[Determinant factors and disturbances in controlling power distribution patterns by the hyperthermia-ring system BSD-2000. 2. Measuring techniques and analysis]

Clinical observables and phantom measurements (part 1) have suggested that the control of power deposition patterns can still be improved for the hyperthermia system BSD-2000. This is addressed to system-specific phase errors as well as inadequacies of phase selection (target point method), which might be corrected by modifications of the manufacturer. Furthermore, frequency-dependent physical effects (coupling, mode excitation) are existing, which might cause distortions and asymmetries of current distribution on antennas and consequently deteriorate the power deposition pattern (e.g. focussing capability). The application of a network analyzer system is described in order to determine electrical material constants, phase errors, coupling coefficients, reflection coefficients and current distributions on antennas. The analysis of the measurement datas suggests that ring-applicator has a variable frequency-optimum (supposed around 80 ... 95 MHz) characterized by minimal coupling and asymmetries.

Coagulation changes and the influence of the early perfusate in the course of orthotopic liver transplantation (OLT) when aprotinin is used intra-operatively

The changes in relevant haemostatic parameters during the course of ten orthotopic liver transplantation were studied when aprotinin was given intra-operatively. Increases of tissue-type (P = 0.008) and urokinase-type (P = 0.009) plasminogen activators during the anhepatic phase could be correlated with hyperfibrinolysis. Thrombin-antithrombin III complexes (TAT) increased after revascularization of the liver graft (P = 0.003). Parallel studies in the perfusate showed that TAT concentrations were 350% and protease inhibitor activities (antithrombin III, protein C) only 52% of the systemic circulation before reperfusion, suggesting that thrombin activation together with protease inhibitor consumption occurs during graft liver reperfusion. The relatively smaller increases in profibrinolytic parameters and a lower blood loss when compared with other groups may be explained by aprotinin administration in our patients.

[Non-tropical sprue and chronic inflammatory rectal stenosis in a patient with abuse of ergotamine-containing suppositories]

A 51 year old Yugoslavian patient was admitted to our hospital in reduced general condition with distinct hypocalcemia, osteomalacia, and with rectum stenosis. Our investigations led to the diagnosis of a malabsorption syndrome due to non-tropical sprue. The most likely cause of the rectum stenosis is an abuse of ergotamine-containing suppositories for several years. A gluten-free diet and the interruption of the use of the suppositories improved her general condition remarkably.

[The influencing factors and interfering effects in the control of the power distributions with the BSD-20000 hyperthermia ring system. 1. The clinical observables and phantom measurements]

A new generation of annular-phased-array systems BSD-2000 has been clinically applied in a pilot study. Therapeutic intratumoral temperatures greater than 42 degrees C were obtained in 15/15 sessions with six patients. However, the control of power deposition pattern has to be improved in order to increase the therapeutic gain and to guarantee an efficient therapy. A retrospective analysis of clinical phenomena has been performed by phantom set-ups because the power deposition pattern cannot be determined during therapy. Phantom measurement techniques are outlined, specifically phantom materials and visualization of power distributions. The problem of focus balance and frequency choice is illustrated by self-developed phantoms (liquid crystal sheets, light-emitting-diode-arrays). Especially, the limitation of modeling calculations is demonstrated.

Improvement of pneumonia and arthritis in Felty's syndrome by treatment with granulocyte-macrophage colony-stimulating factor (GM-CSF)

A 63-year old man with Felty's syndrome and pneumonia of unknown origin was treated with GM-CSF. Granulocyte counts increased and arthritis-related symptoms improved under GM-CSF. Pneumonia was treated effectively with antibiotics only during or after GM-CSF application. This suggests, that antibiotic-resistant infections can be treated effectively in patients with Felty's syndrome when granulocyte counts are raised by GM-CSF.

[Bodily movement of teeth in atrophic jaw segments]

This experimental animal study was conducted to evaluate the extent of bone restructuring after bodily movement of teeth into an area of atrophied alveolar bone. The measured values as well as the radiographic and histologic data indicate that partial or total bone restructuring occurs depending on the rate of tooth movement. In our experiment we observed marked bone formation at an average tooth movement rate of 15 microns/day, whereas no noteworthy bone formation occurred at higher rates of tooth movement (26-40 microns/day). Basically, an improvement in attachment is possible with bodily movement in atrophic alveolar bone. However, it is important to remember the delayed periosteal reaction when planning the mechanics to be applied.

[The effect of the antiarrhythmic, prajmalium bitartrate, on human thrombocyte function]

Studies of the in vitro effects of the antiarrhythmic drug prajmalium bitartrate (PBT, Neo-Gilurytmal) showed inhibitory effects on platelet aggregation and thromboxane production. PBT inhibited the primary and secondary phases of aggregation induced by adrenaline (epinephrine) or adenosine diphosphate (ADP). Platelet aggregation stimulated with collagen, platelet activating factor (PAF), and the thromboxane mimetic 9,11-azo-prostaglandin H2 (U 44064) was inhibited. The secondary phase of aggregation induced by ristocetin and aggregation caused by arachidonic acid (AA) were inhibited in samples from some donors (responders) but not in others (nonresponders). Platelet aggregation by the ionophore calcimycine (A 23187) was not inhibited, but small doses of calcimycine abolished the PBT-induced inhibition of aggregation caused by ADP. Thromboxane production of platelets with collagen of ADP was inhibited by higher concentrations of PBT, whereas AA-induced thromboxane synthesis remained unchanged. The observed antiplatelet activities of PBT are thought to result from calcium and sodium channel blocking properties of the drug.

[Modification of blood coagulation by the anti-arrhythmia drug prajmalium bitartrate in vivo]

We studied the effects of prajmaliumbitartrate (PBT, Neo-Gilurytmal, Giulini Pharma, Hannover, FRG), an antiarrhythmic drug on some parameters of blood coagulation in patients. PBT, 20 mg given three times a day, significantly prolonged template bleeding time and ex vivo thrombus formation time in a modified Chandler's loop. Ex vivo platelet aggregation using different agonists and tests of the plasmatic coagulation system remained unchanged.

[Operability of primary inoperable pelvic tumors by preoperative regional hyperthermia in combination with systemic chemotherapy exemplified by Ewing's sarcoma]

Failure of local tumor control is of critical importance in the clinical management of large pelvic tumors. For bulky sarcomas of the pelvis a new treatment strategy could be of importance in the future using preoperative regional hyperthermia combined with systemic chemotherapy. In our case history of a patient with unresectable Ewing sarcoma of the pelvis no tumor response could be observed during multi-drug chemotherapy alone. However, after treatment with regional hyperthermia combined with systemic chemotherapy, the tumor mass became resectable and was separated from the adjacent tissue by a fibrotic pseudocapsule. Histological evaluation of the tumor tissue showed a complete change of the pattern.

Dose-response relationship in the treatment of idiopathic thrombocytopenic purpura with intravenous immunoglobulin

The dose-response relationship in the intravenous immunoglobulin treatment of idiopathic thrombocytopenic purpura was studied in 20 adult patients in a multicenter prospective crossover trial. The rate of response increases from 3 out of 11 (27%) to 6 out of 10 treatment periods (60%) by raising the 7S-IgG dose given on 5 consecutive days from 164.50 +/- 24.55 to 359.65 +/- 58.62 mg/kg body weight. The onset and duration of response as well as the peak platelet count were found to be independent of the doses. A long-term benefit induced by intravenous immunoglobulin treatment could be achieved in 2 out of 14 patients with chronic idiopathic thrombocytopenic purpura.

Manic syndrome following head injury: another form of secondary mania

Two cases of mania secondary to head injury are reported. Only four well-documented reports of head trauma as a cause of secondary mania were found in an English and foreign literature search, although such a search is made difficult by the paucity of cases meeting modern diagnostic criteria for mania. Previous reviews of the causes of secondary mania have not included head injury, but the two case reports confirm that head injury may be an additional cause. A diagnosis of mania secondary to head trauma should be considered in manic patients with atypical age of onset, absence of previous psychiatric illness, negative family history for bipolar illness, and close temporal proximity of head trauma to subsequent mania.

Thromboxane receptor blockade versus cyclooxigenase inhibition: antiplatelet effects in patients

In a randomized pilot study we compared the antiplatelet effects of aspirin and BM 13.177 in two groups of 7 patients each undergoing PTCA. As compared with the pretreatment values template bleeding time was prolonged and collagen induced aggregation was inhibited in PRP and WB in all patients. In the course of angiography and PTCA a rise in platelet factor 4 and beta thromboglobulin was observed in both groups, followed by a decrease below the baseline levels. Thromboxane B2 in plasma and serum decreased in the aspirin group but remained unchanged during BM 13.177 treatment. In PRP and WB aggregation induced by U 46 619 was inhibited after ingestion of BM 13.177 but not following ASA. After three months a control coronary angiography was done. There was no difference in regard to the degree of restenosis between both groups. Medication was well tolerated, compliance was good and no side effects were noted.

Unsaturated platelet-activating factor: influence on aggregation, serotonin release and thromboxane synthesis of human thrombocytes

Unsaturated platelet-activating factor (paf-acether) aggregated thrombocytes of healthy male volunteers like saturated paf-acether. Unsaturated paf-acether released serotonin in the presence of imipramine. Within one minute the release increased depending on the concentrations of unsaturated paf-acether up to 45% of the serotonin. Human thrombocytes synthesized only a small amount of thromboxane B2 (TXB2) after aggregation induced by unsaturated paf-acether. Unsaturated paf-acether prevented the binding of radiolabelled saturated paf-acether to intact washed thrombocytes in the same extent as saturated paf-acether.