Biomedical subjects
Publications and source records attributed to R Ludwig.
Report of a 13-year-old boy who developed osteolytic lesions in the chronic phase of myelogenous leukemia. Five months later a blastic crisis followed.
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Twelve children with their first relapse of acute lymphoblastic leukemia who had the same initial therapy were treated on an out-patient basis. After 28 days all entered second remission. Medium remission duration was 11 months. At the end of the study seven patients were in continuous complete remission. Of the twelve children seven suffered bone marrow, two meningeal, two testicular relapses and one a combined bone marrow and meningeal relapse. Side effects were compatible with an out-patient treatment.
Case report of a child with pericardial effusion and septic fever. Increasing mediastinal enlargement and osteolytic lesions were obviously not caused by inflammation. Open thoracic surgery revealed a lymphangioma inaccessible to resection.
During the early phase of their disease three children with acute lymphoblastic leukemia showed unusual skeletal changes radiologically. Mainly osteolysis in the lower jaw, opacity of the sinus, decreased hight of the vertebrae, and a unilateral necrosis of the head of the femur. These skeletal alterations are much more common in other diseases than in acute lymphoblastic leukemia.
Alpha1-Acid glycoprotein (AGP) was quantitated by an electroradioimmunoassay (ERIA) in in vivo neutralized gastric juice (nGJ) of 226 patients, including normals and patients with various gastic diseases. The accuracy of ERIA was tested by extraction and recovery experiments. A possible interference of nGJ constituents with the quantitation procedure was excluded. The mean AGP concentration in gastric juice of normals was 1.04 mu/ml (range 0.04-4.1 mu/ml). The concentration was significantly higher in the gastric cancer group (mean 31.6 mu/ml, p less than 0.01), in the group of chronic metaplastic gastritis (mean 5.7 mu/ml, p less than 0.01) and in the group of BII resections (mean 8.8 mu/ml, p less than 0.05). In 6 out of 12 nGJ samples with high AGP concentrations, a spur formation (Ouchterlony type III) was observed in double gel diffusion when compared to serum AGP. In 3 out of these 12 samples, the dilution curve in ERIA differed from the serum AGP dilution curve. These results indicate a difference in the antigenic properties of AGP in nGJ.
Gastric juice was neutralized (nGJ) in vivo by 80 ml of a phosphate buffer containing radiolabelled vitamin B12 as dilution indicator. Unprocessed nGJ was analyzed in the double gel diffusion technique for the presence of serum proteins using monospecific antisera. Alpha1-Acid glycoprotein (AGP) was found in a high incidence (36 out of 38 subjects) in nGJ of gastric cancer patients. AGP was also observed less frequently in nGJ of patients with Billroth II resections (6/15), metaplasia (11/52), gastric ulcer (3/24), chronic atrophic gastritis (2/26) and chronic gastritis (3/63). AGP was absent in the control group (0/21), in patients with surface gastritis (0/38) and in subjects with normal acid secretion (0/45). Immunochemical studies demonstrated no identity of AGP with human "gastrointestinal tumor associated antigens." In 7 out of 17 AGP positive samples immunochemical differences between gastric and serum AGP were observed.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
OBJECTIVE: Treatment of fractures of the proximal femur by open reduction and internal fixation is prone to complications and frequently requiring secondary joint replacement. The aim of the present study was to examine the results of total hip arthroplasty as a salvage procedure for failed internal fixation of femoral or acetabular fractures. PATIENTS AND METHODS: We retrospectively studied 145 patients who had undergone 146 total hip arthroplasties for failed internal fixation of femoral (n = 135) or acetabular fractures (n = 11). Mean follow-up time after insertion of the hip endoprosthesis was 7.1 years (1.5-14.7 years). Patient evaluation included a history, clinical examination, and standard radiographs. RESULTS: Twenty-eight patients had died, and 18 patients were lost to follow-up. Kaplan-Meier analysis with revision of the implants as the end-point demonstrated 85 percent survival after ten years. Using the Merle d'Aubigné rating system, we found good or excellent results in 85 percent of the cases. However, only 73.9 percent of the patients were satisfied with their result, and 40.9 percent still showed a positive Trendelenburg gait at follow-up. The perioperative mortality was 2.7 percent. Surgery-related femoral fractures or fissures were observed in 18 cases, and deep infections in four. CONCLUSIONS: In comparison with data of patients who had undergone primary total hip arthroplasty for osteoarthritis in our department, the results reported here after secondary hip replacement are clearly inferior. Nonetheless, alloarthroplasty of the hip still is the most effective procedure after failed internal fixation for acetabular or proximal femoral fractures.
The therapeutic strategy of the SIOP-9 study includes pre-operative chemotherapy for all patients with nephroblastoma diagnosed by imaging methods aged between 0.5 and 16 years. By pre-operative chemotherapy the rate of radical resectable tumors should be increased and thereby the intensity of postoperative therapy, in particular of radiotherapy, diminished. Patients with nephroblastoma stage I-III were in case of tumorresponse randomised in either a 4 weeks or 8 weeks arm of pre-operative treatment with ACT D and VCR. The question was, if a prolongation of pre-operative chemotherapy could increase the relative part of stage I. Between 1/1/89 and 6/30/91 from 49 oncologic centres of former western Germany 188 patients were registered in the SIOP-9/GPO. From the stage I-III patients between 0.5 and 16 years 80.1% were pretreated with cytostatic agents. Only 53.9% of the patients with tumorresponse were randomised. The relative frequency of intraoperative ruptures was with 3% lower in the group of pretreated patients than in the primary operated (15.3%). The stage distribution for all Wilms' tumor patients showed a prevalence of stage I with 43.3% (after pre-operative treatment 59%; after primary operation 28%). Abdominal radiotherapy was performed in 22.4%. The event-free survival rate of all nephroblastoma lay at 85% 3 years after diagnosis (stage I standard 96%; unfavorable histology all stages 45%). 7.3% of the patients developed a hepatopathy under treatment and 7.8% even a VOD according to the criteria of McDonald.(ABSTRACT TRUNCATED AT 250 WORDS)
According to the international SIOP 9 study preoperative chemotherapy for patients between 6 months and 16 years old is a major component of the therapeutic management of Wilms' tumour. Prior to treatment, the diagnosis is established by diagnostic imaging alone, without biopsy. This study was therefore undertaken to verify the accuracy of diagnostic imaging in the German GPO study group. Between July 1988 and November 1990, 156 patients with known histology were registered in the study centre. Of these patients, 67% (105/156) received preoperative chemotherapy. The diagnosis was initially established by US, TVP and CT, and in some cases MRT without prior biopsy. Of these preoperatively treated patients, 92.4% (97/105) had Wilms' tumour or one of its variants. Five patients had a different malignant tumour. Three cases, i.e. 2.8% of the preoperatively treated patients or 1.9% of all registered patients with known histology, had benign tumours of the kidney. Morphologically, the Wilms' tumour was revealed by a characteristic inhomogeneity in sonography and the CT scan. The inhomogeneity in the CT scan increased following injection of contrast medium. Intratumoral bleeding and cystic areas were observed frequently in the native scan. Calcifications were seen in 5% of the cases. The predictive value of pretherapeutic diagnostic imaging was good enough to justify instituting chemotherapy without diagnostic biopsy. It is still difficult in diagnostic imaging to differentiate the very rare benign cystic nephroma from malignant nephroblastoma. Intravenous pyelography proved to be the best method for distinguishing extrarenal from renal tumours.
99 children with non-Hodgkin's lymphoma entered the prospective, multicenter BFM study 81/83. They were treated with a four-fold stratified therapy according to clinical stage and origin of the lymphoma from B- or non-B-lymphocytes. In the BFM study 75/81, these criteria had been proven to be most relevant for prognosis. Therapy of non-B-NHL was very similar to the therapeutic concept as applied in acute lymphoblastic leukemias by the BFM group. For the NHL of B-type, a new therapeutic regimen was developed. Cytostatic drugs applied in this group were: medium dose methotrexate, cyclophosphamide in a fractionated manner of application, adriamycin, cytarabine, VM 26 and prednisone. The probability of disease-free survival was 80% after nearly 3 years for all patients. In non-B-NHL it was 89% in localized, and 79% in disseminated disease. All patients with localized B-NHL are surviving without relapse, while the probability of disease-free survival in patients with disseminated B-NHL was 67%. Thus, the therapy result in the latter group was doubled as compared to the result of the BFM study 75/81.