[Pretherapeutical diagnosis of metastases in carcinoma of the breast (author's transl)]

Conscientious pretherapeutic search for metastases is a prerequisite for every curative local therapy of breast carcinoma. This must be preceded by thorough physical checkup, supplemented by the usual blood tests, thoracic x-ray, and contralateral mammography. The axillary lymphatic nodes should be biopsied, since clinical assessment alone, unsupported by other examinations, yields false results in about one-third of the cases. Skeleton scintigraphy is recommended for routine skeleton diagnostics, possibly followed by specific roentgenography or tomography of individual skeleton sections. Bone marrow biopsy as well as individual biochemical examinations (discussed in this article in detail) are hardly useful in the search for hidden skeleton metastases, but they can be of importance in assessing the course of therapy. If there is the slightest clinical suspicion of metastases of the liver, brain or other organs, additional special examinations must be performed. Scintigraphy in combination with laparoscopy or ultrasound tomography is recommended in liver diagnostics. Brain metastases can be reliably detected by means of computer tomography.

[The question of the possibility to reproduce field positions in high-voltage therapy (author's transl)]

In order to obtain informations about the possibility to reproduce field positions in high-voltage therapy, controls were made by therapy films on several patients during the irradiation with a linear accelerator and a telecobalt unit. An incorrect position of the fields and/or lead satellites was found in 51% of the controls. The authors discuss possible reasons and their consequences for the radiotherapeutic practice. It must be taken into consideration especially when therapy plans are elaborated, that their realization may cause difficulties in the daily practice.

[Diagnostic laparotomy in Hodgkin's disease: indication, management, results (author's transl)]

Till December 31st 1976, diagnostic laparotomy was carried out in 58 patients with Hodgkin's disease. Of these, 23 cases (40%) revealed abdominal involvement. The tumor stage found by conventional diagnostics before surgical treatment had to be altered in 16 patients (27%). It had to be increased in ten and lowered in six cases. Of 13 splenic Hodgkin infiltrations twelve had not been supposed preoperatively; four out of 43 sound organs had been suspected preoperatively because of splenomegaly. Subdiaphragmatic histological findings involving a rather unfavorable prognosis were seen in nine patients (16%). In Hodgkin's disease, risk groups cannot be selected with confidence, as no definite correlation between the frequency of subdiaphragmatic affection and the primary manifestations, histology or general symptoms was observed. Since operation risk of diagnostic laparotomy is low, operable stage I-III cases with Hodgkin's disease should undergo diagnostic laparotomy prior to treatment planning.

[Dosis-performace-effects on the pluripotent hematopoietic stem cell. Results of partial body irradiation using 8MeV-x rays]

It was the aim of this study of document the influence of various dose rates on the CFU'S compartment. The information obtained should serve as a guideline to the design of radiotherapeutic programs with less hemopoietic toxicity in clinical radiation therapy. CBA mice were subjected to partial body X-ray irradiation from a linear accelerator (8MeV). The effect of dose rates of 6,70, 520 and 2800 R/min on CFU'S were studied in the irradiated and shielded marrow immediately after irradiation and 5,24 resp. 48 hours, 1 week and 3 weeks later. The following conclusions can be made: The reduction of CFU'S is significantly greater for low dose rates. After a dose of 150 R CFU'S reach normal values at 2 weeks, after 300 R at 3 weeks. With 450 R they are still subnormal at 3 weeks. A rebound phenomenon with increased CFU'S is seen at 3 weeks with 150 R and 300 R. An increase of CFU'S in shielded marrow is seen immediately after irradation. This increase is not dependent on the dose rate. The clinical implications of these findings are discussed.

[Behavior of individual immune parameters in patients with locally-regionally circumscribed breast cancer]

Significant and long lasting depression of lymphocyte function and distribution was demonstrated in 15 patients with breast cancer at varying clinical stages after postoperative radiotherapy.

Synthesis, purification, and chemical characterization of the amino-terminal 1-34 fragment of bovine parathyroid hormone synthesized by the solid-phase procedure

Peptides prepared by solid-phase synthesis during a systematic study of structure-activity relations in parathyroid hormone have been subjected, after sequential purifications, to rigorous analysis of purity by a variety of analytical techniques including sequence analysis by the Edman procedure. The present paper undertakes a critical appraisal of the utility of different tests of peptide purity and the use of the procedures in guiding and monitoring optimal synthesis strategies. Sequence analysis of a peptide representing the amino-terminal 34 residues of bovine parathyroid hormone (bPTH-(1-34)) revealed the presence of at least 30% of contaminating error peptides which were undetected by other analytical procedures. The major contaminant was identified as a peptid in which glutamine at position 29 was deleted. A repeat synthesis using fluorescamine rather than ninhydrin to monitor the coupling reaction resulted in a preparation that lacked the contaminant resulting from deletion. These findings demonstrate the particular value of sequence analysis in the evaluation of purity of peptides synthesized by the solid-phase technique.

[Treatment of pathologic fractures]

Eight pathologic fractures of benign and 52 of malignant origin are reported. Open reduction and rigid internal fixation should be performed to give the patient the use of his affected limb as soon as this can be accomplished. Treatment consists of internal fixation in lesions of the shaft and prosthetic replacement in the case of lesions near joints. Only very rarely a primary amputation must be performed. Malignant fractures are most frequently caused by metastases from breast cancers. The treatment will at least make nursing easier, and three-quarters of these patients can be mobilized. The combination of surgical treatment and radiotherapy is discussed. In spite of this approach the average time of survival of 14 months is short because a pathological fracture due to a malignant tumor is a late symptom of the disease.

[Volumetric follow-up measurements in normal and pathologic lymph nodes (author's transl)]

Alteration of Lymph node volume are measured in different groups of patients. Irradiated Lymph nodes diminish volume significantly more and faster than non-irradiated ones. Lymph nodes with reactive hyperplasia with/without irradiation show a significantly smaller volume decrease than normal Lymph nodes. Malignant systemic diseases have a significant higher volume decrease than normal or reactive hyperplastic Lymph nodes with identical irradiation-dose.

[Radiotherapy of brain metastases]

Experiences are reported obtained with radiation therapy of brain metastases in 121 patients during the last 15 years. The treatment to lesser extent aimed at prolongation of survival but much more at the attempt to alleviate troubles and to spare pain. The indication thus involved medical points of view as well as ethical ones. The radiotherapy of cerebral metastases comprises the whole cranial volume and requires a focal dose of minimally 4000 R within four weeks. In 53% of the patients, the regression of neurological symptoms was considerable, in 18% even complete, partly beginning already after a few days of treatment. The number of recurrences was small. Under conditions of rigorous indication, the radiation therapy of brain metastases offers a rewarding palliative measure.

[Demonstration of skeletal metastases using the bone marrow biopsy and the radiographic skeletal survey within the scope of pretherapeutic diagnosis in bronchial carcinoma]

In the course of pretherapeutic diagnostics of bronchogenic carcinoma, bone marrow biopsy revealed in ten out of 116 patients (9%) and radiographic skeletal survey in 16 out of 62 patients (26%) metastases to the skeleton. The two methods are complementary with reference to anaplastic and oat-cell carcinomas. On account of our experiences, we never fail to control the skeleton before the beginning of a local curative therapy in bronchial carcinoma.

[Contrast retention in retroperitoneal lymph nodes after lymphography; the effect of lymph node abnormalities, radiotherapy and contrast quantity]

The rate of contrast loss from retroperitoneal lymph nodes after lymphography was studied radiologically over a prolonged period in 302 patients. It varied remarkably, even in normal persons who were not receiving any treatment. Lymph nodes empty more quickly if only a small quantity of contrast has been used. Irradiation accelerates contrast transport, not only in the irradiated, but also in the neighbouring, group of nodes. This effect is dose dependent. There is evidence that pathological lymph nodes empty more quickly than normal ones.