Liver transplantation in malignant disease

Liver transplantation for malignant disease has gained increasing attention as part of transplant oncology. Following the implementation of the Milan criteria, hepatocellular carcinoma (HCC) was the first generally accepted indication for transplantation in patients with cancer. Subsequently, more liberal criteria for HCC have been developed, and research on this topic is still ongoing. The evident success of liver transplantation for HCC has led to the attempt to extend its indication to other malignancies. Regarding perihilar cholangiocarcinoma, more and more evidence supports the use of liver transplantation, especially after neoadjuvant therapy. In addition, some data also show a benefit for selected patients with very early stage intrahepatic cholangiocarcinoma. Hepatic epithelioid hemangioendothelioma is a very rare but nonetheless established indication for liver transplantation in primary liver cancer. In contrast, patients with hepatic angiosarcoma are currently not considered to be optimal candidates. In secondary liver tumors, neuroendocrine cancer liver metastases are an accepted but comparability rare indication for liver transplantation. Recently, some evidence has been published supporting the use of liver transplantation even for colorectal liver metastases. This review summarizes the current evidence for liver transplantation for primary and secondary liver cancer.     

Diagnosis and therapy of eating disorders

Even though there is no convincing evidence that eating disorders in general are on the rise, there has been an enormous increase in "treated" cases of patients with eating disorders. This review will cover important aspects of diagnosis and treatment of eating disorders. Psychotherapeutical and pharmacological treatment strategies in anorexia and bulimia nervosa will be discussed. For both eating disorders, psychotherapy is the treatment of choice. Drugs with a serotonergic function, e.g. serotonin-reuptake-inhibitors (SSRI), have demonstrated significant results in the treatment of bulimia nervosa and eating disorders with comorbid depression. In clinical practice "treatment packages" are offered because of the complexity of the disorders. The paper also deals with medical complications of eating disorders, motivational interviewing in anorexia nervosa and treatment with self-help manuals in bulimia nervosa.     

Detection of the sentinel node in breast carcinoma using method of a single subcutaneous injection of radiopharmaceutical

The objective of this work is retrospective evaluation of results of the intraoperative detection of sentinel node in breast carcinoma after a single subcutaneous injection of radiopharmaceutical (RF) within a two-day protocol. From May/2001 to June/2002, lymphoscintigraphy of the sentinel node (SN) and its subsequent radioguided intraoperative detection (RGS) was performed in 43 women having stage T1-T2, N0 breast carcinoma. The static scans in the anterior and relevant lateral projections were performed using a gamma camera at approximately 30-minute intervals after the subcutaneous administration of 15 MBq 99mTc Senti-Scint, until the SN was displayed. The localization of the SN was marked on the overlying skin with a water-resistant permanent marker in 1-2 projections. RGS was accessed within 18-24 hours after the injection of the RF and all patients underwent an axillary dissection. The SN was detected in all patients, and in all cases was localized in the ipsilateral axilla. In 26 patients (60%), no metastatic process was found either in the SN or in any other axillary node. However, in one node, deposits of the carcinoma were detected in surrounding fatty tissue with propagation along the vessels and nerve. In 16 patients (37%), metastases in the SN were proved, in 7 cases (16%), a metastatic process was proved at the same time even in further lymph nodes. A number of false negative findings (5.8%) is consistent with the literature data. The method fails in the detection of intramammary localized SNs.     

Erfahrungen mit der Ambrusschen Liquor-Kolloidreaktion

Ohne Zusammenfassung     

Treatment of Oral Cavity and Oropharyngeal Cancer

Excellent local control rates of interstitial brachytherapy in oral cavity cancer and oropharyngeal carcinoma have been demonstrated in different retrospective studies. Compared to external-beam radiation therapy the high local control rates with a low rate of side effects obtained by interstitial brachytherapy are the result of a steep dose reduction in the implant-surrounding normal tissues. Therefore, interstitial brachytherapy offers rather the possibility to give high doses without inevitably leading to high complication rates. Low-dose-rate (LDR) and pulsed-dose-rate (PDR) interstitial brachytherapy with 0.4-0.55 Gy/h/24 h for tumors of the oral cavity and oropharynx in selected patients is a proven, effective and safe treatment method with excellent long-term data both as a sole treatment modality and a postoperative method, as well as a unique treatment method of head and neck tumors in previously irradiated areas. This paper deals with the technical aspects of interstitial brachytherapy, that seem to be relevant to high-quality outcome, and gives an overview of indications as well as past and recent results of interstitial brachytherapy in head and neck cancer.     

Teilbrustbestrahlung nach brusterhaltender Operation bei Brustkrebs

Ohne ZusammenfassungStellungnahme der Deutschen Gesellschaft für Radioonkologie, der Deutschen Gesellschaft für Senologie (D. Wallwiener und M. Bamberg, Tübingen) und der Arbeitsgemeinschaft Gynäkologische Onkologie der Deutschen Krebsgesellschaft (M.W. Beckmann, Erlangen, M. Kaufmann, Frankfurt/M., und G. von Minckwitz, Neu–Isenburg)     

Linking information systems in the health service

Various information systems have existed in the hygiene service for a number of years and the outputs of these systems are partially used. By interconnection (comprehensive evaluation) of these systems objective information on the relationship of various factors could be obtained. For the epidemic season 1985/86 (September-April) the outputs of information systems "Reports on acute respiratory diseases" (ARD), "Contamination of the atmosphere in the CSR", "Meteofond" were analyzed in a comprehensive way. The incidence of acute respiratory diseases, the sulphur dioxide concentration, the concentration of dust and nitrogen oxides in the air, the temperature and the moisture of the atmosphere were evaluated. The incidence of acute respiratory diseases, which markedly depends on the season, is recorded most accurately in the age group of 0-5 years. The most marked excesses of the incidence are associated as a rule with the circulation of the influenza virus in the population. The sulphur dioxide concentration is also dependent on the season, similarly as the concentration of dust and the temperature and moisture of the air assessed at 2 p.m. There are some identical features between the level of the incidence of acute respiratory diseases, the atmospheric concentration of the mentioned substances and values of the mentioned climatic factors in the course of the epidemic season of acute respiratory diseases. Causal relationships between the incidence of acute respiratory diseases and all mentioned factors must be, however, evaluated with great care.     

Reoxygenation of tumors of the uterine cervix during combined radiotherapy using low dose gamma-neutron irradiation with californium-252

A polarographic method was used to follow the changes in oxygenation of a tumour of uterus cervix after intracavital irradiation by 252Cf by a physical dose of 2 Gy, applied at the beginning of a therapeutic cycle of combined radiotherapy. The results reached are compared with the results of tumour oxygenation in the course of a conventional therapeutic procedure. It has become apparent that even after the irradiation of a tumour of uterus cervix by a small dose of gamma-neutron radiation with 252Cf there is, beginning with 2nd week of therapy, a significant reoxygenation of the tumour population. The changes of oxygenation after a conventional irradiation have been less marked and reached, in the 4th week of therapy, only marginally significant increase. Differences in reoxygenation of tumours of uterus cervix were confirmed by analysis of the oxygen test. The importance of tumour reoxygenation after the application of 252Cf source of radiation for facilitation of its regression in a combined treatment with Californium-252 and gamma irradiation is discussed.