Animal Physiology: Adaptation and Environment

in dogs lasting up to 40 days following moderate doses of 1600 rads in eight treatments of X-irradiation. There is a discussion of the difficulties encountered in attempting to irradiate gastric mucosa with radioactive sources placed directly within the stomach. The techniques of external beam treatment used at the University of Chicago are described in detail. Finally, the clinical results and complications are presented for this rather considerable experience, over 3000 patients treated during a 35-yr period. The treatment of benign ulcer disease with X-irradiation is certainly controversial and has not been widely accepted for general use in most medical centers. The results of this considerable clinical experience are difficult to assess because of the variability in the natural history of this condition. Most encouraging are the results of a randomized prospective study carried out by Erwin Levin with 68 patients, all of whom were treated with intensive medical management, half of whom were randomly selected to receive approximately 2000 rads to the fundus and body of the stomach in about ten total treatments. The control group had significantly more failures in therapy than the irradiated group. In a 5-yr period over 70% of the nonirradiated patients had recurrent ulcers compared to only 11% in the irradiated group. The irradiated patients showed decreased levels of basal and Histalog stimulated free acid excretion. Particular emphasis is placed on the examination of the possibility of radiation induced neoplasia. Careful followup of the patients treated at the University of Chicago gives no indication that this is a significant complication. A number of criticisms may be offered. The general format of the book, a number of small independently written chapters, leads to disorganization, fragmentation, and needless repetition. In many instances the details of the radiation technique and the suggested mechanisms of action are not up to the standards of modern radiation therapy and radiobiology. This will be more annoying to radiation therapists than other readers. When describing what is clearly a nonuniversally accepted treatment, it might have been useful to include a brief presentation by a gastroenterologist not enthusiastic about this technique. In a very brief chapter, five pages, Dr. Melvin Griem, one of the country's leading radiation therapists and Director of the Tumor Institute at the University of Chicago, describes the techniques and dosimetry used at that institution in great detail, but conspicuously fails to discuss the usefulness of the treatment and the possible complications and contraindications. Even with these shortcomings the book has definite merit. Every internist and surgeon should be aware that this form of treatment does exist. Even if it never becomes universally popular, there will always be certain patients, those, for example, with severe recurrent disease who are medically inoperable for other reasons, who might possibly benefit from this form of treatment.