Die Diskussion um die adjuvante Chemotherapie und adjuvante Radiochemotherapie bei Patienten mit komplett operiertem Magenkarzinom ist in Europa nach wie vor kontrovers. Eine hohe lokoregionale Rezidivrate und Fernmetastasierungsrate nach initial kompletter Resektion eines Magenkarzinoms zeigt deutlich den Bedarf einer effektiven adjuvanten Systemtherapie. Daher wurden in den letzten Jahren innerhalb klinischer Studien verschiedene adjuvante Therapieregimes untersucht, um die Prognose von Patienten mit lokalisiertem resektablem Magenkarzinom zu verbessern. Dabei wurden sowohl die adjuvante alleinige Chemotherapie und alleinige adjuvante Radiation als auch die adjuvante kombinierte Radiochemotherapie eingesetzt.

BACKGROUND. The objective of this Phase II study was to assess the clinical activity and toxicity of docetaxei (D) and cisplatin (P) in patients with locally advanced unresectable, metastatic, or recurrent squamous cell carcinoma of the head and neck (SCCHN).PATIENTS. Of 34 patients, 30 were eligible for treatment with D 80 mg/m(2) on Day 1 and P 70 mg/m(2) on Day 2. Therapy was repeated every 3 weeks. At the start of chemotherapy, the tumors had the following extensions: locoregional, n = 15; distant metastatic, n = 2; and relapse, n = 13.RESULTS. Overall, the rate of objective responses in the population of all eligible patients based on an intention-to-treat analysis was 53%, with a 95% confidence interval (CI; 34.33-71.66%). Two patients had complete disease remission (pathologic), 4 patients had complete disease remission (clinical), 10 patients had partial disease remission, 3 patients had no change in disease status, and 7 patients had disease progression. The duration of objective response was median 5+ months (range 3-8+ months). Eleven patients (37%) had Grade 4 granulocytopenia and three patients (10%) had Grade 3 granulocytopenia (grades were based on the classification of the National Cancer Institute of Canada-Common Toxicity Criteria). Six patients died of septicemia.CONCLUSIONS. Overall, the combination of D and P represents a highly active chemotherapeutic regimen for the treatment of patients with SCCHN. However, because of the high toxicity of this regimen, prophylactic administration of antibiotics and hematopoietic growth factors is essential as is a three-day corticosteroid premedication regimen. Above all, this combination of drugs is not recommended for treatment of patients with a World Health Organization performance status of > 1. Cancer 2002;94:2953- 8. (C) 2002 American Cancer Society.

The curative treatment of carcinoma of the rectum in the early stage of the disease is radical local surgery. If there is a solitary liver metastasis, resection is also a curative treatment. This report describes a female patient with rectal carcinoma, in whom a solitary liver metastasis in the left lobe was diagnosed only by FDG-PET and verified at surgery. This case report demonstrates the potential role of FDG-PET even for primary staging in detecting occult hepatic and extrahepatic metastases, thus significantly influencing the therapeutic management and prognosis of these patients.

Twenty-three patients with an ileal bladder substitute formed after cystectomy for invasive bladder cancer were evaluated clinically and urodynamically between 3 and 38 months post-operatively. The urodynamic measurements were compared with the clinical findings. After re-education of the patients' voiding habits the mean voiding volumes of the bladder substitutes stabilised 6-9 months post-operatively at 350 ml. The frequency of micturition was 3 to 5 times during the day and once or twice at night. The maximum functional capacity (maximum voiding volume) was about 490 ml. Ninety-one per cent of the patients were continent during the day 18 months after the operation and 82% were continent during the night. Micturition was problem-free with an average maximum flow of 25 ml/s and an average micturition time of 50 s. The mean voiding volume of ileal bladder substitutes was 50% of the measured cystometric capacity; the maximum functional capacity (= max. micturition volume) was 80% of the cystometric capacity. The average basal pressure was < 20 cm H2O from the third post-operative month onwards. Eleven of the 23 patients had contractions in the bladder substitute (average at 30 cm H2O) at 55-76% of the maximum cystometric capacity or at approximately 90% of the maximum functional capacity. Such spike waves had no clinical or radiological consequences. If the patients were shown how to increase the functional capacity of a reservoir made from only 40 cm of ileum, the clinical results were excellent.

When a urinary reservoir intended to replace the bladder is made from bowel, it should meet several requirements: good capacity, viscoelasticity and compliance, voluntary control of micturition without residual (infected) urine, a sensation of the filled state and urinary continence. In addition, there should be no major metabolic changes due to malabsorption after bowel resection or due to reabsorption of urinary constituents by the reservoir. In this review several conflicting aspects of bladder reconstruction are addressed: the persisting intestinal peristalsis and urinary incontinence, the volume of the reservoir and its metabolic impact, the bowel segment to be used and the amount that can be resected without the risk of long-term sequelae. Our clinical experience with ileal bladder substitutes in 80 patients underlines the theoretical aspects. After careful instruction, our patients increased the functional capacity of their reservoirs to 500 ml, a precondition for good urinary continence. Provided that the patients were regularly followed-up, the functional, clinical and metabolic results were good. The operative procedure was easy to perform, and no major metabolic sequelae occurred during a maximal observation time of 6 years. Nevertheless, continuing careful follow-up for the detection of potential long-term sequelae, such as disturbances in lipid metabolism or chronic bone demineralisation, are required before definitive statements on the role of intestinal bladder substitutes can be made.

After a 48-hour rehydration period 28 of 31 patients with cancer-associated hypercalcemia (serum calcium greater-than-or-equal-to 2.8 mmol/l) were treated intravenously with the bisphosphonate pamidronate. In three patients fluid repletion with 0.9% saline solution had already normalized serum calcium levels. Pamidronate was given in a single infusion on day 0, the dose of pamidronate adapted to the severity of hypercalcemia. If the serum calcium concentration was greater-than-or-equal-to 2.8 mmol/l on day 3, application of pamidronate was repeated. In all patients normocalcemia was restored; mean serum calcium decreased from 3.2 +/- 0.35 on day 0 to 21.5 +/- 0.32 on day 12. Hypercalcemia recurred in 11 patients, seven of these underwent pamidronate treatment according to the same therapeutical regimen. Normal calcium levels were attained in five cases. Side effects were of minor gravity: brief hyperthermia occurred in four patients and transiet, asymptomatic hypocalcemia was noticed in nine cases.

After a 48-hour rehydration period 28 of 31 patients with cancer-associated hypercalcemia (serum calcium greater than or equal to 2.8 mmol/l) were treated intravenously with the bisphosphonate pamidronate. In three patients fluid repletion with 0.9% saline solution had already normalized serum calcium levels. Pamidronate was given in a single infusion on day 0, the dose of pamidronate adapted to the severity of hypercalcemia. If the serum calcium concentration was greater than or equal to 2.8 mmol/l on day 3, application of pamidronate was repeated. In all patients normocalcemia was restored; mean serum calcium decreased from 3.2 +/- 0.35 on day 0 to 2.15 +/- 0.32 on day 12. Hypercalcemia recurred in 11 patients, seven of these underwent pamidronate treatment according to the same therapeutical regimen. Normal calcium levels were attained in five cases. Side effects were of minor gravity: brief hyperthermia occurred in four patients and transient, asymptomatic hypocalcemia was noticed in nine cases.

Spheroidal bladder substitutes made from double-folded ileal segments, similar to Goodwin's cup-patch technique, are devoid of major coordinated wall contractions. This, together with the reservoir's direct anastomosis to the membranous urethra, prevents major intraluminal pressure peaks and assures a residue-free voiding of sterile urine. In order to determine whether, under these conditions, an afferent tubular isoperistaltic ileal segment of 20-cm length protects the upper urinary tract as efficiently as an antireflux nipple, 60 male patients who were subjected to radical cystectomy were prospectively randomised to groups in which a bladder substitute was formed together with either of these 2 antireflux devices. An analysis of the results obtained in 20 patients from each group who could be followed for more than 1 year (median observation time 30 and 36 months) showed no differences between the groups in metabolic disturbances, kidney size, reservoir capacity, diurnal and nocturnal urinary continence, the incidence of urinary tract infection or episodes of acute pyelonephritis. Later than 1 year postoperatively, intravenous urograms of the renoureteral units of 25% of the patients with antireflux nipples showed persistent but generally slight dilatation of the upper urinary tracts. This observation was significantly more frequent than it was in patients with afferent tubular segments. Urodynamic and radiographic studies showed that the competence of the antireflux nipples was secured by the raised surrounding intravesical pressure. This, however, also resulted in a transient functional obstruction, and a gradual rise of the basal pressure in the upper urinary tracts was recorded. In patients with afferent ileal tubular segments, contrast medium could be forced upwards into the renal pelvis when the bladder substitutes were overfilled. However, despite raised intravesical pressures, peristalsis in the isoperistaltic afferent tubular segment gradually returned contrast medium back to the reservoir. Our results suggest that the combination of an ileal low-pressure reservoir together with an afferent tubular isoperistaltic limb is at least as good as an antireflux nipple valve. Moreover, the use of the afferent ileal limb makes it possible to resect the distal and often diseased ureters together with the paraureteric lymphatics at a safe distance from the bladder tumor. This avoids also distal ischemic ureteric stenosis and makes possible a simple end-to-side ureterointestinal anastomosis with a small complication rate.

After a 48-hour rehydration period 28 of 31 patients with cancer-associated hypercalcemia (serum calcium ≥2.8 mmol/1) were treated intravenously with the bisphosphonate pamidronate. In three patients fluid repletion with 0.9% saline solution had already normalized serum calcium levels. Pamidronate was given in a single infusion on day 0, the dose of pamidronate adapted to the severity of hypercalcemia. If the serum calcium concentration was ≥2.8 mmol/1 on day 3, application of pamidronate was repeated. In all patients normocalcemia was restored; mean serum calcium decreased from 3.2±0.35 on day 0 to 2.15±0.32 on day 12. Hypercalcemia recurred in 11 patients, seven of these underwent pamidronate treatment according to the same therapeutical regimen. Normal calcium levels were attained in five cases. Side effects were of minor gravity:brief hyperthermia occurred in four patients and transient, asymptomatic hypocalcemia was noticed in nine cases.

Two protein kinase activities have been separated from the supernatants of homogenized human blood platelets by DEAE cellulose chromatography. One of them (peak I enzyme) is an efficient stimulator of the uptake of Ca2+ into isolated membrane vesicles in the presence of cyclic AMP and ATP. The second (peak II enzyme), although equally active towards histone, exerts only about one third of the activity of the peak I enzyme. The stimulation of Ca2+ uptake is accompanied by the phosphorylation of a membrane protein with an apparent molecular weight of 22 000, which appears to play an essential role in the regulation of the intracellular Ca2+ level and hence of platelet activity.

It is shown that the following dynamical phenomena occur on a scree slope: Collapse because of lack of stability, rapid slides of debris material, slow sliding of large blocks, jumping and rolling of large stones, and particle-separation due to a sieving effect. The mechanisms of these phenomena are investigated in detail; it is shown that the stability and the slow sliding of blocks can be explained by soil mechanics methods, the debris slides by the law of dry friction, the rolling of stones by the laws or rolling of spheres, and the sieving effect by a theory analogous to that encountered in the filtration of suspensions through porous media.

The "IRE Standards on Piezoelectric Crystals-The Piezoelectric Vibrator" specifies nomenclature and methods of measurement of the various quantities associated with piezoelectric vibrators. This paper gives in detail the theoretical considerations of these measurements, which are based on the frequency of maximum transmission through a simple pi resistance network which includes the vibrator in the series arm. The motional resonance frequency of the vibrator and the value of the motional resistance by the substitution of a resistor in place of the vibrator may be obtained from the frequency measurement. The theoretical considerations take into account stray capacitances and other impedances, and show how the somewhat involved formulas may be simplified with the average run of presently available vibrators. By the aid of capacitance-bridge measurements and frequency measurements of the vibrator with series impedances, all of the elements of its equivalent electrical circuit may be determined. Charts based on the formulas are included. They relate the measured to the fundamental values of the vibrator elements with any desired degree of precision. It is shown that when using typical quartz vibrators, the measurement of the frequency at maximum transmission will not differ from its value at motional resonance by more than a few parts in a million. Resistance substitution measurements have been found to compare within about two per cent. In addition to the generally available resistance and capacitance bridges, transmission network measurements require a stable RF generator or oscillator, the transmission network, and a sensitive detector.

A method is described for measuring the equivalent parameters of both the main and spurious modes of very high-frequency crystal units. The crystal is placed between the plate and cathode of an amplifier tube, and the voltage developed across it is recorded as a function of frequency. The series resistance R88. can be obtained by comparing the resulting voltage peaks with the voltage developed across a pure capacitive load. The series capacitance C8 is measured by recording the resonance curve with the crystal unit in circuit, and then recording a second resonance curve when the capacitance across the crystal unit has been increased by a known amount. The frequency difference between the two curves gives a measure for C8. Correction functions are derived for evaluating the recorded data for crystal units having high R8 and low reactance of the static capacitance Co.