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Biomedical subjects

E Dühmke

Publications and source records attributed to E Dühmke.

At least 73 records · Page 4Linked to original sources
PubMed1990

[Radiotherapeutic quality assurance in the Hodgkin's disease study HD4 supported by the BMFT (Bundesministerium für Forschung und Technologie)].

In the German Hodgkin Study Group a radiotherapy assurance program is being carried out at the radiotherapeutic reference centre in Göttingen since April 1988: 74 patients were entered from 27 radiotherapeutic institutions. 18 of them participated in a quality assurance program and submitted the data of 29 patients: In 21 of the 29 patients the protocol was followed correctly. Physical aspects of quality control showed two major deviations from the protocol: one center used photon energies of more than 15 MVX without mould; another had a anterior-posterior loading of 3:1. The radiation oncology assessment detected six inadequate treatments: The safety margin was inappropriate in three of 26 mantle fields. Another center used a multiple field technique, and in two patients the paraaortic region was not irradiated.

Cobalt Radioisotopes↗
PubMed1990

Optimized afterloading therapy of cervix carcinoma with the discontinuous movement of the iridium source.

Optimization of brachytherapy means first of all a physical adaptation of isodoses to shape and tolerances of radiosensitive tissues surrounding the target volume, and also to shape and dosage requirements of the tumor to be treated. Dose computation algorithms for optimizing afterloading therapy postulate the discontinuous movement of the iridium source. A new method for the application of the discontinuous movement to our afterloading equipment was worked out. It combines the abilities of the source movements and the demands of the clinical optimization of the isodoses used for the brachytherapy of cervix carcinoma.

Brachytherapy↗
PubMed1987

[Staging in Hodgkin's lymphoma. Exploratory laparotomy with splenectomy].

In the present paper, 66 Studies on exploratory laparotomy with splenectomy in Hodgkin's lymphoma from Western Europe and the USA are presented in tables. This statistical compilation on 7183 laparotomies shows that the spleen was involved in 39.9% (2685 out of 6900 cases investigated), the liver in only 7.7% (446 out of 5789) and the abdominal lymph nodes were involved in 30.3% (1389 out of 4578) of the cases. Altogether, laparotomy with splenectomy led to a change in staging in 33% of the patients (1892 out of 5745). In the period from 1970 to 1986, 123 patients with Hodgkin's lymphoma were laparotomized (and also splenectomied apart from one exception) at the Surgical Division, University of Göttingen. The patients comprised 52 cases in the context of primary staging and 71 cases in the context of secondary staging. In 43 cases (35.2%) the spleen was affected, in seven cases (5.7%) the liver was affected, and there was combination with spleen involvement in each case. Infiltration of abdominal lymph nodes was shown in 38.2% (26/68). Exploratory laparotomy led to a change in stage in 46 cases (37.1%) comprising 28 improvements and 18 deteriorations. Before laparotomy, 15 patients were in stage I, 29 in stage II, 44 in stage III and 21 in stage IV. After pathological staging, 14 were in stage I, 40 were in stage II, 47 were in stage II and 19 were in stage IV. Out of the 14 patients who could not be assigned to any stage before the operation, 11 could be definitively staged afterwards. In addition, lymphography was performed in 103 patients, liver and spleen scintigraphy in 51 patients, sonography in 30 patients and computer tomography in 22 patients. In the re-examination of the lymph node situation in the retroperitoneal space, lymphography attained a specificity of 48% and a sensitivity of 71.4% with a positive prediction precision of 35.7% and a negative prediction precision of 88.8%.

Hodgkin Disease↗
PubMed1986

[Clinical and prognostic relevance of the Kiel classification of non-Hodgkin lymphomas].

The Kiel classification provides a new subdivision of non-Hodgkin lymphomas into distinct entities showing different clinical and prognostic properties. In comparison with earlier classifications this system defines additional types of lymphoma (e.g. CC lymphoma, LP immunocytoma) (for abbreviations see text) which are to be considered separate entities also from a clinical point of view. By data derived from a multicenter prospective observation study (1,127 patients recruited from 1975 to 1980, follow-up until 1985) a precise definition of the clinical features of each lymphoma entity (e.g. frequency, age and sex distribution, patterns of initial involvement and spread of disease) was possible. In addition, the effect of radio- and/or chemotherapeutic measures was evaluated. Strictly localized disease (stage I/IE according to the Ann Arbor classification) occurred in 1.5 to 8% of patients with NHL of low-grade malignancy (comprising 69.4% of cases studied) and in 8 to 17% of patients with high-grade malignant NHL (comprising 30.2% of cases studied). Loco-regional irradiation alone was able to induce complete remission in 86 to 89% (CB and IB lymphomas) and in 100% (LP immunocytoma, CB-CC and CC lymphomas), respectively, of stage I/IE patients. Only CC and IB lymphomas showed a relevant risk of relapse (40% and 50%, respectively). Total lymphoid irradiation as able to induce stable complete remissions in about 50% of patients with stage III of CB-CC lymphoma. Probabilities of survival of patients with initial stages III and IV treated by several types of chemotherapy reflect different prognostic features of individual lymphoma entities.(ABSTRACT TRUNCATED AT 250 WORDS)

Combined Modality Therapy↗
PubMed1985

[Allogeneic bone marrow transplantation after fractionated whole body irradiation. Results at the Kiel transplantation center].

Allogeneic bone marrow transplantations were carried out between March 1983 and July 1985 in 31 patients aged 7 to 45 years (median 18 years). Acute lymphoblastic leukaemia in 1st to 5th remission was present in 8 patients, acute myeloblastic leukaemia in 1st and 2nd remission in 4 patients, chronic myeloid leukaemia, with various remission status, in 6 patients, 3 patients had severe aplastic anaemia and there were single cases of myelodysplasia and immature cell megakaryocytic myelosis. Transplantation was carried out during relapse in 8 patients with either acute myeloid or lymphoblastic leukaemia. Phenotypic HLA-identical mothers (n = 2) as well as genotypic HLA-identical siblings (n = 27), and in two cases HLA-non-identical mothers, served as bone marrow donors. In leukaemia patients the conditioning treatment consisted of fractionated total body irradiation and high dose cyclophosphamide or etoposide. Patients with severe aplastic anaemia received cyclophosphamide (4 X 50 mg/kg) and fractionated total nodal irradiation (total dose 8 Gy). 19 patients (61%) survived 14 to 605 days after bone marrow transplantation. 15 patients (48%) continue to remain in complete remission with Karnofsky indices of greater than or equal to 90%. Causes for death were infection (n = 3), interstitial pneumonia (n = 3), relapse (n = 3) as well as single cases involving acute graft-versus-host-disease, non-engraftment of donor marrow and veno-occlusive disease of the liver.

Acyclovir↗
PubMed1985

[Fractionated homogeneous whole body irradiation prior to bone marrow transplantation].

At the University of Kiel, myeloid and acute lymphatic leukemia is treated since 1983 by total-body irradiation applied prior to bone marrow transplantation. Dose deviations in the midplane caused by the irregular surface and tissue inhomogeneities of the patient are reduced down to +/- 3.5% compared to the central ray, with the help of CT-based individual compensators. This method prevents above all an excessive dose to the lungs. The radiobiologic advantages of fractionated irradiation have been employed for all patients treated hitherto (n = 9). At present, a total body dose of 12 Gy in six fractions is applied within three days. There were no undesired acute radiogenic reactions except a mild acute mucositis found in all patients. Chronic side effects, especially in the lungs, were not demonstrated, too. However, the average follow-up time of 149 days has been rather short. One patient died from relapse of leukemia after a total dose of 10 Gy, another patient died because the transplanted bone marrow was rejected, and a third died from catheter sepsis. Six out of nine patients are in complete remission with a maximum index of Karnofsky. The limited experiences gained hitherto show that the homogenous accelerated-fractionated total-body irradiation offers essential advantages compared to non-compensated single dose irradiation with respect to the prevention of undesired radiogenic effects in sound tissues and that its therapeutic efficacy is at least the same.

Adolescent↗
PubMed1985

[Cisplatin and radiotherapy].

The cytotoxic action of ionizing radiation can be increased by cis-platinum (CDDP) and its derivates. This effect is due to interactions in the cellular desoxyribonucleic acid (DNA), and it is especially marked in a hypoxic medium. A synergistic and an additive summation can be discerned depending on the type and dosage of the applied substance and the temporal relation between its application and irradiation. The radiosensitization of DNA before radiotherapy (RT) and the restriction of recovery processes after RT are considered as main mechanisms of this effect. A therapeutic potentialization of CDDP and RT could be demonstrated in a series of experimentations on animals. E.G. a therapeutic gain factor of 1.7, related to the sound surrounding tissue, was found out for the C3H mammary carcinoma during a series of in-vivo experimentations on mice. The applicability of a simultaneous treatment with CDDP and RT of human tumors depends on the systemic and local side effects of such a therapy. The results achieved hitherto in clinical pilot studies on advanced solid tumors situated above all in the head and neck area are at least equivalent to those of a sequential induction chemotherapy and subsequent definitive radiotherapy. They can possibly be improved by a further optimization of the temporal application and dosage of CDDP, but also by using other platinum derivates. It is not yet possible to describe any undesired long-term effects. However, the side effects observed hitherto in the irradiated areas are apparently of minor clinical importance.

Animals↗
PubMed1984

[Optimization of dose distribution in whole body irradiation by means of compensators].

In case of whole-body irradiation prior to bone marrow graft, an undesired irregular dose deposition in the median body plane is caused by the irregular body shape and the tissue inhomogeneities of the patient, which can amount up to 50% of the planned focal dose in case of laterally opposing irradiation. A procedure is proposed allowing to modify the dose distribution in the irradiated body systematically by means of compensators. Such compensators are produced with the aid of an adequate number of serial CT scans, a programme system considering these data and the individual irradiation geometry, and a computer-controlled cutter working in three dimensions. First a casting mould is manufactured which is then filled up with an adequate compensation material. The actual compensation data and the planned irradiation geometry are controlled before and during the treatment. Taking into consideration the individual shapes and the different tissue densities, it is not only possible to prevent the dose inhomogeneities mentioned above but also to introduce by means of a special programme part regions with a higher or lower dose deposition at any point of the irradiation field, at the therapeutist 's discretion.

Bone Marrow Transplantation↗
PubMed1982

[Treatment results of Schmincke tumors].

This is a report on the results of a continuous series of 78 previously untreated patients with a lymphoepithelioma (Schmincke-Regaud), who got their diagnosis and therapy in the Medical Center of the University of Kiel between 1951 and 1980. 90% of the patients were treated by radiotherapy alone, which included the primary in the oropharynx (n = 29) or the nasopharynx (n = 48) as well as the regional lymph nodes regardless of whether they were affected (71%) or not; residual lymph nodes of 8 cases were removed afterwards. Thereby a clinically full regression of the tumor disease was achieved in 85%. This group revealed a constant actuarial survival of 39% 7 years later. All therapy failures however, died within two years. The probability to remain free of disease after a primarily successful treatment amount to 86% for the oropharynx tumors (n = 24) and to only 29% for the nasopharynx lesions (n = 31). The analysis of the relapses especially with regard to the nasopharynx tumors showed that in most cases the disease was already very extended at the beginning of the treatment (stage IV according to the UICC-classification). The actuarial survival of this numerous group fell down to a constant rate of 16%, whereas stages I to III finally survive in 59%. The corresponding survival values of the oropharynx tumors were 25% in stage IV and 41% in stages I to III including a lot of age-related deaths. Drawing conclusions out of our retrospective study we recommended to add an appropriate chemotherapy for lymphoepitheliomas of the nasopharynx in stage IV.

Adolescent↗