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  • 1
    ISSN: 1439-099X
    Keywords: Key Words: cT4-rectal cancer ; Preoperative radiochemotherapy ; Schlüsselwörter: cT4-Rektumkarzinom ; Präoperative Radiochemotherapie
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Ziel: Bei cT4-Rektumkarzinomen ist die lokale Kontrolle und das Überleben nach alleiniger Operation unbefriedigend, eine primäre R0-Resektion oft nicht möglich. Wir analysierten die Rate an kurativen (R0) Resektionen nach präoperativer Radiochemotherapie, die Toxizität der Radiochemotherapie, die chirurgische Morbidität sowie die lokale Kontrolle und das Fünf-Jahres-Gesamtüberleben nach multimodaler Therapie. Patienten und Methodik: Von Januar 1990 bis Dezember 1998 wurden 31 Patienten mit lokal fortgeschrittenen cT4-Rektumkarzinomen behandelt. Alle Patienten wiesen Tumoren auf, die von umliegenden Organen im Becken nicht abgrenzbar oder klinisch adhärent/fixiert waren. Acht Patienten hatten synchrone Fernmetastasen. Die Gesamtdosis der Radiotherapie (Einzeldosis: 1,8 Gy) betrug 50,4 Gy + Boost von 5,4 bis 9 Gy. 5-FU wurde als 120-stündige Dauerinfusion (1000 mg/m2/d) an den Tagen 1 bis 5 und 29 bis 33 verabreicht. Sechs Wochen nach Radiochemotherapie erfolgte die Reevaluierung der Operabilität. Ergebnisse: Nach präoperativer Radiochemotherapie konnten 29/31 Patienten (94%) in kurativer Intention operiert werden, bei 26/31 Patienten (84%) wurde eine radikale Resektion (R0) des Rektumtumors erreicht, bei drei Patienten verblieb mikroskopisch ein Tumorrest (R1). Eine histologisch komplette Entfernung von Fernmetastasen gelang bei 3/8 Patienten. Die Toxizität der Radiochemotherapie bestand aus Diarrhö (NCI-CTC-Grad 3: 23%), Hauterythem (Grad 3: 16%) und Leukopenie (Grad 3: 10%). Postoperative Komplikationen traten als Anastomoseninsuffizienzen (drei Patienten), Wundinfektionen (zwei Patienten), Fistel, Abszess und Blutung (je ein Patient) auf. Bei einer medianen Nachbeobachtungsdauer von 33 Monaten sind bislang nach R0-Resektion vier Lokalrezidive (19%) aufgetreten, drei Patienten entwickelten neue Fernmetastasen (14%). Die Fünf-Jahres-Überlebensrate betrug für alle Patienten 51%, nach kurativer Operation 68%. Schlussfolgerung: Durch präoperative Radiochemotherapie und nachfolgende Operation kann bei mehr als 80% der Patienten mit initial weit fortgeschrittenen cT4-Rektumtumoren eine R0-Resektion erreicht werden. Die lokale Kontrolle und das Überleben sind für dieses multimodale Regime vielversprechend.
    Notes: Purpose: In cT4-rectal carcinoma disease-free margins often cannot be obtained by primary surgery, and even if total en bloc resection is accomplished, local failure remains high with surgery alone. Herein we report on the curative resectability rate, acute toxicities, surgical complications, local control and 5-year survival rates achieved with a more aggressive multimodality regimen, including preoperative radiochemotherapy. Patients and Methods: Between 1/1990 and 12/1998, a total of 31 patients with cT4-rectal cancer were treated at out institution. All patients presented with tumor contiguous or adherent to adjacent pelvic organs. Eight patients had synchronous distant metastases. A total radiation dose of 50.4 Gy with a small-volume boost of 5.4 to 9 Gy was delivered (single dose: 1.8 Gy). 5-FU was scheduled as a continuous infusion of 1000 mg/m2 per 24 hours on day 1 to 5 and 29 to 33. Six weeks after completion of radiochemotherapy, patients were reassessed for resectability. Results:After preoperative radiochemotherapy, 29/31 patients (94%) underwent surgery with curative intent. Resection of the pelvic tumor with negative margins was achieved in 26/31 patients (84%), 3 patients had microscopic residual pelvic disease. In 3/8 patients with distant spread at presentation a complete resection of metastases was finally accomplished. Toxicity of radiochemotherapy occurred mainly as diarrhea (NCI-CTC Grade 3: 23%), dermatitis (Grade 3: 16%) and leucopenia (Grade 3: 10%). Surgical complications appeared as anastomotic leakage in 3, wound infection in 2, fistula, abscess and hemorrhage in 1 patient, respectively. With a median follow-up of 33 months, local failure after curative resection was observed in 4 patients (19%), 3 patients (14%) developed distant metastases. The 5-year overall survival rate for the entire group of 31 patients was 51%, following curative surgery 68%. Conclusion: A combination of high-dose preoperative radiochemotherapy followed by extended surgery can achieve clear resection margins in more than 80% of patients with locally advanced cT4 rectal tumor. An encouraging trend evolves for this multimodality treatment to improve long-term local control and survival.
    Type of Medium: Electronic Resource
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  • 2
    Electronic Resource
    Electronic Resource
    Springer
    European archives of psychiatry and clinical neuroscience 190 (1953), S. 342-356 
    ISSN: 1433-8491
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Zusammenfassung In weiterer Verfolgung unserer bisherigen Untersuchungen zur Frage der neurologischen Krankheitsbilder bei cervicaler Osteochondrose wird an Hand eines Materials von 500 Fällen eine Reihe klinisch-statistischer Ergebnisse vorgelegt. Sie beschäftigen sich einmal mit der Frage der Altersverteilung und Altersabhängigkeit von Ausprägungs- und Ausdehnungsgrad der cervicalen Osteochondrose in einer Syndrom- und einer Vergleichsgruppe. Als wesentlichstes Resultat ergibt sich die Tatsache, daß die prädilektive Syndromentstehung im 5. Dezennium mit einer diesen Lebensabschnitt charakterisierenden, verstärkten Manifestationsphase osteochondrotischer Umbauvorgänge zusammenfällt. Die pathogenetischen Folgerungen, die hieraus für die Syndromgenese zu ziehen sind, werden eingehend erörtert. Insbesondere wird auf den biologischen Zusammenhang mit lebensphasischen Vitalschwankungen hingewiesen. Ferner wird an Hand von 100 Fällen über die prozentuale Häufigkeit der das cervicale Reizsyndrom repräsentierenden Symptome berichtet. Als neurologische Symptomkomplexe finden sich bestimmt charakterisierbare Formen von Schmerzirradiationen, vegetativ-dysästhetischen Sensationen, sensorischen Krisen und psychischen Veränderungen. Als wesentlicher pathophysiologischer Mechanismus für das Zustandekommen dieses Symptomverbandes, der seinem topischen Prinzip nach alsoberes Körperviertelsyndrom bezeichnet wird, lassen sich Irritationszustände im Bereich des Halssympathicus nachweisen.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1530-0358
    Keywords: Recurrent rectal carcinoma ; Multimodal treatments ; Preoperative radiotherapy ; 5-Fluorouracil
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: This was a pilot study of high-dose preoperative concurrent radiation and chemotherapy before extensive surgery in patients with locally advanced recurrent rectal cancer. Here we report on curative resectability, acute toxicities during chemoradiotherapy, surgical complications, local control, and three-year survival rates achieved with this aggressive multimodal regimen. METHODS: Between 1994 and 1997, 35 previously nonirradiated patients with pelvic recurrence of rectal cancer were entered in the study. All patients presented with tumor contiguous or adherent to adjacent pelvic organs and were not deemed amenable to primary curative surgery. A total radiation dose of 50.4 Gy with a small-volume boost of 5.4 to 9 Gy was delivered in conventional fractionation (single dose, 1.8 Gy). 5-Fluorouracil was scheduled as a continuous infusion of 1,000 mg/m2/day on Days 1 to 5 and 29 to 33. Six weeks after completion of chemoradiotherapy, patients were reassessed for resectability, and radical surgery was attempted whenever feasible. RESULTS: After preoperative chemoradiotherapy 28 of 35 patients (80 percent) underwent resection with curative intent. In 16 of 35 patients (57 percent) extended resection of adjacent organs was performed. Resections with negative margins were achieved in 17 patients (61 percent); 9 patients had microscopic, and 2 patients had gross residual disease. There was no postoperative mortality. Fourteen patients (44 percent) experienced postoperative complications. Toxicity from chemoradiotherapy occurred mainly as diarrhea (National Cancer Institute Common Toxicity Criteria Grade 3; 23 percent), dermatitis (Grade 3; 11 percent), and leucopenia (Grade 3; 11 percent). One patient died of tumortoxic multiple organ failure during chemoradiotherapy. With a median follow-up of 27 months, local re-recurrence after curative resection was observed in only three patients (18 percent); six patients developed distant metastases. Three-year actuarial survival rate was significantly improved after complete resection (82 percent) as compared with noncurative surgery (38 percent;P=0.03). CONCLUSION: A combination of high-dose preoperative chemoradiotherapy followed by extended surgery can achieve clear resection margins in more than 60 percent of patients with recurrent rectal tumor not amenable to primary surgery. An encouraging trend evolved for this multimodal treatment to improve long-term local control and survival rate.
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    New York, NY : Wiley-Blackwell
    Journal für Praktische Chemie/Chemiker-Zeitung 340 (1998), S. 608-612 
    ISSN: 0941-1216
    Keywords: Chemistry ; Organic Chemistry
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Chemistry and Pharmacology
    Notes: The syntheses and the properties of new sulfurligated liquid crystalline sulfones, containing biphenyl units, as well as the influence of lateral nitro groups on their phase behaviour are described. Differential scanning calorimetry, optical polarizing microscopy and X-ray diffraction measurements reveal liquid crystalline properties for most of the synthesized bis(4-alkoxy-biphenyl-3-yl)sulfones (4). The mesomorphic behaviour of these compounds is compared with that of the corresponding nitro compounds 6. The bis(4-alkoxy-6-nitrobiphenyl-3-yl)sulfones (6) are not mesogenic. The results demonstrate that lateral nitro groups introduced into the biphenyl unit, changing the length-breadth relation, depress the thermal stability and lead to the loss of the mesomorphic properties.
    Additional Material: 3 Ill.
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 0947-3440
    Keywords: Liquid crystals ; Carbohydrates ; Amphiphilic fluoro deoxy sugars ; Thioglucosides ; Thiomannosides ; smectic Mesogens ; Chemistry ; Organic Chemistry
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Chemistry and Pharmacology
    Notes: The homologous series of the amphiphilic alkyl 2-deoxy-2-fluoro-1-thio-α-D-glucopyranosides 5a-e and alkyl 2-deoxy-2-fluoro-1-thio-α-D-mannopyranosides 9a-e were prepared from the 2-deoxy-2-fluoro-D-glycosyl fluorides 1 and 6, respectively. Their liquid crystalline properties were investigated by polarising microscopy, DSC measurements, and X-ray measurements. The fluorine-containing thioglycosides 5a-e as well as 9a-e form enantiotropic mesophases of the type smectic A. The effects of F for OH and S for O substitution are discussed with reference to the homologous alkyl-1-thio-α-D-glucopyranosides 10 and alkyl 2-deoxy-2-fluoro-α-D-glucopyranosides 11.
    Additional Material: 3 Ill.
    Type of Medium: Electronic Resource
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  • 6
    Electronic Resource
    Electronic Resource
    Basel : Wiley-Blackwell
    Die Makromolekulare Chemie, Rapid Communications 1 (1980), S. 407-409 
    ISSN: 0173-2803
    Keywords: Chemistry ; Polymer and Materials Science
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Chemistry and Pharmacology , Physics
    Type of Medium: Electronic Resource
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