[The use of an early postoperative interstitial-hyperthermia combination therapy in malignant gliomas]. / Einsatz einer früh postoperativen interstitiellen Hyperthermiekombinationstherapie bei malignen Gliomen.

BACKGROUND: The survival of people suffering from malignant gliomas (WHO level III and IV) is predominantly limited by local progress in the primary tumor region. Interstitial hyperthermia combined with radiotherapy or chemotherapy is one approach for the intensification of local therapy. It is possible to combine (partial) tumor resection with hyperthermia as well as with brachytherapy by implanting catheters intraoperatively. PATIENTS AND METHODS: A pilot study was performed to examine practicality, tolerability, effectiveness and scope for improvement in early postoperative hyperthermia treatment following catheter implantation as part of (partial) tumor resection. Each CT data set was transferred into a VAX 3100 workstation for retrospective analysis of the hyperthermia treatment. The implanted catheters were segmented and the distributions of power density and temperature were simulated. We sought to achieve the best possible temperature distributions by optimising the catheter arrangement in the planning calculations. The corresponding Ir-192-source brachytherapy treatments were simulated in a similar way using the implanted, as well as optimised catheter arrays. RESULTS: Intraoperative catheter implantation in 4 patients was problem-free. Postoperative complications were not observed, neither were infections. Interstitial microwave hyperthermia in combination with percutaneous irradiation or chemotherapy a few days after the operation was also tolerated well by all patients. Effective temperatures (of at least 42 degrees C) were regularly achieved at measurement points, but the temperature distributions were unsatisfactory, with T90 values (the temperature reached in at least 90% of the target volume) of under 38 degrees C. Measured temperature/position curves showed qualitative correlation with the simulated calculations. The catheter positions determined by optimisation varied significantly from the positions clinically used. CONCLUSIONS: Early postoperative combination therapy using hyperthermia for the treatment of malignant gliomas is a very practical approach. The optimisation strategies described should be used preoperatively to plan catheter arrays for interstitial hyperthermia and brachytherapy, and these arrays should be implanted using stereotaxic surgery.

Calcium citrate markedly enhances aluminum absorption from aluminum hydroxide.

The effect of calcium citrate on intestinal aluminum absorption, assessed by the increment in urinary aluminum excretion, was evaluated in eight normal men. Baseline urinary aluminum excretion was determined for 2 days; thereafter, subjects ingested aluminum hydroxide for 3 days. In a cross-over study, subjects were given either calcium citrate, 950 mg four times a day, or placebo during the 3 days of aluminum hydroxide ingestion (2.4 g/d). Plasma aluminum levels were measured on the second control day and the third day of aluminum hydroxide ingestion. Baseline urinary aluminum excretion was 0.02 +/- 0.004 (6.5 +/- 1.1 micrograms/g creatinine) and 0.03 +/- 0.005 mumol/mmol creatinine (7.4 +/- 1.3 micrograms/g creatinine). These values increased during aluminum hydroxide therapy, but values were much greater when calcium citrate was ingested with aluminum hydroxide. On 3 consecutive days, urinary aluminum excretion levels were 11.1 +/- 3.23, 8.8 +/- 2.9, and 5.3 +/- 0.7 times greater during the administration of calcium citrate with aluminum hydroxide than with aluminum hydroxide alone. Plasma aluminum levels did not differ in the two treatment groups. Thus, calcium citrate markedly enhances the absorption of aluminum from aluminum hydroxide and the two must not be prescribed together in patients with renal failure.

A neutron diffraction study of the headgroup conformation of phosphatidylglycerol from Escherichia coli membranes.

By using neutron diffraction, the headgroup conformation of purified phosphatidylglycerol from Escherichia coli membranes has been investigated. Measurements at 25 degrees C and 15% relative humidity on oriented multilayers of lipid selectively deuterated at the sn-3-position of the glycerol backbone and of the gamma-position of the glycerol headgroup show that the labels are at a mean distance of 23.0 A and 27.6 A from the centre of the hydrocarbon chain region. This suggests that the negatively charged headgroup is oriented at about 30 degrees to the membrane surface. The orientation of the phosphatidylglycerol headgroup makes the negatively charged phosphate group easily accessible to cations present in the adjacent water layer.

A Functional Dementia Scale.

Development of a scale to quantify the severity of functional disabilities associated with dementia is described. The Functional Dementia Scale (FDS) is designed for use by caretakers of disabled elderly. It contains 20 items in three subscales: activities of daily living, orientation, and affect. Cronbach's alpha coefficient of internal consistency for the scale was .90, and test-retest correlation was .88.

Dielectrophoresis of malignant human melanocytes.

Dielectrophoretic experiments on pearl-chain formation and collection of human melanocytes were performed as a function of the frequency of the applied nonuniform electric field. Evidence is reported showing that the behavior of malignant melanocytes is markedly dependent upon the type of established cell line (pigmented or achromic), age, and drug treatment (e.g., chlorpromazine).

Membrane fusion and deformation of red blood cells by electric fields.

Human red blood cells suspended in a slightly hypotonic solution of low electric conductivity were exposed to an inhomogeneous and alternating electric field (sine wave, 30 V peak-to-peak value, electrode distance 120 microns, 0.5 to MHz). Due to the dielectrophoretic effect the cells align parallel to the field lines under the formation of pearl chains. At high voltages (10 V amplitude) membrane fusion is observed between the adhered red blood cells in the pearl chains, whereby the chains become attached to the electrodes. In contrast to the pearl chains observed at voltages of up to 5 V amplitude the resulting fused and uniform aggregates which exhibit no recognisable individual cells under the light microscope, remain stable, even after the alternating electric field has been switched off or after haemolysis in response to osmotic shock. The fused aggregates are highly elastic. If the field strength of the applied alternating electric field is further increased they are stretched in the direction of the opposite electrode. Frequently, bridges are formed between the two electrodes. The uniform bridges remain stable for some time even in the absence of an electric field. The possibility of cell fusion and its initiation by electrical breakdown of the cell membranes are discussed.