[Mobile Health Units: An Analysis of Concepts and Implementation Requirements in Rural Regions.] / Mobile Versorgungseinrichtungen zur Stärkung der Versorgungssicherheit im ländlichen Raum? Eine Analyse von Konzepten und Implementationsanforderungen.

BACKGROUND: Access to health services in rural regions represents a challenge. The development of care models that respond to health service shortages and pay particular attention to the increasing health care needs of the elderly is an important concern. A model that has been implemented in other countries is that of mobile health units. But until now, there is no overview of their possible objectives, functions and implementation requirements. METHOD: This paper is based on a literature analysis and an internet research on mobile health units in rural regions. RESULTS: Mobile health units aim to avoid regional undersupply and address particularly vulnerable population groups. In the literature, mobile health units are described with a focus on specific illnesses, as well as those that provide comprehensive, partly multi-professional primary care that is close to patients' homes. The implementation of mobile health units is demanding; the key challenges are (a) alignment to the needs of the regional population, (b) user-oriented access and promotion of awareness and acceptance of mobile health units by the local population, and (c) network building within existing care structures to ensure continuity of care for patients. To fulfill these requirements, a community-oriented program development and implementation is important. CONCLUSIONS: Mobile health units could represent an interesting model for the provision of health care in rural regions in Germany. International experiences are an important starting point and should be taken into account for the further development of models in Germany.

Lack of correlation between apoptosis and DNA single-strand breaks in X-irradiated human peripheral blood mononuclear cells in the course of ageing.

The dependence on age of both the basal and the X-radiation-induced levels of apoptosis was examined in human peripheral blood mononuclear cells (PBMC). In the same samples, the base value and the extent of induced DNA single-strand breaks were determined, using a sensitive and fast microplate assay. PBMC were isolated from blood of donors of various age groups (20-30, 40-60 and > 70 years of age) and X-irradiated ex vivo using a 6 MV linear accelerator to give a total exposure of 4 Gy. The mean basal levels of apoptosis in PBMC from donors in the 40-60 year age group and the > 70 year age group were found to be only slightly higher (by 20-10%) compared to that of the 20-30 year age group, whereas the extent of DNA damage strongly and significantly (P < 0.01) increased with age by up to 2-fold. In contrast to the extent of induced DNA damage, which steadily increased in the course of ageing by up to 1.8-fold, there was only a transient increase in the level of induced apoptosis to 1.5-fold in PBMC from X-irradiated blood (4 Gy photons) from donors aged 40-60 followed by a decrease to 0.9-fold in PBMC from old donors (>70), compared to age group 20-30. The results show that X-ray-induced apoptosis and DNA damage in PBMC are not correlated during ageing.

MRI-assisted radiation therapy planning of brain tumors--clinical experiences in 17 patients.

A new and simple method for precise determination of lateral opposed treatment portals was developed and used in 17 patients. Compared to CT, MRI led to significant changes of portals in 59% (10/17) of cases. Individual shielding blocks could be precisely designed by use of our new method. MRI is the procedure of choice in local radiation therapy planning of brain tumors.

[Sterno-costo-clavicular hyperostosis (author's transl)]. / Sterno-kosto-klavikuläre Hyperostose

A case is described in which bilateral subclavian vein occlusion was caused by fusiform expansion of the clavicle with hyperostosis, ankylosis of the sterno-clavicular joint, widening and thickening of the sternum and ossification of the costal cartilage of the first ribs. Histologically this proved to be due to an hyperostotic spongiosclerosis.

[The use of computer tomography for radiation therapy of cerebral tumours (author's transl)]. / Der Einsatz der Computertomographie in der Strahlentherapie der Hirntumoren.

The application of computer tomography should be extended for indicating the need and choice of radiotherapy for cerebral tumours, and for observing the effects of treatment. In 26 patients it has been shown that CT is superior to conventional neuro-radiological methods in showing indications and in planning of radiation therapy. Forms of treatment can be suitably adapted where the histological type of the tumour is known. In most cerebral tumours, the beneficial effect of irradiation has been evident in our patients. Our criteria were based on the concept of "clinical malignancy", no attempt was made at a histological classification of the tumours.

[The distribution of Sn2+ after application as a complex (author's transl)]. / Das Verhalten von Sn2+ nach seiner Applikation als Komplexsalz

On animal experiments was shown that Sn2+ after i.v. application with 113Sn as radioactiv indicator was deposited in the skeleton. Experiments were done with citrat-, tartrat-, pyrophosphat-, phosphat- and Sn2+/HCl-complexes. The importance of the results for the use of Sn2+-solutions in Nuclear Medicine for men are discussed.

[The diagnosis of post-operative lymphatic cysts in the pelvis (author's transl)]. / Wertigkeit der Diagnostik postoperativer Lymphzysten im Becken.

As a side effect after radical lymphonodectomy in the pelvic lymphatic cysts may occur on one or both sides. Only when they are big clinical signs will arise by compression. For diagnostic ultrasonic and computer tomography are superior to other radiological methods.

[Sonography of bone metastases--its place in comparison with computed tomography and conventional x-ray diagnosis]. / Sonographie bei Skelettmetastasen--Stellenwert im Vergleich zur Computertomographie und konventionellen Röntgendiagnostik.

The value of CT, conventional radiography and ultrasound was compared in 40 patients with 52 skeletal metastases. For superficial lesions, the combination of sonography and conventional radiography was equivalent to CT in showing the extent of bone destruction and soft tissue involvement. As expected sonography was unsatisfactory for deeper lesions. Sonography can provide useful information for planning radiation therapy for superficial lesions, but it does not replace conventional radiography.

[Bone-seeking behavior of rhenium and yttrium complexes]. / Zur Osteotropie von Rhenium- und Yttrium-Komplexen.

The results of experimental work on rats with strontium (85SrCl2, 89SrCl2) and yttrium (90Y) in a citrate complex demonstrate high affinity to bone. Rhenium perrhenat (186Re) Re-colloid and Re-methylene-diphosphonate were rapidly eliminated without bone affinity.

[A comparative radioisotope study of calcium metabolism in bone and teeth of rats (author's transl)]. / Vergleichende Radioisotopen-Untersuchungen über den Kalzium-Stoffwechsel von Knochen und Zähnen bei Ratten.

Investigations with bone-seeking radionuclides (47Ca, 99mTc-PP, 113Sn) in rats of different age demonstrated a true accumulation in teeth as compared to bone. Blood flow was evaluated by 99mTcO4 and 51Cr-Albumin. Differences of accumulation depended on the isotopes used and on the age of the animals.

[Distribution in rats after intravenous injection of 88Y compounds (author's transl)]. / Verteilungmuster bei Ratten nach intravenAoser Injektion von 88Y-verbindungen.

88Y was given to rats in form of citrate, diphosphonate or chloride to determine its accumulation in various organs. The activity in the bones was high but not as high as that of calcium. The application of methylene-diphosphonate showed high enrichment in the liver because of intravital colloid formation. Elimination by the kidneys depends on the type of the 88Y compound applied.

[Blood picture changes in rats after 90Y-citrate administration]. / Blutbildveränderungen bei Ratten nach Verabreichung von 90Y-Zitrat.

Therapeutic doses of 90Y-citrate show a high selective accumulation in bone. Bone marrow is the critical organ. Investigations in rats show a decrease of leucocytes, erythrocytes and thrombocytes depending on dose. A significant decrease of the leucocytes and thrombocytes was seen with 0.5 mCi (17.5 MBq) 90Y per kg bodyweight, with 2.0 mCi (74 MBq) also of the erythrocytes. This would be equivalent to a dose of 35 to 140 mCi (1.295 to 5.18 GBq) for a normal patient (70 kg). Therefore, a single dose of 10 mCi (370 MBq) of 90Y-citrate should be tolerated by a tumor patient without any blood cell depression, if there was no prior chemotherapy.

[Changing of organ distribution of radioactive yttrium in rats by varying amounts of carrier]. / Anderung der Organverteilung von radioaktivem Yttrium bei Ratten durch unterschiedlich hohe Trägermengen.

There is little change in the organ distribution of yttrium citrate complex after addition of 0.01 mg/kg BW as carrier. Adding increasing amounts of inactive yttrium up to 1 mg/kg BW caused a considerable reduction in bone uptake and an increasing accumulation in the liver and spleen by transformation to colloid. Uptake in the lung indicates formation of macro-particles. The transformation into colloid can be varied by changing the citrate concentration. The 90Y-citrate complex for therapy should be used either without or with very little carrier of inactive yttrium.

[Scintigraphic use of 87Y during 90Y therapy of bone metastases]. / Szintigraphische Verwendung von 87Y bei der 90Y-Therapie von Knochenmetastasen.

Carrier-free 87Y is produced by cyclotron irradiation of Rb. It decays with a half-life of 80.3 h, transforming via 87mSr to stable 87Sr with the emission of gamma lines of 0.48 and 0.39 MeV. Experience in 6 patients shows good scan quality and correspondence between 99mTc-DPD and 87Y images useful in 90Y-citrate therapy for bone metastases. 87Y offers new possibilities of studying biological kinetics in 90Y therapy. To avoid contamination this should only be used in departments with possibilities of radioactive waste storage and controlled disposal.

[Treatment of pains from bone metastases with 90Y (author's transl)]. / Yttrium-90 zur Schmerztherapie von Knochenmetastasen.

For palliation of pain caused by bone metastases beta radiation isotope therapy was successful. As shown in experimental work on animals bone uptake of 90Y with its shorter half-life is high when it is administered as a citrate complex. 90Y can be eluted with high purity from a 90Sr "cow". The retention in man was found by whole-body counting to be higher than 80%. In preliminary trials on 16 patients the analgetic effect was the same as that of 89Sr. The properties of 90Y therapy are discussed.

Preoperative radiochemotherapy and radical surgery in comparison with radical surgery alone. A prospective, multicentric, randomized DOSAK study of advanced squamous cell carcinoma of the oral cavity and the oropharynx (a 3-year follow-up).

A multicentric, randomized study of squamous cell carcinoma (SCC) of the oral cavity and the oropharynx has been undertaken by DOSAK. The results after radical surgery alone have been compared with the results of combined preoperative radiochemotherapy followed by radical surgery. Patients with primary (biopsy proven) SCC of the oral cavity or the oropharynx with tumor nodes metastasis (TNM) stages T2-4, N0-3, M0 were included in the study. A total of 141 patients were treated by radical surgery alone, whereas 127 patients were treated by radical surgery preceded by preoperative radiochemotherapy. The preoperative treatment consisted of conventionally fractioned irradiation on the primary and the regional lymph nodes with a total dose of 36 Gy (5 x 2 Gy per week) and low-dose cisplatin chemotherapy with 5 x 12.5 mg cisplatin per m2 of body surface during the first week of treatment. Radical surgery according to the DOSAK definitions (DOSAK, 1982) was performed after a delay of 10-14 days. During the follow-up period, 28.2% of all patients suffered from locoregional recurrence, and 27.2% of the patients died. The percentages were higher after radical surgery alone for locoregional recurrence (31% and 15.6%) and for death (28% and 18.6%). The life-table analysis showed improved survival rates of 4.5% after 1 year and 8.3% after 2 years in the group of patients treated with combined therapy. The demonstrated improvement appeared to be significant with the Gehan-Wilcoxon test as well as with the log rank test below a P value of 5%.

Prophylaxis of radiogenic sialadenitis and mucositis by coumarin/troxerutine in patients with head and neck cancer--a prospective,randomized, placebo-controlled, double-blind study.

OBJECTIVE: To study the efficacy of coumarin/troxerutine for the protection of salivary glands and mucosa during irradiation. DESIGN: Prospective, randomized, placebo-controlled, double-blind trial. SETTING: University hospital, Germany. PATIENTS: 48 patients who had radiotherapy to the head and neck. MAIN OUTCOME MEASURES: Salivary gland scintigraphy and acute side-effects of radiotherapy (Radiation Therapy Oncology Group (RTOG) score). RESULTS: 23 patients (11 experimental, 12 placebo) completed the study. The global efficacy measure combining scintigraphy and RTOG score favoured the experimental arm (P=0.07). The RTOG score showed significantly fewer acute side-effects of radiation in the experimental arm (P<0.05). CONCLUSION: The results suggest that coumarin/troxerutine have a favourable effect in the treatment of radiogenic sialadenitis and mucositis.