A phase III trial of topotecan and whole brain radiation therapy for patients with CNS-metastases due to lung cancer.

Brain metastases represent an important cause of morbidity in patients with lung cancer and are associated with a mean survival of less than 6 months. Thus, new regimens improving the outcome of these patients are urgently needed. On the basis of promising data raised in a phase I/II trial, we initiated an open, randomised, prospective, multicentric phase III trial, comparing whole brain radiation therapy (WBRT; 20 x 2 Gy) alone with WBRT+topotecan (RCT; 0.4 mg m(-2) day(-1) x 20). A total of 320 patients with CNS-metastases due to SCLC or NSCLC were projected. The primary end point was overall survival, whereas second end points were local response and progression-free survival. However, until the cutoff date of study completion (i.e., a study duration of 34 months), only a total of 96 (RCT:47, WBRT:49) patients had been recruited, and so an analysis was performed at that time point. Although the numbers of grade 3/4 non-haematological toxicities (besides alopecia 115 (RCT/WBRT: 55 out of 60) were evenly distributed, the 25 haematological events occurred mainly in the combined treatment arm (24 out of 1). Local response, evaluated 2 weeks after treatment, was assessable in 44 (RCT/WBRT: 23 out of 21) patients, showing CR in eight (3 out of 5), PR in 17 (11 out of 6), SD in 14 (8 out of 6) and PD in five (1 out of 4) patients (all differences n.s.). Neither OAS (RCT/WBRT: median (days)): 87 out of 95, range 3-752/4-433; HR 1.32; 95% CI (0.83; 2.10)) nor PFS (median (days)): 71 out of 66, range, 3-399/4-228; HR 1.28, 95% CI (0.73; 2.43) differed significantly. On the basis of these results and the slow recruitment, a continuation of the study did not seem reasonable. The available data show no significant advantage for concurrent radiochemotherapy for patients with lung cancer; however, the recruited number of patients is too low to exhibit a small advantage of combined treatment.

Cerebral magnetic resonance imaging findings in multiple sclerosis. Relation to disturbance of affect, drive, and cognition.

Forty-six patients with multiple sclerosis were rated with respect to their psychologic symptoms, and magnetic resonance imaging was performed. A significant correlation between the cerebral multiple sclerosis manifestations and the psychologic scores was found. The periventricular and frontal lesions seem to be the most important lesions for the psychologic symptoms of patients with multiple sclerosis.

Positron emission tomography reveals a leiomyosarcoma causing proteinuria.

Obstruction of the renal veins may result in proteinuria and is frequently caused by thrombosis or tumorous processes. Since thrombosis and malignancy may occur simultaneously in the venous outflow of the kidneys, search for an underlying intraluminal tumor may be impeded by extensive thrombosis in the lumen of renal and caval veins. We report the case of a 30-year-old man with moderate proteinuria which was caused by an obstructing process of the vena cava inferior and the renal veins. While the obstructive mass was initially misdiagnosed as thrombosis, positron emission tomography helped to reveal the tumorous character of the lesion and fine-needle biopsy allowed rapid diagnosis of a leiomyosarcoma originating from the caval or renal veins. We conclude that undelayed diagnosis of the cause of renal and caval vein obstruction is facilitated by early positron emission tomography and subsequent fine-needle biopsy to identify possible tumorous lesions.

The automated waterpath scanner (Octoson)--advantages and limitations in diseases of the liver, pancreas and gallbladder.

In a comparative study of 591 examinations the Octoson and a conventional ultrasound scanner were analysed. Examinations with the Octoson showed a sensitivity of 92% and with a conventional ultrasound scanner a sensitivity of 82% in diseases of the liver. With the long focus of the Octoson's large aperture transducers, it is possible to demonstrate both superficial and deep subdiaphragmatic metastases. It is difficult, however, to find the optimal scanning angle with this system, and for this reason examinations undertaken in disorders of the gallbladder and bile ducts require considerably more time. In pancreatic disease (Octoson sensitivity: 77%; conventional ultrasound scanner sensitivity: 65.35%) the favourable air distribution in the stomach and transverse colon is advantageous when the examination is performed with the patient in the prone position.

Lissencephaly: diagnosis by computed tomography and magnetic resonance imaging.

A patient with Miller-Dieker-Syndrome, which is associated with lissencephaly, was examined by Computed Tomography (CT) and Magnetic Resonance Imaging (MRI). While CT demonstrated the main features of lissencephaly, MRI detected disturbed myelination and cell migration in the cerebral hemispheres and a normal appearance of the cerebellum. MRI provides more accurate information of the pathomorphologic changes of lissencephaly and is thus superior to CT.

[The value of sonography for the discovery of complications after the implantation of silicone gel prostheses for breast augmentation or reconstruction]. / Stellenwert der Sonographie für die Aufdeckung von Komplikationen nach Implantation von Silikongelkissen zur Mammaaugmentation bzw. -rekonstruktion.

PURPOSE: To determine sensitivity and specificity of real-time ultrasonography in detecting breast implant complications. MATERIAL AND METHODS: The results of preoperative ultrasonography of 121 silicone implants in 65 patients were compared with the results after operative implant removal. RESULTS: With a sensitivity of 89.25% and a specificity of 92.1%, complications such as gel bleeding (n = 43), rupture with leakage (n = 63), and implant dissolution (n = 4) become manifest. Capsule formation, fibrosis, siliconoma and calcifications were often underestimated in their extent. Negative ultrasonography findings were found in 10.7% (n = 13) with positive clinical findings. CONCLUSIONS: The combination of clinical and ultrasonography findings leads to the detection of implant complications.

[Comparison of computed tomography, automated multisector scanner (Octoson) and conventional ultrasound in pancreatic diseases]. / Vergleich Computertomographie, automatisierter Multisektorscanner (Octoson), konventioneller Ultraschall bei Pankreaserkrankungen.

Two hundred and eighty-six patients suspected of having pancreatic disease were examined by computed tomography, Octoson and conventional ultrasound. Computed tomography with angio-CT had the highest sensitivity (87.4%). The Octoson, with a sensitivity of 77.16% was better than conventional ultrasound, which had a sensitivity of 65.35%. Specificity for CT was 91.2%, for the Octoson 88.67% and conventional ultrasound 85.5%. The better results of the Octoson examination are due to the thin air gap when the patient is prone and the greater focal length of the large transducer and the somewhat more stable focus.

[Direct cervical myelography using iotrolan 300]. / Die direkte zervikale Myelographie mit Iotrolan 300.

A prospective study of direct cervical myelography with Iotrolan 300 showed the following advantages: 1. Clear differentiation of the nerve roots. 2. Increased retention of contrast in the cervical region. 3. Improved contrast compared with conventional contrast media. 4. Optimal contrast temperature was found to be between 20 and 22 degrees C. 5. Reduction in non-specific and central nervous system complications.

[Optimization of conditions for detecting density variations in focal activity in SPECT using the rotating gamma camera. Model calculations, phantom measurements and clinical applications]. / Optimierung der Nachweisbedingungen von fokalen Aktivitätsdichteschwankungen, in der SPECT mit der rotierenden Gammakamera. Modellrechnungen, Phantommessungen, klinische Anwendungen.

The signal to noise ratio (quotient of contrast and mean noise) is a quality parameter for identifying activity gaps during single photon emission computed tomography (SPECT). Contrast and mean noise level are site-dependent on the reconstruction plane which is influenced in a complex manner by absorption conditions (strong or weak absorption), modes of rotation (full angle or partial angle imaging), interdependencies of opposing partial projections (arithmetic or geometric mean), magnitude of defect (relative to the resolution of the imaging system), geometry of the object to be measured, and scatter. In the present study the authors performed analysis and graphical representation of the SPECT imaging properties on the basis of model calculations illustrated by phantom measurements. The optimal conditions of examination or evaluation and the diagnostic criteria in SPECT of the heart, liver, brain and pelvis are discussed by comparative calculation of signal to noise ratios in defect identification.

[Comparison of 133xenon and 123I-isopropylamphetamine for measuring regional cerebral circulation]. / Vergleich von 133Xenon und 123J-Isopropyl-Amphetamin zur Messung der regionalen Hirndurchblutung.

In 26 patients the regional cerebral blood flow was measured using 123I-isopropyl-amphetamine. The measurement was performed with a dynamic single photon emission tomograph. In 16 patients we compared the findings with the results of the tomographic 133Xe-Clearance. Both methods seem to be suitable for the measurement of the effective perfusion and gave similar results. In the case of the tomographic 133Xe-clearance we need a more specialized technical equipment whereas the permanent costs are lower and the performance less complicated. Besides the applicability of this method is more universal. On the contrary the use of 123I-isopropyl-amphetamine makes a higher resolution possible depending on the available equipment and does not need an ability to cooperation of the patient. With the presently disposable radionuclides the hope was not yet adequately accomplished, to get a tomographic in-vivo-information of cerebral metabolic and receptor-functions by means of SPECT.

[Measurement of regional cerebral blood flow as a supplement to carotid angiography in assessing cerebrovascular insufficiency]. / Die Messung der regionalen Hirndurchblutung als Ergänzung der Karotisangiographie zur Beurteilung der zerebrovaskulären Insuffizienz.

The examination of 91 patients was undertaken in order to establish the relevance of tomographical measurement of the regional cerebral blood-flow, following inhalation of 133Xenon, as a complementary method to the conventional carotis-angiography. In many cases the findings revealed a more precise or even deviating judgement on the hemodynamic relevance of stenosis and obliteration than was proved only by angiography. Especially in the stages I and IV of cerebrovascular disease of the a. cerebri anterior, a. carotis interna and a. carotis communis the rCBF-measurement seemed to be an important parameter for the decision between conservative and surgical therapy as a prognostic parameter for the individual risk of many patients to suffer a cerebral infarction.

[Noninvasive tomographic measurement of regional cerebral blood flow]. / Tomographische nicht-invasive Messung der regionalen Hirndurchblutung.

The measurement of the regional cerebral bloodflow by means of the dynamic single-photon-emission-computed tomography is a method of examination which is completely free of risk for the patient, causes no inconvenience and can be repeated whenever it seems necessary. This method gives a quantitative explanation for the distribution of the effective cerebral perfusion and can only be substituted by the very complicated positron-emission-computed tomography. As well as the exact assessment of the hemodynamic relevance of cerebral vascular disease, this method enables us to prove whether or not in various types of psychiatric disorders an interference in the regional perfusion exists. This method can also contribute to the clarification of pathogenic mechanisms, as well as to the nosological classification of specific psychopathological conditions.

[Diagnostic significance of intravenous digital subtraction angiography of the supra-aortic extracranial vascular system. Comparative study of i.v. DSA and plain film angiography]. / Diagnostische Aussagekraft der intravenösen digitalen Subtraktionsangiographie des supraaortalen extrakraniellen Gefässsystems. Eine vergleichende Studie von i.v. DSA und Blattfilmangiographie.

Digital intravenous subtraction angiography (DSA) and conventional film angiography were used to evaluate the diagnostic reliability of DSA-examinations. In 90% of 650 DSA-angiogramms the image quality was diagnostic. For 124 carotid angiographies a comparison of both methods was possible and gave a sensitivity of 87%, a specificity of 96% and an accuracy of 90% for the DSA examinations. The authors believe that digital subtraction angiography is suitable as a screening method for supraaortal vascular occlusive diseases.

[The reliability of myocardial scintigraphy with thallium201, A comparison with lacvocardiography and perfusion scintigraphy (author's transl)]. / Zur Zuverlässigkeit de Myokardszintigraphie mit Thallium 201-Vergleich mit der Lävokardiographie und der Perfusionsszintigraphie

Eighteen patients were investigated by laevocardiography, perfusion scintigraphy and with a 201thallium scan. In four patients with normal contractility of the left ventricle, normal uptake of 202thalium was found in every patient. Hypokinesia of the anterior wall or apex of the ventricle showed normal uptake on the 201thallium scintigram in four out of five patients. It follows that it is not usually possible to diagnose hypokinetic mural portions on 201thallium scintigrams without quantitative analysis. Our experience up to date with areas of akinesia has shown that it is possible to demonstrate areas of scarring (as negative contrast) in seven out of nine cases.

[Results of myocardial perfusion scintigraphy (author's transl)]. / Ergebnisse der myokardialen Perfusionsszintigraphie.

Myocardial perfusion scintigraphy by means of the microsphere technique is a valuable method for detecting regional myocardial scars. The use of the microsphere technique is indicated in all patients who have had myocardial infarction and before coronary bypass operations. In a certain group of patients with severe but atypical angina pectoris and a normal coronary arteriogram and in some arrhythmias the perfusion scintigram can provide information on changes coronary microcirculation. The assessment of myocardial blood flow redistribution under pharmacological intervention is a further indication for the microsphere technique.

[Myocardial perfusion scintigraphy - methods and fundamentals (author's transl)]. / Die myokardiale Perfusionsszintigraphie Methodik und Grundlagen.

Myocardial perfusion studies with labelled particles make a detailed analysis of the distribution of myocardial perfusion possible. Methodical and physiological fundamentals are described and the reliability of the method is shown by double radionuclide imaging. LAD-stenoses (greater than 70%) show a decreased activity in the distal areas of the LAD (on the average 36,5 +/- 10,3% in contrast to 59 +/- in normals). Mean local activity is 14,9 +/- 1,8% within scars. Scars and hemodynamically effective stenoses can be imaged with high sensitivity. Total defects (smaller than 15% of the activity maximum) correspond to a scar. A moderate reduction of uptake (15--50% of the activity maximum) does not allow any differentiation between scar and reversible diminution of perfusion.

Diagnosis of spinal arteriovenous malformations by MRI at 1.0 T.

Eight patients were examined by magnetic resonance imaging (MRI) at 1.0 T; seven had an angiographically proved spinal intradural arteriovenous malformation and one had a hemangioblastoma of the spinal cord. Myelography was also performed in five and computed tomography (CT) in four patients. The clinical and radiological findings are presented. MRI revealed the location and extent of the lesion. Myelomalacia, edema, and hematomyelia were demonstrated in three patients. In our opinion MRI is the method of choice for the diagnosis of spinal arteriovenous malformation and facilitates spinal angiography, whereas myelography and CT do not provide any further information.

[Hepatic adenoma and hepatocellular carcinoma in 3 brothers with type I glycogenosis]. / Adénome hépatique et carcinome hépatocellulaire chez deux frères atteints de glycogénose de type I.

We report 2 cases of type I glycogen storage disease (Von Gierke's disease) discovered in 2 brothers at the age of 7 and 5 years, respectively. Both developed hepatic adenoma at the age of 19 and 17. Hepatocellular carcinoma occurred in the older brother the discovery of adenoma 4 years after. The frequency of these tumors in patients with type I glycogen storage disease raises problems concerning the treatment and modality of regular surveillance of the liver in these patients. The policy for the detection and treatment of these tumors, and particularly the indications for liver transplantation are discussed.

[Can nuclear magnetic resonance tomography supplement and expand splenic diagnosis in malignant systemic diseases? Comparison of nuclear magnetic resonance tomography, ultrasound and computerized tomography findings]. / Kann die Kernspintomographie die Milzdiagnostik bei malignen Systemerkrankungen ergänzen bzw. erweitern? Vergleich kernspintomographischer, sonographischer und computertomographischer Befunde.

Can magnetic resonance imaging supplement or expand the diagnostic evaluation of the spleen in malignant systemic disease? A comparison of magnetic resonance imaging, ultrasonography and computed tomography.