NOTE The report of the Committee without its annexes appears as Official Records of the General Assembly, Sixty-third Session, Supplement No. 46. The designations employed and the presentation of material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the United Nations concerning the legal status of any country, territory, city or area, or of its authorities, or concerning the delimitation of its frontiers or boundaries. The country names used in this document are, in most cases, those that were in use at the time the data were collected or the text prepared. In other cases, however, the names have been updated, where this was possible and appropriate, to reflect political changes. Scientific Annexes Annex A. Medical radiation exposures Annex B. Exposures of the public and workers from various sources of radiation INTROdUCTION 1. In the course of the research and development for and the application of atomic energy and nuclear technologies, a number of radiation accidents have occurred. Some of these accidents have resulted in significant health effects and occasionally in fatal outcomes. The application of technologies that make use of radiation is increasingly widespread around the world. Millions of people have occupations related to the use of radiation, and hundreds of millions of individuals benefit from these uses. Facilities using intense radiation sources for energy production and for purposes such as radiotherapy, sterilization of products, preservation of foodstuffs and gamma radiography require special care in the design and operation of equipment to avoid radiation injury to workers or to the public. Experience has shown that such technology is generally used safely, but on occasion controls have been circumvented and serious radiation accidents have ensued. 2. Reviews of radiation exposures from accidents have been presented in previous UNSCEAR reports. The last report containing an exclusive chapter on exposures from accidents was the UNSCEAR 1993 Report [U6]. 3. This annex is aimed at providing a sound basis for conclusions regarding the number of significant radiation accidents that have occurred, the corresponding levels of radiation exposures and numbers of deaths and injuries, and the general trends for various practices. Its conclusions are to be seen in the context of the Committee's overall evaluations of the levels and effects of exposure to ionizing radiation. 4. The Committee's evaluations of public, occupational and medical diagnostic exposures are mostly concerned with chronic exposures of …

sources and effects of ionizing radiation

BACKGROUND

Regional chemotherapy of isolated, nonresectable colorectal liver metastases (CRLMs) by hepatic artery infusion (HAI) has the advantages of high response rates and the possibility of downstaging and resection of CRLMs. 5-Fluorodeoxyuridine (5-FUDR) has been the drug studied in most Phase II and III trials. The meta-analysis of the Phase III trials comparing HAI with systemic or supportive therapy confirmed an advantage for response and even survival for HAI. Hepatic artery infusion with 5-FUDR, however, is hepatotoxic, inducing sclerosing cholangitis (SC). The authors have introduced 5-fluorouracil (5-FU) with folinic acid for HAI and found equal effectivity but no SC when compared with HAI with 5-FUDR. Now, they report a new combination chemotherapy protocol based on HAI with 5-FU with FA and on in vitro Phase II studies suggesting mitoxantrone and mitomycin C as active drugs for HAI in CRLM.



PATIENTS AND METHODS

Between February 1993 and August 2000, 63 patients with CRLM were treated with HAI using mitoxantrone, 5-FU with FA, and mitomycin C (MFFM) via port catheters with a protocol planing up to 11 cycles of treatment. Toxicity and response were analyzed according to World Health Organization (WHO) criteria, and survival was analyzed according to Kaplan–Meier. All patients were treated with more than two HAI cycles.



RESULTS

The objective response rate (complete remission and partial remission) was 54% and primary intrahepatic progression (progressive disease) occurred in 4.8%, whereas in 41.3% of the patients the intrahepatic disease was evaluated as no change. Median survival times from the first diagnosis of CRLM or start of HAI were 25.7 months and 23.7 months, respectively, and 7 patients lived longer than 40 months. Grade 3 toxicity according to WHO occurred in 34.9%, and Grade 4 occurred in 3.2%. No toxic death or SC occurred.



CONCLUSIONS

Our new HAI protocol with MFFM seems to be superior to HAI with 5-FUDR, 5-FU with FA, and systemic chemotherapy with 5-FU and FA at acceptable toxicity. Currently, HAI with MFFM is compared with systemic chemotherapy using 5-FU and FA intravenously in a randomized Phase III trial. Cancer 2001;92:2746–53. © 2001 American Cancer Society.

Regional chemotherapy of nonresectable colorectal liver metastases with mitoxantrone, 5-fluorouracil, folinic acid, and mitomycin C may prolong survival.

The theoretical pharmacologic benefit of regional vs. systemic chemotherapy is defined and the concentration response behavior of cytostatic drugs and their optimal exposure times are described with human cancer cell lines (HT29, NMG64/84) and fresh human tumor cell suspensions in the human tumor colony assay (HTCA). The theoretical pharmacological advantages are 5.8 to 6 for adriamycin (ADM), 8 for cisplatinum (CDDP), 6.3 for epidoxorubicin (EPI), 22 to 58 for 5-fluorouracil (5FU), 4.6 for mitomycin C (MMC), and 6.3 for mitoxantrone (NOV). The drugs differed in their cytotoxic potency in vitro and thus also potential efficacy for regional chemotherapy; however, all but 5-fluorodeoxyuridine (5FUDR) exerted cytotoxicity dependent on exposure time and concentration. On average, elevation of the test concentrations by 1 lg doubled responses in fresh human tumor cell suspensions. From these results and clinical considerations, optimal times were defined for the regional chemotherapy strategies of hepatic artery infusion, intraperitoneal instillation, and chemoembolisation as performed at our institution. Semin. Surg. Oncol. 14:189–201, 1998. © 1998 Wiley-Liss, Inc.

In vitro concentration response studies and in vitro phase II tests as the experimental basis for regional chemotherapeutic protocols.

Die Analyse der Beingeometrie umfast die Achsenausrichtungen frontal, sagittal und longitudinal sowie Langen und Torsionen. Die klinische Untersuchung beurteilt neben der knochernen Geometrie auch funktionelle Aspekte, die ligamentare Stabilitat und die Weichteilsituation, u.a.m. Frontale und sagittale Ubersichts-radiographien (Ganzbeinaufnahmen) liefern Informationen zu den Achsausrichtungen und Gelenkwinkeln von Hufte, Knie und oberem Sprunggelenk. Gleichzeitig werden damit Hohe und Ausmas axialer Deformitaten definiert. Standardisierte CT- oder Ultraschallmethoden erlauben — bei erwiesener Reproduzierbarkeit — die Messung von Langen und Torsionen sowohl des gesamten Beines, als auch von Ober- und Unterschenkel isoliert.

Analyse der Beingeometrie

Unterdem Aspekt primarer Pravention wird fur alle aktiv Sporttreibenden eine sportarztliche Vorsorgeuntersuchung gefordert (Clasing u. Siegfried 2002).Sie hat das Ziel, gesundheitliche Probleme oder Risikofaktoren zu erkennen und im Idealfall Schadigungen und manifeste Schaden zu vermeiden (Banzer u. Hoffmann 1990). Neben der Beurteilung des kardiopulmonalen Systems sind die muskuloskelettale Funktionsdiagnostik und Analyse der Karperzusammensetzung von groser Bedeutung. Dieses Kapitel soll einen Uberblick etablierter, klassischer und moderner, mehrdimensionaler anthropometrischer Messverfahren geben.

Verfahren zur Analyse von Körperbaumerkmalen und Körperzusammensetzung (»body composition«)

Nach Traumen oder im Rahmen der Skelettentwicklung kann es zu Fehlstellungen der unteren Extremitat kommen. Mit konventionellen Ubersichtsradiographien konnen problemlos Achsenfehlstellungen in der Koronar- und Sagittalebene erkannt werden, schwieriger ist die Erkennung von Torsionsfehlstellungen. Geeignete konventionelle radiologische oder klinische Methoden zur Messung von Torsionsfehlern fehlen. Mikulicz beschrieb 1878 erstmals die Messung des Antetorsionswinkels, wobei er Leichenfemora untersuchte. Mehrere projektionsradiographische Verfahren wurden seitdem vorgestellt, das bekannteste und bis heute benutzte Verfahren ist das Verfahren nach Rippstein [5].

Möglichkeiten der magnetresonanztomographischen Messung des femoralen Torsionswinkels

Intraarterial chemotherapy for nonresectable liver cancer : Effectivity and toxicity of hepatic intraarterial infusion, chemoembolization and the combination modality

The proportion of the total dose-area product due to fluoroscopy during interventional radiology of the biliary system has been investigated. Fifty-five interventional procedures were performed on 30 patients. During the examinations, a computer-based system registered the number of radiographs and determined the relative proportions of the total dose-area product due to radiography and fluoroscopy, respectively. In 52 of 55 cases (94.5%), the computer program correctly differentiated between fluoroscopy and radiography. The median total dose-area product was 20.11 Gy.cm 2 , while that due to fluoroscopy was 19.45 Gy.cm 2 . On average, fluoroscopy accounted for more than 96% of the total dose-area product. Limiting fluoroscopy time and keeping the field of view as small as possible are therefore the most effective means of achieving relevant reductions in radiation exposure during interventional radiology of the biliary system.

Radiation Exposure from Interventional Radiology of the Biliary System: How Much is Due to Fluoroscopy?

Embolization of liver neoplasms in patients with occluded celiac trunk

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Möglichkeiten der magnetresonanztomographischen Messung des femoralen Torsionswinkels

Intraarterial chemotherapy for nonresectable liver cancer : Effectivity and toxicity of hepatic intraarterial infusion, chemoembolization and the combination modality

Radiation Exposure from Interventional Radiology of the Biliary System: How Much is Due to Fluoroscopy?

Embolization of liver neoplasms in patients with occluded celiac trunk