Biomedical subjects
H L Seewann
Publications and source records attributed to H L Seewann.
[Drug therapy in advanced squamous cell carcinoma of the ORL region].
This paper reviews the role of chemotherapy in advanced squamous cell carcinoma of the head and neck region (SSCHN). Two different areas of administration are discussed separately: (1) Palliative therapy in recurrent disease, and (2) chemotherapy as additional measure in first line treatment of advanced SSCHN aiming at an increase of the disease-free survival and the cure rate. Overall response rates of 80% and complete clinical remissions in about 40% of the cases can be achieved in locally untreated tumors. On the other hand, recurrent SSCHN respond not as well to chemotherapy; nevertheless, a good temporary palliative effect is reached in more than half of the patients. As example for the numerous combination programs studied in the last few years, we report some data of the two protocols evaluated at our clinic, cis-diamminedichloroplatinum/adriamycin and methotrexate/5-fluorouracil, respectively.
The value of bone marrow biopsy in chronic myeloid leukaemia.
Seventy-six patients with chronic myeloid leukaemia (CML) could be subdivided by core biopsy into chronic granulocytic leukaemia (CGL, n = 24) and chronic megakaryocytic granulocytic myelosis (CMGM, n = 52). By pure clinical definition 59 patients were grouped as classical CML and 17 showed a course which we termed atypical myelosis. The most reliable criteria for distinguishing between the classical and atypical forms were ALP-Index, peripheral leukocyte and platelet count and the estimated number of megakaryocytes in the bone marrow. The classical myeloses consisted of 40 per cent CGL and 60 per cent CMGM whereas the atypical consisted of CMGM only including all stages of fibrosis. Fibrosis was at the time of bone marrow biopsy found in 20 per cent of classical CML and in about 50 per cent of atypical myeloses. In classical CML Philadelphia chromosome could be detected in all the patients with CGL and in 50 per cent of those with myelofibrosis. Atypical myeloses did not exhibit Philadelphia chromosome. In 70 per cent of the cases it was possible to distinguish between CGL and CMGM by peripheral blood findings and bone marrow cytology.
[IgD-paraproteinemia in lymphoplasmacytoid immunocytoma].
Laminectomy was performed in a 54-year-old patient who had a hemicauda syndrome. An epidural tumour, extending into the spongiosa of the third lumbar vertebra was found. Histologically it was a lymphoplasmacytoid lymphoma. Subsequent haematological investigation revealed a multilocular involvement (stage IV) and paraproteinaemia of the IgD-kappa-type. There was no Bence-Jones protein in the urine. After irradiation of the affected lumbar vertebra the patient was treated with a combination of chlorambucil and prednisone, later on with COP and VMCP regimens. A rapid downhill course set in 16 months after diagnosis and the patient died from intracerebral expansion of the immunocytoma. The clinical diagnosis was confirmed at autopsy. The generalized lymphoplasmacytoid immunocytoma contained evidence of terminal transformation into the polymorph subtype.
[Comparative clinical and histological investigations in chronic myeloid leukaemias ].
76 cases of CML were divided according to clinical parameters (duration of illness prior to diagnosis, size of spleen, leucocyte and platelet counts, ALP index, bone marrow cytology and others) into groups showing a classical or an atypical course of the disease. All patients were submitted to bone marrow biopsy, using the method of Jamshidi and Swaim. The histological subtypes of CML, i.e. chronic granulocytic leukaemia and chronic megakaryocytic granulocytic myelosis were correlated with the two clinical types of disease. The classical form of CML was histologically inhomogeneous and was subdivided into 40% cases of chronic granulocytic leukaemia and 60% cases of chronic megakaryocytic granulocytic myelosis. At the time of bone marrow biopsy 20% of patients with classical leukaemia were already found to have myelofibrosis. The atypical myeloses consisted of chronic megakaryocytic granulocytic myelosis only and myelofibrosis was present initially in 50% of patients. In view of these findings agnogenic myeloid metaplasia is considered to be merely a variant of chronic myeloid leukaemia and the term "atypical myelosis" is preferred.
[Drug-induced disorders of the granulocytic cell system].
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[Subacute idiopathic autoimmunehemolytic anemia with prolonged aplastic phase and erythremic reaction (author's transl)].
A case of idiopathic autoimmune hemolytic anemia with subacute onset and peculiar course is reported. In the beginning of the disease there was a long lasting severe aplastic phase, during which numerous blood transfusions were required. The low antiglobuline test titre compared with the severe hemolytic activity and the ineffective erythropoesis suggested first of all the presence of pure red cell anemia. Later on blood regeneration with erythroblastosis started and resembled the picture of erythremic myelosis. The transient course of the disease with full normalisation of all blood values and continuous remission lasting now for more than one year is a peculiar variant of idiopathic autoimmune hemolytic anemia.
[The hemolytic syndrome in subacute bacterial endocarditis].
Long lasting subacute bacterial endocarditis often presents with marked anemia. Infective mechanisms and hemolysis are considered as most important pathophysiological mechanisms. Pronounced hemolytic anemia, thrombocytopenia and edema observed in two cases are possible misleading symptoms in the diagnosis of subacute bacterial endocarditis.
[Terminal acute leukemia with pseudo-Pelger phenocopy in IgG plasmacytoma].
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[Laparotomy and splenectomy in Hodgkin's disease].
Explorative laparotomy and splenectomy represents the most accurate methode to recognize a lymphogranulomatous process below the diaphragm. The demonstration or exclusion of a subdiaphragmatic propagation of disease plays an essential role in therapy. Since 1973 we have performed explorative laparotomy and splenectomy in stage (I) II-III a of Hodgkin's disease. In the course of this invasive diagnostic procedures (39 primary and 12 reassessing laparotomies and splenectomies) no case of death and no persisting postoperative complications were noticed. Clinical staging was altered in 47% of cases by the procedure but in only one quarter of patients this result influenced therapeutic regimen.
[Functional gastrointestinal symptoms and syndromes as forms of vital somatic dysthymia].
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[Aplastic anemia in thymoma].
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Toxicity and preliminary results with a new eight-drug regimen (CEOP-IMVP-DEXA) in the treatment of aggressive lymphomas.
A combination of two non-cross-resistant regimens, CEOP and IMVP-Dexa given every 4 weeks, three to six times according to response was tested in patients with untreated histological proven high and intermediate grade non-Hodgkin's lymphoma. To date eight Austrian centres entered 37 patients in this multicentre trial. Data are available from 33 patients, three were excluded, two because of pretreatment, one because of wrong histology. Twenty-five patients are evaluable for response, 21 had a complete and three a partial remission, two of them entered a complete remission after radiotherapy to residual disease, resulting in a complete remission rate of 92 per cent. Only one patient progressed during therapy. Until now three patients relapsed after achieving a remission. Observation time is 0.4-23.8 months, median 8.8 months. Toxicity was primarily hematologic with 53.3 per cent of patients having granulocyte nadirs below 0.5 x 10(9)/L and 3.3 per cent below 0.1 x 10(9)/L. Although 60 per cent of patients had infections, there was only one life-threatening infection in an AIDS patient. CEOP-IMVP-Dexa can be safely given even in smaller hematologic centres and is able to achieve a high rate of complete responses in patients with high and intermediate grade malignant non-Hodgkin's lymphomas.