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Dr. Donato Perez Garcia

This is the case of a forty-five year old male who began experiencing fever and night sweats in November of1984. Over an ensuing period of three and a half months he also developed dyspnea, dizziness, and a sharp pain in the right posterior hemithorax. A weight loss of 12 kg (27 lbs) accompanied the evolution of all these symptoms. The patient had a 23 pack-year history of cigarette smoking. Previous health history included a hemorrhoidectomy in 1974, and a L5-S1 laminectomy in 1980. The patient first presented with this history to the Central Military Hospital in Mexico City in late January of 1985.

Physical Examination

The patient was a forty-five year old male appearing older than his stated age, complaining of fatigue, dyspnea, posterior chest pain, and weight loss as above. Height: 5 feet 11 inches (1.8 m). Weight: 156 lbs (69 kg). Blood pressure: 130/75 mm Hg. Pulse: 105/ min. and regular. Temperature: 100oF orally (37.8oC). Respirations: 24/min. Head & Neck: The HEENT were normal. The patient had a prominent mass visible on the right side of his neck. On palpation, this mass was seen to consist of two contiguous masses which were tender, each measuring approximately 2 cm in diameter. Chest: The lung fields are clear to percussion and auscultation in all fields. The heart sounds are normal, without murmurs or extra sounds. There is a sinus tachycardia at 105/min. The peripheral pulses are present and equal bilaterally. Abdomen: Soft without masses or organomegaly. The bowel sounds are normal. Stool examination for occult blood was negative. Central nervous system: Grossly normal.

Labratory Investigations

Hgb 12.0 gm%. Hct 36%. RBC 3.4 x 106/mm3. WBC 15,40 0/mm3 with a normal differential count. Platelets 701,000/mm3. Glucose 110 mg%. BUN 11 mg%. Creatinine 0.9 mg%. Urinalysis was negative. Sputum for cytology was negative for malignant cells. Bone marrow aspiration showed no malignant infiltration. Liver/spleen scan was negative. AP and lateral chest xray revealed a dense 6 cm mass with irregular contours localized to the right hilar region. Chest tomograms confirmed the presence of the mass confined to the posterior mediastinum and producing extrinsic compression of the right inferior bronchus. Bronchoscopic examination revealed an extrabronchial mass compressing the right inferior bronchus. A biopsy specimen was obtained from the cervical mass. Pathological examination of specimens from the bronchoscopy and the cervical node reported a Hodgkin’s lymphoma, stage II-B (figure VIII.1). The patient was started on a conventional-dose chemotherapy regimen consisting of cyclophosphamide, adriamycin, vincristine, bleomycin, metclopramide, and prednisone. Following only one cycle of the prescribed course of treatment, the patient refused to go on because of severe side-effects of nausea, vomiting, weakness, and malaise. In February of 1985, the patient presented to the Drs. Perez Garcia for management of his condition with IPT. Apart from the one cycle of high-dose chemotherapy this patient had received no other form of treatment for his disease.

The patient tolerated his treatments without adverse effects, either from the chemotherapy agents or the insulin. The residual cervical mass disappeared, his chest pain, dyspnea, and weakness were relieved, and he gained weight up to 90 kg (203 lbs). All hematologic parameters returned to normal values. His pretreatment chest xray demonstrates the right hilar mass (figure VIII.2). Subsequent chest xrays showed a gradual reduction in the size of the right hilar mass. A chest xray taken following this patient’s final treatment showed the right hilum to be essentially clear of the neoplasm (figure VIII. 3). Follow-up xrays at yearly intervals have shown no recurrence of the chest lesion.

Clinically the patient remains in good health up to the present time (4/92).