Strahlenbiologie der Normalgewebe

Strahlentherapie und Onkologie -     

Effekte einer niedrig dosierten Co-60-Bestrahlung auf den Verlauf einer aseptischen Arthritis am Kniegelenk des Kaninchens

Purpose

Numerous clinical observations demonstrate the efficacy of low radiation doses in the treatment of painful osteoarthritis. Experimental investigations remain scarce. We investigated the effects of locally daily 5 times 1.0 Gy 60-Co irradiation on an artificially induced aseptic gonarthritis in rabbits.

Material and Methods

Three separate experiments (EV) were performed (10 rabbits per experiment, 5 treated/5 controls; duration: EV1: 18 days; EV2: 6 days; EV3: 29 days). An aseptic arthritis in the right knee joint of rabbits was induced by intraarticular injection of 0.5 ml papain solution (3%, 30,000 USP/mg) on day 0. The arthritic knee joint of the anesthesized animals was irradiated daily from day 1 to 5 with 5 times 1.0 Gy. The controls were sham-irradiated under the same conditions. The time course of arthritis in treated animals and sham-treated controls was evaluated by clinical laboratory-chemical and histological criteria. The clinical investigation was performed daily, the puncture of the kneejoints was carried out several times in EV1, and at the end of experiments in EV2 and EV3. At the end of the observation period, animals were killed and the knee joints excised for histological analysis.

Results

The intraarticular injection of papain caused a peracute inflammatory response in all animals. After 1 week the chronical stage was reached, and the experimental arthritis resolved slowly within several weeks. Local irradiation accelerated the decrease of inflammatory joint swelling, being significant by day 4. On day 6 the volume of synovial fluid in irradiated knee-joints was significantly smaller. The morphometric data indicated a reduction in thickness of synovial membrane, a decrease in number of synovial cell layers, and a decrease in distance between capillaries and the synovial membrane surface following irradiation of arthritic joints. Due to considerable individual variability, the morphometric data partially did not reach statistically significance.

Conclusion

The experiments provide evidence for an antiphlogistic effect of irradiation with 5 times 1.0 Gy in vivo. They support the clinical observations of the efficacy of anti-inflammatory radiotherapy.     

Rekanalisation am Unterschenkel

Percutaneous transluminal angioplasty (PTA) and stent placement are currently accepted methods for endovascular treatment of critical limb ischemia, if infragenual vessels are involved. Outcome results in high technical success and satisfactory clinical results for treatment of infrapopliteal lesions with regard to patency rates and amputation-free survival. These treatment modalities are also safe for the patients. The question whether PAT alone or additional stent placement is the better choice, is still unanswered due to limited data.     

Kontrastmittelsonographie am Tiermodell

In the past the detection of tumor perfusion was achieved solely via invasive procedures, such as intravital microscopy or with the help of costly modalities, such as multidetector computed tomography (MDCT), magnetic resonance tomography (MRT) or the combined use of positron emission tomography and computed tomography (PET/CT). Ultrasound offers the non-invasive display of organs without usage of ionizing radiation and it is widely available. However, colour-coded ultrasound and power Doppler do not allow the detection of tumor microcirculation. The introduction of contrast-enhanced ultrasound (CEUS) as well as new high-frequency ultrasound probes made it possible to detect and quantify tumor microcirculation with high resolution. CEUS has been used clinically on human beings for more than 10 years. During the last years different tumor models in experimental animals were used for the establishment of this new technique, e.g. in rats, hamsters and mice. CEUS allows the detection of functional parameters, such as the angiogenetic metabolic status of tissue pretreatment and posttreatment. Further research is required to solve the problems of absolute quantification of these perfusion parameters to allow the comparison of CEUS with other modalities (e.g. MRT and CT).     

DNA-Untersuchung von Hautepithelzellen asserviert am Rollkragenpullover und am Hals des Opfers

A 34-year-old woman who was separated from her husband, was killed by him by strangulation and several stab wounds in the chest. The post-mortem examination was carried out approximately 5 h after death. At the place of discovery one swab of her right and one of her left neck side were taken. Additionally, a swab was taken out from the front side of the collar of her polo-neck pullover. It was obvious that the skin of the neck below the larynx showed a fabric pattern leading to the assumption that the collar was temporarily pressed between the hands of the suspect and the neck of the victim. DNA typing (short tandem repeat-PCR) of these swabs led to the detection of mixed patterns for the swabs of the neck and the collar which matched the patterns of the victim and the suspect.     

Rechtssicherheit am Lebensende?

Ohne Zusammenfassung     

Das Recht am Leichnam

Ohne Zusammenfassung     

Der Tod am Volant

Zusammenfassung Der Herztod am Steuer ist selten. Er führt nach unseren Erfahrungen nur in vereinzelten Fällen zur Gefährdung oder Schädigung anderer Straßenbenützer. Es ist deshalb nicht gerechtfertigt, Herzkreislaufkranke rigoros aus dem Verkehr auszuschalten. Sie sind vielmehr auf die Gefährdungs-Möglichkeiten ihres Leidens aufmerksam zu machen, wobei ihnen der behandelnde oder begutachtende Arzt entsprechende Verhaltens-Richtlinien erteilen sollte.

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Résumé La mort subite au volant est rare. D'après nos experiences elle cause dans très peu de cas des dangers ou mème des dommages aux autres participants de la route. Les porteurs de maladies circulatoirs ne doivent alors pas être éliminés rigoureusement du traffic. Il faut leur expliquer plutôt les possibles dangers liés à leur maladie. Le devoir du médecin traitant ou de l'expert consiste à leur donner des directives correspondantes.

     

Effekte von Fraktionierung und Dosisleistung bei der PDR-Brachytherapie von B14-Zellen

Purpose

Present radiobiological studies for different cell lines in vitro demonstrate the equivalence and efficacy of continuous low-dose-rate brachytherapy (LDR-BT) and pulsed dose rate brachytherapy (PDR-BT) when using small and frequent dose pulses. The aim of this study was to examine monolayer fibroblast cultures in vitro to examine the biological effects of different pulse doses and dose rates under clinically conditiones.

Material and Methods

B14 cells, Hy B14 FAF 28, peritoneal fibroblasts, were cultured in multi-well plates and exposed to a PDR radiation source at a distance of 9 mm. The following PDR-schemes were compared: dose per pulse: 1 Gy, 2.5 Gy and 5 Gy to a total dose of 5 Gy/5 h (overall time). 10 Gy/10 h, 20 Gy/20 h and 30 Gy/30 h. The pulse duration for the examination of dose rate effects was 20 min, 30 min or 52 min corresponding to a pulse dose rate of 300 cGy/h, 200 cGy/h or 115 cGy/h. Treatment endpoints were cell survival measured by dye exclusion test and clonogenic cell survival.

Results

Cell survival decreased for pulse doses of 5 Gy compared to 2.5 Gy or 1 Gy per pulse (mean dose rate 200 to 300 cGy/h). No differences were observed with dose rates during irradiation of 300 cGy/h, 200 cGy/h or 115 cGy/h (20 Gy/l Gy).

Conclusion

Radiobiological effects of PDR-BT are dependent on the dose per pulse, with differences in biological effects only with a dose per pulse of more than 2.5 Gy, considering the described in-vitro conditiones. More examinations with a more pronounced difference in dose rate will be continued for evaluation of dose rate effects.     

Chronische Krankheitsbilder am Sprunggelenk

The etiology of chronic diseases of the ankle joint comprises a wide spectrum including chronic inflammatory processes and chronic degenerative, tumorous and neuropathic processes, as well as some specific syndromes based on chronic changes of the ankle joint. Of the inflammatory processes, chronic juvenile arthritis (JVC) is the most common disease. However, also Reiter disease, psoriasis or chronic monoarthritid diseases such as gout, as well as granulomatous diseases (tuberculosis, sarcoidosis) and fungal infections, may affect the ankle joint in a chronic course. Chronic degenerative changes are usually secondary due to abnormal positioning of the joint constituents or repetitive trauma. Neuropathic changes, as frequently seen in the course of diabetes, present with massive osseous destruction and malposition of the articular constituents. Chronic osseous as well as cartilaginous and synovial changes are seen in hemophilic patients. Chronic traumatic changes are represented by pigmented villonodular synovitis (PVNS), and chondromatosis, both with a predilection for the ankle joint. Due to the possibilities of magnetic resonance imaging (MRI), diagnosis of chronic ankle changes includes chronic ligamentous, tendinous and soft tissue changes. With the use of MRI, specific syndromes can be defined which particularly affect the ankle joint in a chronic way, such as the os trigonum syndrome, the anterolateral impingement syndrome and the sinus tarsi syndrome. Nevertheless, plain film radiographs are still the basic element of any investigation. MRI, however, can be potentially used as a second investigation, saving an unnecessary cascade of investigations with ultrasound and CT. The latter investigations are used only with very specific indications, for instance CT for subtle bone structures and sonography for a limited investigation of tendons or evaluation of fluid. Particularly due to the possibilities of MRI and the development of special gradient-echo imaging or high-resolution coils, the investigation of the ankle joint still offers a wide spectrum of innovation for the next years, which is particularly enforced by the increasing demand for specific diagnosis of chronic diseases in orthopedic medicine.     

Geschlechtsunterschiede am menschlichen Brustbein

Zusammenfassung Bei der Untersuchung von 326 Brustbeinen (160 männliche und 166 weibliche) fanden wir in einer Anzahl von Abmessungen und daraus abgeleiteten Parametern hoch signifikante Unterschiede zwischen beiden Gleschlechtern. In allen Fällen zeigten sich jedoch erhebliche Überschneidungen zwischen beiden Kollektiven. Zur Geschlechtsbestimmung am Brustbein ist nach unseren Untersuchungen die sog. Summenformel nach Dürwald am besten geeignet. Durch Addition der Gesamtlänge des Brustbeines ohne Xiphoid, der Breite des Corpus im ersten und zweiten Segment sowie der Dicke des Manubrium und der des Corpus im ersten Segment (alle Maße in mm) gelangten wir zu Durchschnittswerten von 233,9 für männliche und 203,3 für weibliche Brustbeine. Als Richtwert ist 220 geeignet, unterhalb welchem nur noch 20% der männlichen Brustbeine liegen, während nur 11% der weiblichen ihn übersteigen.

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Summary 326 sterna (160 male and 166 female) were examined. Measurements and parameters derived from this examination disclose highly significant differences between both sexes. In all cases, however, there was considerable overlapping of both groups. According to our examinations summation of measurements is best suited as suggested by Dürwald. By adding the total length of the sternum without the xiphoid, the breadth of the corpus in the first and second segments and the thickness of the manubrium and that of the corpus in the first segment (all measurements in mm) we obtained average values of 233.9 for male and 203.3 for female sterna. As a standard value we propose 220, as only 20% of the male sterna are below this figure, whereas only 11% of the female sterna exceed it.

     

Der Schrittmacherpatient am Volant

Zusammenfassung Eine Überprüfung der 24 autolenkenden zürcherischen Schrittmacher-träger (Gesamtfahrpraxis circa 700000 km) zeigt eine gute Fahrbewährung ohne nachweisbare Verkehrsgefährdung durch das Herzleiden. Unser Ergebnis stimmt überein mit ähnlichen Untersuchungen in Stockholm und in Hamburg [4, 13]. Ein generelles Fahrverbot bei dieser Krankengruppe wird deshalb abgelehnt; vielmehr muß jeder Schrittmacherträ ger individuell beurteilt werden.

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Summary The driving record of 24 Zürich drivers with permanent pacemakers (total driving experience about 700000 km) has been examined. No traffic hazards due to their heart condition could be detected. Our results agree with similar investigations in Stockholm and Hamburg [4, 13]. We reject the idea of a general driving ban for this group of patients. Instead, each pacemaker-carrier should be evaluated individually.

Herrn Prof. Dr. B. Mueller zum 75. Geburtstag gewidmet.