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Biomedical subjects

K G Hering

Publications and source records attributed to K G Hering.

At least 19 recordsLinked to original sources

Evaluation and classification of high-resolution computed tomographic findings in patients with pneumoconiosis.

The standard ILO classification for pneumoconiotic changes using conventional X-ray films has become well established. In recent years computed tomography has played an increasing role in occupational medicine and above all in the assessment of pneumoconiosis. Therefore a standardised method of classification for CT also seems necessary. A system of classification developed by occupational hygienists and radiologists allows a detailed description of parenchymal and pleural changes and the use of 28 additional symbols. Furthermore, special diagnoses relevant to occupational medicine and additional comments can be made. The classification system was tested in practice in the research project "Early diagnosis of asbestos-related diseases" (Frühdiagnostik asbestverursachter Erkrankungen). It was shown to be both practicable and easily reproducible, intra-individually and interindividually.

Asbestosis

Epirubicin and ifosfamide in metastatic breast cancer.

In a randomized, phase II trial, we evaluated the effectiveness of continued chemotherapy with epirubicin/ ifosfamide versus unmaintained treatment interruption in advanced metastatic breast cancer. Three hundred fifty-seven patients were enrolled and 331 were evaluable for response. Complete response was achieved in 25 patients (8%) and partial response in 121 patients (37%). Pretreatment status correlated significantly with response (complete and partial response). While 54% of unpretreated patients responded, only 42% of the patients responded who had been pretreated with adjuvant chemotherapy and 33% who had been pretreated in the metastatic stage of disease; 69 patients (21%) had disease progression. Of 11 patients pretreated in both the adjuvant and metastatic setting, only two responded. Toxicity of treatment was mild, with leukopenia being the treatment-limiting factor. Thrombocyte levels were not altered significantly by treatment. Thus, there seems to be room for dose escalation using granulocyte colony-stimulating factor. There was no considerable cardiotoxicity, central nervous system toxicity, or cystitis observed. The low rate of cardiotoxicity appeared to be related to dose fractionation of epirubicin. After randomization of patients to treatment interruption versus continuation of chemotherapy, a longer relapse-free survival was observed for patients who continued chemotherapy (mean relapse-free survival, 2+ months); however, this did not translate into prolonged survival. The cumulative scores of toxicity and quality of life parameters showed increasing superiority for treatment interruption. Therefore, a strategy of treatment until maximum response and subsequent treatment interruption seems to be superior to treatment continuation.

Antineoplastic Combined Chemotherapy Protocols

[The importance of thoracic radiology for public health since 1896].

Without imaging procedures a variety of chest diseases cannot be diagnosed sufficiently. Examples are acute and chronic pneumonia, toxic effects on the bronchial and alveolar system, immunologic and malignant changes and cardiovascular disease involving the lung. Especially important are the types of disease that attack large sections of a population, because a path of infection may be hidden or because of short- or long-term exposure to relevant concentrations of toxic or allergic agents--not necessarily recognized as such--at work, in the general environment or associated with certain types of behaviour or illness. All this may have effects on biostatistical and socioeconomic data. Considering available epidemiologic data on morbidity and mortality, then pulmonary tuberculosis, unspecific pneumonias, drug-induced and AIDS-associated lung disease, pneumoconioses (silicosis and asbestosis) and primary and secondary chest malignancies have to be included in this category. Conventional chest radiography with high-kV technique and modern film-screen combinations continues to be the imaging modality for initial evaluation of chest disease worldwide. Low radiation exposure, low cost and overall availability are major advantages. Conventional tomography, however, has nowadays been largely replaced by CT, though a few special indications remain. High-resolution CT (HRCT) and the spiral technique bring additional benefits. Periodic radiographic mass screening of populations with certain disease prevalence still seems feasible, taking risk assessment, cost effectiveness and radiation exposure into account.(ABSTRACT TRUNCATED AT 250 WORDS)

Germany

[Radiologic diagnosis of pneumoconioses].

Radiology is extremely important in the diagnosis of occupational lung disease. Owing to its general availability and international comparability, the roentgenographic pa view of the chest obtained by the high-voltage technique is still the basis of the radiologic examination. Supplementary investigations are necessary for medical reasons, however, as well as for documentation of experts' certification. Valuable diagnostic information is supplied by oblique views of the thorax and by conventional X-ray tomography, though not by scintigraphic examinations or - up to now - by digital luminescence radiography. Ultrasound helps in the differentiation of free pleural fluid, organized pleural effusion, and pleural malignancy. In addition, computed tomography (CT) can be guided by ultrasound. CT has emerged as the method of choice for examination and for support of medical experts' certification of pneumoconiotic pleural disease, and high-resolution CT (HRCT) is also increasing used for examination of pneumoconiotic lung foci as well. Diagnostic accuracy in pneumoconiosis is further improved by shorter CT scanning times in combination with HRCT.

Asbestosis

[Imaging of cecal tumors using computer tomography].

Although contrast enema of the colon and endoscopy remain the preferential diagnostic methods in tumour of the caecum, computed tomography can accurately determine the extent of extraluminar tumour growth and hence help to arrive preoperatively at the appropriate therapeutic concept. Adenocarcinomas are morphologically distinctly different, due to focal thickenings of the colon wall, from the diffuse wall thickenings associated with malignant lymphomas, or from inflammatory conglomerate tumours. Computed tomography of the caecal region is a noninvasive examination method that can speed up diagnosis especially in elderly patients with elongated colon and stool incontinence.

Adenocarcinoma

[Value of lymphography in the preoperative diagnosis of gynecologic cancers].

In advanced tumors, the imaging techniques such as ultrasound, computer tomography or magnetic resonance imaging are at the forefront. In order to plan surgical procedure, lymphography is indicated as a supplementary diagnostic measure mainly in tumors of the corpus and the cervix uteri, especially in the early and middle stages. In tumors of the ovary, the vagina and the vulva, diagnostic assistance in deciding on therapy is to be expected only in occasional cases. The indication for lymphography should not only be established in relation to the tumor stage, but also tumor grading, since a very much higher local regional metastatic spreading is to be reckoned with in increasing grading, so that the choice of therapeutic procedure is crucially affected. In using preoperative diagnostic measures, the postoperative morphological follow-up should be considered: Examinability of the removed lymph nodes, especially in preoperative suspicion of metastases. Behavior of the lymph nodes in the post-therapeutic phase with consideration of recurrence diagnostics. Planning of radiotherapeutic target volume considering collateral circulations and atypical lymphatics.

Combined Modality Therapy

[Inflammatory changes in shoulder arthrography].

Arthrography of the shoulder joint in so-called periarthritis humeroscapularis often shows nodular contrast defects, irregular defects in the bursa and contrast-filling of irregular lymphatics; these are characteristic signs of a synovitis. Arthrography can provide an exact diagnosis, not only in suspected post-traumatic rotator cuff, tears, but also in other painful conditions that limit movement. It is superior to CT in demonstrating inflammatory changes.

Arthrography

[Combined low-dose radiation and adriblastin therapy of lung metastases].

Two patients with lung metastases are presented who were submitted to a combined low-dose radiotherapy and adriamycin monotherapy with good palliative results. The mode of action as well as the experimental examination results are discussed. The ineffectiveness of single low-dose chemotherapy is demonstrated by the non-response of lung metastases beyond the irradiation fields (heart block, diaphragm). Both patients were resistant to chemotherapy.

Adenocarcinoma

[Gorham-Stout syndrome--progressive osteolysis with viscerocranial involvement].

Two rather young patients with spontaneous massive mandible osteolysis are presented, i.e. a woman suffering from a rhinogenous liquor fistula and recurrent meningitides, and a young man. The authors discuss etiology, pathologic anatomy, clinical and radiological course, as well as the combined surgical and radiotherapeutical treatment. The pathologic process shall be stopped by the combination of both therapy methods. A radiation dose of 30 to 50 Gy is recommended.

Adult