[Evaluation system in assessing radiological examinations of clinical significance for the patient]. / Bewertungssystem zur Erfassung des Stellenwertes radiologischer Leistungen für die klinische Arbeit am Patienten.

PURPOSE: The purpose of this study was to test a scoring system and its utility for the assessment of the clinical significance of radiological examinations. MATERIAL AND METHODS: The reports of all diagnostic studies obtained in patients with a clinical suspicion of pancreatitis, urinary tract obstruction, biliary or gallbladder diseases, ileus and gastrointestinal perforation were scored prospectively in 4 categories from 0 to 3. These categories were related to the ability to establish a definite diagnosis, to exclude suspected disease, to influence further diagnostic work-up and therapeutic decision-making. RESULTS: This scoring system showed significant differences of the efficacy of different imaging modalities in these 5 clinical settings. CONCLUSION: This scoring system was helpful to determine the clinical significance of radiological examinations.

Comparison of electro-oculogram recording methods.

The purpose of this study was to compare the variability of the amplitude ratios and latencies of the electro-oculogram (EOG) light peak (LP) in three different recording conditions: Arden ratio (dark trough (DT): 12 min), modified Arden ratio (DT: 15 min) and light peak/dark baseline ratio (LP/BL: 35 min of dark adaptation). Additionally, EOGs from eyes with dilated and undilated pupils were recorded. The light intensity stimulating the eyes with dilated pupils was attenuated 1 log unit. The EOG amplitude ratios displayed no significant difference between the three conditions tested. The comparison of implicit times (time from onset of light exposure to LP) revealed significantly (p < 0.001) shorter values when the recording of the LP was preceded by a dark adaptation of 35 min. The broadening of the curves in DT/LP recordings might be caused by a superposition of a residual dark oscillation on the LP. The recordings from eyes with dilated pupils--stimulated with 1 log unit lower intensity--revealed lower amplitude ratios than the recordings from eyes with undilated pupils.

The dark trough in clinical electro-oculography. Influence of preadaptation on amplitudes and latencies.

The influence of four different intensities of the preadapting light on amplitude and implicit time of the dark-induced oscillation (dark trough) of the electro-oculogram was tested in 10 healthy individuals. The amplitude of the dark trough (normalized to preadapting baseline) was found to be dependent on the intensity of the preadapting light (analysis of variance: p < 0.0001). No correlation could be proven between preadapting light intensity and the implicit time of the dark trough (p = 0.299). The confidence intervals of the implicit time of the dark trough exceeded 14 minutes in all four intensity settings. There was no significant dependence of the absolute baseline values on preadapting intensities (p = 0.236).

Prostacyclins in diabetes: an electrophysiological study.

Twelve patients with juvenile (insulin-dependent, type I) diabetes were treated either with prostacyclins or placebo in a double-masked randomized study. The electroretinogram (ERG) was recorded before, 1 day and 8 months after treatment. An analysis of variance and covariance was carried out to evaluate possible treatment or time effects on the a and b waves and the oscillatory potentials of the ERG. Mean values of potentials displayed a decrease of amplitude and an increase of latency over the follow-up period in all patients. No statistically significant difference between treated and placebo groups could be proven.

Age-related influence of piracetam on mitotic index and number of silver-stained nucleolus organizer regions.

Mitotic indices and the number of silver-positive nucleolus organizer regions (AgNORs) were scored in phytohemagglutinin-stimulated cultures of peripheral lymphocytes from two age groups of females (mean = 23.1 and 84.0 yr, respectively) under the influence of Piracetam (2-oxo-pyrrolidine-1-acetamid; Nootropil, Reg. No. 17051) and in simultaneously set up control cultures without Piracetam addition. Piracetam concentrations of 10, 14 and 16 mg/ml culture medium produced a highly significant, decreasing effect on both parameters tested, without an age-related difference. Lower Piracetam concentrations (2 and 4 mg/ml culture medium) showed a depressant effect on some of the cultures only; but, on average, there was a rather equal, significant, dose-dependent, linear decrease of the mitotic indices of both age groups, whereas the suppressive effect on the number of AgNORs was significant in cultures from the young females only.

Combined modality treatment of advanced cancers of the oral cavity and oropharynx.

From May 1985 to June 1988, 70 evaluable patients with advanced squamous cell cancers of the oral cavity and the oropharynx were treated with preoperative combined radio-chemotherapy. Treatment consisted of 50 Gy/25 fractions/5 weeks, combined with concomitant administration of mitomycin C on day 1 (15 mg/m2, i.v. bolus) and 5-fluorouracil during the first 5 days of irradiation (750 mg/m2/24 hours, continuous infusion). Surgery was performed 3 to 5 weeks following irradiation. Treatment tolerance was good and local mucosal reaction was increased, but no major systemic side effects were recorded. At surgery, 3-5 weeks following irradiation, 48.6% of the operation specimens did not contain any histologically detectable residual tumor. Overall survival is 61%, being 69% in T2 and T3, while none of the patients with bone invasion has survived. Median survival is 28, 26, and 9 months in T2, T3 and T4 stages, respectively. Loco-regional relapses have been recorded in 33% of the patients, occurring in 27% of T2, 25% of T3, and 88% of T4 stages. Patients have been spared mutilating radical neck dissection because of combined presurgical treatment without impaired survival or loco-regional relapse rate.

Intraoperative retinal light damage reflected in electrophysiologic data.

In a series of 30 unilaterally pseudophakic patients, electroretinograms and electrooculograms were recorded 6 months postoperatively. The unoperated on fellow eyes served as controls. High intraoperative retinal light exposure (3.4-7.3 mW/cm2, Zeiss OPMI6 operating microscope) caused a substantial reduction of electrophysiologic potentials. Light protection prevented deterioration of electroretinogram and electro-oculogram potentials; reducing the bulb voltage, tilting the axis of illumination, filtering short wavelengths and the use of light shields resulted in 4-log-unit lower intensities (0.8-3.7 microW/cm2).

[Therapy of organic brain syndrome with nicergoline given once a day]. / Therapie des hirnorganischen Psychosyndroms mit Nicergolin in täglicher Einmalgabe.

In a double-blind, active-controlled study 30 patients with mild to moderate multiinfarct dementia diagnosed according to DSM III definition were treated by either 20 mg nicergoline or 4.5 mg co-dergocrine mesilate once daily during eight weeks. Therapeutic effects on symptoms of the organic brain syndrome were quantitatively measured by standardized psychological and psychometric methods evaluating cognitive and thymopsychic functions. Main criteria, which were tested by inferential analysis, were SCAG total score (Sandoz Clinical Assessment Geriatric Scale), SCAG overall impression and the AD Test (alphabetischer Durchstreichtest). Other results were assessed by descriptive statistics. Both treatments resulted in a statistically significant improvement in most of the tested functions. The effects of 4.5 mg co-dergocrine mesilate s.i.d. were in accordance with published results. Although differing slightly with respect to individual results 20 mg of nicergoline once daily showed the same efficacy on the whole.

Response to preoperative concomitant radiochemotherapy with mitomycin C and 5-fluorouracil in advanced head and neck cancer.

Advanced head and neck tumours have a poor prognosis due to the high frequency of local recurrence. Multimodality treatment has been shown to be effective in decreasing local recurrence. In this study, 51 patients with advanced oral and oropharyngeal carcinoma were entered in a trial of preoperative radio-chemotherapy. After exclusion of -10 protocol violations (no surgery or no chemotherapy), 41 patients remained evaluable. Chemotherapy consisted of 15 mg mitomycin C/m2 given intravenously (bolus) on day 1. 5-Fluorouracil (750 mg/m2/24 h) was infused during days 1-5 (continuous infusion for 120 h). Radiotherapy was performed simultaneously with chemotherapy beginning on day 1. A total dose of 50 Gy to the primary tumour and neck region was delivered over 5 weeks. Treatment was well tolerated. Side-effects were mainly of local character (mucositis). No severe systemic toxicity was seen. Some delayed wound healing was noted at the operation (4 weeks after irradiation). The CR rate of the primary tumours was 56% (23/41). In 39% (16/41) only histological residual tumour was found. Two patients had minor response (categorized as NR) of their tumour (macroscopic residual tumour). None had tumour progression. The response rates considering lymph node metastases were 59% (22/37) CR, 35% (13/37) PR and 5% (2/37) NR. After a follow up of 18-30 months, analysis of local recurrent disease and survival was performed. The loco-regional recurrence rate was 32% (13/41) and the survival rate 63% (26/41). All deceased patients, except two, died of tumour progression. Patients with T4 tumours showed inferior prognosis whereas no significant difference in survival of T2 and T3 patients was found. Patients with CR of tumour and lymph nodes (including NO) have all survived and are without evidence of disease.

[Iodine deficiency in childhood despite prevention. Current data from the Vienna area]. / Jodmangel im Kindesalter trotz Prophylaxe. Aktuelle Daten aus dem Wiener Raum.

Since 1963 iodized table salt prophylaxis (10 mg KI/kg table salt) in Austria has led to a decrease in endemic goitre in children. Nevertheless, goitre frequency is rising again after the first two decades of life and iodine deficiency is found in 50% of the patients. In order to evaluate the adequacy of the iodine supply in childhood in the Vienna area the urinary iodine excretion was determined in 124 healthy non-goiterous children from 4 weeks to 16 years of age. Our investigation demonstrates a decrease in urinary iodine excretion in the older children (iodine excretion 400 micrograms/per g creatinine in the first year of life versus 96 micrograms I/per g creatinine after the age of 10, p less than 0.001). At the same time the number of children showing grade I iodine deficiency (according to WHO criteria) increases with age, so that more than 50% of children older than 10 years in the Vienna area have an insufficient iodine supply (p less than 0.0001). Thus, the iodine supply should be improved by increasing the level of iodization of table salt to 20 mg KI/kg and by the more frequent intake of food naturally containing a higher iodine concentration.

[Cloning of solid tumors in double agar (human tumor stem cell assay]. / Cloning von soliden Tumoren im Doppelagar (human tumour stem cell assay).

62 specimens from 37 patients with solid malignant tumours were cloned by the human tumour stem cell assay (HTSCA). The growth rate, the use of two different disaggregation methods and their influence on vitality and plating efficiency were analyzed as well as the cloning rate from different tumour regions and metastases. The growth rate was 68%, and there was a significant difference in the vitality, depending on which mode of disaggregation was used. Enzymatic disaggregation showed a higher vitality than the mechanical method, although there was no difference in plating efficiency (PE). There was a marked heterogeneity in the PE of specimens from different sites of the same tumour and lymph node metastases (variation coefficient 0.507 and 2.093 respectively). The possibilities and limitations of the HTSCA are discussed with respect to our own results and those in the literature.

[Prognostic factors in cardia cancer]. / Prognostische Faktoren beim Kardiacarcinom.

Among 164 patients operated upon for adenocarcinoma of the cardia 102 (61%) were resected, 87 of them with curative intent. The mortality within 30 days was 20%, and the 5-year survival 15%. A total gastrectomy was performed in 36 patients, whereas a proximal partial gastrectomy was carried out in 66 cases. The median survival was 19 months after total gastrectomy, and 11 months after proximal resection (Breslow: 0.22). Only in stages N0 and N1 total gastrectomy resulted in a significantly longer (32 months) median survival than proximal resection (11 months; p = 0.03). The impact of total gastrectomy was more pronounced in the diffuse type according to Lauren, whereas lymphadenectomy was more effective in stages N0 and N1 and in Lauren's intestinal type. It is concluded that total gastrectomy should be carried out in all cases of carcinoma of the cardia.

Dermatoglyphics and creases in patients with neurofibromatosis von Recklinghausen.

Fingerprint and palmar dermatoglyphics and creases were investigated in 60 patients (20 males and 40 females) with generalized neurofibromatosis. Like previous investigators, we found a significantly increased frequency of digital central pocket patterns. Furthermore, affected males and females had an increased frequency of monocentric whorls (P = 0.0037), higher quantitative values on digit II of both hands (P = 0.04), more often a reduction of main line C (P less than 0.05) with decreased frequencies of patterns in the 3rd and 4th interdigital area of the left hand (P less than 0.05), and a lower ab ridge count (males P less than 0.005; females P less than 0.001) than control individuals. On the right hand of males the frequency of high endings (5' or 5'') of line A was decreased (P less than 0.05). A significantly increased frequency of Sfl (Sydney line) was found in female patients (P less than 0.001). Male and female patients often showed a high number of secondary creases (P less than 0.001).

[Statistical standards for clinical long-term studies]. / Statistische Standards für klinische Langzeitstudien.

Interest in the implementation of long-term clinical studies has grown considerably in Austria in recent years, partly encouraged by studies of this nature performed in West Germany, Great Britain and the United States. However, such studies have to be based on biometric standards that must be adhered to in the planning, implementation and reporting phases of long-term studies if they are to be regarded as authoritative and to find international acceptance. The present paper deals with such standards, based on the current level of methodological development as well as the authors' experience gathered over many years of participation in such projects. Special emphasis is placed on planning, random sampling and analysis, randomization, documentation, organization, termination of studies, reporting, multicentre investigations and cooperation between doctors and statisticians. The authors present several alternatives with and without the use of computers, attempt to explain to clinicians the role of the biostatistician in the supervision of long-term studies and offer their services to those interested in their cooperation.

[Treatment of advanced ovarian cancer as an interdisciplinary task: surgery, histopathology, radiotherapy, and chemotherapy]. / Die Behandlung fortgeschrittener Ovarialkarzinome als interdisziplinäre Aufgabe: Chirurgie, Histopathologie, Strahlentherapie, Chemotherapie.

From February 1977 to February 1981 we treated 55 patients with ovarian cancer (45 stage III and 10 stage IV) with simultaneous radio-chemotherapy; 34 of these patients underwent a therapeutic second-look operation. The overall response rate was 94%, comprising 63% complete and 31% partial remissions. In the group with residual tumours exceeding 2 cm in diameter after primary operation 52% complete remissions were observed. In the stage III group there were 74% complete and 26% partial remissions. Cytoreductive surgery to less than 2 cm was achieved by means of an early second-look operation in 74% of these cases. These patients have as good a prognosis as those with an equivalent residual tumour after primary resection. Unlike the cases with tumour spread to the retroperitoneal area, macroscopic tumour spread to the surface of the liver or diaphragm indicated a worse prognosis. The survival time of patients who prove to be tumour-free at the time of the diagnostic operation is significantly longer than of those with residual tumours. Neither the age of the patients nor the histological findings after primary operation have any significant influence on survival time. Late intestinal complications made us change the therapeutic strategy employed since March 1981 to sequential radio-chemotherapy. Possible cure for stage III patients can be achieved only by way of interdisciplinary cooperation. In stage IV patients the prognosis is so bad that local therapy is possible only in selected cases.

Idiopathic uric acid lithiasis: epidemiologic and metabolic aspects.

Of 264 patients with urolithiasis those with pure uric acid or urate stones were compared to those with other types of calculi for differences in epidemiologic factors and uric acid, calcium and phosphate metabolism. Patients with uric acid stones were predominantly older men. These patients had comparatively lower incomes and spent less money on food but consumed more alcohol. The urinary pH was lower than in the other groups. The absence of abnormally elevated serum uric acid levels and elevated 24-hour urinary uric acid excretion suggests this variety of uric acid lithiasis to be idiopathic in nature. This finding is supported by the results of standardized oral purine loading, which showed no post-loading differences in serum levels and revealed urinary concentrations in 12 patients with pure uric acid stones and 10 normal subjects. However, there is evidence to suggest that this condition may be a precursor of primary gout. Hereditary mechanisms are absent and the relapse rate is the same as in patients with other stones. Therefore, our results suggest the existence of an idiopathic variety of uric acid lithiasis that, at least in central Europe, occurs more frequently than previously assumed. The condition is not inherited, alcohol consumption is a major etiologic factor and there is no evidence of a causative role of abnormalities in purine metabolism.

The fast oscillation of the electro-oculogram. Influence of stimulus intensity and adaptation time on amplitude and peak latency.

The dependence of amplitudes and peak latencies of the light-induced fast EOG oscillation was studied using rectangular light stimulation. A linear increase of the amplitude was observed in the intensity range tested (24-3,000 asb). No influence of the time of preadaptation to darkness on the amplitudes could be proven in a range of 20 s to 21 min. The peak latency was not dependent on light intensity. Prolonged peak latencies were observed following short and long periods of dark adaptation.