Biomedical subjects
Publications and source records attributed to J Kutzner.
From 1963 to 1978 119 patients with a carcinoma of the tonsillar fossa received cobalt-60-therapy from 60 to 70 Gy to the primary lesion and the lymph nodes. The 5-year-survival-rate was 34%, with a combined therapy of surgery and irradiation it was 43.6%. For 44 patients with a sarcoma of the tonsillar fossa the 5-year-survival was 32%. For the patients with a carcinoma chemotherapy was only given for palliation.
A simple and cheap method is described for the manufacturing of individual positioning aids made of foamed polyurethane. Some examples are given to demonstrate the applicability of these positioning aids for the irradiation of different body regions. The reproducibility of the radiation field in the head and neck area was investigated with and without positioning aid. It was proved that the field is adjusted more exactly when positioning aids are applied. The dosimetric investigations performed showed a negligible influence of foamed polyurethane on the radiation quality. So the positioning aids could be left within the radiation field when drawing the field borders.
Therapeutic doses of 90Y-citrate show a high selective accumulation in bone. Bone marrow is the critical organ. Investigations in rats show a decrease of leucocytes, erythrocytes and thrombocytes depending on dose. A significant decrease of the leucocytes and thrombocytes was seen with 0.5 mCi (17.5 MBq) 90Y per kg bodyweight, with 2.0 mCi (74 MBq) also of the erythrocytes. This would be equivalent to a dose of 35 to 140 mCi (1.295 to 5.18 GBq) for a normal patient (70 kg). Therefore, a single dose of 10 mCi (370 MBq) of 90Y-citrate should be tolerated by a tumor patient without any blood cell depression, if there was no prior chemotherapy.
A combined therapy of the rectum carcinoma was performed from 1973 to 1980; a randomization was made between preoperative irradiation with 34.5 Gy and operation. The irradiation was performed with Co-60 with opposing fields, including the small pelvis as well as the para-aortal region of the 2nd lumbar vertebra. The evaluation of March 1983 showed a significantly higher number of deaths caused by the tumor in the only operated patients. With respect to side effects, there are no essential differences between the preirradiated and the only operated group.
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The results of experimental work on rats with strontium (85SrCl2, 89SrCl2) and yttrium (90Y) in a citrate complex demonstrate high affinity to bone. Rhenium perrhenat (186Re) Re-colloid and Re-methylene-diphosphonate were rapidly eliminated without bone affinity.
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The possibilities of diagnosing Wilms' tumor correctly have been greatly extended by the introduction of computerised tomography and ultrasonic examination. In view of the fact that Wilms' tumor is subjected to combined treatment involving chemotherapy, surgery and radiotherapy, it appears justified to reduce the dose to 20--30 Gy, depending upon the age of the child and the extension of the tumor. It is believed that preoperative radiotherapy will yield better surgical possibilities in large tumours. Radiotherapy can be omitted in infants in the stages I and II as well as in children in stage I.
For palliation of pain caused by bone metastases beta radiation isotope therapy was successful. As shown in experimental work on animals bone uptake of 90Y with its shorter half-life is high when it is administered as a citrate complex. 90Y can be eluted with high purity from a 90Sr "cow". The retention in man was found by whole-body counting to be higher than 80%. In preliminary trials on 16 patients the analgetic effect was the same as that of 89Sr. The properties of 90Y therapy are discussed.
In 72 children (44 boys and 28 girls, 1 to 14 years old) with acute lymphocytic leukemia (ALL) or malignant non-Hodgkin lymphomas (NHL), computed tomography was used for exploration of the brain before and up to 8 years after the radiation therapy. Thus, 67 normal and 25 pathological findings resulted; nevertheless, in 10 of the children examined prior to radiation therapy, computed tomography had already shown pathological findings.
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88Y was given to rats in form of citrate, diphosphonate or chloride to determine its accumulation in various organs. The activity in the bones was high but not as high as that of calcium. The application of methylene-diphosphonate showed high enrichment in the liver because of intravital colloid formation. Elimination by the kidneys depends on the type of the 88Y compound applied.
48 patients with malignant lymphoma received a 60Co-radiation dose of 30 to 50 Gy using the mantle field technique. Thyroid function tests were performed 34 to 92 months after radiation therapy. One patient developed myxedema, ten (20.8%) had subclinical hypothyroidism and six (12.5%) latent hypothyroidism. The incidence of hypothyroidism after treatment of malignant lymphomas is summarized in a review of the literature. Discrepancies on the incidence of hypothyroidism were found, and their possible cause is discussed. Periodic examinations of all patients with thyroid radiation exposure are recommended. The examination can be limited to measurement of TSH concentration and palpation of the thyroid for nodules.
Opacification of the bile ducts was found to be optimal 30-60 minutes after drip infusion for 20-60 minutes. The radiographs were taken at times between 15 and 120 minutes after the infusion. Opacification was assessed subjectively by the radiologists and objectively by transmission densitometry. The concentration of the contrast material in the blood shows a multi-compartment system with a rapid component of 30 minutes and a slow component of 2-4 hours. The normal; normalization can be expected after about 3 months.
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Abnormal brain findings on computer assisted tomography can be expected in 30-50% of cases after acute lymphoblastic leukaemia and malignant non-Hodgkin lymphoma in childhood. In order to define more exactly the influence of necessary treatment of the CNS in these diseases a computer assisted tomography was performed in 27 children with acute lymphoblastic leukaemia and 3 children with malignant non-Hodgkin lymphoma before head irradiation and intrathecal cytostatic injection had been given. Abnormal findings were seen in 10 out of 30 children. Thus the previously reported abnormalities in computer assisted tomography scans after CNS treatment of acute lymphoblastic leukaemia or non-Hodgkin lymphoma are probably not due to treatment in the majority of cases. A statistically significant correlation taking varying clinical criteria into account could not be obtained on comparison of the two groups.
The causes and localization of chest pain are numerous. They can derive from infections, traumas, or tumors. Possible sites of origin are: skeletal portions vertebral column, ribs, and sternum, as well as mediastinum and pleura. In women, occurrence tends to be cyclic and affect the mamma region. Radiological diagnosis includes radiography, nuclear techniques as well as whole body computer-tomography. Radiation therapy is indicated in cases of mediastinal tumor formation. Radiation of painful osteolytic vertebral metastases and rib destructions proves to be an efficient palliative measure.