors were confined to the larynx and were noticed within 3 years of treatment. Surgery was subsequently performed in three of the five patients but was successful in only one. In 19 of the 24 patients, the voice sounded relatively normal after radiation therapy.

Time-dose relationships for local tumor control and complications following irradiation of squamous cell carcinoma of the base of tongue.

Between October 1964 and September 1981, 114 previously untreated patients with squamous cell carcinoma of the base of the tongue were treated with curative intent by a radical course of irradiation at the University of Florida. With a minimum 2-year follow-up, local control was achieved in 78, 65, 76, and 17% of T1, T2, T3, and T4 lesions, respectively. Control results could be correlated with time-dose factors and treatment techniques. No patient required mandibulectomy for osteoradionecrosis following radiation therapy. Complications of bone and soft tissue could not be related to time-dose factors.

Combination of surgery, irradiation, and hyperthermia in treatment of recurrences of malignant tumors.

Management of recurrent tumors after initial treatment by surgery, radiotherapy, and sometimes chemotherapy is a formidable challenge. Proximity of tumor to critical organs (e.g., carotid artery in recurrent head and neck tumors) often makes radical surgery impossible. Prior definitive course of radiation therapy precludes delivering a second radical course of irradiation. In the Division of Radiation Oncology, Washington University, we have used combined postoperative hyperthermia and modest dose radiotherapy to treat 23 patients with recurrent tumors and postoperative residual disease. Generally, 3200 to 4000 cGy was delivered in eight to ten fractions in 4 to 5 weeks, in combination with eight to ten sessions of minimum tumor heating to 42.5 degrees to 43 degrees C for 60 minutes, twice a week as stated in the results. Follow-up period was one to 5+ years. Of the 23 patients treated, only three failed within the treatment volume.

Multidrug chemotherapy using bleomycin, methotrexate, and cisplatin combined with radical radiotherapy in advanced head and neck cancer

Thirty-one patients with Stage III-IV head and neck squamous cell cancer were treated by three courses of combination chemotherapy using bleomycin, methotrexate, and cisplatin followed by a radical course of radiation and in two cases by surgery. Of 29 evaluable patients, 4 (14%) achieved complete remission (CR) with chemotherapy and 13 (45%) had a partial response (PR). With the addition of radiotherapy and surgery, the CR rate increased to 72%. At 30 months the actuarial survival of all evaluable patients was 61% and of complete responders, 76%. Patients with nasopharyngeal cancer had an actuarial survival of 80% at 30 months, whereas patients with squamous malignancies at other sites in the head and neck region had an actuarial survival of only 37%. Side effects were tolerable. It is concluded that complete responders to combination chemotherapy and radiotherapy have a survival benefit at 30 months. The combined approach is most effective in nasopharyngeal cancer.

An Alternative to the Traditional Model? Laudan on Disagreement and Consensus in Science

Larry Laudan's primary aim in his latest book, Science and Values, is to account for the high degree of agreement and the ubiquity of disagreement in science. Arguing that earlier philosophers have either concentrated on agreement and ignored disagreement or highlighted disagreement at the expense of agreement, he sets out to provide “a single, unified theory of rationality which promises to be able to explain both these striking features of science” (p. 3). However, while recognizing that Laudan has done much to clarify this issue and to bring traditional thinking about science into line with scientific practice, I shall argue that the basic problem remains to be solved. To do justice to agreement and disagreement, we must pursue a more radical course than the one Laudan charts.

Treatment of superficial (T1) tumours of the bladder by radical radiotherapy.

Local tumour control and survival is reported for 190 patients with T1 transitional cell cancer of the bladder who received a radical course of X-ray therapy. There was no difference in survival by the histological grade of the cancer but patients with grade 3 cancers had the highest probability of local control. After initial complete local tumour regression there was a similar probability of subsequent distant metastases irrespective of the grade of the cancer. Radical small field beam directed radiotherapy is commended for patients with T1/pT1 grade 3 transitional cell cancer of the bladder.

Adenoid cystic carcinoma of the salivary glands

Eighty-two patients with adenoid cystic carcinoma treated by a radical course of radiotherapy are reviewed. In 44 cases the tumour arose in the major salivary glands and, of these, 77% had an incomplete surgical excision and 23% had only a tumour biopsy before radiotherapy. Thirty-eight tumours arose in the minor salivary glands and, of these, 18% had an incomplete surgical excision and 82% a biopsy only before treatment. Primary tumour control was achieved in 67% of patients at 5 years. The local control was significantly better in patients who had an incomplete surgical excision: 86% compared with 37% at 5 years. The local control of tumours arising in the major salivary glands is significantly better than that of tumours arising in the minor glands, but this difference is explained by more patients with major gland tumours having had incomplete surgery. For patients treated after only a biopsy, local tumour control was achieved in 37%, demonstrating the radioresponsiveness of this type of carcinoma. No difference in survival was demonstrated in patients with major or minor gland tumours. Despite local tumour control, 43% of patients with major gland tumours died from metastatic disease. The commonest cause of death of patients with minor gland tumours was local failure.

Carcinoma of the base of the tongue: results of radical irradiation with surgery reserved for irradiation failure.

Between 1964 and 1977, 95 previously untreated patients with squamous cell carcinoma of the base of the tongue received treatment with curative intent at the University of Florida. Eighty-six of the 95 patients (91%) had Stage III or IV disease at presentation. Eighty-nine patients received radical courses of irradiation to the primary with or without neck dissection(s), with surgery reserved for salvage of irradiation failure. Six patients underwent planned combined treatment of the primary lesion. Of the 89 patients whose primary lesions were radically irradiated, failure at the primary site occurred in 24% of those with T1-3 lesions and 78% with T4 lesions. Control results were related to irradiation treatment technique. None of the 9 patients with Stage I-II disease died of the cancer. Actuarial survival at 5 years for Stage III patients was 46%. Within the Stage IV population there is a subgroup of patients with highly treatable and curable disease. The addition of a neck dissection following irradiation of N2-N3 neck disease decreased the incidence of failure in the neck. No patient developed severe soft tissue necrosis or required mandibulectomy for bone exposure following irradiation.

Factors influencing salvage cystectomy results.

Analysis of 86 patients who underwent salvage cystectomy following a radical course of radiotherapy for bladder cancer and 37 patients who underwent primary cystectomy has shown a greater survival for women than men. The following factors were associated with a significant deterioration in survival: 1. Age at time of cystectomy: post-operative mortality and tumour recurrence are greater over the age of 70. 2. Non-function of one kidney on IVU. 3. Grade 3 tumour on cystectomy specimen. 4. pT3 or pT4 tumour on cystectomy specimen.