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Twenty-six bone marrow transplantations were performed at the West Germany Tumour Centre at Essen between December 1975 and December 1981. Three patients had aplastic anaemia, 23 acute leukaemia. Of the leukaemia patients 13 had a recurrence and ten were in full remission at the time of the transplantation. Two of the patients with a recurrence received deep-frozen autologous marrow from the remission phase. One patient with aplastic anaemia had an identical twin as donour, while all other patients received allogeneic marrow from histocompatible family members. Eleven patients are still alive, all three of those with aplastic anaemia, one of those with leukaemia in a recurrence, and seven of those with acute leukaemia in full remission. Two of the survivors have a chronic graft-host reaction, but the others are symptom-free, after an observation period of up to four years. Main causes of death were leukemic recurrence (6), infection (5), and graft-host reaction (2). It would seem that at present bone marrow transplantation offers the best chance of a cure for severe aplastic anaemic and acute leukaemia in adults, but only if transplantation is undertaken early and not in the end-stage of the disease.

Combined treatment with adriamycin, cyclophosphamide and vincristine (ACO) was used in 50 out-patients with histologically verified small-cell bronchial carcinoma. In 26 patients with locally and regionally limited metastases ("limited disease") radiotherapy (3000 rad focal dose) to mediastinum, hili and tumour opacity as well as prophylactic cranial irradiation (3000 rad focal dose) were performed after 3 cycles of chemotherapy. Complete clinical remission (without endoscopic control) was achieved in 32 out of 50 patients. Remissions in patients with bilateral pulmonary or extrathoracic metastases ("extensive disease", n = 24, 12 complete remissions) only led to limited asymptomatic prolongations of life (median survival time 10 months, median remission period 5 months) despite maintenance therapy. On the other hand patients with "limited disease" had considerable life prolongation (median survival 21 months, historical control value 3--4 months). Seven out of 26 patients in this group survived for 30 months after the onset of the disease, 6 out of 26 are now in their third year after starting therapy without signs of tumour recurrence. The results show that early recognition of patients with local and regional metastases has considerable prognostic value.

Multiple myeloma of IgG kappa type was diagnosed in a 42-year-old man with bone pains, dyspnoea on exertion and increasing drowsiness. Six chemotherapy cycles extending over 14 weeks and consisting of 15 mg/m2 melphalan intravenously on day 1 and 60 mg/m2 prednisolone orally on days 1-4 produced a partial remission. As the HLA-identical sister of the patient was willing to donate bone marrow, an allogeneic marrow transplantation was planned. After 7 days' conditioning treatment (hyperfractionated whole-body irradiation with 12 Gy, chemotherapy with 70 mg/m2 melphalan and 60 mg/kg cyclophosphamide), 4.2 x 10(8) nucleated cells of donor marrow were infused per kg recipient body-weight through a central venous catheter. Despite prophylaxis with short-course methotrexate and cyclosporin, an acute graft-versus-host reaction of grade II-III occurred on day 26, though it settled almost completely after treatment with daily 2 mg/kg prednisone and monoclonal interleukin-2 receptor antibodies (B-B10, daily 10 mg). On day 100 after the marrow transplantation, marrow puncture showed the picture of complete remission with normal regeneration of haemopoietic cells. Allogeneic marrow transplantation may therefore be considered as a new and promising mode of treatment for younger patients with multiple myelomas.

Bone-marrow transplantations were performed in 71 patients, 11 with panmyelopathy, 17 with recurrence of acute leukaemia, 25 with acute leukaemia and remission, 18 with chronic myeloid leukaemia. The transplantation was allogenic in 67, autologous in 2, isologous in 2. Eight patients each survived in the panmyelopathy and chronic myeloid leukaemia groups. In the group of patients with acute leukaemia only one patient of those in a recurrence survived the transplantation for several years, but after 6 years there was another recurrence. Of the 20 patients with acute myeloid leukaemia who received the transplantation during their first remission, 11 are still alive. Retransplantation because of the recurrence was employed in one case each of acute and chronic myeloid leukaemia. Main cause of death was interstitial pneumonia with an overall risk of 23%. Only 5% of patients developed severe acute graft-versus-host reaction, grades III-IV. The low incidence of this reaction is possibly due to the strict gnotobiotic measures which in most of the patients led to decontamination of the intestinal tract.

32 Patienten mit lokal fortgeschrittenen Tumoren (T2-4, N1-3, M0) der Kopf-Hals-Region erhielten Cisplatin (20 mg/m2 an 5 aufeinanderfolgenden Tagen zusammen mit Hydratation und Osmodiurese) in zwei Behandlungszyklen. Das cisplatin-freie Intervall betrug mindestens 4 Wochen. Gleichzeitig erfolgte eine Bestrahlungstherapie mit Photonen oder Elektronen in taglichen Fraktionen von 2 Gy vier- bis funfmal pro Woche bis zur Zielvolumendosis von 60-70 Gy. Reduktive chirurgische Masnahmen erfolgten, wenn nach 40 Gy und einem Cisplatin-Zyklus die Tumorinvolution ≤ 50 % war. Die Gesamtremissionsrate (komplette und partielle Remissionen) betrug 91 %. 22 Patienten (69 %) hatten komplette Remissionen. Biopsien waren bei 14 Patienten nach 40 Gy und einem Cisplatin-Zyklus durchgefuhrt worden; sieben von ihnen waren histologisch tumorfrei. Ein klinisch bedeutsamer Anstieg der lokalen Toxizitat wurde nicht beobachtet. Allerdings traten Erytheme und Odeme in den Bestrahlungsfeldern haufiger und fruher auf als bei alleiniger Bestrahlung. Die Ergebnisse weisen darauf hin, das durch die kombinierte Cisplatin- und Bestrahlungstherapie gleiche oder sogar bessere Resultate als mit aggressiver Polychemotherapie und anschliesender Bestrahlungsbehandlung erreicht werden konnen. Cisplatin (20 mg/m2 on five successive days, together with hydration and osmotic diuresis) was administered in two treatment cycles to 32 patients with locally advanced tumours (T2-4, N1-3, M0) of the head and neck region. Cisplatin-free intervall was at least four weeks. At the same time there was radiotherapy with photons or electrons, daily fractions of 2 Gy four to five times weekly to a final volume dose of 60-70 Gy. Tumour resection was undertaken if there was no tumour involution of at least 50 % after 40 Gy and one cisplatin cycle. Total remission rate (complete and partial) was 91 %. Complete remission occurred in 22 patients (69 %). Biopsies in 14 patients after 40 Gy and one cisplatin cycle indicated that in seven there was no histological evidence of tumour. There was no clinically serious rise in local toxicity. However, erythema and oedema in the radiation fields were more frequent and earlier than with radiotherapy alone. The results indicate that combined cisplatin administration and radiotherapy give the same or even better results than aggressive chemotherapy followed by radiotherapy.

Among 334 patients (aged 15-57 years) with malignant non-Hodgkin's lymphoma there were 14 who developed CNS complications, none in 144 with lymphoma of low malignancy. Lymphoblastic lymphoma predominated amoung those with CNS involvement. In adults with this form treatment should therefore be undertaken to prevent such complications. The study confirms the need for histological subclassification in malignant non-Hodgkins's lymphoma.

Between 1973 and 1978 combined radiotherapy and chemotherapy were given to 22 patients with histologically proven Ewing's sarcoma. The combined chemotherapy consisted of cyclophosphamide, vincristin, adriamycin, as well as dacarbazine in some cases. The neoplasm was a localized one at the beginning of treatment in 14 of the 22. These patients received high-voltage radiotherapy to the primary focus at a focal dose between 42 and 55 Gray (4200-5500 rad), followed by chemotherapy. After 6--8 treatment cycles, adriamycin was replaced by methotrexate. Nine of the 14 patients survived without recurrence for 12 to over 59 months. Eight patients had extensive metastases at the beginning of treatment: they at first received only chemotherapy, followed by radiotherapy or operation, as indicated. Full clinical remission was achieved in five of them: in three this remission has now lasted for more than 18, 40 and 44 months, respectively. These results indicate that (1) additional chemotherapy improves the prognosis of localized Ewing's sarcoma, and (2) even in far-progressed cases the combination of chemotherapy and radiotherapy can achieve lasting remission, which may in fact be a true cure.

The results of treatment of the first 100 patients with uveal melanomas treated with 106-Ruthenium applicators in Essen are presented. The mean follow-up period was 2 years; 80 of the patients presented with choroidal melanomas and 20 with melanomas of the ciliary body. Five of the 100 patients had metastatic disease originating from the primary uveal melanoma. Compared to 60-cobalt therapy, therapeutic results are similar in terms of tumor regression, but the incidence of complications was significantly lower. In 16 patients the eye with the tumor had to be removed, because of tumor growth (12), neovascular glaucoma (3), and vitreous hemorrhage (1). Visual acuity did not decrease in 20% of the cases treated. In the light of our results 106-Ruthenium therapy seems to be a reliable method of tumor treatment in tumors with a maximum prominence not exceeding 8 mm.

From October 1, 1979 to September 30, 1981 a prospective study on the side-effects of BCG inoculation was conducted in the cities of Duisburg, Essen, and Mulheim, in very close cooperation with practising pediatricians, public health authorities, and obstetric departments. Particular consideration was given to suppurating regional lymphadenitis. In the period covered by the study 21.294 infants from 23.390 live births (i.e., 89%) were BCG-vaccinated using the Copenhagen 1331 strain manufactured by Behringwerke. A suppurating regional lymphadenitis occurred in 66 cases, i.e., a complication rate of 0.3%. The conversion ratio was high. Out of 8.144 documentation forms that could be assessed 6.840 (84%) attested to a positive tuberculin reaction caused by prophylactic test U 4. If the result of this test was negative a second test, after Mendel-Mantoux, strength 10, was used. According to this a total of 7.311, i.e., altogether 98.4% of the inoculation results evaluated, were positive. Both the conversion ratio as well as the incidence of ulcers at the vaccination site depend to a slight degree on the concentration of units in the vaccine which are capable of reproduction, to the extent that at higher concentrations the conversion ratio increases, as does the number of ulcers at the vaccination site.

ZusammenfassungUntersucht wurde der Effekt verschiedener Dosen von Natrium-Perchlorat in unterschiedlicher Dosisfraktionierung auf das Ausmaß und den zeitlichen Verlauf der Depletion von Radiopertechnetat in Abhängigkeit von der Applikationsform.Eine Dosis von 50 mg Perchlorat intravenös hat sich im Hinblick auf eine kompetitive Hemmung der aktiv Pertechnetat-konzentrierender Organe als gleich wirksam erwiesen wie 1000 mg ClO4 − intravenös simultan oder 1000 mg peroral 30 Minuten vor Injektion von Radiopertechnetat.Auch eine nachträgliche intravenöse Injektion von Perchlorat erzeugt eine vollständige und sofort einsetzende Depletion des bereits in der Schilddrüse akkumulierten Pertechnetats innerhalb eines Zeitraumes von 195 Minuten nach 99m-TcO4 −-Injektion mit komplementärem Anstieg der Blutaktivität.20 mg führen zu einer unvollständigen Depletion des Pertechnetats, deren Vollständigkeit durch eine zweite zusätzliche Dosis erreicht werden kann.Die intravenöse Applikation von Perchlorat kann in der klinischen Anwendung Vorteile bieten.

ZusammenfassungIn einer Vergleichsstudie von 99mTc-Pyrophosphat- und 85Sr-Szintigrammen an 22 erwachsenen Patienten mit metastatischen Knochenumbauprozessen wurde versucht, die von verschiedenen Autorengruppen hervorgehobene bessere Qualität der 99mTc-Pyrophosphatszintigramme gegenüber 85Sr-Szintigrammen auch quantitative zu belegen:Wegen der Möglichkeit der höheren Dosierung und der für das Auflösungsvermögen der verwendeten Kollimatoren günstigeren Photonenenergie des 99mTc waren bei den 99mTc-Pyrophosphatszintigrammen 97 einzelne pathologische Anreicherungsherde abzugrenzen gegenüber 58 Anreicherungsherden bei den 85Sr- Szintigrammen.Quantitative Aussagen über das Anreicherungsverhalten beider Nuklide in pathologischen Knochenumbauprozessen sowie in normal speichernden Skelettabschnitten wurden mit Hilfe von Densitometerkurven getroffen. Hierbei wurden die Steilheit des Aktivitätsanstieges, die maximale Kurvenhöhe und die Untergrundaktivität berücksichtigt. Die entsprenchenden, rechnerisch ermittelten Werte der 99mTc-Pyrophosphat- und 85Sr-Szintigramme zeigten signifikante Unterschiede.

A retrospective study of 56 MRT chest examinations showed the left intercostal vein in its horizontal trajectory in 3 patients with left mediastinal masses compressing the superior vena cava. In 2 patients the posterior trajectory of the horizontal segment was clearly visualised. In the third case the anterior part, namely the insertion of the left superior intercostal vein into the left brachiocephalic trunk, was demonstrated.