Radiotherapy in stage I-III follicular non-Hodgkin lymphoma. Retrospective analysis of a series of 50 patients.

PURPOSE: The goal of this work was to analyze the response rate and outcome of patients with stage I-III follicular lymphoma (FL) treated with radiotherapy (RT) alone. PATIENTS AND METHODS: The records of 50 consecutive patients with stage I-III FL treated with RT alone at our department from 1988-2009 were analyzed. The median age was 60 years (range 32-80 years) with a median follow-up duration of 8 years (range 4-11 years). Clinical staging was performed according to the Ann Arbor system. Stage I: 30 patients (60%), stage II: 15 patients (30%), stage III: 5 patients (10%). Thirty-two patients (64%) presented with nodal disease, 14 patients (28%) presented with disease in extranodal sites, and 4 patients (8%) had nodal and extranodal involvement. The RT field encompassed only the involved Ann Arbor nodal regions (involved-field RT) in 26 patients (52%), mantle and whole abdominopelvic fields in 6 patients (12%), mantle field in 10 patients (20%), whole abdominopelvic fields in 5 patients (10%), and a so-called mini-mantle in 3 patients (6%). The total RT dose ranged from 26-56 Gy (median 40 Gy) in daily fractions of 1.2-2.5 Gy. RESULTS: Complete remission (CR) and partial remission (PR) were observed in 39 (76%) and 9 (20%) patients, respectively. Only 2 of 8 patients (25%) with tumor bulk > 5 cm reached CR, whereas 37 of 42 patients (88%) with a maximum lymphoma diameter < 5 cm achieved CR (p = 0.0001). The median overall survival (OS) and median event-free survival (EFS) were 18 years (CI 95% 10-26 years) and 7 years (6-8 years), respectively. The 2-, 5-, and 10-year OS were 96 ± 3%, 90 ± 5%, and 70 ± 9%, respectively. The 2-, 5-, and 10-year EFS were 90 ± 5%, 70 ± 7%, and 38 ± 9%, respectively. Fifteen patients developed a recurrence outside the radiation field (30%) and 4 patients developed an in-field recurrence (8%). All in-field recurrences were observed in regions without clinical (macroscopic) involvement, which were irradiated with a dose of ≤ 26 Gy. Pretreatment maximum lymphoma diameter < 5 cm (p = 0.039) and complete remission after RT (p = 0.021) were significantly associated with a better OS in the univariate analysis. CONCLUSION: RT is a curative option in the treatment of limited stage FL. If RT of microscopically uninvolved area is necessary, a reduction in the radiation dose should be carefully weighed against the risk of in-field recurrences.

[Diagnosis of pleural effusion in intensive care patients with supine digital thoracic imaging. A study of CT validated cases]. / Diagnostik von Pleuraergüssen bei Intensivpatienten mit der digitalen Thoraxliegeaufnahme. Eine Studie in CT-validierten Fällen.

PURPOSE: The significance of the recumbent chest x-ray using digital luminescence radiography was to be assessed in respect of diagnosis of pleural effusions. MATERIAL AND METHODS: Three experienced radiologists evaluated 32 digital recumbent chest x-rays of 32 intensive-care patients. The radiologists were asked to estimate the effusion volume and to assess whether typical x-ray signs of pleural effusions were seen. These evaluations were compared with one another and with the simultaneously produced CTs. RESULTS: Diagnostic accuracy of the digital recumbent chest x-ray is of medium quality in respect of diagnosis of pleural effusions (sensitivity: 69%, specificity: 54%, positive predictive value: 81%, negative predictive value: 34%, rate of accuracy: 65%). Diagnostic safety is the same for right-sided or left-sided pleural effusions, and increases with increasing effusion volume. The ratings by the radiologists are statistically not significantly different, but are significantly different from the CT measurements (Wilcoxon test, p < 0.05). Correlations of the assessments and the measurements were weakly positive (r = 0.24, r = 0.36, r = 0.47). The pleural effusions were on the average underestimated by the radiologists. The median predictive error was 203 ml. CONCLUSIONS: Recumbent chest x-ray with digital luminescence radiography is an imaging method of limited accuracy in respect of diagnosis of pleural effusions. Supplementary diagnostic methods are recommended, as the present results show, especially in such cases where the recumbent chest x-ray does not reveal an effusion or if the volume must be determined accurately. Digital recumbent chest x-ray ranks equal with conventional x-ray in the diagnosis of pleural effusions.

Studies on the effects of betamethasone, L-carnitine, and betamethasone-L-carnitine combinations on the dipalmitoyl phosphatidylcholine content and phosphatidylcholine species composition in foetal rat lungs.

Administration of L-carnitine or betamethasone to pregnant rats failed to increase either the total phospholipid or dipalmitoylphosphatidylcholine (DPPC) contents in foetal rat lungs on the 20th day of gestation, compared to controls. The combined administration of betamethasone (0.3 mg/kg) and L-carnitine (80 mg/kg) resulted in a pronounced increase of dipalmitoylphosphatidylcholine (7.8 +/- 2.5 mg/g dry weight) compared with the control group (5.4 +/- 1.8 mg/g dry weight), and compared with the groups receiving betamethasone (5.9 +/- 1.9 mg/g dry weight) or L-carnitine (5.6 +/- 1.5 mg/g dry weight) alone. The proportion of dipalmitoylphosphatidylcholine in the phosphatidylcholine species increased from 20.9 +/- 2.1% in the foetal lungs of the control group to 22.6 +/- 5.0% in the L-carnitine group, to 24.3 +/- 3.3% (p less than 0.01) in the betamethasone-L-carnitine (20 mg/kg) group, to 25.2 +/- 3.5% (p less than 0.01) in the betamethasone group, to 27.1 +/- 2.6% (p less than 0.01) in the betamethasone-L-carnitine (40 mg/kg) group, and to 28.4 +/- 3.7% (p less than 0.01) in the betamethasone-L-carnitine (80 mg/kg) group, while the palmitic acid portion in the phosphatidylcholine fatty acids was nearly unchanged. A pronounced increase of palmitoyl-myristoyl phosphatidylcholine (PC-30), the second disaturated phosphatidylcholine species present in lungs in significant amounts beside dipalmitoylphosphatidylcholine, was noted only in betamethasone treated animals. Furthermore, after betamethasone and betamethasone-L-carnitine treatment, a significant diminution (p less than 0.01) of the proportion of palmitoyl-palmitoleyl phosphatidylcholine (16 : 0/16 : 1-PC) in the phosphatidylcholine species was demonstrated.(ABSTRACT TRUNCATED AT 250 WORDS)

[Pharmacologic influencing of fetal phospholipid synthesis. Part IV: influencing the DPL(dipalmitoyl-lecithin) content of fetal lung by betamethasone (author's transl)]. / Pharmakologische Beeinflussung der fetalen Phospholipidsynthese Teil IV: Beeinflussung des pulmonalen DPL-(Dipalmitoyl-Lezithin)-Spiegels durch Betamethason.

Dipalmitoyllecithinic (DPL) is the quantitatively largest and most active portion of the surfactant system. Hence only a quantitative DPL determination allows a relevant statement of fetal lung maturity. The antenatal prophylaxis of RDS should result in an increase of the DPL-level in a fetal lung. A new gaschromatographical method for determination of DPL was developed. The results were secured by gaschromatography-mass-spectrometry-couplings. After treatment with betamethasone an increase of the relative DPL-amount in fetal rat lung lecithin species was found, but not an increase of the lecithin-level in the lung-tissue. Corticosteroids probably induce transesterification of the lecithins.

[Changes of the essential fatty acids in plasmalipid fractions of polytraumatized patients with different parenteral nutrition (author's transl)]. / Veränderungen der essentiellen Fettsäuren in Plasmalipidfraktionen polytraumatisierter Patienten bei unterschiedlicher parenteraler Ernährung.

In two groups of polytraumatized patients we investigated changes in the fatty acid pattern of plasma-lipids during the phase of total parenteral nutrition. For parenteral nutrition we gave L-amino acid solutions in a dose of 0.24 g N/kg body weight/day. In addition, we administered in the first group glucose and fructose and in the second group glucose, fructose and fat emulsions in a total dose of 30 kcal/kg body weight/day. In the latter group, the proportion of the fat emulsions was 30-40% of the administered calories. We compared the achieved results with the values of a group of control persons. The most essential findings of these studies were the striking decrease of the essential fatty acids with regard to the phospholipid fraction in the early post-traumatic phase. In the first group we observed a further reduction of essential fatty acids during the period of observation. This could be avoided by administering fat emulsions of the same type as we gave in the case of the second group of patients. The functions of essential fatty acids in membranes and in intermediary metabolism are discussed.

[Pharmacologic influencing of fetal phospholipide synthesis. Part II: Carnitin - a new way of dyspnea syndrome prophylaxis? (author's transl)]. / Pharmakologische Beeinflussung der fetalen Phospholipidsynthese. Teil II: Carnitin - ein neuer Weg der Atemnotsyndromprophylaxe?

Carnitine is a body-owned Betaine which is wide-spread in living nature in the form of a physiologic metabolit. On account of its central metabolic function, Carnitine has various effects in the intermediary metabolism. Toxicity of Carnitine is very low. DL-Carnitine hydrochloride (30 mg/kg body weight) was injected into 25 gravid Wistar rats and 24 gravid rabbits, 4 days before the Cesarean section. Compared to the group of controls, the group treated with Bromhexine metabolit VIII, as well as to the group treated with Betamethason, significantly higher values with regard to the content of total phospholipids, lecithine and palmitic acid could be found in the fetal rat lungs. Effects of Carnitine on the phospholipid metabolism are discussed.

Changes in essential fatty acids in plasma lipid fractions of polytraumatized patients with different parenteral nutrition.

We investigated changes in the fatty acid pattern of plasma lipids during the phase of total parenteral nutrition in two groups of polytraumatized patients. For parenteral nutrition we gave L-amino acid solutions in a dose of 0.24 g N day-1kg-1 body weight. In addition, we administered in the first group glucose and fructose, and in the second group glucose, fructose and fat emulsions in a total dose of 30 kcal day-1kg-1 body weight. In the latter group, the proportion of the fat emulsions was 30-40% of the calories administered. The most striking findings were the decrease of the essential fatty acids with regard to the phospholipid fraction from about 60% to 30% in the early post-traumatic phase. In the first group of patients we observed a further reduction of the essential fatty acids in the period of observation. This could be avoided by administering fat emulsions of the same type as we gave in the second group of patients. The functions of essential fatty acids in membranes and in the intermediary metabolism are discussed.