[Malignant lymphoma of the skin: update on diagnostics and therapy of primary cutaneous B-cell lymphoma]. / Maligne Lymphome der Haut : Update zu Diagnostik und Therapie primär kutaner B-Zell-Lymphome.

The diagnosis of primary cutaneous B-cell lymphoma is made based principally on the results of histological investigations and staging. For an exact staging abdominal sonography and chest X-ray examinations and for appropriate clinical symptoms special investigations as well as radiological imaging procedures including PET are indicated in addition to conventional laboratory investigations. For therapy rituximab is normally administered as monotherapy in order to avoid over therapy of indolent lymphoma. Further options are radiotherapy and new approaches with electrochemotherapy as well as pegylated doxorubicin.

Neurosarcoidosis: an unusual indication for radiotherapy.

Up to 70% of patients with systemic sarcoidosis developing neurosarcoidosis do so within the first 2 years of their systemic illness. Central nervous system (CNS) involvement as the only manifestation of sarcoidosis can be seen both at first time of disease and at recurrence in a few isolated cases. A young man showed neurological symptoms caused by isolated CNS sarcoidosis after unsuccessful treatment of primary pulmonary sarcoidosis by steroids. MRI scans of the head showed a distinct structural lesion temporodorsal in the left hemisphere and in the left-sided basal ganglia. The diagnosis was proved by neurosurgical resection. Post-operative systemic treatment with long-term corticosteroids was ineffective. After low-dose whole-brain irradiation of the isolated CNS lesion with 20 Gy, partial resolution of the clinical features and stabilization of disease proved by MRI ensued. In neurosarcoidosis the use of radiation therapy remains an appropriate therapy option with minimal adverse sequelae if primary medical treatment fails.

Effect of distortions and asymmetry in MR images on radiotherapeutic treatment planning.

Before using MR-images for radiotherapeutic treatment planning, it is necessary to check whether geometrical distortions influence the calculated dose distribution. In this study, 27 MRI units from different manufacturers and with different magnetic field strengths were investigated. First, all geometrical distortions and asymmetry were determined by specially defined parameters. Virtual planning target volume and organ of risk were drawn into MR images from different units and optimized dose distributions were calculated. The resulting field parameters were then transferred to the reference geometry. Geometric distortions caused small variations of the dose maximum (+/-0.5%). Twenty-five percent of the investigated calculated dose distributions showed an increase of the 95% isodose volume, 60% a decrease. The dose deviations in the organ of risk were comparable with the dose deviations in the planning target volume (PTV). This study has shown that measurements of geometrical distortions and asymmetry are necessary for MR-assisted treatment planning. For evaluation, we recommend dose calculations with hypothetical PTV's and organs of risk. Int. J. Cancer (Radiat. Oncol. Invest.) 90, 46-50 (2000).

Epirubicin and ifosfamide in metastatic breast cancer.

In a randomized, phase II trial, we evaluated the effectiveness of continued chemotherapy with epirubicin/ ifosfamide versus unmaintained treatment interruption in advanced metastatic breast cancer. Three hundred fifty-seven patients were enrolled and 331 were evaluable for response. Complete response was achieved in 25 patients (8%) and partial response in 121 patients (37%). Pretreatment status correlated significantly with response (complete and partial response). While 54% of unpretreated patients responded, only 42% of the patients responded who had been pretreated with adjuvant chemotherapy and 33% who had been pretreated in the metastatic stage of disease; 69 patients (21%) had disease progression. Of 11 patients pretreated in both the adjuvant and metastatic setting, only two responded. Toxicity of treatment was mild, with leukopenia being the treatment-limiting factor. Thrombocyte levels were not altered significantly by treatment. Thus, there seems to be room for dose escalation using granulocyte colony-stimulating factor. There was no considerable cardiotoxicity, central nervous system toxicity, or cystitis observed. The low rate of cardiotoxicity appeared to be related to dose fractionation of epirubicin. After randomization of patients to treatment interruption versus continuation of chemotherapy, a longer relapse-free survival was observed for patients who continued chemotherapy (mean relapse-free survival, 2+ months); however, this did not translate into prolonged survival. The cumulative scores of toxicity and quality of life parameters showed increasing superiority for treatment interruption. Therefore, a strategy of treatment until maximum response and subsequent treatment interruption seems to be superior to treatment continuation.

Surgical ligation vs. angiographic embolization of the vena spermatica: a prospective randomized study for the treatment of varicocele-related infertility.

Varicoceles as a common cause of male infertility are treated either by surgical ligation or, more recently, by angiographic occlusion of the spermatic vein. In the present prospective randomized study 38 patients were treated by surgical ligation and 33 by angiographic embolization. During the 12-month follow-up period a significant increase in sperm number (at 3 and 12 months) and sperm motility (at 12 months) occurred in both groups while sperm morphology remained unaffected. Altogether, 22 pregnancies (31%) were reported within the year following treatment, of which 11/38 (29%) occurred in the ligation group and 11/33 (33%) in the embolization group. Thus both treatment modalities appear equivalent, whereby embolization has the advantage that it can be performed on an outpatient basis.

[Neurofibromatosis and multiple nonossifying bone fibromas]. / Neurofibromatose und multiple nicht-ossifizierende Knochenfibrome.

Three patients with a combination of neurofibromatosis and multiple non-ossifying fibromas are presented. All patients possessed multiple osteolytic lesions with sclerotic margins, resembling non-ossifying fibromas. Two patients showed similar lesions in additional localizations. In two patients, non-ossifying fibroma was histologically verified. The simultaneous occurrence of neurofibromatosis and multiple non-ossifying fibromas can possibly be put down to a generalized mesodermal dysplasia. However, the definite explanation is unknown.

Preoperative renal tumor embolization. A useful procedure?

The medical reports of 113 patients operated upon for renal tumors were retrospectively reviewed to assess the value of preoperative embolization. Coils or ethanol were used preoperatively in 55 patients while 58 patients underwent nephrectomy without embolization. The tumors were staged according to the TNM and the Robson staging classification. T1 and T2 tumors as well as T3 and T4 tumors were grouped together for statistical evaluation. There was no significant difference in intraoperative blood loss, operation time and survival rate between patients undergoing preoperative embolization and those who had only nephrectomy. Duration of hospital stay was always longer in the preoperatively embolized group. Preoperative embolization of renal tumors neither improved the patients' outcome nor reduced the surgical risk. Robson's classification, stage III/IV, did not show any significant differences for embolized patients or for those nephrectomized without embolization.

[Microabscesses of the spleen in patients with acute leukemia]. / Mikroabszesse in der Milz bei Patienten mit akuten Leukämien.

Eight patients with acute myelogenous leukemia in complete remission after induction chemotherapy developed septic fever. Fever was unresponsive to broad-spectrum antibiotic therapy. Ultrasonography showed multiple 0.5-2 cm in diameter, anechoic densities and some 1-3 cm "target" appearances in spleen and liver. Computed tomography demonstrated multiple, round, 0.5-2 cm areas of diminished attenuation in spleen and liver, which did not enhance like the surrounding parenchyma. These microabscesses increased in size and number without equivalent antifungal therapy and decreased or disappeared after specific treatment. Candida-infection was confirmed by histologically from liver specimens in four patients, fungal organisms were seen microscopically an liver-biopsy in one patient and at autopsy one patient was found to have candida disseminated to the spleen, liver, kidneys, lung and CNS.

[Acute focal bacterial nephritis]. / Die akute fokale bakterielle Nephritis (AFBN).

Acute focal bacterial nephritis is a very rare type of infective nephritis. It is characterised by groups of abscesses of 1 to 5 mm. situated in the renal cortex with pus tracking to the papillae. Urography is normal or suggests a non-specific enlargement. On sonography, non-homogeneous foci with reduced echogenicity are observed. Unenhanced CT shows indefinite lesions of reduced density, which do not enhance as much as the surrounding parenchyma after contrast injection. On angiography these areas appear as hypovascular lesions. The disease must be differentiated from a malignant renal tumour and from an acute renal abscess. The clinical findings and the results of sonographic and radiological observations on five patients with acute focal bacterial nephritis are described.

[X-ray diagnosis of foot deformities]. / Röntgendiagnostik der Fussdeformitäten.

In order to analyze foot deformities, the foot is divided into three compartments. Their normal and pathological positions are defined by the alignment of the bones' axes. The various foot deformities can be put down to a malalignment of the particular compartments. X-ray analysis of the malalignment allows a diagnosis to be made. The most important congenital and acquired foot deformities are discussed.

[Candida abscesses in the liver and spleen. The sonographic and computed tomographic morphology]. / Candida-Abszesse in Leber und Milz. Sonographische und computertomographische Morphologie.

In three patients with acute leukemia candidal abscesses occurred. In spite of ready response to induction chemotherapy, septic fever as well as hepatic and splenic enlargement were observed. Broad-spectrum antibiotics did not improve the patients' condition either. Ultrasonography of liver and spleen revealed multiple, small echolucent foci and target lesions. Computed tomography detected multiple, hypodense foci 1-2 cm in diameter; after contrast medium application there was no enhancement. Candidal septicaemia was demonstrated in all three patients.

[CT studies following ethanol embolization of malignant kidney tumors]. / CT-Untersuchungen nach Athanolembolisation maligner Nierentumoren.

CT studies were carried out in 25 patients after alcohol embolisation. It was shown that the embolisation reaches the very periphery of the renal capsule. Nevertheless, contrast enhancement in renal tumours persists, due to capsular and collateral vessels. These subsequently permit further tumour growth. Intratumoral gas could be demonstrated in all patients. In the absence of symptoms, this must be regarded as a normal post-embolic event.

[Diagnostic possibilities of computer tomography in spinal and paraspinal space-occupying lesions]. / Diagnostische Möglichkeiten der Computertomographie bei spinalen und paraspinalen Raumforderungen.

Characteristic CT findings of intramedullary, intradural and epidural as well as of vertebragenic and paraspinal tumours are described, basing on literature and on the authors patient material. The value of CT is discussed and compared with that of other imaging modalities. Attention is also drawn to the value of i.v. application of contrast medium and of primary or secondary CT myelography.

["Intensive lungs"--possibilities for quality improvement]. / "Intensivlungen"--Möglichkeiten zur Qualitätsverbesserung.

X-ray lung diagnosis in an intensive-care unit makes special demands on technique, imaging and on the physician's experience. The quality of image interpretation and evaluation is considerably improved by superimposing the technical data on the x-ray image and by using an antiscatter grid cassette. Proper evaluation of the parameters important for diagnosis is improved by registration of the data on the x-ray film; taking a maximum possible score of 100 as reference value, quality of evaluation is improved from 66.5 points to 71.8 points by data registration on the film itself, whereas the simultaneous use of an antiscatter grid cassette improves the score still further, namely, to 84.3 points. The importance of the clinical condition of the patient, and of the type of breathing chosen, for assessing the chest x-ray, is emphasised.

[Clinical aspects and radiotherapy of stage III and IV neuroblastomas]. / Klinik und Strahlentherapie bei Neuroblastomen des Stadiums III und IV.

Contrary to other tumors in children, e.g. leukemia and Wilms tumor the prognosis of which has been considerably improved by the application of surgery, radiotherapy, and chemotherapy, the treatment results of one of the most frequent tumors, namely the neuroblastoma, have not essentially ameliorated during the last few years. The authors present 28 own case records of irradiated patients and describe the clinical symptoms, diagnosis and therapy, especially radiotherapy of the neuroblastoma. A prolongation of the survival time by several months could be achieved in a small group of eight patients treated additionally with an aggressive chemotherapy. The overall long-term prognosis, however, could not be improved hitherto.

[Primarily malignant tumors of the renal pelvis and the ureter - clinical manifestations and results of radiotherapy]. / Primär maligne Tumoren des Nierenbeckens und des Ureters - Klinik und Ergebnisse der Strahlentherapie.

Twenty-two own cases are presented in order to describe the clinical manifestations and therapy, especially the postoperative radiotherapy, in case of carcinomas of the upper urinary tract. The authors agree with literature to recommend a high voltage radiotherapy with 45 Gy to the regional lymph node groups and with 50 to 55 Gy to the former tumor region in case of all tumors with infiltrating growth, of demonstrated lymph node metastases and of subtotally removed primary tumors. Radiotherapy should become an essential part of the therapeutic conception for carcinomas of the renal pelvis and of the ureter because of the nearly complete absence of side effects and the small rate of local recurrences.