Traditionelle Chinesische Medizin in der Onkologie

Over the last 50 years, Western medicine has generated major improvements for the treatment of malignant diseases. At the same time limitations have become obvious. Traditional Chinese medicine (TCM), with its functional approach to health and disease, can offer new perspectives for diagnosis and treatment. The diagnostic procedures can be used to evaluate deviations from healthy development. The resulting pharmacological treatment opportunities consciously use the interactions of botanical, mineral and animal products to influence the interactions between the healthy body and the malignant disorder. In this combination, TCM supplies supportive treatment, in addition to the mainly cytotoxic substances of Western medicine. This extended treatment concept is supported by observational studies, but needs confirmation in controlled clinical studies.     

The radial forearm flap in head and neck reconstruction

The radial forearm flap has proven to be a very reliable and versatile technique for reconstructing head and neck defects. It is of particular value where segmental defects in the mandible and intraoral mucosa exist, and in reconstructing defects within radiated tissue. The skin of the flap drapes well over the radial bone to allow denture fitting. The radial bone provides an adequate bony strut to allow essentially normal mandibular function. In a previously radiated bed, the flap (from a non-irradiated area) has the virtue of being highly vascular, thus benefiting wound healing. The lack of bulk in the flap prevents separation at the site of inset as wound healing occurs. It is a one-stage reconstruction, and since the donor site is on the upper extremity, early patient mobilization is possible. The donor defect is cosmetically acceptable, and since it lies against the body in the position of rest, it is not frequently exposed. The osseous portion of the flap in a postmenopausal woman should be approached with caution and patients should be warned of the risk of radius fracture. This flap is capable of providing tissue for reconstruction of the head and neck and should be considered for closure of all major defects, particularly those with bone defects or in defects created postirradiation.     

Add-on rTMS for treatment of depression: a pilot study using stereotaxic coil-navigation according to PET data

OBJECTIVE: Repetitive transcranial magnetic stimulation (rTMS) is regarded as a potentially new tool to treat depression. In a double-blind, randomized, sham-controlled pilot study we investigated the efficacy of neuronavigated rTMS, guided according to the prefrontal metabolic state determined by positron emission tomography (PET). METHODS: 25 patients with major depression were included. Prior to rTMS, PET scans were obtained. For the real stimulation condition, the dorsolateral prefrontal cortex (DLPFC) with lower metabolic activity compared to the contralateral hemisphere was selected, if detected by prior PET. Stimulation parameters were 15 Hz, 110% motor threshold (MT), 3000 stimuli/day, for 10 days. A neuronavigational system was used to place the magnetic coil above each individuals' selected cortical region (real condition: DLPFC, sham: midline parieto-occipital, intensity 90% of MT). RTMS was administered add-on to medication. Depression-related symptoms were rated with Beck's, Hamilton's (HAM-D), and Montgomery-Asberg's (MADRS) depression rating scales. RESULTS: Real stimulation improved depression according to HAM-D and MADRS moderately but significantly better compared to sham at the end of the stimulation sessions. In the real condition, four out of 13 patients responded with a mean improvement in HAM-D and/or MADRS of at least 50%, whereas none responded to sham. Antidepressant effects of stimulation of the relatively hypometabolic DLPFC were comparable to stimulation in absence of metabolic differences. CONCLUSIONS: A moderate improvement of depressive symptoms after rTMS was observed. Our preliminary data show that stimulation of prefrontal hypometabolism may not be advantageous to stimulation irrespective of the metabolic state.     

Serum beta-glucuronidase activity is inversely associated with plant-food intakes in humans

Beta-glucuronidase hydrolyzes glucuronide moieties from steroids and xenobiotics, such that circulating glucuronyl conjugates can interact with target tissues. In animal models, dietary constituents can alter beta-glucuronidase activity. In humans, serum beta-glucuronidase activity reflects liver enzyme loss during cell turnover, and thus is a surrogate for hepatic beta-glucuronidase. We recruited 83 men and 120 women, who were nonsmokers, 20-40 y of age, with self-reported vegetable and fruit (V&F) intakes of < or = 2.5 or > or = 4.5 servings/d. Diet was assessed by 3-d food record and serum carotenoids were measured as biomarkers of V&F intake (e.g., servings V&F vs. alpha-carotene; r = 0.47, P = 0.0001). Serum beta-glucuronidase activity (Modified Sigma Units/L), determined in blood samples collected on two consecutive days from fasting subjects, was higher in men than women (mean +/- SEM: 20.4 x 10(3) +/- 1.0 x10(3) and 17.0 x 10(3) +/- 0.6 x 10(3), P = 0.002). beta-Glucuronidase activity (adjusted for sex) was inversely associated with intakes of plant protein, fruit, dietary fiber (r = -0.24 to -0.30; P < 0.001), botanical groupings Cucurbitaceae, Rosaceae, and Leguminosae (r = -0.16 to -0.19; P < 0.05), and serum alpha- and beta-carotene and beta-cryptoxanthin (r = -0.18 to -0.26; P < or = 0.01). Activity was not associated with overall vegetable intake. Although these associations are modest, the data suggest that plant foods, particularly constituents of fruits and fiber-containing foods, may influence human beta-glucuronidase activity in a potentially favorable direction.     

Professionalization of nursing aides at the State of Sao Paulo: a study of supply/demand regarding training

The purpose of this exploratory study was to verify the problem of nursing aides professionalization and to analyze the offer of courses and demand regarding technical level capacitation at the state of S?o Paulo, Brazil. Data were obtained through the analysis of documents on professional capacitation in the area in the 1990s. Authors identified a scenario of conceptual and political changes regarding the professionalization and the existence of a great number of aides being professionalized. They also verified a tendency to increase the offer of courses and the demand regarding the capacitation and specialization at the technical level.     

Familial neurofibromatosis microdeletion syndrome complicated by rhabdomyosarcoma.

Neurofibromatosis type 1 with dysmorphism and developmental delay is reported in a mother and two children. The son required treatment for a prostatic rhabdomyosarcoma. His sister has an optic pathway glioma. Fluorescence in situ hybridisation confirmed a submicroscopic deletion at 17q11.2. New evidence suggests an increased malignancy frequency in microdeletion cases.     

Unilateral haemorrhagic parenchymal lesions in the preterm infant: shape, site and prognosis

Rademaker KJ, Groenendaal F, Jansen GH, Eken P, de Vries LS. Unilateral haemorrhagic parenchymal lesions in the preterm infant: shape, site and prognosis. Acta Pædiatr 1994;83:602–8. Stockholm. ISSN 0803–5253 In a prospective cranial ultrasound study of 544 infants with a gestational age of 32 weeks or less, 20 (3.6%) infants were diagnosed as having a unilateral parenchymal lesion (PL). Based on the shape of the PL and the evolution on ultrasound, the infants were divided into three groups: group I consisted of 11 infants, in whom the PL was triangular/fan-shaped and separate from the ventricle. The PL evolved into small cystic lesions; group II comprised 3 infants who had a PL with a similar shape, but partially communicating with the ventricle; group III consisted of 6 infants who had a globular-shaped lesion in communication with the ventricle. In groups II and III, the PL evolved into one porcncephalic cyst. The PL was considered to be due to venous infarction in all cases with intraventricular haemorrhage preceding the PL in 7 cases. Sixteen infants survived. A postmortem was performed in 2 of the 4 infants who died, confirming the diagnosis of venous infarction. Neurologicdl sequelae were present in only 2 cases in the first group, while all 6 survivors of the other two groups developed mild to severe hemiplegia. Long-term follow-up was not always available and 4 of the 18 survivors were still less than 18 months when last seen. In 9 of the 11 infants in group I, the PL was localized in the frontoparietal region, while in 8 of the 9 infants in group II or III, the PL was beyond the trigone in the occipital region. The outcome of the unilateral PL is not always unfavourable. It was evident that not only the shape of the lesion and whether or not there was communication with the lateral ventricle, but also the site of the lesion (whether or not it extended into the occipital periventricular white matter) appeared to be important with regard to neurodevelopmental outcome.