Renal function studies using 99mTc-MAG3: pharmacokinetics and slope clearance determination.
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Humans↗
Biomedical subjects
K zum Winkel
Publications and source records attributed to K zum Winkel.
Radiological evaluation of temporal bone disease: high-resolution computed tomography versus conventional X-ray diagnosis.
Sixty-two patients with different temporal bone lesions were prospectively examined by high-resolution computed tomography (CT) and conventional plain radiography, including pluridirectional tomography. High-resolution CT enabled a clear diagnosis in 80% of cases, conventional radiology in 63%; 1.6-times more bone information was recorded by high-resolution CT which is clearly superior for imaging cholesteatomas, metastases and inflammatory processes and for evaluating osseous destruction. With regard to pathological soft tissue or effusions filling the tympanic cavities, conventional radiology shows poor sensitivity (0.61). High-resolution CT is the most sensitive method for the imaging and classification of temporal bone fractures, including labyrinthine damage and ossicular chain injuries. Only in cases of atypical fractures with an unfavourable relationship to the CT planes, can carefully directed tomography be more effective. In most cases high-resolution CT replaces conventional radiology and should be the method of choice for comprehensive radiological examination of the temporal bone.
Bone Diseases↗
[Results of local radiotherapy and modified total-brain irradiation in astrocytoma].
A retrospective evaluation was made on the results of primary or postoperative radiotherapy in 162 patients with grade I to IV astrocytomas. The greatest part of the overall group was built by 113 patients suffering from glioblastoma multiforme. For the survival analysis, the prognostic importance of the following factors was investigated: sex, age, surgery, radicality of surgery, grading according to Kernohan, tumorous lesions in central structures, and target volume of radiotherapy. The prognosis is first of all dependent on the operability, the grading, and the age of the patient. The survival of patients with malignant gliomas is not influenced by the radicality of the operation and the extension of the target volume to the whole brain (total-brain irradiation and boost). Thus in the treatment of malignant astrocytomas, the less extensive surgical and radiotherapeutical intervention seems an adequate method to manage this disease.
Adolescent↗
Combined neutron-photon-therapy of locally recurrent rectosigmoidal tumors.
21 patients with unresectable recurrent adenocarcinoma of the rectum were treated with combined photon-neutron radiation therapy. 40 Gy photon were given to the whole pelvis followed by a boost field of 6.6 or 10 Gy utilizing 14 MeV monoenergetic neutrons. The latter was given with an arc therapy technique whereby the dose output fluctuations normally encountered during gantry rotation were compensated for by a computer guided system. All patients had severe pain symptoms before therapy. Twelve patients had a full remission of the symptoms and nine reported considerable relief of pain during follow-up examination. In three patients, further pain symptoms developed after six, seven, and nine months due to renewed tumor progression. In spite of the relative high neutron doses applied, side effects with the arc-technique remained minimal and did not exceed those encountered with photon therapy alone. Although the total follow-up time is relatively short at a maximum of 20 months, with a mean time of 8.5 months, the preliminary results so far are extremely optimistic leading us to further pursue the study.
Adenocarcinoma↗
[The radiotherapeutic effect on bone metastases in relation to the frequency of metastases, sites of metastases and histology of the primary tumor].
In a retrospective study on 239 patients irradiated for osseous metastases in 578 different skeletal areas, the therapy effect was evaluated in dependence on the frequency of metastases, the sites of metastases, and the histology of the primary tumors. Furthermore the duration of improved findings was verified. The primary tumor was a mammary carcinoma in 186 patients, a bronchial carcinoma in 21 patients, a renal cell carcinoma in 20 patients, and a prostatic carcinoma in 12 patients. In patients with bronchial carcinoma the relief of pain by radiotherapy was not as good as in other tumor types. However, a significant correlation between subjective therapy effect and histology of the primary tumor was not demonstrated. Remineralization was found in 55% of all irradiated skeletal areas and an unchanged X-ray picture of bone metastases in 35%. A dependence of the objective therapy effect from the histology of the primary tumor was not statistically demonstrated (recalcification rate in mammary carcinoma 62%, in prostatic carcinoma 57%, in bronchial carcinoma 28%, and in renal cell carcinoma 11%). Significant differences of remineralization were found in solitary bone metastases (68%) and in multiple skeletal metastases (56%). A significant correlation between sites of metastases and objective irradiation effect was proved by the fact that osteolytic destructions of spine and pelvis showed a better remineralization than lesions situated in the extremities. The average duration of the objective, radiologically verified amelioration of findings was 16 months in patients with mammary carcinomas and 12 months in patients with prostatic carcinomas, bronchial carcinomas, and renal cell carcinomas.
Adult↗
[Accelerated irradiation of bone metastases].
In a prospective study, accelerated irradiation was performed over 60 portals in 34 tumor patients with peripheral bone metastases. During a period of three days, three daily fractions of 3 Gy each were applied with intervals of four hours, resulting in a total dose of 27 Gy. Using this fractionation schedule introduced by Ammon, a reduction of metastasis-associated pain was achieved in 90% of cases (54/60). The onset of pain reduction was observed earlier than seen with conventional fractionation schedules (five fractions of 2 Gy each per week, total dose 40 Gy). With regard to objective treatment effects, no significant difference was found between accelerated irradiation and conventional fractionation, the rate of remineralization being 43% (26/60), and the rate of stabilization of formerly progressive bone destructions being 55% (33/60). Accelerated irradiation was tolerated well usually. Marked acute side reactions occurred in only one case with metastatic involvement of joint and reaction of synovia. The major advantage of accelerated irradiation is the shortening of the total treatment period and the consequent reduction of treatment stress in patients with advanced cancer.
Adult↗
[Indications for and value of computed tomography and conventional skeletal diagnosis in suspected bone metastases].
In 1003 patients with a total of 2467 clinically or scintigraphically suspect skeletal parts, conventional x-ray examination at the time of first study resulted in 95% of cases (2331 skeletal parts) in a correct diagnosis. Computed tomography permitted an exact diagnosis in 52% of roentgenologically equivocal findings (136 skeletal parts). In 40% of these patients even by computed tomography metastasis was only suspected, in 8% there were unspecific findings, while by follow-up bone metastasis was proven. In 64.8% of the whole patient collective there were metastatic destructions and in 32.6% of patients benign lesions were found. Superiority of CT compared to conventional x-ray diagnosis resulted from exact demonstration of the intra- and extraosseous extent of lesions and the possibility of density measurements. It depended mainly upon the localisation of the pathologic process.
Adult↗
[Electron therapy of malignant parotid tumors].
Between 1968 and 1984, 61 patients with malignant parotid tumors were irradiated with fast electrons. The irradiation was performed after surgery in 58 patients, 37 out of them had tumor reresidues at the beginning of radiotherapy. The local recurrence rate was 16%, and there were no differences between patients operated in sano and patients operated non in sano. The survival at five years, however, was only 43%. This is explained by the preponderance of tumor histologies with unfavorable prognoses. Distant metastases were observed in 38% of patients. 8/10 patients with local recurrences developed distant metastases. It is noticeable that polymorphous adenomas were found in the anamneses of ten patients and histologically different secondary carcinomas in 9/61 cases.
Adenocarcinoma↗
Stereotactic percutaneous single dose irradiation of brain metastases with a linear accelerator.
The effectivity of stereotactic percutaneous single dose irradiations in the treatment of solitary brain metastases has been assessed in a series of 12 consecutive patients. Only radioresistant deeply localized metastases have been treated. Photon-irradiation was carried out with the convergent beam technique using stereotactic localization methods, in a linear accelerator facility. In 11 of the 12 patients no side effects occurred. The first 7 patients, who could be observed 3 months or longer, have been studied in detail. In each of these cases single dose irradiation with 20-30 Gy yielded arrest of tumor growth. In one case a marked decrease in contrast enhancement and in four cases shrinkage of the metastasis as well as a marked decrease of the edema occurred. In every patient a marked, sometimes dramatic improvement of the clinical condition was achieved, beginning a few days after irradiation. Stereotactic radiosurgery is a valuable tool in the treatment of inoperable, radioresistant brain metastases, the major advantage being high efficacy and smoothness of the procedure, as well as extremely short hospitalization times (2-3 days).
Adult↗
[Value of 3-phase skeletal scintigraphy in the diagnosis of bone metastases].
51 patients suffering from 125 bone metastases of various primary tumors were investigated with three-phase skeletal scintigraphy in an attempt to define criteria characteristic for bone metastases with regard to differential diagnosis. During the 3 phases of imaging, the metastases exhibited 5 different patterns of activity concentration. None of these patterns was correlated either to the size and morphological X-ray appearance of the metastases or to the histology of the primary tumors. The intensity of radionuclide concentration was also varying. The most frequent patterns of activity concentration were increased uptake during the blood-pool phase and skeletal phase combined with absence of concentration during the angiographical phase (43%), and increased uptake during all of the 3 phases (34%). In this series, a pattern of scintigraphical findings characteristic for bone metastases or helpful in the differential diagnosis could not be determined. In our experience, three-phase skeletal scintigraphy is not useful in the diagnosis and differential diagnosis of bone metastases.
Bone Neoplasms↗
Carcinoid tumors: CT and I-131 meta-iodo-benzylguanidine scintigraphy.
The diagnostic value of computed tomography (CT) and iodine-131 meta-iodo-benzylguanidine (MIBG) scintiscanning was studied in nine patients with histologically proved carcinoid tumors of intestinal (n = 4), bronchial (n = 3), or thymic (n = 2) origin. CT scans clearly depicted the tumors and metastases in relation to surrounding vital structures but did not provide findings specific for carcinoids. The appearance on CT of an abdominal soft-tissue mass with a radiating pattern of linear densities was found to be highly suggestive of intestinal carcinoid tumors. I-131 MIBG scintiscans disclosed intense tracer uptake in the tumors and metastases in five patients. MIBG studies correctly depicted nine of nine tumor manifestations in intestinal carcinoids and four of six tumor manifestations in bronchus carcinoids. No MIBG concentration was found in thymus carcinoids. Because of its selective uptake mechanism, I-131 MIBG scintigraphy can allow specific detection and localization of neuroendocrine tumor tissue in patients with suspected carcinoid tumors. MIBG scintigraphy has diagnostic potential as a screening procedure in carcinoid tumors, especially those of intestinal origin.
3-Iodobenzylguanidine↗
Perspectives of radiotherapy.
The 5 years' survival rate of all cancer patients is 35-45%. In that survival rate radiotherapy takes part in 15%. By further development of radiological methods and techniques radiotherapy gains significance in the recent time. Optimizing radiation planning and tactics, all modern imaging techniques are applied consequently. The radiotherapist must be able to asses their immanent specifity which should remain object of the radiological training, even if separated into therapy and diagnostics. Dose distribution is calculated by computer; three-dimensional planning is done in tumors of the mediastinum, oesophagus carcinoma and paraaortic lymphomas. Critical description of radiation techniques, results, problems and prognoses are given by results in tumors of the epipharynx and gastric cancer. After-loading, done until now only in gynaecological tumors, is performed in recurrences of pharyngeal tumors by individually shaped applicators. Reducing the number of therapy failures as well as possible, the application of higher tumor doses, new kinds of rays as neutrons and combinations with physical and chemical methods is outlined. Modifications of radiation volumes are discussed, especially the irradiation of the complete abdomen in ovarian cancer, the irradiation of the complete body surface by electrons in mycosis fungoides, and the total body irradiation prior to autologue bone marrow transplantation. Modifications of fractionation are shown in short-time radiation of bone metastases and single-time radiation of brain lesions. Low penetrating electron therapy facilitates intraoperative single-time irradiation. Because of higher biological efficiency neutrons and heavy ions allow to irradiate low sensible tumors or recurrences embedded in fibrotic tissue respectively. The combination with hyperthermia yields good results in tumors of the head and neck with better local response and total remissions of 59%. There are potentials in synchronising with chemotherapeutics. Remissions of different duration were achieved in 190 patients. Because of neutrotoxicity there are still problems in applicating radiosensitizers. New methods are applied treating endocrine active tumors by labelled hormone precursers.
Brachytherapy↗
[Value of ultrasound diagnosis in staging, therapy planning and after-care of ENT tumors].
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Follow-Up Studies↗
Therapeutic strategies in primary and metastatic liver cancer: indication and results of external radiation therapy.
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Clinical Trials as Topic↗
[Bone marrow scintigraphy using radiocolloids in bone metastases. Sensitivity, specificity, reliability and indications].
The sensitivity and specificity of bone marrow scintigraphy in demonstrating skeletal metastases was examined in 40 patients with focal metastases. Radiology and MDP scintigraphy were used as reference methods. Sensitivity depends on the region of the skeleton. False negatives are the rule in parts of the skeleton containing little bone marrow. In relation to the entire bone marrow content, sensitivity is 0.64. The high proportion of false negatives (36%) in the presence of confirmed metastases and the incomplete demonstration of the bone marrow makes marrow scintigraphy unsuitable as a screening method. Occasionally lesions confined to the marrow can be demonstrated when radiographs and bone scintigrams are still negative. In advanced cases, marrow scintigraphy can demonstrate the extent of destruction of the bone marrow. Demonstration of displacement or of an 'empty bone' is evidence of invasion of the bone marrow in patients with tumours. In patients with reduced haematopoiesis of unknown origin or unidentified diffuse skeletal uptake, bone marrow scintigraphy may provide valuable information.
Adult↗
[Functional heterogeneity of liver metastases in 3-phase computerized tomograms].
Ninety patients with liver metastases (68 colorectal carcinomas, 22 breast carcinomas) were examined by triphasic angio-CT. This included demonstration of the entire liver after a bolus-like injection of contrast. Originally, the metastases were hypodense, but showed four patterns of contrast enhancement. Quantitative evaluation of the mammary carcinomas showed a marked increase in density during the bolus phase, with similar contrast values in the liver and at the centre and edge of the metastasis at ten minutes after the injection. Colorectal carcinomas showed only slight increase in density after contrast injection. The difference in density between the centre and the periphery of the metastasis was still present on later images. This finding indicates that there are differences in the vascularisation of these metastases.
Breast Neoplasms↗
[Real-time sonography. An important imaging procedure in the diagnosis and treatment planning of bone metastases].
The value of sonography for diagnosis and therapy planning of bone metastases is shown in 110 affected skeletal regions (60 patients with malignant diseases). Whereas sonography is inferior to conventional x-ray in respect of defects of the spongiosa, it is equal with regard to defects of the cortical layer but superior in respect of changes of the periosteum and the surrounding soft tissue. Moreover, there is an excellent correlation (97%) between pain and the reaction of periosteum and soft-tissue layer. Because of the three dimensional representation of the tumourous processes sonography has proved valuable in radiotherapy planning (field size, radiation method, risk organs etc.).
Adult↗
[Radiotherapy of pathological fractures and skeletal lesions in danger of fractures].
Radiotherapy is of great importance in the treatment of pathologic fractures and skeletal lesions bearing the risk of fracture which are induced by malignomas, especially if these are in an advanced stage. In dependence on site and extent of skeletal destruction as well as on the general tumor dissemination, it can be distinguished between palliative radiotherapy and curative radiotherapy aiming at analgesia and remineralization. A retrospective analysis of 27 pathologic fractures and 56 skeletal lesions bearing the risk of fracture in malignoma patients showed an analgetic effect obtained by radiotherapy in 67% of pathological fractures and in 80% of skeletal lesions bearing the risk of fracture, whereas a remineralization could be demonstrated for 33% of pathological fractures and 50% of destructions bearing the risk of fracture. A stabilization of destructions progressing before therapy was found in 55% of pathological fractures and 40% of skeletal lesions bearing the risk of fracture. Thus a partial loading, supported by orthopedic prostheses, was possible for more than 50% of all patients.
Adult↗