TEL-AML1 positivity in relapsed B cell precursor acute lymphoblastic leukemia in childhood. Berlin-Frankfurt-Münster Study Group.
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Burkitt Lymphoma↗
Biomedical subjects
G Schmitt
Publications and source records attributed to G Schmitt.
Thymoma: prognostic factors and treatment outcomes.
BACKGROUND: The objective of this study was to establish prognostic factors for thymoma and determine the impact of surgery with or without postoperative radiotherapy. METHODS: Seventy patients treated at the University Hospital Düsseldorf during the period 1954-1991 were retrospectively studied. All thymoma patients underwent surgery, 22 received postoperative radiotherapy, and 3 also received chemotherapy. According to thymoma staging as described previously by Masaoka et al., 21% were Stage I, 26% Stage II, 43% Stage III, 7% Stage IVA, and 3% Stage IVB. Lymphocytic type disease was found in 36% of patients, lymphoepithelial type in 33%, epithelial type in 23%, and spindle cell type in 9%. The relevance of Karnofsky performance status (KPS), gender, age, myasthenia gravis, histology, tumor size, and stage to survival was determined by univariate analysis, and their independent significance was tested by multivariate analysis. Survival rates were calculated using the Kaplan-Meier method and the log rank test. RESULTS: In univariate analysis, KPS (P < 0.001), histologic type (P=0.0093), and stage (P=0.0001) proved to be significant predictors of overall survival. Spindle cell type was associated with the best and epithelial type the worst prognosis; patients with the latter type had a 5-year survival rate of 30%. Multivariate analysis revealed that stage, histology, and KPS were predictive of overall survival. In Stages III and IV, relapses were reduced by postoperative radiotherapy from 50% to 20%. The site of relapse was outside the irradiated area in 80% of patients. Disease free survival (P=0.36) and median survival (P=0.72) of patients with completely resected advanced thymomas did not differ from that for patients with incompletely resected tumors who received radiotherapy. CONCLUSIONS: Postoperative radiotherapy can improve local control in patients with advanced thymoma. Survival after incomplete resection is not compromised when postoperative radiotherapy is employed. KPS should be considered an important prognostic factor in future studies.
Adolescent↗
Chondrosarcoma of the larynx: the role of radiotherapy revisited--a case report and review of the literature.
BACKGROUND: Experience in the treatment of laryngeal chondrosarcoma is based on about 250 cases reported to date. The standard therapy is conservative surgery. Radiotherapy has universally been regarded as ineffective in the treatment of this disease. METHODS: A patient with a laryngeal chondrosarcoma was observed for 11 years after radical radiotherapy. The literature on laryngeal chondrosarcoma was critically reviewed, with emphasis placed on radiotherapy. RESULTS: The review of the literature revealed that experience with radiotherapy of laryngeal chondrosarcoma has been lacking, with fewer than 10 cases with short follow-up documented up to now. Meanwhile, increasing evidence of the efficacy of radiotherapy in the treatment of skeletal chondrosarcoma has emerged. The authors report the first case of chondrosarcoma of the larynx in which radical radiotherapy resulted in a long term remission of more than 10 years. CONCLUSIONS: Radiotherapy should be considered when radical surgery is not feasible without severe mutilation. It should also be considered for the treatment of residual disease. Laryngectomy should be restricted to salvage treatment when radiotherapy fails. In this study, radiotherapy appeared to be an effective modality in the treatment of low grade laryngeal chondrosarcoma, and these results contrast with the current widespread disapproval of this treatment.
Aged↗
Clinical in vivo dosimetry using optical fibers.
Discoloring of glass due to ionizing radiation depends on the absorbed dose. The radiation-induced light attenuation in optical fibers may be used as a measure of the dose. In high-energy photon beams (6 MV X rays), a lead-doped silica fiber can be calibrated. A dosimeter based on an optical fiber was developed for applications in radiation therapy. The diameter of the mounted fiber is 0.25 mm, whereas the length depends on the sensitivity required. To demonstrate the applicability, a customized fiber device was used to determine scattered radiation close to the lens of the eye. Measurements were compared with TLDs (LiF) in an anthropomorphic phantom. The comparison with TLD measurements shows good agreement. In contrast to TLD, optical fibers provide immediate dose values, and the readout procedure is much easier. Owing to its small size and diameter, interesting invasive dose measurements are feasible.
Fiber Optic Technology↗
[Comment. Hyperbaric oxygenation (HBO) in the treatment of radiogenic side effects. Clinical experiences are decisive!].
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Angiogenesis Inducing Agents↗
Treatment of radiation proctitis with hyperbaric oxygen: what is the optimal number of HBO treatments?
AIM: Our objective was to investigate the effectiveness of hyperbaric oxygenation (HBO) in the treatment of radiation proctitis. The current literature was reviewed with regard to the necessary number of HBO treatments. PATIENTS AND METHODS: Two patients with proctitis after pelvic irradiation were treated with 40 and 38 HBO treatments, respectively. Hyperbaric oxygenation was delivered at 240 kPa over 90 min. RESULTS: In one patient, proctosigmoidoscopy showed a significant improvement after 40 HBO sessions. The other patient interrupted therapy after 38 HBO treatments without subjective change. The reported number of HBO sessions for a successful treatment of radiation proctitis ranges from 12 to 90. CONCLUSION: HBO should be considered before more invasive treatment modalities are performed for radiation proctitis.
Aged↗
Combined therapy of medulloblastoma: review of 46 patients treated in a single institution.
Medulloblastoma is the most frequent malignant brain tumor in pediatric patients. Early treatment strategies, combining surgery and radiotherapy alone, resulted in survival rates of about 40% only. In the last 15 years, chemotherapy was used more frequently in combination with surgery and radiotherapy. The rationale was to increase the survival rate and to decrease radiation toxicity in young children. Forty-six patients younger than 16 years were treated between July 1977 and September 1995 in our institution (32 boys and 14 girls). Thirty-nine patients could be evaluated according to their postoperative treatment with regard to different protocols such as SIOP 1, SIOP 2, HDMTX/VCR, HIT protocol 89/91 and Carbo-PEI (one patient). In total, 21/39 patients are alive without evidence of disease (EFS 55 +/- 7%) with a follow-up of 26 to 210 months. Four children are lost to follow-up. Twelve patients died after relapse, 1 child died of MTX-induced brain atrophy, 1 patient developed a secondary malignancy (acute lymphoblastic leukemia) and died. The best results were seen in patients treated according to the HIT 89/91 protocol as first-line treatment (CR 9/10). The improvement in outcome of our patients with medulloblastoma in recent years suggests the benefit of intensified chemotherapy on survival. In addition, refinement in surgical and radiological treatment have certainly also contributed to the better results.
Adolescent↗
Advantages of a new Taq DNA polymerase in multiplex PCR and time-release PCR.
Extensive diagnostic and scientific investigations are often restricted by limited availability of material. Therefore, methods like multiplex PCR strategies are needed to conserve as much sample as possible. Unfortunately, the establishment of such procedures poses several difficulties. Here we describe the advantages of a new enzyme, AmpliTaq Gold DNA Polymerase, in multiplex and time-release PCR. The application of this thermostable recombinant Taq DNA polymerase allows the specific amplification of DNA/cDNA targets with very high sensitivity. With our protocol, the specific amplification of 13 different cDNAs of cytokines and cytokine receptors can be realized in three multiplex PCRs (IL-2R alpha, IL-2/15R beta, gamma c-chain, IL-4 and IL-4R alpha; IL-10, IL-15 and IL-15R alpha; and IL-2, IFN gamma, IL-7, IL-7R alpha and IL-9R alpha). The novel application of AmpliTaq Gold DNA Polymerase in a time-release PCR protocol allows specific amplification of target DNA/cDNA when only limited amounts of material are available or only low-copy-number DNA/cDNA is suspected. No IL-9 cDNA can be detected in peripheral blood mononuclear cells (PBMC) in the absence of any stimulation, thus it was difficult to amplify this target with routine PCR protocols. Here we demonstrate the reliable and reproducible amplification of IL-9 cDNA in the Hodgkin's lymphoma cell line KM-H2, in PBMC and in stimulated PBMC. Results with AmpliTaq Gold DNA Polymerase were more sensitive and specific compared with AmpliTaq DNA Polymerase, with and without manual hot-start procedure.
DNA, Complementary↗
Uptake of ethylenediamine tetramethylene phosphonic acid in normal bone after multiple applications. A non-human primate study.
Palliation of bone pain in patients with bone metastases has previously been evaluated using 153Sm (samarium) complexed to bone seeking ethylenediamine tetramethylene phosphonic acid (CAS 1429-50-1, EDTMP). Repeated application of the radioligand as needed was found progressively less effective. This study questions whether EDTMP exerts a blocking function, limiting access to bone or osseous tumours with successive administration. The pharmacokinetics and biodistribution of 153Sm-EDTMP in the normal experimental baboon (n = 6) during three successive applications (6 weekly) each with two different concentrations of EDTMP (0.7 and 1.4 mg/kg b.wt.) were investigated using bone scintigraphy. 153Sm-EDTMP (111 MBq) was injected in each case and monitored for 5 h. Curves of tracer kinetics and bone to background uptake were obtained, also blood and cumulative urine curves. Comparisons were statistically assessed in each group between successive applications and between EDTMP concentrations. Partial blocking with the low EDTMP concentration reached statistical significance after the third application. The first application of the high EDTMP concentration yielded lower uptake in the bone than did low EDTMP pointing to blocking by the high concentration, but not seen with repeated applications. Continual application of high concentration EDTMP could lead to a reduced level of calcium in serum and increased parathyroid hormone levels which might trigger osteoblastic activity and bone remodelling. This would partially affect the blocking which was thus more obvious at the low EDTMP concentration.
Animals↗
[Large cervical hematoma of parathyroid origin].
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Female↗
[Repeated thyroid surgery. Indications and results].
OBJECTIVES: To analyze the histology results and to assess operative risk of iterative operations for thyroid surgery. PATIENTS AND METHODS: A total of 249 re-operations were performed in 248 patients over a 6.5 year period. Two groups of patients were defined according to the indications for re-operation. Group 1: 80 patients; pathology examination of the surgical specimen discovered thyroid cancer. Group 2: 169 patients; recurrent nodular goitre after an initially benign disease. RESULTS: In group 1, 14 cancers were bilateral (17.5%) and 7 patients had cervical node metastases (8.8%). In group 2, 19 cancers were discovered (11.1%), including 5 cases with cervical node invasion (26.3%) and 4 with visceral metastases (21.1%). Twenty complications occurred in 20 patients (8%): compressive cervical hematomas (n = 3, 1.2%), recurrent nerve palsy (n = 7, 2.8%), hypoparathyroidism (n = 9, 3.6%; including 3 definitive cases, 1.2%) and mediastinitis (n = 1). These complications were significantly more frequent in patients re-operated for hyperthyroidism or those who had a past history of more than one cervicotomy. CONCLUSION: The frequency of bilateral cancer justifies completing thyroidectomy after partial thyroidectomy. The rate of definitive complications after re-operations is greater than first line cervicotomy but is low enough to allow iterative surgery using rigorous procedure in selected patients.
Goiter, Nodular↗
[Preoperative irradiation and interstitial radiotherapy-hyperthermia boost in breast tumors > or = 3 cm. The Düsseldorf experience].
AIM: The aim of this protocol was to investigate breast conservation rates with and without flap-supported surgery after preoperative chemotherapy, radiotherapy and hyperthermia. PATIENTS AND METHODS: One hundred and fifty-eight patients with stage IIA-IV breast cancers were initially treated with chemotherapy, radiotherapy and hyperthermia. Radiation treatment consisted of an interstitial boost of 10 Gy 192Ir-afterloading therapy and a course of external beam radiotherapy of 50 Gy, using 5 x 2 Gy/week. Local hyperthermia with 43.5-44.5 degrees C over 60 minutes was delivered immediately before interstitial radiotherapy. RESULTS: One hundred and forty-two patients underwent salvage surgery. A breast-conserving approach was possible in 74 patients (52%). Fifty-three patients (37%) underwent flap-supported surgery. After a median follow-up of 20 months, one patient developed isolated local recurrence. In 14 cases, locoregional recurrences occurred in combination with distant metastases. CONCLUSION: In about 50%, breast conservation was achieved by chemotherapy, radiotherapy and hyperthermia. The low isolated local recurrence rate of 0.6% (1/158) has to be substantiated by further follow-up.
Adult↗
Absorption of tretinoin in rats and rabbits following oral and dermal application.
To assess the teratogenic potential of Airol cream (0.05% tretinoin, CAS 302-79-4), plasma concentrations were compared after repeated dermal applications of the maximum dose which could be applied reliably and after oral administration of the highest non-teratogenic dose. The test preparation was applied dermally in two equal portions to rats and rabbits at 2 g/animal/d (equivalent to a tretinoin dose of 3.7 mg/kg/d) and at 6 g/kg/d (equivalent to 3 mg tretinoin/kg/d), respectively. After a single oral administration of 2 mg/kg, Cmax and AUC for tretinoin in rat plasma were 285 +/- 14.6 ng/ml and 595 +/- 123 ng h/ml, respectively. Corresponding values for the rabbit were 78.4 +/- 16.9 ng/ml and 126 +/- 25.4 ng h/ml. In both species, plasma concentrations of tretinoin after dermal application were consistently below the assay quantification limit (< 5 ng/ml and < 2 ng/ml for rat and rabbit, respectively), despite marked irritation of the skin. Thus repeated topical application of the test preparation produced plasma concentration of tretinoin which were well below the plasma concentrations produced by a non-teratogenic oral dose of 2 mg/kg in the rat and rabbit.
Administration, Oral↗
Ethyl glucuronide concentration in serum of human volunteers, teetotalers, and suspected drinking drivers.
The kinetic profile of ethanol and ethyl glucuronide (EtG) in serum was investigated in three subject groups: 1) Healthy, moderately drinking volunteers (daily intake less than 30 g ethanol) who ingested a single dose of ethanol. In this group the maximum of serum ethyl glucuronide concentration (SEtGC) and of serum ethanol concentration (SEC) did not exceed 3.7 mg/L and 1.5 g/L respectively. EtG peaked 2 to 3.5 h later than ethanol. EtG was eliminated with a terminal half-life of 2 to 3 h. EtG decreased slower than ethanol--the metabolite could still be determined in serum up to 8 h after complete ethanol elimination. 2) In serum samples of teetotalers neither ethanol nor EtG could be found. 3) In 37 of 50 serum samples of drivers suspected of driving under the influence of ethanol, SEtGC was found between the limit of detection (0.1 mg/L) and 20 mg/L. If the SEC is less than 1 g/L and the SEtGC is significantly higher than 5 mg/L, we assume alcohol misuse.
Adult↗
Emphysematous cystitis and pyelitis in a diabetic renal transplant recipient.
Emphysematous cystitis is a rare complication of urinary tract infection. Patients with diabetes mellitus, neurogenic bladder, bladder outlet obstruction, and recurrent urinary tract infection are at increased risk for the disease. We present a case of emphysematous cystitis and pyelitis in a diabetic renal transplant recipient. He was treated with antibiotics alone with complete clinical and radiologic resolution. The clinical course was benign, as described in most patients. The prognosis of emphysematous cystitis is good after early diagnosis and prompt treatment with appropriate antibiotics, blood glucose control, and adequate urinary drainage.
Cystitis↗
Effect of recombinant human granulocyte colony stimulating factor (R-metHuG-CSF) as an adjunct to large-field radiotherapy: a phase I study.
PURPOSE: To test the feasibility of recombinant human granulocyte colony stimulating factor application during large-field radiotherapy. METHODS AND MATERIALS: Fifteen patients with clinically and histologically proven malignancy who received large-field radiotherapy entered this study. Administration of recombinant granulocyte colony stimulating factor (G-CSF) at a dose of 300 microgram subcutaneously was started on Friday and was continued on Saturday and Sunday after the first radiotherapy treatment, which began on the Monday before. In this way four courses of G-CSF were applied every Friday, Saturday, and Sunday during the radiotherapy period. Absolute neutrophil cell (ANC) and blood counts were monitored twice a week and compared to a second group of 15 patients who received large-field radiotherapy without G-CSF. Before and at the end of every cycle of G-CSF, ANC, blood counts, and biochemistry were measured. We compared the myelotoxicity of the patients treated with G-CSF with 15 patients without G-CSF treated at the same period with large-field radiotherapy, in match pair technique. RESULTS: G-CSF increased the ANC throughout the period of irradiation, and the treatment time needed for competing radiotherapy was shorter in the group who received G-CSF. Fourteen of 15 patients who received G-CSF treatment completed large-field radiotherapy without pause. Only 1 of 15 patients not receiving G-CSF was able to receive radiation treatment on schedule. Patients receiving G-CSF completed treatment with the mantle-field technique in 24 days and those with the abdominal bath technique in 26.5 days. Conversely, patients treated without G-CSF completed treatment with the mantle-field technique in 30.5 days and those with the abdominal bath technique in 36 days. The most frequent side effect was musculoskeletal pain. CONCLUSION: The prophylactic application of G-CSF during large-field radiotherapy before the onset of neutropenia was feasible in this schedule. Whether or not this shortening of treatment duration will translate into an improvement in efficacy is not clear.
Adult↗
The neutron therapy clinical programme at the National Accelerator Centre (NAC).
A total of 721 patients were treated in the neutron therapy programme at NAC from February 1989-March 1995 with a p(66)/Be isocentric unit. The preliminary results showed: 3-year local control and survival probabilities of 57 and 79% respectively for advanced salivary gland tumours; increased local control for twice-daily neutron therapy for advanced head and neck cancer compared with photon therapy; local control rates of 68 and 83% for locally advanced breast cancer treated with 17 and 19 Gy respectively; complete response rates of 67% for macroscopic residual soft tissue sarcomas and those with irresectable disease of less than 10 cm; complete response rate of 56% for macroscopic residual uterine sarcoma with a median follow up of 38 months; 2-year local control rate and survival of 44 and 38% respectively for advanced squamous carcinoma of the maxillary antrum; complete response rate of 38% for advanced osteosarcomas and chondrosarcomas.
Breast Neoplasms↗
Interstitial pneumopathy after mantle field irradiation for Hodgkin's disease.
This retrospective analysis was undertaken to determine the incidence of interstitial pneumopathy and the clinical course after mantle field irradiation for Hodgkin's disease focusing on the role of radio- and chemotherapy. 136 patients were evaluable, 40 having received radiotherapy only and 96 patients having received combined radio-chemotherapy. The median follow-up time was 21.5 months. The overall incidence was 19%; 4 patients died of severe interstitial pneumopathy and 3 died of simultaneous severe complications. The radiation dose was correlated with the incidence of interstitial pneumopathy (P = 0.0021).
Adolescent↗