Monophasische orale Kontrazeptiva im Langzyklus

Oral contraceptives are usually taken for 21 days followed by a 7 day pill-free interval. This interval results in a monthly bleeding pattern that is perceived as natural but which is not physiologically necessary and in some women is even associated with considerable discomfort. The present paper explains the theoretical background of the extended cycle regimen (i.e. the continuous intake over a longer period of time) and reviews the practical experience available to date.     

Totale Pankreatektomie

Permanent reduction of morbidity and death in centers for pancreatic surgery has led to a change in the indication for total pancreatectomy from rescue pancreatectomy for complications of pancreatic surgery increasingly to elective surgery, especially in the management of advanced intraductal papillary mucinous neoplasms. We discuss the indication for oncologic total pancreatectomy, rescue pancreatectomy, and removal of the whole pancreas for chronic pancreatitis. Furthermore we describe technical and metabolic aspects following total pancreatectomy.     

Therapie des schweren Schädel-Hirn-Traumas

The main target of treatment in patients with head trauma is to maintain the physiological parameters within the following normal limits: intracranial pressure (ICP) below 20 mmHg, cerebral perfusion pressure (CPP) between 50 and 70 mmHg, normoxemia (SpO₂ >90%), normocapnia (paCO₂: 35–38 mmHg), normoglycemia (80–130 mg/dl) and normothermia (36.0–37.5°C). Space-occupying intracranial bleeding or edemas must be evacuated immediately. If these interventions do not result in adequate control of ICP and CPP, the next step would be to administer mannitol and barbiturates. Mild hyperventilation, therapeutic hypothermia, or decompressive craniectomy should be used solely in patients with a persistent ICP increase. Infusion of calcium antagonists or glucocorticoids is never indicated in patients with head trauma.     

Körperliche Aktivität im Alter

Regular physical activity is key to avoiding or delaying age-related health problems and minimising their impact. In Western societies, the old and older population (the 75+ population segment in particular) is the least likely to exercise or do the recommended amount of health-enhancing physical activity. Thus far, there has been insufficient understanding of and research on the prevalence, impact and effectiveness of the wide array of physical activities that the old and older population can do to improve their health and degree of independence. Along this line, non-sports-related activities should receive special attention. Due to the limited extent of knowledge, there are few age-specific recommendations for physical activity. Subsequent research should focus more on the problems and realities of physical activity in the older and old population. This may serve to clarify and consolidate a scientific and practical consensus leading up to age-specific guidelines for physical activity.     

Intraoperative Radiotherapy of Soft Tissue Sarcoma of the Extremity

PURPOSE: Evaluation of treatment outcome after intraoperative radiotherapy (IORT) +/- external-beam irradiation (EBRT) in patients with localized soft tissue sarcoma of the extremity at high risk for local recurrence after limb-sparing surgery. PATIENTS AND METHODS: 28 patients treated between 1989 and 1999 were evaluated retrospectively. Patients presented with locally recurrent (n = 17), T2 (n = 20), high-grade (n = 26), or incompletely resected tumors (n = 11). All patients underwent limbsparing surgery and IORT (median dose of 15 Gy) given either with high-dose-rate brachytherapy or a linear accelerator. 25 patients received additional EBRT with a mean of 50.6 Gy (range: 30.6-60 Gy). The mean follow-up time was 4.3 years (95% confidence interval [CI]: 3.0-5.6 years). RESULTS: The 5-year overall and distant disease-free survival rates were 66% and 54%, respectively. The overall actuarial recurrence rate after 5 years is 16% (95% CI: 1%, 31%). The crude rate after 8 years is 18%. Surgical margin status, primary versus recurrent tumor and tumor stage did not show any statistically significant influence (univariate analysis) on local recurrence rates. Patients with T1 tumors exhibited a borderline significant (p = 0.053) better distant disease-free survival (83%) compared to T2 tumors (43%). Five (24%) grade 3-4 late side effects were observed. CONCLUSION: In patients with high-risk soft tissue sarcomas, IORT +/- EBRT after limb-preserving surgery achieves high local control rates. The risk of normal tissue toxicities is comparable to conventional limb-sparing treatment.