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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.

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.

To determine the safety and efficacy of bipolar radiofrequency ablation (RFA) in benign thyroid nodules.23 patients with 24 symptomatic benign thyroid nodules (21 regressive, 3 adenomas) ranging in volume from 0.5 to 112 ml (mean ± sd: 18 ± 24.4 ml) underwent bipolar RFA. Pain during the procedure was measured on a 10-point scale. Side-effects revealed by ultrasound or patients' complaints were documented. Periablative efficacy was measured 24 hours after RFA as change (Δ) in serum thyreoglobulin (Tg) and sonographic criteria (echogenity, Doppler blood flow and elasticity) categorized on a 3-point scale (echogenity, Doppler blood flow) or 4-point scale (elasticity). Efficacy in the 3 autonomous adenomas was measured as normalization of (99 m)Tc-pertechnate scintigraphy.Bipolar RFA was well tolerated by all patients with a median pain score of 3 ± 1.5 (range: 1 - 7). Side-effects were hematomas in 4 of 23 patients (17 %). Bipolar RFA resulted in a significant (p 0.01) decrease in echogenity, blood flow, elasticity (Δ = 1 ± 0.28, 1 ± 0.46 and 1 ± 0.85 points, respectively), a median increase in Tg of 403 ± 2568 ng/ml as well as in a normalization of scintigraphy.Bipolar RFA is a safe and effective treatment option for symptomatic benign thyroid nodules.• Bipolar RFA is a safe and effective treatment for benign thyroid nodules.• Ultrasound imaging allows guidance during bipolar radiofrequency ablation.• (99 m)Tc-pertechnetate is able to detect the ablation area of autonomous adenomas. Citation Format: • Korkusuz Y, Erbelding C, Kohlhase K et al. Bipolar Radiofrequency Ablation of Benign Symptomatic Thyroid Nodules: Initial experience with Bipolar Radiofrequency. Fortschr Röntgenstr 2016; 188: 671 - 675.

Zielsetzung. Vorstellung der Wertigkeit der kontrastmittelverstarkten Mehrschicht-Computertomographie (MS-CT) bei der Evaluation abdomineller Neoplasien mit Schwerpunkt primare Lebertumoren, Pankreaskarzinom und kolorektales Karzinom. Material und Methodik. Optimierte Untersuchungsprotokolle fur die Mehrschicht-Computertomographie unter Verwendung oraler und intravenoser Kontrastmittelapplikation werden prasentiert. Ergebnisse. Fur die primaren Lebertumoren wie das hepatozellulare Karzinom und cholangiozellulare Karzinom werden Treffsicherheiten von 82–94% erreicht. Fur das Pankreaskarzinom werden diagnostische Treffsicherheiten erzielt von 85–96%. Fur die Diagnostik des kolorektalen Karzinoms sind die Ergebnisse relevant beim Staging des Primartumors, der Lymphknotenmetastasierung sowie weiterer Organmetastasen in Leber und Lunge. Die Ergebnisse erreichen dabei die Werte von 86–92% fur die Sensitivitat, Spezifitat und diagnostische Genauigkeit. Schlussfolgerung. Die kontrastmittelverstarkte Mehrschicht-Computertomographie (MS-CT) stellt eine schnelle und verlassliche Untersuchungsmodalitat zur Detektion und zum Staging abdomineller Neoplasien dar im Hinblick auf die vorgestellten Schwerpunkte Oberbauch und kolorektales Karzinom.

control. Purpose: The aim of this study was to demonstrate the possibilities of a hybrid rendering method, the combination of a color-coded surface and volume rendering method, with the feasibility of performing surface-based virtual endoscopy with different representation models in the operative and interventional therapy control of the chest. Material and Method: In 6 consecutive patients with partial lung resection (n=2) and lung transplantation (n=4) a thin-section spiral computed tomography of the chest was performed. The tracheobronchial system and the introduced metallic stents were visualized using a color-coded surface rendering method. The remaining thoracic structures were visualized using a volume rendering method. For virtual bronchoscopy, the tracheobronchial system was visualized using a triangle surface model, a shaded-surface model and a transparent shaded-surface model. Results: The hybrid 3D visualization uses the advantages of both the color-coded surface and volume rendering methods and facilitates a clear representation of the tracheobronchial system and the complex topographical relationship of morphological and pathological changes without loss of diagnostic information. Performing virtual bronchoscopy with the transparent shaded-surface model facilitates a reasonable to optimal, simultaneous visualization and assessment of the surface structure of the tracheobronchial system and the surrounding mediastinal structures and lesions. Conclusions: Hybrid rendering relieve the morphological assessment of anatomical and pathological changes without the need for time-consuming detailed analysis and presentation of source images. Performing virtual bronchoscopy with a transparent shaded-surface model offers a promising alternative to flexible fiberoptic bronchoscopy.

Purpose: The aim of this study was to demonstrate on a complex anatomical structure the possibilities and the advantages of a superimposition of a color-coded surface and volume rendering (hybrid rendering) method with the possibility of the performance of a virtual endoscopy. Material and Method: In 6 patients with cochlear implants a high-resolution spiral computed tomography of the petrous bone was performed. The cochlear implants, the middle and inner ear structures were visualized using a color-coded surface rendering method, either shaded or as a grid. The petrous bone was visualized using a transparent volume rendering method. Results: The hybrid 3D visualization uses the advantages of both the color-coded 3D surface and volume rendering method. In comparison to the axial source images, the hybrid 3D visualization thus facilitates a clearer representation and better assessment of the complex topographical relationship without loss of diagnostic information. The virtual endoscopy facilitates an intraluminal visualization and inspection of all color-coded 3D surface- and volume rendered structures. Conclusions: The hybrid rendering and virtual endoscopy make the morphological assessment of cochlear implants easier by the simultaneous visualization of the surrounding structures and thereby support the diagnostic imaging methods. This image processing method can be used pre-operatively for the individual planning, simulation, training and further development of surgical procedures and interventions and post-operatively for the control of the position and further developments of implants.

Cross-sectional imaging techniques are increasingly being considered as alternative imaging modalities for colorectal screening. While CT-colonography uses air to insufflate the colon, an enema containing small amounts of paramagnetic contrast represents the basis for MR-colonography. Both techniques provide large three-dimensional data sets of the abdomen, containing the entire colon. Using sophisticated post-processing, the colon can be assessed in any desirable plane from various viewpoints. Thus even virtual endoscopic views can be rendered to assess the inside of the colon. This chapter briefly describes the technical aspects underlying both CT- and MR-colonography. Advantages and disadvantages of the two techniques are critically discussed, comparing them with one another as well as with conventional colonoscopy and barium enema.

Es wurde eine Methode zur uberlagerungsfreien Darstellung von Gefasen mittels der CT-Angiographie (CTA) entwickelt und erprobt. Dazu wurde ein automatisierter, sog. „elastischer“ digitaler Subtraktionsalgorithmus entwickelt, der es ermoglicht, einen Spiral-CT-Datensatz ohne Kontrastmittel von einem solchen mit Kontrastmittel artefaktfrei zu subtrahieren. Der „elastische“ Subtraktionsalgorithmus korrigiert stochastische, transmissionsbedingte und durch Bewegung verursachte Inkongruenzen zwischen den beiden zu subtrahierenden Datensatzen und ist somit der einfachen digitalen Subtraktion uberlegen. Bisher wurde die CT-Subtraktionsangiographie (CTSA) an 7 Patienten im Bereich der Hals- und intrakraniellen Gefase erprobt. Der „elastische“ Subtraktionsalgorithmus war bei der Beurteilung von Bildqualitat und -artefakten in allen Fallen und statistisch signifikant besser als die einfache digitale Subtraktion. Die „elastische“ CTSA ermoglicht eine automatisierte Trennung von ossaren Strukturen und Gefasen und erleichtert somit die uberlagerungsfreie, raumliche und selektive Darstellung der Hals- und intrakraniellen Gefase.

In a prospective study 140 couples who had at least three spontaneous abortions (RSA) were studied for the presence of Fc receptor blocking antibodies detected by the erythrocyte antibody rosette inhibition (EAI) assay, for anti-paternal cytotoxic antibodies (APCA), and for mixed lymphocyte culture inhibiting (MLCI) antibodies before and after active immunization with paternal lymphocytes. The comparative analysis revealed the EAI assay to possess a higher sensitivity than the APCA and/or MLCI tests in monitoring the specific immune response after active immunization. The success of pregnancy in EAI positive post-immunization patients was not influenced by the presence or absence of APCA or MLCI. In the light of a successful pregnancy outcome of 85.7% (n = 37) in this study we conclude that the monitoring of Fc receptor blocking antibodies is useful in active immunization protocols for RSA patients.

Mit dem Zellseparator A 201 stand ein neuer Prototyp für Thrombozytapheresen zur Verfügung, der bei diskontinuierlichem Spendefluß eine kontinuierliche Sammlung von plättchenreichem Plasma (PRP) durchführte. Aus dem PRP wurde in einem zweiten Arbeitsschritt mit Hilfe des Plasmazell-CTM-Separators ein Thrombozytenkonzentrat (Tk) und ein gerinnungsaktives Frischplasma (GFP) hergestellt. Das Tk enthielt 2,6 ± 0,7 x 1011 Thrombozyten mit einer Leukozytenkontamination von 3,9 ± 3,9 × 108 und einer Erythrozytenverunreinigung von 3,0 ± 3,0 × 108. Das GFP war nahezu zellfrei. Zur Beurteilung der Biokompatibilität untersuchten wir Hämolyse- und Gerinnungsparameter vor, während und nach der Apherese. Es fand sich kein Anhalt für eine Hämolyse, doch die Analyse der Gerinnungs-faktoren und des Thrombin-Antithrombin III-Komplexes (TAT) ergab Hinweise auf eine Gerinnungsaktivierung.

In order to remove the EAI "blocking" activity, EA inhibition positive sera from patients with recurrent abortions were absorbed after alloimmunization with paternal lymphocytes by the lymphoblastoid cell line (LCL) of the husband. To avoid non-specific binding via the Fc-receptor, the cells were first fixed with 0.05% glutaraldehyde. Absorption was performed for 3 h at 4 degrees C. For subsequent elution, the cells were incubated with 0.1 M glycine-HCl, pH 2.3, for 30 min at 4 degrees C. After each step, EAI assay was carried out to determine the "blocking" activity in the supernatants. Furthermore, 10% SDS-PAGE and immunoblotting with goat antihuman IgG of the whole serum and the supernatants were performed. The results obtained give evidence that the EAI "blocking" activity can be absorbed by and eluted from the LCL of the immunizing husband, and is due to an IgG antibody directed against an antigen present on the LCL. Further absorption experiments with trophoblast cells will show whether this antigen is also displayed by the trophoblast.

For staging, follow-up and even screening (www.screening.info) an "all-in-one" imaging examination is desirable. In the concept of whole body MRI, lung imaging prevails as the weakest link. The purpose of our study was to determine the optimal MRI sequences for the detection of malignant lung nodules.On the basis of 6 lung cancer, 46 metastases and one tuberculoma in 13 patients eight MRI sequences--HASTE, IR-HASTE, fat saturated TrueFISP, STIR, VIBEipat = 2, and contrast-enhanced (CE) VIBE (with ipat = 2, 0, 4) performed with parallel imaging and 12 matrix coil elements--were compared in terms of contrast-to-noise ratio (CNR) and quality in the visualization of the lung nodules using multidetector CT as standard of reference. The parameters of the sequences were pragmatically selected to minimize the imaging time to allow for imaging the entire lung within one breathold interval.The STIR sequence was found to be the best for detecting malignant lung nodules (p0.01) followed by the FS TrueFISP, CE VIBE subsetipat = 0, CE VIBE subsetipat = 2, IR-HASTE, HASTE, CE VIBE subsetipat = 4, and VIBE. The STIR sequence visualized malignant nodules down to 2 mm in size and did not display the 19 mm tuberculoma.The STIR sequence should be included in future studies investigating if MRI can compete with CT in the early identification (detection and classification) of malignant lung nodules.

With the introduction of multislice CT extensive volumetric data sets can be quickly acquired in high spatial resolution. The high spatial resolution reduces partial volume effects and enables multiplanar reconstructions. Regarding the colorectum this means that the colon can be assessed if the colon is sufficiently cleaned and distended, and that transmural infiltration of colorectal carcinoma and liver metastases can be better detected. T-staging of colon cancer is less important than T-staging of rectal cancer. Based on the higher contrast MRI is superior to CT in T-staging of rectal cancer and in the differentiation between scarring tissue and recurrence of carcinoma.

Cancer screening is currently offered for the organs breast, prostate, cervix and colorectum. With progressing technique in computerized tomography (CT) and magnetic resonance imaging (MRI) the colorectum can be increasingly better assessed. Because in CT and MRI also other organs are imaged with the colorectum, a colorectal screening automatically becomes a multiorgan screening. CT and MRI protocols designed for early detection of colorectal tumors are presented and discussed with regard to monoorganscreening (in CT: low dose, no i.v. contrast) and multiorganscreening (in CT: diagnostic dose for neighboured organs with i.v. contrast). More information under http://www.multiorganscreening.org.

Presentation and evaluation of diagnostic procedures for the follow-up in patients with suspected local recurrence of rectal cancer.Follow-up usually is performed using endoscopy and endosonography. Imaging techniques applied are also contrast enema as well as helical CT,MR imaging (MRI), and positron emission tomography (PET).The results demonstrate the difficulty of all available modalities to differentiate between early tumor recurrences from post-therapeutic alterations. Especially the differentiation of scar tissue and local tumor recurrence, the detection of lymph node as well as pulmonary or hepatic metastasis requires a large diagnostic effort with employment of various imaging modalities. Values determined for sensitivity and specificity for CT are 84% and 91% with a positive predictive value (PPV) of 78%. For MRI and PET the sensitivity are 94% and 98%,and the specificity 92% and 90% with a PPV of 93% for the PET.The results demonstrate the increasing importance of CT and MRI in the follow-up of patients with rectal cancer and enable an accurate and early diagnosis through employment of new examination strategies and sequence protocols.PET remains an add-on examination in uncertain local lesions.

Demonstration of clinical value of contrast-enhanced multislice CT (MS-CT) for evaluating abdominal neoplasias with focus on primary liver tumors, pancreatic carcinoma and colorectal carcinoma.Optimized examination protocols for multislice CT are presented using oral and intravenous application of contrast agent.For primary liver tumors like hepatocellular carcinoma and cholangiocellular carcinoma diagnostic accuracies are achieved from 82 to 94% and for pancreatic carcinomas from 85 to 96%. For diagnosis of colorectal carcinoma results are relevant for staging of primary tumor, lymph node metastases and further metastases in liver and lung. The results achieve values from 86 to 92% for sensitivity, specificity and diagnostic accuracy.Contrast-enhanced multislice CT proves to be a quick and reliable examination technique for detection and staging of abdominal neoplasms with a focus on the epigastric region and colorectal carcinoma.

With further improvements in multislice CT, enabling now the combination of lung and colon imaging within one breathhold with automated dose optimization, MR colonography has almost been given up. But similar to angiography, we are optimistic that MR can be compatible to CT in colonography and report in this article on the current status and perspective of MR colonography. For more information see www.multiorganscreening.org.

The aim of this study was to demonstrate the possibilities of a hybrid rendering method, the combination of a color-coded surface and volume rendering method, with the feasibility of performing surface-based virtual endoscopy with different representation models in the operative and interventional therapy control of the chest.In 6 consecutive patients with partial lung resection (n = 2) and lung transplantation (n = 4) a thin-section spiral computed tomography of the chest was performed. The tracheobronchial system and the introduced metallic stents were visualized using a color-coded surface rendering method. The remaining thoracic structures were visualized using a volume rendering method. For virtual bronchoscopy, the tracheobronchial system was visualized using a triangle surface model, a shaded-surface model and a transparent shaded-surface model.The hybrid 3D visualization uses the advantages of both the color-coded surface and volume rendering methods and facilitates a clear representation of the tracheobronchial system and the complex topographical relationship of morphological and pathological changes without loss of diagnostic information. Performing virtual bronchoscopy with the transparent shaded-surface model facilitates a reasonable to optimal, simultaneous visualization and assessment of the surface structure of the tracheobronchial system and the surrounding mediastinal structures and lesions.Hybrid rendering relieve the morphological assessment of anatomical and pathological changes without the need for time-consuming detailed analysis and presentation of source images. Performing virtual bronchoscopy with a transparent shaded-surface model offers a promising alternative to flexible fiberoptic bronchoscopy.

Thin-section spiral computed tomography was used to acquire the volume data sets of the thorax. The tracheobronchial system and pathological changes of the chest were visualized using a color-coded surface rendering method. The structures of interest were then superimposed on a volume rendering of the other thoracic structures, thus producing a hybrid rendering. The hybrid rendering technique exploit the advantages of both rendering methods and enable virtual bronchoscopic examinations using different representation models. Virtual bronchoscopic examinations with a transparent color-coded shaded-surface model enables the simultaneous visualization of both the airways and the adjacent structures behind of the tracheobronchial wall and therefore, offers a practical alternative to fiberoptic bronchoscopy. Hybrid rendering and virtual endoscopy obviate the need for time consuming detailed analysis and presentation of axial source images.

The aim of this study was to demonstrate on a complex anatomical structure the possibilities and the advantages of a superimposition of a color-coded surface and volume rendering (hybrid rendering) method with the possibility of the performance of a virtual endoscopy.In 6 patients with cochlear implants a high-resolution spiral computed tomography of the petrous bone was performed. The cochlear implants, the middle and inner ear structures were visualized using a color-coded surface rendering method, either shaded or as a grid. The petrous bone was visualized using a transparent volume rendering method.The hybrid 3D visualization uses the advantages of both the color-coded 3D surface and volume rendering method. In comparison to the axial source images, the hybrid 3D visualization thus facilitates a clearer representation and better assessment of the complex topographical relationship without loss of diagnostic information. The virtual endoscopy facilitates an intraluminal visualization and inspection of all color-coded 3D surface- and volume rendered structures.The hybrid rendering and virtual endoscopy make the morphological assessment of cochlear implants easier by the simultaneous visualization of the surrounding structures and thereby support the diagnostic imaging methods. This image processing method can be used pre-operatively for the individual planning, simulation, training and further development of surgical procedures and interventions and post-operatively for the control of the position and further developments of implants.

Filling the colon lumen with contrast allows for 3D-MR-colonography. The 3D data set can be postprocessed to multiplanar reconstruction, surface shaded displays as well as virtual colonoscopy. The latter facilitates the differentiation between haustra and polyps and enables detection of polyps down to 6 mm in size. Multiplanar reconstructions provide the assessment of the inner wall contour. The morphology of the colonic wall itself can be assessed on T1- or T2-weighted images. T1-weighted sequences performed before and after i.v. contrast administration and T2-weighted sequences depict pathologies based on their contrast uptake respectively on their tissue water content. This concept of colonic imaging practicable in less than 15 minutes is useful for the assessment of inflammatory disease, for polyp detection as well as for tumour staging.

Background: To evaluate the potential of magnetic resonance colonography (MRC) in detecting colorectal mass lesions. Methods: Twenty patients underwent MR imaging (MRI) before colonoscopy. The colon was filled with a gadolinium (0.5 mol):water mixture (1:100) under MRI control, and patients were imaged while breath-holding imaged with a three-dimensional spoiled gradient echo sequence in the prone and supine positions. Images were interactively analyzed based on the combination of multiplanar reconstruction and virtual colonoscopy by a radiologist blinded to colonoscopic findings and the patient's history. MRC interpretations were correlated with colonoscopic results. Results: Polyps smaller than 5 mm could not be identified with MRC. The sensitivity for detecting polyps of 5–10 mm was 70%, whereas mass lesions larger than 10 mm were all detected (sensitivity = 100). The sensitivity, specificity, and accuracy for identifying polyp-positive patients including the three patients with small (

The purpose of this study was to develop a shaded-surface and volume display (hybrid rendering method) of the whole vascular system of the cervico-cranial arteries using spiral computed tomography (SCT).We examined 12 patients with anatomic abnormalities and pathological conditions of the arterial vascular system. The cervico-cranial arteries were segmented using an interactive threshold interval density volume-growing method and visualized with a color-coded shaded-surface display (SSD) rendering method. The adjacent bone structures were visualized using a transparent volume rendering method.In all cases, the entire volume of the vascular system of the cervico-cranial arteries and the anatomic abnormalities and pathological conditions could be visualized.Hybrid rendering of the circulation of the cervico-cranial arteries using image data sets from a subsecond spiral CT scanner is useful for the visualization of anatomical and pathological abnormalities and offer a promising minimally invasive alternative compared with other diagnostic procedures.

To develop and implement a method to obtain digital subtraction (DS) spiral computed tomography angiograms (SCTA) in order to avoid superimposition of bony structures and vascular calcifications on SCTA maximum intensity projections (MIPs) and shaded surface display (SSD).Two SCTA data sets, one before and one during the injection of a contrast agent bolus, were obtained with identical scan parameters. Since ordinary subtraction of the two data sets fails to reliably separate bones and calcifications from the vascular lumen because of motion, a so-called elastic subtraction procedure was designed to correct 3D misregistration between the two data sets. It automatically accommodates for local position changes between baseline and contrast images, including regionally inconsistent non-linear displacements and arbitrary rotations. This method was tested in seven patients and evaluated against ordinary DS in terms of image quality and artifacts.In all patients "elastic" CTSA proved superior to ordinary DS. It provides automated and reliable separation of vessels from bones and calcifications. This improves the delineation of vessels in the neck and the skull base and of intracranial vessels. DS-SCTA facilitates MIPs and SSD without artifacts introduced by thresholding.Elastic DS-SCTA is a robust method for automated unmasking of vessels from bones and warrants clinical trials and comparison with MR- and conventional angiography.

Magnetic resonance angiography (MRA) using three-dimensional (3D) gradient-echo sequences with ultra-short echotimes (USTE; 2 ms) and luminal enhancement of vessels with a gadolinium bolus affords the depiction of extended vascular territories with high spatial resolution within 20-60 s. Because of the ultra-short echo and repetition times, filling of the vascular lumen with gadolinium is depicted; the latter is relatively independent of the complex flow effects on which conventional MRA is based. MRA typical flow voids caused by turbulence or slow flow are thus significantly reduced and allow more reliable depiction of stenoses. After implementing the sequences on our scanner, we evaluated the potential of USTE-MRA for the delineation of various vascular territories in 56 patients. A total of 70 vascular territories were depicted and evaluated by two independent radiologists for image quality and obscuring the arteries because of the contrast of veins. Out of the 56 (4%) diagnostic angiographic quality could not be obtained in only 2 cases. In 13 patients (23%) the studies were judged suboptimal, but diagnostic. In only 3 cases (5%) was venous filling judged to obscure the arteries completely on MIPs (maximum intensity reconstructions), although the studies were diagnostic when evaluated with MRPs (multiplanar reconstructions). Venous superimposition occurred significantly more frequently in the neck than else-where. The greatest improvement over conventional MRA was obtained in the abdomen and thorax where USTE-MRAs can be obtained within a breath-hold without motional artifact.

In analogy with a recently developed reaction scheme for a channel activated by acetylcholine (ACh; nicotinic), we propose a cyclical reaction scheme which agrees with all data published on the completely desensitizing channel type activated by glutamate (Glu) in crayfish muscle. For very high Glu concentrations, desensitization is mainly from the open state, while at lower Glu concentrations desensitization from the singly Glu liganded closed state contributes significantly. The latter pathway and the high Glu affinity of the desensitized channel states account for complete steady-state desensitization of the channel by low Glu concentrations which can occur without any channel opening.

The cell separator A 201 was a new platelet pheresis prototype designed to carry out a discontinuous apheresis while platelet-rich plasma (PRP) is sampled continuously. After donation, a platelet concentrate (PC) and a fresh frozen plasma was collected from the PRP by the plasma cell-C device. The PC contained 2.6 +/- 0.7 x 10(11) platelets with a leucocyte contamination of 3.9 +/- 3.9 x 10(8) and an erythrocyte contamination of 3.0 +/- 3.0 x 10(8). The fresh frozen plasma was nearly cell-free. Prior, during and after apheresis we analysed hemolysis and coagulation parameters. There was no evidence for hemolysis. The analysis of the coagulation factors and of the Thrombin-Antithrombin III-complex, however, gave a hint of an activation of coagulation.

This report deals with our first experiences in testing the new system A 201 (Baxter Fenwal Division) for plateletpheresis in routine application. The apparatus developed from the well-known plasmapheresis equipment Autopheresis C only requires a single venipuncture and uses two separation devices. The platelet cell device produces a primary platelet concentrate. After the donor's disconnection, the platelet-containing plasma is separated into 400 ml of red cell and leucocyte-free plasma and the platelet concentrate, which is done by a rotating membrane filter of the same instrument. Plateletpheresis was performed on 34 healthy donors (26 male and 8 female), formerly experienced by other apheresis procedures. Different samples were drawn from the donors before, during and after apheresis. In comparison with other apheresis procedures there were no significant differences in the harvested platelets (3 +/- 0.7 x 10(11), but the preparations showed a higher contamination of leucocytes (3.7 +/- 3.7 x 10(8). This means a considerable disadvantage and requires improvement. Yet the advantages of this separator are obvious: Reduction of needed anticoagulation to only 6% of processed blood volume, single needle technique, safety of operation and, due to less size, more mobility.

Cytomegalovirus infections are frequent and often life-threatening in bone marrow transplant recipients. Among 112 of our patients after bone marrow transplantation (BMT), 28 developed clinical symptoms or laboratory test results of CMV infection, and 15 of them died. In our experience blood cell substitution with products from CMV negative blood donors does not completely prevent CMV infections. Other factors like disturbances of immunoreconstitution after BMT are relevant in promoting the development of CMV disease.

About 2 or 3 weeks after transplantation, even ABO-Incompatible bone marrow shows a successful graft. Haemopoiesis is not always free of problems. Suppression of erythropoiesis is caused by persistently incompatible agglutinins. Patient's well-being is limited by longer periods of low levels of haemoglobin concentration. Long-lasting need for transfusions is related to the well-known risk of infections. A procedure to eliminate the residual titers of alloantibodies should be discussed in time with the staff of the transfusion department.

As an alternative technique to density-gradient separation, we studied the preparation of red blood cell (RBC)-depleted marrow mononuclear cells (MNC) by continuous-flow centrifugation (CFC) using the IBM 2997 cell separator in a dog model. Mean recoveries of nucleated and mononuclear cells obtained by this separation technique were 43.1% and 77.7% , respectively, and the mean residual RBC volume was 1.8 mL (1.2% of the RBC volume prior to separation). A mean of 91.4% of marrow progenitor cells were regained in the RBC-depleted fraction. Transplantation of the separated marrow MNC into seven lethally irradiated beagle littermates resulted in complete and durable hematopoietic chimerism. Our results indicate that separation of marrow MNC using an IBM 2997 cell separator is an effective and technically uncomplicated alternative to gradient medium separation.

IgG and IgA heavy chain allotypes were determined in the sera of 483 Caucasian Type 1 diabetes patients and 503 Caucasian healthy controls. There was no significant difference between patients and controls neither on the level of Gm phenotype frequencies nor on the level of Gm three-locus and two-locus haplotype frequencies. A selective IgA deficiency was found in 14 patients (2.9%) but in none of the control individuals (P less than 10(-4].

Twenty-one patients with chronic granulocytic leukaemia underwent marrow transplantation. The donors were human-lymphocyte antigen-identical siblings in 19 cases. In the remaining 2 cases the donor was a parent in one and an identical twin in the other. The preparatory regimen included cyclophosphamide and 8.6 Gy total body irradiation given at either a dose of 0.1 Gy/min or 0.04 Gy/min. Five patients were in the accelerated phase of the disease, one was in remission following blast crisis, and the rest were all in the chronic phase. After chemotherapy and irradiation, all patients received bone marrow transplants. To date, nine patients are still alive, with a median survival of 64 days (range 28-683 days). One patient continued to have leukaemic cells and in another, the leukaemia recurred 18 months following transplantation. Interstitial pneumonitis was the cause of death of eight patients (38%). Graft-versus-host disease occurred in ten patients (47%).

Children, young people and women at the age of possible maternity form the majority of patients operated by extracorporal circulation. A longterm planning of these operations should also have donor in call, who are compatible with the patients' Rh groups and Kell antigens. Having practiced such a selection of donors we succeeded in reducing the formation of immune antibodies. 6 out of 330 patients had antibodies, but 4 had been sensibilized before operation. In the case of the other 2 it would not be excluded that they might have been immunized a long time ago. We emphasize the importance of hemodilution, strict indication of every postoperative therapy with red cells and the autologous transfusion.

Die auch bei Erwachsenen verhaltnismasig seltene abdominale Form der Neurofibromatose v. Recklinghausen kann schon im Kindesalter auftreten. multiple cutane Anomalien wie Cafe-au-lait-Flecken und gestielte oder der Haut aufsitzende Tumoren sind diagnostisch von Bedeutung, auch zur Klarung sog. vegetativer Beschwerden. Grosere Bauchtumoren bei Nf. rufen zunachst lediglich Verdrangungssymptome hervor. Zur histologischen Sicherung der Diagnose ist die Probelaparatomie unbedingt erforderlich. Die totale Excision der Tumoren scheitert oft an deren Ausdehnung und Lokalisation. Um den Patienten nicht zusatzlich zu gefahrden, sind grosere operative Eingriffe nur bei Notfallsitationen angezeigt. Sorgfaltige arztliche Uberwachung aller Kinder mit Verdacht auf sog. Schwachform der Nf. ist besonders bei familiarer Belastung anzuraten, weil es sich oft um Entwicklungsstadien zu Organmanifestationen des Leidens handelt. Das dysontogenetische Geschehen kann bis jetzt therapeutisch nicht entscheidend beeinflust werden. Maligne Entartung der Tumoren, aber auch spontane Regression werden diskutiert.

Der vonProkop und Mitarbeitern bekanntgegebene hypotonische Kochsalztest ist ein fluchtiges Phanomen und weist zu vicle Fehlermoglichkeiten auf. Bei kritischer Prufung dieses Verfahrens mit dem Coombs-Test mus man beim Kochsalz-Test mit etwa 32% falschen Resultaten rechnen. Fur die Routinediagnostik des Rh-faktorenbedingten Morbus hamolyticus neonatorum eignet sich daher dieser hypotonische Kochsalz-Test nicht.

Das Serumferritin korreliert eng mit dem im retikuloendothelialen System gespeicherten Reserveeisen und ist daher ein geeigneter Parameter zur Überwachung des Eisenhaushalts von Blutspendern. Untersucht wurden 284 Personen (171 ♂, 113 ♀) mit einem Spendeabstand von 12 Wochen ohne Eisensubstitution und 59 (20 ♂, 39 ♀) mit einem Spendeabstand von 6 Wochen, die täglich 100 mg Fe 2+ erhielten. Alle Gruppen zeigten bei der radioimmunologischen Bestimmung ein kontinuierliches Absinken des Serumferritins, aber nur bis zur Grenze des prälatenten Eisenmangels. Ein kürzerer Spendeabstand von wenigen Wochen mit Eisengabe wurde von den Frauen signifikant besser toleriert als das längere Spendeintervall ohne Eisensubstitution. Bei den Männern unterschieden sich die Werte nicht signifikant. Bei gesteigertem Bedarf an Blutkonserven oder vor geplanten autologen Transfusionen können die Spendeabstände unter zuverlässiger Eisensubstitution verkürzt werden. Bei Frauen empfiehlt sich generell eine Eisengabe.

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.

Aggressive chemotherapy of acute lymphoblastic leukemia (ALL) in childhood has led to long-term survival and potential cure in more than 50% of the patients. Despite recent advances in the treatment of adult acute leukemia, the majority of these patients die due to recurrence of the disease within 2 years of diagnosis.

The preoperative collection of a patient's blood for later retransfusion during operation is the only way to avoid the risks of immunization and infection by homologous blood. If larger volumes of blood are needed the storage of the red cells by deep freezing techniques (liquid Nitrogen) ist very helpful. To get such a deposit of autologous blood, especially from patients with rare antigens or antibodies against public antigens, depends upon some criterias. The patient must be in sufficiently good condition for undergoing several phlebotomies in shorter intervals than a normal donor. The equipment of freezing and thawing may be more expensive and finally autologous transfusion programmes require more planning and time than ordinary blood donation. Therefore the combination of such a programme with preservation by freezing will be reserved for certain centres, even in the near future.

Von zahlreichen Autoren ist immer wieder versucht worden, mit Urinuntersuchungen das akute Nierenversagen von anderen Oligo-Anurieformen abzugrenzen [1–5]. Bei prarenaler Oligurie, etwa auf dem Boden einer Hypovolamie, einer Exsikkose oder einer Herzinsuffizienz ist dies moglich [1]. Schwieriger dagegen erweist sich die wichtige Abtrennung des akuten vom chronischen Nierenversagen.