[Radiotherapy following a breast-preserving operation in breast carcinoma]

Between 1980 and 1988, 116 patients with invasive breast cancer were treated by limited surgery with axillary node dissection followed by radiation therapy. Radiotherapy was performed by individually computerized treatment planning. The target volume dose was 50 Gy to the whole breast followed by an electron boost of 10 Gy to the tumor bed. The median follow-up period was 59 months. The actuarial overall survival rate is 93%, and the disease-free survival 75.2%. Ten (8.6%) breast recurrences occurred. Analysis of clinical and pathological prognostic factors revealed that local control was impaired by young age, negative hormone receptors, G3-4 tumors and intraductal growth. The recurrence rate for T3- and T4-tumors was 12.5%.

Pancreatic insulinomas

We report a series of 30 patients with pancreatic insulinoma treated from 1967 to 1990. Twenty-nine patients underwent surgery. In 24 patients, the lesion was a benign adenoma. The pancreatic lesion was localized preoperatively in 59% of cases (94% since 1980), and all lesions that were identifiable histologically were palpable intraoperatively. Endoscopic pancreatic ultrasonography, performed twice, appeared to be a very promising method of investigation. In the 24 patients with adenoma, 14 enucleations and 10 pancreatic resections were performed, with the enucleation rate increasing over time. One patient died during the postoperative period. Pancreatic fistulas (43%) were the most common cause of morbidity and were more common after enucleation (57% versus 29% after pancreatectomy). The mean follow-up period was 7 years. Excluding the patients with adenocarcinomas, the recovery rate was 92% (23 of 25 among whom 2 patients had transitory recurrent hypoglycemia), 2 patients who underwent corporeo-caudal pancreatectomy being diabetic (8%).

Determination of cocaine and benzoylecgonine by derivatization with iodomethane-D3 or PFPA/HFIP in human blood and urine using GC/MS (EI or PCI mode)

A method for the simultaneous detection and quantification of cocaine and benzoylecgonine from human blood and urine has been developed. Cocaine and benzoylecgonine were extracted from blood and urine with solid-phase columns containing C18 packing material. Clean, emulsion-free extracts were obtained. The analytes were derivatized with PFPA/HFIP or iodomethane-D3. The underivatized cocaine and derivatized benzoylecgonine were determined by GC/MS with positive chemical ionization (PCI) and the selected ion monitoring mode. Benzoylecgonine was derivatized with iodomethane-D3 to cocaine-D3. Both derivatives were chromatographed on a CP-SIL 5 capillary column. The recovery of extraction was greater than 70%. The detection limit for the PFPA/HFIP derivatives (20 ng/mL) was better than that for iodomethane-D3 derivatives (40 ng/mL). The procedure is simple, rapid, and reproducible. Standard curves were linear and the procedure was suitable for routine analysis. Using fluorescence polarization immunoassay (TDx, Abbott) (cutoff 100 ng/mL), along with one of the GC/MS methods described, we found no false positive or false negative results.

[Glue solvent as the cause of a "breath alcohol value" of "1.96 promille"]

After sniffing of glue solvents (mixture of aliphatic hydrocarbons: boiling fraction 60-90 degrees C, ethylacetate and toluene) a blood alcohol concentration of 1.96 permille was indicated with an instrument using the infrared wavelength of 3.4 micrometer for the spectrophotometrical determination of breath alcohol. Testing of the individual solvents with a simple manual procedure showed linear relationships between concentrations in breathing air and the false positive breath alcohol values. Aliphatic hydrocarbons predominantly are responsible for the false positive breath alcohol determination. With 500 micrograms/liter a value of nearly 1.5 permille can be produced (using the factor of 2100 for the calculation of the blood alcohol concentration from breath alcohol). With ethylacetate or toluene up to 1 milligram/liter 0.5 permille ethanol in the blood will erroneously be found. The problem of recognition of crossreactive other gases by the measurement at two wavelengths (3.4 and 9.2 micrometer) is discussed.

Intraarterial 5-FU-infusion and simultaneous radiotherapy as palliative treatment of recurrent rectal cancer

Palliative treatment of recurrent rectal cancer remains to be a challenge. From 1989 to 1991 13 patients with recurrent rectal cancer were treated with intraarterial infusion of 5-Fluorouracil and simultaneous radiotherapy in a palliative intent. Seven patients had received postoperative adjuvant radiotherapy with 56 to 60 Gy. Three patients had been treated with systemic chemotherapy. Radiotherapy of the recurrence was performed with 19.8 to 30.6 Gy in the pre-irradiated patients and with 50.4 to 59.4 Gy in the others. One complete remission, three partial remissions and nine minor responses were observed. Three patients had complete pain relief after the treatment, in the remaining patients major pain reduction was achieved. Palliation lasted from three to twelve months (median: five months). Our results indicate that locoregional chemo- and radiotherapy are a effective modality in recurrent rectal cancer.

[Suicide with chloroquine combined with maprotiline and trimipramine]

Report on suicide with chloroquine in combination with maprotiline and trimipramine. Chloroquine and his metabolite monodesethylchloroquine could be determined in organs and body fluids. The highest organ-concentrations of chloroquine were found in liver and kidney. The survival time and dose are discussed.

[Radiochemotherapy concepts in advanced carcinomas of the mouth, oro- and hypopharynx]

Among combined radiochemotherapy regimens of advanced head and neck tumors four modalities can be discriminated: 1. Induction chemotherapy, 2. simultaneous radiochemotherapy, 3. adjuvant chemotherapy, 4. accelerated hyperfractionated radiotherapy and chemotherapy. The results of the presently available randomized trials are as follows: 1. Induction chemotherapy has no influence on long-term recurrence-free survival. 2. With respect to simultaneous radiochemotherapy, recurrence-free survival has been unproved with 5-FU and Mitomycin C. 3. There is evidence that adjuvant cisplatin therapy improves recurrence-free survival. 4. No results are available to date using hyperfractionated accelerated radiotherapy regimens in combination with chemotherapy.

Phase I study of hyperfractionated accelerated radiation and simultaneous Carboplatin therapy for advanced head and neck carcinomas

From 1990 to 1991 15 patients with advanced head and neck carcinomas underwent hyperfractionated accelerated radiotherapy (2 x 1.6 Gy/day, five days/week, total dose 64.0 to 67.2 Gy) and simultaneous intravenous application of Carboplatin (60 mg/m2, days 1 to 5 and 29 to 33) in a pilot study. Eleven patients had T4 and four had T3 tumours. At the end of treatment twelve patients had a complete tumour remission and in the others a partial tumour involution was seen. Although acute side-effects were more pronounced compared to conventional irradiation this treatment regimen is feasible and the initial complete remission rate of 80% is encouraging.

Successful renal transplantation in a patient with systemic sarcoidosis and renal failure due to focal glomerulosclerosis

In 1987, a patient presented with pulmonary sarcoidosis and progressive renal failure. Percutaneous renal biopsy showed focal glomerular sclerosis (FGS). Over the subsequent 4-year period, her renal failure progressed to require hemodialysis. During this time, her pulmonary sarcoidosis was treated with daily corticosteroid therapy and she remained in clinical remission. The patient received a one-haplotype-identical living-related renal transplant from her mother. The patient is now 25 months posttransplant with a serum creatinine of 106 mumol/L (1.2 mg/dL). Her sarcoidosis continues to be in clinical remission. In this report, we review the rare association of a primary glomerular lesion causing renal failure in patients with sarcoidosis. In addition, we detail the first successful renal transplant in such a patient.

Radiotherapy of aggressive fibromatosis

The long term results of 24 patients treated with postoperative irradiation for aggressive fibromatosis are presented. Tumour sites were the pelvis (8), chest wall (5), shoulder (5), extremities (4) and head and neck (2). Macroscopic complete resection (R1) was performed in 3 cases. 17 patients presented postoperatively with gross disease (R2), 8 of which were recurrent tumours. 4 patients with inoperable disease had biopsies only. Radiation doses ranged from 28 to 64 Gy at a fractionation of 5 x 2 or 4 x 2.5 Gy/week. 4 patients had external irradiation in combination with 192Ir implants, 2 were irradiated with implants alone. In the combined treatment group, external doses ranged from 28 to 52 Gy and additional interstitial doses from 35 to 50 Gy. 192Ir treatment alone was given with 45 and 57 Gy to the contour of the target volume. The 10 year recurrence free survival rate is 75%. A dose response relationship has been established in the dose range of 30-60 Gy revealing an expected 80% persistent tumour control rate at 60 Gy. A dose volume relationship however, could not be derived from our data. Moderate fibrosis without functional impairment developed in 5 patients (21%). These data support a policy of postoperative radiotherapy with 60 Gy in patients with incompletely excised or gross residual tumour following surgery.

The prognostic value of DNA content measured by image cytometry in soft tissue sarcomas

Nuclear DNA content in soft tissue sarcoma was determined by image cytometry using archival, paraffin embedded material. In a retrospective study 138 specimens of 81 patients have been analysed. The ploidy level was correlated to clinical outcome regarding tumor volume and histological grading, the most important prognostic parameters. Ploidy has a significant prognostic value and correlates well with histological grading (p = 0.01). Tumour volume was found to be an independent prognostic factor (p = greater than 0.1) [chi 2 test]. The DNA content of the primary tumour and of multiple local recurrences remained similar.

Hemorrhagic infarct conversion in experimental stroke

STUDY OBJECTIVE

This study investigated the relations between hemorrhagic infarction and occlusion, release, levels of glycemia, brain energy state, and lactate content after cerebrovascular occlusion.

DESIGN

Prospective, controlled laboratory investigation.

TYPE OF PARTICIPANTS

One hundred six pentobarbital-anesthetized cats.

INTERVENTIONS

The middle cerebral artery was occluded with a Yasargil clip transorbitally either temporarily (0.5, four, and eight hours) or permanently. Normoglycemic and hyperglycemic animals were closely monitored for eight hours. Brain pathology was assessed after two weeks' survival or at the time of spontaneous animal death. Topographic brain metabolite studies were carried out after four hours of middle cerebral artery occlusion.

MEASUREMENTS AND MAIN RESULTS

Morphometric quantitation of cerebral hemorrhage and infarction and fluorometric determinations of blood and brain tissue, glucose, glycogen, lactate, adenosine triphosphate, and phosphocreatine from 16 topographic brain sites were carried out. Twenty-one of 82 (25.6%) animals evaluated neuropathologically showed hemorrhagic infarcts. Occluding the artery in hyperglycemic animals caused fivefold more frequent and 25-fold more extensive hemorrhage into infarcts than in normoglycemic animals. Temporary occlusion with clip release after four hours in hyperglycemic animals caused the most extensive hemorrhage into infarcts. Most hemorrhages into infarcts (81%) took place in animals that died within a few hours after they experienced ischemia and that showed infarction and marked edema of the entire middle cerebral artery territory. Linear regression analyses demonstrated a close relation between hemorrhage into infarcts and near-total energy depletion (adenosine triphosphate, less than 0.3 microM/g; phosphocreatine, less than 0.5 microM/g) in brain sites that showed extremely high tissue lactate concentrations (more than 30 microM/g). The biochemical changes that correlated with hemorrhage into infarcts were more marked than those with infarcts without hemorrhage.

CONCLUSION

Hyperglycemia and restoration of blood flow to ischemic territories were strong risk factors for hemorrhagic infarct conversion. Concomitant tissue metabolic changes suggest that marked tissue energy depletion accompanied by acidosis damages brain vessels and renders them penetrable for edema fluid and, ultimately, red blood cell extravasation.

Simultaneous radiotherapy and chemotherapy with carboplatin in inoperable squamous cell carcinoma of the head and neck: a phase II study

Fifty-six untreated patients with inoperable squamous cell carcinoma of the head and neck were treated with carboplatin 70 mg/m2 i.v. daily on days 1-5 and 29-33 in combination with simultaneous conventional radiation up to a target volume dose of 50 Gy. Depending on tumor response and upon recommendation of surgeons, 21 of 56 patients underwent surgery after a radiation dose of 50 Gy and two courses of carboplatin. Patients who showed pCR after surgery received no further radiotherapy. In all other patients radiotherapy was continued using a shrinking field technique up to a target absorbed dose of 70-74 Gy. Combined modality induced 66% complete remission (CR) and an overall response rate of 98%. After completion of the whole treatment program (combined modality +/- surgery) 53 (94%) of the 56 patients were disease free. The median survival for all patients is 25+ months and the percentage of two-year survivors is 53%. Myelosuppression was the most frequent toxicity, but rarely was severe; leukopenia and thrombocytopenia of WHO grade 3 occurred in 21% of the patients. No other toxicities above WHO grade 2 occurred. Nephrotoxicity, neurotoxicity and ototoxicity were not seen. The addition of carboplatin did not increase the rate of surgical complication over that expected for preoperative radiotherapy. Two patients died of pulmonary embolism after surgery. Combined modality with carboplatin and simultaneous radiation is a highly active and well-tolerated regimen for untreated patients with inoperable squamous cell carcinoma of the head and neck.

[Long-term follow-up of the accuracy of blood alcohol determination (GC and ADH method) with test sera (about 0.6 and 1.5 g/L) with reference to safety recommendations regarding 0.1 promille]

For the precision and accuracy testing of the gaschromatographic and the ADH-enzymatic ethanol determination respectively, we used two commercially available control sera (approximately 0.6 g/L and 1.5 g/L respectively). During one year of testing during 1990 at 200 different days, they were daily and routinely used together with the specimen analysed. The mean serum ethanol concentration obtained for both sera was less than the value stat-ed by the manufacturer. Our investigation also aimed at a possible lower threshold value from 0.8 promille to 0.5 promille (BAK) as a consequence of the german "Wiedervereinigung". The combination of GC- with ADH-method always performed the safety-value set up as judged by the german "Bundesgerichtshof" (= 0.1 promille). Even if quality criteria could be hold in this study, some doubt is remaining concerning a sufficient accuracy of blood alcohol measurements in the more complex matrices of individual blood samples to which the results can not be transferred.

Overexpression of Acetohydroxyacid Synthase from Arabidopsis as an Inducible Fusion Protein in Escherichia coli: Production of Polyclonal Antibodies, and Immunological Characterization of the Enzyme

Acetohydroxyacid synthase (AHAS, EC 4.1.3.18) is the first enzyme unique to the biosynthesis of valine, leucine, and isoleucine. This enzyme is the target site of several classes of structurally unrelated herbicides. The conventional method of antibody production using purified protein has not been successful with this enzyme. Two separate fragments of a gene encoding a portion of the mature region of AHAS from Arabidopsis were fused with the trpE gene from Escherichia coli using the pATH1 vector. E. coli cells transformed with each respective plasmid expressed a fusion protein at levels greater than 10% of the total cell protein. The fusion protein was purified and used to immunize rabbits. Antisera obtained from the immunized rabbits immunoprecipitated AHAS activity from Arabidopsis cell free extracts. The anti-AHAS antisera reacted with a 65 kilodalton protein band in electrophoretically resolved extracts of Arabidopsis. In cross-reactivity tests, this antibody was able to immunoprecipitate AHAS activity from various plant species. Furthermore, a protein band with a molecular mass of 65 kilodaltons was detected in the crude extracts of all plant species tested on a Western blot. These results indicate that the 65 kilodalton protein represents AHAS in various plant species. The wide spectrum of cross-reactivity for the antisera supports the view that the AHAS enzyme is highly conserved across all plant species.

[Intravenous mitoxantrone use and simultaneous radiotherapy as a palliative treatment in recurrent head and neck tumors]

After preceding radiotherapy, chemotherapy and/or surgery the therapeutic options are limited in case of recurrence. In order to enhance the effect of a reduced radiation dose we have combined intravenous mitoxantrone and simultaneous irradiation. From 1988 to 1991 22 patients with recurrent head and neck carcinomas were treated with this combined regimen. 20 patients had already been irradiated with 50 to 70 Gy. The second treatment course was given with 19.8 to 56.0 Gy and simultaneous application of one to three courses of mitoxantrone. Eleven (50%) patients achieved a clinical complete remission. A partial remission was seen in nine patients.

[Therapy of multiple myeloma by allogeneic bone marrow transplantation]

Multiple myeloma of IgG kappa type was diagnosed in a 42-year-old man with bone pains, dyspnoea on exertion and increasing drowsiness. Six chemotherapy cycles extending over 14 weeks and consisting of 15 mg/m2 melphalan intravenously on day 1 and 60 mg/m2 prednisolone orally on days 1-4 produced a partial remission. As the HLA-identical sister of the patient was willing to donate bone marrow, an allogeneic marrow transplantation was planned. After 7 days' conditioning treatment (hyperfractionated whole-body irradiation with 12 Gy, chemotherapy with 70 mg/m2 melphalan and 60 mg/kg cyclophosphamide), 4.2 x 10(8) nucleated cells of donor marrow were infused per kg recipient body-weight through a central venous catheter. Despite prophylaxis with short-course methotrexate and cyclosporin, an acute graft-versus-host reaction of grade II-III occurred on day 26, though it settled almost completely after treatment with daily 2 mg/kg prednisone and monoclonal interleukin-2 receptor antibodies (B-B10, daily 10 mg). On day 100 after the marrow transplantation, marrow puncture showed the picture of complete remission with normal regeneration of haemopoietic cells. Allogeneic marrow transplantation may therefore be considered as a new and promising mode of treatment for younger patients with multiple myelomas.

[The value of postoperative radiotherapy in colonic carcinomas]

From 1979 to 1988 63 patients with cancer of the colon received postoperative adjuvant radiotherapy. The mean age was 62 years and the median follow-up period was 71 months. Pathologic staging showed a B1-tumour in nine cases, B2 in 25, C1 in three and a C2-tumour in 26 cases according to the Astler and Coller modification of the Duke's classification. 53 patients received doses between 41 and 50 Gy. 47 patients were treated with a 60Co megavoltage unit and 16 cases with 8 MV photons. The overall five years survival rate is 65%. There was no significant difference between the survival rates for all stages. Only four patients with primary positive lymph nodes experienced a local relapse. 16 developed metastatic disease. In twelve cases (19%) liver metastases appeared: four patients (6%) developed intraperitoneal metastases, one patient had a metastasis in the abdominal wall and another showed pulmonary carcinosis. Acute and transient side effects were seen in 35% of our patients. Three patients underwent a second operation for radiation induced bowel stenosis. Compared with the results of surgery adjuvant radiotherapy yields improved five-year survival data in patients with C2 and G4 tumours.

Antitumor activity of oxysterols. Effect of two water-soluble monophosphoric acid diesters of 7 beta-hydroxycholesterol on mastocytoma P815 in vivo

Oxysterols, a family of naturally occurring products, have been shown to possess several biological activities. In particular, they are more toxic towards tumor cells than towards normal cells. In addition, they markedly modify immune cell responses. To carry out in vivo studies, we have synthesized phosphodiesters of 7 beta-hydroxycholesterol (JB69 and XA29). These water-soluble prodrugs have a similar toxicity to their parent compound under in vitro conditions. When administered intraperitoneally to mice bearing the P815 mastocytoma, they induced significant increases in life span. The results depend on the administration protocol. Under appropriate conditions, 20 to 40% of treated mice recover completely. This, together with their immunological effect, suggests that these oxysterols should be considered to be agents for immunochemotherapeutic investigations. By their ability to inhibit HMG CoA reductase, they may prevent the biosynthesis of prenyl groups whose coupling to oncogenes is responsible for the biological activity expression of the latter. Several indications are compatible with an effect on the cell membrane. Our recent studies have shown Protein Kinase C to be a target of oxysterols. On the basis of results obtained by our group and by others, we believe that oxysterols may form a new class of antitumor agents.

Host response to mycobacterial infection in the alcoholic rat

Animals, chronically treated with alcohol, were inoculated with mycobacteria (bacillus Calmette-Guérin, 10.2 x 10(6) organisms) into the spleen to produce a granulomatous hepatitis. Before infection, chronic alcohol ingestion was associated with a depressed skin test response to phytohemagglutinin, 71.7% of baseline (P = 0.009). Mycobacterial (bacillus Calmette-Guérin) infection stimulated phytohemagglutinin skin test response to 417% of baseline in controls and 299% in alcoholics (P less than 0.001). The hepatic granuloma response was altered with smaller but more numerous granulomas (mean +/- SEM, 81.2 +/- 1.5 microns2 of area with a frequency of 1.8 granulomas per field in alcoholics vs. 129.8 +/- 5.71 microns2 and 1.2 granulomas per field in controls; P less than 0.001). These changes were associated with a 10-fold increase in colony-forming units per gram of liver (54.5 +/- 18.2 in alcoholics vs. 5.6 +/- 1.83 in controls; P = 0.0006). This model offers precise parameters for host response to infection and indicates that alcohol significantly impairs the clearing capacity for mycobacteria from the liver.

[The therapy of acute radiogenic epitheliolysis with a dressing of hydrocolloids and polymers (Biofilm). A report on clinical experience]

Acute skin lesions following radiotherapy are uncomfortable and unacceptable side effects. They are observed predominantly after high surface doses as in conventional roentgen or electron beam therapy. To accelerate the wound healing we tested a bandage consisting of hydrocolloids and polymers, which is permeable for gas and water. Handling, compatibility and effectiveness of this plaster were tested in this study. According to the RTOG scoring system 19 irradiated fields with grade II to IV lesions were treated. Densitometric measurements of verification films with and without Biofilm showed no energy absorption. The bandage was comfortable for the patients and easy to handle.

The determination of drugs of abuse in whole blood by means of FPIA and EMIT-dau immunoassays--a comparative study

Six groups of common drugs of abuse (cannabinoids, benzoylecgonine, opiates, barbiturates, benzodiazepines and amphetamines) were determined in whole blood after acetone precipitation, using enzyme multiplied immunoassay (EMIT dau) and fluorescence polarisation immunoassay (FPIA--Abbott TDx and ADx) methods. Both methods, designed primarily for urine, allowed the determination of all above mentioned class of drugs but amphetamine. Only 1 ml of a pre- or postmortem blood sample was needed. The sensitivity of cannabinoids determination was higher by FPIA. The FPIA method gave more precise results, particularly in the case of autopsy blood. The method was applied for drug screening in autopsy and police blood samples. The results (both positive and negative) were in agreement with those obtained with chromatographic methods.

[Experience after one year's computer-assisted determination and evaluation at the alcohol dehydrogenase laboratory]

The processing of blood alcohol measurements by alcohol dehydrogenase method (ADH) was improved by using a tailored software program. The program is written in Turbo BASIC and requires an IBM Personal Computer (PC/XT/AT) or compatible with at least 640K memory and a graphic adapter (EGA or Hercules). All features of the program are available from the menu bar with pull down menus. The program stores on disk or harddisk the optical density values measured with an HITACHI spectrophotometer. After the measurement the calculation of alcohol concentration is accomplished by the program. The results can be transferred and further handled with database systems (e.g. DBASE III). Stored values are used to calculate the reproducibility of calibration and the precision of single determinations.