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Biomedical subjects

R P Müller

Publications and source records attributed to R P Müller.

At least 19 recordsLinked to original sources
PubMed1992

Phase I/II study of simultaneous carboplatin and radiotherapy in unresectable squamous cell carcinoma of the head and neck.

Escalating dose levels of carboplatin together with simultaneous accelerated radiation were administered to 36 previously untreated patients with unresectable carcinomas of the head and neck (two stage III and 34 stage IV disease). Twenty-three patients received a total radiation dose of 58.8 Gy with two daily fractions of 2.1 Gy on days 1 to 4 in weeks 1, 2, and 5 and on another 2 days in week 6. Simultaneous carboplatin was given intravenously in escalating dose levels: 20 mg/m2 in three patients, 30 mg/m2 in five patients, 40 mg/m2 in five patients, 50 mg/m2 in six patients, and 60 mg/m2 in four patients. Another 13 patients were treated with an escalated radiation dose of 67.2 Gy, which led to 2 additional days of chemoradiotherapy in week 6. Six patients in this group received carboplatin 60 mg/m2/d, and seven received 50 mg/m2/d. All patients were evaluable for toxicity according to World Health Organization (WHO) criteria, and 35 of 36 patients were evaluable for response. Dose-limiting toxicity was myelosuppression, with WHO grades 3 and 4 leukopenia in five of six patients treated with carboplatin 60 mg/m2 and 67.2 Gy radiation. In patients treated with carboplatin 50 mg/m2 and 67.2 Gy radiation, no grade 4 myelosuppression developed and toxicity was generally tolerable. Independent of the carboplatin dose, grade 3 or 4 mucositis was seen in 12 patients. No other toxicities above grade 2 occurred. There were 19 complete responses (53%) and 16 partial responses (44%). Comparing these results with our earlier data with sequential chemoradiotherapy (carboplatin/5-fluorouracil followed by conventional radiotherapy) indicated that the higher tumor-clearing rate of simultaneous chemoradiotherapy produced significantly better rates of survival and disease-free response.

Carboplatin↗
PubMed1991

Carboplatin plus radiation therapy in head and neck cancer.

To determine toxicity and response, escalating dose levels of carboplatin were given simultaneously with accelerated radiation to 36 previously untreated patients with unresectable squamous cell carcinomas of the head and neck (SCCHN) (2 with stage III and 34 with stage IV disease). Twenty-three patients received a total radiation dose of 58.8 Gy with two daily fractions of 2.1 Gy on days 1 through 4 in weeks 1, 2, and 5 and on two additional days in week 6. Simultaneous carboplatin was given intravenously at escalating dose levels: 20 mg/m2 in 3 patients, 30 mg/m2 in 5 patients, 40 mg/m2 in 5 patients, 50 mg/m2 in 6 patients, and 60 mg/m2 in 4 patients. Another 13 patients were treated with an escalated radiation dose of 67.2 Gy, which resulted in 2 more days of radiochemotherapy in week 6. Six patients in this group received 60 mg/m2/d and 7 received 50 mg/m2/d carboplatin. All patients were evaluable for toxicity according to World Health Organization (WHO) criteria and 35 of 36 patients were evaluable for response. Dose-limiting toxicity was myelosuppression with WHO grades 3 and 4 leukopenia in 5 of 6 patients treated with 60 mg/m2 carboplatin and 67.2 Gy. With radiochemotherapy doses of 67.2 Gy and 50 mg/m2, no grade 4 myelosuppression occurred and toxicity was generally tolerable. Independent of the carboplatin dose, mucositis grade 3 or 4 was seen in 12 patients. No other toxicities above WHO grade 2 occurred, except in 2 patients with grade 3 nausea and vomiting. There were 19 complete responses (53%) and 16 partial responses (44%). Our preliminary data suggest that 50 mg/m2 carboplatin together with a total radiation dose of 67.2 Gy might be the best combination for advanced, unresectable SCCHN.

Carboplatin↗
PubMed1991

[Functional microcirculatory disorders in the rat kidney after cobalt-60 irradiation measured by tissue pO2].

The left kidneys of Wistar rats were irradiated with a single dose of 20 Gy percutaneously and the local tissue partial oxygen saturation was measured with the multi wire surface electrode (Kessler and Lübbers). The rats were sacrificed at various intervals post irradiation and the pO2-measurements were compared with control values from the unirradiated contralateral kidneys in each animal. Beforehand "normal histograms" were obtained in unirradiated rats. 24 hours post irradiation hyperemia and local perfusion changes were observed, which nearly turned to normal in the course of four weeks. The histograms after 16 weeks proved persisting damage. After a short delay the nonirradiated right kidneys showed similar significant injuries. Further studies are required to clarify these alterations. The multi wire surface electrode render it possible to conceive early functional disturbances in organ microcirculation after high energy irradiation.

Animals↗
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

[Primary cutaneous plasmacytoma. A case report and review of the literature].

Primary extramedullary plasmacytoma of the skin is a very rare disease; to our knowledge, only a few cases have been published in the world literature. In this paper, a patient who had a primary cutaneous plasmacytoma of the lower lip for 20 years is described. Serological, radiological and histological examinations excluded the possibility of an underlying multiple myeloma. The position of cutaneous plasmacytomas within the group of malignant plasma cell neoplasias is discussed and the relevant literature is reviewed.

Diagnosis, Differential↗
PubMed1990

[The radiotherapy of epidemic Kaposi's sarcomas in AIDS patients].

From August 1986 to May 1989, 15 patients suffering from Kaposi's sarcoma and serologically proven HIV infections were treated in the Department of Radiotherapy, University of Cologne, Medical Hospital. All patients were male and homosexual. Therapeutic objectives were palliation of pain and functional impairment as well as elimination of the cosmetically disturbing Kaposi's sarcoma. 68 localizations (facial skin, torso, extremities, sole of the foot, penis, oral mucosa and oropharynx) were irradiated. Depending on the individual therapy regimen, photons or high-energy electrons up to a total dose of 26 to 40 Gy, with single doses of 1.8 to 2.5 Gy were applied four to five times a week. In 66% of the cases, complete remission was achieved within the area of irradiation at the dermal or mucosal level, with at most a discrete residual pigmentation of the cluster remaining. Partial remission with at least 50% regression or a distinctive residual pigmentation was achieved in 31%. In 3% of the cases, a less than 50% regression of the Kaposi's lesions were achieved after radiotherapy. There were five local recurrences. Treatment with radiation is an effective local therapy in epidemic Kaposi's sarcoma and yields good functional and cosmetic results and also provides relief from pain.

Acquired Immunodeficiency Syndrome↗
PubMed1990

[Liposuction].

Explore the source record for details and available documents.

Humans↗
PubMed1989

Long-term results in treating squamous cell carcinoma of the lip, oral cavity, and oropharynx.

At the department of Maxillofacial Surgery of the University of Münster, squamous cell carcinomas of the lip, oral cavity, and oropharynx are treated according to the principle of surgical resection of the tumour and, if indicated, radical neck dissection. In cases of lymph node infiltration, additional radiotherapy is given. The data of 352 patients, treated within 15 years, were evaluated with regard to 5-year minimal survival rate and to the incidence of recurrences in correlation to the tumour stages and form of treatment.

Adult↗
PubMed1989

[Radiotherapy in (localized) non-Hodgkin's lymphoma of the orbit].

Orbital NHLs are rare and manifest themselves primarily in localized stages. The value of radiotherapy is discussed, reviewing retrospectively the treatment results obtained in 41 patients irradiated for orbital NHL between 1958 and 1966. All were histologically verified. There were 15 lymphomas of low and nine of high malignancy according to the Kiel classification. Among the 17 remaining patients, 15 cases had been classified as reticulum cell sarcoma and two as lymphosarcoma. Fourteen cases were in stage IE, 19 in stage IIE, and eight in stage IIIE/IVE. After surgical biopsy (n = 25) or resection (n = 5), megavoltage irradiation was delivered in conventional fractionation from 20 Gy up to a total dose of 50 Gy. During the last decade treatment has been based on CT scans and corresponding computer assisted treatment planning. Clinically, complete remission was achieved in 13 out of 14 patients (93%) with stage IE, in 17 out of 19 patients (90%) with stage IIE, and in five out of eight patients (63%) with stage IIIE/IVE. The nonrecurrence rate is 65% (10 out of 14) for stage IE and 75% (13 out of 17) for stage IIE after a mean follow-up time of 36 months. As regards lymphomas of low and high malignancy, the nonrecurrence rate is 89% and 43% respectively. Recurrence (n = 8) and dissemination (n = 6) occurred only twice more than two years after radiotherapy had been discontinued. The incidence of side effects was low. Two patients developed a "dry eye." In two eyes the lens had to be removed because of progressive cataract. Radiotherapy with individual treatment planning based on CT scans is the curative treatment of choice fo localized orbital NHL.

Adolescent↗
PubMed1989

The effect of the number of fractions of cranial irradiation on growth in children with acute lymphoblastic leukaemia.

Growth was documented over a period of 7 years in all long-term survivors treated for acute lymphoblastic leukaemia (ALL) with the DAL-70- (n = 15) and BFM-70-protocol (n = 27). Normal growth was documented in patients of the DAL-70-protocol during and after therapy. In contrast, in children treated with the BFM-70-protocol the mean height standard deviation score (SDS) decreased significantly from 1.21 SDS prior to therapy to 0.80 SDS at the end of therapy (p less than 0.001) and remained unchanged thereafter. Prophylactic cranial irradiation was given in total doses of 15 to 30 Gy. Ten children of the DAL-70- and 20 children of the BFM-70-protocol received 24 Gy of cranial irradiation. No significant change in height-SDS was observed in any patients of the DAL-70- and in 8 patients of the BFM-70- group, who received 24 Gy of cranial irradiation in 16-26 fractions. Adult height in 7 girls and 6 boys was normal and 3.15 cm and 5.06 cm above target height. In the remaining 12 patients of the BFM-70-protocol the total dose of 24 Gy of cranial irradiation was applied in 11-14 fractions. Their height-SDS had fallen significantly from 1.24 SDS before to 0.66 SDS (p less than 0.001) at the end of therapy. Adult height in 4 girls and 6 boys was also normal, but the height increase was comparatively smaller, -2.20 cm below target height in the girls and 1.91 cm above in the boys.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

[Wound treatment with autogenous epidermal cell expansion culture].

Sheets of autologous epidermal cells grown by expansion culture were used to cover small skin defects in seven patients with postoperative necroses, necroses due to temporal arteritis, varicose ulcers or after tangential excision of tattoos. Several transplantation techniques were used: backing of the cultured epithelia with vaseline gauze, Surfasoft, Adaptic, Silastic foil, culturing directly from Petriperm-foil. Meshed Silastic-foil proved to give the best support. Optimal take of the in-vitro epithelia (more than 80% of their surface area) was achieved only for fresh dermal wound-beds. The take was only moderate on chronic granulation tissue, but the transplants reduced the formation of fibrinous-necrotic material and favoured the formation of fresh granulation tissue.

Adult↗
PubMed1988

[Free skin transplants].

The considerations of defect-closure in skin surgery are associated with the question--flap or graft? Different areas and conditions require individualized approaches to reconstruction. A great variety of ingenious flaps and the new method of skin-expander promote and favourise these techniques in surgical defect closure. Anyway the different grafts are still main-topics in skin surgery. Generally there exist three types of grafts. The split-thickness skin grafts, in its various modifications, are useful for functional closures of defects, while full-thickness skin grafts give better cosmetic results. The composite graft, containing epidermis, full dermis and cartilage, fits for reconstruction of contoured defects at the nose and ear. The nutrition of this special graft is limited by the contact-periphery between graft and defectborder. In contrast the survival of the other types of grafts depends on the undersurface, the degree of granulation tissue in the wound bed. The attention of many technical details, the skillness of the surgeon and some artistic considerations are the guarantors of successful grafting and of good cosmetic results.

Humans↗
PubMed1988

[Treatment results of surgical and radiologic therapy of penile cancer].

A retrospective analysis was made about the results achieved in 64 patients after combined surgical and radiotherapeutic treatment. The tumor areas were irradiated by fast electrons or cobalt 60 with 50 to 55 Gy, the lymph nodes received doses of 45 to 55 Gy. Local tumor control was achieved in 27 out of 28 patients irradiated immediately after surgery (96%). In case of demonstrated lymph node invasion, local control was achieved in 14 out of 19 cases (74%). The median survival was 9.6 years for patients in stage T1/2, N0, M0 and 2.5 years for patients in stage T1-4, N+, M0. The first two years following to therapy were decisive for the prognosis. Among those of our patients who developed recurrences during this period, not one could be cured in the long run. Two years after the end of therapy, the survival probability of patients without lymph node metastases becomes comparable to the survival curve of normal male population of the same age. In the treatment of penile carcinoma, a gradual proceeding depending on the stage is recommended for the combination of surgery and radiotherapy. In case of lymph node metastases, the application of adjuvant chemotherapy should be taken into consideration.

Adult↗
PubMed1987

Testicular function in eight patients with seminoma after unilateral orchidectomy and radiotherapy.

Testicular function was monitored in eight patients with low stage seminoma who were treated with radiotherapy following unilateral orchidectomy. The absorbed gonadal radiation dose ranged from 15 to 157.5 rad. At 10-24 months after radiotherapy, serum hormone levels, sperm analysis, sperm penetration into zona-free hamster ova (HOP-test) and lymphocyte chromosome abnormalities were evaluated. Two patients were azoospermic with elevated serum levels of LH and FSH. The remaining six patients had slightly decreased (n = 3) or normal (n = 3) seminal parameters. Their HOP rates were within the normal range. A low incidence of polyspermy (i.e. only one penetrating sperm per ovum) was found in the patients, suggesting low penetrability of motile sperm. A highly significant correlation was found between sperm count or sperm penetrability and time post-irradiation. The results indicate that restitution of testicular function is time-dependent.

Adult↗
PubMed1986

Results of high dose 106-ruthenium irradiation of choroidal melanomas.

The favored treatment of intraocular melanomas in Germany is 106-ruthenium eye plaque therapy. The Departments of Radiation Therapy and Ophthalmology (University of Münster) initiated a clinical study in 1981 to reveal the effect of high-dose beta irradiation (15.000 cGy to the apex of the tumor) regarding tumor regression, treatment related side effects, visual acuity, and survival. Sixty-seven patients have been treated since 1981. In 12 patients a second course of irradiation has been performed because of insufficient tumor regression or no change after the first plaque treatment. Sixty-five percent (44/67 pts.) were over 60 years of age. Twenty-four patients had a small tumor (up to 3 mm in height), 20 patients had a medium sized tumor (3.1-5 mm in height), and 22 patients had a large tumor (more than 5.1 mm in height). Fifty-one patients had a follow-up of at least 12 months. A total tumor regression was achieved in 34/51 patients (67%), partial tumor regression occurred in 13/51 patients (25%), and in 4/51 patients (8%) there was no change after the first course. After the second course of 106-ruthenium-irradiation 5 of the 12 patients showed total tumor regression, 3 had partial regression, and in 4 patients only an increase of the tumor echogenity could be assessed by ultrasonography, but no change in height. Visual acuity, which depends mostly on the localization of the tumor, was preserved at pretreatment levels in 72% of the patients. Two patients died with documented metastatic disease, one patient died of myocardial infarction. There was only one enucleation because of neovascular glaucoma.

Adult↗
PubMed1986

[Radiotherapy in juvenile xanthogranuloma of the iris].

Nevoxanthoendotheliomas (and juvenile xanthogranulomas) are very rare benign skin diseases which occur in infants. An ocular manifestation, mainly in the iris, has been found in approximately. 10% of the cases, The clinical picture is characterized by a recurrent unilateral hemorrhage of the anterior chamber, which is the reason for seeing an ophthalmologist. The clinical diagnosis of juvenile xanthogranuloma is based on the characteristic iris changes - heterochromia, circumscribed vascularized tumor, or diffuse thickening of the iris. Sometimes elevated intraocular pressure is also found. In combination with a mild local steroid, radiotherapy with 300 to 400 cGy should be started immediately in order to prevent a sometimes uncontrollable secondary glaucoma. The good results achieved in 5 of the authors' own cases underline the value of low-dose radiotherapy in this disease: the affected eye was healed in all 5 cases.

Child, Preschool↗