Über eine primäre Cliradonsucht

Ohne ZusammenfassungVortrag gelegentlich der Tagung der Deutschen Gesellschaft für gerichtliche und soziale Medizin in München 1952.     

Modell zur primären und sekundären Metastasierung beim Mammakarzinom und dessen klinische Bedeutung

BACKGROUND: An adjuvant locoregional radiotherapy after radical surgery results in a survival advantage for breast cancer patients. The advantage starts with a delay and reaches about 10% 15 years after diagnosis. What could explain such a delayed efficacy? METHODS: A population-based cohort from 1996 to 1998 and the Munich Cancer Registry with courses of breast cancer disease since 1977 are the empirical basis. The analysis concerns survival rates and survival times in respect to metastases, local and lymph node recurrencies. A metastatic model is derived from the data. RESULTS: A cohort of 9,347 patients with a mean follow-up of 6.5 years and 2,587 courses with metastases and/or local recurrencies were registered. The overall survival after 15 years was for pT1 57.6%, pT2 37.9%, pT3 24.4% and for pT4 10.5%. Five years after metastasization 20.1 to 12.4% survived, 10 years 6% independent on pT. Ten years after local recurrencies the survival was dependent on pT of the primary tumor: pT1 36.3%, pT2 21.0%, pT3 13.1% und pT4 4.6%. A local recurrency is a prognostic factor for metastasization of the primary tumor, but local recurrencies can also cause metastases. The mean survival time after metastasization of the primary pT1 tumor is estimated about 61 months, after metastasization by local recurrencies about 99 months with a mean time to local recurrencies of 38 months. Further results of the metastatic model are: the development of metastasization is homogeneous and independent on pT-category, the metastatic initiation starts up to 5 years before diagnosis, metastatic-free survival time and progression survival time are independent and an impact of lymph node recurrencies on survival could not be detected. CONCLUSIONS: The reduction of local recurrencies by high-quality primary therapy with radiotherapy and also the early detection of local recurrencies may reduce secondary metastasization and therefore improve survival. The metastasization model also explains the limitation of the therapeutical strategies and the almost mandatory chance of early detection programs of breast cancer.     

Über die Kronenbildung des auffallenden Bluttropfens und ihre Beziehungen zu sekundären Blutspritzern

Ohne ZusammenfassungHerrn Medizinalpraktikant Dr.Völler und Frl.El. Feldmann spreche ich für ihre Hilfe bei Ausführung der Versuche meinen herzlichen Dank aus.     

Über Ehefähigkeit und Unfall

Ohne Zusammenfassung     

Über Lebensdauer und Handlungsfähigkeit Schwerverletzter

Ohne ZusammenfassungHerrn Prof.Fritz Reuter zu seinem 60. Geburtstage gewidmet.     

Über elektropathologische Semiotik und Kausalität

Ohne Zusammenfassung     

Über Gewebsspezifität und Pathoklise im Zentralnervensystem

Ohne Zusammenfassung     

Über Bewußtlosigkeit und Handlungsunfähigkeit

Ohne Zusammenfassung     

Analyse unterschiedlicher Applikationsformen und CT-gestützter Planungsvarianten in der Behandlung primärer Endometriumkarzinome

Background

Intracorporal brachytherapy is regarded as the definitive component of treatment for inoperable patients with endometrial carcinoma. Until now the whole uterus has been claimed to represent the target volume independent of individual tumor spread. The purpose of this work is to analyse the correlation between target volume and treated volume using different application- and planning procedures.

Patients and Methods

In a consecutive series of 10 patients with primary irradiated endometrial carcinoma we analyzed the correlation between target volume and treated volume using either standard 1-channel applicators or individual Heyman-applicators. Application of the ovoids was followed by a planning CT scan for all patients. Based on this, target volume (uterus volume) was estimated on a 3D-planning system. According to the measurable length of the uterus cavity we determined the corresponding standard 1-channel applicator and calculated the respectively treated volume. Estimating the advantages of an optimized treatment planning strategy for individual Heyman- applications we compared the treated volumes, which result from a standardized and optimized treatment planning procedure.

Results

the mean uterus volume was 180 cm³ (range 57 to 316 cm³). Asymmetric uterus configurations with longitudinal or sagittal side differences exceeding 1 cm were found in 40% of the cases. Using standard 1-channel applicators on average 47% (range 25 to 89%) of the uterus volume were enclosed by the treated volume compared to 70% for Heymanapplications. Differentiating these individual applications according to the variable treatment modality values of mean 66% (range 36 to 110%) for the standardized and 73% (range 48 to 95%) for the optimized treatment planning strategy were found. Moreover optimized planning modalities led to an improved coverage of the target volume in 5 out of 10 cases with an increase in volume of 20% on average (range 11 to 32%). In 3 cases changes of less than 5% were noticed (no improvement). In order to protect organs at risk treated volume had to be decreased in 2 cases for 19% and 40% respectively.

Conclusions

Intracavitary brachytherapy of primary endometrial carcinoma was improved by individualized application-and planning procedures, which led to better adaptations of the treated volumes to the target volumes. Nevertheless a complete coverage — corresponding to the primary intent — was not possible. Individualized and optimized brachytherapy must be performed according to the individual tumor spread and uterus configuration. Therefore, different applicators are required.     

Über periphere Aneurysmen und ihre gerichtsärztliche Bedeutung

Ohne Zusammenfassung     

Über Leichenveränderungen,autolytische, Fäulnis- und Verwesungsvorgänge

Ohne ZusammenfassungReferat, bestimmt für die 13. Tagung der Dtsch. Ges. f. gerichtl. u. soz. Med. Sept. 1923.     

Über Mageninhalt und Todeszeit

Ohne ZusammenfassungVorgetragen auf der Tagung der Deutschen Gesellschaft f. gerichtl. u. soziale Medizin in Erlangen, September 1921.     

Über ärztliche Ethik

Ohne ZusammenfassungMeinem verehrten Lehrer, Herrn Prof. Dr. med. Dr. jur. h. c. Dr. med. vet. h. c. V.Müller-Hess zum 70. Geburtstag.     

Über Charakterfehler und ihre Beziehungen zur geminderten Zurechnungsfähigkeit

Ohne Zusammenfassung Vortrag, gehalten in der forensisch-psychiatrischen Vereinigung zu Dresden am 5. Mai 1927.     

Über Testierfähigkeit

Ohne Zusammenfassung     

Biopsien von Nierenläsionen: wann und wie?

The demand for image-guided renal biopsy has increased due to the better detection of renal lesions; however, despite modern imaging techniques many small renal tumors cannot be classified as benign because they cannot be differentiated from renal cell carcinoma. Ultrasound and computed tomography (CT)-guided kidney biopsy is a safe and accurate method in the diagnostics of renal lesions and can be helpful in the selection of new ablative and pharmaceutical forms of treatment and avoid unnecessary operations. This article describes the clinical indications for an image-guided biopsy and discusses factors which should be considered when performing a biopsy.     

Laserinduzierte Thermotherapie von Lungenmetastasen und primären Lungentumoren

We present laser-induced thermotherapy (LITT) of primary and secondary lung tumors analysing indications and technical concepts. Thirty patients with lung metastases of different primary tumors (n=24) as well as localized lung tumors (n=6) were prospectively treated in 41 sessions using laser-induced thermotherapy (LITT). An MR-compatible puncture system was used with direct puncture technique. The puncture was performed via CT guidance in care vision technique. Eight patients were thermoablated using MR tomographical monitoring, 22 patients using CT monitoring. Local therapy effects, tumor control rate, side effects, complications, and survival were evaluated. In 74% of cases (28/38 lesions) of 24 patients with lung metastases and in all cases of the 6 patients with lung carcinoma a complete local ablation could be achieved. The complication rate (pneumothorax) was 9,8%. One patient with bronchial carcinoma had to be thoracotomized and resected. 93% of the patients are still alive. Percutaneous LITT of lung tumors permits a complete ablation of lung metastases and lung carcinomas with a low complication rate. Indications for the procedure were defined for patients with no more than 5 metastases up to 3 cm in size.