[The QuIK-Registry of the German Society of Cardiologists in private practice: countrywide and benchmarking quality assurance in invasive cardiology]. / Das QuIK-Register des Bundesverbands Niedergelassener Kardiologen. Flächendeckende vergleichende Qualitätssicherung in der Invasivkardiologie.

QuIK is the German acronym for QUality Assurance in Invasive Cardiology. It describes the continuous project of an electronic data collection in Cardiac catheterization laboratories all over Germany. Mainly members of the German Society of Cardiologists in Private Practice (BNK) participate in this computer based project. Since 1996 data of diagnostic and interventional procedures are collected and send to a registry-center where a regular benchmarking analysis of the results is performed. Part of the project is a yearly auditing process including an on-site visit to the cath lab to guarantee for the reliability of information collected. Since 1996 about one million procedures have been documented.

Automatic analysis of pacemaker diagnostic data in the identification of atrial tachyarrhythmias in patients with no prior history of them.

AIMS: Modern pacemakers provide a large amount of diagnostic data. Given the limited time available during a pacemaker follow-up visit essential information may be overlooked. This registry was conducted to assess the utility of an expert system that analyses the diagnostic data collected by an implanted pacing device and notifies and advises the physician about suspected technical issues and arrhythmias that need further attention. METHODS: Patients with various standard indications for pacing were included in this registry and received single or dual chamber pacemakers. Data were collected and analysed by the expert system during at least two subsequent follow-up visits. The evaluation of this system focused on data obtained from patients with a dual chamber pacing device without prior history of atrial arrhythmias. RESULTS: A total number of 239 patients without prior history of atrial tachyarrhythmias were included in this analysis. Atrial tachyarrhythmias were detected in 73 (31%) of these patients. The highest incidence of newly detected arrhythmias occurred in the group of patients with high-degree AV block and VDD pacemakers. Furthermore, newly detected arrhythmias predominantly occurred in the period shortly after implantation. Device programming suggestions by the expert system were adopted in 30% of the cases. Following detection of atrial tachyarrhythmias by the expert system, pharmacological management was adjusted at 71% of the first follow-up visits and at 27% of later follow-up visits. CONCLUSION: Results of this registry show that this expert system provides a valuable tool for the detection of atrial tachyarrhythmias during pacemaker follow-up visits.

[CHOP-Bleo therapy in high-malignancy non-Hodgkin lymphoma]. / Kifejezett malignitasú non-Hodgkin lymphomás betegek CHOP-Bleo kezelése.

The records of 85 patients were reviewed in order to study the efficacy of CHOP-Bleo combination chemotherapy and to determine factors influencing prognosis. The patients were treated between 1978 and 1989, the median age was 44.4 (range, 15-68) years, the majority of them were in advanced clinical stages (92.9%). Systemic (B) symptoms were present in half of the patients and a quarter of them had bulky disease. Complete response was achieved in 36 patients (42.5%), partial response in 26 patients (30.5%), and primary treatment failure occurred in 23 patients (27.0%). The median survival was 92.6 months and 36.5% of the patients remained relapse-free at 10 years. The expected 5-year and 10-year survival rates were 47% and 39%, respectively. Using multivariate analysis B symptoms, involvation of two or more extralymphatic sites and lymphoblastic histologic subtype proved to be unfavourable prognostic factors. The most frequently observed side-effects were myelosuppression, neurotoxicity and gastrointestinal symptoms. No treatment-related death have occurred.

[Complications of radical vulvectomy and adjacent lymphadenectomy based on 58 cases of vulvar cancer]. / Kiterjesztett szeméremtest- és környéki nyirokcsomó-eltávolítás szövödményei 58 szeméremtestrák esete alapján.

The authors report on the complications of 58 radical vulvectomy with bilateral inguinal lymphadenectomy due to vulvar carcinoma. There was no operative mortality and no serious intraoperative complication was encountered. Wound disruption with or without infection was the most frequent early postoperative complication that occurred in 59% of the cases. Surgical intervention for secondary haemorrhage was necessary in 3 patients. Lymphatic fistula and lower extremity oedema developed in 3 women. The most disturbing long term complication, the persistent lower extremity oedema, occurred in 11 patients. Difficulties with micturation and vaginal prolapse developed in 4 subjects. The complication rate of this series compares favourably with the literature data. In the author's view radical vulvectomy with groin node dissection is a major operation and should be performed in oncological centers.

[Clinical significance of steroid receptors in breast cancer]. / Az emlörák szteroid receptorainak klinikai jelentösége.

The steroid receptor determination (first of all estrogen receptor--ER--) of the breast cancer tissue has become an important factor for prognostication and treatment. Authors from the Surgical Department of the National Institute of Oncology provide a biostatistical survey of their 727 breast cancer patients. Following factors proved to have significant impact on the prognosis: positivity of ER, the quantitative value of ER, ER vs. lymph node status, ER vs. DFI, ER and the site of metastases and the hormone therapy. The progesterone receptor (PR) provides indication in case only for DFI for metastases. However, in this very respect it has a more significant value than that of ER. Multidimensional analysis has shown that the most important prognostic factors are the lymph node status, patient's age, size of the tumour and the ER value.

[K-cell activity in patients with germ cell testicular tumors. Effect of cytostatic therapy]. / Csírasejt eredetü heredaganatban szenvedök K-sejt aktivitásának vizsgálata. A citosztatikus kezelés hatása.

The antibody-dependent cell mediated cytotoxicity of peripheral blood mononuclear cells from 92 patients with germinal cell tumours and 60 healthy male controls was measured against 0, Rh(D) positive human red blood cells sensitized with anti-D antibody. To determine the maximal K-cell activity the enzym-like kinetic model of citotoxicity was employed in which maximal activity was measured in presence of target-cell excess. To avoid variation due to the individual sensitivity of target erythrocytes red blood cells were obtained from a single donor. It was demonstrated that compared to the control group the K-cell activity of patients with germinal cell tumours was significantly enhanced. Cytotoxic activity of patients with clinically detectable tumours was significantly higher than that of patients with no detectable tumour. The K-cell activity of patients with detectable tumours was significantly increased after chemotherapy.

Randomized phase II trial of high-dose 4'-epi-doxorubicin + cyclophosphamide versus high-dose 4'-epi-doxorubicin + cisplatin in previously untreated patients with extensive small cell lung cancer.

One hundred and eleven previously untreated patients with extensive small cell lung cancer were included in a prospective randomized study with the aim to assess the efficacy and tolerance of high-dose epirubicin (120 mg/m2) in combination with either cyclophosphamide (800 mg/m2; arm 1) or cisplatin (60 mg/m2; arm 2). Ninety-six patients were evaluable for response and toxicity and additional 12 patients for toxicity only. The overall response rate (CR+PR) in arm 1 and 2 were 61.4 (27/44) and 67.3% (35/52), respectively. The mean duration of remission was 4.4 months (arm 1) and 4.9 months (arm 2). The mean survival time was 6.6 months in arm 1 and 7.7 months in arm 2. WHO grade 4 toxicity was encountered in 25.5 and 15.8% of patients in arm 1 and 2, respectively. One case of cardiotoxicity resulting in the patient's death was observed in arm 1. Both combinations showed considerable antitumor activity. Toxicity was acceptable.

Follicular cancer of the thyroid gland.

Between 1965 and 1987 the authors studied the survival of 169 patients (130 females, 39 males) suffering from follicular thyroid cancer. It is established that the factors favorably influencing the course of the disease are as follows: age below 40 years, female sex, tumor location inside the thyroid capsule. Radical surgery does not affect the survival, though it prolongs the time to the onset of metastases. In women below 40 years of age, iodine treatment performed within 1.5 months following surgery does not increase the effectiveness; therefore, its routine application is not recommended. In case of local metastases associated with hindered swallowing or respiration, external beam radiotherapy is indicated. Hormone substitution ensuring TSH restriction results in improved prognosis.

Differences in the competitive capacity of monoclonal antibody sensitized human A and B erythrocytes in complement mediated cytotoxicity.

Lysis of group A and B erythrocytes by human complement was studied using 9 anti-A (IgM) and 10 anti-B (IgM) monoclonal antibodies in direct and cold target competition 51Cr-release assays. The relative concentration of membrane-bound immunoglobulins was detected by indirect immunofluorescence in flow cytometric analysis. The number of binding sites/cell and affinity of the monoclonal antibodies was measured in ELISA assays. Complete haemolysis was obtained at 2 micrograms.ml-1 antibody concentrations with the majority of reagents when only a small proportion of the antibody binding sites were occupied. The influence of membrane-bound antibody on complement binding was examined by the complement consumption capacity of sensitized erythrocytes at supra-haemolytic antibody concentration. We found that complement consumption correlated with the amount of membrane-bound immunoglobulins. To obtain equal level of target and competitor cell lysis group B erythrocytes had to be equipped with higher amounts of antibodies than group A erythrocytes. The different lytic activity of IgM anti-A and anti-B monoclonal antibodies could not be accounted for merely by differences in their surface density.

Differential susceptibility of haemolysin-sensitized erythrocytes to complement-mediated cytotoxicity: a biological manifestation of the relationship between antibody availability and complement fixation.

The influence of the concentration of membrane-bound antibody on the susceptibility of individual human erythrocyte populations to complement-mediated haemolysis has been examined using cold competition analysis. It was observed that under conditions where complement is limiting, the relative susceptibility of erythrocytes to complement lysis is dependent on the availability of sensitizing antibody, even when all target red cells possess sufficient membrane antibody to permit maximal lysis in the presence of excess complement. Furthermore, preliminary evidence is presented which suggests that, where the availability of complement is limiting, sensitized blood group A erythrocytes are more susceptible to complement lysis than are sensitized group B cells. Taken together the data indicate that the quantity, and possibly the distribution, of the membrane antibody dictates the relative susceptibility of erythrocytes to complement haemolysis.

[Prospective study of K-cell activity in patients with malignant gynecologic tumors. Effect of radiation therapy]. / Rosszindulatú nögyógyászati daganatos megbetegedésben szenvedö betegek K-sejt aktivitásának prospectiv vizsgálata. A sugárkezelés és mütét hatása.

K cell activity was measured in the enzyme-like kinetic model of cytotoxicity against O, Rh (D) positive erythrocytes in 127 patients with carcinoma of the uterine cervix, 55 with carcinoma of the corpus uteri and 30 with malignant tumors of the ovary. The control groups included 62 healthy age matched women and 39 patients with benign tumor of the ovary. The cytotoxic activity was measured in a number of cases before any treatment and after irradiation and surgery in patients with cervical and endometrial cancer. The target cells were obtained from the same donor. ADCC activity of cervical and ovarian tumor patients enhanced depends on the stage of the disease. K cell activity of endometrial carcinoma patients was similar to the controls. ADCC activity of patients with carcinoma of the uterine cervix was increased, with carcinoma of the uterine corpus was indicated an increasing tendency following irradiation. There was connection with the dose of the irradiation and K cell activity. On the contrary, operation did not influence ADCC activity.

The role of antibody density in the immune lysis of sensitised erythrocytes. A mathematical appreciation.

The influence of sensitizing antibody density on target cell selection by effector monocytes was examined by modifying the sensitization of red cells either by dilution of the antiserum, variation of the number of erythrocytes or both in a cold target competition assay of antibody-dependent cellular cytotoxicity (ADCC). Human A1 and B erythrocyte target and competitor cells were employed in the presence of hyperimmune anti-A and anti-B sera at concentrations above that necessary for saturation of red cells with respect to lytic susceptibility. When the number of red cells was kept constant and the dilution of antisera was varied a linear relationship between the competitive capacity of erythrocytes and the concentration of sensitizing antiserum was observed. When the number of target (competitor) cells and the concentration of antisera were varied simultaneously it was apparent that the competitive capacity was dependent upon the relative densities of the sensitizing antibodies. When competition was tested in the presence of suboptimal concentrations of complement, rather than effector cells it was observed that, in common with ADCC, the effectiveness of cold competition was dependent upon the concentration of sensitizing antibody.

The influence of antibody sensitization on target cell selection in monocyte-mediated antibody-dependent cellular cytotoxicity.

The role of sensitizing antibody in monocyte-mediated antibody-dependent cellular cytotoxicity (ADCC) has been investigated using human erythrocyte target cells and hyperimmune anti-A and anti-B antisera. The influence of sensitizing antibody concentration on target cell selection by effector monocytes was measured using a cold target competition assay. It was observed that even when red cells were saturated with sensitizing antibody with respect to lytic susceptibility further increases in the density of membrane bound IgG continued to influence their capacity to inhibit lysis in cold target competition assays. It is suggested that although a critical level of sensitization is required for the initiation of lysis, the avidity of interaction between monocyte and target erythrocytes is significantly influenced by further increases in the availability of target-bound antibody.

Comparison of monocyte and complement mediated haemolysis of human A1 erythrocytes: the relationship between antibody, target and effector concentrations in the induction of lysis.

Haemolysis of sensitized A1 erythrocytes by blood monocytes or complement was measured under conditions where antibody, complement, target and effector concentrations varied relatively to each other. When sensitization was limiting, cell-mediated lysis remained constant with increasing red cell number. When antibody was in excess and complement was limiting, complement-mediated lysis remained constant with increasing red cell number. These effects could be explained if a non-homogeneous expression of A1 antigens on individual erythrocytes is assumed. Considering that the capacity of antibody to bind to the antigen is random and uniform, at high dilution of antibody only those erythrocytes with sufficiently high antigen density will be appropriately sensitized for cell-mediated lysis. At antibody excess binding sites are saturated, and therefore the number and distribution of cell bound antibodies reflect the number and distribution of antigens. The fact that under such conditions increasing target concentrations did not reduce lysis induced by a suboptimal complement concentration also argues for an uneven antigen distribution among erythrocytes.

K cell activity is low in newborn infants.

K cell activity of 18 mature, healthy newborns was measured against O,Rh(D)-positive erythrocytes, sensitized by anti-D antibodies, in cord and venous blood (later obtained 3-4 days after delivery). 53 healthy women served as controls. Activity was determined as a function of target cell number in the enzyme-like kinetic model of cytotoxicity. It was low in cord blood, increased in venous blood by days 3-4 but it did not reach the level of adults. While cytotoxic activity of male infants increased significantly from birth to the 3rd-4th day of life, it did not change in female infants. No correlation was found between the weight and K cell activity of newborns.

Quantitative comparison of direct and cold-target competition assay in monocyte- and complement-mediated lysis of sensitized erythrocytes.

Differences in the number of the antigenic determinants of A1 and B erythrocytes were exploited to study the influence of the sensitization on antibody-dependent monocyte- and complement-mediated cytotoxicity. Lysis was compared in direct and cold target competition assays. The findings were: (1) Monocyte mediated lysis of both targets was similar; A1 erythrocytes, however, showed stronger competitive inhibition than B cells; (2) the competitive inhibition was influenced by the antiserum concentration in a range where the direct lysis was not; (3) in the presence of optimal concentrations of hyperimmune antisera and complement, A1 erythrocytes were lysed, while B erythrocytes were not; and (4) A1 cells exposed to suboptimal concentrations of complement consumed complement, while B cells did not. It was concluded that the cold target competition assay is more sensitive than the direct cytotoxicity test to detect differences in the sensitization of erythrocytes.

Diagnostic value of infrared thermography in breast cancer, and in proliferative and non proliferative mastopathies.

The authors present the results of breast examinations in 201 female patients controlled by cytology and histology. Based on their results obtained by an AGA 680 type infrared thermography, their conclusion was that the method is primarily suitable for the examination of biological thermogenesis, one of the functional characteristics of tumours. Some T1 breast cancer of the same histological type are thermographically "silent", i.e. display no pathological alterations. Thermographical signs characteristic of carcinomas are to be found only in 60-70% of the cases. It is explained by the biological heterogeneity of tumours, i.e. the amount of heat generated by the metabolic processes of the different carcinomas is not equal, as well as they are different in vascularization and as a consequence of it in their heat conduction parameters. Similar reasons explain the appearance of different thermographic patterns--negative or characteristic of cancerous alterations--in proliferative mastopathies.