Neue Entwicklungen in der Strahlentherapie

Ziel dieses Beitrags ist es, einen Überblick über neue Techniken der Strahlentherapie in der gynäkologischen Onkologie zu geben. Vorgestellt und erläutert werden die technischen und klinischen Aspekte der intensitätsmodulierten Strahlentherapie (IMRT) und der helikalen Tomotherapie, der volumetrisch modulierten Strahlentherapie und der atemgetriggerten Strahlentherapie, insbesondere die Strahlentherapie in tiefer Inspiration („deep inspiration breath hold“, DIBH). Weiterhin werden Hypofraktionierung und stereotaktische Strahlentherapie (Radiochirurgie, stereotaktisch fraktionierte Strahlentherapie und stereotaktische Körperstrahlentherapie) erklärt. IMRT gilt als Standardstrahlentherapie für gynäkologische Krebserkrankungen im Becken. Das DEGRO(Deutsche Gesellschaft für Radioonkologie)-Brustkrebs-Expertengremium empfiehlt DIBH als die beste Technik zur Herzschonung bei Brustkrebspatientinnen.     

Impulse oscillometry in preschool children and association with body mass index

Background and objective: The use of the impulse oscillometry system (IOS) allows differentiated lung function testing with a minimum of cooperation at normal tidal breathing. The aim of this cross‐sectional study was to assess the association of body mass (overweight and obese) with oscillometric parameters in preschool children. Methods: A preschool medical check of 518 children (age 6.01 ± 0.25 years) included IOS recordings of airway resistance and lung reactance (MasterScreen IOS, CareFusion, Höchberg, Germany). Measured values of respiratory resistance (R5) and reactance (X5) at 5 Hz were correlated with BMI. In addition, data were compared with recently published reference equations. Results: In this young age group of 241 boys and 277 girls there was no significant association between oscillometric parameters and BMI. When compared with current IOS reference values of healthy subjects the relationship of R5 (109 ± 25%) and X5 (105.5 ± 35%) suggested mildly elevated peripheral resistance in this unselected group of preschool children. Conclusions: IOS is ideally suited to obtain measurements of respiratory function in preschool children. At the age of 6 years, standard oscillometric values do not indicate impaired respiratory function associated with increased BMI.     

Influence of the absorption behavior of sunscreens in the short-wavelength UV range (UVB) and the long-wavelength UV range (UVA) on the relation of the UVB absorption to sun protection factor

The absorption of filter substances in sunscreens, reducing the incident ultraviolet (UV) radiation, is the basis for the protecting ability of such formulations. The erythema-correlated sun protection factor (SPF), depending mainly on the intensity of the UVB radiation, is the common value to quantify the efficacy of the formulations avoiding sunburn. An ex vivo method combining tape stripping and optical spectroscopy is applied to measure the absorption of sunscreens in the entire UV spectral range. The obtained relations between the short-wavelength UV (UVB) absorption and the SPF confirm a clear influence of the long-wavelength UV (UVA) absorption on the SPF values. The data reflect the historical development of the relation of the concentration of UVB and UVA filters in sunscreens and points to the influence of additional ingredients, e.g., antioxidants and cell-protecting agents on the efficacy of the products.     

Evaluation of sperm recovery following annexin V magnetic-activated cell sorting separation

Magnetic-activated cell sorting (MACS) using paramagnetic annexin V-conjugated microbeads eliminates spermatozoa with externalized phosphatidylserine, which is considered one of the features of apoptosis. The objective of this study was to evaluate sperm recovery following the use of MACS as a sperm preparation technique. Mature spermatozoa were separated and divided into two fractions: the first was prepared by density gradient centrifugation (DGC) and MACS, while the second was prepared by DGC only. Following MACS, the percentage of cells collected in the annexin-negative fraction was significantly higher than the annexin-positive fraction and the sperm recovery rate was 73.8 +/- 12.1%. In conclusion, the integration of MACS with DGC can be considered as an effective sperm preparation technique that does not lead to significant cell loss. Separating a distinctive population of non-apoptotic spermatozoa with intact membranes may optimize the outcome of assisted reproduction.     

Häufigkeit und Ursache zivil- und strafrechtlicher Verfahren in der Radiologie

Zusammenfassung Die Bereitschaft deutscher Patienten, wegen tatsächlicher oder vermuteter Kunstfehler ihres Arztes vor Gericht zu ziehen, stieg im Verlauf der Jahre, wie auch in anderen westlichen Ländern, an. Durch die Berichterstattung in den Medien werden Ärzte und ihre Leistungen kritischer betrachtet als früher. Dies betrifft auch die Radiologie, wenngleich für Radiologen im Vergleich zu chirurgischen Disziplinen eine deutlich geringere Wahrscheinlichkeit besteht, in einen Rechtsstreit verwickelt zu werden. Im Unterschied zu anderen Fachrichtungen liegen die Bilder der Radiologie zur erneuten Begutachtung allerdings jederzeit vor.In der vorliegenden Studie wurde 4760 Radiologen ein Fragebogen zugesandt. Der Fragebogen wurde von 1503 Radiologen ausgefüllt zurückgeschickt. Die abgefragten und mitgeteilten Daten aus anhängigen oder abgeschlossenen Verfahren wurden ausgewertet. Die Klagen richteten sich in 38% gegen die Beurteilung, in 30% gegen die Durchführung einer Untersuchung und in 14% der Fälle gegen die Aufklärung (18% sonstige Angaben).Angiographien, Mammographien oder Radiographien waren der häufigste Grund, eine Klage zu führen. Die Mehrzahl der Patienten, die klagten, war zwischen 40 und 50 Jahren alt. 30% der Verfahren hatten zivilrechtliche, 5,5% strafrechtliche Folgen. 73% der Ärzte, denen ein fehlerhaftes Verhalten vorgeworfen worden war, waren der Meinung, dies geschehe zu Unrecht, 26% hielten den Vorwurf für berechtigt, der Rest hatte noch keine feste Meinung. Am häufigsten wurden niedergelassene Ärzte und Chefärzte (70%) verklagt.     

Identification of diabetes- and obesity-associated proteomic changes in human spermatozoa by difference gel electrophoresis

Difference gel electrophoresis (DIGE) of fluorescently labelled human sperm proteins was used to identify diabetes- and obesity-associated changes of the sperm proteome. Semen samples from type 1 diabetics, non-diabetic obese individuals and a reference group of clinically healthy fertile donors were evaluated in a comparative study. The adaptation of a general protein extraction procedure to the solubilization of proteins from isolated progressively motile human spermatozoa resulted in the detection of approximately 2700 fluorescent protein spots in the DIGE images. Comparison of the patients’ sperm proteomes with those of the reference group allowed the identification of 20 spots containing proteins that were present in the sperm lysates at significantly increased or decreased concentrations. In detail, eight of these spots were apparently related to type 1 diabetes while 12 spots were apparently related to obesity. Tryptic digestion of the spot proteins and mass spectrometric analysis of the corresponding peptides identified seven sperm proteins apparently associated with type 1 diabetes and nine sperm proteins apparently associated with obesity, three of which existing in multiple molecular forms. The established proteomic approach is expected to function as a non-invasive experimental tool in the diagnosis of male infertility and in monitoring any fertility-restoring therapy.     

Comparison of manual and automated size measurements of lung metastases on MDCT images: potential influence on therapeutic decisions

PURPOSE: The goal of this study was to evaluate the influence of automated measurement of diameter, area, and volume from chest CT scans on therapeutic decisions of lung nodules as compared to manual 2-D measurements. PATIENTS AND METHOD: The retrospective study involved 25 patients with 75 lung metastases. Contrast enhanced CT scans (16 row) of the lung were performed three times during chemotherapy with a mean time interval of 67.9 days between scans. In each patient, three metastases were evaluated (n=225). Automatic measurements were compared to manual assessment for the following parameters: diameter, area, and density. The influence on the therapeutic decisions was evaluated using the RECIST criteria. RESULTS: The maximum diameter measured by the automatic application was on an average 27% (S.D. 39; CI: 0.22-0.32; p<0.0001) higher than the maximum diameter with manual assessment, and the differences depended on metastases size. Based on diameter calculation, manual and automated assessment disagreed in up to 32% of therapeutic decisions. Volumetric assessment tended towards more changes in therapy as compared to diameter calculation. The calculation of mean transversal area of metastases was 36% (S.D. 0.305; CI: -0.40 to -0.32; p<0.0001) less with automated measurement. Therapeutic strategy would be changed in up to 25.7% of nodules using automated area calculation. Automated assessment of nodules' area and volume could influence the therapeutic decisions in up to 51.4% of all nodules. Density of the nodules was not validated to determine the influence on therapeutic decisions. CONCLUSION: There is a discrepancy between the manual and automated size measurement of lung metastases which could be significant.     

Assessment of pneumonia severity: multidetector-row CT in comparison to clinical score CRB-65

This study involved 92 patients with clinically diagnosed pneumonia. Differences in the frequency of typical pattern were calculated for patients with mild pneumonia and for patients with severe pneumonia (confusion, respiratory rate, blood pressure, 65 years of age and older). The frequency of singular morphologic changes did not differ significantly between the two groups. Empyema and pleural effusion, as well as an atelectasis in combination with patchy infiltrates and a positive bronchogram/multisegmental infiltrates, seem to have an influence on severity of pneumonia.