[Persistent left atrial thrombus in atrial fibrillation under oral anticoagulation]. / Persistierender linksatrialer Thrombus bei Vorhofflimmern unter oraler Antikoagulation.

The case of a 78-year-old female patient who suffered atrial fibrillation and persistent thrombus in the left atrial appendage despite sufficient anticoagulation is reported. The case is chosen to demonstrate the complexity inherent in prophylaxis as well as risk evaluation of thromboembolism on the basis of clinical and echocardiographic criteria. We also discuss transesophageal echocardiography as the standard diagnostic procedure for detection of intracardiac thrombi prior to cardioversion as well as cardiac computer tomography as an alternative.

Sequential polychemotherapy in exocrine pancreatic cancer.

The results of palliative chemotherapy in 162 patients suffering from exocrine pancreatic cancer are presented. They are mainly discussed with respect to the possibility of improving survival of exocrine pancreatic cancer patients by an efficacy-orientated sequential polychemotherapy (EOSP). In about 40% of the patients treated between 1998 and 2001, sequential chemotherapy induced more than one effective treatment in the case that SD after a progressive prephase as well as MR, PR and CR are considered as antitumoral efficacy. Sequential polychemotherapy seems to be able to prolong the survival of these patients. The whole group of patients showed a 1-year survival of 56% and a 2-year survival of 16%. Especially in the case of metastasized tumor disease (M1), sequential polychemotherapy seems to be able to prolong survival: 45% of the metastasized tumor patients survived more than 1 year, 12% more than 2 years. The median survival for the whole group of locally advanced tumors was 15 months and the median survival for the whole group of metastasized tumors was 8 months. The results should stimulate clinicians to try palliative chemotherapy for pancreatic cancer more actively than before and to rediscuss the actual concepts of prospective therapeutical trials mainly based on analysing the effects of single agents or drug combinations on survival.

MR-cholangiopancreaticography (MRCP) and MR-angiography: morphologic changes with magnetic resonance imaging.

Since 1997 we have prospectively tried to assess/confirm the diagnostic value of MR-Cholangiopancreaticography (MRCP) and MR-Angiography in patients suffering from pancreatic carcinoma. Till today we have studied 116 adult patients with two 1,5 Tesla MRT scanners using a body phased-array coil: 27 patients with benign diseases of the pancreas, 58 with carcinoma of the pancreas, 15 with no disorder of the pancreatobiliary system, 14 with hepatic abnormalities and 2 with other tumors. MR examinations included routinely T1-weighted (TSE, SE), T1-weighted fat-suppressed (TSE, SE), T2 weighted fast turbo spin-echo (UTSE, Haste), T2-weighted fat-suppressed fast turbo spin-echo (SPIR), 2D-cholangiopancreaticography (images were obtained with breath-held) or 3D-cholangiopancreaticography (images were obtained in coronal and axial plane with respiratory triggering). In cases with pancreatic cancer we added MR-angiography. MR images were retrospectively compared with CT, ERCP amd sonography data. Summarizing the results confirm that MRCP is a safe and non-invasive technique for studying pancreatic and biliary diseases which yields information in many cases complemontory to ERCP and PTC. MRCP images can also be used as a guide for subsequent interventional procedures. MRCP will, therefore, allow the restriction of ERCP and PTC to more therapeutical indications and cases offering special problems. Considering staging and follow-up of pancreatic cancer, MRCP cross-sectional images and MR-angiography should be performed, allowing the visualization of the extraductal anatomy/pathology. These techniques may provide the clinicians with complementary information compared to other conventional imaging methods like US and CT. Clinicians engaged in pancreatic oncology, therefore, should have MRCP, MR-angiography and MR imaging available in addition to the conventional diagnostic tools.

[Is short-term follow-up by skeletal scintigraphy of use in deciding on curative irradiation of inoperable non-small cell bronchial carcinoma? The experiences with 363 cases]. / Ist die kurzfristige Kontrolle des Skelettszintigramms von Nutzen bei der Entscheidung zur kurativen Bestrahlung des inoperablen nichtkleinzelligen Bronchuskarzinoms? Erfahrungen an 363 Fällen.

In a series of 363 patients, it was investigated if close-meshed bone scintigraphy is valuable for the decision whether or not to perform a high-dose curative radiotherapy of non-small cell bronchial carcinomas. The control of the bone scintigram made at the time of diagnosis, which was performed during the last phase of the treatment period before finally defining the treatment aim, was only helpful in some exceptional cases. Therefore a control of the first examination is not necessary if the latter has been performed not more than six months ago and if in the meantime no suspicious findings or other symptoms of a formation of skeletal metastases have been observed.