Prognose und Prognosefaktoren enossaler Implantate im bestrahlten Kiefer

Zusammenfassung Einleitung: Die kaufunktionelle Wiederherstellung nach Kopf-Hals-Bestrahlung ist gegenuber anderen Tumorpatienten durch Strahlenkaries, Radioxerostomie und Osteoradionekroserisiko zusatzlich limitiert. Es wurde der Frage der Implantatprognose und potentieller Prognosefaktoren im bestrahlten Kiefer nachgegangen. Material und Methode: Die retrospektive Studie erfaste von 1988–1997 197 Implantate (47 Patienten). Die Implantatprognose wurde durch Uberlebenszeitanalyse (Kaplan-Meier) bestimmt, wobei implantatunabhangige Verluste zensiert wurden. Auserdem erfolgte eine Gruppenbildung nach potentiell die Prognose beeinflussenden Parametern. Grupppenunterschiede in den Uberlebensrat…

Therapeutische Strategien bei malignen Weichteiltumoren

Einleitung: Ziel einer Weichteiltumor-Registerstudie der Chirurgischen Arbeitsgemeinschaft Onkologie (CAO) der Deutschen Gesellschaft fur Chirurgie war die Erfassung der Behandlungsstrategien bei malignen Weichteiltumoren des Erwachsenen. Methodik: In 19 Monaten wurden Daten von 292 Patienten von 99 chirurgischen Kliniken Deutschlands nach einem speziell entwickelten Dokumentationsbogen prospektiv zur pratherapeutischen Biopsie, Vorbehandlung, definitiven chirurgischen Therapie, zu multimodalen Masnahmen und zum pathohistologischen Befund erhoben. Ergebnisse: 39 % der Tumoren wurden in Universitatskliniken, 36 % in Schwerpunktkrankenhausern und 24 % in Krankenhausern der Grundversorgung beh…

Klinische und ökonomische Evaluation der Inanspruchnahme zahnärztlicher Leistungen im Ausland

Purpose During the past decade German patients developed an increasing tendency to dental health tourism in countries outside the European Union. The present investigation aimed at evaluating both clinical and economic outcome of dental care in these countries with regard to German directive standards. Methods Based on physical examinations performed by the Medizinische Dienst der Krankenversicherung Rheinland-Pfalz in the context of reimbursement or regress requests after dental care in countries outside the European Union, an individual treatment concept was designed and its direct costs from the patient's perspective were estimated according to German standards. Furthermore, the clinical…

Incidence of postoperative nausea and vomiting (PONV) after general pre-anaesthetic prophylaxis with antihistamines

Prävention des früh-postoperativen IOD-Anstiegs nach Phakoemulsifikation

Purpose. To compare the ocular hypotensive effect of different antiglaucomatous eye drops. Patients and methods. This double-blind, randomized study included 119 eyes of 119 patients without other ocular pathology undergoing standardized (one surgeon, Healon) small incision cataract surgery with foldable intraocular lens implantation.The patients were assigned to one of five groups: group 1:0.25% timolol in Gelrite (extended efficacy, n=23); group 2: 2% dorzolamide (n=24); group 3: combination of 0.5% timolol plus 2% dorzolamide (n=22); group 4: brimonidine (n=26); group 5: gentamicin (control, n=24). Intraocular pressure (IOP) was measured preoperatively and at 3±1,6±1,9±1,24±3, and 48±3 h…

Prätherapeutisches Staging und der interdisziplinäre Therapieansatz bei malignen Weichteiltumoren — Ergebnisse der Registerstudie der CAO

Ziel: Ziel der Weichteiltumor-Registerstudie der Chirurgischen Arbeitsgemeinschaft Onkologie (CAO) der Deutschen Gesellschaft fur Chirurgie war die Erfassung des aktuellen multimodalen Therapiekonzepts bei malignen Weichteiltumoren. Methodik: In einem Zeitraum von 19 Monaten konnten die Daten von 292 Patienten mit der Primarmanifestation eines malignen Weichteiltumors aus 99 Kliniken prospektiv erfast werden und die individuelle Behandlungsstrategie von Krankenhausern unterschiedlichen Versorgungsgrades evaluiert werden. Ergebnisse: 18% der Patienten wurden vor definitiver chirurgischer Therapie unzureichend vorbehandelt, uberwiegend in Form einer nicht-onkologischen Tumorexzision. Diese er…

Läßt sich das sonomorphologische Lymphknotenstaging bei Kopf-Hals-Karzinomen automatisieren?

OBJECTIVES B-scan ultrasound imaging is an obligatory examination of great clinical relevance in patients with head and neck cancer. The procedure, however, is dependent on an experienced examiner and thus requires higher personal resources than other examination techniques. In addition, its subjective character leads to possible deficits in reliability and objectivity. Established sonomorphologic criteria (echo-contour, echo-density, echo-structure, boundary) should therefore be matched to the findings of computer aided sonomorphometry. METHOD 200 sonographic images of the cervical region of patients with oral carcinoma were analysed semi- and fully automatically as well as interactively b…

Chirurgische Radikalität und Indikation zur adjuvanten Therapie bei malignen Weichteiltumoren — Ergebnisse einer Registerstudie / The Extent of Radical Surgery and Indication for Adjuvant Therapy of Soft Tissue Sarcomas: Results of an Evaluation Study

Ziel dieser Studie der Chirurgischen Arbeitsgemeinschaft Onkologie (CAO) der Deutschen Gesellschaft fur Chirurgie war die Erfassung eines aktuellen Status des chirurgisch-onkologischen Vorgehens bei malignen Weichteiltumoren des Erwachsenen. In 19 Monaten wurden die Daten von 292 Patienten aus 99 Kliniken prospektiv erfast. 39% wurden an Uni-Kliniken, 36% in Schwerpunkt- und 24% in Krankenhausern der Grundversorgung therapiert. An den Extremitaten konnte in 96% ein extremitatenerhaltender Eingriff durchgefuhrt werden. Die Haufigkeit einer RO-Resektion unterschied sich in den einzelnen Kliniken nicht signifikant, jedoch kamen lokal ausgedehntere Verfahren und additive Masnahmen an Uni-Klinik…

Reference values of fetal aortic flow velocity waveforms and associated intra-observer reliability in normal pregnancies

Objectives It was the aim of the present study to calculate new Doppler reference ranges for blood flow velocities (Vmax, Vmean, Vmin) and resistance indices (PI, RI) for the fetal descending aorta by automatic waveform analysis. Design Cross-sectional prospective study. Subjects Nine hundred and twenty-six low-risk pregnancies at 18–41 weeks' gestation. Methods Aortic blood flow velocities were derived with pulsed-wave color Doppler. Measurements were carried out at the level of the diaphragm. Reference ranges for the individual measuring parameters were constructed based on a growth function from a four-parameter class of monotonic continuous functions according to the smallest square pri…

Individuell dosiertes Levothyroxin mit 150 µg Jodid versus 100 µg Levothyroxin kombiniert mit 100 µg Jodid: Eine randomisierte Doppelblindstudie

BASIC PROBLEM AND OBJECTIVE Intrathyroid deficiency and the influence of thyroid stimulating hormone (TSH) are the main pathogenetic factors in the development of endemic euthyroid goitre. Goitre reduction is achieved with either administration of levothyroxine, which diminishes hypophyseal TSG production, or of iodide. Aim of this study was to compare the efficacy of treatment with a dose-fixed combination of levothyroxine plus iodide with that of an individualized dosage of levothyroxine plus iodide. PATIENTS AND METHODS After randomization 49 patients with euthyroid goitre (24 women, 25 men, aged 20-43 years) were treated for 12 weeks in a double-blind trial. Patients in group A received…

The Mainz Severity Score Index: a new instrument for quantifying the Anderson-Fabry disease phenotype, and the response of patients to enzyme replacement therapy

Anderson-Fabry disease (AFD) is an X-linked disorder caused by deficient activity of the lysosomal enzyme alpha-galactosidase A. The availability of enzyme replacement therapy (ERT) for this debilitating condition has led to the need for a convenient and sensitive instrument to monitor clinical effects in an individual patient. This study aimed to develop a scoring system--the Mainz Severity Score Index (MSSI)--to measure the severity of AFD and to monitor the clinical course of the disease in response to ERT. Thirty-nine patients (24 males and 15 females) with AFD were assessed using the MSSI immediately before and 1 year after commencing agalsidase alfa ERT. Control data were obtained fro…

Das polyglanduläre Autoimmunsyndrom Typ II: Epidemiologie und Manifestationsformen

Background and objective Polyglandular autoimmune syndrome (PAS), is characterized by the coexistence of several autoimmune diseases, affecting predominantly the endocrine glands. The juvenile form (PAS type I) is distinguished from the adult type II in which autoimmune thyroiditis, adrenal cortical insufficiency and diabetes mellitus type I predominate. The connections between epidemiological, clinical and immunological aspects were analysed and described in this study of patients with PAS type II. Patients and methods Among a total patient population of over 15,000 seen in our endocrinological university policlinic from 1992 through 1996, the clinical data of all 151 patients with PAS typ…

Lack of association between carotid artery volume blood flow and cardiac output.

Objective. The correlation of cardiac output and cerebral perfusion is unclear. We tested this potential association by correlating cardiac output data obtained by echocardiography and cerebral blood flow data as determined by color M-mode measurements of carotid artery blood flow. Methods. We studied 43 patients with a broad spectrum of cardiac performance by means of transthoracic echocardiography. In these patients, different cardiac indices such as stroke volume, ejection fraction, and heart minute volume were determined. The data were correlated with volumetric flow measurements (color M-mode duplex system) of the common carotid arteries bilaterally. Results. Heart minute volume ranged…

Analyse von Kosten und Nebenwirkungen der Membranplasmaseparationsbehandlung

In der aktuellen Diskussion um das adaquate Therapieverfahren (intravenose Immunglobulintherapie vs. Plasmaseparation) beim akuten Guillain-Barre-Syndrom (GBS) besteht derzeit kein allgemeingultiger Konsens. Die vorliegende Untersuchung uber Komplikationshaufigkeit resp.-schwere von 155 Plasmaseparationen und die Kostenevaluierung beider Verfahren leistet hierzu einen Beitrag.

Viral and host factors in the prediction of response to interferon-alpha therapy in chronic hepatitis C after long-term follow-up.

Acute infection with hepatitis C virus (HCV) develops into a chronic hepatitis in about 50-70% of patients. Treatment of these patients with interferon-alpha (IFN-alpha) results in a sustained long-term response in only 15-20% but causes numerous unwanted side-effects in a higher percentage of patients. The aim of our study was to define host or viral parameters that would allow identification of responders and non-responders to IFN-alpha prior to the onset of treatment. We studied a group of 87 patients suffering from chronic hepatitis C who were treated with IFN-alpha. After long-term follow-up, 18 patients (21%) showed a sustained response to IFN-alpha therapy (normalization of serum tra…

Use of gabapentin to reduce chronic neuropathic pain in Fabry disease.

The effect of the anticonvulsant gabapentin on neuropathic pain was studied in six male patients with Fabry disease, aged 15-45 years. After 4 weeks of treatment, pain, as measured using the Brief Pain Inventory, was decreased compared with baseline. Treatment was generally well tolerated. This study indicates that gabapentin should be considered as a treatment option for the neuropathic pain of Fabry disease.

Kostenoptimale Planung kontrollierter Studien bei Diagnoseinstrumenten mit begrenzter Reproduzierbarkeit

Der nachfolgende Text beschreibt einen einfach durchfuhrbaren Ansatz zur kostenoptimalen Fallzahlplanung von kontrollierten Diagnose- oder Therapiestudien, wenn das zur Diagnostik oder zur Festmachung eines Therapieerfolges notwendige bildgebende Verfahren wie in der Nuklearmedizin keine volle Reliabilitat (Reproduzierbarkeit der Einzelauswertung) aufweist, sondern mehrere wiederholte Auswertungen der Rohdaten eines Patienten notwendig sind. Unter Vorgabe einer Kostenstruktur fur die geplante Studie kann dann uber eine kostenoptimale Replikationszahl pro Studienteilnehmer eine an diese Replikationszahl angepaste Studiengruppengrose berechnet werden. Das beschriebene Vorgehen bringt vor alle…