[Follow-up evaluation of metastatic neuroblastoma using high dose [131I-meta]iodobenzylguanidine]. / Verlaufsbeurteilung des metastasierten Neuroblastoms mittels hochdosiertem [131J-meta]Jodobenzylguanidin.

Between 1989 and 1990 nine children with neuroblastoma stage IV (according to Evans) have been treated with high-dose [131I-meta]Iodobenzylguanidine (HD-mIBG). The total HD-mIBG dose administered to each child was at mean 699.3 +/- 111 MBq/kg body weight. Prior to (median 28 days) and after (median 50 days) HD-mIBG treatment a diagnostic scan with [123I-meta]Iodobenzylguanidine ([123I-m]IBG) was performed. Scans performed with HD-mIBG were superior to diagnostic scans for the detection of bone lesions in 8/9 children, for the detection of soft tissue lesions in 4/9 children, and for a more precise diagnosis of the primary tumor in 1 child. In 4 children lesions which were primarily identified in the therapeutic scan could be further observed in posttherapeutical examinations.

[131(I)-meta-iodobenzylguanidine treatment of 32 children with therapy-refractory neuroblastoma]. / 131J-Metajodbenzylguanidin-Behandlung bei 32 Kindern mit therapierefraktärem Neuroblastom.

The selective uptake and accumulation of 131J-Metaiodobenzylguanidine in neuroblastoma cells in vivo may be utilized for targeted irradiation. The experience with 32 neuroblastoma patients refractory to conventional high dose chemotherapy is reported. At diagnosis 8 patients had Evans stage III and 22 stage IV. 11/32 experienced recurrences after complete tumor disappearance and before mIBG treatment, 16/32 progressed from residual or nonresponding tumor and in 3/32 insufficient tumor regression by chemotherapy was observed. 2 children received one mIBG course each with no evidence of disease. Mean applied activity was 128 mCi per course (35-300 mCi), 360 mCi per patient (80-1033 mCi) and 19.2 mCi/kg per patient (3.2-37.9 mCi/kg), respectively. A total of 84 courses was given (mean 2.6 per patient). Pain relief was noticed in 14/14 patients with bone pain. Complete or very good partial remission was achieved in 5/32, partial remission in 11/32 and stable disease in 6/32 patients. In 8 children progression occurred and 2 patients were not evoluable. 20 children died, 12 are still alive (6 patients with initial stage IV, 6 with stage III disease). Main side effect was transient thrombocytopenia, which became more severe with increasing number of courses. We conclude that mIBG treatment is effective in some patients with refractory neuroblastoma and may be utilized in the future as front line therapy for patients achieving only incomplete regressions after high dose chemotherapy.

[The quality of washed autotransfused erythrocytes. The elimination of plasma hemoglobin, osmotic fragility and survival rate of retransfused erythrocytes]. / Die Qualität gewaschener autotransfundierter Erythrozyten. Untersuchungen zur Elimination von Plasmahämoglobin, osmotischen Resistenz und Uberlebensrate retransfundierter Erythrozyten.

Intraoperative transfusion has until recently been understood to mean full retransfusion of the blood removed by a suction pump without significant changes due to external influences, which considerably limited its utilization. Intraoperative transfusion can only be performed without decisive disadvantages when the blood can be suctionally removed in large amounts and immediately retransfused. In recent years, the Cell Saver has provided a system which can also prepare soiled blood for retransfusion. Extensive orthopedic surgery entails large blood losses due to oozing from expanded wound areas; only rarely does acute bleeding occur. Because of intensive tissue contact, the suctioned blood has been soiled with activated clotting factors, lytic enzymes, free haemoglobin from damaged red cells, cleaning solutions, and other undesired elements. With the Cell Saver system, it is possible to remove the plasma and recover 70-80% of the intact red cells sufficiently freed from stroma and free haemoglobin. The osmotic fragility of these cells served as a measure of integrity and membrane stability. They were compared to red cells withdrawn preoperatively and showed an identical osmotic relationship. Determining the survival rate of the retransfused cells in vivo shows that they provide a high-quality and in most cases, a sufficient replacement of blood loss. Even after 6 days, over 70% were found in the circulating blood. Premature, disproportionate elimination, which could be dangerous for the patient, does not occur.