[Surgical treatment of spinal metastases]. / Chirurgische Therapie von Wirbelmetastasen.

An analysis of indications, techniques, results of decompression and stabilization in 164 spinal metastasis was carried out. Actual possibilities of rigid stabilization from the anterior and posterior approach are demonstrated.

[Effect of tumor size and lymph node status on the prognosis of pancreatic cancer]. / Der Einfluss von Tumorgrösse und Lymphknotenstatus auf die Prognose des Pankreascarcinoms.

Between 1982 and 1987 186 patients with a carcinoma of the pancreas underwent surgery. In 69 patients (37%) a resective surgical procedure was performed. In these patients, lymph node staging was conducted intraoperatively. The operative mortality of the resection was 4.3%. The median survival of the resected patients with papillary carcinoma was 21 months and of the patients with ductal pancreatic carcinoma 7 months. A correlation between survival time and frequency as well as localization of the lymph node attack could be established. Only patients in the TNM stage I of a ductal carcinoma appeared to have profited significantly from the resection compared to the palliative procedure.

High sensitivity and specificity of CA 19-9 for pancreatic carcinoma in comparison to chronic pancreatitis. Serological and immunohistochemical findings.

The serum carbohydrate antigenic determinant (CA 19-9) was assayed in patients with various diseases (87 patients with pancreatic carcinoma, 747 patients with benign diseases, and 547 patients with extrapancreatic malignant growths) and it proved to be particularly sensitive for adenocarcinoma of the pancreas (80 of 87, 92%) as compared to only 14% in the group of patients with benign diseases. Twenty-seven percent of the patients with chronic pancreatitis and 28% of the patients with acute pancreatitis showed elevated CA 19-9 concentrations of more than the upper normal value of 37 U/ml. In 38% and 32% of our cases with carcinoma of the stomach and colorectal carcinoma, respectively, CA 19-9 was estimated as being above the normal range. The preoperatively raised CA 19-9 concentration in patients with pancreatic carcinoma decreases after curative resection of the carcinoma to values within the normal range. However, in no CA 19-9 estimation following a palliative surgical intervention or in cases of inoperable carcinomas a serum concentration of less than 37 U/ml was recorded. In immunohistochemical specimens we found a difference between CA 19-9 antigen concentrations on the cell surface and secretion in pancreatic carcinoma and chronic pancreatitis.

[Therapy and prevention of reflux esophagitis. Results of a multicenter study with cimetidine. I: Epidemiology and results of acute therapy]. / Therapie und Prophylaxe der Refluxösophagitis. Ergebnisse einer Multizenterstudie mit Cimetidin. Teil I: Epidemiologie und Ergebnisse der Schubtherapie.

In a sequential observational study efficacy and safety of two dosage regimens of cimetidine for the treatment of reflux-oesophagitis (RE) were examined. 22 office-based specialists took part in the trial. 187 patients received 1600 mg cimetidine (400 mg q.i.d.) daily and 136 patients received 800 mg cimetidine (400 mg b.i.d.) daily, over twelve weeks. The two dosages proved to be equally effective. In the group of patients with RE of stage I at the beginning of the trial, the healing rates were 82% under 1600 mg cimetidine/die and 86% under 800 mg cimetidine/die. In the group of those patients, who entered the study with RE of stage II, in both dosage groups the lesions of 87% of the patients were healed completely or had decreased to stage I. The severity of the mucosal lesions was judged endoscopically, based on a classification scheme modified according to Savary and Miller. The incidence of unwanted symptoms was not significantly different in both dosage groups (1600 mg: 5.3%, 800 mg: 3.4%); none of the symptoms which occurred was judged as definitely caused by cimetidine. The patient collective of the trial was characterized epidemiologically; out of the risk factors examined, only duration of RE history and number of previous RE episodes correlated with the severity of the disease, smoking and alcohol consumption showed no influence.

[Bone marrow transplantation in chronic myeloid leukemia. Influence of gnotobiotic measures, especially antiviral prophylaxis]. / Knochenmarktransplantation bei chronischer myeloischer Leukämie. Einfluss gnotobiotischer Massnahmen, insbesondere antiviraler Prophylaxe.

Bone marrow from HLA-identical siblings was transplanted in 14 patients with chronic myeloid leukaemia (CML), including one patient in acceleration phase and one in chronic phase following 2 blast crises. Restoration of the bone-marrow occurred in all cases and Philadelphia chromosome could not be detected in any of the patients after the transplantation. Two patients died due to lung complications. Twelve patients who received antiviral prophylaxis (aciclovir per os, anti-CMV-hyperimmunoglobulin) after the transplantation are in very good condition with 140 to 790 days complete clinical and cytogenetic remission. Bone-marrow transplantation, as a curative measure for patients with CML up to the age of 45 (50), should be included in therapy schemes when an HLA-identical sibling is available.

Bone marrow transplantation for acute leukemia in second or subsequent remission.

Twenty-one patients with acute leukemia in second to fifth remission were treated with bone marrow transplantation: 19 patients with transplants from HLA-matched siblings and two with transplants from identical twins. Twelve patients survived from 15 to 1,625 days after transplantation: six of 11 in the ALL group and six of 10 in the AML group. Recurrence of leukemia after marrow transplantation occurred in five patients. The cause of death in five patients was infection, in two patients combined with graft-versus-host disease. Long-term disease-free survival can probably be achieved in 30%-35% of all patients with acute leukemia who receive a marrow transplant in second or subsequent remission.

[The course of pain in patients with confirmed duodenal ulcer under therapy with cimetidine]. / Schmerzverlauf bei Patienten mit gesichertem Ulcus duodeni unter Therapie mit Cimetidin.

In an open multicenter trial 1047 patients with endoscopically or X-ray verified duodenal ulcer were treated with 400 mg Cimetidin (Tagamet) b.i.d. The analysis of subjective pain records demonstrates 69% of the patients to suffer from severe pain before start of treatment while 3% were pain-free. Two days after start of treatment a statistically significant reduction (p less than 0.01) of intensity of pain has been proven. Five days after onset of treatment 30% of the patients are pain-free, 33% show minor impairment of well-being, 25% report moderate pain and 12% show clinically relevant pain.

[Bone marrow transplantation in patients with leukemia]. / Knochenmarktransplantation bei Patienten mit Leukämien.

Between October 1979 and March 1982, bone marrow transplantations were performed by the Tübingen Group for BMT on 19 patients with acute leukemia in remission and on one patient with chronic myelocytic leukemia in chronic phase. The conditioning regimen consisted of 2 x 60 mg cyclophosphamide/kg and 10 Gy whole-body irradiation with the linear accelerator. The lung dose was limited by shielding to 8 Gy. In 15 patients, the bone marrow cell suspension of the donor was preincubated with antihuman T-cell globulin (AHTCG) for prophylaxis of graft-versus-host disease (GVHD). All patients showed prompt engraftment of donor cells with good hemopoietic function and complete chimerism. Under reverse isolation in sterile units, no severe bacterial or fungal infections were seen in the phase of bone marrow aplasia. Twelve in twenty patients survived between 25 and 900 days. A severe GVHD was seen only in two patients - one after preincubation with AHTCG. One patient died from relapse of his leukemia, another patient had a testicular relapse which was treated with local radiotherapy. Major problems were seen with chronic GVHD (six patients) and infectious complications, most importantly interstitial pneumonia, in the late post-transplant period.

Nucleic acid hybridization studies on Microbacterium, Curtobacterium, Agromyces and related taxa.

Thirty strains of Agromyces, Arthrobacter, Curtobacterium, Brevibacterium, Corynebacterium and Microbacterium, exhibiting the rare peptidoglycan of group B, were subjected to extensive nucleic acid hybridization studies. The DNA homology values indicate that Corynebacterium insidiosum DSM 20157 is genetically identical with Corynebacterium michiganense DSM 20134. Corynebacterium sepedonicum NCPPB 378 and Corynebacterium nebraskense DSM 20400 are closely related to Corynebacterium michiganense DSM 20134. Corynebacterium betae DSM 20141, Corynebacterium oortii ATCC 25283 and Corynebacterium poinsettiae ATCC 9682 are genetically identical with Corynebacterium flaccumfaciens DSM 20129. In addition, Curtobacterium citreum ATCC 15828, Curtobacterium luteum ATCC 15830 and Curtobacterium pusillum ATCC 19096 share a high degree of relatedness to Corynebacterium flaccumfaciens DSM 20129. All other described species are more distantly related to each other. DNa-rRNA cistron similarity studies reveal that all corynebacterium with a peptidoglycan group B are members of one homogeneous cluster for which the rank of a genus is suggested.