[Clinical results of neutron therapy. Limitations and possibilities of a specialized management technic in present-day cancer therapy].
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Biomedical subjects
Publications and source records attributed to R Schwarz.
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Between 1977 and 1987, 30 patients with adenoid-cystic carcinomas of the head and neck region were treated, at the Hamburg-Eppendorf neutron therapy facility, with a 14 MeV-DT-generator. The present review deals with 15 patients treated before October 1986 e.g. with follow up longer than one year. These results, although preliminary, tend to confirm that fast neutrons is the best irradiation modality of adenoid-cystic carcinomas of the head and neck region, especially when surgery is not possible, or cannot be radical.
Radiotherapy in advanced and highly differentiated tumors of the inner nose and the paranasal sinuses is a particular challenge. A report is given about indication, performance and results of neutron therapy in 16 patients treated between 1976 and 1987 at the Radiological University Hospital Hamburg-Eppendorf. Neutron therapy proves to be of great efficiency, especially in case of adenoid cystic carcinomas as well as highly differentiated adenocarcinomas and sarcomas.
47 patients with primary ovarian cancer stage I c have been treated following radical operation additionally with an intraperitoneal instillation of 5.5 GBq radioactive gold colloid. 5-year survival rate was 87 per cent. Severe complications have not been observed.
All histological specimens obtained from patients with Stage-Ia cervical carcinoma, between 1966 and 1986, were re-examined and reclassified in a retrospective study for the purpose of checking on the validity of prognostic factors with relevance to cervical carcinoma at Stage Ia. The criteria valid at present were satisfied by 226 cases. No accurate sub-division by sub-groups Ia1 and Ia2 was possible by tumor measurement. Multicentric tumors were recorded in eight cases. Conisation proved to be an optimum approach to diagnosis of Stage-Ia cervical carcinoma. The percentual amount of histologically identified koilocytosis as an expression of preceding virus infections went up with significance from 13 to 34%. Maximum infiltration of 3 mm in depth was exhibited by 93% all tumours, while 5 mm infiltration was recorded by seven per cent. Significant correlations were found to exist between depth of infiltration, tumour volume, shape of growth, degree of differentiation, and involvement of lymphatic vessels.
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The study describes lectin reactivity of the developing vascular network in fetal mammalian skin. Skin samples were taken from fetuses of different gestational age of the pig, the goat and the cat. Clearly positive, endothelial lectin staining of capillaries and smaller vessels could only be obtained during mid gestation. The sequence of lectin reactivity, demonstrating: 1st alpha-D-N-acetylglucosamine and N-acetyl-alpha-D-galactosamine, 2nd alpha-D-galactose and sialic acid, and 3rd alpha-L-fucose, sialic acid and probably alpha-D-mannose/alpha-D-glucose residues, emphasizes different stages of cell surface coat as well as of cell membrane development. Thus, the typical outgrowth period of developing integumental blood vessels is reflected histochemically.
In corpora lutea of pregnancy of dairy cows delta 5-3 beta-hydroxysteroid dehydrogenase and succinate dehydrogenase were demonstrated histochemically and evaluated densitometrically. Serum progesterone was determined radioimmunologically. Activities per volume unit of delta 5-3 beta-hydroxysteroid dehydrogenase and succinate dehydrogenase in large and small luteal cells as well as progesterone concentrations, exhibited no typical and correlated pattern during pregnancy. Large luteal cells in regressive tissue regions showed weaker delta 5-3 beta-hydroxysteroid dehydrogenase activities than in maturing or well-developed tissue regions. Succinate dehydrogenase activities of small luteal cells were highest in regressive luteal tissue. The results indicate that structural development of bovine luteal tissue during pregnancy is reflected by corresponding enzyme activities.
After change of management at the Radiotherapy Department of the University of Hamburg also a change in treatment policy resulted. Of 72 patients treated since then 63 had soft-tissue sarcomas (at 83 localisations) and 13 adenoid-cystic carcinomas, only ten were treated for other indications. Neutrons only were applied in contrast to many boost applications in the past. The total doses administered were between 13.6 and 16 Gy and the doses per fraction between 0.8 and 1.2 Gy depending on tumor mass and localisation. To compare the treatment modalities all earlier treated patients with soft tissue sarcomas were reexamined and the results critically compared to earlier reported ones. There were considerable differences in the side effects found now and reported earlier. Moderate or severe fibrosis was found in 13% of the cases who received less than 13.4 Gy and in 54% of the cases who received a higher total dose. In the new series up to now only in 15 cases local recurrences and in eleven cases distant metastases occurred. Nothing can be yet said on the late effects.
A report is given on 226 cases of stage Ia cervical carcinoma from 1966 to 1986. One third of the patients were younger than 30 years. Only 23% of all cases had symptoms which lead to further diagnostics. When coming to hospital 12% of the cases did not have any cytological smear. The remainder of the patients had an unphysiological cervical smear. Colposcopy showed an unphysiological result in 74% and a physiological result in 3%. 23% of the patients did not have any colposcopy when coming to hospital. Cervical biopsies are insufficient to clarify a suspicious case. The importance of conisation for making the diagnose "stage Ia cervical carcinoma" is explained.
A report is given on histomorphological and tumormetrical examinations of 226 patients with stage Ia cervical carcinoma. Stage Ia cervical carcinoma is a well to moderate differentiated squamous cell carcinoma. Netlike tumors had a significant higher frequency of invasion of lymph vessels than carcinomas with drop infiltration. Undifferentiated tumors had a significant higher frequency of invasion of lymph vessels than well differentiated carcinomas. Invasion of lymph vessels also depended on the depth of infiltration and the tumor volume. A division into the substages Ia1 and Ia2 by tumormetry was not possible. During the periods of examination koilocytosis as a sign of viral infection of the vagina significantly grew up.
A report is given on therapy and healing results of 226 patients with stage I a cervical carcinoma from 1966 to 1986. The five-years-survival-rate is 94%. Two patients (1%) had a recurrence, another patient died from tumor progression. The tendency of more conservative operation procedures is to be expected during the examination period. Because of a frequency of lymph node metastases of less than 1% lymphadenectomy is not indicated. When having practised cone biopsy and checking clinical and histomorphological parameters by a tumor-score there are given therapeutic recommendations for stage I a cervical carcinoma.
In order to clarify the controversial issue of informing cancer patients of their condition, the following questionnaire was administered to 41 patients with cancer, and 106 patients with other conditions. The questions were: How often and in what form will cancer patients be informed about the nature of their illness? What types of reactions followed? How often did hopelessness and suicidal phantasies arise? What type of support system was the most helpful? The result showed that 90% of all patients wanted to be informed; 85% of the patients with cancer reacted with great anxiety: an increased loss of hope and risk of suicide was not encountered; the most important support system is the family and the patient's trust in the doctor.
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Both uterine horns of 14 dairy cows with ovarian follicular cysts, and four animals affected with purulent endometritis were flushed via catheter using 30 ml phosphate buffered saline, following evisceration at a local abattori. Activity in the flushing media of alkaline phosphatase (ALP) and aspartate aminotransferase (GOT) were examined. Ovaries were prepared for light microscopy. Amount and morphological integrity of luteinized tissue found on the ovaries were reflected by correspondent levels in ALP activity, which was higher in the media taken from the ipsilateral to the luteal tissue situated uterine horns (651 +/- 228 vs 244 +/- 62 u/l, n = 3). Only cows having relatively large amounts of luteal tissue on the cystic ovaries (as in luteinized follicular cysts) exhibited very high ALP activity in uterine flushings (2693 +/- 1348 u/l, n = 2). Results suggest the existence of local relationships between luteal tissue in the ovary and the ipsilateral uterine horn in cows with ovarian follicular cysts.
Cyanobacterial cells accumulate substantial amounts of a membrane-associated 42 kilodalton polypeptide during adaptation to low CO(2) conditions. The role of this polypeptide in the process of adaptation and in particular in the large increase in the ability to accumulate inorganic carbon (C(i)), which accompanies this process, is not yet understood. We have isolated a mutant Synechococcus PCC7942 that does not accumulate the 42 kilodalton polypeptide. The mutant requires a high-CO(2) concentration for growth and exhibits a very low apparent photosynthetic affinity for extracellular C(i). The latter might be attributable to the observed defective ability of the mutant to utilize the intracellular C(i) pool for photosynthesis. The 42 kilodalton polypeptide does not appear to participate directly in the active transport of C(i), since the difference between the observed capabilities for CO(2) and HCO(3) (-) uptake of the mutant and the wild type is not sufficient to account for their different growth and photosynthetic performance. Furthermore, high CO(2)-grown wild-type cells, where we could not detect the 42 kilodalton polypeptide, transported CO(2) faster than the mutant. An analysis of the curves relating the rate of accumulation of C(i) to the concentration of CO(2) or HCO(3) (-) supplied, in the presence or absence of carbonic anhydrase, indicated that under the experimental conditions used here, CO(2) was the preferred C(i) species taken up by Synechococcus.
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