Intestinal non-Hodgkin's lymphoma: a multicenter prospective clinical study from the German Study Group on Intestinal non-Hodgkin's Lymphoma.

PURPOSE: Intestinal non-Hodgkin's lymphomas are not well characterized. We therefore studied prospectively their clinical features and response to standardized therapy. PATIENTS AND METHODS: Fifty-six patients with primary intestinal lymphoma were included in a prospective, nonrandomized multicenter study. Lymphoma resection was recommended and staging was performed according to the Ann Arbor classification. Patients were scheduled to receive six cycles of cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP) chemotherapy, and at stages EIII to EIV, they received additional involved-field radiotherapy. Corticosteroids were used in patients who could not receive chemotherapy. RESULTS: Thirty-five patients had intestinal T-cell lymphoma (ITCL), 21 patients had intestinal B-cell lymphoma (IBCL; 18 diffuse large-cell lymphomas, two marginal-cell lymphomas, and one follicle-center lymphoma). Thirty-four patients at stages EI to EII (14 ITCL and 20 IBCL) and nine patients at stages EIII to EIV (all ITCL) received chemotherapy. No patient in stages EIII to EIV received radiotherapy, because death occurred in 12 of 14 patients. Two-year cumulative survival in patients with IBCL was 94% (95% CI, 82% to 100%) and higher than in patients with ITCL (28% [95% CI, 13% to 43%]; P <.0001), even when only stages EI to EII were considered (ITCL, 37.5% [95% CI, 16.5% to 58.5%]; P <.0001). IBCL patients compared with ITCL patients were at lower lymphoma stages (P <.01), had higher Karnofsky status (P <.005), had intestinal perforation less often (P <.05), required emergency operation less often (P <.05), received CHOP (P <.05) more often, and reached complete remission (P <.0005) more frequently. CONCLUSION: IBCL patients at stages EI and EII respond well to chemotherapy, but the prognosis and treatment of ITCL patients is unsatisfactory.     

Implantation of biventricular assist devices for chronic heart transplant rejection

Mechanical circulatory support has been used to treat graft failure caused by rejection after heart transplantation, but the prognosis remains bleak. Organ failure induced by the addition of or an increase in immunosuppressive medication is known to be a cause of the poor outcomes. Thus we tried a new therapeutic technique that allows complete withdrawal of immunosuppressive medication, as the donor heart is removed and circulatory support is maintained with a biventricular assist device.     

The differential vulnerability of striatal projection neurons in 3-nitropropionic acid-treated rats does not match that typical of adult-onset Huntington's disease

In adult-onset Huntington's disease (HD), striatal projection neurons are much more vulnerable than striatal interneurons, but even striatal projection neurons show differences in their vulnerability, with the striatal projection neurons projecting to the internal segment of the globus pallidus being the least vulnerable. Previous studies have shown that systemic chronic treatment with 3-nitropropionic acid (3NP), an inhibitor of succinate dehydrogenase, induces the preferential loss of striatal projection neurons over striatal interneurons that is characteristic of HD, which has been taken to support the hypothesis that the pathogenic defect in HD may involve impaired energy metabolism. We sought to determine whether the patterns of survival for striatal projection neurons in 4-month-old rats after chronic systemic 3NP treatment also resemble those in adult-onset HD. We assessed the projection neuron survival using neuropeptide immunolabeling of striatal efferent fibers in striatal target areas and quantified the degree of fiber loss in the striatal target areas using computer-assisted image analysis. We found that 3NP produced relatively equal loss of striatal fibers and terminals in the globus pallidus, substantia nigra, and entopeduncular nucleus, indicating a nondifferential vulnerability of striatal projection neurons to 3NP-induced impairment in energy metabolism. The results suggest that the 3NP rat model does not fully mimic adult-onset HD pathogenesis.     

Using orbital sonography to diagnose and monitor treatment of acute swelling of the eyelids in pediatric patients

OBJECTIVE. Clinical signs of acute erythematous swelling of the periorbital region may be related either to benign superficial inflammation or to the more severe and potentially life-threatening condition of orbital infection. CONCLUSION. We recommend orbital sonography in every child with periorbital swelling and erythema. In contrast to superficial infection in which edematous swelling of the eyelid can be documented without lesions of the orbital content, either a hyper- or a hypo-echoic mass displacing the medial rectus muscle laterally is highly suggestive of orbital infection. Introducing sonography into early diagnostic interventions in pediatric patients avoids delaying appropriate treatment and allows disease monitoring on a daily basis.     

Technologists' productivity when using PACS: comparison of film-based versus filmless radiography

OBJECTIVE: The objective of this study was to assess the impact of filmless operation and computed radiography on technologists' examination times compared with conventional film-based operation and film-screen radiography. CONCLUSION: Compared with conventional film-screen operation, filmless operation using computed radiography was associated with a significant decrease in technologist examination times in the performance of general radiographic examinations. This decrease in technologist examination times in a filmless environment offers the potential for increased productivity with resulting personnel savings and improved operational efficiency.     

Interdisciplinary longitudinal curriculum "Medical psychology,psychotherapy and psychosomatics" (MPPP) at the University of Ulm

We report the clinical part of the longitudinal curriculum MPPP which was developed by the departments of Medical Psychology, Psychotherapy and Psychosomatic Medicine at the University of Ulm. The commitment and creativity of the participating students in their two undergraduate years inspired us to offer them an interest-guided curriculum for their six clinical semesters. Our paper reports the extensive results of two evaluations that we conducted during the clinical part of this new teaching-model. It became evident that we were successful in transferring continuous, intense and patient-centred psychosomatic and psychosocial contents. Yet the transfer of basic and methodological knowledge was not realised to the extent the students would have appreciated. The positive results of our project encouraged us to expand the concept of an interest-guided curriculum onto the whole academic education in psychotherapy and psychosomatic medicine at our university.     

Magnetic resonance imaging as a supplement for the clinical staging system of Durie and Salmon?

BACKGROUND: This study evaluated the prognostic value of a three-grade staging system of spinal involvement using magnetic resonance imaging (MRI) in patients with multiple myeloma and determined its usefulness as an independent parameter in the staging system of Durie and Salmon. METHODS: Seventy-seven previously untreated patients with multiple myeloma underwent MRI of the thoracic and lumbar spine with unenhanced T1-weighted spin echo and short-tau inversion time inversion recovery sequences. The patients were evaluated according to their infiltration patterns and the extent of bone marrow involvement was staged using a three-grade scale: Stage I, no focal or diffuse infiltration; Stage II, 1-10 foci or mild diffuse infiltration; Stage III, more than 10 foci or strong diffuse infiltration. RESULTS: The infiltration patterns had no significant effect on survival. Of 77 patients, 25 would have been understaged using the standard staging system of Durie and Salmon without the findings of MRI and 8 patients would have been understaged if the staging was based only on MRI. The combination of the staging system of Durie and Salmon and MRI was highly significant with respect to survival (P < 0.0001, log rank analysis). MRI staging I-III was independent of the staging system of Durie and Salmon (Cox regression model). CONCLUSIONS: A three-grade staging of spinal MRI provides a significant prognostic tool for patients with multiple myeloma. The authors propose including it in the staging system of Durie and Salmon.     

Anastomosis protection and preservation of continence in the surgical treatment of rectal carcinoma

AIMS: To find clues to a risk-adjusted therapy with regard to the use of protective colostomies and the value of Hartmann-resection. METHODS: In 108 patients with rectal cancer the results of surgical treatment were examined during a period from 1996 to 1998. RESULTS: One surgeon always performed a defunctioning colostomy in low anterior resection if the patients were male with lower and advanced tumors after preoperative radiation, while others carried out anastomotic protection in none of these patients. Anastomotic dehiscence never occurred in these patients, but in male patients with more proximal tumors and without preoperative radiation. Overall, preoperative radiation did not result in a higher rate of complications and local recurrence never occurred. Nineteen patients with high comorbidity underwent Hartmann-resection as a therapy with assumed lower risk for postoperative complications when compared with abdomino-perineal resection. The postoperative mortality rate of 16% was well above the mean postoperative mortality of 4.6%. Local recurrence occurred in 31% in comparison with 16% after abdomino-perineal resection, but all of these patients were operated on for obstructing node-positive T4-tumors. CONCLUSIONS: Technical difficulties in performing a low rectal anastomosis should be more important for the indication of anastomotic protection than generalizing guidelines. Preoperative short-term radiation is safe and has a beneficial effect on local recurrence. The Hartmann-resection is advisable only in patients with colonic obstruction and locally advanced tumors and in patients with a markedly higher comorbidity, in whom the risk of an anastomosis is not justified.