Visualization of 3-D treatment plans with fast neutrons.

The treatment planning for radiotherapy with fast neutrons requires modifications of the planning systems used for photons. The neutron- and photon-component of the treatment fields must be determined and can then be used for separate calculations. The corrections for inhomogeneities are performed by use of attenuation coefficients and the corresponding corrections for changes in the kerma. The treatment planning system MEVAPLAN (Siemens) was modified to follow these requirements. Thus treatment planning for 14 MeV DT-neutrons could be performed. The multiplanar option is used to calculate 3D-dose distributions based on up to 40 serial CT slices. The generated three-dimensional dose matrix and the CT data are transferred via magnetic tape to the visualization system VOXEL-MAN developed at the University Hospital of Hamburg. This system uses a ray casting algorithm based on the generalized Voxel-model to display detailed 3D-images of human anatomy together with the calculated dose distribution. Different treatment plans for neutrons and photons are calculated and visualized. Various manipulations of the data-sets are displayed to improve the critical examination of the simulated dose distribution and to discern the quality of treatment techniques.     

Follow-up data of our pilot study on concomitant hyperfractionated radiotherapy and cisplatinum (CDDP) in patients with advanced cancer of the head and neck.

Since 1988, 52 patients with stage III/IV squamous cell cancer of the head and neck have been treated by concomitant irradiation with 2 x 1.2 Gy/d on five days per week up to a total dose between 72 and 76.8 Gy without split and 5 x 20 mg/m2 cisplatinum (CDDP) as short infusion finished approximately 30 min before the second session on five days of the first and the fifth week of radiotherapy. Radiotherapy has been suspended after 30 and 50 Gy in three patients for insufficient response. In all other patients, radiotherapy has been completed. Due to a slow haematologic recovery, 34% of the patients received only one cycle of CDDP Grade 3 mucositis, occurring during radiotherapy in all patients, healed in a couple of weeks after radiotherapy. Three patients have a persisting ulcer between eight and 36 months after radiotherapy with biopsies negative for tumour and also no other signs of tumour. The ulcers are situated in the region of the former primary tumour with an extensive destruction of tissue already before radiotherapy (cumulative risk of this complication after three years 8%). There were no other major complication. Cumulative local control after three years was 67% (75% including salvage surgery in two patients) with a plateau after twelve months. Total survival after three years was 62%. For the whole follow-up period, local control in the region of the primary tumour after radiotherapy was: 19/29 (T4), 10/15 (T3), 7/10 (T1 + 2, including salvage surgery: 8/10). Local control in the region of the nodal metastasis after radiotherapy was: 5/14 (N3, including salvage surgery: 6/14). 18/21 (N2) and 6/8 (N1).     

Lifetime and six-month prevalence of mental disorders in the Munich follow-up study

Summary The Lifetime and 6 month DSM-III prevalence rates of mental disorders from an adult general population sample of former West Germany are reported. The most frequent mental disorders (lifetime) from the Munich Follow-up Study were anxiety disorders (13.87%), followed by substance (13.51%) and affective (12.90%) disorders. Within anxiety disorders, simple and social phobia (8.01%) were the most common, followed by agoraphobia (5.47%) and panic disorder (2.39%). Females had about twice the rates of males for affective (18.68% versus 6.42%), anxiety (18.13% versus 9.07%), and somatization disorders (1.60% versus 0.00%); males had about three times the rates of substance disorders (21.23% versus 6.11%) of females. Being widowed and separated/divorced was associated with high rates of major depression. Most disordered subjects had at least two diagnoses (69%). The most frequent comorbidity pattern was anxietyand affective disorders. Simple and social phobia began mostly in childhood or early adolescence, whereas agoraphobia and panic disorder had a later average age of onset. The majority of the cases with both anxiety and depression had depression clearly after the occurrence of anxiety. The DIS-DSM-III findings of our study have been compared with both ICD-9 diagnoses assigned by clinicians independently as well as other epidemiological studies conducted with a comparable methodology.     

Accurate diagnosis of acute appendicitis: a retrospective and prospective analysis of 686 patients.

OBJECTIVE--To formulate a score system that would make the preoperative diagnosis of acute appendicitis more accurate. DESIGN--Retrospective then prospective study. SETTING--City University Hospital. SUBJECTS--536 patients who had their appendixes removed between 1981 and 1986 (retrospective study), and 150 consecutive patients admitted with a presumptive diagnosis of appendicitis between 1987 and 1988 (prospective study). MAIN OUTCOME MEASURES--Correlation between the histological diagnosis of appendicitis and variables representing history, clinical examination, and laboratory investigations. RESULTS--The rate of histologically proven negative appendicectomies in the retrospective series was 40% and in the prospective series 33%. The variables that were thought to be predictive were: male sex, white cell count of greater than 11 x 10(9)/l, history of less than 24 hours with no previous complaints, rebound tenderness, shift of pain from the epigastrium, and localised guarding, but all criteria had low specificities and sensitivities when applied prospectively, and combining the scores did not improve them. CONCLUSION--The accurate diagnosis of appendicitis depends largely on the experience of the surgeon and is not improved by the application of a score system that includes the above variables.     

Cerebral involvement in adult onset Still's disease

Still's disease was diagnosed in a 40-year-old patient as a cause of psycho-organic syndrome with complete disorientation and stupor, sensory and motor aphasia. There were no signs of a tumour, cerebrovascular accident, bacterial or viral infection. The patient recovered quickly from the cerebral disturbances under treatment with corticosteroids. Similar symptoms in adult patients with Still's disease are seldom found in the literature.     

Haarkrankheit oder hitze-(brand)-einwirkung?

Zusammenfassung Ein 4 Tage nach einem offensichtlich durch Brandstiftung erfolgten Dachstuhlbrand einer Kirche untersuchter Tatverdächtiger wies in einem umschriebenen Bezirk stumpfe Haarenden auf. Typische Haarspitzenveränderungen durch Hitzeeinwirkung waren makroskopisch und lupenmikroskopisch nicht sicher erkennbar. Mikroskopisch konnte jedoch die Diagnose eindeutig gestellt werden. Auffällige spindelförmige Haarveränderungen, die zunächst ebenfalls als hitzebedingt oder durch krankhafte Haarveränderungen hervorgerufen angesehen wurden, erwiesen sich als Artefakte durch Aufsprühen eines Haarfestigers.Auszugsweise auf der Tagung der Deutschen Gesellschaft für Rechtsmedizin in St. Gallen im September 1986 vorgetragen     

Glutaraldehyde affects biocompatibility of bioprosthetic heart valves.

A marked release of glutaraldehyde from commercially available pericardial bioprosthetic heart valve (BHV) material in washing solutions was found by high performance liquid chromatography (up to 1.8 ppm of glutaraldehyde per gram of dry tissue). In vitro endothelial cell proliferation rate was impaired dose-dependently in the presence of increasing glutaraldehyde concentrations of the cultivation medium (r = 0.9; p less than 0.05). Cultivation of endothelial cells was impossible on the surface of commercially available BHV material, but successful and uninhibited when toxic glutaraldehyde ligands of the BHV material were antagonized by treatment with L-glutamic acid.     

Kongenitale Duodenalstenose im Erwachsenenalter

Zusammenfassung Eine hochgradige Duodenalstenose im Erwachsenenalter kann in seltenen Fällen angeboren sein und findet ihre Ursache in einer intraduodenal gelegenen Membran. Die Anamnese zeigt Wachstumsstörungen mit Erbrechen und Meteorismus und abdominelle Beschwerden. Eine Perforationsöffnung in dieser Membran ist die Ursache fur ein Überleben bis ins Erwachsenenalter. Die Röntgendarstellung und die tiefe Duodenoskopie lassen auf einfache Weise die Diagnose stellen. Differentialdiagnostisch müssen der Volvulus bei Malrotation, Ladd-Bänder und das Pancreas anulare, sowie die Kompression des Duodenums durch Mesenterialgefäße erwogen werden. Das operative Verfahren der Wahl ist die Resektion der intraduodenalen Membran. Dabei ist v. a. die Papilla Vateri darzustellen, da diese nicht selten im Bereich des Septums mündet. Das längs eröffnete Duodenum wird quer verschlossen. Bei der Wind-Sock-Web-Anomalie sollte das Duodenum an der Ansatzstelle des Diaphragmas eröffnet werden. Die Anlage einer Gastrojejunostomie ist inadäquat und zu vermeiden.

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Congenital duodenal stenosis in adulthood

A high-grade duodenal stenosis in adults can, in rare cases, be congenital, and its cause is found in an intraduodenally sited membrane. The anamnesis reveals growth disorders with vomiting and meteorism and abdominal complaints. A perforation opening in this membrane is the reason for survival into adulthood. The X-ray appearance and deep duodenoscopy make the diagnosis easy. Volvulus in cases of malrotation, Ladd's ligaments, anular pancreas, and compression of the duodenum by mesenteric vessels must be considered in the differential diagnosis. When the intraduodenal membrane is resected it is most important to expose the papilla Vateri, since this not uncommonly ends in the area of the septum. If necessary, a duodenoduodenostomy is performed. If the windsock web abnormality is present the duodenum should be opened at the point of attachment of the diaphragm. The construction of a gastrojejunostomy should be avoided.

     

Quantitative determination of oestradiol-17 beta hydroxysteroid dehydrogenase: increased sensitivity by HPLC separation of the hormones permits the measurement of enzyme activity in cryostat sections

The activity of the oestradiol-17 beta hydroxysteroid dehydrogenase in human endometrial and breast cancer specimens was determined by the NAD-dependent conversion of oestradiol-17 beta to oestrone. The sensitivity of the determination was improved by the separation of the hormones by HPLC. We are now able to determine oestradiol-17 beta hydroxysteroid dehydrogenase quantitatively in cryostat sections. A clear correlation of serum progesterone levels and oestradiol-17 beta hydroxysteroid dehydrogenase activity in the endometrium was demonstrated, and we found a more than 30-fold increase in enzyme activity after the progesterone surge. In contrast, in breast cancer samples, we found no correlation between oestradiol-17 beta hydroxysteroid dehydrogenase and the measured serum parameters.