[The course of inpatient rehabilitation in gastrointestinal and metabolic diseases under increasing integration of behavior and experience]. / Verlaufsbeschreibung stationärer Rehabilitation bei Verdauungs- und Stoffwechselkrankheiten unter zunehmender Integration von Verhalten und Erleben.

Starting out from the thesis that behaviour and felt experience, i.e., the patient's "subjective world", have considerable influence on chronic diseases and their consequences in the gastrointestinal field, a "basic course documentation"-based comparison has been carried out of the courses of 4-week in-patient rehabilitation programmes designed to increasingly incorporate interventions directed at this area; the study population had consisted of two groups of patients (n = 688 each) without any significant differences concerning age and sex distribution admitted during the summer terms of 1990 (Group A) and 1991 (Group B), respectively. This documentation (in DBASE IV format) compiles (anonymized) patient data at an "objective" level on the one hand, i.e. basic data (such as diagnoses, age, sex), results obtained by the Edinburgh Rehabilitation Status Scale (ERSS), risk behaviour, and scope of interventions both in the organ-medical and physical therapy fields and in the area of "instruction, motivation, support, group work, and creativity" (designed to achieve integration of behaviour and felt experience); on the other hand, at "subjective level", it comprises the patient's own judgements relative to the treatment regimen and its environment, with subsequent correlational analysis of the data obtained (using the SPSSPC statistical package). As had been expected, correlations have on the one hand been stated at the "objective" level between an increased share of more "serious" conditions (ICD) in 1990 as compared to 1991 and higher ERSS scores (i.e., increased impact of disease consequences), greater organ-medical care intensity, and frequency of incapacity for work; on the other hand, at "subjective" level, strong linkages were found among the item ratings for general sense of improvement, specific and general therapy, as well as so-called "therapeutic environment". When the two levels are linked, the sense of improvement, as expected, is found to correlate negatively with the ERSS, but positively with the scope of the interventions designed to foster integration of behaviour and felt experience. The judgements given for quality of care provided relative to the patient's self-reported primary disorder and for general medical care correlate positively both with the scope of diagnostic/therapeutic organ-medical interventions and integration-focussed ones, which, at least from the patient's perspective, hence exercise an ascertainable, essential effect in the therapeutic setting of in-patient rehabilitation in gastrointestinal and metabolic diseases.

[Comparison of microwave and infrared thermography in detecting malignant breast tumors]. / Vergleich von Mikrowellen- und Infrarotthermographie bei der Entdeckung von malignen Brusttumoren.

Microwave thermography is a new method in the diagnosis of breast cancer. The paper reports on the use of a microwave thermographic unit in the examination of 190 patients. Evaluation criteria are defined and the results are compared with those obtained by infrared thermography.

[Dosage of conservative therapy of the mammary carcinoma by means of opposing Co-60 wedge filter fields (author's transl)]. / Die Dosierung bie der brusterhaltenden Therapie des Mammakarzinoms mittels opponierender Co-60-Keilfilterfelder.

A method of measurement is described which allows to determine the maximum dose (tumor dose) for routine radiotherapy of the breast with opposing Co-60 wedge filter stationary fields. Furthermore it could be demonstrated that--independently of the form of the mamma--a sufficiently precise dosage can also be achieved by means of a simple calculation. For this purpose one must only know the base (= distance of the dorsal field marks on the skin) and the irradiation time for the dose to be applied into the depth dose maximum of a rectangular stationary field without filter.

[Irradiation planning in conservative treatment of cancer of the breast (author's transl)]. / Bestrahklungsplanung bei der brusterhaltenden Therapie des Mammakarzinoms.

Investigations of homogeneous irradiation of the breast with opposed wedge filter fields are presented. Isodose plans calculated with the help of computer programs were compared with measurements of isodose distributions (LiF rods in polystyrol phantoms), and the possibility of optimizing the irradiation method by means of computed plans was examined. Differences between the calculated and the measured values maximally amounted to 10% (programs SIDOS U2 and COMRAD). The calculations correctly describe the place of dose maxima, the homogeneity of the irradiation and tendency to isodose shift caused by variation of the shape of the breast, of the angle of incidence of radiation and of the angles of the wedges. The results are demonstrated using isodose lines in the mediolateral and in the craniocaudal plane of the breast.

[The dosage for tangential pendulum irradiation of the thoracic wall using 60Co in surgically treated cancer of the breast and the irradiation of the parasternal lymph nodes (author's transl)]. / Die Dosierung bei der tangentialen Co-60-Pendelbestrahlung der Thoraxwand beim operierten Mammakarzinom und die Bestrahlung der parasternalen Lymphknoten.

The determination of the dose to the patient during excentric pendulum irradiation of the thoracic wall is described. The dose delivered in the course of irradiation is simultaneously measured at the patient's surface, using a measuring system with LiF-rods which was especially developed for this purpose. The value obtained has to be multiplied with a correction factor FK=0.96 in order to yield the maximum dose, being located at a depth of 2.5 mm below the skin. The accuracy of this method for determination of doses is discussed, and the deviations are shown not to exceed 5 or 6% of the total dose. The dosage by means of tube chamber measurement is represented as an alternative method. The parasternal lymph nodes are irradiated, in addition to the dose from pendulum irradiation, with a fixed field and employing a lead wedge, both lymphatic chains thus receiving a homogeneous dose.

[Tangential pendulum irradiation of the thoracic wall with co-60 during radiation therapy of surgically treated cancers of the breast: comparison of measurement and computation methods for irradiation planning (author's transl)]. / Die tangentiale Co-60-Pendelbestrahlung der Thoraxwand bei der Strahlentherapie des operierten Mammakarzinoms: Ein Vergleich von Mess- und Rechenverfahren zur Bestrahlungsplanung.

The irradiation technique for tangential pendulum 60-Co-irradiation of the thoracic wall is described, and the possibility of a homogeneous irradiation of the thoracic region of interest by means of individual irradiation planning together with a careful, but practicable, technique of positioning and adjustment is shown. The radiation load to the lung can be kept on a moderate level. Phantom measurements with thermoluminescence probes, films and an ionization chamber have been performed for three typical forms of the thorax. Dose distributions thus obtained show a satisfying accordance with calculated values of the dose, the deviations amounting to 3 to 8%. The EDP program applied, COMRAD, thus permits computation of individual pendulum isodoses with sufficient accuracy in practice, and therefore, may be used regularly.

[Comparison of measured relative isodose distributions in tangential stationary fields of Co-60 radiation with calculated isodose plans (author's transl)]. / Vergleich von gemessenen relativen Isodosenverteilungen bei tangentialen Stehfeldern von Co-60-Strahlen mit errechneten Isodosenplänen.

The relative isodose distributions in tangential stationary fields are measured in rectangular phantoms by means of four different methods: film measurements, thermoluminescence probes, ionization chamber, and semiconductor probes. The different measuring methods are compared, and the influence exercised by the part of the field running in the air is examined. Within the scope of their applicability, all measuring methods produce the same values which differ only by +/- 1%. It is possible to reach a better estimation of the dose distribution in the depth of the "partial fields" (a part of which is running in the air) by reducing adequately a "complete field". Furthermore, isodose distributions of measured "partial fields" are compared with calculations from a programme for the irradiation planning (programme COMRAD), and they are discussed. It is shown that the losses due to scattered radiation are not rendered by the calculation.

[Phantom experiments and early clinical experience with a mammogram apparatus using a grid (author's transl)]. / Phantomuntersuchungen und erste klinische Erfahrungen an einem Raster-Mammographiegerät.

The effect of a grid on film quality and dose was investigated in a newly developed mammographic apparatus (Mammo Diagnost U--C. H. F. Müller). It was shown that available film-screen combinations used with a grid produced practically the same picture quality as Definix Medical used without screen or grid. Although the dose required is almost doubled by the use of the grid, the latter, nevertheless, produces a reduction of surface dose to about a quarter (4 cm. plexiglass phantom). Using a film-screen combination not at present commercially available, there was some improvement in the demonstration of microcalcification, but the improvement resulted in an increase in the required radiation dose.

[Critical notes on risk calculations in mammography (author's transl)]. / Kritische Bemerkungen zu Risikoberechnungen bei der Mammographie.

Since 1971 a Mammography Screening Study was carried out in Hamburg. This project shows that mammography is the only method to detect a high percentage of minimal breast cancer. The chance to cure these patients (10-years-survival) then is 80% and more. With mean literature values for parenchym dose, incidence rate and induction period the risk of cancer induction by mammography as a function of age was calculated. It is shown that benefit exceeds risk not only for women over 50 years of age. Even for younger women the use of mammography seems justified, if longer inspection periods from 2 to 5 years are considered.

[Dose distribution in cobalt-60 irradiation of the axillary efferent lymphatic area in breast cancer]. / Dosisverteilung bei der Kobalt-60-Bestrahlung des axillären Lymphabfluss-gebietes beim Mammakarzinom

A method of postoperative irradiation of breast cancer is reported using high dosage in the area of the axillary and subclavicular efferent lymphatic ducts. Within opposite fixed fields it was possible to modify the dose distribution by means of wedges, thus obtaining a maximum value of axillary and clavicular doses, together with a small radiation load on the lymphatic vessels which drain the region of the arm. The dose distributions in the depth of the shoulder are discussed on the basis of measurements at a phantom using different adjustments of the wedge filter. The most favorable dose distribution was noted with 17.5 degree lead wedges whereas, however, the angular aperture in the axillary and clavicular region was reduced to 2.5 degrees. This method is now being tested clinically.

[Dose distribution and irradiation technique in the radiotherapy of breast cancer stage I]. / Dosisverteilungen und Bestrahlungstechnik bei der Strahlenbehandlung des Mammakarzinoms im Stadium I

A method for homogenous irradiation of the breast by means of opposite standing fields, with the use of wedge filters, is described here. The field is focussed so that the interior thoracic wall under symmetric position of the mamma is still completely situated in the irradiation field, and the lateral area of the ray beam passes 1-2 cm into the pulmonary tissue. On a series of typical breast models, made under consideration of the irradiation position, the isodose distributions were determined by film-dosimetry. The therapeutically most important 80%-isodose corresponds in practically every case with the mamma contour. Peak doses or areas of underdosage were not observed. The thoracic wall is still exposed to about 75% of the maximum dose. In order to reach a more accurate irradiation by the desired maximum dose of, for example, 250 r, the deviation of which does not exceed plus or minus 7%, it is necessary, at the beginning of an irradiation series, to use ionisation chamber measurements with an intensifying hood on the surface of the mamma, 1.5 cm above the border of the field. In the case of lateral irradiation, the measurement need only be made laterally, in medial irradiation it is only necessary on the medial side. The portion of the dose affecting the opposite field on the measuring place can be calculated by the use of depth dose tables. From the values so gained the desired maximum dose within the mamma may be ascertained by multiplication by the factor 1.03.