Characterization of CNS lesions by using high-resolution 1H MR spectroscopy of CSF: preliminary results.

Sixty-six samples of CSF from 66 patients with a variety of diseases, including tumors, arteriovenous malformations, aneurysms, brain infarctions, and lumbar back pain, were studied with 1H MR spectroscopy at 360 MHz. 1H MR spectroscopy offers a simple means to obtain fast information about different metabolites simultaneously. As compared with the control group, which consisted of 19 CSF samples from the same group of 66 patients, but from individuals who had no abnormal findings on neurologic examination, common clinicochemical tests, or neuroradiologic studies, our preliminary results suggest that tumors and hemorrhages may be differentiated by 1H MR spectroscopy. MR peak intensities relative to lactate peak intensity were used as variables in a statistical analysis to determine the significance of individual resonance intensities in predicting CNS abnormalities. The most important factors for diagnosis were analyzed by means of a multivariate general linear hypothesis and a principal component method. The most important factors for predicting CNS abnormalities in the studied diseases were creatinine, glucose, creatine, citrate, protein content, glutamine, amount of cells, and valine. By using this model for discriminant analysis, we could predict hemorrhages correctly in 88% of cases and tumors in 75% of cases. All samples of controls were determined correctly. In cases of brain infarctions, different signals were observed, which may lead to further characterization of such lesions. 1H MR spectroscopy may offer a simple means for further characterizing CNS lesions. However, this needs confirmation by a prospective study, which would include a larger patient population with different diseases.

[Evaluation of isotope nephrograms by the deconvolution method (author's transl)]. / Auswertung von Isotopennephrogrammen durch die Entfaltungsmethode.

By means of deconvolution, which can be preformed simply with a minicomputer, a new function is derived from the circulation activity time function and the renal activity time function. This function describes the impulse response of the system "Kidney". The activity time functions are determined with a four-probe counter. The impulse response allows statements about the time during which the activity remains in the kidney, the relative blood flow of both kidneys and a so-called passage time distribution. It was also attempted to substitute the circulation activity time function by a derivative of the bladder activity time function.

[NMR-diagnosis in radiotherapy?]. / NMR-Diagnostik in der Strahlentherapie.

The results of NMR tomography obtained hitherto in the imaging of malignant tumors are presented in order to show that this new method is of great importance for radiotherapy. A quantification of radiotherapy and chemotherapy seems possible with the aid of NMR diagnosis, as vital and necrotic tumors zones as well as radiation effects in the tumor and in sound tissue can be visualized.

[Consideration of the volume dependence of tolerance doses (author's transl)]. / Berücksichtigung der Volumenabhängigkeit von Toleranzdosen.

A general formula for consideration of the dependence of tolerance doses upon volume is obtained by mathematical evaluation of known skin tolerance doses. The validity for different organs is verified using available data of literature. It is recommended to introduce the volume dependence into the Ellis-formula for tolerance doses.

[Importance of the tumor duplication time for the clinical radiotherapy (author's transl)]. / Die Bedeutung der Tumorverdopplungszeit für die klinische Strahlentherapie.

Malignant tumors of man have duplication times ranging between few days and several years. This fact allows to estimate the age of tumor and metastases. The decision whether a curative of a palliative irradiation is to be executed can be taken according to the development and the age of the tumor. The duplication time has an influence on the fractionation of the irradiations and the possible focal dose and also on the time after which check-up examinations are to be made. A method for the determination of the tumor volume by means of radiographs is described in the appendix.

[Digital archiving and communication in hospitals]. / Digitale Archivierung und Kommunikation in Krankenhäusern.

Different concepts and already available components of a HIS (Hospital Information System) for archiving all data in a hospital are described. Using the example of the Kiel University Hospital, it is shown that a complete HIS-system can be made from already commercially available components.

[Radiographic diagnosis of chylothorax (author's transl)]. / Röntgendiagnostik des Chylothorax.

Presentation of causes, clinical- and radiographic findings and therapy of chylothorax, along with a review of the anatomy of the thoracic duct. Radiographic demonstration of the thoracic duct by lymphography is necessary prior to surgery in order to demonstrate the site of the lesion to assure reasonable ligation.

[Treatment results of Schmincke tumors]. / Behandlungsergebnisse bei Schmincke-Tumoren.

This is a report on the results of a continuous series of 78 previously untreated patients with a lymphoepithelioma (Schmincke-Regaud), who got their diagnosis and therapy in the Medical Center of the University of Kiel between 1951 and 1980. 90% of the patients were treated by radiotherapy alone, which included the primary in the oropharynx (n = 29) or the nasopharynx (n = 48) as well as the regional lymph nodes regardless of whether they were affected (71%) or not; residual lymph nodes of 8 cases were removed afterwards. Thereby a clinically full regression of the tumor disease was achieved in 85%. This group revealed a constant actuarial survival of 39% 7 years later. All therapy failures however, died within two years. The probability to remain free of disease after a primarily successful treatment amount to 86% for the oropharynx tumors (n = 24) and to only 29% for the nasopharynx lesions (n = 31). The analysis of the relapses especially with regard to the nasopharynx tumors showed that in most cases the disease was already very extended at the beginning of the treatment (stage IV according to the UICC-classification). The actuarial survival of this numerous group fell down to a constant rate of 16%, whereas stages I to III finally survive in 59%. The corresponding survival values of the oropharynx tumors were 25% in stage IV and 41% in stages I to III including a lot of age-related deaths. Drawing conclusions out of our retrospective study we recommended to add an appropriate chemotherapy for lymphoepitheliomas of the nasopharynx in stage IV.

[Further considerations on the basis of the Ellis-formula and its application (author's transl)]. / Ergänzungen zu den Grundlagen und Anwendungen der Ellis-Formel.

Computational methods for the determination of normal tissue tolerance under various modes of dose fractionation are applied at many radiation therapy installations. The methods differ in details, but most are based on the Ellis-formula. A survey of the relevant quantities and relations is given in order to facilitate comparison of the various methods. The established equations which are applicable to regular fractionation are related to the generalization of the Ellis-formula which is also applicable to irregular fractionation modes.

[Measurement and calculation of the air activation caused by 15 MeV continuous radiation emitted by a linear accelerator (author's transl)]. / Messung und Berechnung der Luftaktivierung durch die 15-MeV-Bremsstrahlung eines Linearbeschleunigers.

The rate of air activation caused by the 15 MeV continuous radiation of a "Clinac 20" can be concluded from activation measurements in urea tablets. In case of the most unfavourable irradiation conditions, a maximum field size of 35 X 35 cm2, and a distance focus-wall of 450 cm, an air activation of 6, 18 X 10(4) Bq per individual irradiation is calculated. The limit of activity concentration prescribed by the Strahlenschutzverordnung (radioprotection directive) is not reached if a sufficient change of air is guaranteed. This method of measuring the air activation is simple, not time-consuming and can be effected with a high degree of accuracy. Measurements and calculations are compared.

[Measurements of the surface dose for the irradiation of cultured cells with a Co-60 source (author's transl)]. / Oberflächendosismessungen zur Bestrahlung von Zellkulturen mit einer Co-60-Quelle.

In order to exactly determine the irradiation dose for cultured cells in culture containers (Petri dishes and others), it is necessary to have a detailed knowledge of the depth dose curve in water-equivalent layers near the surface. This curve was determined for Co-60 radiation by means of a window-less liquidity dosemeter. The dosemeter liquid was a solution of ammonium-iron (II) sulfate (solution of Fricke), the extinction of which was measured at 304 nm. Petri dishes were used instead of closed irradiation flasks. The distance QOA was 50 cm for all experiments, the field size was 10 X 10 cm. The depth dose maximum was found in a depth of 5,0 mm which corresponds to a mass of 0,50 g cm-2 relating to the surface. The surface dose was determined to be 39,2% and 106,6% of the maximum dose, respectively. This method can also be applied for closed culture containers (flasks).

[Results of the treatment of 197 squamous cell carcinomas of the oropharynx (1964-1982 treatment period)]. / Die Behandlungsergebnisse von 197 Plattenepithel-Carcinomen des Oropharynx (Behandlungszeitraum 1964-1982).

197 consecutive patients with squamous cell carcinomas of the oropharynx were treated between 1964 and 1982. The 5 year actuarial survival was 43% (+/- 5%). In patients with stage I and II disease the actuarial survival with combined surgery and radiotherapy was 87% (+/- 16%), but with primary radiotherapy 40% (+/- 28% (p = 0.0250). The results in stage III and IV disease were 59% (+/- 11%) with combined therapy and 29% (+/- 15%) for radiotherapy alone (p = 0.0010). The five year actuarial survival for lymphoepithelial carcinomas (Schmincke) was 71% (+/- 16%) after radiotherapy whilst the patients with undifferentiated carcinomas achieved only 29% (+/- 11%). The survival rate for women (71% +/- 12%) was significantly better than for men (31% +/- 7%), although the proportion of stages was not different in both sexes. Because of these results and because of the minimal chances of controlling recurrent disease we prefer combined treatment not only in stage III and IV disease, but also in stage I and II disease. In these early stages partial mandibulectomy can be avoided. In selected cases transoral surgery can be combined with functional, discontinuous neck dissection. The functional results of surgery are thus minimised in the early stages of oropharyngeal carcinoma.

[Development and utilization of the Nominal Standard Dose for the tolerance dosage to healthy tissue in radiotherapy]. / Die Entwicklun und Anwendung der Nominal Standard Dose für die Toleranzdosis des gesunden Gewebes in der Strahlentherpie

The utilization of the Ellis-formula for the determination of the tolerance of normal connective tissue is described. Beyond this, the formula is adapted to so-called critical organs. The individual suppositions implicated by the Ellis-formula are commented. Because of the verifyable congruency of the Ellis-formula with data obtained in clinical practice also by other authors, this conception is presented for the provisional determination of the limits of tolerance of normal tissue together with a computerized programme elaborated for use in different therapeutic techniques.

Cerebrospinal fluid: detection of tumors and disk herniations with MR spectroscopy.

Cerebrospinal fluid (CSF) samples from 84 patients with confirmed or suspected diseases of the central nervous system were studied with hydrogen-1 magnetic resonance (MR) spectroscopy. In 19 of the patients, clinical chemical tests of the CSF indicated normal protein contents and normal quantities of cells; these samples were used as controls. Preliminary results indicate that tumors may be reflected in the MR spectra of CSF; disk herniations could not be distinguished on the basis of the MR spectral characteristics.