Bev?lkerungsbezogene Studie über die Anwendung adjuvanter Strahlentherapie bei Patientinnen mit Mammakarzinom

Ziel: Die Umsetzung von Behandlungsempfehlungen zur adjuvanten Strahlentherapie bei Patientinnen mit Mammakarzinom zu evaluieren. Patientinnen und Methoden: Die Studie basiert auf Daten einer bevölkerungsbezogenen Kohortenstudie. In der Studienregion Ostthüringen leben ca. eine Million Einwohner. In den Jahren 1995 bis 2000 wurden 2031 Fälle mit invasivem Mammakarzinom ohne primäre Fernmetastasierung (MO) und ohne inflammatorische Ausbreitung erfasst. Von diesen konnten 1700 Fälle mit vollständigen Angaben der Kovariaten in eine multivariate Analyse einbezogen werden. Der Einfluss von klinischen Faktoren und "Caseload" als Klassifizierung nach behandelten Fällen pro Jahr. Bzw. einzelnen Kliniken auf die Durchführung von adjuvanter Strahlentherapie des Brustdrüsenkörpers oder der Thoraxwand nach Mastektomie wurde in logistischen Regressionsmodellen ermittelt. Ergebnisse: Nach brusterhaltender Therapie (BET) wurden 90,6% der Patientinnen adjuvant behandelt. In der univariaten Analyse wurden bei älteren Patientinnen (S 70 Jahre) seltener eine Strahlenbehandlung durchgeführt. Dies war auch bei Patientinnen mit Begleiterkrankungen zu beobachten. Für die übrigen Kofaktoren wurden keine Assoziationen mit der Strahlentherapie beobachtet. Nach Mastektomie wurden 33,0% der Patientinnen adjuvant bestrahlt. Zunehmende Tumorgröße war eine Indikation für die ajuvante Strahlentherapie. Ebenso hatten der Befall von mehr als drei Lymphknoten, Multifokalität, hoher Malignitätsgrad und mediale Lokalisation Einfluss auf die Anwendung von Strahlentherapie. Hingegen konnte für die R-Klassifikation, den Hormonrezeptorstatus und Begleiterkrankungen kein Einfluss beobachtet werden. Zwischen den Kliniken waren hinsichtlich der Umsetzung von Therapieempfehlungen sowohl nach BET als auch Mastektomie Variationen zu beobachten. Schlussfolgerung: Nach BET wurde überwiegend die empfohlene Strahlentherapie durchgeführt, nur im höheren Alter und bei Begleiterkrankungen wurde seltener eine Strahlentherapie durchgeführt. Nach Mastektomie beeinflussten relevante Risikofaktoren die Therapieentscheidung zur Strahlentherape. Zwischen den Kliniken waren Variationen in der Therapieentscheidung zu beobachten. Aim: The assessment of the compliance with consensus recommendations for adjuvant radiation therapy among women with breast cancer. The study is based on data obtained in a population-based cohort-study, which was performed to evaluate the quality of health care for patients with breast cancer. Patients and Methods: About one million inhabitants live in the study region Eastern Thuringia, 2,031 cases with invasive breast cancer without distant metastasis (MO) or inflammatory spread were registered from 1995 to 2000. Out of these 1,700 with complete documentation of covariates were included in multivariate analysis. To examine the simultaneous influence of all clinical factors and "caseload" on the likelihood to receive adjuvant radiation therapy a logistic regression model was fitted for radiation therapy after mastectomy. In order to describe the impact of each individual clinic on treatment decision as "caseload" was replaced by the clinics with more than 30 primary treatments. Results: Following breast conserving therapy (BCT) 90.6% of the patients received adjuvant radiation therapy. In the univariate analysis older age was negatively associated with the use of radiation therapy among women with BCT (Table 1). Furthermore, comorbid conditions were negatively associated with the use of radiation therapy. For all other cofactors no associations were found. Subsequent to mastectomy 33.0% of the women underwent radiation therapy (Table 2). Associations between the use of radiation therapy and age, tumor category, number of positive lymph nodes, multiple tumors, histologic differentiation grade, residual tumor as well as hormone receptor status were found. In the multivariate analysis only older age (S 70 years) was identified as negative indicator for the utilization of radiation therapy. Among patients with mastectomy increasing tumor size was a positive predictor on radiation therapy (Table 3). In addition more than three positive lymph nodes, multiplicity, poor histologic differentiation grade (G3/4), medial localization, and younger age (35-49 years) were positive predictors for the application of radiation therapy. For R-classification, hormone receptor status and comorbidity no influence on the use of radiation therapy was observed. Among clinics adjusted for case-mix variations in the compliance of treatment recommendation both following BCT and mastectomy were found (Figure 1). Conclusion: Following BCT compliance with treatment recommendations regarding radiation therapy was high. Women in older age or with comorbidities received less often radiation therapy. Subsequent to mastectomy indicators for the use of radiation therapy were identified. Among clinics differences in the adherence to treatment recommendations were observed.     

Smith-Lemli-Opitz综合征的啮齿动物模型中的视网膜退行性病变 电生理、生物化学和形态学方面的特性

目的：评估Smith-Lemli—Opitz综合征（SLOS）动物模型的电生理、组织学和生物化学方面的特性。     

Nucleosomes in colorectal cancer patients during radiochemotherapy.

Apoptotic markers and tumor-associated antigens might be suitable to indicate the response to radiochemotherapy early. We analyzed the courses of nucleosomes, CEA, CA 19-9 and CYFRA 21-1 in 25 colorectal cancer patients during radiochemotherapy (4 postoperative, 13 preoperative, 8 local relapse therapy). Blood was taken before therapy, daily during the first week, once weekly during the following weeks, and at the end of the radiochemotherapy. After a temporary decline 6 h after the first irradiation, nucleosomes rose in most patients rapidly reaching a maximum during the first days which was followed by a subsequent decrease. In patients receiving postoperative therapy after complete resection of tumor, nucleosome levels generally were lower than in patients with preoperative or relapse therapy. Correspondingly, CEA, CA 19-9 and CYFRA 21-1 levels of postoperatively treated patients were the lowest whereas those with tumor relapse had the highest ones. During preoperative therapy, lower nucleosome concentrations were found in patients with response to therapy resulting in a smaller area under the curve of days 1-3 (AUC) than in those with progressive disease (p = 0.028). The other parameters did not indicate the response to therapy at the initial treatment phase. In conclusion, the course of nucleosomes (AUC) might be valuable for the early prediction of therapy response in preoperatively treated colorectal cancer patients.     

Magnetic resonance flow measurements in real time: comparison with a standard gradient-echo technique

Ultrafast gradient systems and hybrid imaging sequences offer the opportunity to acquire phase contrast flow data in real time. In a 1.5-Tesla magnetic resonance (MR)-tomograph, peak velocity and volume flow were assessed in 36 large vessels (aorta) and 33 medium-sized vessels (carotid and iliac artery) using a real-time (segmented k-space turbo gradient-echo planar imaging sequence) in comparison with a gradient-echo technique. With the real-time technique, the matrix was reduced from 116 to 64, and temporal resolution changed from 30 msec to 124 msec. Measurements of peak velocity correlated in large (r = 0.88) and medium-sized vessels (r = 0.81). Volume flow measurements correlated in large vessels (r = 0.87), however, a poor correlation (r = 0.64) was found in medium-sized vessels. Thus, scan time can be significantly reduced and images acquired without electrocardiogram (ECG)-triggering. Flow volume can only be determined in large vessels with sufficient accuracy, mainly due to reduced spatial resolution in smaller vessels.     

Accelerated coronary MRA by simultaneous acquisition of multiple 3D stacks

The implementation and first in vivo results of a novel coronary magnetic resonance angiography (MRA) protocol allowing simultaneous acquisition of multiple geometrically independent 3D imaging stacks are presented. Each imaging stack is acquired in a separate cardiac phase using an individual magnetization preparation and navigator-based gating and prospective motion correction. Each stack covers one of the main coronary vessels. Thus, an improvement of scan efficiency was achieved, which was used in this study to reduce total scan time at standard image quality. Experiments performed in healthy volunteers and in patients using a two-stack approach yielded a total scan time reduction of 50% with an image quality equivalent to standard single-stack coronary MRA.     

Laser in der Ohrchirurgie

Ohne Zusammenfassung     

Congenital myasthenic syndromes: II. Syndrome attributed to abnormal interaction of acetylcholine with its receptor

A 21-year-old woman had myasthenic symptoms since birth that responded poorly to anticholinesterase therapy. Tests for acetylcholine receptor (AChR) antibodies were negative. An intercostal muscle specimen was obtained to investigate the character of the neuromuscular transmission defect. There were no immune deposits at the endplates. The quantal content of the endplate potential was normal. Miniature endplate potentials and currents were very small, but the number of AChR per endplate was normal. On electron microscopy, the synaptic vesicles were of normal size, the junctional folds were intact, and the density and distribution of AChR on the folds was normal. The kinetic properties of AChR were studied by analysis of acetylcholine (ACh)-induced current noise. The mean single channel conductance was normal. The noise power spectrum was abnormal, containing two components of different time course. This could result from an abnormal interaction of ACh with AChR, or from two populations of AChR at the endplate. The second possibility is unlikely because if two populations of AChR were present at the endplate, then both would have to have low conductance to explain the small miniature endplate current, but the average conductance of the channels that did open was normal. © 1993 John Wiley & Sons, Inc.