Ungewöhnliche Strahlenreaktion nach Röntgenweichstrahltherapie bei einer Patientin mit Pemphigus vulgaris

Zusammenfassung Bei einer 71j?hrigen Frau trat nach R?ntgenweichstrahltherapie an der Nase (Gesamtdosis 28 Gy, Gewebehalbwerttiefe 10,5–11,5 mm) eine ausgepr?gte Strahlenerosion auf. Diese zeigte 5 Wochen nach Ende der Bestrahlung noch keine Tendenz zur Abheilung. Ursache dieses ungew?hnlichen Verlaufes war ein gleichzeitig bestehender Pemphigus vulgaris. Dieser hatte sich nach der Strahlentherapie, vermutlich als Folge einer Freisetzung epidermaler Antigene, verschlimmert. Da? der Pemphigus in diesem Fall durch die Bestrahlung ausgel?st wurde – wie mehrfach in der Literatur berichtet – ist unwahrscheinlich, aber nicht sicher auszuschlie?en. Eingegangen am 11. April 1994 Angenommen am 10. Juni 1994     

Metabolic effects of i.v. propacetamol, metamizol or external cooling in critically ill febrile sedated patients

We have measured the metabolic response to sequential administration of propacetamol, metamizol and/or external cooling in 20 febrile patients under sedation and analgesia and during mechanical ventilation. There was no change in temperature (T degree) after propacetamol therapy, whereas after metamizol only a small decrease was noted (from 38.9 (SEM 0.2) to 38.5 (0.3) degrees C; P = 0.02). External cooling produced a significant decrease in T degree (39.1 (0.2) to 37.1 (0.2) degrees C; P < 0.0001) accompanied by a decrease in energy expenditure (EE) (2034 (73) to 1791 (88) kcal day-1; P < 0.004). Heart rate and minute ventilation decreased significantly in parallel. There were no other changes in haemodynamics or pulmonary gas exchanges. We conclude that propacetamol and metamizol did not produce a clinically significant decrease in T degree in febrile ICU patients whereas external cooling decreased both T degree and EE. The parallel decrease in body temperature and EE seemed to be related to opioid administration or sedation, or both.      

Thermally crosslinked rigid-rod aramids, 2. Fiber spinning and fiber properties

Fibers of three rigid-rod aromatic copolymers, produced by polycondensation of 2,2,6,6-tetraoxo-1,3,5,7-tetrahydro-2,6-dithia-s-indacene-4,8-diamine (DSDA), p-phenylenediamine and terephthaloyl dichloride, were spun from nematic solutions and characterized by wideangle X-ray-diffraction (WAXD) measurements and mechanical tests. A post-spin heat treatment was employed to improve the low degrees of orientation and crystallinity exhibited generally by the untreated fibers. The dominating crystal structures of the copolymers are similar to “modification I” of the well known fibers from poly(p-phenyleneterephthalamide) (PPTA). Thermally induced crosslinking of the fibers in the solid state was performed simultaneously with post-spin treatment. The influence of the annealing conditions on the mechanical fiber properties and the molecular order in the fibers was also investigated. All mechanical parameters were time-dependent, probably due to the generation of stable radicals during heat treatment. The radicals may give rise to chain scission.     

Organization of intensive care units in Europe: lessons from the EPIC study

Objective: To study differences related to intensive care unit (ICU) structure and patient demography between the various countries of Western Europe. Design: Application of data collected by the European Prevalence of Infection in Intensive Care (EPIC) study, a one-day prevalence study. Setting: Voluntary participation of all Western European ICUs. A total of 1417 ICUs responded. Patients: All patients, older than 10 years of age, occupying a bed in the participating ICUs over a 24-h period. 10 038 patient case reports were submitted. Results: The study revealed important differences. In particular, there seems to be a north/south divide with fewer ICU beds and more severely ill patients in the south. The United Kingdom seemed more similar to southern European countries than to the north. Conclusion: While there are similarities between European countries, large differences still remain and are important to identify to enable us to work together to create a more uniform system of intensive care, which will in turn give more effective and efficient patient care. Received: 7 February 1997 Accepted 8 July 1997     

Late side-effects with cosmetic relevance following soft X-ray therapy of cutaneous neoplasias

Background Cosmetic changes are to be expected after radiotherapy for skin tumours. Objectives This study aimed to answer the questions: How frequent are cosmetic changes after soft X‐ray therapy? Do treatment parameters, tumour thickness, localization and size of the irradiated field have a major influence? Were patients irritated by the visual appearance of the irradiated field? Methods In total, 2474 examinations of 1149 irradiated fields were performed. Results Hypopigmentation was found in 64.7% of examinations more than 90 days after therapy, teleangiectases in 43.1%, erythema in 24.8%, and hyperpigmentation in 16.8%. The frequency of hypopigmentation, teleangiectases and hyperpigmentation increased with time from X‐ray exposure; more than 4 years after therapy hypopigmentation was diagnosed in 91.8% and teleangiectases in 82.2% of examinations. Total dose, the time–dose–fractionation factor (TDF), field size and dose per fraction were significantly related to the frequency of cosmetic changes. Incidence rates of cosmetic changes differed by less than 15% if different treatment conditions were compared: thicker vs. thinner tumours, larger vs. smaller fields, higher vs. lower total doses, doses per fraction, and TDF. Frequencies of hypopigmentation, teleangiectases, erythema and hyperpigmentation differed by more than 15% between some localizations on the head. Women reported irritation by the visual appearance of the irradiated field in 12.6% of 1116 interviews, and men in 4.4% of 1284 interviews. Conclusions Cosmetic changes after soft X‐ray therapy are relatively frequent. Treatment parameters, tumour thickness and field size have only a minor influence. Few patients, but more women than men, were irritated by the visual appearance of the irradiated field.     

Percutaneous interstitial chemotherapy of a small hepatocellular carcinoma under ultrasound guidance

A small (less than 3 cm) inoperable hepatocellular carcinoma was treated with percutaneous interstitial chemotherapy (PIC). 5-Fluorouracil was injected by a fine needle under ultrasound guidance. After 3 months a fine needle biopsy (FNB) yielded fibronecrotic material. After 18 months another FNB yielded steatosis and dysplastic cells and the lesion showed no increase in size. PIC could be an interesting alternative treatment for small tumors unresponsive to conventional therapies.