Okkulte Schenkelhalsfraktur im proximalen Femur

Die Knochenszintigraphie ist eine hochsensitive Methode zum Nachweis von Frakturen. Sind ein Traumaereignis und eine eindeutige Klinik gegeben, ist der Röntgenbefund aber unauffällig, kann die Szintigraphie zur Diagnose führen. Im vorliegenden Fall einer okkulten Fraktur im proximalen Femur ergab erst die Szintigraphie Hinweise auf eine Fraktur, die dann topographisch durch den Einsatz der Magnetresonanztomographie bestätigt werden konnte.

Fast T1- and T2-weighted pulmonary MR-imaging in patients with bronchial carcinoma

PURPOSE

A prospective study to evaluate the diagnostic potential and limitations of three fast MRI sequences in patients with bronchial carcinoma based on the comparison with spiral CT.

MATERIAL AND METHODS

Three fast chest MRI sequences from 20 patients with central or peripheral bronchial carcinoma were evaluated by two observers for relation of tumour to adjacent structures, lymph node enlargement, additional pulmonary lesions and artefacts. The information from MR-imaging was compared with the results from spiral CT. MRI comprised a T1-3D-GRE breath-hold examination ("VIBE", TR/TE 4.5/1.9 ms, flip-angle 12 degrees , matrix 502 x 512, 2.5 mm coronal slices), a breath-hold, T2-HASTE sequence (TR/TE 2000/43 ms, matrix 192 x 256, 10 mm coronal slices) and a respiration-triggered T2-TSE sequence (TR/TE 3000-6000/120 ms, matrix 270 x 512, 6 mm transverse slices). The FOV was adapted individually (380-480 mm).

RESULTS

The presence of the primary bronchial carcinoma and infiltration of thoracic structures by tumour tissue could be demonstrated by all sequences. VIBE sequence was more suitable for detecting small pulmonary nodules than the other MRI examinations, but compared to CT still 20% of these lesions were missed. Contrary to VIBE and T2-weighted TSE scans, HASTE sequence was limited in imaging mediastinal lymph nodes due to missing relevant findings in 2/20 patients. HASTE images significantly provided the lowest rate of artefacts in imaging lung parenchyma (P < 0.001 in peripheral parenchyma), but spatial resolution was limited in this sequence. Concerning the differentiation between tumour and adjacent atelectasis (n = 8), T2-weighted TSE imaging was superior to CT and VIBE in all cases and to HASTE sequence in 4/8 patients.

CONCLUSION

The combination of VIBE and HASTE sequence allows for an adaequate imaging of thoracic processes in patients with bronchial carcinoma, limited only in visualizing small pulmonary nodules. To obtain more detail resolution and to differentiate tumour tissue from adjacent atelectasis, T2-TSE examination may be added in selected cases.

CD40 activation: potential for specific immunotherapy in B-CLL

Despite encouraging scientific and therapeutic advances, chronic lymphocytic leukemia (CLL) principally remains an incurable disease. Allogeneic transplantation represents the only curative approach, but is marked by high mortality. Novel and less toxic treatment modalities are needed. Immunotherapeutic approaches have clearly demonstrated potential effectiveness in CLL and other B-cell malignancies. To successfully direct immunity against CLL, highly immunogenic tumor cells or tumor-antigen-loaded antigen-presenting cells are necessary. The CD40-CD40L interaction has been shown to significantly increase antigen presentation in normal and malignant B-cells. Here we discuss biology and potential therapeutic applications of the CD40-system in CLL.

Isolated Bacterial Meningitis as the Key Syndrome of Infective Endocarditis

BACKGROUND

Bacterial meningitis is an unusual first manifestation but a major complication of infective endocarditis.

PATIENTS AND METHODS

We present three well documented cases of isolated bacterial meningitis in endocarditis. Against this background we review the literature.

RESULTS

All patients presented with bacterial meningitis. Staphylococcus aureus was isolated in blood cultures of all patients, but was found only in the cerebrospinal fluid (CSF) of one patient. The underlying endocarditis was confirmed histologically in all three cases. Two patients recovered completely and one died.

CONCLUSION

An extensive search for endocarditis is recommended in every case of an unusual isolate in bacterial meningitis whether it is isolated from blood or CSF.

MCP-1 modulates chemotaxis by follicular lymphoma cells

The localization and establishment of follicular lymphoma (FL) cells in distinct anatomic sites probably involves chemokine and adhesion receptors on the neoplastic cells and appropriate chemokines and adhesion receptor ligands in the microenvironment. Several chemokines play an important role in normal B-cell trafficking and differentiation. Monocyte chemoattractant protein-1 (MCP-1) is a C-C chemokine that induces chemotaxis of a variety of lymphoid cells through its receptor CCR2. CCR2 is also expressed on B cells, and MCP-1 induces chemotaxis of normal B cells. In this report, we investigated expression and function of CCR2 on FL cells. We found FL cells as well as the t(14; 18)+ B-cell lymphoma line H2 expressed CCR2. MCP-1 potentiated SDF-1-induced chemotaxis of FL cells and H2 cells, but MCP-1 alone did not induce chemotaxis. The specificity of the effects of MCP-1 and SDF-1 was demonstrated by antibody blocking studies. Because FL cells are generally associated with follicular dendritic cells (FDCs), FDCs may be an important source of chemokines. We found that cultured FDCs produced MCP-1, and this production was enhanced by tumour necrosis factor. These data implicate MCP-1 in the migration and localization of FL cells.

Primary gastrointestinal non-Hodgkin's lymphoma: I. Anatomic and histologic distribution, clinical features, and survival data of 371 patients registered in the German Multicenter Study GIT NHL 01/92

PURPOSE

The study was initiated to obtain epidemiologic data and information on anatomic and histologic distribution, clinical features, and treatment results in patients with primary gastrointestinal non-Hodgkin's lymphomas (PGI NHL).

PATIENTS AND METHODS

Between October 1992 and November 1996, 371 PGI NHL patients were eligible to evaluate clinical features. Radiotherapy and chemotherapy were stratified according to histologic grading, stage, and whether surgery had been carried out or not.

RESULTS

A total of 74.8% patients had gastric NHL (PGL). Within the intestine, the small bowel and the ileocecal region were involved in 8.6% and 7.0% of the cases, respectively. Multiple GI involvement (MGI) was 6.5%. Approximately 90% of the GI NHL were in stages IE/IIE. Aggressive NHL accounted for the majority, with a distinguishable pattern in several sites. Forty percent of PGL were of low-grade mucosa-associated lymphatic tissue type. One third of large-cell lymphomas had low-grade components. Most intestinal NHL were germinal-center lymphomas. The site of origin was prognostic. In gastric and ileocecal lymphoma, event-free (EFS) and overall survival (OS) were significantly higher as compared with the small intestine or MGI (median time of observation, 51 months). In PGL, localized disease was prognostic for EFS and OS. Histologic grade influenced only EFS significantly. Numbers in intestinal lymphomas were too small for subanalyses.

CONCLUSION

PGI NHL are heterogeneous diseases. The number of localized PGL allowed for detailed analyses. Larger studies are needed for stages III and IV and for intestinal NHL. A uniform reporting system for PGI NHL, in terms of definitions and histologic and staging classifications, is needed to facilitate comparison of treatment results.

Primary gastrointestinal non-Hodgkin's lymphoma: II. Combined surgical and conservative or conservative management only in localized gastric lymphoma--results of the prospective German Multicenter Study GIT NHL 01/92

PURPOSE

The aim of the study was to obtain data on anatomic and histologic distribution, clinical features, and treatment results of patients with primary gastrointestinal non-Hodgkin's lymphomas, particularly combined surgical and conservative treatment (CSCT) versus conservative treatment (CT) alone for primary gastric lymphoma (PGL) in localized stages.

PATIENTS AND METHODS

Whether the treatment included surgery was left to the discretion of each participating center. Radiotherapy (Rx) and chemotherapy were stratified according to histologic grading, stage, and the inclusion or omission of surgery as follows: patients with low-grade PGL were treated with extended-field (EF) Rx (30 Gy). In case of residual tumor after surgery or in case of CT only (in stage IIE after six cycles of cyclophosphamide, vincristine, and prednisone), an additional boost of 10 Gy was given. All patients with high-grade PGL were treated with four (stage IE) or six (stage IIE) cycles of cyclophosphamide, doxorubicin, vincristine, and prednisone followed by EF Rx (stage IE) or involved-field (IF) Rx (stage IIE). Rx dosage corresponded to low-grade NHL.

RESULTS

Between October 1992 and November 1996, 106 patients had CT only. The survival rate (SR) after 5 years was 84.4% and was influenced neither by patients' characteristics nor by stage or histologic grade. Seventy-nine patients had CSCT. Their SR was 82.0%. Complete resection of the tumor (R0) was prognostic for the overall survival (P =.0165) as compared with incomplete resection.

CONCLUSION

Although the study was not randomized, a stomach-conserving approach may be favored.

[Tumors of the anterior skull base. Effects of perioperative imaging on adjuvant radiotherapy planning]

OBJECTIVES

Treatment of anterior skull base tumours is still considered being a major challenge for all involved disciplines. Surgical management, complications, as well as the role of imaging for multimodality treatment options should be evaluated critically.

PATIENTS AND METHODS

57 patients underwent interdisciplinary one step trans-basal approaches for resection of benign and malignant anterior fossa tumours. Beside assessment of surgical results and perioperative morbidity, in 13 patients with malignant tumours perioperative imaging was evaluated with regard to further possible radio-oncological treatment options.

RESULTS

Applying trans-basal approaches radical tumour resection could be achieved in all cases independent of tumor-size (diameter 12-114 mm). Permanent postoperative complications (until 6 months postoperatively) were found in 4 cases (7%), transient complications in 7 cases (12.3%). Evaluation of perioperative imaging showed a heterogen use of different imaging modalities and revealed lack of standardization, hampering further planning of radiation therapy.

CONCLUSION

Treatment of anterior skull base tumours requires a maximum level of standardization of perioperative imaging, to grant a successful surgical and radio-oncological interdisciplinary patient management.

[The age-specific results of the adjuvant radiotherapy of breast carcinoma]

BACKGROUND

Aim of our work was to evaluate the standards of treatment in elder women with breast cancer and their results of radiation therapy.

PATIENTS AND METHODS

In our hospital 218 breast cancer patients were treated in the years 1990 and 1991. Forty-three women were younger than 50 years of age (group I), 92 between 50 and 64 years (group II), 83 elder than 64 years (group III). One hundred and forty-nine patients underwent mastectomy, 65 patients had conservative treatment (Table 5). Four patients were not operable. All of the patients were irradiated uniformly loco-regionally with 50 Gy Co-60-photons, followed by a boost to the tumor bed with 10 Gy with 6- to 12-MeV electrons. Forty-four patients had an additional chemotherapy.

RESULTS

The 5-year survival rate was 79.8% (n = 174), the disease free survival was 59.1% (n = 129) (Table 6). The mean rate of local recurrence was 3.6% (n = 8), 4% after mastectomy (n = 6) and 3% (n = 2) with breast conservation. Age group specific 5-year survival rates were 72% (I), 85.6% (II) and 77.1% (III), respectively, disease free survival rates were 48.8% (I), 65.2% (II) and 57.8% (III), respectively. The rates of local recurrence were 9.3% (I), 3.2% (II) and 1.2% (III), respectively. Significant age group specific differences in surgical and radiotherapeutical treatment could not be found.

CONCLUSION

The curative chance of treatment has to be used in every age. A treatment of elder patients below the actual valid standards of treatment is not justified.

[Results of radiotherapy in brain metastasis]

PURPOSE

To evaluate the effect of radiation therapy in the treatment of brain metastases.

PATIENTS AND METHODS

Fifty-eight patients with brain metastases were irradiated. In 52 patients the post-therapeutic survival time could be evaluated. Most frequent basic tumor entity was lung cancer, followed by breast cancer. Eighteen patients underwent neurosurgery prior to radiation therapy, 23 patients underwent only radiotherapy and in 13 patients an additional chemotherapy was performed. Four patients were treated by all these means. Radiation therapy was done as a whole brain irradiation with a total dose of 40 Gy at single doses of two Gy or 30 Gy at single doses of 3 Gy respectively.

RESULTS

There were no radiogenic complications. 42 of 58 patients (72%) showed an improved neurological status. In ten patients radiation therapy had to be abandoned due to deterioration of the patients condition, five patients died in the hospital. Mean survival time for all the patients were 213 days, by subtracting the preterminally treated patients the time improved up to 269 days. The prognosis was dependant of several factors. Main importance had the basic tumor entity itself leading to a mean survival time in breast cancer patients of 347 days in contrary to those with lung cancer and 152 days mean survival time. Good general status, young age and solitary metastasis were positive predictive factors.

CONCLUSIONS

Radiation therapy is capable to improve quality of life and to prolong survival after an only short treatment period. Treatment should be initiated quickly and consequently after diagnosis.

[Outcome of primary combined radio-chemotherapy in head and neck tumors with simultaneous salivary gland protection by amifostine]

AIM

Demonstration and critical evaluation of the use of cytoprotective agents in radiation therapy.

PATIENTS AND METHODS

In 1996 9 patients with head and neck tumors were irradiated with a mean dose of 66 Gy and simultaneous application of amifostine. Primaries were in the oropharynx (3), tongue (2), tonsils (2) as well as nasopharynx and soft palate. Parallel carboplatin was administered 6 times with a dose of 100 mg/week and amifostine twice a week with 500 mg over 6 weeks. The evaluation was performed clinically and by sialoscintigraphy (Figure 1).

RESULTS

There were no lasting side effects, but episodes of hypotension in 7 of 9 patients and nausea. Radiogenic acute toxicity was nearly uneffected, complaints from xerostomia, however, were diminished. All patients showed increased dermal pigmentation and dermatitis. Sialoscintiraphies 6 months after therapy proved better salivary gland function with correlated better patient condition.

CONCLUSION

Amifostine might gain a role in the prevention of lasting radiogenic xerostomia. The required dose is not yet clear. A broader use of amifostine would be favored by lower costs of the substance.

[Occult fracture of the femoral neck fractures of the proximal femur]

Bone scintigraphy is a highly sensitive method for the detection of fractures. In case a trauma and clear clinical signs are evident, but the radiography is inconspicuous, bone scintigraphy may lead to the final diagnosis. In the present case of an occult fracture in the proximal femur only scintigraphy indicated the fracture, which then was proved topographically by magnetic resonance imaging.

[Late results of radiotherapy of soft tissue sarcoma]

PURPOSE

To evaluate the effect of radiation therapy in the treatment of soft-tissue sarcomas.

MATERIALS AND METHODS

Between March 1970 and January 1990, 58 patients with soft-tissue sarcoma were referred for radiation therapy. The most frequent histologic diagnoses included fibrosarcoma (n = 15), neurofibrosarcoma (n = 5) and rhabdomyosarcoma (n = 5). Central tumor sites in the trunk (n = 31) were much more frequent than in the head and neck region (n = 14) or the extremities (n = 13). Thirty-nine of 58 primary tumors were bigger than 5 centimeters. Forty-five patients were irradiated after surgery, 5 patients prior to surgery; in 8 cases only radiation therapy was used. Radiation therapy was performed with Co-60 photons and an average total dose of 58 Gy, fractionated in single doses of 2 Gy. The treatment results were obtained by actual follow-up examinations.

RESULTS

Twenty-three of 58 patients survived at least 5 years (39.9%). Of 15 patients with R0 resection 11 were alive after 5 years (73.3%). Local tumor control was achieved in 34 of 58 patients (58.6%). Low 5-year-survival rates were associated with dedifferentiation of the primary tumor (three survivors in 10 patients with G3 tumor), tumor diameters over 5 cm (13 survivors of 39), R2 resection (3 survivors of 16) and tumor sites in the body trunk (11 survivors of 31).

CONCLUSIONS

(1) The best results of radiation therapy were achieved after R0 resection of the primary tumor. (2) Tumors in the trunk are prognostically worse because of bigger tumor diameters due to later diagnosis.

Induction of anti-mistletoe lectin antibodies in relation to different mistletoe-extracts

Mistletoe extracts are frequently applied in adjuvant cancer treatment. The mistletoe lectins are especially suggested to mediate an antitumorous effect. During treatment with mistletoe lectin-rich extracts, anti-mistletoe lectin antibodies preferentially of the immunoglobulin G type are produced against mistletoe lectin (ML)-1. Interestingly, after application of mistletoe extracts containing natural micelles, anti-mistletoe lectin antibodies of the immunoglobulin G as well as one of the immunoglobulin E type were induced in parallel, suggesting that the nature and preparation of the antigens within the extract modifies immune responses. Anti-mistletoe lectin antibodies were shown to neutralize the cytotoxic effect of mistletoe lectin on peripheral blood mononuclear cells in vitro. Thus, the mode of application of these extracts seems to be of importance with respect to the therapeutic effect.

Rapid Ca2+-dependent NO-production from central nervous system cells in culture measured by NO-nitrite/ozone chemoluminescence

We have established simple and reliable measurement of constitutive nitric oxide (NO) synthase-dependent nitrite formation in supernatants from primary central nervous system (CNS) cells in culture using NO-ozone chemoluminescence. We found that: (1) astrocytes, endothelial cells and cerebellar granule cells produce NO upon stimulation with the calcium ionophore A23187 (1 microM); (2) application of 100 microM glutamate for 2 min results in NO-production in cerebellar granule cells and cortical neurons. NO-formation upon application of 50 mM KCl was found in cortical neurons; (3) in cultivated cerebral endothelial cells, an inducible form of NO-synthase (iNOS) is found under standard culture conditions. This induction was blocked by dexamethasone applied for at least 48 h and stimulation of constitutive NOS was detectable while iNOS was inhibited. The activity of iNOS was selectively inhibited by application of aminoguanidine for 48 h. Our results suggest that all major CNS cells implied in cerebral blood flow regulation and neurovascular coupling are capable of rapidly producing the vasodilator NO upon intracellular increases of the universal second messenger calcium.

Nitric oxide synthase inhibition does not affect somatosensory evoked potentials in the rat

Nitric oxide synthase (NOS) inhibition reduces the regional cerebral blood flow (rCBF) responses to somatosensory stimulation. It is controversial whether this is caused by a signalling role of nitric oxide (NO) between neurons and vascular smooth muscle, or by effects of NOS inhibition on neuronal activity. We here report that more than 85% inhibition of NOS activity by topical application of the NOS inhibitor N omega-nitro-L-arginine (L-NNA) for 2 h does not affect somatosensory evoked potentials (SEPs) elicited by vibrissal deflection or electrical forepaw stimulation in choloralose anaesthetised rats equipped with a closed cranial window, whereas cerebral blood flow (CBF) responses due to these stimulation paradigms are reduced by approximately 60%. We conclude that the decrease of the regional vascular response to increased neuronal activity during NOS inhibition is not caused by a suppression of neuronal activity.

[The results of strontium-90 contact therapy to prevent the recurrence of pterygium]

AIM

Aim of the study was the evaluation of the role of adjuvant radiation therapy in the prevention of recurrence after excision.

PATIENTS AND METHODS

Between July 1, 1985 and April 1, 1993, 64 patients (43 male, 21 female) were referred to radiation therapy after excision of a nasal pterygium. Radiation therapy was done with a strontium-90 eye applicator and a total dose of 30 Gy, fractionated in 6 fractions of 5 Gy each, 3 times a week. Forty-nine patients were treated primarily, 15 patients underwent radiation therapy for the first time in case of recurrent pterygium after multiple re-excisions. All patients had a following of 1 to 9 years with a median of 5.5 years.

RESULTS

In 8 of 64 irradiated patients recurrent pterygium was detected (12.5%). Differentiated into the 2 groups 4 of the primarily treated patients had recurrent pterygium (8.16%), the other 4 were in the group with multiple former re-excisions (26.7%). With regard to the initiation of the irradiation after surgery pterygium did not recur in any of the primarily treated patients who were irradiated in between 3 days after surgery. In contrary 3 of 7 primarily treated patients (42.9%) who started radiation therapy between 7 and 10 days after surgery had recurrent pterygium. For the patients with primarily recurrent pterygium no dependence of the initiation of radiation therapy after surgery could be detected.

CONCLUSIONS

Adjuvant radiation therapy after excision of pterygium lowers the rate of recurrence from about 40% to 12.5%, in a primarily adjuvant situation to 8.16%. In these patients radiation therapy should be initiated within 3 days after surgery. Patients with primarily recurrent pterygium have an elevated risk of recurrence independently of the initiation of radiation therapy.

Results of adjuvant radiation therapy after surgical excision of pterygium

The aim of the present study was the evaluation of the role of adjuvant radiation therapy in the prevention of recurrence after excision. Between July 1, 1985, and April 1, 1993, 64 patients (43 men, 21 women) were referred for radiation therapy after excision of a nasal pterygium. All patients were followed for 1-9 years (median 5.5 years). Radiation therapy was done with a strontium 90 eye applicator at a total dose of 30 Gy fractionated into six fractions of 5 Gy each. In all, 49 patients were treated after their first excision and 15 patients had undergone multiple prior excisions. In 8 of 64 irradiated patients, recurrent pterygium was detected (12.5%); 4 recurrences developed after first excision and adjuvant radiation therapy (8.16%) and the other 4, following multiple former reexcisions and radiotherapy (26.7%). Pterygium did not recur in any of the primarily treated patients who were irradiated within 3 days of surgery. In contrast, 3 of 7 accordingly treated patients (42.9%) who started radiation therapy at between 7 and 10 days after surgery developed recurrent pterygium. Adjuvant radiation therapy after excision of pterygium lowers the overall rate of recurrence to 12.5%. In an adjuvant situation after first excision, radiation therapy should be initiated within 3 days of surgery, the result being freedom from recurrence.

B7-mediated costimulation and the immune response

In addition to presentation of antigen, T cells require additional or 'costimulatory' signals from antigen-presenting cells. Failure to receive costimulation following antigen presentation renders T cells anergic, and these cells are functionally incapable of proliferating or secreting cytokines in response to subsequent rechallenge. Recent evidence has demonstrated that a critical costimulatory signal is delivered by members of the B7 family. B7-1 (CD80) and B7-2 (CD86) provide costimulation through CD28, their ligand on the T cell. Dysregulation of expression of B7 may be implicated in the pathogenesis of autoimmune disease. In contrast, lack of expression of B7 on tumor cells may explain in part the lack of immune response against the majority of tumors. It may now be possible to exploit this pathway to induce immunological response against tumors. Blockade of this pathway will likely have significant impact on transplantation biology, to induce T-cell anergy and prevent graft rejection and graft-versus-host disease.

[Validity of bone scintigraphy for radiotherapy treatment planning of the skeletal system]

Aim of this paper is to assess the validity of bone scanning for radiation therapy treatment planning in the skeletal system. Radiation therapy treatment planning in the skeletal system is based on plain film radiographs and bone scanning. Between January 1, 1993 and June 30, 1994, 228 patients were irradiated due to malignancies in the skeletal system. Included were bone metastases, lymphomas, sarcomas and bone invasion of neuroblastoma. The morphological display of the plain film radiographs and the bone scintigraphies were compared and modifications of the target volume due to the scan findings quantified. In 17 of 228 patients (7.5%) the target volume was modified by at least 2 cm due to tumor invasion depicted by radionuclide scanning only. Bone scintigraphy enables a sensitive display of bony invasion in skeletal malignancies. Because of a scan induced alteration of the target volume in 7.5% of the cases, bone scanning cannot be abandoned in RT treatment planning.

Wertigkeit der Knochenszintigraphie für die Bestrahlungsplanung im Skelettsystem

In dieser Arbeit soll die Bedeutung der Knochenszintigraphie für die Bestrahlungsplanung im Skelettsystem evaluiert werden. Im Rahmen der technischen Zielvolumendefinition bei Knochenprozessen wurde neben röntgenologischen Methoden und den digitalen Schnittbildverfahren auch die nuklearmedizinische Bildgebung einbezogen. Zwischen dem 1. Januar 1993 und dem 30. Juni 1994 erfolgte eine Radiotherapie des Skelettsystems bei 228 Patienten. Die morphologische Zielvolumendarstellung der angewandten Bildgebung wurde verglichen und Veränderungen des Bestrahlungsvolumens infolge nuklearmedizinischer Befunde quantifiziert. Bei 17 von 228 Patienten, entsprechend 7,5 Prozent, erfolgte eine Änderung des Zielvolumens durch die szinti-graphisch nachgewiesene, röntgenologisch so nicht faßbare Befallsausdehnung. Wegen ihrer sensitiven Darstellung ossärer Umbauprozesse bleibt die Knochenszintigraphie deshalb für die Bestrahlungsplanung und Feldoptimierung unverzichtbar.

[The new possibilities of digital luminescence radiography (DLR) and digital imaging data processing for the making of field verification images]

BACKGROUND

Treatment verification for reasons of quality control takes an important place in daily radiotherapeutic work. The quality of conventional, e.g. not digital imaging methods, is often poor. Moreover, portal and verification imaging are commonly used only for photon beam control; even digital portal radiographs were not suitable for verification of electron beams, rotation beams, conformation therapy or dynamic multileaf collimation yet.

MATERIALS AND METHODS

We developed a method, using digital luminescence radiography (DLR), not only for portal imaging of photon beams in an excellent quality, but also for verification of electron beams. Further on, DLR was used as basic instrument for image fusion of portal and verification film and simulation film respectively for image processing in "beams-eye-view" verification (BEVV) of rotating beams or conformation therapy.

RESULTS

Digital radiographs of an excellent quality are gained for verification of photon and electron beams. In photon beams, quality improvement vs. conventional portal imaging may be dramatic, even more for high energy beams (e.g. 15-MV-photon beams) than for Co-60. In electron beams, excellent results may be easily obtained. By digital image fusion of 1 or more verification films on simulation film or MRI-planning film, more precise judgement even on small differences between simulation and verification films becomes possible. Using BEVV, it is possible to compare computer aided simulation in rotating beams or conformation therapy with the really applied treatment. The basic principle of BEVV is also suitable for dynamic multileaf collimation.

CONCLUSIONS

DLR is a multipotent and suitable method for many aspects of imaging treatment verification.

[The use of contrast media for quality assurance in radiotherapy planning]

PURPOSE

The target volume definition in radiation therapy was evidently improved by CT and MRI. Basis of treatment planning, however, remains the therapy simulator. Important instruments for adequate fluoroscopic treatment planning are contrast media that recently have been applied less out of legal and professional reasons. Aim of this work is to evaluate the possible benefit of contrast media applications.

PATIENTS AND METHODS

In 1303 simulations between 1.1.1993 and 30.9.1993 105 times intravenous contrast media were applied, supplied by oral or endolymphatic contrast agents. It was studied if the previously intended plan had to be altered due to contrast media application.

RESULTS

In 17 out of 105 cases (16.2%) the target volume or the preplanned technique had to be altered after contrast media application. Main reason was the existence of anatomical variations especially in kidney and small bowel detected by use of contrast agents. So standard indications for contrast media applications were defined.

CONCLUSIONS

Contrast media are an important tool in treatment planning that should be orientated on diagnostical standards. Applications of contrast agents facilitate the detection of anatomical variations and the selection of the appropriate technique in order to shield sensitive tissues. The therapeutical and legal benefit outweigh potential hazards due to intolerances or professional obstacles.

[Early diagnosis and therapy of brain metastases. Goal: improved quality of life and perhaps extended survival]

Diagnosis of cerebral metastasis is based on specific anamnestic information, clinical-neurological symptomatology and appropriate imaging. On account of its high level of sensitivity, ready, availability and, in comparison with MRI, relatively low cost, CT scanning remains the most important imaging modality. Curative treatment is not possible. For palliation and, in part, long-term symptom-free survival, radiation is the modality of first choice. On no account must this possibility be neglected by adopting an attitude of therapeutic nihilism.

Primary fibroblasts from human adults as target cells for ex vivo transfection and gene therapy

Diploid fibroblast (dFb) cultures were established from a total of 106 skin and serosa biopsies of human adults. Using an optimized enzymatic dissociation procedure, 10(11) dFb/cm2 skin were obtained from patients younger than 60 years after an average time of 89 +/- 8 days, with a mean population doubling time of 3.87 +/- 1.4 days. Enzymatic dissociation of skin biopsies yielded cultures of significantly higher growth capacity of dFb than those prepared by mechanical dissociation followed by spontaneous outgrowth of cells. The plating efficiency that may be crucial for clonal selection of transfected cells was negligible when dFb were plated without feeder cells at low density, while it was enhanced to 9-24% by the addition of a feeder layer of irradiated human embryonal fibroblasts. DFb secreted various cytokines with spontaneous release of interleukin-6 (IL-6) in high quantities of up to 20 ng/10(6) cells/24 hr. In addition, one-third of the culture secreted substantial amounts of granulocyte-macrophage colony-stimulating factor (GM-CSF), while low amounts of tumor necrosis factor-alpha (TNF-alpha) were detectable in some cases after irradiation of the cells. Comparison of various transfection methods by a transient luciferase expression assay demonstrated that receptor-mediated gene transfer was approximately 10-fold more efficient than cationic lipofection of dFb, while electroporation resulted in substantially less expression of the reporter gene. We conclude that primary dFb can be obtained reproducibly from human adults and represent a suitable target cell population for receptor-mediated gene transfer and cationic lipofection.(ABSTRACT TRUNCATED AT 250 WORDS)

Poor prognosis of prethymic phenotype acute lymphoblastic leukemia (pre-T-ALL)

Pre-T-ALL is an important subgroup of ALL with clinical features different from adult T-ALL. Expression of intracytoplasmic CD3 represents the earliest marker for the prethymic phenotype. We studied four consecutive adult patients with this phenotype. Three of the four patients did not respond to the induction chemotherapy with vincristine, daunorubicin, prednisone and asparaginase. They reached a delayed remission only after chemotherapy with cyclophosphamide and cytosine arabinoside. All four patients relapsed 3, 9, 10 and 13 months after diagnosis. One patient died 2 months after relapse, another one 2 months after allogeneic BMT performed in second relapse. We conclude that patients with early T-cell precursor leukemia do not respond adequately to conventional chemotherapy and should be considered as a high-risk subgroup within the T-lineage ALL.

[Large epidermoid cyst of the posterior cranial fossa]

An extensive epidermoid cyst in the posterior fossa was diagnosed in a 59 year old male patient. The most valuable indicator for differential diagnosis was given by plain skull x-ray showing a peripheral zone of sclerosis as the leading x-ray sign of epidermoids. CT and MRI complemented the preoperative diagnostic measurements.

Preparation of high-density lipoproteins labelled exclusively at the cholesteryl ester moiety

The in vitro preparation of HDL radiolabelled at the cholesteryl ester moiety was determined by incubating different serum fractions with [3H]cholesteryl linoleate or cholesteryl [14C]oleate dissolved in dimethylsulfoxide (DMSO) and subsequent re-isolation of HDL from the incubation mixture by ultracentrifugation. Using the supernatant obtained by precipitation of apolipoprotein B-containing lipoproteins with phosphotungstate/MgCl2 or using the greater than 1.075 kg/l fraction of sera, the bulk of the added radioactivity could be recovered in the re-isolated HDL fraction, as demonstrated by density gradient ultracentrifugation or by gel chromatography. Incubation experiments using whole sera or the greater than 1.063 kg/l fraction of sera resulted in the preferential association of the labelled cholesteryl linoleate with apolipoprotein B-containing lipoproteins.