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Hackl A, Nüsken E, Voggel J, Abo Zed SED, Binz-Lotter J, Unnersjö-Jess D, Müller C, Fink G, Bohl K, Wiesner E, Diefenhardt P, Dafinger C, Chen H, Wohlfarth M, Müller RU, Hackl MJ, Schermer B, Nüsken KD, Weber LT. The effect of mycophenolate mofetil on podocytes in nephrotoxic serum nephritis. Sci Rep 2023; 13:14167. [PMID: 37644089 PMCID: PMC10465485 DOI: 10.1038/s41598-023-41222-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/23/2023] [Indexed: 08/31/2023] Open
Abstract
Mycophenolate mofetil (MMF) is applied in proteinuric kidney diseases, but the exact mechanism of its effect on podocytes is still unknown. Our previous in vitro experiments suggested that MMF can ameliorate podocyte damage via restoration of the Ca2+-actin cytoskeleton axis. The goal of this study was to characterize podocyte biology during MMF treatment in nephrotoxic serum (NTS) nephritis (NTN). NTN was induced in three-week old wild-type mice. On day 3, half of the mice were treated with MMF (100 mg/kgBW/d p.o.) for one week. On day 10, we performed proteomic analysis of glomeruli as well as super-resolution imaging of the slit diaphragm. For multiphoton imaging of Ca2+ concentration ([Ca2+]i), the experimental design was repeated in mice expressing podocyte-specific Ca2+ sensor. MMF ameliorated the proteinuria and crescent formation induced by NTS. We identified significant changes in the abundance of proteins involved in Ca2+ signaling and actin cytoskeleton regulation, which was further confirmed by direct [Ca2+]i imaging in podocytes showing decreased Ca2+ levels after MMF treatment. This was associated with a tendency to restoration of podocyte foot process structure. Here, we provide evidence that MPA has a substantial direct effect on podocytes. MMF contributes to improvement of [Ca2+]i and amelioration of the disorganized actin cytoskeleton in podocytes. These data extend the knowledge of direct effects of immunosuppressants on podocytes that may contribute to a more effective treatment of proteinuric glomerulopathies with the least possible side effects.
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Affiliation(s)
- A Hackl
- Department of Pediatrics, Faculty of Medicine, University Hospital Cologne, University of Cologne, Kerpener Street 62, 50937, Cologne, Germany.
- CECAD, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany.
| | - E Nüsken
- Department of Pediatrics, Faculty of Medicine, University Hospital Cologne, University of Cologne, Kerpener Street 62, 50937, Cologne, Germany
| | - J Voggel
- Department of Pediatrics, Faculty of Medicine, University Hospital Cologne, University of Cologne, Kerpener Street 62, 50937, Cologne, Germany
| | - S E D Abo Zed
- Department of Pediatrics, Faculty of Medicine, University Hospital Cologne, University of Cologne, Kerpener Street 62, 50937, Cologne, Germany
- CECAD, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - J Binz-Lotter
- CECAD, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
- Department 2 of Internal Medicine, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - D Unnersjö-Jess
- CECAD, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
- Department 2 of Internal Medicine, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - C Müller
- Department of Therapeutic Drug Monitoring, Pharmacology at the Laboratory Centre, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - G Fink
- Department of Pediatrics, Faculty of Medicine, University Hospital Cologne, University of Cologne, Kerpener Street 62, 50937, Cologne, Germany
| | - K Bohl
- CECAD, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
- Department 2 of Internal Medicine, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - E Wiesner
- CECAD, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
- Department 2 of Internal Medicine, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - P Diefenhardt
- CECAD, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
- Department 2 of Internal Medicine, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - C Dafinger
- Department of Pediatrics, Faculty of Medicine, University Hospital Cologne, University of Cologne, Kerpener Street 62, 50937, Cologne, Germany
- CECAD, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - H Chen
- CECAD, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
- Department 2 of Internal Medicine, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - M Wohlfarth
- Department of Pediatrics, Faculty of Medicine, University Hospital Cologne, University of Cologne, Kerpener Street 62, 50937, Cologne, Germany
| | - R-U Müller
- CECAD, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
- Department 2 of Internal Medicine, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
- Center for Rare Kidney Diseases Cologne, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - M J Hackl
- CECAD, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
- Department 2 of Internal Medicine, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - B Schermer
- CECAD, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
- Department 2 of Internal Medicine, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - K-D Nüsken
- Department of Pediatrics, Faculty of Medicine, University Hospital Cologne, University of Cologne, Kerpener Street 62, 50937, Cologne, Germany
| | - L T Weber
- Department of Pediatrics, Faculty of Medicine, University Hospital Cologne, University of Cologne, Kerpener Street 62, 50937, Cologne, Germany
- Center for Rare Kidney Diseases Cologne, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
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Hackl A. Monterescu, Daniel & HaimHazan. Twilight nationalism: politics of existence at life's end. xiv, 270 pp., illus., bibliogr. Stanford: Univ. Press, 2018. £19.99 (paper). J R Anthropol Inst 2021. [DOI: 10.1111/1467-9655.13520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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3
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Deconinck E, Vanhee C, Keizers P, Guinot P, Mihailova A, Syversen PV, Li-Ship G, Young S, Blazewicz A, Poplawska M, Al-Sayed JL, Stengelshøj Olsen L, El-Atma O, Leist R, Jönsson KH, Afxentiou M, Barrios MM, Diaz ID, Zemser M, Kozokin A, Hackl A, Portela MJ, Beerbaum N, Bertrand M. The occurrence of non-anatomical therapeutic chemical-international nonproprietary name molecules in suspected illegal or illegally traded health products in Europe: A retrospective and prospective study. Drug Test Anal 2021; 13:833-840. [PMID: 33453144 DOI: 10.1002/dta.3001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/23/2020] [Accepted: 01/12/2021] [Indexed: 11/11/2022]
Abstract
The General European Official Medicines Control Laboratory (OMCL) Network (GEON), co-ordinated by the European Directorate for the Quality of Medicines & HealthCare (EDQM), regularly organises market surveillance studies on specific categories of suspected illegal or illegally traded products. These studies are generally based on a combination of retrospective and prospective data collection over a defined period of time. This paper reports the results of the most recent study in this context with the focus on health products containing non-Anatomical Therapeutic Chemical-International Nonproprietary Name (ATC-INN) molecules. In total 1104 cases were reported by 16 countries for the period between January 2017 and the end of September 2019. The vast majority of these samples (83%) were collected from the illegal market, while only 3% originated from a legal source. For the rest of the samples, categorisation was not possible. Moreover, 69% of all the reported samples were presented as medicines, including sexual performance enhancers, sports performance enhancers, physical performance enhancers and cognitive enhancers or nootropic molecules that act on the central nervous system (CNS). Although the popularity of anabolics, PDE-5 inhibitors and CNS drugs in illegal products has already been reported, the study showed some new trends and challenges. Indeed, 11% of the samples contained molecules of biological origin, that is, research peptides, representing the second most reported category in this study. Furthermore, the study also clearly shows the increasing popularity of Selective Androgen Receptor Modulators and nootropics, two categories that need attention and should be further monitored.
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Affiliation(s)
- Eric Deconinck
- OMCL Falsified Medicines Working Group, GEON Network, EDQM-Council of Europe, Strasbourg, France.,Scientific Direction Chemical and Physical Health Risks, Service of Medicines and Health Products, Sciensano, Brussels, Belgium
| | - Celine Vanhee
- Scientific Direction Chemical and Physical Health Risks, Service of Medicines and Health Products, Sciensano, Brussels, Belgium
| | - Peter Keizers
- OMCL Falsified Medicines Working Group, GEON Network, EDQM-Council of Europe, Strasbourg, France.,Department of Product Composition, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Pauline Guinot
- OMCL Falsified Medicines Working Group, GEON Network, EDQM-Council of Europe, Strasbourg, France.,Laboratory Controls Division, French National Agency for Medicines and Health Products Safety, Vendargues, France
| | - Albena Mihailova
- Laboratory, Division Reliable Supply, Norwegian Medicines Agency, Oslo, Norway
| | - Per Vidar Syversen
- OMCL Falsified Medicines Working Group, GEON Network, EDQM-Council of Europe, Strasbourg, France.,Laboratory, Division Reliable Supply, Norwegian Medicines Agency, Oslo, Norway
| | - Graziella Li-Ship
- OMCL Falsified Medicines Working Group, GEON Network, EDQM-Council of Europe, Strasbourg, France.,Inspections, Enforcement and Standards Division, Medicines and Healthcare Products Regulatory Agency, London, UK
| | - Steven Young
- Inspections, Enforcement and Standards Division, Medicines and Healthcare Products Regulatory Agency, London, UK
| | - Agata Blazewicz
- OMCL Falsified Medicines Working Group, GEON Network, EDQM-Council of Europe, Strasbourg, France.,Falsified Medicines and medical Devices Department, National Medicines Institute, Warsaw, Poland
| | - Magdalena Poplawska
- Falsified Medicines and medical Devices Department, National Medicines Institute, Warsaw, Poland
| | | | - Lone Stengelshøj Olsen
- OMCL Falsified Medicines Working Group, GEON Network, EDQM-Council of Europe, Strasbourg, France.,Medicines Control and Inspection Division, Danish Medicines Agency, Copenhagen, Denmark
| | - Oliver El-Atma
- Medicinal Products, Chemical and Veterinary Investigation Office, Karlsruhe, Germany
| | - Roman Leist
- OMCL Falsified Medicines Working Group, GEON Network, EDQM-Council of Europe, Strasbourg, France.,OMCL, Swissmedic, Swiss Agency for Therapeutic Products, Bern, Switzerland
| | - Karl-Henrik Jönsson
- OMCL Falsified Medicines Working Group, GEON Network, EDQM-Council of Europe, Strasbourg, France.,Laboratory Department, Swedish Medical Products Agency, Uppsala, Sweden
| | - Maria Afxentiou
- OMCL Falsified Medicines Working Group, GEON Network, EDQM-Council of Europe, Strasbourg, France.,Forensic Chemistry and Toxicology Laboratory, State General Laboratory, Nicosia, Cyprus
| | - M Mendoza Barrios
- OMCL Falsified Medicines Working Group, GEON Network, EDQM-Council of Europe, Strasbourg, France.,Chemical and Pharmaceutical Division, Medicines for Human Use Department, Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Madrid, Spain
| | - I Dorronsoro Diaz
- Chemical and Pharmaceutical Division, Medicines for Human Use Department, Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Madrid, Spain
| | - Marina Zemser
- OMCL Falsified Medicines Working Group, GEON Network, EDQM-Council of Europe, Strasbourg, France.,Institute of Standardization and Control of Pharmaceuticals, Ministry of Health Israel, Jerusalem, Israel
| | - Alla Kozokin
- Institute of Standardization and Control of Pharmaceuticals, Ministry of Health Israel, Jerusalem, Israel
| | - Andreas Hackl
- OMCL Falsified Medicines Working Group, GEON Network, EDQM-Council of Europe, Strasbourg, France.,Institute Assessment & Analytics, Analytics of chemical-pharmaceutical Medicinal Products, AGES-Österreichische Agentur für Gesundheit und Ernährungssicherheit GmbH, Wien, Austria
| | - Maria-Jao Portela
- OMCL Falsified Medicines Working Group, GEON Network, EDQM-Council of Europe, Strasbourg, France.,Direção de Comprovação da Qualidade, INFARMED-Autoridade Nacional do Medicamento e Produtos de Saúde, I.P., Lisbon, Portugal
| | - Nico Beerbaum
- Institut für Lebensmittel, Arzneimittel, Tierseuchen und Umwelt, Landeslabor Berlin-Brandenburg, Berlin, Germany
| | - Marie Bertrand
- OMCL Falsified Medicines Working Group, GEON Network, EDQM-Council of Europe, Strasbourg, France
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Hackl A. The good Arab: conditional inclusion and settler colonial citizenship among Palestinian citizens of Israel in Jewish Tel Aviv. J R Anthropol Inst 2020. [DOI: 10.1111/1467-9655.13316] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Andreas Hackl
- School of Social and Political ScienceUniversity of Edinburgh Room 3.20, 18 Buccleuch Place Edinburgh EH8 9LD UK
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Hackl A. Salazar, Noel B. & KiranJayaram (eds). Keywords of mobility: critical engagements. 188 pp., bibliogrs. Oxford, New York: Berghahn Books, 2016. £78.00 (cloth). J R Anthropol Inst 2018. [DOI: 10.1111/1467-9655.12902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Affiliation(s)
- Andreas Hackl
- Social Anthropology; University of Edinburgh; Edinburgh EH8 9LD United Kingdom
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Hackl A. Monterescu, Daniel. 2015. Jaffa shared and shattered: contrived coexistence in Israel/Palestine. Bloomington, IN: Indiana University Press. 384 pp. Pb.: US$32. ISBN: 978-0-253-01677-5. Social Anthropology 2017. [DOI: 10.1111/1469-8676.12376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Pullirsch D, Bellemare J, Hackl A, Trottier YL, Mayrhofer A, Schindl H, Taillon C, Gartner C, Hottowy B, Beck G, Gagnon J. Microbiological contamination in counterfeit and unapproved drugs. BMC Pharmacol Toxicol 2014; 15:34. [PMID: 24965483 PMCID: PMC4088308 DOI: 10.1186/2050-6511-15-34] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 06/19/2014] [Indexed: 11/10/2022] Open
Abstract
Background Counterfeit and unapproved medicines are inherently dangerous and can cause patient injury due to ineffectiveness, chemical or biological contamination, or wrong dosage. Growth of the counterfeit medical market in developed countries is mainly attributable to life-style drugs, which are used in the treatment of non-life-threatening and non-painful conditions, such as slimming pills, cosmetic-related pharmaceuticals, and drugs for sexual enhancement. One of the main tasks of health authorities is to identify the exact active pharmaceutical ingredients (APIs) in confiscated drugs, because wrong API compounds, wrong concentrations, and/or the presence of chemical contaminants are the main risks associated with counterfeit medicines. Serious danger may also arise from microbiological contamination. We therefore performed a market surveillance study focused on the microbial burden in counterfeit and unapproved medicines. Methods Counterfeit and unapproved medicines confiscated in Canada and Austria and controls from the legal market were examined for microbial contaminations according to the US and European pharmacopoeia guidelines. The microbiological load of illegal and legitimate samples was statistically compared with the Wilcoxon rank-sum test. Results Microbial cultivable contaminations in counterfeit and unapproved phosphodiesterase type 5 inhibitors were significantly higher than in products from the legal medicines market (p < 0.0001). Contamination levels exceeding the USP and EP limits were seen in 23% of the tested illegal samples in Canada. Additionally, microbiological contaminations above the pharmacopoeial limits were detected in an anabolic steroid and an herbal medicinal product in Austria (6% of illegal products tested). Conclusions Our results show that counterfeit and unapproved pharmaceuticals are not manufactured under the same hygienic conditions as legitimate products. The microbiological contamination of illegal medicinal products often exceeds USP and EP limits, representing a potential threat to consumer health.
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Affiliation(s)
- Dieter Pullirsch
- AGES - Austrian Agency for Health & Food Safety, Austrian Medicines and Medical Devices Agency, Traisengasse 5, Vienna AT-1200, Austria.
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Hackl A, Vojta M. Hackl and Vojta reply. Phys Rev Lett 2013; 111:139702. [PMID: 24116823 DOI: 10.1103/physrevlett.111.139702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Indexed: 06/02/2023]
Affiliation(s)
- Andreas Hackl
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
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Hackl A, Vojta M. Zeeman-driven Lifshitz transition: a model for the experimentally observed Fermi-surface reconstruction in YbRh2Si2. Phys Rev Lett 2011; 106:137002. [PMID: 21517414 DOI: 10.1103/physrevlett.106.137002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Indexed: 05/30/2023]
Abstract
The heavy-fermion metal YbRh(2)Si(2) displays a field-driven quantum phase transition where signatures of a Fermi-surface reconstruction have been identified, often interpreted as a breakdown of the Kondo effect. We argue that instead many properties of the material can be consistently described by assuming a Zeeman-driven Lifshitz transition of narrow heavy-fermion bands. Using a suitable quasiparticle model, we find a smeared jump in the Hall constant and lines of maxima in susceptibility and specific heat, very similar to experimental data. An intermediate non-Fermi-liquid regime emerges due to the small effective Fermi energy near the transition. Further experiments to discriminate the different scenarios are proposed.
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Affiliation(s)
- Andreas Hackl
- Department of Physics, California Institute of Technology, Pasadena, California 91125, USA
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Krieter DH, Hackl A, Rodriguez A, Chenine L, Moragues HL, Lemke HD, Wanner C, Canaud B. Protein-bound uraemic toxin removal in haemodialysis and post-dilution haemodiafiltration. Nephrol Dial Transplant 2009; 25:212-8. [DOI: 10.1093/ndt/gfp437] [Citation(s) in RCA: 140] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Hackl A, Roosen D, Kehrein S, Hofstetter W. Nonequilibrium spin dynamics in the ferromagnetic Kondo model. Phys Rev Lett 2009; 102:196601. [PMID: 19518982 DOI: 10.1103/physrevlett.102.196601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2009] [Indexed: 05/27/2023]
Abstract
Motivated by recent experiments on molecular quantum dots we investigate the relaxation of pure spin states when coupled to metallic leads. Under suitable conditions these systems are well described by a ferromagnetic Kondo model. Using two recently developed theoretical approaches, the time-dependent numerical renormalization group and an extended flow equation method, we calculate the real-time evolution of a Kondo spin into its partially screened steady state. We obtain exact analytical results which agree well with numerical implementations of both methods. Analytical expressions for the steady state magnetization and the dependence of the long-time relaxation on microscopic parameters are established. We find the long-time relaxation process to be much faster in the regime of anisotropic Kondo couplings. The steady state magnetization is found to deviate significantly from its thermal equilibrium value.
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Affiliation(s)
- Andreas Hackl
- Institut für Theoretische Physik, Universität zu Köln, Zülpicher Strasse 77, 50937 Köln, Germany
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Abstract
We discuss a new analytical approach to real-time evolution in quantum many-body systems. Our approach extends the framework of continuous unitary transformations such that it amounts to a novel solution method for the Heisenberg equations of motion for an operator. It is our purpose to illustrate the accuracy of this approach by studying dissipative quantum systems on all timescales. In particular, we obtain results for non-equilibrium correlation functions for general initial conditions. We illustrate our ideas for the exactly solvable dissipative oscillator and, as a non-trivial model, for the dissipative two-state system.
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Affiliation(s)
- A Hackl
- Institut für Theoretische Physik, Universität zu Köln, Zülpicher Straße 77, 50937 Köln, Germany
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Ziebland G, Hackl A. Begaste Flüssig/Flüssig-Sprühkolonnen. CHEM-ING-TECH 2004. [DOI: 10.1002/cite.330500514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Mayer R, Stranzl H, Prettenhofer U, Quehenberger F, Stücklschweiger G, Winkler P, Hackl A. Palliative treatment of unresectable bile duct tumours. Acta Med Austriaca 2003; 30:10-2. [PMID: 12558559 DOI: 10.1046/j.1563-2571.2003.02049.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE Report on outcome of intraluminal high-dose-rate iridium-192 (HDR-Ir192) brachytherapy with or without external radiotherapy in patients with unresectable bile duct tumours suffering from symptoms of malignant obstructive jaundice. MATERIAL AND METHODS Fourteen patients (mean age: 63 years) who were unsuitable for surgical resection on preoperative evaluation/laparotomy or inoperable due to poor general condition were referred for palliative radiotherapy. After percutaneous transhepatic drainage, HDR-Ir192 brachytherapy was performed with a single dose of 2.5 Gy. Brachytherapy was given twice a day with at least a 6-h interval for 2 days, 2 or 3 days apart, up to a total dose of 10 Gy. Five patients received small-volume external radiotherapy (RT) (45 - 50.4 Gy/1.8 Gy) additionally. RESULTS Palliation with relief of the aggravating symptoms of obstructive jaundice was achieved in all patients. The actuarial 2-year survival rate of all patients was 11.9 % with a median survival of 6.5 months. Patients treated with brachytherapy alone had a median survival of 4.5 months as compared with 6.5 months after combined internal and external irradiation (log rank, P = 0.95). CONCLUSION Patients with advanced unresectable bile duct cancer face a dismal prognosis; however, biliary drainage, and intraluminal brachytherapy with or without external RT, seem to be able to improve quality of life in the remaining time span.
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Affiliation(s)
- Ramona Mayer
- Department of Radiotherapy, Karl-Franzens University, Graz.
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Prettenhofer U, Ramschak-Schwarzer S, Langmann A, Mayer R, Schedlbauer P, Hackl A. [Radiotherapy of endocrine orbitopathy--state of the art]. Acta Med Austriaca 2002; 28:97-8. [PMID: 11593899 DOI: 10.1046/j.1563-2571.2001.01023.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Since several decades, radiotherapy is included in the multimodal treatment concept of Graves' disease. By using orbital irradiation alone or in combination with oral corticosteroids up to two thirds of the patients respond to the treatment and achieve improvement of soft tissue signs and extraocular muscle impairment.
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Affiliation(s)
- U Prettenhofer
- Universitätsklinik für Strahlentherapie, Auenbruggerplatz 32, A-8036 Graz.
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Mayer R, Klemen H, Quehenberger F, Sankin O, Mayer E, Hackl A, Smolle-Juettner FM. Hyperbaric oxygen--an effective tool to treat radiation morbidity in prostate cancer. Radiother Oncol 2001; 61:151-6. [PMID: 11690680 DOI: 10.1016/s0167-8140(01)00430-3] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE We report the results of hyperbaric oxygen therapy (HBO) used in the treatment of radiation cystitis and proctitis following irradiation of prostate cancer. MATERIALS AND METHODS Between June 1995 and March 2000, 18 men (median age 71 years) with radiation proctitis (n=7), cystitis (n=8), and combined proctitis/cystitis (n=3) underwent HBO therapy in a multiplace chamber for a median of 26 sessions (range 2-60). The treatment schedule (2.2-2.4 atmospheres absolute, 60 min bottom time, once-a-day, 7 days a week) was set at a lower limit of 20 sessions; the upper limit was left open to symptom-related adjustment. Prior to HBO treatment, RTOG/EORTC late genitourinal (GU) morbidity was Grade 2 (n=3), Grade 3 (n=6) or Grade 4 (n=2); modified RTOG/EORTC late gastrointestinal (GI) morbidity was either Grade 2 (n=4) or Grade 3 (n=6). RESULTS Sixteen patients underwent an adequate number of sessions. RTOG/EORTC late GU as well as modified GI morbidity scores showed a significant improvement after HBO (GI, P=0.004; GU, P=0.004; exact Wilcoxon signed rank test); bleeding ceased in five out of five patients with proctitis and in six out of eight patients with cystitis; one of those two patients, in whom an ineffective treatment outcome was obtained, went on to have a cystectomy. CONCLUSIONS HBO treatment seems to be an effective tool to treat those patients with late GI and GU morbidity when conventional treatment has led to unsatisfactory results. Particularly in patients with radiation cystitis, HBO should not be delayed too long, as in the case of extensive bladder shrinkage improvement is hard to achieve.
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Affiliation(s)
- R Mayer
- Department of Radiotherapy, University Medical School of Graz, Auenbruggerplatz 32, A-8036 Graz, Austria
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Prettenhofer U, Mayer R, Quehenberger F, Stranzl H, Zurl B, Hackl A. Locally advanced uveal melanoma: primary and postoperative external radiotherapy. Eur J Cancer 2001. [DOI: 10.1016/s0959-8049(01)80786-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Mayer R, Fruhwirth J, Beham A, Groell R, Poschauko J, Hackl A. Radiotherapy as adjunct to surgery for malignant carotid body paragangliomas presenting with lymph node metastases. Strahlenther Onkol 2000; 176:356-60. [PMID: 10987018 DOI: 10.1007/pl00002343] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE Three cases of malignant carotid body paragangliomas with nodal metastases are reported. PATIENTS AND METHODS Between 1985 and 1994, 3 female patients (51 to 65 years of age) were referred for postoperative radiotherapy after complete (2) or incomplete (1) surgical excision of a malignant carotid paraganglioma (Shamblin III). Preoperative angiographic embolization of the tumor-supplying arteries was performed in all cases. In 2 patients resection of the internal carotid artery and reconstruction by saphenous vein graft was necessary. Continuous course radiotherapy of the tumor bed (50 to 56 Gy/2 Gy) and regional lymph nodes (50 Gy) using photon beams was delivered in 2 patients. The third patient having had incomplete resection cancelled radiotherapy after 4 Gy. RESULTS Within an observation time of 110 and 119 months no evidence of recurrence was obtained in both patients irradiated postoperatively. The third patient died of progressive disease. Twelve months after the withdrawn irradiation she presented with a tumor progression into the brain and an ulcerated mass on the right side of the neck and was irradiated consecutively for palliation (Figures 1a to 1f). In none of the patients severe acute or late radiation-induced complications were observed. CONCLUSION In patients with malignant paraganglioma moderate dose postoperative radiotherapy of the tumor bed and regional lymph nodes is well tolerated. It seems to be effective to prolong local control after surgery, to eradicate microscopic lymphatic disease and eventually to postpone further spreading.
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Affiliation(s)
- R Mayer
- Department of Radiotherapy, University Medical School of Graz, Austria.
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Abstract
PURPOSE To determine retrospectively the outcome of postoperative radiation therapy in male breast cancer. Local/distant control was assessed with attention to age, stage, lymph node involvement, histopathological differentiation and hormone receptor status. MATERIALS AND METHODS Thirty-one male patients were irradiated postoperatively at the chest wall (mean dose 50 Gy) and 16 patients received radiation to regional lymph nodes. Tumour distribution by stage was: stage 0 (9.7%), stage I (22.6%), stage II (32.2%) and stage III (35.5%). Nine patients were subjected to additional hormone therapy and three patients to chemotherapy. RESULTS Local control was achieved in 30/31 (96.8%) patients. Kaplan-Meier estimates of overall survival (OS), disease specific (DSS) and disease free survival (DFS) at 5 years were 77% (95% confidence interval (CI), 0.61-0.93), 84% (CI, 0.69-0.98) and 73% (CI, 0.57-0.91), respectively. Five-year DFS for stage 0 + I, II and III was 100, 56.3 and 67.3%, respectively. Favourable results were observed in patients with negative axillary nodes with 5-year OS/DFS of 90.9% (CI, 0.74-1.0). For lymph node positive patients DFS was 71% (CI, 0.4-1.0). Patients who presented lymph node metastases with extracapsular extension the 5-year OS was 80% (CI, 0.45-1.00), but the DFS was 0%. Stage of disease, lymph node involvement and histological differentiation were found to have statistically significant influence on DFS, but not on OS. CONCLUSION Application of postoperative radiotherapy approved in females resulted in one local relapse in our study population. Other treatment modalities (hormone therapy/chemotherapy) should continue to be considered a necessary treatment option for appropriately selected patients.
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Affiliation(s)
- H Stranzl
- Department of Radiotherapy, University Clinic of Radiology, University Medical School of Graz, Austria
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Kapp KS, Kapp DS, Poschauko J, Stücklschweiger GF, Hackl A, Pickel H, Petru E, Winter R. The prognostic significance of peritoneal seeding and size of postsurgical residual in patients with stage III epithelial ovarian cancer treated with surgery, chemotherapy, and high-dose radiotherapy. Gynecol Oncol 1999; 74:400-7. [PMID: 10479500 DOI: 10.1006/gyno.1999.5477] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to retrospectively analyze the prognostic importance of age, histologic type and grade, ascites, lymph node status, size and type of postoperative residual disease, and radiation dose on disease-specific (DSS) and progression-free survival (PFS) in stage III epithelial ovarian cancer patients who had been treated with radical surgery, postoperative chemotherapy, and high-dose radiotherapy. METHODS Consolidation radiotherapy including whole abdominal radiation, pelvic, and upper abdominal boosts was employed in 46 patients who showed no evidence of residual or progressive disease after completion of multiagent chemotherapy. The median follow-up for all patients was 36 months and 103 months for patients at risk. The prognostic impact of pretreatment and treatment parameters on DSS and PFS was tested in univariate and multivariate analyses. RESULTS The 5-year DSS and PFS rates for all patients were 38 and 33%, and for patients with 0-< or =2 cm residual tumor 65 and 61%, respectively. In univariate analysis, initial peritoneal seeding (both: P = 0.02), ascites (P = 0.03; 0.01), size of residual (0-< or =2 cm vs >2 cm), and residual miliary subdiaphragmatic (MDS) and localized peritoneal seeding (LPS) in the upper abdomen (P = 0.0002; 0.0003) were significantly correlated with DSS and PFS. Dose of radiation (< or =30 vs >30 Gy) correlated with DSS only (P = 0.02). In multivariate analysis size of residual disease (0-< or =2 cm vs >2 cm and/or MDS or LPS) remained the only independent prognostic factor for DSS and PFS (both; P = 0. 001). CONCLUSION Patients with localized peritoneal seeding who were rendered free of disease elsewhere had an outcome equally poor as that of patients with gross residuals (>2 cm) in the upper abdomen. If our findings can be confirmed, attempted resection of all localized seeding in patients who are otherwise cytoreducible to no or minimal residual disease may be considered in combination with Taxol-containing regimens as are now being utilized for patients with gross disease.
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Affiliation(s)
- K S Kapp
- Department of Radiology, Karl-Franzens-University Medical School, Auenbruggerplatz 32, Graz, A-8036, Austria.
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Mayer R, Beham-Schmid C, Groell R, Smolle-Juettner FM, Quehenberger F, Stuecklschweiger GF, Prettenhofer U, Stranzl H, Renner H, Hackl A. Radiotherapy for invasive thymoma and thymic carcinoma. Clinicopathological review. Strahlenther Onkol 1999; 175:271-8. [PMID: 10392168 DOI: 10.1007/bf02743578] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE This study reports clinicopathological features and outcome of thymic tumors. Twenty-seven patients with invasive thymoma and 6 patients with thymic carcinoma who had received radiotherapy either primary or postoperatively were analyzed retrospectively. PATIENTS AND METHODS All 33 patients were irradiated with a mean dose of 50 Gy after complete resection (16 patients), partial resection (9 patients) or biopsy (8 patients). Staging was done according to the Masaoka classification; there were 12 Stage II, 12 Stage III and 9 Stage IV patients. RESULTS In patients with invasive thymoma Stage II to IV (median follow-up 54.4 months) Kaplan-Meier estimates of overall survival (OS), disease-specific (DSS) and disease-free survival (DFS) at 5 years were 63.7% (95% confidence interval [CI], 42 to 84%), 88.3% (CI, 75 to 100%) and 77.4% (CI, 58 to 95%), respectively. Among the prognostic factors tested, such as age, myasthenia gravis, completeness of surgery and histologic subclassification, total radiation dose, and Masaoka Stage, the latter was the only significant predictor of improved survival (p = 0.04). Considering local control, radiation dose was a significant prognostic factor (p = 0.0006). In patients with thymic carcinoma (median follow-up 43.4 months) 5-year DSS, and DFS were 22.2% (CI, 0 to 60%) and 16.7% (CI, 0 to 46%), respectively. Thymoma as compared to thymic carcinoma had a statistically significant better DSS (p = 0.007) and DFS (p = 0.0007). CONCLUSION Postoperative radiotherapy with sufficient doses plays an important role as adjuvant treatment in complete or incomplete resected invasive Stage II to III thymoma. In unresectable thymoma Stage III to IV as well as in thymic carcinoma a multimodality approach should be considered to improve survival.
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Affiliation(s)
- R Mayer
- Department of Radiotherapy, University Medical School of Graz, Austria.
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23
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Lahousen M, Haas J, Pickel H, Hackl A, Kurz C, Ogris H, Stummvoll W, Winter R. Chemotherapy versus radiotherapy versus observation for high-risk cervical carcinoma after radical hysterectomy: A randomized, prospective, multicenter trial. Gynecol Oncol 1999; 73:196-201. [PMID: 10329034 DOI: 10.1006/gyno.1999.5343] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Adjuvant treatment modalities after radical hysterectomy have long been used in an attempt to eradicate microscopic tumor residuals in patients at high risk for recurrence. However, it has not been clearly demonstrated that adjuvant radiation, adjuvant chemotherapy, or both improve the outcome. To evaluate the effect of adjuvant treatment in patients with high-risk cervical cancer after radical hysterectomy, the Austrian Gynecologic Oncology Group conducted a prospective, randomized, multicenter clinical trial between 1989 and 1995. MATERIAL AND METHODS Seventy-six patients with stage IB-IIB cervical cancer treated with radical hysterectomy with pelvic lymph node metastases and/or vascular invasion randomly received adjuvant chemotherapy (400 mg/m2 carboplatin, and 30 mg bleomycin), standardized external pelvic radiation therapy, or no further treatment. RESULTS After a median follow-up of 4.1 years (range, 2-7) there were no statistically significant differences (P = 0.9530) in disease-free survival among the three treatment arms. CONCLUSION The data suggest that adjuvant chemotherapy or radiation do not improve survival or recurrence rates in high-risk cervical cancer patients after radical hysterectomy. The most important treatment for these patients seems to be radical abdominal hysterectomy with systematic pelvic lymphadenectomy.
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Affiliation(s)
- M Lahousen
- Department of Gynecology and Obstetrics, University of Graz, Graz, A-8036, Austria
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Pickel H, Lahousen M, Petru E, Stettner H, Hackl A, Kapp K, Winter R. Consolidation radiotherapy after carboplatin-based chemotherapy in radically operated advanced ovarian cancer. Gynecol Oncol 1999; 72:215-9. [PMID: 10021304 DOI: 10.1006/gyno.1998.5184] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate the effect of additional radiotherapy after chemotherapy on the relapse-free and overall survival rates of patients with advanced ovarian cancer. METHODS Between 1985 and 1992 64 patients with radically operated ovarian cancers (4 stage IC, 2 stage II, 54 stage III, and 4 stage IV) were enrolled in a randomized study. Radical surgery comprised total abdominal hysterectomy and bilateral salpingo-oophorectomy, omentectomy, and pelvic and paraaortic lymphadenectomy. All patients received adjuvant chemotherapy with carboplatin IV 400 mg/m2, epirubicin IV 70 mg/m2 on day 1 and prednimustine orally 100 mg/m2 on days 3 to 7 at 1-month intervals. Thirty-two patients without residual disease were randomized to whole abdominal radiation (30 Gy, administered over 4 weeks). An additional 21.6 Gy were delivered to the pelvis and 12 Gy to the paraaortic region up to the diaphragm for total doses of 51.6 and 42 Gy, respectively. Cancer-related survival was calculated with the Kaplan-Meier and Cox proportional hazards methods. RESULTS The relapse-free and overall survival rates of patients who received adjuvant chemoradiotherapy were significantly higher than those of patients who received adjuvant chemotherapy only (68% vs 56% at 2 years and 49% vs 26% at 5 years, P = 0.013, and 87% vs 61% at 2 years and 59% vs 33% at 5 years, P = 0.029). The differences were most pronounced in patients with stage III disease (77% vs 54% at 2 years and 45% vs 19% at 5 years, P = 0. 0061, and 88% vs 58% at 2 years and 59% vs 26% at 5 years, P = 0. 012). Toxicities were acceptable. CONCLUSION Sequential combination of platinum-based chemotherapy with open-field abdominal radiotherapy is a promising adjuvant regimen for patients with advanced ovarian cancer.
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Affiliation(s)
- H Pickel
- Department of Obstetrics & Gynecology, University of Graz, Graz, Auenbruggerplatz 14, A-8036, Austria
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Prettenhofer U, Haas A, Mayer R, Stranzl H, Willfurth P, Guss H, Hackl A. 2226 Progressive growth of subfoveal choroidal neovascularization after radiotherapy in age-related macular degeneration. Int J Radiat Oncol Biol Phys 1999. [DOI: 10.1016/s0360-3016(99)90495-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Königsmaier H, de Pauli-Ferch B, Hackl A, Pendl G. The costs of radiosurgical treatment: comparison between gamma knife and linear accelerator. Acta Neurochir (Wien) 1998; 140:1101-10; discussion 1110-1. [PMID: 9870054 DOI: 10.1007/s007010050223] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Radiosurgical treatment can be carried out by means of a Gamma Knife or a Linear Accelerator. The Linear Accelerator may be either a single-purpose appliance, exclusively employed in radiosurgery, or an adapted appliance, which is used primarily for fractioned radiotherapy, and only additionally for radiosurgical purposes. The first alternative will be referred to briefly as a "dedicated Linac", the latter as an "adapted Linac". Cost accounting data for these alternatives will be discussed under three main categories: investment costs, operating costs, and finally staffing costs. Costs are only considered to the extent that this is necessary to facilitate a comprehensive cost comparison. Factors for which the costs remain the same or at least broadly the same will from the outset not be taken into consideration. These include, for instance, the costs of general or special administration, diagnosis, and image processing. The results and conclusions of this study therefore cannot be employed immediately in the evaluation of cost reimbursement schemes of the type carried out by agencies responsible for social insurance. Here, appropriate complete cost analyses especially for this purpose are required. The final comprehensive cost comparison reveals that the adapted Linac is the most favourable alternative with small annual quantities of patients. With larger numbers of patients the Gamma Knife represents the most favourable from a cost accounting angle. The dedicated Linac accordingly does not have a cost advantage for any of the examined numbers of patients. Clearly the lowest treatment costs per patient can be achieved by employing a Gamma Knife and using it to capacity.
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Affiliation(s)
- H Königsmaier
- Department of Accounting and Auditing, Karl-Franzens University Graz, Austria
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Prettenhofer U, Haas A, Mayer R, Oechs A, Pakisch B, Stranzl H, Willfurth P, Hackl A. [The photon therapy of subfoveal choroidal neovascularization in age-dependent macular degeneration. The results of a prospective study in 40 patients]. Strahlenther Onkol 1998; 174:613-7. [PMID: 9879347 DOI: 10.1007/bf03038508] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM To determine the effect of external beam radiotherapy on subfoveal choroidal neovascularization in age-related macular degeneration. PATIENTS AND METHODS Between September 1995 and July 1996, 40 patients (9 males and 31 females; mean age 74 years, range 61 to 83 years) were included in a prospective study. Eight patients had classic, well-defined neovascularisations, 32 patients had occult lesions. Complete ophthalmic investigations included visual acuity contrast sensitivity as well as fluorescein and indocyanine green angiographic examinations prior to treatment and 1, 3, 6, and 12 months after radiotherapy. External beam radiotherapy (8-MV photons) was delivered with a total dose of 14.4 Gy in 8 fractions of 1.8 Gy per day (Figures 1 and 2). The field size averaged 5.5 x 4.5 cm. RESULTS No treatment related morbidity during or after treatment was obtained. After 6 months follow-up the visual acuity was improved in 2 (5%) patients and maintained at pretreatment level in 17 (42%) patients. However, 12 months post treatment a stable situation was found in 6 (15%) patients and a decrease in visual acuity in 34 (85%) patients (Table 1). The central visual fields deteriorated significantly from 16.5 decibel (dB) to 12.4 dB. The enlargement of exudates and neovascular membranes increased 5- to 7-fold. At 12 months after treatment, 3 (7.5%) patients stated that they had improved vision subjectively, 12 (30%) patients had no change and 25 (62.5%) patients suffered from subjective decrease in visual acuity. CONCLUSIONS Using a total dose of 14.4 Gy/1.8 Gy no difference concerning visual acuity and exudative changes in comparison to the natural history on age-related macular degeneration was obtained after 12 months. However, the results of multicenter studies are to be awaited.
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Affiliation(s)
- U Prettenhofer
- Abteilung für Strahlentherapie, Universitätsklinik für Radiologie, Karl-Franzens-Universität, Graz, Osterreich
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Kapp KS, Stuecklschweiger GF, Kapp DS, Poschauko J, Pickel H, Lahousen M, Hackl A. Prognostic factors in patients with carcinoma of the uterine cervix treated with external beam irradiation and IR-192 high-dose-rate brachytherapy. Int J Radiat Oncol Biol Phys 1998; 42:531-40. [PMID: 9806511 DOI: 10.1016/s0360-3016(98)00255-7] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Prognostic factors in cancer of the cervix for patients treated with external beam irradiation (EBR) and low-dose-rate (LDR) brachytherapy have been characterized. However, despite the increasing use of high-dose-rate (HDR) intracavitary placements (ICP), few studies with adequate follow-up have analyzed prognostic factors. This study investigates pretreatment and treatment factors for their correlation with treatment outcome after EBR and HDR-ICP. METHODS AND MATERIALS Between September 1985 and December 1994, 181 patients with carcinoma of the cervix FIGO stages IB-IV received EBR and HDR brachytherapy. Hemoglobin (Hb) levels were maintained above a level of 11 g/dl during the treatment by transfusion. Patient age ranged from 34 to 84 years (median: 66). The median follow-up time for patients at risk is 69 months (range: 23-140). Pretreatment and treatment parameters analyzed to determine their prognostic value included age, FIGO stage, tumor size, tumor type and grade, pretreatment Hb level, number of HDR-ICP, total dose from HDR-ICP, overall dose to point A, and overall treatment time. Also evaluated was the prognostic value of enlarged lymph nodes noted on pretreatment CAT scan of the abdomen and pelvis. Endpoints studied in uni- and multivariate analyses were disease-specific survival (DSS), freedom from disease (FFD), pelvic control (PC), and probability of distant metastases (DM). RESULTS At 5 years the DSS, FFD, and PC rates for all patients were 60%, 58%, and 67%, respectively. The 5-year FFD by stage was: IB: 94%; II: 63%; IIIB: 43%; and IV: 0%. The PC rates were 94%, 66%, 59%, and 0%, respectively. In univariate analysis the prognostic factors identified for FFD were FIGO stage, tumor size, initial Hb level, and enlarged pelvic and/or paraaortic nodes (all: p < 0.0001). Age was inversely correlated with outcome (p = 0.0081). The 5-year FFD rates for tumors (< 3, > or = 3 < 6, > or = 6 cm) were 97%, 65%, and 24%; patients with initial Hb levels < or = 11g/dl had a FFD of 26% versus 69% for patients with levels > 11g/dl; and those with pelvic and/or paraaortal nodes > or = 1 cm had a survival of 32% versus 68% in patients with negative readings. The same factors were also prognostically significant for DSS, PC, and DM. Patients with persistent disease or pelvic failures had a significantly higher incidence of DM than patients in whom pelvic disease was controlled (p < 0.0001).Histological and treatment parameters including overall treatment time were not of prognostic significance for any of the endpoints studied. In multivariate analysis tumor size was the most powerful parameter for DSS, FFD, PC (p < 0.0001) and DM (p = 0.0001), followed by low initial Hb level (DSS: p = 0.0004, FFD: p = 0.0009, PC: p = 0.0012, DM: p = 0.0265), and enlarged pelvic and/or paraaortic nodes which were predictive for DSS (p = 0.0210) and DM (p = 0.0011). CONCLUSION This study confirms that prognostic factors for patients treated with HDR brachytherapy are similar to those reported in previous series that employed LDR brachytherapy. The significance of tumor size, pretreatment Hb level, and enlarged pelvic and/or paraaortic lymph nodes on CAT scan over FIGO stage of disease were demonstrated. Future prospective trials should be undertaken to confirm the validity of these factors and to elucidate their therapeutic implications.
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Affiliation(s)
- K S Kapp
- Department of Radiology, Karl-Franzens-University Medical School, Graz, Austria.
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Geyer E, Kapp K, Stuecklschweiger G, Gebhart F, Hackl A. 62 Results of external beam radiation and IR-192 HDR implants in patients with anal canal carcinomas. Radiother Oncol 1998. [DOI: 10.1016/s0167-8140(98)80067-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Mayer R, Smolle-Juettner FM, Szolar D, Stuecklschweiger GF, Quehenberger F, Friehs G, Hackl A. Postoperative radiotherapy in radically resected non-small cell lung cancer. Chest 1997; 112:954-9. [PMID: 9377958 DOI: 10.1378/chest.112.4.954] [Citation(s) in RCA: 92] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To evaluate the value of adjuvant postoperative external-beam radiation (EBR) in patients with radically resected non-small cell lung cancer (NSCLC) pT1-3 pN0-2 compared to patients with resected NSCLC without adjuvant EBR. MATERIALS AND METHODS In 155 patients (121 male, 34 female; mean age, 59 years) 105 lobectomies, 12 bilobectomies, and 38 pneumonectomies with radical lymph node dissection of the contralateral [corrected] side were performed. Postoperative staging was done according to the TNM system and was as follows: pT1 (n=38), pT2 (n=89), pT3 (n=28); pN0 (n=39), pN1 (n=67) and pN2 (n=49). Histopathologic study revealed 68 squamous cell carcinomas, 53 adenocarcinomas, 21 large cell carcinomas, 6 adenosquamous cell carcinomas, and 7 bronchioloalveolar cell carcinomas. All patients were randomly assigned into two treatment groups: 72 patients with no further treatment (control group), and 83 patients (EBR group) with adjuvant postoperative EBR of the bronchial stump and mediastinum (50 to 56 Gy, 8 or 23 MV photons, 2 Gy/d, 5 d/wk) beginning 4 to 6 weeks after surgery. RESULTS The overall 5-year survival rate (median observation time, 43 months) of all patients was 24.1% (EBR group, 29.7%; control group, 20.4%; p>0.05, not significant). The relative risk of the EBR group was 0.85 with a two-sided confidence interval of 0.66 to 1.09. The overall 5-year recurrence-free survival was 20.6% (EBR, 27.1%; control group, 15.6%; p=0.07). The relative risk of the EBR group was 0.80 with a confidence interval of 0.63 to 1.01. The rate of local recurrences at the bronchial stump and/or mediastinum was significantly smaller in the EBR group (n=5) than in the control group (n=17) (p<0.01). Multivariate analysis (chi2 test) demonstrated an independent influence of postoperative EBR on the incidence of local recurrences. The incidence of distant metastases was slightly but not significantly higher in patients without EBR (38 patients) compared to those who had EBR (32 patients). CONCLUSION High-dose postoperative EBR to the mediastinum significantly reduces the risk of local recurrence at the bronchial stump and/or mediastinum. Age, sex, histologic subtype, tumor size, surgical approach, or extent of lymph node involvement had no prognostic value--only postoperative EBR had an independent influence on the risk of local recurrence. The effect of postoperative EBR was on the verge of significance with respect to recurrence-free survival and showed the same tendency in overall survival, however with an attenuated relative risk.
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MESH Headings
- Adenocarcinoma/radiotherapy
- Adenocarcinoma/surgery
- Adenocarcinoma, Bronchiolo-Alveolar/radiotherapy
- Adenocarcinoma, Bronchiolo-Alveolar/surgery
- Adult
- Aged
- Carcinoma, Adenosquamous/radiotherapy
- Carcinoma, Adenosquamous/surgery
- Carcinoma, Large Cell/radiotherapy
- Carcinoma, Large Cell/surgery
- Carcinoma, Non-Small-Cell Lung/pathology
- Carcinoma, Non-Small-Cell Lung/radiotherapy
- Carcinoma, Non-Small-Cell Lung/secondary
- Carcinoma, Non-Small-Cell Lung/surgery
- Carcinoma, Squamous Cell/radiotherapy
- Carcinoma, Squamous Cell/surgery
- Confidence Intervals
- Disease-Free Survival
- Dose Fractionation, Radiation
- Evaluation Studies as Topic
- Female
- Humans
- Incidence
- Lung Neoplasms/pathology
- Lung Neoplasms/radiotherapy
- Lung Neoplasms/surgery
- Lymph Node Excision
- Male
- Middle Aged
- Multivariate Analysis
- Neoplasm Recurrence, Local/pathology
- Neoplasm Staging
- Pneumonectomy/methods
- Postoperative Care
- Radiotherapy Dosage
- Radiotherapy, Adjuvant
- Radiotherapy, High-Energy
- Risk Factors
- Survival Rate
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Affiliation(s)
- R Mayer
- Department of Radiotherapy, University Medical School of Graz, Austria
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Mischinger HJ, Hauser H, Cerwenka H, Stücklschweiger G, Geyer E, Schweiger W, Rosanelli G, Kohek PH, Werkgartner G, Hackl A. Endocavitary Ir-192 radiation and laser treatment for palliation of obstructive rectal cancer. Eur J Surg Oncol 1997; 23:428-31. [PMID: 9393572 DOI: 10.1016/s0748-7983(97)93724-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Endoscopic laser therapy (ELT) either alone or combined with endocavitary Ir-192 radiation is performed for advanced, inoperable rectal cancer and when patients are ineligible for surgery due to severe concomitant medical illness. During the period from January 1984 to January 1997 we treated 81 patients (51 males, 30 females). Sixty-seven patients had ELT only using a ND-Yag Laser system. Twenty-five patients (average age: 80.5 years) were ineligible for surgery (Group I). Forty-two patients (74.1 years) had an advanced locally inoperable tumour (Group II). Fourteen patients (76.5 years) underwent a combined therapeutic regime with endocavitary Ir-192 afterloading following ELT (Group III). Adequate desobliteration was achieved in 100% (groups I and III) and 97% (group II) of the patients. The average interval to aftertreatment was 8.4 weeks in group I and 9.4 weeks in group II, compared to 11.5 weeks in group III. Serious complications (perianal abscess, rectovaginal fistula) occurred in 3.7%, minor complications (laser-induced bleedings, unclear fever) in 12.3%. All laser-induced bleedings could be dealt with using laser therapy. The frequency of treatment was governed by tumour mass and the patient's survival. The results suggest that additional endocavitary radiation significantly prolongs the maintenance of normal bowel function compared with laser therapy alone.
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Affiliation(s)
- H J Mischinger
- Department of General Surgery, Karl-Franzens University Medical School, Graz, Austria
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Kapp KS, Stuecklschweiger GF, Kapp DS, Poschauko J, Pickel H, Hackl A. Carcinoma of the cervix: analysis of complications after primary external beam radiation and Ir-192 HDR brachytherapy. Radiother Oncol 1997; 42:143-53. [PMID: 9106923 DOI: 10.1016/s0167-8140(96)01881-6] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND PURPOSE There is still a concern that the use of HDR brachytherapy might result in an increase of late tissue damage. This restrospective study evaluates the incidence and severity of late complications in patients with carcinoma of the cervix who underwent combined external beam radiation (EBR) and Ir-192 HDR brachytherapy and attempts to identify pretreatment and treatment parameters correlating with late complications. MATERIAL AND METHODS Between 1985 and 1992, 161 patients with carcinoma of the cervix (FIGO stages IB-IVB) received EBR to the pelvis (ave, max. dose 48.8 Gy) followed by 1-6 Ir-192 HDR placements (median 2). Doses to point A ranged from 8.5 to 38.7 Gy (median 17 Gy). Parameters examined included age, diabetes, obesity, history of inflammatory bowel disease or diverticulitis, prior surgery, hemoglobin level, FIGO stage, EBR dose, technique and daily dose fraction, number of HDR treatments and total dose to point A, maximum doses to bladder and rectum delivered by brachytherapy and cumulative dose to point A. Median follow-up for all patients was 37 months. Complications were rated using an in-house scoring system and according to the French-Italian Glossary (FIG). RESULTS Actuarial 5-year survival was 93%, 57%, 46%, and 0% for stages IB, II, IIIB, and IV, respectively. Of 161 patients, 11% developed moderate and 3.7% severe sequelae (FIG: 2.5%, 3.7%). Since some patients experienced more than one complication, the overall incidence was 13.6% and 4.9% (FIG: 3.1%, 4.9%) with respective 5-year actuarial rates of 14% and 5% for moderate, and 2% and 8% for severe bowel and genitourinary tract complications (FIG: 3.5%, 0, and 2%, 8%). All severe bowel complications occurred within 1.5 years whereas urinary tract sequelae continued to develop throughout the follow-up period. FIGO stage was associated with a significant increase in late sequelae (P = 0.015). Analysis of the remaining pretreatment and treatment parameters failed to reveal any statistically significant correlation with moderate or severe sequelae. CONCLUSION In our series using HDR brachytherapy, complication and survival rates were comparable with other series employing either LDR or HDR procedures. Of all parameters analysed, stage of disease was the only parameter significantly correlated with complications in univariate and multivariate analysis.
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Affiliation(s)
- K S Kapp
- Division of Radiation Oncology, University Clinic of Diagnostic Radiology, Graz, Austria
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Pakisch B, Stu¨cklschweiger G, Schmidt F, Hausegger K, Leitner H, Poschauko J, Zurl B, Mayer R, Hackl A. 151 Intralumenal fractionated HDR irradiation for the treatment of malignant bile duct obstruction. Radiother Oncol 1996. [DOI: 10.1016/0167-8140(96)87952-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Smolle-Juettner FM, Mayer R, Pinter H, Stuecklschweiger G, Kapp KS, Gabor S, Ratzenhofer B, Hackl A, Friehs G. "Adjuvant" external radiation of the mediastinum in radically resected non-small cell lung cancer. Eur J Cardiothorac Surg 1996; 10:947-50; discussion 951. [PMID: 8971505 DOI: 10.1016/s1010-7940(96)80395-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE The effect of postoperative external beam radiation in MO non-small cell lung cancer resected with curative intention was evaluated in a randomized trial. METHODS In 155 patients (121 males, 34 females; mean age: 59 years) 105 lobectomies, 12 bilobectomies and 38 pneumonectomies with radical lymph node dissection to the contralateral side were carried out. Histology revealed squamous cell (n = 68), adeno- (n = 53), large cell (n = 21), adenosquamous (n = 6) or bronchioloalveolar type (n = 7) carcinomas. The pathologic stages T1 (n = 38), T2 (n = 89), T3 (n = 28); NO (n = 39), N1 (n = 67), and N2 (n = 49) were evenly distributed between the two treatment groups: group A (72 patients) had no further oncologic treatment, while group B (83 patients) had external beam radiation to the mediastinum (50-56 Gy, 8 or 23 MeV photons, 2 Gy/day, 5 days a week) beginning 4 weeks after the operation. RESULTS The overall 5-year survival rate of the whole collective was 24.1% without any significant difference between the radiotherapy group B (29.7%) and the control group A (20.4%) (log-rank test: P > 0.05). The overall 5-year recurrence-free survival rate was 20.1%, with no difference between groups B and A (radiotherapy: 22.7, controls: 15.6%, long-rank test: P > 0.05). There was no difference in the incidence of distant metastases (external beam radiation: n = 32; controls: n = 38). The rate of local recurrences at the bronchial stump or in the mediastinum, however, was significantly reduced in the radiotherapy group (n = 5) compared with 17 in the controls (P < 0.01 chi-square test). A multivariate analysis confirmed the independent influence of postoperative radiotherapy on the incidence of local recurrence. CONCLUSIONS External radiation of the mediastinum in radically resected non-small cell lung cancer reduces the risk of local recurrence, but has no influence on distant metastastic spread and overall survival.
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Stuecklschweiger G, Zurl B, Kapp K, Pakisch B, Geyer E, Hackl A. 662ICRU-50 — Dose-specification — Concept: Our experience in patients with carcinoma of the breast. Radiother Oncol 1996. [DOI: 10.1016/s0167-8140(96)80671-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Pakisch B, Urban C, Lackner H, Leitner H, Stücklschweiger G, Schmidt F, Hackl A. 687Synchronous radio/chemotherapy for children with highly malignant brain tumors. Radiother Oncol 1996. [DOI: 10.1016/s0167-8140(96)80696-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Pakisch B, Stoeger H, Poschauko H, Samonigg H, Bauernhofer T, Pojer E, Leitner H, Stuecklschweiger G, Peichl K, Quehenberger F, Hackl A. Treatment results in males with breast cancer. Eur Radiol 1995. [DOI: 10.1007/bf00171304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pakisch B, Stoeger H, Poschauko H, Samonigg H, Bauernhofer T, Pojer E, Leitner H, Stuecklschweiger G, Peichl KH, Quehenberger F, Hackl A. Treatment results in males with breast cancer. Eur Radiol 1995. [DOI: 10.1007/bf00957114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Burghardt E, Winter R, Tamussino K, Pickel H, Lahousen M, Haas J, Girardi F, Ebner F, Hackl A, Pfister H. Diagnosis and surgical treatment of cervical cancer. Crit Rev Oncol Hematol 1994; 17:181-231. [PMID: 7865138 DOI: 10.1016/1040-8428(94)90054-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- E Burghardt
- Department of Obstetrics and Gynecology, University of Graz, Austria
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Mályusz M, Hackl A, Wrigge P, Lange M, Mályusz T, Sick H, Gronow G. Ammonia production from hippurate by the rat kidney in vitro. Ren Physiol Biochem 1994; 17:307-15. [PMID: 7533310 DOI: 10.1159/000173863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Hippurate is known to be synthesized from benzoate and glycine in the liver and kidney. It takes part in renal ammoniagenesis by modulating the activity of gamma-glutamyl transpeptidase (gamma GT). Due to its chemical structure, however, hippurate might also serve as a substrate of renal ammoniagenesis. Hippurate may yield ammonia either having been cleaved by hippuricase or by Erlenmeyer's reaction after condensation with an aldehyde. In order to elucidate the possibility of hippurate being a substrate of renal ammoniagenesis, experiments were carried out on cortical kidney slices and on isolated tubular segments of the rat. The incubation medium (pH 7.1) was enriched with 10 mmol/l hippurate spiked with 15N-hippurate, some of the known competitive inhibitors of hippuricase, acivicin and different aldehydes. Factors known to affect hippuricase or gamma GT did not interfere with renal ammonia production. Glyceraldehyde (up to 1.0 mmol/l) but not glycerate had a stimulating effect, especially on the ammoniagenesis from hippurate. In normal rats fed a vegetarian diet, 1% of the added 15N moiety was found to be 15NH3. Renal 15NH3 production was significantly greater if, prior to the experiments, the animals were either acidotic or had a reduced renal mass or were fed animal proteins. These results indicate that hippurate may, to a certain extent, serve as substrate for ammoniagenesis.
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Affiliation(s)
- M Mályusz
- Department of Physiology, University of Kiel, Germany
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Hammer J, Track C, Pakisch B, Seewald D, Zoidl J, Leitner H, Labeck W, Hackl A. 77 The impact of the boost type (E−, IR-192 HDR) on the cosmetic result in conservative breast cancer treatment. Radiother Oncol 1994. [DOI: 10.1016/0167-8140(94)91175-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Leitner H, Pakisch B, Stücklschweiger G, Siegl T, Hackl A. 24 Brachytherapy treatment plan optimization using chebyshev analysis. Radiother Oncol 1994. [DOI: 10.1016/0167-8140(94)91122-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Stuecklschweiger G, Leitner H, Poier E, Zurl B, Pakisch B, Hackl A. 15 A quality assurance program for HDR-remote afterloading systems. Radiother Oncol 1994. [DOI: 10.1016/0167-8140(94)91113-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pakisch B, Leitner H, Kohek P, Poier E, Stückschweiger G, Poschauko J, Hammer J, Hackl A. 91 Extrapolated response doses in combined HDR brachytherapy and external beam irradiation in esophageal cancer treatment. Radiother Oncol 1994. [DOI: 10.1016/0167-8140(94)91189-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hackl A. The challenge of waste : Strategies for waste reduction and waste management in chemical industry Vienna, Austria, September 23-25, 1993. Environ Sci Pollut Res Int 1994; 1:127. [PMID: 24234221 DOI: 10.1007/bf02986526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- A Hackl
- Technical University of Vienna, Austria
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Smolle-Juettner FM, Geyer E, Kapp KS, Ratzenhofer B, Stuecklschweiger G, Kaufmann NB, Smolle J, Pongratz GM, Hackl A, Friehs G. Evaluating intraoperative radiation therapy (IORT) and external beam radiation therapy (EBRT) in non-small cell lung cancer (NSCLC). Five years experience. Eur J Cardiothorac Surg 1994; 8:511-6. [PMID: 7826646 DOI: 10.1016/1010-7940(94)90067-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
A pilot study on intraoperative radiation therapy (IORT) combined with external beam radiation therapy (EBRT) in nonresectable non-small cell lung cancer (NSCLC) was performed in 31 patients (mean age: 66.2 years, range: 51-80; 10 anatomically and functionally, 21 functionally, nonresectable; 20 squamous-cell, 11 adenocarcinoma). The tumor was exposed by lateral thoracotomy and a staging lymph node dissection was performed (final staging 7 T1, 16 T2, 8 T3; 11 nodal positive). Ten to 20 Gy IORT (energy: 7-20 MeV electrons) were delivered to the tumor. Unilateral continuous positive airway pressure ventilation of the diseased lung was used to reduce the amount of healthy lung tissue in the IORT port and to minimize the ventilatory movement. Secondary collimation and direct shielding of radio-sensitive structures within the IORT port by aluminium sheets were used to further reduce collateral damage. Four weeks after IORT, 46 Gy EBRT (2 Gy/day 5 times a week; 8-23 MeV photons) were administered to the mediastinum and to the tumor-bearing area on an outpatient basis. In nodal positive cases the mediastinal dose was increased to 56 Gy. Twenty-three patients were evaluable. In 13 complete, in 8 partial (50-97% regression) and in 2 minor response has been achieved. Five patients experienced a recurrence (local only: 2; local and distant: 1; distant only: 2). Twelve patients died of underlying cardio-respiratory disorders within 6 to 25 months after IORT; 7 died of cancer. The overall 5-year survival rate including the incidental deaths is 14.7%. The recurrence-free survival rate is 53.2%.
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Affiliation(s)
- F M Smolle-Juettner
- Department Thoracic and Hyperbaric Surgery, University Medical School, Graz, Austria
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Pakisch B, Kohek P, Poier E, Stücklschweiger G, Poschauko J, Raith J, Quehenberger F, Mayer R, Hackl A. Iridium-192 high dose rate brachytherapy combined with external beam irradiation in non-resectable oesophageal cancer. Clin Oncol (R Coll Radiol) 1993; 5:154-8. [PMID: 7688549 DOI: 10.1016/s0936-6555(05)80314-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Forty-eight patients with non-resectable cancer of the oesophagus and oesophagogastric junction (group A: Stage I/II: n = 32; group B: Stage III/IV: n = 16) underwent intralumenal iridium-192 high dose-rate afterloading brachytherapy (5-7 Gy/session, total dose 5-21 Gy, mean 12.4 Gy) and external beam irradiation (Karnofsky > or = 80%: 50-60 Gy/2 Gy per day; Karnofsky 60%-79%: 30 Gy/3 per day). Prolonged satisfactory palliation (intake of at least semi-solid food) was demonstrated in 96% of patients. The mean survival for group A was 19.1 months and that for group B 6.9 months, with a 12-month survival rate of 66% for group A and 0% for group B (P < 0.001). Local tumour response and complication rate were significantly dose related with a predicted response rate of 70.5% and a complication rate of 50% at extrapolated response dose (ERD) 129.3 GY3 (Gy at alpha/beta = 3).
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Affiliation(s)
- B Pakisch
- Department of Radiotherapy, University of Graz, Austria
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Hackl A. Einf�hrung in den Themenkreis ?Abluftreinigung? CHEM-ING-TECH 1992. [DOI: 10.1002/cite.3306409115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Hackl A, Vitovec W. Bilanzierung von N2O-Emissionen aus pyrogenen Quellen. CHEM-ING-TECH 1992. [DOI: 10.1002/cite.3306409122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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