Simultane Radiochemotherapie mit intraluminaler HDR-Brachytherapie des Ösophaguskarzinoms

PURPOSE: To study efficacy and toxicity of radiochemotherapy in esophageal cancer including initial endoluminal high-dose-rate brachytherapy (HDR-BT). PATIENTS AND METHODS: Between 01/1995 and 06/2005, 61 patients with esophageal cancer were treated preoperatively with definitive and palliative intent. Treatment started with intraluminal HDR-BT for recanalization of the esophagus (single fraction size of 8 Gy in 0.5 cm depth, three times, q7d) followed by external-beam radiation therapy (50 Gy total dose, 5 x 2 Gy/week, 25 fractions in 5 weeks). Chemotherapy was started simultaneously with external irradiation (three courses of cisplatin and 5-fluorouracil, q21d). RESULTS: Swallowing function improved in 55/61 patients (dysphagia classification according to the RTOG), and worsened in 6/61 patients, respectively. Median duration of symptomatic improvement was 11 months, median follow-up 12 months (range 3-68 months). Following simultaneous radiochemotherapy, tumor resectability was achieved in 7/25 patients of the neoadjuvant group, and the histological specimen showed complete remission in 6/7 patients. CONCLUSION: These results indicate a favorable effect of simultaneous radiochemotherapy starting with endoluminal HDR-afterloading-( AL-)BT in esophageal cancer.     

Time dependent loss of tissue GABA content and immunoreactivity in hippocampal slices

Immunohistochemical detection of GABA was used to evaluate changes of the GABA innervation in hippocampal slices maintained in vitro. In parallel experiments the amount of GABA, glutamate and aspartate was measured with high performance liquid chromatography. The results showed that while glutamate and aspartate levels remained fairly constant, GABAergic neurons suffered remarkable alterations. During 8 hours' incubation the GABA content of the tissue and the number of GABA containing neuronal cell bodies decreased by 79.7% and 84.6%, respectively. The qualitative features of the immunoreactivity of the neuropil did not change. In conclusion, while in hippocampal slices tissue glutamate and aspartate levels are only slightly affected by the in vitro maintenance, more than half of the tissue GABA content is lost during prolonged in vitro incubation. As a consequence of the GABA loss, the ratio of endogenous inhibitory and excitatory amino acid transmitters has been altered, which could influence the viability of adult hippocampal tissue in vitro conditions.     

Effect of testosterone and anabolic steroids on the size of sebaceous glands in power athletes

The effect of testosterone and anabolic steroids on the size of sebaceous glands was studied by means of interactive morphometry in skin biopsies of power athletes. The subjects used self-administered high doses of testosterone and anabolic steroids during a 4-week strength training period. After 4 weeks' use of hormones, the area of sectioned sebaceous glands enlarged significantly by a factor of 89.2% (p less than 0.005). The number of cells in the so-called differentiating cell pool (DCP) and in the undifferentiated cell pool (UCP) also increased significantly (p less than 0.025, p less than 0.05, respectively). The size of the area occupied by UCP cells increased significantly (p less than 0.05). The study suggests that high doses of testosterone and anabolic steroids lead to an enlargement of sebaceous glands in male power athletes.     

Gallstones and previous cholecystectomy in 77- to 78-year-old women in an urban population in Sweden

A randomly selected sample of 120 women, born in 1906-1907 and living in the city of Gothenburg, were invited to an ultrasound examination for gallstone disease. One hundred and nine subjects participated in the study, and among these, 24% gave a history of a previous cholecystectomy, 27% had gallstones, and 49% had no stones in the gallbladder. Among the women with stones in the gallbladder only 35% had associated symptoms. The design of the study enabled a comparison among women with no stones in the gallbladder, with gallstones, and with a previous cholecystectomy. Women with gallstones, previous or present, had a higher body weight, body mass index, skinfold thickness, and serum triglyceride level than subjects without gallstones.     

Analgesic nephropathy in Hungary: the HANS study.

BACKGROUND: The diagnosis of analgesic nephropathy has improved significantly with modern imaging techniques. We reviewed a large portion of the Hungarian dialysis population to obtain additional insight into the problem. METHODS: Twenty-two participating dialysis units enrolled 1400 patients on renal replacement therapy between 1 January 1995 and 1 January 1998. Patients with no known aetiology (n = 284) were interviewed and studied with renal imaging. We assessed the presence of decreased renal mass combined with either bumpy contours, papillary calcification, or both. The subjects studied were interrogated extensively. RESULTS: Our survey suggested analgesic nephropathy in 47 of 1400 patients (3.3%), 3-fold higher than the EDTA database estimate for Hungary. The analgesics most commonly abused were phenacetin-containing mixtures. The driving symptoms were mainly headache and joint pain. Cardiovascular complications were more common than in the rest of the dialysis population, independent of smoking and lipid values (P<0.01). CONCLUSIONS: Phenacetin should be banned. Our study results support the need for longitudinal cohort and case-control studies in Hungary.     

Primary Radiotherapy of Stage IIA/B–IIIB Cervical Carcinoma

BACKGROUND: Comprehensive literature on cervical cancer demonstrates, even today, the need for optimization of the timing of external-beam radiotherapy (EBRT) and high-dose-rate brachytherapy (HDR-BT) in the treatment of stage IIA/B-IIIB cervical carcinoma. PATIENTS AND METHODS: 210 patients with carcinoma of the cervix were treated in the Municipal Center of Oncoradiology between January 1991 and December 1996 (FIGO IIA: n = 10, FIGO IIB: n = 113, and FIGO IIIB: n = 87). Two regimens were compared: sequential radiation therapy (SRT) with 4 x 8 Gy HDR-BT to point A followed by EBRT, and continuous radiation therapy (CRT) in which 5 x 6 Gy HDR-BT to point A, one session per week, was integrated into the EBRT. A total dose of 68-70 Gy to point A and 52-54 Gy to point B was given in EBRT with SRT, five fractions per week were applied. Four fractions per week were applied in CRT, i. e., no EBRT was performed on the day of HDR-BT. Total doses to points A and B were identical in both regimens. Overall treatment time (OTT) amounted to 56 days for SRT and 35 days for CRT. Median follow-up time was 3.4 (2.5-4.2) years. RESULTS: Progression-free 5-year-survival (PFS) was 71% in the CRT and 56% in the SRT group. Nevertheless, this difference was not statistically significant (p = 1.00), and the same was found in a subgroup analysis of the different tumor stages, showing, however, an unequivocal trend. Late bladder and rectal injuries occurred in 13% and 25%, respectively. Late rectal injuries were significantly more frequent with SRT than CRT (35 patients in the SRT and 18 patients in the CRT group; p = 0.037). This was due to the higher doses per fraction of HDR-BT in the SRT group. No difference was found regarding late bladder injuries (p = 0.837). CONCLUSION: For the patients included in this study, no advantage has been found so far in using CRT, i. e., shortening the OTT by weekly integration of HDR-BT into EBRT. Nevertheless, an obvious trend exists. The dose of 8 Gy per fraction of HDR-BT in the SRT regimen was obviously too high. To achieve a significant improvement in local control and disease-free survival (DFS) as well as overall survival (OS), the combination with modern chemotherapy regimens and regional deep hyperthermia may rather be the treatment option.     

Treatment of airway inflammation in cystic fibrosis]

Cystic fibrosis airway inflammation is characterized by neutrophilic efflux and high levels of proinflammatory cytokines such as IL-8 and IL-6. Inhaled corticosteroids are widely used despite lack of evidence of efficacity. Despite evidence of efficacity of ibuprofen, many clinicians have chosen not to use this therapy because of concerns regarding potential side effects. Azithromycin has antiinflammatory properties and is effective in cystic fibrosis (CF) patients. Deoxyribonuclease (rhDNase) has been shown to improve lung function in patients with cystic fibrosis and may also have a positive effect on inflammation. Other antiinflammatory drugs are in the process of validation.     

Successful surgical correction of persistent truncus arteriosus by an aortic homograft]

After palliative procedure a 2 years old girl with congenital heart disease was corrected with aortic homograft. Truncus arteriosus is a rare congenital heart disease and this is the first successfully corrected case in our country. Using homograft in this age group improves the early and late result of this type of corrective surgery.