Asunto(s)
Carcinoma de Células Escamosas/terapia , Neoplasias de Cabeza y Cuello/terapia , Adulto , Anciano , Análisis de Varianza , Carcinoma de Células Escamosas/tratamiento farmacológico , Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/cirugía , Terapia Combinada , Femenino , Neoplasias de Cabeza y Cuello/tratamiento farmacológico , Neoplasias de Cabeza y Cuello/radioterapia , Neoplasias de Cabeza y Cuello/cirugía , Humanos , Masculino , Persona de Mediana Edad , Neoplasias de la Boca/terapia , Neoplasias Orofaríngeas/terapia , Estudios Prospectivos , Análisis de Supervivencia , Factores de Tiempo , Resultado del TratamientoRESUMEN
Twenty-nine patients with disk herniations, 7 patients with intraspinal tumors, 4 patients with multiple sclerosis and one patient with infection by borrelia have been studied by CT, myelography and/or MR. To gain information on the metabolism of central nervous system disease (CNS), and thus, to improve diagnosis the cerebrospinal fluid (CSF) was studied in all cases using high-resolution 1H NMR spectroscopy at 360 MHz. Seventeen metabolites could be identified in CSF in addition to the usual clinical chemical parameters. As compared to a control group discrimination of tumors from inflammation was possible by means of different metabolites and/or metabolite concentration. The CSF in disk herniations differed in the concentration of acetate from the control group. In CSF of tumors, multiple sclerosis and of infection by borrelia distinct differences in the concentrations of putrescine, citrate, valine, alpha-alanine, acetate, creatinine, glucose, beta-hydroxy-butyric acid, glutamine and creatine have been observed both as compared directly and in comparison to the control group. Thus, high-resolution 1H NMR spectroscopy of CSF gives speedy information on metabolism, since a variety of metabolites, usually examined only in different tests, can be studied in one single step. Thus, high-resolution 1H NMR spectroscopy supports imaging, especially MR, as morphological changes in diseases may be differentiated by means of different metabolite profiles. This assumption needs further confirmation on a prospective study with a larger patient population.
Asunto(s)
Enfermedades de la Columna Vertebral/líquido cefalorraquídeo , Infecciones por Borrelia/líquido cefalorraquídeo , Enfermedades del Sistema Nervioso Central/líquido cefalorraquídeo , Enfermedades del Sistema Nervioso Central/diagnóstico , Humanos , Hidrógeno , Desplazamiento del Disco Intervertebral/líquido cefalorraquídeo , Espectroscopía de Resonancia Magnética/métodos , Esclerosis Múltiple/líquido cefalorraquídeo , Enfermedades de la Columna Vertebral/diagnóstico , Neoplasias de la Columna Vertebral/líquido cefalorraquídeoAsunto(s)
Carcinoma de Células Escamosas/terapia , Neoplasias de la Boca/terapia , Neoplasias Orofaríngeas/terapia , Austria , Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/patología , Terapia Combinada , Femenino , Estudios de Seguimiento , Alemania , Humanos , Masculino , Persona de Mediana Edad , Neoplasias de la Boca/mortalidad , Neoplasias de la Boca/patología , Neoplasias Orofaríngeas/mortalidad , Neoplasias Orofaríngeas/patología , Estudios Prospectivos , Tasa de Supervivencia , SuizaRESUMEN
Different concepts and already available components of a HIS (Hospital Information System) for archiving all data in a hospital are described. Using the example of the Kiel University Hospital, it is shown that a complete HIS-system can be made from already commercially available components.
Asunto(s)
Sistemas de Información en Hospital , Sistemas de Información Radiológica , Alemania , HumanosRESUMEN
Nausea and emesis after exercise were leading symptoms in a 28 year old patient with indirect vena azygos continuation syndrome. This anomaly was verified by sonography, abdominal CT and by venography. The CT examination revealed initially structures of malignant appearance low to the renal position by angiography. This appeared to be distended collaterals. Therapeutic intervention aims primarily to the prevention of complications such as thrombosis of the distal venous flow or venous insufficiency of the lower extremities. Prophylactically we suggest low dose heparin and compression stockings.
Asunto(s)
Aneurisma/diagnóstico por imagen , Vena Ácigos/anomalías , Vena Cava Inferior , Adulto , Aneurisma/complicaciones , Vena Ácigos/diagnóstico por imagen , Femenino , Humanos , Masculino , Flebografía , Síndrome , Tomografía Computarizada por Rayos X , Ultrasonografía , Vena Cava Inferior/diagnóstico por imagenRESUMEN
Based on the postoperative data evaluated in September 1989, the results of a regional prospective treatment study conducted by the DOSAK on preoperative radio-chemotherapy and radical surgery for carcinomas of the oral cavity and the oropharynx are presented. In the univariate analysis the histologic lymph node findings after pretreatment, the histologic grading, and the TPI correlated well with the survival rates. The multivariate analysis confirmed that the histologic demonstration of vital tumor cells in the neck lymph nodes after the end of pretreatment is of grat prognostic relevance. The histologic degree of differentiation, the demonstration of vital tumor cells in the primary tumor area after pretreatment and the length of time between radiotherapy and surgery were of secondary importance.
Asunto(s)
Neoplasias de la Boca/tratamiento farmacológico , Neoplasias de la Boca/radioterapia , Cuidados Preoperatorios/métodos , Adulto , Análisis de Varianza , Austria , Carcinoma de Células Escamosas/tratamiento farmacológico , Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/cirugía , Terapia Combinada , Femenino , Estudios de Seguimiento , Alemania , Humanos , Metástasis Linfática , Masculino , Persona de Mediana Edad , Neoplasias de la Boca/cirugía , Análisis Multivariante , Neoplasias Orofaríngeas/tratamiento farmacológico , Neoplasias Orofaríngeas/radioterapia , Neoplasias Orofaríngeas/cirugía , Pronóstico , Estudios Prospectivos , Tasa de Supervivencia , Suiza , Factores de Tiempo , Resultado del TratamientoRESUMEN
165 patients with carcinomas of the oral cavity or oropharynx, clinically appearing operable, were treated between 1985 and 1987 within the framework of a prospective multicenter study. The treatment concept consisted in preoperative irradiation with 32 Gy, cisplatin sensitization with 5 X 20 mg per m2 body surface area and subsequent radical removal of the primary tumor and the regional cervical lymph nodes. Regarding recurrence and survival rates the patient data were analyzed using one- and multi-dimensional statistical methods. The observed survival rates were compared with those assessed with the aid of the treatment-dependent prognosis index TPI (Platz et al. 1982). After 1 years the survival rates under the selected combination therapy were 12% and after 2 years 19% above the assessed survival rates under radical surgery alone.
Asunto(s)
Cisplatino/uso terapéutico , Neoplasias de la Boca/cirugía , Neoplasias Faríngeas/cirugía , Terapia Combinada , Humanos , Neoplasias de la Boca/tratamiento farmacológico , Neoplasias de la Boca/radioterapia , Estudios Multicéntricos como Asunto , Neoplasias Faríngeas/tratamiento farmacológico , Neoplasias Faríngeas/radioterapiaRESUMEN
Sixty-six samples of CSF from 66 patients with a variety of diseases, including tumors, arteriovenous malformations, aneurysms, brain infarctions, and lumbar back pain, were studied with 1H MR spectroscopy at 360 MHz. 1H MR spectroscopy offers a simple means to obtain fast information about different metabolites simultaneously. As compared with the control group, which consisted of 19 CSF samples from the same group of 66 patients, but from individuals who had no abnormal findings on neurologic examination, common clinicochemical tests, or neuroradiologic studies, our preliminary results suggest that tumors and hemorrhages may be differentiated by 1H MR spectroscopy. MR peak intensities relative to lactate peak intensity were used as variables in a statistical analysis to determine the significance of individual resonance intensities in predicting CNS abnormalities. The most important factors for diagnosis were analyzed by means of a multivariate general linear hypothesis and a principal component method. The most important factors for predicting CNS abnormalities in the studied diseases were creatinine, glucose, creatine, citrate, protein content, glutamine, amount of cells, and valine. By using this model for discriminant analysis, we could predict hemorrhages correctly in 88% of cases and tumors in 75% of cases. All samples of controls were determined correctly. In cases of brain infarctions, different signals were observed, which may lead to further characterization of such lesions. 1H MR spectroscopy may offer a simple means for further characterizing CNS lesions. However, this needs confirmation by a prospective study, which would include a larger patient population with different diseases.
Asunto(s)
Enfermedades del Sistema Nervioso Central/líquido cefalorraquídeo , Espectroscopía de Resonancia Magnética , Enfermedades del Sistema Nervioso Central/diagnóstico , Hemorragia Cerebral/líquido cefalorraquídeo , Hemorragia Cerebral/diagnóstico , Glucosa/líquido cefalorraquídeo , Humanos , Malformaciones Arteriovenosas Intracraneales/líquido cefalorraquídeo , Malformaciones Arteriovenosas Intracraneales/diagnóstico , Lactatos/líquido cefalorraquídeo , Ácido Láctico , Neoplasias de la Columna Vertebral/líquido cefalorraquídeo , Neoplasias de la Columna Vertebral/diagnósticoAsunto(s)
Cámaras gamma , Procesamiento de Imagen Asistido por Computador , Pantallas Intensificadoras de Rayos X , Autorradiografía/instrumentación , Humanos , Procesamiento de Imagen Asistido por Computador/instrumentación , Radioisótopos de Yodo , Modelos Anatómicos , Plantas/anatomía & histología , Cintigrafía , Tecnecio , Glándula Tiroides/diagnóstico por imagenRESUMEN
Cerebrospinal fluid (CSF) samples from 84 patients with confirmed or suspected diseases of the central nervous system were studied with hydrogen-1 magnetic resonance (MR) spectroscopy. In 19 of the patients, clinical chemical tests of the CSF indicated normal protein contents and normal quantities of cells; these samples were used as controls. Preliminary results indicate that tumors may be reflected in the MR spectra of CSF; disk herniations could not be distinguished on the basis of the MR spectral characteristics.
Asunto(s)
Neoplasias Encefálicas/diagnóstico , Líquido Cefalorraquídeo/análisis , Desplazamiento del Disco Intervertebral/diagnóstico , Espectroscopía de Resonancia Magnética , Neoplasias Encefálicas/líquido cefalorraquídeo , Humanos , Desplazamiento del Disco Intervertebral/líquido cefalorraquídeoRESUMEN
197 consecutive patients with squamous cell carcinomas of the oropharynx were treated between 1964 and 1982. The 5 year actuarial survival was 43% (+/- 5%). In patients with stage I and II disease the actuarial survival with combined surgery and radiotherapy was 87% (+/- 16%), but with primary radiotherapy 40% (+/- 28% (p = 0.0250). The results in stage III and IV disease were 59% (+/- 11%) with combined therapy and 29% (+/- 15%) for radiotherapy alone (p = 0.0010). The five year actuarial survival for lymphoepithelial carcinomas (Schmincke) was 71% (+/- 16%) after radiotherapy whilst the patients with undifferentiated carcinomas achieved only 29% (+/- 11%). The survival rate for women (71% +/- 12%) was significantly better than for men (31% +/- 7%), although the proportion of stages was not different in both sexes. Because of these results and because of the minimal chances of controlling recurrent disease we prefer combined treatment not only in stage III and IV disease, but also in stage I and II disease. In these early stages partial mandibulectomy can be avoided. In selected cases transoral surgery can be combined with functional, discontinuous neck dissection. The functional results of surgery are thus minimised in the early stages of oropharyngeal carcinoma.
Asunto(s)
Carcinoma de Células Escamosas/terapia , Neoplasias Orofaríngeas/terapia , Neoplasias Faríngeas/terapia , Adulto , Anciano , Carcinoma de Células Escamosas/patología , Terapia Combinada , Femenino , Humanos , Metástasis Linfática , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Neoplasias Orofaríngeas/patología , PronósticoRESUMEN
Allogeneic bone marrow transplantations were carried out between March 1983 and July 1985 in 31 patients aged 7 to 45 years (median 18 years). Acute lymphoblastic leukaemia in 1st to 5th remission was present in 8 patients, acute myeloblastic leukaemia in 1st and 2nd remission in 4 patients, chronic myeloid leukaemia, with various remission status, in 6 patients, 3 patients had severe aplastic anaemia and there were single cases of myelodysplasia and immature cell megakaryocytic myelosis. Transplantation was carried out during relapse in 8 patients with either acute myeloid or lymphoblastic leukaemia. Phenotypic HLA-identical mothers (n = 2) as well as genotypic HLA-identical siblings (n = 27), and in two cases HLA-non-identical mothers, served as bone marrow donors. In leukaemia patients the conditioning treatment consisted of fractionated total body irradiation and high dose cyclophosphamide or etoposide. Patients with severe aplastic anaemia received cyclophosphamide (4 X 50 mg/kg) and fractionated total nodal irradiation (total dose 8 Gy). 19 patients (61%) survived 14 to 605 days after bone marrow transplantation. 15 patients (48%) continue to remain in complete remission with Karnofsky indices of greater than or equal to 90%. Causes for death were infection (n = 3), interstitial pneumonia (n = 3), relapse (n = 3) as well as single cases involving acute graft-versus-host-disease, non-engraftment of donor marrow and veno-occlusive disease of the liver.
Asunto(s)
Trasplante de Médula Ósea , Irradiación Corporal Total , Aciclovir/uso terapéutico , Adolescente , Adulto , Anfotericina B/uso terapéutico , Anemia Aplásica/terapia , Niño , Ciclofosfamida/uso terapéutico , Etopósido/uso terapéutico , Femenino , Supervivencia de Injerto , Enfermedad Injerto contra Huésped/prevención & control , Antígenos HLA , Herpes Genital/prevención & control , Humanos , Leucemia Linfoide/terapia , Leucemia Mieloide Aguda/terapia , Masculino , Metotrexato/uso terapéutico , Persona de Mediana Edad , Nistatina/uso terapéutico , Prednisolona/uso terapéutico , Donantes de TejidosRESUMEN
The results of NMR tomography obtained hitherto in the imaging of malignant tumors are presented in order to show that this new method is of great importance for radiotherapy. A quantification of radiotherapy and chemotherapy seems possible with the aid of NMR diagnosis, as vital and necrotic tumors zones as well as radiation effects in the tumor and in sound tissue can be visualized.
Asunto(s)
Espectroscopía de Resonancia Magnética , Neoplasias/radioterapia , Humanos , Estadificación de Neoplasias , Neoplasias/diagnóstico , Neoplasias/patología , Dosificación Radioterapéutica , Tomografía Computarizada por Rayos XRESUMEN
In case of whole-body irradiation prior to bone marrow graft, an undesired irregular dose deposition in the median body plane is caused by the irregular body shape and the tissue inhomogeneities of the patient, which can amount up to 50% of the planned focal dose in case of laterally opposing irradiation. A procedure is proposed allowing to modify the dose distribution in the irradiated body systematically by means of compensators. Such compensators are produced with the aid of an adequate number of serial CT scans, a programme system considering these data and the individual irradiation geometry, and a computer-controlled cutter working in three dimensions. First a casting mould is manufactured which is then filled up with an adequate compensation material. The actual compensation data and the planned irradiation geometry are controlled before and during the treatment. Taking into consideration the individual shapes and the different tissue densities, it is not only possible to prevent the dose inhomogeneities mentioned above but also to introduce by means of a special programme part regions with a higher or lower dose deposition at any point of the irradiation field, at the therapeutist 's discretion.
Asunto(s)
Irradiación Corporal Total , Trasplante de Médula Ósea , Computadores , Humanos , Dosis de RadiaciónRESUMEN
This is a report on the results of a continuous series of 78 previously untreated patients with a lymphoepithelioma (Schmincke-Regaud), who got their diagnosis and therapy in the Medical Center of the University of Kiel between 1951 and 1980. 90% of the patients were treated by radiotherapy alone, which included the primary in the oropharynx (n = 29) or the nasopharynx (n = 48) as well as the regional lymph nodes regardless of whether they were affected (71%) or not; residual lymph nodes of 8 cases were removed afterwards. Thereby a clinically full regression of the tumor disease was achieved in 85%. This group revealed a constant actuarial survival of 39% 7 years later. All therapy failures however, died within two years. The probability to remain free of disease after a primarily successful treatment amount to 86% for the oropharynx tumors (n = 24) and to only 29% for the nasopharynx lesions (n = 31). The analysis of the relapses especially with regard to the nasopharynx tumors showed that in most cases the disease was already very extended at the beginning of the treatment (stage IV according to the UICC-classification). The actuarial survival of this numerous group fell down to a constant rate of 16%, whereas stages I to III finally survive in 59%. The corresponding survival values of the oropharynx tumors were 25% in stage IV and 41% in stages I to III including a lot of age-related deaths. Drawing conclusions out of our retrospective study we recommended to add an appropriate chemotherapy for lymphoepitheliomas of the nasopharynx in stage IV.
Asunto(s)
Carcinoma de Células Escamosas/terapia , Neoplasias Faríngeas/terapia , Adolescente , Adulto , Factores de Edad , Anciano , Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Faríngeas/radioterapia , Neoplasias Faríngeas/cirugía , Estudios Retrospectivos , Factores SexualesRESUMEN
The rate of air activation caused by the 15 MeV continuous radiation of a "Clinac 20" can be concluded from activation measurements in urea tablets. In case of the most unfavourable irradiation conditions, a maximum field size of 35 X 35 cm2, and a distance focus-wall of 450 cm, an air activation of 6, 18 X 10(4) Bq per individual irradiation is calculated. The limit of activity concentration prescribed by the Strahlenschutzverordnung (radioprotection directive) is not reached if a sufficient change of air is guaranteed. This method of measuring the air activation is simple, not time-consuming and can be effected with a high degree of accuracy. Measurements and calculations are compared.
Asunto(s)
Aire , Aceleradores de Partículas , Radioterapia de Alta Energía/instrumentación , Humanos , Matemática , Dosis de Radiación , Protección RadiológicaRESUMEN
In order to exactly determine the irradiation dose for cultured cells in culture containers (Petri dishes and others), it is necessary to have a detailed knowledge of the depth dose curve in water-equivalent layers near the surface. This curve was determined for Co-60 radiation by means of a window-less liquidity dosemeter. The dosemeter liquid was a solution of ammonium-iron (II) sulfate (solution of Fricke), the extinction of which was measured at 304 nm. Petri dishes were used instead of closed irradiation flasks. The distance QOA was 50 cm for all experiments, the field size was 10 X 10 cm. The depth dose maximum was found in a depth of 5,0 mm which corresponds to a mass of 0,50 g cm-2 relating to the surface. The surface dose was determined to be 39,2% and 106,6% of the maximum dose, respectively. This method can also be applied for closed culture containers (flasks).