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Biomedical subjects

H Pape

Publications and source records attributed to H Pape.

At least 19 recordsLinked to original sources
PubMed2000

[Conventional and virtual simulation in retrobulbar irradiation].

BACKGROUND: Radiotherapy is commonly used in Grave's ophthalmopathy. The target volume encompasses the ocular muscles and the orbital tissue. The result of conventional simulation can be examined by means of CT simulation. PATIENTS AND METHODS: Twenty-five planning CTs with Grave's ophthalmopathy were studied. The conventional simulation of 4 x 4 cm2 lateral portals confined anteriorly by the fleshy canthus was performed on a CT-simulator using the observer's eye view (OEV) and digitally reconstructed radiographs (DRR). The coverage of the target volume and sparing of the eye lenses were studied on axial CT slices and multiplanar reconstructions (MPR). The distances between the apex of the orbita and cornea, fleshy canthus, and bony canthus were measured as well as the distance between cornea and posterior face of the lens. RESULTS: The pituitary gland and the ocular lenses were spared in each case (25/25). The orbita was entirely covered in 24 cases (96%). However, anterior parts of the external eye muscles were not completely encompassed in 7 cases (28%). The distance from the apex of the orbita to the cornea was 54.6 mm (53.3 to 55.8 mm, 95% confidence interval), to the fleshy canthus 40.3 mm (39.4 to 41.2 mm), and to the bony canthus 31.4 mm (30.2 to 32.5 mm). The distance between cornea and posterior face of the lens was 8.3 mm (7.9 to 8.7 mm). The distance between cornea and canthus differed significantly from normal eyes while the distance between cornea and posterior face of the lens was very similar to normal eyes. CONCLUSIONS: Conventional simulation of orbital irradiation with lateral fields confined anteriorly by the fleshy canthus ensures protection of the ocular lenses and the pituitary gland. However, anterior parts of the eye muscles may occasionally not completely be covered. The fleshy canthus and the cornea are more reliable landmarks as compared to the bony canthus.

Computer Simulation↗
PubMed2000

Interdisciplinary treatment in pediatric patients with malignant CNS tumors.

Despite sophisticated surgical methods only a few pediatric CNS tumors can be controlled by operation alone. Therefore multimodality treatment regimens are needed to improve quality of life and survival, which is most important in malignant neoplasms. Since 1998 we have treated 16 children with malignant CNS tumors. All 16 patients have been treated on an interdisciplinary basis and are therefore accompanied by a pediatric neurooncology group consisting of a neurosurgeon, pediatric oncologist, and radiotherapist. Depending on tumor histology, child's age, and extent of surgery, further adjuvant therapy is planned by this group. Newly diagnosed tumors are typically treated by a specific chemotherapy protocol according to a multi-institutional study. In recurrent tumors more individual treatment regimens are considered. Data concerning surgery, adjunctive treatment, complications, and outcome of all patients and four case reports are presented.

Adolescent↗
PubMed2000

Allogeneic and autologous stem-cell transplantation in advanced Ewing tumors. An update after long-term follow-up from two centers of the European Intergroup study EICESS. Stem-Cell Transplant Programs at Düsseldorf University Medical Center, Germany and St. Anna Kinderspital, Vienna, Austria.

BACKGROUND: An update of results from the High Risk Protocol of the Meta-EICESS Study, conducted at the Pediatric Stem-Cell Transplant Centers of Düsseldorf and Vienna. In order to evaluate a possible therapeutic benefit after allogeneic SCT in patients with advanced Ewing tumors (AET), we compared outcome after autologous and allogeneic stem-cell transplantation (SCT). PATIENTS AND METHODS: We analyzed 36 patients treated with the myeloablative Hyper-ME protocol (hyperfractionated total body irradiation, melphalan, etoposide +/- carboplatin) between November 1986 and December 1994. Minimal follow-up for all patients was five years. All patients underwent remission induction chemotherapy and local treatment before myeloablative therapy. Seventeen of thirty-six patients had multifocal primary Ewing's tumor, eighteen of thirty-six had early, multiple or multifocal relapse, one of thirty-six patients had unifocal late relapse. Twenty-six of thirty-six were treated with autologous and ten of thirty-six with allogeneic hematopoietic stem cells. We analyzed the following risk factors, that could possibly influence the event-free survival (EFS): number of involved bones, degree of remission at time of SCT, type of graft, indication for SCT, bone marrow infiltration, bone with concomitant lung disease, age at time of diagnosis, pelvic involvement, involved compartment radiation, histopathological diagnosis. RESULTS: EFS for the 36 patients was 0.24 (0.21) +/- 0.07. Eighteen of thirty-six patients suffered relapse or died of disease, nine of thirty-six died of treatment related toxicity (DOC). Nine of thirty-six patients are alive in CR. Age > or = 17 years at initial diagnosis (P < 0.005) significantly deteriorated outcome. According to the type of graft, EFS was 0.25 +/- 0.08 after autologous and 0.20 +/- 0.13 after allogeneic SCT. Incidence of DOC was more than twice as high after allogeneic (40%) compared to autologous (19%) SCT, even though the difference did not reach significance (P = 0.08, Fisher's exact test). CONCLUSIONS: Because of the rather short observation period. secondary malignant neoplasms (SMN) may complicate the future clinical course of some of our patients who are currently viewed as event-free survivors. EFS in AET is not improved by allogeneic SCT due to a higher complication rate. The patient group was to small to analyze for a possible graft-versus-tumor effect.

Adolescent↗
PubMed1999

[Young victims in Oslo--a problem of immigration?].

There has been considerable concern over victimization from violence in Norway over the last couple of years. This study investigated risk groups for victimization with special emphasis on the importance of immigrant background. All students enrolled in the secondary school system in Oslo (ages 13-18, N = 10,812) filled in a questionnaire at school. 79% had a background from Norway, the rest had a background from other countries. 32% had experienced mild victimization, 12% had experienced moderately serious victimization, while 6% had experienced serious victimization--defined as being hurt so hard as to need medical treatment. Serious victimization was related to working-class background, having parents who were economically inactive, living in the eastern part of Oslo, and to immigrant background. However, immigrant adolescents also had low rates of mild and moderate victimization, and thus high rates of non-victimization. These associations to immigrant background persisted, also when we controlled for other variables. Overall, immigrant background is associated with reduced risk for victimization. However, a sub-segment of immigrants are at increased risk of serious violent victimization, also when we control for other risk factors.

Adolescent↗
PubMed1999

[Problematic puberty?].

This paper shows how involvement in problem behaviour among 13- and 14-year-olds varies according to level of pubertal development. Furthermore, it explores whether psychosocial factors such as characteristics of the peer network (deviance and gang membership), parental behaviour (supervision, care, and parents' frequency of alcohol intoxication) and masculine gender identity mediate this relationship. The data stem from a nation-wide representative survey of the general youth population in Norway (n = 3,139, response rate 97%). The prevalence of problem behaviour (i.e. shoplifting, truancy, vandalism etc.) increased with increasing levels of physical maturation for both sexes. The association was strongest among boys, however. Further analyses revealed that this gender difference could be attributed to the fact that early mature boys, to a greater extent than early mature girls, associate with deviant peers.

Adolescent↗
PubMed1999

[Changes in hemoglobin concentrations in combined radio- and chemotherapy in locally advanced ORL tumors].

BACKGROUND: Despite multimodality treatment strategies of locally advanced head and neck cancers long-term results leave much to be desired. There is evidence that oxygenation status of head and neck tumors is directly influenced by the hemoglobin concentration. The aim of this study was to verify changes in the hemoglobin level during combined radio-chemotherapy of locally advanced head and neck tumors. PATIENTS AND METHODS: Sixty-eight patients with locally advanced head and neck cancer had primary or adjuvant radiotherapy with doses of 60 to 74 Gy in combination with cisplatin- (+/- 5-FU) or carboplatin chemotherapy in the first and fifth week of treatment. Hemoglobin levels were analyzed before and at the end of radiotherapy. RESULTS: In 41% of all patients the initial hemoglobin concentration was below normal levels. The mean hemoglobin values in all patients dropped significantly from 12.9 +/- 1.7 g/dl before to 11.6 +/- 1.6 g/dl at the end of treatment. In 12 cases (18%) allogeneic erythrocytes had to be transfused during treatment. At the end of treatment 76% of all patients had anemic hemoglobin levels. In the groups of patients with cisplatin and carboplatin chemotherapy a significant decrease in hemoglobin levels was seen without meaningful statistical difference between these 2 groups. CONCLUSIONS: In patients with locally advanced head and neck cancer a high initial rate of anemia was registered (41%): This rate was nearly doubled during chemoradiation (76%). Since several studies have shown a correlation between hemoglobin levels and local tumor control, there is evidence, that this group might benefit from correcting anemia before combined radio-chemotherapy.

Adult↗
PubMed1999

Radiotherapy and high-dose chemotherapy in advanced Ewing's tumors.

BACKGROUND: Ewing's tumors are sensitive to radio- and chemotherapy. Patients with multifocal disease suffer a poor prognosis. Patients presenting primary bone marrow involvement or bone metastases at diagnosis herald a 3-year disease-free survival below 15%. The European Intergroup Cooperative Ewing's Sarcoma Study (EICESS) has established the following indications for high-dose therapy in advanced Ewing's tumors: Patients with primary multifocal bone disease, patients with early (< 2 years after diagnosis) or multifocal relapse. PATIENTS AND METHOD: As of 1987, 83 patients have been treated in the EICESS group, 39 of them at the transplant center in Düsseldorf, who have been analyzed here. All individuals received 4 courses of induction chemotherapy with EVAJA and stem cell collection after course 3 and 4. Consolidation radiotherapy of the involved bone compartments was administered in a hyperfractionated regimen 2 times 1.6 Gy per day, up to 22.4 Gy simultaneously to course 5 and 22.4 Gy to course 6 of chemotherapy. The myeloablative chemotherapy consisted of melphalan and etoposide (ME) in combination with 12 Gy TBI (Hyper-ME) or Double-ME with whole lung irradiation up to 18 Gy (without TBI). RESULTS: The survival probability at 40 months was 31% (44% DOD; 15% DOC). Pelvic infiltration did not reach prognostic relevance in this cohort. Radiotherapy encompassed 75% of the bone marrow at maximum (average 20%). Engraftment was not affected by radiotherapy. CONCLUSION: High-dose chemotherapy can improve outcome in poor prognostic advanced Ewing's tumors. The disease itself remains the main problem. The expected engraftment problems after intensive radiotherapy in large volumes of bone marrow can be overcome by stem cell reinfusion.

Adolescent↗
PubMed1999

Multimodality diagnostics and megatherapy in poor prognosis Ewing's tumor patients. A single-center report.

BACKGROUND: The prognosis of Ewing's tumor patients has been improved gradually through cooperative therapy studies, so that meanwhile 55 to 65% of the patients survive relapse-free in the long term. Patients with multifocal primary, early or multiply-relapsed Ewing's tumors have a dismal prognosis. Megatherapy with subsequent stem cell transplantation seems to improve outcome in this patient cohort. Feasibility of this intense megatherapy regimen is crucially dependent on collaboration and multidisciplinary coordination of radiologists, radiotherapists, surgeons and oncologists. PATIENTS AND METHODS: Since 1988, 25 patients were treated with megatherapy consisting of melphalan, etoposide and total-body irradiation followed by stem cell transplantation. All patients received 6 courses of an induction therapy. Before the fourth therapy block, tumors that were bulky at initial diagnosis (> 200 ml) were excised, as well as lung metastases which could still be detected after the third chemotherapy block. During the fifth and sixth chemotherapy block, patients received local irradiation on all infiltrated sites. Persisting immunosuppression after high-dose treatment may facilitate the incidence of relapse. To improve proliferation and cytotoxic activity of early regenerating NK-cells, adoptive immunotherapy with systemic IL-2 therapy after megatherapy is part of the treatment protocol. RESULTS: Of 25 patients treated with megatherapy, 10 patients are still alive with a follow-up time of 6 months to 9 years after megatherapy. The time up to engraftment was decreased from 15 +/- 6 days down to 9 +/- 2 days through the use of G-CSF and CD34+ selected stem cells. At the same time, erythrocyte and platelet replacement was shortened. Frequently occurring complications were mucositis and infections. One patient died after developing septicemia and multi-organ failure, another patient developed a myelodysplastic syndrome 4.5 years after megatherapy. However, relapse is still the major cause of death. The influence of IL-2 on event-free survival cannot valued because 21 of 25 patients were treated with adoptive immunotherapy. CONCLUSION: The complex diagnostic and therapeutic strategy renders and EFS of 34% for a patient group with otherwise dismal prognosis. To clarify the efficiency of megatherapy in patients with advanced Ewing's tumors, a standardized treatment strategy is necessary to accumulate a sufficient number of patients for large cooperative studies in this subject.

Adolescent↗
PubMed1999

[Optimal timing for secondary surgery in polytrauma patients: an evaluation of 4,314 serious-injury cases].

INTRODUCTION: It has been argued that secondary operations in multiple trauma patients impose an additional systemic burden, representing an additional risk of organ dysfunction. We investigated whether the timing of a secondary operation of > 3 h duration is related with the development of organ dysfunction. METHODS: In a retrospective analysis, 4,314 polytrauma patients treated at our institution between January 1975 and January 1999 were investigated. Patients were divided according to the presence ( + MOF) or absence (-MOF) of organ failure (Goris' criteria). RESULTS: In both groups, the injury severity, rescue time, duration and incidence of primary operations were comparable. Secondary surgery in patients who later developed organ failure was significantly more often performed between day 2 and 4, whereas patients without organ failure were usually operated between day 6 and 8 (P < 0.0001). The initial laboratory data in these two groups were comparable. If patients with organ failure were operated on days 6-8, significantly worse initial laboratory data were determined, indicating that these patients were at high risk of developing MOF. CONCLUSION: In patients with severe trauma requiring secondary operations of > 3 h duration, performance of this operation should be avoided on post trauma days 2-4.

Adult↗
PubMed1999

[Optimal duration of primary surgery with regards to a "Borderline"-situation in polytrauma patients. Arbeitsgemeinschaft "Polytrauma" der Deutschen Gesellschaft für Unfallchirurgie].

Primary stabilization of major fractures in polytrauma patients is known to represent an important principle of treatment and has been shown to reduce the incidence of posttraumatic complications and of organ failure. However, in critically injured patients it has been discussed that extensive primary definitive treatment may also cause adverse effects due to its systemic burden by blood loss, loss of temperature etc. Patients who deteriorated unexpectedly following primary surgery have been named "borderline patients". In these patients it appears necessary to limit the amount of operative procedures, e. g. by performing temporary fixation of major fractures primarily. The threshold beyond which surgical procedures may cause more harm than good has not been well defined. This holds true especially for the duration of primary surgery. We investigated the clinical outcome in a large number of prospectively documented multiple trauma patients with respect of the duration of primary fracture stabilization. If a primary surgical procedure exceeded 6 hours in multiple trauma patients with an ISS of 25 points, patients demonstrated a significantly elevated ventilation time, an increased mortality, and a higher incidence of death from MOF in comparison with patients that were injured comparably, but were submitted to shorter primary operative procedures.

Adult↗
PubMed1999

Young, wet & wild? Associations between alcohol intoxication and violent behaviour in adolescence.

AIMS: To assess gender- and age-specific associations between alcohol intoxication and engagement in violent behaviours in young people. DESIGN, PARTICIPANTS AND MEASUREMENT: Cross-sectional study comprising a national sample of 12,000 Norwegian adolescents aged 12-20 years. Data on violent behaviour, alcohol intoxication and various confounders were obtained by self-administered questionnaires in school. FINDINGS: 2.8% had been in fight with a weapon and 32.6% had been beating or threatening to beat someone during the past year. Violent behaviours were more often reported among boys, in the younger age groups, with increasing frequency of alcohol intoxication, among users of other drugs, among those engaged in criminal activities and among those in wet environments (friends drinking regularly and parents often being intoxicated). The impact of intoxication frequency on number of times engaged in violent behaviours was of modest magnitude. It was greater in the youngest age group compared to those in the middle and late teens and greater for boys than for girls. However, when criminal activities were controlled for, the adjusted effect of intoxication on violent behaviour was significantly reduced, the effect was then of the same magnitude for both genders, whereas there was no longer any significant effect in the youngest age group. Controlling also for parents' and friends' drinking and parental monitoring did not alter these findings. CONCLUSIONS: A small direct effect of alcohol intoxication on violent behaviour appears to remain after controlling for various relevant confounders in middle and late teens. However, possible indirect effects of alcohol intoxication, mediated by own deviant life-style and wetness of environment, should also be taken into consideration.

Adolescent↗
PubMed1998

Hyperthermia for the treatment of patients with malignant germ cell tumors: a phase I/II study in ten children and adolescents with recurrent or refractory tumors.

BACKGROUND: Extracranial nontesticular germ cell tumors (GCTs) are rare malignancies in children and adolescents. Cisplatin-containing regimens and complete tumor resection are important determinants for a favorable outcome; however, patients with recurrent tumors that cannot be eradicated by surgical procedures and chemotherapy have a poor prognosis. Noninvasive electromagnetic technologies for superficial and regional deep hyperthermia (RHT) are under investigation to enhance local tumor control in various malignancies. The objectives of this Phase I/II study were to examine 1) whether RHT can be used in combination with platinum-based chemotherapy with acceptable toxicity in children and adolescents and 2) whether this combined regimen can induce objective tumor response in patients with malignant nontesticular GCT that persisted or recurred locoregionally after validated, intensive, cisplatin-based chemotherapy +/- surgery as unsuccessful first-line treatment. METHODS: The authors studied the effects of RHT induced by electromagnetic waves in combination with platinum-based chemotherapy in ten children and adolescents with recurrent or refractory GCTs. RESULTS: Seven of ten patients with recurrent or refractory GCTs had objective responses. Of these, two patients had a partial response and five patients had a complete response. CONCLUSIONS: The results of the current study found that combined RHT and platinum-based chemotherapy can be used in children and adolescents. This regimen was found to induce objective tumor response in 70% of study patients with recurrent or refractory GCTs. The results thus far are encouraging and the study has been extended to patients with a poor response to first-line treatment.

Adolescent↗
PubMed1998

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↗
PubMed1997

[Victims of violence in the general youth population. A longitudinal study of risk factors].

This paper presents new knowledge on risk factors involving violent victimization. The data stem from a representative survey of youths living in the Oslo area (n 447, response rate 86%). Questions on victimization experiences, drinking habits, alcohol problems, violence towards others and conflict-provoking behavior were first asked between the ages of 18 and 20 years (1993), and were repeated in the follow-up two years later. More men than women had been victimized. In both sexes there was a significant connection between alcohol problems and experiences as a victim. However, the consumption of alcohol and frequency of intoxication were only slightly related to such experiences. In men, both cross-sectional and longitudinal analyses showed that violence towards others had a much greater statistical effect than any of the variables relating to drinking behavior. In fact, the effect was greater than that of any other variable in the study. In women, previous victimization was, without doubt, the most significant predictor for future victimization. Stability over time of such experiences was also much higher for women than for men. As regards preventive efforts targeted towards victimization among youths, our findings suggest that a specific programme for each of the sexes needs to be developed and implemented.

Adolescent↗
PubMed1996

[Bone marrow transplantation: role of radiation therapy].

Conditioning regimes before bone marrow transplantation serve a dual purpose. Firstly they have to destroy the host immune system sufficiently to allow permanent engraftment, secondly they have to eliminate the abnormal tumor cells. The special aim of total body irradiation is to eradicate those cells, which escape chemotherapy. The effectiveness of TBI is influenced by: delivered dose, fraction size and dose rate. Dose escalation improves the results of TBI. The seven year survival probability is 74%, if more than 9,9 Gy are administered and only 38% under 9,9 Gy. Combining TBI and chemotherapy promotes the outcome in patients with acute leukaemia and allogeneic bone marrow transplantation. The two year relapse rate is 16% with and 37% without TBI. Side effects are distinctly determined by fraction size and dose rate.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1996

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↗
PubMed1996

Sober adolescence--predictor of psychosocial maladjustment in young adulthood?

We have explored how age at first intoxication with alcohol relates to mental health, social integration and adjustment to the adult role. The data stem from a longitudinal representative study of 2000 Norwegians. The sample was assessed at ages 19-22, 21-24 and 25-28. Among females, only early intoxication was related to young adult symptoms of poor mental health. A U-shaped association between intoxication debut and psychological problems was revealed among males, implying that both early and late beginners had more such problems than those who had followed the mainstream. These associations persisted without change over time. However, males who remained abstainers in adulthood were psychologically healthy, but they showed indications of a delayed entry into the adult role. Male late beginners were also somewhat reluctant to adopt adult role-behaviors. Thus, getting drunk for the first time in mid-adolescence seems to be an ingredient in the normal developmental process in young males.

Adolescent↗