On the dynamics of self-organization in living organisms.

We show that in nonlinear systems dynamical order can be reached through the flows of matter, energy, and information, which can be non uniformly spread over the organism due to self-trapping induced by the correlated coherence domains of interfacial water. Endogenous electromagnetic field is self trapped in these domains and forms the dynamical pathways as wave-guides, along which these flows can occur via soliton mechanisms. Solitons in the pathways can be stimulated either by intrinsic dynamics or by external stimuli and can be visualized in the infrared range as bright or dark solitons. The formation of such pathways is the consequence of coherence-non coherence transitions occurring in the biological cycle of the organism. A rational therapy appears then to be the induction of conditions for soliton existence necessary for maintaining the coherence of the system.

[Primary tumor volume and prognosis in bronchial carcinoma]. / Primärtumorvolumen und Prognose beim Bronchialkarzinom.

UNLABELLED: Lymph node involvement and histologic type are well known and accepted as prognostic factors for bronchial carcinoma. The role of the primary tumor volume has been but rarely examined. However, it is accepted that there is a clear correlation between primary tumor mass and the level of tumor cell dissemination. Therefore primary tumor volume can be a useful prognostic indicator especially for those tumors of which no evidence of metastases can be proved even with CT or MR. In case of 1022 patients, having been received a tumor dose more than 5600 cGys (on the 80% isodose curve), if metastatic including the primary lymph nodes, we examined the correlation between histologic type, lymph node involvement, primary tumor volume and overall survival, response on chest X-ray films, and tumor destruction in autopsy materials, respectively. We found: 1. There was a strong correlation, especially in N0-cases, between primary tumor volume and overall survival, in all histologic types. 2. Small regional metastatic tumors (N1, N2) had a better prognosis than that of great tumors with no metastases (N0), in all histologic types. 3. Small adenocarcinomas and large-cell tumors without lymph node involvement had a better prognosis than that of squamous cell tumors of the same stage. 4. In 222 cases of T2N0-tumors five-year overall survival was 15.3%, in 43 cases of large-cell tumors and adenocarcinomas 29%, respectively. CONCLUSION: Primary tumor volume is an important prognostic factor and can be easily and objectively evaluated.

[Does the initial hemoglobin value modify the primary tumor reaction? A study of 264 irradiated bronchial cancers]. / Beeinflusst der initiale Hämoglobinwert die Primärtumorreaktion? Eine Untersuchung an 264 bestrahlten Bronchialkarzinomen.

In a retrospective investigation the remission rate was determined in roentgen picture for 264 male patients with bronchogenic carcinoma after intensive radiotherapy (target dose 56 Gy). Classification of roentgenologic remission was done in 3 groups (complete, partial, minimal/no remission). For each patient the pretherapeutic haemoglobin value was taken from casebook and clinical relevant limit concentrations for an anaemia were correlated with the classified remissions. The difference of regression frequency between complete and partial remission always can be secured statistically irrespectively of chosen limit, that is the anaemia has a provable influence on roentgenologic tumor reaction. To prove that the tumor value as a third variable is not responsible for that a covariant analysis was done. According to that the corrected mean haemoglobin values were 8.9 mmol/l for complete, 8.1 mmol/l for partial and 7.7 mmol/l for minimal/no remission. These differences of the mean values are significant in Newman-Keuls-test, the relation between initial haemoglobin value and remission type is provable independently of tumor volume. Also for bronchogenic carcinoma with that a dependence could be shown between haemoglobin concentration--and by this the oxygen supply of the tumor--and the reaction of the primary tumor after radiotherapy. From this we deduce the recommendation to treat anaemia before beginning of radiotherapy or to irradiate anaemic patients applying an effective sensitizer.

[Adjuvant postoperative irradiation of rectal cancer in a risk group]. / Adjuvante postoperative Bestrahlung beim Rektumkarzinom in einer Risikogruppe.

The results of the pilot study carried out in 1985 are described. The group with high risk of recurrence is clearly distinguishable by means of prognostic factors. The adjuvant postoperative supervoltage therapy on the former rectum lodge (2 x 5.0 Gy per week up to a total dose of 45.0 Gy) failed to increase the survival rate. The tendency towards reduction of the recurrence rate, 56% vs. 70%, was levelled by post-radiogenic side effects.

[Experiences with intensive radiotherapy of prostatic cancer in conjunction with surgery (transurethral resection, pelvic lymph node excision)]. / Erfahrungen bei der intensiven Strahlentherapie des Prostatakarzinoms im Zusammenhang mit operativen Eingriffen (TUR, PLA).

Since 1981 a curative radiation treatment was performed in 84 patients with prostatic carcinoma. Previously, in 37 cases a transurethral resection of bladder outlet obstruction was done and in 18 patients a pelvic lymph node dissection was performed, whereas 29 patients were without operative therapy. Mild side effects of radiation could observed in all 3 groups in nearly the same portion (59/56/65%). However, in the group with transurethral resection after follow-up of 4,4 years severe late complications were found (cystitis, incontinence, urethral fistula). Therefore, radiation treatment of prostatic carcinoma after transurethral resection was abandoned. The cumulative 5-year-survival rate was 63% and in the TUR group only 41%. 9 out of 10 patients with histological verified lymph node metastases and radiation treatment are alive after mean follow-up time of 3.1 years without evidence of recurrent disease.

[Results of intensive radiotherapy of bladder cancer following transurethral tumor resection]. / Ergebnisse der intensiven Strahlentherapie des Harnblasenkarzinomas nach transurethraler Tumorresektion.

During the period from 1977 to 1984 173 patients with a bladder carcinoma were exposed a combined operative-radiological therapy. It includes the transurethral tumor resection and the percutaneous high voltage irradiation after an interval of six weeks. After individual irradiation planning--since 1981 by means of CT--pendulum technique has been applied exclusively for careful treatment of risk organs. The total target dose (= 80% isodose) was 56 Gy with daily application of 1.8 Gy. We attained a 5-years-healing of 27%, obviously the first two years therapy beginning were deciding for fate (2-years-survival 45%). Among infiltration grade and histological type also the primary tumor localization had prognostic relevance. In locally advanced bladder carcinoma with invasion into the environment the radiotherapy gives chance for permanent healing. Acute passing side-reactions during intensive therapy, mainly as cystitis, we recorded in 2/3 of the patients. Only with the combined occurrence of cystitis and proctitis we had to record chronic effects in 2.5% of the cases for a period of more than 5 years.

[Dermatofibrosarcoma protuberans. Results of radiosurgical therapy by photon and electron rays or fast neutrons]. / Dermatofibrosarcoma protuberans. Ergebnisse der radiochirurgischen Therapie mit Photonen- und Elektronenstrahlung bzw. schnellen Neutronen.

The dermatofibrosarcoma protuberans, a rare entity of soft tissue sarcomas, is specified as a tumor of intermediate malignancy because of its marked tendency to form local recurrences. Regarding the prevention of local recurrences, the results of combined radiosurgical therapy (n = 13) could be improved in our patients by the application of fast neutrons (n = 6). Despite multiple previous operations for recurrences, a reliable prevention of local recurrences (average follow-up period 5.5 years) was achieved in all patients by neutron irradiation with focal doses of approximately 9 Gy. One patient with multiple macroscopic recurrences received two neutron series with 17 Gy. At seven years, she is still recurrence-free. We consider the postoperative irradiation of the dermatofibrosarcoma protuberans with fast neutrons following to primary tumor excision as method of choice for a reliable prophylaxis of local recurrences, because this method allows to dispense with major radical surgery.

[Results of high-voltage and neutron therapy in the treatment of the postoperative anastomotic recurrence of stomach cancer]. / Ergebnisse der Hochvolt- und Neutronentherapie in der Behandlung des Anastomosenrezidivs beim operierten Magenkarzinom.

Local recurrence in anastomotic region after resection of stomach cancer is not a rare event. The role of radiotherapy in palliative treatment is commonly underestimated. Our experiences were demonstrated in 2 treatment groups (megavoltage therapy alone, 23 cases; in combination with neutrons, 13 patients). Decrease in dysphagia in 75% of patients was comparable with roentgenologic findings, where reduced tumor in 63% was established. These encourageable findings were confirmed in examination of anastomotic region in autopsy (megavoltage therapy 14 cases, combined neutron therapy 12 cases). Smaller tumors could be totally destroyed by megavoltage therapy. The local tumor destroying rate increased by combination with neutrons (6/12 cases). No advantage in life prolongation could be stated, because local recurrence was quickly followed by widespread disease (77%). Finally we demonstrate a treatment plan, which bases on our clinical experience. With 3-4 fractions of 5-7 Gy a real clinical and radiological demonstrable palliation effect is to be reached.

[The role of computerized tomography in the diagnosis and treatment planning of prostatic cancer]. / Die Rolle der Computertomographie in der Diagnostik und für die Therapieplanung des Prostatakarzinoms.

The influence of computerized tomography on planning the therapy of 58 patients with histologically confirmed carcinoma of the prostate gland was examined. In classifying the early tumour stages there were differences from the clinical findings. With more advanced stages CT in some cases gave much more detail for diagnosing the extension. In 11.5% of the cases this led to the irradiation field being either enlarged or reduced. CT also proved to be useful for follow-up, especially as regards decisions on increasing the irradiation dose.

[Stabilization of proximal femoral fractures using the compression and sliding screw]. / Die stabile Versorgung hüftgelenksnaher Oberschenkelfrakturen mit der Kompressions-Laschengleitschraube.

Between 1979 and 1983 we treated 169 fractures with a sliding compression hip screw out of 402 operated fractures of the upper femur. The indication for this method included all types of proximal femoral fractures. In case of instable trochanteric fractures convincing results of treatment could be achieved because of early weight bearing. As complications could be found in two cases loss of fixation. The mortality rate was 17.8 per cent. Still 2/3 of the injured with an average age of 76.2 years could leave the hospital walking on their own after an average stay of 37.6 days.

[Autopsy and clinical findings of metastases in bronchial carcinoma. A study of 649 intensively irradiated cases]. / Autoptische und klinische Befunde der Metastasierung des Bronchialkarzinoms. Eine Untersuchung an 649 intensiv bestrahlten Fällen.

Between the years of 1958 to 1980, 1636 patients suffering from histologically demonstrated bronchial carcinomas were submitted to an intensive radiotherapy at the Robert-Rössle Hospital in Berlin-Buch. The tumors received a minimum dose of 5000 Gy. The autopsy reports of 649 cases could be evaluated. The tumor destruction rate determined by autopsy and the distribution of metastases in dependence on the histologic tumor type are described and compared to the frequency of metastases determined by clinical or X-ray examination. With respect to clinical practice, the conclusion is drawn that a prophylactic radiotherapy to the brain, the upper abdominal lymph nodes and the adrenal glands possibly could improve the therapeutic results because of the high rate of metastases of microcellular and non-differentiated bronchial carcinomas found in these regions.

[Osteosynthesis of unstable pertrochanteric femoral fractures with the compression hip screw]. / Zur Osteosynthese instabiler pertrochantärer Oberschenkelfrakturen mit der Kompressionslaschengleitschraube.

Injuries of unstable pertrochanteric fractures of the upper femur represent a contingent with high multi-morbidity at highest average age. The only successful procedures within biologically set boundaries, would be those of an early and weight-bearing resistive osteo-synthesis. Starting in 1979 till the middle of 1982, we treated 70 unstable pertrochanteric fractures out of 350 proximal femur fractures, with this compression hip screw. Because of its underlying bio-mechanical principle, its advantageous operative handling, as well as high durability of the material used, this version of an osteosynthesis showed few complications. We found neither head penetration and pseudoarthrosis, nor did we find any implant bending and breaking so far. Although averaging almost 80 years, 63% of our patients could be released after hospitalization for an average of 39 days, leaving at full mobility. The set goal of an early weight-bearing with elderly patients was fully achieved by means of this version of osteo-synthesis, since dynamic compression of even comminuted fracture zones permitted a statically sound and unhindered possibility at weight-bearing.