Accuracy of navigation-assisted acetabular component positioning studied by computed tomography measurements: methods and results

The postoperative position of the acetabular component is key for the outcome of total hip arthroplasty. Various aids have been developed to support the surgeon during implant placement. In a prospective study involving 4 centers, the computer-recorded cup alignment of 37 hip systems at the end of navigation-assisted surgery was compared with the cup angles measured on postoperative computerized tomograms. This comparison showed an average difference of 3.5 degrees (SD, 4.4 degrees ) for inclination and 6.5 degrees (SD, 7.3 degrees ) for anteversion angles. The differences in inclination correlated with the thickness of the soft tissue overlying the anterior superior iliac spine (r = 0.44; P = .007), whereas the differences in anteversion showed a correlation with the thickness of the soft tissue overlying the pubic tubercles (r = 0.52; P = .001). In centers experienced in the use of navigational tools, deviations were smaller than in units with little experience in their use.

Clinical Outcome of Salmon Calcitonin Nasal Spray Treatment in Postmenopausal Women after Total Hip Arthroplasty

OBJECTIVE

The increasing rate of hip fractures is giving rise to a number of socio-economic problems for the aging community. In addition to being unable to resume their previous living habits, many patients fail to achieve full functional recovery after the fractures. Total hip arthroplasty (THA) is a successful operation for the majority of patients with all forms of hip fractures, being performed increasingly often throughout the world. Revision rates for THA range up to 20% per year. Aseptic loosening is the reason for 75% of the revisions. An additional problem post-THA is the rate of heterotopic soft tissue calcification after THA, resulting in severely impaired function, pain, and a reduced range of hip movement.

SUBJECTS

In an open study, 37 women who had undergone cementless THA after accidental hip fractures were treated twice daily with 200 IU of salmon calcitonin nasal spray for 12 months. Simultaneously the patients received one bag of 1,000 mg calcium plus 880 IU vitamin D daily throughout the treatment period of 1 year. A parallel group of 38 women with a similar clinical status in terms of hip fractures and cementless THA were treated with only one bag of 1,000 mg calcium plus 880 IU vitamin D daily through the treatment period.

RESULTS

The results of this 12-month clinical trial show that 200 IU of salmon calcitonin nasal spray per day significantly improves the clinical outcome of postmenopausal elderly women following THA. Treatment with a salmon calcitonin nasal spray significantly reduces bone turnover, loss of bone density, and pain. The functional status of the patients was improved and the risk of falling reduced by rehabilitation during the observation period of 12 months. Additionally, calcitonin promoted the repair of hip fractures and was associated with a significantly lesser rate of refractures as well as periprosthetic ossifications.

CONCLUSION

The increasing revision rate for THA during the first year and the patient's problem of resuming their previous living habits are the main foci of our study. Calcitonin nasal spray seems to cause few side effects. The additive treatment appears to improve the clinical outcome of THA in elderly postmenopausal women.

Akinetic mutism caused by bilateral infiltration of the fornix in a patient with astrocytoma

In a 59-year-old female patient, a World Health Organization (WHO) grade II astrocytoma had been diagnosed 16 years ago, which finally progressed into WHO grade III. Several right frontal neurosurgical resections, local radiation and a local radioimplant had been applied. Despite this long record, she was reported alert with a Karnofsky index of 90% until admission. Within a few weeks she rapidly developed akinetic mutism. Upon admission, computed tomography (CT) scan showed a large cystic right frontal defect and a suggested small tumor recurrence. White matter of the frontal lobe appeared to be translucent and compatible with previous radiation. The severe mental changes were initially attributed to a delayed radiation encephalopathy. Neuropathologically, the white matter of the frontal lobe showed mild elevated cell density consistent with gliosis; however, a tumor recurrence invading the tip of the corpus callosum and invading the entire length both fornices appeared. From the neuropathological findings of massive local tumor recurrence in both fornices, together with the acute clinical onset, it seems unlikely that the sequel of radiotherapy caused akinetic mutism, but the symmetric and severe involvement of the limbic system. We conclude that the rapid progression from a state of alertness to a full clinical picture of akinetic mutism was because of infiltration of both fornices.

[Determination of therapy management in rectal carcinoma by staging with 18-FDG-PET]

The curative treatment of carcinoma of the rectum in the early stage of the disease is radical local surgery. If there is a solitary liver metastasis, resection is also a curative treatment. This report describes a female patient with rectal carcinoma, in whom a solitary liver metastasis in the left lobe was diagnosed only by FDG-PET and verified at surgery. This case report demonstrates the potential role of FDG-PET even for primary staging in detecting occult hepatic and extrahepatic metastases, thus significantly influencing the therapeutic management and prognosis of these patients.

Serum crosslaps in comparison to serum osteocalcin and urinary bone resorption markers

In this study we evaluated the routine practice and clinical application of serum crosslaps to urinary-crosslaps, -N-telopeptide-related fraction of type 1 collagen, -deoxpyridinoline, -totalpyridinoline and serum osteocalcin. The utility of both the serum and urine immunoassays for bone formation and resorption marker were tested in a cohort of 593 female and male patients from our outpatient clinic for osteology and rheumatology and compared to important osteoporosis risk factors like age, gender, E2 deficiency, bone density and chronic renal failure. The biochemical maker of bone formation, serum osteocalcin exhibit significant correlations to all five tested serum and urinary markers of bone resorption (p < 0.0001) crosswise to all different groups of patients. The group of chronic renal failure patients showed no significant correlation between the tested bone turnover parameters and the serum creatinine level except a significant increase and correlation for serum crosslaps and for the ratio of serum and urinary crosslaps. Associations between the age of the patients and the markers of bone turnover were rather poor. We found a significant, negative association between serum and urinary bone turnover markers and bone density and were interested, whether in patients with bone density < 2.5 SD an enhanced bone turnover could be detected in the same way as for E2 deficiency. Applying a discriminant analysis it was possible to discriminate between the patient with BD < 2.5 SD and those with BD > 1.0 SD with a sensitivity of 70% and a specificity of 65% using serum crosslaps. In case of urinary crosslaps the discriminatory power was slightly lower (sensitivity: 65.6%, specificity: 67.5%) and for serum osteocalcin the discriminatory power was negligible higher (sensitivity: 79%, specificity: 56%). The highly significant correlation between the urinary and serum crosslinked peptides by ELISA and serum osteocalcin supports the concept that these respective indices of bone formation and resorption both in urine and serum reflect a coupled process in vivo with sensitivity and specificity to pathological bone density, estrogen deficiency and chronic renal failure.

Serum osteocalcin and urinary crosslaps are suitable markers of bone turnover in response to short-term hormone replacement therapy

In this study we evaluated the effect of short-term hormone replacement therapy (HRT) on bone formation (serum osteocalcin) and resorption markers (urinary type I collagen peptides (crosslaps), urinary total free pyridinoline (TPYRI) and urinary free deoxypyridinoline (DPYRI)) as well as female sex hormones (serum estradiol, follicle stimulating hormone (FSH) and luteinizing hormone (LH)) in a group of early postmenopausal women with severe estrogen deficiency. The 46 healthy postmenopausal women with serum estradiol levels < 10 ng/l were subsequently divided into two groups, according to their compliance with HRT. In the group taking HRT significant changes from baseline values could be observed in estradiol, FSH, urinary crosslaps and serum osteocalcin levels after 6 months, whereas no changes could be observed in LH, TPYRI and DPYRI from baseline values. In the group which refused HRT all values were increased relative to baseline values, indicating increased bone turnover. Serum osteocalcin and urinary crosslaps were significantly decreased in women taking HRT in comparison to the group refusing HRT. After 6 months the treated patients showed a decrease in urinary crosslaps of 42% (SD 12%) and in serum osteocalcin of 24% (SD 6%) in comparison with baseline values. In patients who refused HRT, urinary crosslaps were increased by 43% (SD 20%) and serum osteocalcin levels decreased by 2% (SD 9%) compared to baseline values. In postmenopausal women suffering from severe estrogen deficiency (estradiol < 10 ng/l) serum osteocalcin and urinary crosslaps are significantly increased, indicating a clear correlation between estrogen deficiency and an increase in bone resorption as well as bone formation. The recommended HRT dose was sufficient to reduce the rate of bone turnover to premenopausal values. Serum osteocalcin and urinary crosslaps are suitable candidates not only for the assessment of a high postmenopausal bone turnover, but also for monitoring the response to and for verifying the actual intake of HRT or other antiresorptive treatment.

Iliac artery aneurysm causing isolated superior gluteal nerve lesion

Lesions of the superior gluteal nerve (SGN) lead to weakness of hip abduction, manifesting itself as a gait abnormality, with contralateral tilting of the pelvis with each step. Causes are numerous and may occur at different anatomical locations before the nerve enters the suprapiriform foramen, in the foramen itself, or after the nerve has exited the foramen. This case report describes an SGN lesion by a large iliac artery aneurysm in a patient presenting with a gait disorder.

Increase of axial and appendicular trabecular and cortical bone density in established osteoporosis with intermittent nasal salmon calcitonin therapy

The aim of this study was to examine the effect of intranasal administration of salmon calcitonin to a group of 24 postmenopausal women with severe, established osteoporosis (t score < -2.5 SD) and more than one vertebral fracture. The patients were treated with 200 IU of nasal salmon calcitonin daily for 2 months with a subsequent pause of 2 months (3 cycles) and 500 mg calcium daily over a total of 12 months in an open randomized study. The patients were compared with an age matched control group of 18 women of a similar clinical status who were treated with calcium and vitamin D only. In the nasal calcitonin treatment group an increase in the trabecular axial bone density of 2.8% was achieved, as well as increase in trabecular appendicular (forearm) bone density of 1.6%, together with a cortical bone density increase of 1.8% axial and 1% appendicular. Initially, elevated values of urinary deoxypyridinoline were found in 12 women in the nasal calcitonin treatment group; these levels returned to normal under salmon calcitonin nasal therapy and documented the inhibition of increased osteoclastic activity. Cyclic intermittent calcitonin nasal therapy led to a general increase in trabecular and cortical axial and appendicular bone density, marked alleviation of the subjective sensation of pain, and a reduction in the daily dose of accompanying nonsteroidal anti-inflammatory drugs by 50%.

Chest X-ray in collagen vascular diseases. A comparison of chest X-ray with bronchoalveolar lavage and transbronchial forceps biopsy

The diagnostic value of chest X-ray following the ILO standards was compared with bronchoalveolar lavage (BAL) and the histology of transbronchial forceps biopsy in 83 patients with collagen vascular diseases. BAL in the middle lobe was considered abnormal in case of increased cell count per milliliter and/or lymphocytosis and/or neutrophil granulocytosis and this was found in 32 out of 42 cases (76.2%) with, and in 33 of out 41 cases (80.5%) without abnormal radiological finding. Pathological changes in the histology were found in 14 out of 20 cases (70.0%) with and in 40 out of 63 cases (63.5%) without abnormal chest X-ray in the upper lobe from which the transbronchial forceps biopsy specimens were obtained. In histological specimens obtained from transbronchial forceps biopsy, only fibrosis correlated with abnormal radiological findings in this region. Other inflammatory processes defied prediction by chest X-ray. This suggests that, regardless of chest X-ray findings, BAL should be performed together with transbronchial forceps biopsy for the histological examination of patients with collagen vascular diseases in which interstitial lung involvement is suspected.

[Effect of kidney occlusion on survival in renal cell carcinoma: a 10-year retrospective study]

84 out of 116 patients suffering from renal cancer with comparable tumor stages were nephrectomized. 39 out of these 84 patients have had an additional embolization preoperatively. The survival rate and the development of metastases did not show any significant difference between only nephrectomized and occluded plus nephrectomized patients.

[Percutaneous drainage of complicated abscesses and fluid collections]

The original concept of percutaneous, radiological abscess drainage was confined to well circumscribed, solitary abscesses, that could be reached by a short access avoiding transgression of uninvolved organs or compartments. With increasing experience criteria for percutaneous abscess drainage have been expanded to radiological treatment of pancreatic, periappendiceal, diverticular, interloop and mediastinal abscesses and fluid collections. The authors present their experience with percutaneous treatment of such "complicated" abscesses in 140 patients.

[Complications of preoperative arterial vascular embolization in malignant kidney tumors]

In 66 patients with renal tumours on 30 patients a preoperative transfemoral embolisation of the renal artery of the tumour-bearing kidney was performed. The complications were established and compared with the 36 patients without occlusion. On account of the considerable side effects a preoperative occlusion seems to be reasonable only in selected cases.

[Computed tomographic analysis of postoperative abdominal compartments. A comparative study of 100 patients with abdominal abscesses]

100 patients with 140 abdominal abscesses were included in this study: 113 occurred intraperitoneal, 85% of these postoperatively, 15% spontaneously and in 11.5% the retroperitoneal space was affected concomitantly. In the postoperative group multilocular disease (= more than one typical compartment affected) was much more frequent when compared to spontaneous abscesses. Surgery with peritoneal barrier changes resulted in formation of new and "atypical" abdominal compartments which were the site of 39% of postoperative abscesses in this series. Communications of the lesser sac with the left subphrenic space were most frequently involved, followed by the fused right subphrenic and subhepatic space, when the coronary ligament was disconnected operatively. Knowledge of surgically induced changes of normal abdominal anatomy and its role for abscess formation and propagation may be very essential for correct CT-localization and CT-guided drainage.

[The accuracy of ultrasound in the diagnosis of intra-abdominal abscess formations]

During the last two years 73 patients with a total number of 84 abdominal abscesses have been investigated by ultrasound. Two thirds of the patients (67%) had postoperative abscesses. Spontaneous abscesses occurred in the remaining 33%. Multiple abscesses occurred in the postoperative group only (7 patients). The overall sensitivity in detecting an abscess was 84%. The sensitivity was much better with spontaneous abscesses (92%) than with postoperative abscesses (80%). One third of the patients have also been investigated by computed tomography. The diagnosis was confirmed either by needle aspiration or by operative drainage. Ultrasound was most useful in detecting abscesses in the right and left upper quadrant and in the pelvis, while CT was superior in the mid-abdomen and when dealing with multiple abscesses.

[Pulsed duplex sonographic follow-up of varicoceles following sclerotherapy]

Forty-one patients were examined by pulsed duplex sonography immediately before and then one, four and twelve weeks following sclerotherapy of a varicocele. The severity of the varicocele was determined by sonography before treatment and confirmed by phlebography. Sonographic follow-up showed reduction, or disappearance, of the varicocele in 78% of cases. Doppler examination confirmed successful treatment in 85% of patients. Pulsed duplex sonography, combining a non-invasive imaging method and a functional technique, is well suited for the follow-up of varicoceles after treatment.

The intravertebral vacuum phenomenon

An intravertebral vacuum phenomenon was observed within 19 vertebrae of 17 patients. It represents a non-healing vertebral fracture. Three possible pathologic mechanisms are discussed: ischemic bone necrosis, trauma with ensuing ischemic necrosis, and intraosseous disc prolapse. The intravertebral vacuum phenomenon was found in two patients with multiple myeloma and thus does not exclude the presence of malignancy in the affected bone. Radiographs obtained during traction or extension may be of diagnostic value.

[Computerized tomography in the acute diagnosis of spinal injuries]

Additional to conventional x-ray examinations, high-resolution CT has a greater impact on the diagnostic evaluation of severe spine injuries. It allows exact judgment of the condition of vertebral arch, articular processes, joints and spinal axis and therefore a better delineation of the stability or instability of spinal fractures. Intraspinal fracture of spinal stenosis and intra or paraspinal soft tissues lesions are much more easily detected. For this reasons CT-evaluation of severe spinal traumata permits earlier, much more precise and in many cases successful therapy.

Lymph nodes of the neck: evaluation with US

Ultrasound (US) proved highly effective for detection, localization, and delineation of enlarged lymph nodes of the neck. Infiltration of adjacent structures, specifically the common, internal, and external carotid arteries, and the neck muscles was reliably demonstrated. Benign and malignant lymph node enlargement could not be differentiated. US examinations changed the operative course of 56% of patients studied. In 41%, a more radical operative procedure was performed than was previously planned; in 14%, US demonstrated inoperability. Small-parts US is a very useful adjunct to current imaging techniques of cervical lymph node disease.

[High-resolution realtime sonography of varicoceles]

An attempt has been made to classify varicoceles by means of real time sonography in accordance with the findings on palpation. The maximal diameter of the pampiniform plexus and of individual veins was determined sonographically and compared with the results of palpation in 74 patients with varicoceles. The sonographic findings are more accurate than is palpation. Fifteen subclinical varicoceles were discovered by sonography which could not be detected by palpation. It has been found convenient to classify the lesions in four sonographic stages. Maximal transverse diameter of the pampiniform plexus up to one centimetre is regarded as normal. A diameter of one to two centimetres corresponds to grade I, two to three centimetres corresponds to grade II and greater than three centimetres to grade III.

[Chylopericardium as a rare cause of a "large" heart shadow--2 case reports]

Two cases with the diagnosis of asymptomatic chylopericard were evaluated. One was a 20-year old girl who had been operated on for intrathoracic lymphangioma and chylopericardium that existed since birth, and who developed a chylothorax after the operation. The second case report concerns a 22-year old man who had been suffering from a posttraumatic asymptomatic chylopericardium for two years and who is being treated conservatively "Low-fat diet").

[Occult fractures of the skull]

Fractures of the skull represent a problem in traumatologic X-ray-diagnosis. The higher rate of errors in the skull compared with the rest of the skeleton result from problems in differentiation of fracture-lines from vascular channels and impressions in overlying skeletal structures. By special examination of the suspected region (special X-ray-views, conventional tomography, CT, magnification views etc.) additional information can be obtained, e.g., exact demonstration of dislocated bone fragments or the detection of intracranial hematomas as well as the unmasking of the fracture lines and their dimensions. Very often these special procedures results are the basis for correct treatment. For various skull regions, where masked fractures often occur, recommended radiological pathways are presented in order to find these fractures and to obtain additional information.

Long-term results after sclerotherapy of the spermatic vein in patients with varicocele

Ninety-seven patients received transfemoral sclerotherapy of the spermatic vein for varicocele. After observation for 2 to 5 years, follow-up was available in 69 patients (71.2%), in 11 of whom the procedure failed (16.0%). Complications during angiography (N = 12, 12.4%) or sclerotherapy (N = 31, 32.0%) did not require hospital treatment. At least one parameter of the spermiogram was improved in 25 of 32 patients (78.1%). Forty-four of 69 patients (63.8%) treated because of a childless marriage, and whose wives were not known to be infertile, had a pregnancy rate of 47.7%. Thi method may be considered equal to surgical procedures in achieving venous occlusion; furthermore it is simple and can be used on an outpatient basis without anesthesia.

[Mediastinal CT-staging of bronchial carcinomas]

Forty-three patients with proven bronchogenic carcinoma were evaluated with computed tomography (CT) to search for mediastinal and broncho-pulmonary nodal metastases. Definitive staging was achieved by thoracotomy (34 patients) and mediastinoscopy or transbronchial nodal sampling (9 patients). Three parameters of lymph node appearance on CT were studied to improve the sensitivity and specificity of CT in detecting malignancy in bronchogenic carcinoma: 1) node size, 2) node location and 3) border regularity and definition. 762 clearly defined nodes were studied by CT - 391 metastatic and 371 non metastatic. The most useful CT parameters were node size over 10 mm, and node location, which results in a sensitivity of 80% and a specificity of 88%. A combination of all 3 CT parameters increased sensitivity to 82% and specificity to 90%. These results show clearly, that size is not the only relevant CT-parameter in successful preoperative identification of mediastinal nodal metastases.

[Role of computed tomography in malignant tumors of the oral cavity and pharynx]

The CT findings of 22 patients with histologically verified malignant tumors of the oral cavity and pharynx were evaluated to demonstrate the value of CT. Comparison with conventional radiological methods was made. In 16 patients an attempt was made to define tumor expansion and 6 patients were examined after surgery and radiation therapy with regard to tumor recurrence. In the first group we found tumors of different stages: in advanced cancer it was evident that with CT it is possible to describe tumor expansion very exactly and its relationship to surrounding structures, as well as the invasion of the intracranial space or spinal cord. In malignomas of the tongue and mouth floor measurements of size by CT were very precise, as proved by surgery. Our results in the first group of patients show, that CT has a great influence on therapeutic management and is also very important for clinical staging of these malignomas. In the second patient group it is shown that by CT differentiation between postoperative changes and recurrent tumor is as difficult as it is in other organs. Based on the postoperative examination, appropriate follow-up is necessary.

[Computerized tomography in middle ear diagnosis--a comparison with conventional methods]

Due to important improvement in detail resolution and the excellent contrast resolution, in the newest computed tomography (CT) units, normal and pathologic structures of the inner and middle ear can be visualized. The clinical value of CT in comparison to standard X-rays and tomography is prospectively evaluated on the basis of 50 patient examinations. Today CT is unsurpassed in the diagnosis of cholesteatomas and glomus tumors and is superior to all other imaging techniques. Chronic inflammatory diseases of the middle ear can be evaluated in most cases on the basis of standard X-rays and tomography. CT's importance is primarily complementary, except for preoperative cases. Fractures should be visualized first on standard X-rays. If questionable complications are involved (e.g., tympanic or intracranial hematomas), CT should be the next step. Conventional tomograms are not necessary.

[Real-time sonography in breast diagnosis. Indication and value]

With improvement in ultrasound technique, sonography is gaining increasing importance in the evaluation of breast lesions. The following conclusions are drawn on the basis of experience in the use of real-time sonography in 200 patients. Palpable masses are most suitable for examination by sonography, whereas the diagnostic yield in diffuse breast disease is relatively low. The most important task is the differentiation between benign cystic and solid masses. Differential diagnosis of solid tumours may be difficult or even impossible and biopsy should not be carried out solely on the basis of a sonographic examination. Palpation and mammography must still be considered as basic methods of examination, which may be successfully complemented by sonography.

[Ultrasonics and computerized tomography in the diagnosis of large cavernous hemangiomas of the liver]

Cavernous haemangiomas of the liver often pose problems in the differential diagnosis on ultrasound because of the complex echo pattern. Some typical features of their sonomorphology are exemplified by the data obtained in 4 patients. In combination with the almost pathognomonic delayed contrast enhancement on computed tomography, additional angiography seems to be no longer necessary for an accurate diagnosis in most cases.

[Localizing instrument for fine needle puncture of non-palpable changes in the breast]

A simple device for localisation of non-palpable lesions of the breast has been developed. It consists of two metal grids which facilitate mammographic fine needle puncture and preoperative marking of small lesions. The instrument is easy to handle and can be used at any mammographic unit without special adjustments.

[Cowden's disease--"multiple hamartoma syndrome"--with gastrointestinal manifestations]

A case report is given demonstrating changes of the intestinal tract in a patient with Morbus Cowden. The clinical picture of the disease is described including differential diagnosis. The high risk of accompanying malignant lesions and the need of early detection of the disease are pointed out.

[Differential diagnosis of cholestasis by non-invasive methods--comparison of cholecysto-cholangiography, ultrasonics and hepatobiliary sequential scintigraphy]

The value of the three non-invasive morphological methods--cholangiography, sonography, and cholescintigraphy--in the differential diagnosis of "surgical" and "non-surgical" cholestasis was assessed prospectively in 28 patients. The main disadvantage of cholangiography was the large number of patients (11 out of 28) in whom the biliary tract could not be visualized. Correct diagnosis was achieved by sonography in 25 out of 28 and by cholescintigraphy in 23 out of 28 patients.

Radiography and bone scintigraphy in multiple myeloma: a comparative analysis

The sensitivity of radionuclide imaging for detecting skeletal lesions was compared with that of radiography by evaluating 573 different anatomical sites in 41 patients with multiple myeloma. Radiography revealed a significantly greater number of myeloma-related bone lesions than did radionuclide imaging. Of the 179 myeloma-related bone lesions detected when both techniques were applied, 163 were seen by radiography and 82 by radionuclide imaging. Ninety-seven lesions were detected by radiography alone and 16 lesions seen by scintiscanning only, yielding a sensitivity of 91% for the former and of 46% for the latter technique. Radionuclide imaging proved superior to radiography only occasionally in the rib cage, and rarely in other anatomical sites. These findings suggest that radiography is the method of first choice in obtaining a skeletal survey in patients with multiple myeloma. In cases with continued pain, unexplained by standard radiography, the skeletal survey should be supplemented by tomography and radionuclide imaging.

A further case of submucosal lymphangioma of the duodenum diagnosed during endoscopy

Submucosal lymphangiomas are benign tumors which rarely occur in the gastrointestinal tract. The current report describes the tenth case of a submucosal cavernous-cystic lymphangioma of the duodenum. The diagnosis was made during endoscopy and was confirmed histologically in a biopsy specimen. Following a brief review of the localization and symptoms of submucosal lymphangiomas of the gastrointestinal tract published thus far in the literature, therapeutic considerations are discussed.

[Results of postoperative radiotherapy in breast cancer (author's transl)]

The results are presented of postoperative irradiation in the treatment of breast cancer at the Department of Radiotherapy and Radiobiology, University of Vienna. Our data compare well with the best results reported in the literature. Apart from the importance of high loco-regional freedom from disease for the quality of life of these patients, the related increase in survival prospects is stressed.

[Results of postoperative radiotherapy in breast cancer (author's transl)]

The results are presented of postoperative irradiation in the treatment of breast cancer at the Department of Radiotherapy and Radiobiology, University of Vienna. Our data compare well with the best results reported in the literature. Apart from the importance of high loco-regional freedom from disease for the quality of life of these patients, the related increase in survival prospects is stressed.

[The value of postoperative irradiation in the curative management of breast cancer (author's transl)]

A report is presented of the value of post-operative irradiation in patients with operable breast cancer. A combination of conservative surgery followed by irradiation provides optimal loco-regional results. Improved 10-year survival rates have already been reported with adequate irradiation of the peripheral lymphatics. The location and size of the primary tumour, as well as exact quantitative statements about histologically positive axillary lymph nodes are parameters of utmost importance.

[Bisectorial small-angle pendulum irradiation alternatively to other methods of 60Co-teletherapy: valence and volume doses (author's transl)]

A comparison is made between five irradiation methods, the dose distribution and volume doses of which had been ascertained by means of two phantoms presupposed differently large. Of the two methods of small-angle pendulum irradiation, the bisectorial monaxial pendulum technique turns out to be a practicalbe alternative to fixed-field and rotation irradiations. Similarly to fixed-field irradiation with two opposed fields, to which, after all, this technique is superior in every respect, it makes possible a relatively simple spatial irradiation planning. In this regard it is also more favorable than the rotation irradiations, though they give security of a more homogeneous load to axially parallel focuses; but an oblique position of the focal axis can be compensated only by an extension of the target volume and consequently augmentation of the volume dose. The necessity of confining to a certain extent the sum of absorbed energy is accentuated.

[Ideal application of computer tomography in the field of radiotherapeutic planning (author's transl)]

The value of computerized radiotherapeutic planning is illustrated by the case report of a patient with an extensive pelvic wall metastasis of a carcinoma of the uterine cervix diagnosed by conventional methods. The exact topography is delineated by computer tomography and enables optimum dosimetric radiotherapeutic planning.

[Computer tomography in therapy planning (author's transl)]

A report is given on the utilization of computer tomography for the irradiation planning. Owing to international cooperation it was possible to use the obtained pictures as a basis for a computerized irradiation planning. The authors give some practical examples of optimized isodose plans for individual cases which have been elaborated by using the computer-tomographic cross-section pictures and the computerized system for irradiation planning and which give a good idea of the efficiency of the system.