[Lutetium-177-PSMA radioligand therapy : Consensus within the framework of GKV-funded care between the university hospitals in Aachen, Bonn, Düsseldorf, Essen, and Cologne and the MDK Nordrhein]. / Lutetium-177-PSMA-Radioligandentherapie : Konsensus im Rahmen der GKV-finanzierten Versorgung zwischen den Hochschulkliniken in Aachen, Bonn, Düsseldorf, Essen und Köln und dem MDK Nordrhein.

In the last 3 years, Lutetium-177 prostate-specific membrane antigen radioligand therapy (Lu-177-PSMA-RLT) has received increasing attention in nuclear medicine as a new form of treatment for castration-resistant metastatic prostate cancer. This therapy combines the radionuclide Lutetium-177, which has been therapeutically used in nuclear medicine for many years, with a molecular target of the transmembrane prostate-specific membrane antigen expressed by prostate cancer cells. Since there are no prospective randomized studies on Lu-177-PSMA-RLT and the question of reimbursement has repeatedly been the subject of review by the MDK Nordrhein (Medischenische Dienst der Krankenversicherung), there was a desire because of the increasing number of patients being treated to clarify under which circumstances Lu-177-PSMA-RLT can be reimbursed by German statutory health insurance. The goals of this article are to help treating physicians understand how this new therapy option works, to integrate it in the overall therapy concept for castration-resistant metastatic prostate cancer, and, above all, to use Lu-177-PSMA-RLT-based on the current data-at the right place in the therapy sequence of castration-resistant metastatic prostate cancer.

Availability of arsenic, copper, lead, thallium, and zinc to various vegetables grown in slag-contaminated soils.

To anticipate a possible hazard resulting from the plant uptake of metals from slag-contaminated soils, it is useful to study whether vegetables exist that are able to mobilize a given metal in the slag to a larger proportion than in an uncontaminated control soil. For this purpose, we studied the soil to plant transfer of arsenic, copper, lead, thallium, and zinc by the vegetables bean (Phaseolus vulgaris L. 'dwarf bean Modus'), kohlrabi (Brassica oleracea var. gongylodes L.), mangold (Beta vulgaris var. macrorhiza ), lettuce (Lactuca sativa L. 'American gathering brown'), carrot (Daucus carota L. 'Rotin', 'Sperlings's'), and celery [Apium graveiolus var. dulce (Mill.) Pers.] from a control soil (Ap horizon of a Entisol) and from a contaminated soil (1:1 soil-slag mixtures). Two types of slags were used: an iron-rich residue from pyrite (FeS2) roasting and a residue from coal firing. The metal concentrations in the slags, soils, and plants were used to calculate for each metal and soil-slag mixture the plant-soil fractional concentration ratio (CRfractional,slag), that is, the concentration ratio of the metal that results only from the slag in the soil. With the exception of TI, the resulting values obtained for this quantity for As, Cu, Pb, and Zn and for all vegetables were significantly smaller than the corresponding plant-soil concentration ratios (CRcontrol soil) for the uncontaminated soil. The results demonstrate quantitatively that the ability of a plant to accumulate a given metal as observed for a control soil might not exist for a soil-slag mixture, and vice versa.

Eversion endarterectomy versus open thromboendarterectomy and patch plasty for the treatment of internal carotid artery stenosis.

OBJECTIVE: in 1996 we changed our treatment for stenosis of the internal carotid artery (ICA) from open thromboendarterectomy and PTFE-patch plasty (TEA) to eversion endarterectomy (EEA). DESIGN: retrospective study. METHODS: a total of 475 EEAs of the ICA were performed between 2/96 and 11/96. These results were compared to the results of TEA carried out between 2/94 and 11/94 (n=388). RESULTS: clamping and operation time were significantly shorter for EEA. Neurological complications included transient ischaemic attacks in 1. 0% in the EEA group versus 1.3% after TEA (p=0.72), minor strokes (0. 6% vs. 1.8%, p=0.10) and major strokes in 1.5% versus 1.1% (p=0.59). The rate of restenosis >50% was 2.5% after EEA and 10.2% after TEA. The only detectable difference of statistical significance in complication rates was in the lesions of the hypoglossal nerve (5.3% vs. 2.6%, p=0.04). CONCLUSIONS: EEA of the ICA is a safe procedure for carotid reconstruction with the additional advantages of short clamping time, possibility of simultaneous shortening of an elongated ICA, and no requirement for patching.