Treatment of primary or recurrent non-resectable pancreatic cancer with proton beam irradiation combined with gemcitabine-based chemotherapy

BACKGROUND

Pancreatic cancer accounts for around 4.6% of cancers deaths worldwide per year. Despite many advances in treatment regimes, the prognosis is still poor. Only 20% of tumors are primarily resectable. Recurrences-both with distant metastasis as well as locoregional-are frequent. For patients with primary nonresectable localized disease or localized recurrences, we offered chemoradiation to achieve local control over a long period of time. We here report our results on combined chemoradiation of pancreatic tumors and local recurrences using proton beam therapy.

MATERIALS AND METHODS

We report on 25 patients with localized nonresectable pancreatic cancer (15 patients) or local recurrent disease (10 patients). All patients were treated with combined proton radiochemotherapy. Overall survival, progression-free survival, local control, and treatment-related toxicity were analyzed using statistically methods.

RESULTS

Median RT dose was 54.0 Gy (RBE) for proton irradiation. The toxicity of treatment was acceptable. Four CTCAE grade III and IV adverse events (bone marrow disfunction, gastrointestinal [GI] disorders, stent dislocation, myocardial infarction) were recorded during or directly after the end of radiotherapy; two of them were related to combined chemoradiation (bone marrow disfunction, GI disorders). Six weeks after radiotherapy, one additional grade IV toxicity was reported (ileus, caused by peritoneal carcinomatosis, not treatment related). The median progression-free survival was 5.9 months and median overall survival was 11.0 months. The pretherapy CA19‑9 level was a statistically significant prognostic factor for enhanced overall survival. Local control at 6 months and 12 months were determined to be 86% and 80%, respectively.

CONCLUSION

Combined proton chemoradiation leads to high local control rates. Unfortunately, PFS and OS are driven by distant metastasis and were not improved compared to historical data and reports. With this in mind, enhanced chemotherapeutical regimes, in combination with local irradiation, should be evaluated.

Interobserver agreement on definition of the target volume in stereotactic radiotherapy for pancreatic adenocarcinoma using different imaging modalities

PURPOSE

The aim of this study was to evaluate interobserver agreement (IOA) on target volume definition for pancreatic cancer (PACA) within the Radiosurgery and Stereotactic Radiotherapy Working Group of the German Society of Radiation Oncology (DEGRO) and to identify the influence of imaging modalities on the definition of the target volumes.

METHODS

Two cases of locally advanced PACA and one local recurrence were selected from a large SBRT database. Delineation was based on either a planning 4D CT with or without (w/wo) IV contrast, w/wo PET/CT, and w/wo diagnostic MRI. Novel compared to other studies, a combination of four metrics was used to integrate several aspects of target volume segmentation: the Dice coefficient (DSC), the Hausdorff distance (HD), the probabilistic distance (PBD), and the volumetric similarity (VS).

RESULTS

For all three GTVs, the median DSC was 0.75 (range 0.17-0.95), the median HD 15 (range 3.22-67.11) mm, the median PBD 0.33 (range 0.06-4.86), and the median VS was 0.88 (range 0.31-1). For ITVs and PTVs the results were similar. When comparing the imaging modalities for delineation, the best agreement for the GTV was achieved using PET/CT, and for the ITV and PTV using 4D PET/CT, in treatment position with abdominal compression.

CONCLUSION

Overall, there was good GTV agreement (DSC). Combined metrics appeared to allow a more valid detection of interobserver variation. For SBRT, either 4D PET/CT or 3D PET/CT in treatment position with abdominal compression leads to better agreement and should be considered as a very useful imaging modality for the definition of treatment volumes in pancreatic SBRT. Contouring does not appear to be the weakest link in the treatment planning chain of SBRT for PACA.

Comparison of carbon ion and photon reirradiation for recurrent glioblastoma

PURPOSE

Purpose of this study was to investigate overall survival in recurrent glioblastoma treated with either carbon ion reirradiation or photon reirradiation.

MATERIALS AND METHODS

In this retrospective study we evaluated 78 consecutive patients with recurrent IDH (Isocitrate dehydrogenase)-wildtype glioblastoma (38 patients carbon ion re-radiotherapy, 40 patients photon re-radiotherapy) treated with either carbon ion reirradiation or stereotactic photon reirradiation. 45 Gy (RBE; 15 fractions) carbon ion reirradiation (CIRT) or 39 Gy (13 fractions) photon reirradiation (FSRT) was administered, respectively. Overall survival was investigated with respect to histological, clinical, and epidemiological features. Kaplan-Meier and multivariate Cox statistics were calculated. A propensity score-matched analysis of the FSRT and CIRT groups using variables from a validated prognosis score was carried out.

RESULTS

The type of reirradiation (CIRT vs. FSRT) significantly influenced overall survival-8.0 months vs. 6.5 months (univariate: p = 0.046)-and remained an independent prognostic factor in multivariate analysis (p = 0.017). Propensity score-adjusted analysis with CIRT versus FSRT as the dependent variable yielded a significant overall survival advantage for the CIRT group (median OS 8.9 versus 7.2 months, p = 0.041, 1‑year survival 29 versus 10%). Adverse events (AE) were evaluated for both subgroups. For the FSRT group no toxicity ≥ grade 4 occurred. For the CIRT subgroup no grade 5 AE occurred, but 1 patient developed a grade 4 radionecrosis. We encountered 4 grade 3 toxicities. One patient developed a zoster at the trunk, 2 progressed in their paresis, and 1 featured progressive dysesthesia.

CONCLUSION

In conclusion, carbon ion treatment is a safe and feasible treatment option for recurrent glioblastoma. Due to the retrospective nature of the study and two different dose levels for CIRT or FSRT, the improved outcome in CIRT reirradiation might be an effect of higher biological impact from carbon ions or a simple dose-escalation effect. This hypothesis needs prospective testing in larger patient cohorts. A prospective phase III randomized trial is in preparation at our center.

Advantage of proton-radiotherapy for pediatric patients and adolescents with Hodgkin's disease

Abstract

Radiotherapy is frequently used in the therapy of lymphoma. Since lymphoma, for example Hodgkin’s disease, frequently affect rather young patients, the induction of secondary cancer or other long-term adverse effects after irradiation are important issues to deal with. Especially for mediastinal manifestations numerous organs and substructures at risk play a role. The heart, its coronary vessels and cardiac valves, the lungs, the thyroid and, for female patients, the breast tissue are only the most important organs at risk. In this study we investigated if proton-radiotherapy might reduce the dose delivered to the organs at risk and thus minimize the therapy-associated toxicity.

Methods

In this work we compared the dose delivered to the heart, its coronary vessels and valves, the lungs, the thyroid gland and the breast tissue by different volumetric photon plans and a proton plan, all calculated for a dose of 28.8 Gy (EURO-NET-PHL-C2). Target Volumes have been defined by F18-FDG PET-positive areas, following a modified involved node approach. Data from ten young female patients with mediastinal lymphoma have been evaluated. Three different modern volumetric IMRT (VMAT) photon plans have been benchmarked against each other and against proton-irradiation concepts. For plan-evaluation conformity- and homogeneity-indices have been calculated as suggested in ICRU 83. The target volume coverage as well as the dose to important organs at risk as the heart with its substructures, the lungs, the breast tissue, the thyroid and the spinal cord were calculated and compared. For statistical evaluation mean doses to organs at risk were evaluated by non- parametric Kruskal-Wallis calculations with pairwise comparisons.

Results

Proton-plans and three different volumetric photon-plans have been calculated. Proton irradiation results in significant lower doses delivered to organ at risk. The median doses and the mean doses could be decreased while PTV coverage is comparable. As well conformity as homogeneity are slightly better for proton plans. For several organs a risk reduction for secondary malignancies has been calculated using literature data as reference.

According to the used data derived from literature especially the secondary breast cancer risk, the secondary lung cancer risk and the risk for ischemic cardiac insults can be reduced significantly by using protons for radiotherapy of mediastinal lymphomas.

Conclusion

Irradiation with protons for mediastinal Hodgkin-lymphoma results in significant lower doses for almost all organs at risk and is suitable to reduce long term side effects for pediatric and adolescent patients.

Electronic supplementary material

The online version of this article (10.1186/s13014-019-1360-7) contains supplementary material, which is available to authorized users.

Gate-tunable large magnetoresistance in an all-semiconductor spin valve device

A large spin-dependent and electric field-tunable magnetoresistance of a two-dimensional electron system is a key ingredient for the realization of many novel concepts for spin-based electronic devices. The low magnetoresistance observed during the last few decades in devices with lateral semiconducting transport channels between ferromagnetic source and drain contacts has been the main obstacle for realizing spin field effect transistor proposals. Here, we show both a large two-terminal magnetoresistance in a lateral spin valve device with a two-dimensional channel, with up to 80% resistance change, and tunability of the magnetoresistance by an electric gate. The enhanced magnetoresistance is due to finite electric field effects at the contact interface, which boost spin-to-charge conversion. The gating scheme that we use is based on switching between uni- and bidirectional spin diffusion, without resorting to spin-orbit coupling. Therefore, it can also be employed in materials with low spin-orbit coupling.

[Image reconstruction of the corneal subbasal nerve plexus with extended field of view from focus image stacks of a confocal laser scanning microscope]

BACKGROUND

Confocal laser scanning microscopy (CLSM) allows the in vivo analysis of nerve structures of the human cornea. In this way, pathological alterations of the peripheral nervous system that also affect the corneal subbasal nerve plexus (SNP) can be diagnosed non-invasively and possibly earlier than with other methods. The field of view of in vivo CLSM images of the cornea (ca. 0.4 × 0.4 mm²) is not sufficient for a reliable assessment. Two phenomena make the image assessment difficult: the presence of ridge-like tissue deformations in the neighbourhood of the SNP and image distortions that are induced by involuntary and unavoidable eye movements during image acquisition. This paper presents an image processing method for generating undistorted images of the SNP with an extended field of view.

METHODS

The presented method has been tested on five volunteers. Eight focus image stacks have been taken and processed from each subject using a Heidelberg Retina Tomograph with Rostock Cornea Module (HRT). An image registration scheme specifically adapted to the image acquisition system corrects the non-linear motion-induced image distortions and reconstructs a volume from each focus image stack. The epithelial basal boundary surface including the SNP appears as a distinctive hyper-reflective layer inside the reconstructed volume. Extracting this continuous layer generates a depth map and finally a two-dimensional image of the SNP. A final fusion step of the single reconstructed SNP images leads to laterally extended images.

RESULTS

Out of 40 focus image stacks, 34 have been fully processed into two-dimensional SNP reconstruction images. Six focus image stacks could not be transformed into volumes because of extremely fast eye movements during the image acquisition that prevented the complete image registration of the stacks. The 34 SNP reconstruction images depict an average area of 94.7 % ( ± 6.2 %) with respect to the field of view of a single HRT image. The final fusion of the reconstructed images resulted in an average increase of the image area by a factor of 2.6 (ranging from 2.2 to 3.1).

CONCLUSION

The presented image processing algorithms are capable of correcting the motion-induced image distortions and of generating larger two-dimensional images of the SNP even in presence of severe tissue deformations. These images provide the basis for a more reliable assessment of the corneal nerve fibres.

Prävention von Übergewicht und Adipositas am Arbeitsplatz

BACKGROUND

The rise in the prevalence of overweight and obesity and their associated diseases is leading to substantial health and socio-economic problems in industrialized countries. The Commission of the European Community indicates that workplaces are a setting that has a strong potential for health promotion and disease prevention. Against this background the department of occupational medicine and health protection of the BASF Aktiengesellschaft initiated a health promotion campaign "Trim down the pounds--Losing weight without losing your mind" on the prevention of overweight and obesity at the workplace.

SUBJECTS AND METHODS

The target group included all overweight and obese employees among the 34,000 employees at the BASF site in Ludwigshafen. Overweight and obese employees should reduce weight (either in lowering their body mass index (BMI) by 2 points or by reducing their BMI to less than 25 kg/m2) over a period of nine months assisted by a health promotion programme and normal-weight colleagues (weight-loss helpers). All participants were monitored by occupational physicians, this was also to detect obesity-related diseases. A prize money of euro 10,000 for successful participants and their weight-loss helpers was drawn by lot.

RESULTS

A total of 2,062 employees took part in the health promotion campaign (1,313 overweight and obese employees and 749 weight-loss helpers). 708 overweight participants attended the weight-control measurement after nine months, 658 people had succeeded in reducing their body weight, 440 of them had lowered their BMI by more than 2 points. 83% of those attending the weight-control measurement had a weight-loss helper. Medical benefits were shown by improvement of laboratory parameters and detection of obesity-related diseases.

CONCLUSION

The health promotion campaign "Trim down the pounds" demonstrated that the workplace is a promising focal point for conducting prevention programmes based on the proximity of occupational medical services to the employee. Prevention of overweight and obesity in the workplace is possible by promoting healthy diets in workplace-canteens and physical activity programs like "walking in the lunch break". These programs are substantially strengthened by occupational medical activities in detecting obesity-related diseases. Health promotion at the workplace can be viewed as a benefit to employee and employer alike with employers benefiting from a reduction of lost productivity costs.

Darmkrebs-Vorsorge im Betrieb

BACKGROUND AND OBJECTIVE

The annual incidence of colorectal cancer in Germany is estimated at 27000 in men and 30000 in women. If the diagnosis is made early the cure rate is over 90%. Against this background the department of occupational medicine and health protection of the BASF Aktiengesellschaft initiated a study on the potential prevention of colorectal cancer among the staff at its Ludwigshafen site.

SUBJECTS AND METHODS

The target group included all 13265 actively working employees aged 45 years or above. Those expressing interest were given a standardized questionnaire concerning risk factors for colorectal cancer and a test for occult fecal blood (FOBT). If the test was positive and/or a positive answer was given to the question on blood in the stool or on a positive family history, coloscopy - to be arranged via the general practitioner - was advised, in line with the recommendations of the German Society of Digestive and Metabolic diseases (Deutsche Gesellschaft für Verdauungs- und Stoffwechselerkrankungen).

RESULTS

At the end of the study 3732 employees (337 women, 3395 men, mean age 52 years) had completed the questionnaire and the FOBT results were available. Coloscopy was recommended to 688 employees, 323 of whom (47%) underwent the investigation. Nine of the subjects already had manifest cancer, six of them in the early stage T1 or T2. Adenomatous polyps were found in an additional 61 and subsequently excised. Cost-benefit considerations at the company level or in the area of the health system, respectively, gave favourable ratios of 1:10 and 1:14.

CONCLUSION

It requires considerable expenditure to increase the number of participants in the cancer prevention programme and obtain a consequent clarification of suspicious findings. Health care within a company is a valuable complementation in Germany of medical care provided by general practitioners or specialist, if close cooperation between practitioners in the given region is assured. Initiatives like the one presented here protect people personally affected against pain and distress and are also of economic value.

Evaluation of an enzyme-linked immunosorbent assay for detection and quantification of hepatitis B virus PreS1 envelope antigen in serum samples: comparison with two commercial assays for monitoring hepatitis B virus DNA

An in-house sensitive and easy-to-use solid-phase enzyme-linked immunoassay (ELISA) was adapted for the detection and quantification of hepatitis B virus (HBV) PreS1 envelope antigen in serum, and compared with the HBV DNA Hybrid Capturetrade mark system from Murex and the polymerase chain reaction (PCR) Amplicortrade mark HBV Monitor assay from Roche. Twenty-five patients with chronic hepatitis B after liver transplantation were included in this study. The sensitivity of our ELISA was found to be 50 pg of HBsAg/PreS1Ag ml-1. The linearity was between 0.1 and 100 ng ml-1. Intra-assay reproducibility was obtained with a standard deviation of <1%. No correlation between the presence of serum PreS1 antigen and viral DNA detected by direct hybridization (Murex) was observed. In contrast, there was a significant 96% correspondence in the presence of PreS1 antigen and viral DNA detected and quantified by the PCR assay (Roche). In conclusion, the most important and reliable markers for monitoring residual HBV replication in serum were HBV DNA by the PCR assay, and virus envelope PreS1Ag by our in-house ELISA. Thus, PreS1Ag disappearance in serum could be used for evaluating the efficacy of antiviral therapies.

[Functional colonic pain. An important clinical and sonographic differential diagnosis]

Functional abdominal pain may often be sonographically attributed to the colon. Typically a segment of the colon is painful at direct palpation, but the wall is not thickened. The contractions between the haustra are often marked. The haustra are clearly outlined and cast acoustic shadows. If the patient also experiences spontaneous pain in this region, functional colonic pain, explained as spasms of the muscle coat, may be assumed. Clinically there are often other symptoms of the irritable bowel disease or a spastic constipation. In daily practice functional colonic pain is as frequent as dyspepsia. Differential diagnosis includes intestinal (peptic ulcer, Crohn's disease, appendicitis, diverticulitis, colon cancer) and extraintestinal diseases (e.g. of the gallbladder, pancreas and female adnexes).

[Evaluation of Plasmodium falciparum susceptibility to chloroquine and amodiaquine using a simplified, in vivo, 7-day test in southern Cameroon]

Plasmodium falciparum susceptibility to chloroquine and amodiaquine at a posology of 25 mg/kg per os in 3 days was evaluated in the pupils of 6 primary schools of South-West Cameroon during the first semester 1989. Parasitic index was 75%. Plasmodium falciparum was present in 96% of the infections 24% of the 357 children treated with chloroquine were carriers of trophozoites at D3 and 17% at D7. Complete resistance, at level R III, was observed in 4% of the children. By the 55 children treated with amodiaquine, 13% and 10% were carriers of few trophozoites at D3 and D7. The significance of these results is discussed.

[Evaluation of the efficacy of amino 4-quinolones in a chemoresistant zone. Proposals for new therapeutic schemes]

The authors compare the respective therapeutic efficiency of chloroquine and amodiaquine in the treatment of Plasmodium falciparum malaria fever in urban dispensaries. Chloroquine has a constant rate of efficiency, whatever dosage and duration of treatment be and should be saved for home presumptive treatment of malaria fever. Amodiaquine at a dose of 35 mg/kg in 3 days leads to a noticeable clinical success (96.5 p.c.). It should be selected as drug of first to treat any malaria fever case biologically confirmed, in urban dispensaries.

[Accumulation of risk factors before acute gastroduodenal hemorrhage: analgesic/antirheumatic drugs, alcohol and ulcer anamnesis]

72 patients with acute hemorrhage from gastroduodenal peptic lesions were asked about their drug and alcohol consumption as well as about their smoking habits, 43 of them (60%) had used analgetic or antiinflammatory drugs on at least 3 days during the week preceding the gastrointestinal (g. i.) hemorrhage, 20 patients had used more than on drug, 4 patients an overdose of one drug. During a therapy with corticosteroids alone only one thrombopenic patient bled. 21 patients (29%) had an abnormal high alcohol consumption. In the control group significantly fewer patients had such a drug and alcohol history (p less than 0.01 and p less than 0.05, respectively). The relative risk of a g. i. hemorrhage following an exposition with analgetic/antiinflammatory drugs was RR = +7.41 +/- 5.8. Strikingly, 43 patients (60%) had an ulcer history or a g.i. hemorrhage in the past. In 46 per cent of all patients the risk factors analgesic/antiinflammatory drug, alcohol and ulcer history accumulated before the acute hemorrhage. A more careful indication and dosage of analgesic and antiinflammatory drug therapy might reduce the frequency of g.i. hemorrhage. Most of the patients were male (76%). 39 patients (54%) were older than 60 years. The average age of the 6 patients who died was 73 +/- 6.3 years. After analgesic/antiinflammatory treatment the clinical course was by no means better than in the case of spontaneously occurring lesions. Endoscopically, following exposition with analgesic/antiinflammatory drugs more frequently erosions (p less than 0.05), multiple ulcers and gastric ulcers (no statistical significance) were observed.

[The size of the gallbladder in acute viral hepatitis]

We investigated sonographically the gallbladders of 22 patients during the course of acute viral hepatitis. The size of the gallbladders in the fasting state varied characteristically. When the illness was at its severest, the gallbladder was slightly filled or empty. Later on in the course of the illness, the volume increased until the gallbladder was tightly filled. The area of the gallbladder was measured repeatedly with the same patient and individually correlated inversely with the values of aminopeptidases, but not in a strictly linear manner. This is in fact an easily detectable, sonographical marker of the clinical development of a severely disturbed liver function. When a gallbladder is seen empty, slack or with an apparently thickened wall in the fasting state, the diagnosis of a parenchymal jaundice may be considered.

Adult hypophosphatasia without apparent skeletal disease: "odontohypophosphatasia" in four heterozygote members of a family

Twenty members of a family with adult hypophosphatasia were examined clinically and biochemically. Severe caries causing early loss of permanent teeth was the only clinical symptom which could be attributed to hypophosphatasia. None of them had a history of defective bone mineralization, rachitic skeletal alterations, and recurrent pseudofractures or fractures. An iliac crest bone biopsy of the proposita showed a normal finding corresponding to the age of the patient. Four family members in two subsequent generations were affected, thus suggesting an autosomal dominant inheritance. Their serum and leukocyte alkaline phosphatases were reduced. The phosphoethanolamine (PEA) excretion in the urine was increased to a level which suggests a heterozygote state. The serum alkaline phosphatase activity could be ascribed to the liver isoenzyme fraction. This was shown by polyacrylamide electrophoresis, by inhibition studies with organ-specific inhibitors, heat inactivation, inhibition by antibodies, and treatment with neuraminidase. The proposita had an unexplained, diffuse fatty infiltration of the liver. Thus, not only alterations of bone but also of liver metabolism in hypophosphatasia should be considered. The variety of adult hypophosphatasia described in this paper is characterized by the lack of severe bone abnormalities, the apparently autosomal dominant inheritance, and the reduction of bone and intestinal isoenzyme in the serum. Our study suggests that hypophosphatasia is a heterogeneous disorder which includes both severe and clinically mild forms.

[Gallbladder sludge: a sonographically recognizable stage of lithogenesis]

The appearance and the natural course of gallbladder sludge were studied by ultrasonography in 82 patients. Sludge was found in conditions with a functional or organic disturbance of gallbladder emptying: alcoholic cirrhosis and an atonic gallbladder in the fasting state, e.g., extrahepatic ductal obstruction and obstruction of the cystic duct. No clinical complaints could be attributed to sludge. After the normal bile flow had re-established the sludge disappeared in many cases. In 9 of 82 sludge-positive patients (10,9 per cent) ultrasonography revealed gallstone formation. Newly-formed stones obtained from 2 patients had the aspect of pigment stones and were analyzed by infrared spectroscopy. They consisted of calcium bilirubinate. This material constitutes the pigment granules which are suspended in the sludge. It was concluded that sludge was an early phase of stone formation. Alcoholic cirrhosis, obstruction of the biliary tract, gastrectomy, celiac sprue and prolonged fasting may predispose to lithiasis secondary to the precipitation of sludge in a large, atonic or distended gallbladder. Ultrasonography is instrumental to detect an early state of gallstone formation in those patients who carry a risk.

[Pyroderma fistulans sinifica associated with congenital alpha-1-antitrypsin deficiency]

A patient is reported who suffered from pyodermia fistulans sinifica (acne conglobata sinifica, acne tetrade) and who presented a severe congenital alpha-1-antitrypsin deficiency (phenotype ZZ). The possible significance of the protease inhibitor deficiency for the development of this disease is discussed. Alpha-1-antitrypsin deficiency has been observed in several dermatoses (panniculitis, cutaneous vasculitis, Ehlers-Danlos syndrome, acquired angioneurotic edema and cold urticaria). The insufficient neutralization of liberated leukocyte proteases has been considered to play an important role in these disorders. Besides the ultrastructural finding in the liver cell which is typical for alpha-1-antitrypsin deficiency crystals were found as are seen in the cholesterol ester storage disease. This was probably caused by an increased influx of fatty acids.

[Grey-scale ultrasound in the diagnosis of cystic lesions of the kidney (comparison with excretory urography) (author's transl)]

In a total of 155 cystic renal lesions diagnozed by means of ultrasound the correct differentiation of cystic or solid consistency could be determined in 96.8% of cases. The sonographic result was inaccurate or false in only 2.6%. Sonography also determined the correct morphological and anatomical type of the liquid space-occupying formation in 89%. Pathological cavities of the renal pelvis as well as hydronephroses were the cause of incorrect diagnoses. 36.6% of solitary renal cysts revealed by ultrasound (average diameter of cyst: 3.9 cm), could not be detected by pyelography; radiology most frequently failed to determine cortical renal cysts. Sensitivity and specificity of nephrosonography for detection of cystic malformation of the kidney were distinctly better than pyelography. Out of a total of 34 patients with hereditary polycystic renal disease (HRPD) sonography diagnozed multiple cysts of the liver in 15 cases (44%). The use of ultrasound in examining relatives of patients with HPRD enables an earlier diagnosis of the chronic progressive disease.

Polypoid gastric heterotopy of the small intestine in a patient with primary hyperparathyroidism and alpha-1-antitrypsin deficiency belonging to a MEA-family. With particular reference to the ultrastructure of the epithelial cells

A patient with a solitary polypoid gastric heterotopy in the jejunum and severe bleeding as a complication is described. Previous reports on this rare disorder and the conditions of its development are discussed. The patient belongs to a family with multiple endocrine adenomatosis (MEA), some members of which had an alpha-1-antitrypsin deficiency. The association between the familial disease and the gastric heterotopy in this case might be another argument for the assumed congenital nature of the latter. The polyp was studied by means of light and electron microscopy. It was mostly lined by fundic mucosa and only partially by antral mucosa. Focal foveolar hyperplasia, cysts and lymphoplasmacellular infiltration of the mucosa are regarded as secondary tissue alteration. Parietal cells, chief and endocrine cells were identified. The parietal cells were in the nonsecreting state and appeared in two distinct forms which are described in detail.

Scaling Behavior of Superheater Tube Alloys in ASME High Temperature Steam Research Tests at 1100–1500 F

The scales formed on seven ferritic and ten austenitic types of commercial tubing presently in use and of potential future use for superheater service were examined after 6, 12, and 18 months’ exposure to air and to flowing steam of 2000 psi at temperatures of 1100, 1200, 1350, and 1500 F. The effect of temperature and time of exposure on the adherence, thermal-shock resistance, thickness, structure, and chemical composition of the scales was investigated and the relative resistance to scaling of the various alloys evaluated.