Sozialmedizinische Maßnahmen

During the seventies and eighties of the 20th century, France reported a considerable decline in the overall rate of preterm deliveries. The figure for all births before 37 weeks gestation dropped from 8.2% in 1972 to 4.9% in 1988, and births before 34 weeks accounted for 2.4% of all births in 1972 and 0.9% in 1988. This development was paralleled by the creation of a national program for the active support of women, children and families. This program was aimed at improving medical care, together with financial and social support, in particular for education and improved working conditions for mothers inside as well as outside of the home. Surprisingly, in the nineties a rise in the rate of preterm deliveries was noticed and in a national survey in France the number for all deliveries before 37 weeks was 6.8% in 1998 and 2.0% for the early preterm deliveries. A similar development was also seen in other countries. This could not be explained by changes in socio-medical support programs. Instead, it was related to a rise in the mean age of pregnant women as well as to the development of assisted reproduction. The example of France demonstrates that a political initiative for the support of women, children and families is not only effective in reducing the number of preterm deliveries but also has a positive effect on the national fertility rate. In Europe, France together with Ireland, with 1.89 children per women, rank at the top of the list of national fertility rates. The mean for Europe is 1.41 and countries like Spain and Italy, with fertility rates of 1.22 and 1.25, are at the end of the list.     

Impact of Increasing Margin Around the Lumpectomy Cavity to Define the Planning Target Volume for 3D Conformal External Beam Accelerated Partial Breast Irradiation

The purpose of this study was to evaluate the dose to normal tissues as a function of increasing margins around the lumpectomy cavity in accelerated partial breast irradiation (APBI) using 3D-conformal radiotherapy (3DCRT). Eight patients with Stage 0-I breast cancer underwent treatment planning for 3DCRT APBI. The clinical target volume (CTV) was defined as a 15-mm expansion around the cavity limited by the chest wall and skin. Three planning target volumes (PTV1, PTV2, PTV3) were generated for each patient using a 0, 5-, and 10-mm expansion around the CTV, for a total margin of 15, 20, and 25 mm. Three treatment plans were generated for every patient using the 3 PTVs, and dose-volume analysis was performed for each plan. For each 5-mm increase in margin, the mean PTV:total breast volume ratio increased 10% and the relative increase in the mean ipsilateral breast dose was 15%. The mean volume of ipsilateral breast tissue receiving 75%, 50%, and 25% of the prescribed dose increased 6% to 7% for every 5 mm increase in PTV margin. Compared to lesions located in the upper outer quadrant, plans for medially located tumors revealed higher mean ipsilateral breast doses and 20% to 22% more ipsilateral breast tissue encompassed by the 25% IDL. The use of 3DCRT for APBI delivers higher doses to normal breast tissue as the PTV increases around the lumpectomy cavity. Efforts should be made to minimize the overall PTV when this technique is used. Ongoing studies will be necessary to determine the clinical relevance of these findings.     

Entacapone improves complex movement performance in patients with Parkinson's disease.

BACKGROUND: A possible strategy to prolong plasma metabolism of Levodopa/Carbidopa (LD/CD) is Entacapone addition (EN), which improves impaired motor behaviour in patients with Parkinson's disease (PD). AIMS OF THE STUDY: Objectives were to evaluate the clinical response to an increased dopaminergic substitution with EN by clinical rating and assessment of complex motions and to investigate the change of movement in PD patients during repeat drug administration during an eight hour interval. METHODS: We used peg insertion with a computer based device and clinical rating for assessment of motor function in 20 treated PD patients. They received LD/CD and then the same LD/CD dosage plus EN in a standardised, open label fashion. RESULTS: Motor scores and performance of the instrumental task were significantly better and the fluctuation of movement was less intense during the LD/CD/EN condition according to the motor test outcomes. CONCLUSION: EN supplementation improves motor symptoms and provides a more continuous movement behaviour in PD patients.     

Integrated home monitoring predicts lead failure in a pacemaker dependent 4-year-old girl.

A 4-year-old girl with post-surgical complete atrioventricular block received an epicardial dual chamber pacemaker system. During further growth intermittent exit block occurred, first misinterpreted as neurological seizures. The epicardial lead was replaced using a transvenous approach, and a pacemaker with an integrated home monitoring facility was implanted. After her discharge, a rise in the pacing threshold automatically initiated an event message. On the basis of this information, the patient was called in and imminent dislodgement of the ventricular lead was diagnosed by x-ray. The lead was repositioned and was found stable over 1-year follow-up.     

Osteoporose: eine Volkskrankheit?

Zusammenfassung Im folgenden Beitrag werden die Ursachen der Osteoporose und ihre Behandlungsmöglichkeiten dargestellt. Diskutiert werden verschiedene Strategien zur Prävention anhand beeinflussbarer und nicht beeinflussbarer Risikofaktoren sowie die Möglichkeiten, das Frakturrisiko zu reduzieren. Von besonderem Interesse sind Therapien mit und ohne Östrogenzusatz, wie z. B. die Calciumsubstitution, die Vitamin-D₃-Substitution, die singuläre Östrogentherapie sowie die Therapie mit Bisphosphonaten und selektiven Östrogenrezeptormodulatoren. Die Östrogentherapie ist die Therapie der Wahl bei Osteporose. Abstract The following article presents the causes of osteoporosis and possible treatment modalities. Various strategies for prevention are discussed based on modifiable and nonmodifiable risk factors as well as measures to reduce fracture risk. Of particular interest are therapy regimens with and without estrogen supplements, e.g., calcium substitution, vitamin D₃ substitution, single estrogen therapy, and treatment with bisphosphonates and selective estrogen receptor modulators. Estrogen therapy is the treatment of choice for osteoporosis.     

Scale-up of Adhesive Transdermal Drug Delivery Systems

Pharmaceutical Research -