[Postoperative radiotherapy in endometrial carcinoma. A retrospective analysis of 541 cases]. / Die postoperative Strahlentherapie beim Endometriumkarzinom. Eine retrospektive Analyse von 541 Patienten.

PURPOSE: This retrospective study was designed to evaluate the role of adjuvant radiotherapy for surgically treated endometrial carcinoma. PATIENTS AND METHODS: From 1980 through 1988, 541 patients were treated with either intravaginal cuff irradiation with a high-dose-rate (HDR) Iridium-192 remote afterloading technique (n = 294) or with combined HDR-brachytherapy and additional external pelvic irradiation to 54 Gy (n = 247) after surgery for endometrial cancer. Afterloading irradiation was administered in 4 fractions 4 to 6 weeks after surgery. A dose of 30 Gy was delivered at a depth of 0.5 cm from the vaginal mucosa. RESULTS: Patients with HDR-brachytherapy alone showed a 5-year survival of 94.3% for Stage I and 73.6% for Stage II (p = 0.0007). Patients who received both brachytherapy and additional external pelvic irradiation had a 5-year survival of 94.1% for Stage I, 81.1% for Stage II, 70.4% for Stage III and 46.9% for Stage IV (p = 0.0001). The main predictors for survival in a multivariate analysis were stage and grading. Patients with combined radiotherapy had a local recurrence rate of 3.2%, whereas patients with brachytherapy alone who were better selected and had more favorable prognostic factors showed a recurrence rate of 2%. Low-risk patients (Stage I, Grade 1, low infiltration) in the HDR-brachytherapy group had 6 relapses, mainly caused by insufficient treatment on the basis of papillary histology. High-risk patients with poorly differentiated tumors, which infiltrate more than half the myometrial wall might benefit from additional external radiotherapy in terms of reduction of local recurrence and better survival. Five-year actuarial survival rate was 93.6% after combined radiotherapy vs 86.7% after brachytherapy alone. Complications were graded according to the RTOG scoring system. Severe late complications were fistulas of bladder and/or bowel, which occurred in 2.8% in the combined radiotherapy group, and 0.7% in the HDR brachytherapy group. CONCLUSIONS: Low-risk patients should be generally treated postoperative with HDR-brachytherapy alone. Combined radiotherapy decreased pelvic relapses for high-risk patients with overall low complication rates. We conclude that an individually adjusted postoperative radiotherapy allows a well tolerated treatment with excellent results.

Acute radiation reaction and local control in breast cancer patients treated with postmastectomy radiotherapy.

BACKGROUND: We have investigated the variation of acute radiation reactions in medium-risk patients with postmastectomy radiotherapy with regard to a possible correlation between radiation reaction of normal tissues and local tumor control. MATERIAL AND METHODS: From 1985 through 1991, a total number of 194 patients received postmastectomy radiotherapy for breast cancer pT1-2pN0-2M0 at the University of Halle-Wittenberg. The lymphatics were irradiated by an anterior 9-MV photon field and the chest wall by an individually shaped anterior field with 9-MV electrons. Both fields received single doses of 2 Gy 5 times weekly up to a total dose of 44 Gy to the chest wall and 50 Gy to the lymphatics. All patients were routinely evaluated once weekly during radiotherapy for acute side effects by one examiner. Skin erythema was classified as mild, moderate or severe, esophagitis as being present in form of dysphagia or not and pneumonitis, if present, as asymptomatic (visible only on repeated chest X-rays) or clinically symptomatic. A differential blood count was also carried out once weekly. For this analysis, the records of all patients were retrospectively reviewed. The median follow-up at the time of analysis was 4.2 years. RESULTS: Of the patients, 98 (51%) had a mild, 53 (27%) moderate and 43 (22%) a severe erythema. Furthermore, 38 patients (20%) had signs of esophagitis, 13 (7%) had asymptomatic and 26 (13%) symptomatic pneumonitis. Patients with severe erythema or erythema plus esophagitis and pneumonitis had a more pronounced decrease in lymphocyte count during treatment than patients with mild erythema: the lymphocyte nadir was 0.14 vs 0.73 Gpt/l in patients with severe vs mild erythema, and 0.36 vs 0.69 Gpt/l in patients with erythema plus esophagitis plus pneumonitis vs patients with erythema only, p < 0.05. Of the patients, 44 (22%) developed chronic side effects, mostly arm edema. There was no correlation between acute and late effects. An overall number of seven local recurrences (3.6%) occurred. The risk of developing a local recurrence within 5 years after treatment was 0% in patients with severe erythema or erythema plus esophagitis/pneumonitis vs 7% in patients with mild erythema only; this difference was marginally significant, p = 0.055. CONCLUSIONS: This analysis showed a trend towards better local control in patients with severe acute radiation reaction of normal tissue. The data support a recent publication by Dahl and coworkers showing a linkage between acute radiation reaction of normal tissue and tumor response in patients with preoperative radiotherapy for rectal cancer. The correlation between acute normal tissue reaction and local control might be explained by interindividual variations in the intrinsic, genetically determined radiosensitivity. However, local factors might also be involved, e.g. induction of a cytokin cascade in cases of acute reactions in normal tissues.

[Anthropometric studies of healthy, athletic girls 9 to 12 years of age]. / Anthropometrische Untersuchungen an gesunden, sporttreibenden Mädchen im Alter von 9 bis 12 Jahren.

Norm values of the bodily efficiency inform about the level of health and development of the growing-up generation. Anthropometric results from 550 healthy sporting girls of the town Weissenfels aged 9 till 12 years are given in tabulated form (means and standard deviations from 8 anthropometric parameters) differentiated in regard of the biological age of the girls. Impressive differences can be seen. Consequences for the practice are discussed. The given results may be compared with the corresponding ones for boys also aged from 9 till 12, presented before in this journal.

[Progress in biostatistics correlated with the development of computer technics]. / Einige Fortschritte der Biostatistik in Wechselwirkung mit der Entwicklung der Rechentechnik.

The development of computers has positively influenced both Biostatistics and Medical Informatics. Close cooperation between Physicians, Biostatisticians and Experts of Medical Informatics is necessary. The leading role has to play the medical question, the medical problem to be solved, and not one of the cooperating disciplines. Both Biostatistics and Medical Informatics are parts of Medicine and must therefore taught as natural-scientific basic discipline of Medicine.

[Evaluation of body mass of 9-to-12-year-old girls with reference to stage of biological development]. / Beurteilung der Körpermasse 9- bis 12jähriger Mädchen bei Beachtung des biologischen Entwicklungsstandes.

Variations in the body weight of 550 healthy sporting girls aged 9 to 12 years (urban population) were examined with reference to the stage of their biological development. A classification in percentages (from 80% to 150%) for the evaluation of body weight in medical practice is depicted in tabular form and provides a ready and reliable means for examining body weight as a basis which may have therapeutic consequences.

[Physical measurements of healthy, athletic girls 9-12 years of age in percentile values]. / Körpermasse von gesunden, sporttreibenden Mädchen im Alter von 9-12 Jahren in Perzentilwerten.

Eight anthropometric data from 550 healthy sporting girls aged 9-12 years are presented as percentiles in tabular form. The results are of importance for the medical practice.

Verbal affective expression during group and individual psychotherapy. Towards a description of therapist- and setting-related variables.

The paper deals with a comparison between verbal affective interventions by the same psychoanalyst in different therapeutic settings, individual and group therapy. Since the same therapist is involved, an exploration of interactional aspects of his therapeutic style becomes possible, taking into consideration his theoretical allegiance and his hypotheses about the structure and development of the psychotherapeutic milieu. The conformation of therapist-group and therapist-individual dyads shows a high thematic concordance across both settings, particularly with regard to separation anxiety, but also to a significant degree in relation to other verbally expressed affects. However similar the correlations do appear, there remain certain differences in the affective interactions between group or individual patients and the therapist that are due to developmental aspects of the therapeutic relationship in either setting.

[Comparison of 2 possibilities for extracting information in the analysis of (multi-dimensional) contingency tables. Demonstrated with a medical-sociologic example]. / Vergleich zweier Möglichkeiten der Informationsextraktion bei der Analyse (mehrdimensionaler) Kontingenztafeln. Demonstriert an einem medizinischen-soziologischen Beispiel.

In several papers the author has stressed the importance of qualitative characters in medical studies. From this follows the necessity of analysing more-dimensional contingency tables. In the first part of this paper the most important results are repeated. Two procedures may be distinguished: 1. A three-step procedure, called Elementary More-Dimensional Contingency Analysis (EMCTA) with and without model fitting 2. A combined Residual and Contrast Analysis (RA/CA). By the aid of a medical example it is shown, in the second part of the paper, that it is possible to extract rather easily all information about interesting dependencies be the aid of RA/CA in the case of one response variable.

[Anthropometric studies of healthy boys participating in sports 9-12 years of age]. / Anthropometrische Untersuchungen an gesunden, sporttreibenden Jungen im Alter von 9 bis 12 Jahren.

Norm values of bodily efficiency inform about the level of health and development of the growing-up generation. Anthropometric results from 595 healthy sporting boys of the town Weissenfels aged 9 till 12 years are given in tabulated form (means and standard deviations from 8 anthropometric parameters) differentiated in regard of the biological age of the boys. Impressive differences can be seen. Consequences for the practice are discussed.

[Computer-assisted evaluation and analysis of bacteriologic findings]. / Computergestützte Erfassung und Analyse bakteriologischer Befunde.

A computer-aided information system was developed for registration and analysis of microbiological findings. The base of the system is a microcomputer with a 16-bit-processor and a hard disc ensuring the analysis of a great number of material. Besides the printing of bacteriological findings for the senders detailed questions can be analysed to give informations about the distribution and frequency of bacterial species in certain specimens, about the bacterial resistance in dependence on a definite time and about the choice of combinations of chemotherapeutics as well as the existence of multiple resistances.

[Physical measurement of healthy, athletic boys 9-12 years of age in percentile values]. / Körpermasse von gesunden, sporttreibenden Jungen im Alter von 9-12 Jahren in Perzentilwerten.

Values of physical capacity indicate the level of health and development of children to the sports physician and are of importance in other reaches. Anthropometric data from 595 healthy sporting boys aged 9-12 years are presented as percentiles.

[Objective diagnosis of pre-Oedipal disorders]. / Zur objektivierenden Diagnostik präödipaler Störungen.

According to the diagnosis of preoedipal disturbances it should be worked out, that the test-results are not inconceivable formality and uncomprehension. From the selfrating of 74 neurotic patients we determined on 8 scales of narcism clinical description of well-known personality-dimensions of preoedipal fixation. With a Q-factor-analysis 3 subgroups could be established, which are marked as borderline- and narcistical typus against a typus without narcistic disturbance. The validity of such classification can be estimated about the clinical diagnose of 28 patients of this sample. It proves to be much promising for the diagnostic of preoedipal disturbances.

[Effect of orally administered zinc on the inducibility of experimental brain tumors in the rat]. / Die Wirkung peroral applizierten Zinks auf die Induzierbarkeit experimenteller Hirntumoren der Ratte.

The effect of orally administered zinc on induction and growth of brain tumours in rats was investigated. The brain tumours were induced experimentally by N-ethyl-N-nitrosourea injected subcutaneously in a single dose (17 mg/kg body weight) into newborn BD IX rats. The rats were killed after 180 days. Their brains were cut in serial sections and investigated histologically. The incidence of brain tumours of a control group of rats (group 1) was compared with that of rats which received drinking-water containing 22.8 mmol/l (5.0 g/l) zinc acetate from the 4th week (group 2) or from the 150th day (group 3) after birth. The rats of group 2 developed three times more brain tumours than the rats of the control group. This difference is statistically significant. The incidence of brain tumours in rats of group 3 corresponds to that of the control group. The average size of the tumours was the same in all groups. In the brains of the rats that received zinc with the drinking-water up to the 180th day but without administration of a cancerogen immediately after birth (group 4) we could not find any tumour, neither after 180 nor after 380 days. Our results indicate a cocancerogenic (promotion) effect of zinc in experimental neurooncogenesis of the rat.