Prekallikrein-Kallikrein conversion rate as a predictor of contrast material catastrophies

An in vitro is described that attempts to detect patients with a potential for adverse systemic reactions to contrast material. This test involves measuring the rate of conversion of prekallikrein to kallikrein under certain standard conditions. In a preliminary retrospective study, the test could be used to identify such patients with a sensitivity of 88%, a specificity of 82%, and a predictive value of 79%.     

Longterm reduction of back pain risk in women with osteoporosis treated with teriparatide compared with alendronate

OBJECTIVE: To compare the effects on back pain of teriparatide versus alendronate, we analyzed the reporting of back pain in a head to head comparator trial and a followup study. METHODS: In the comparator trial, women were randomized to receive either daily self-injected teriparatide 40 microg plus an oral placebo (n = 73), or daily oral alendronate 10 mg plus self-injected placebo (n = 73). Treatment was for a median 14 months. After completion of the comparator trial, 72% of these patients enrolled in a nontreatment followup study. Adverse events were recorded at each comparator trial visit and followup study visit, and the incidence of new or worsening back pain in each group was compared. RESULTS: During the comparator trial, compared with women randomized to alendronate 10 mg, women randomized to teriparatide 40 microg had reduced risk for any back pain (relative risk 0.27, 95% CI 0.09-0.82) and moderate or severe back pain (relative risk 0.19, 95% CI 0.04-0.86). The differences in the reporting of back pain between the teriparatide treated women and the alendronate treated women were sustained during an interval including the comparator trial plus 18 additional months. During an interval including the comparator trial plus 30 additional months, teriparatide treated patients had numerically fewer occurrences of back pain and moderate or severe back pain. CONCLUSION: Compared with women randomized to alendronate 10 mg, women randomized to teriparatide 40 microg had reduced risk of back pain during the trial and 2.5 years of followup.     

Geriatrisches Assessment

With increasing life expectancy, a therapeutic decision raises the question of the primary goals to be aimed for. Is an absolute gain in age a goal equal to the preservation of an active life? While in younger patients the strategy followed by the patient and the doctor will usually be that of long-term survival, the decision making process for older patients with functional deficits is more challenging. Though functional deficits show a positive correlation with age, a causal relationship does not exist, which implies considerable inter-individual heterogeneity in the group of older patients. In particular, patients who have reached older ages “successfully” without any major limitations in their health should be considered for more intensive treatment strategies. At the same time, younger patients with relevant functional limitations and without any chance of improvement may not benefit from these interventions. The comprehensive geriatric assessment (CGA) offers the opportunity to describe and classify these deficits systematically. It therefore has a key role in the individual decision making process.     

Prediction of necrosis after chemotherapy of advanced germ cell tumors: results of a prospective multicenter trial of the German Testicular Cancer Study Group

PURPOSE: We evaluated the prognostic parameters of necrotic residual tumors after chemotherapy of advanced germ cell tumors to improve on the current indications for surgery. MATERIALS AND METHODS: Between January 1996 and January 2000, in 8 centers of the German Testicular Cancer Study Group, preoperative parameters were assessed to predict necrosis in the residual tumors of 261 patients with retroperitoneal residual tumor resection after first (92%) and second line (8%) chemotherapy. RESULTS: Of 232 evaluable patients 39 had pure seminoma and 5 had viable cancer (1 with seminoma) in the residual tumor. Of the remaining 193 patients with nonseminoma 35% had necrosis, 34% teratoma and 31% had viable carcinoma in the residual tumor. After multivariate analysis and exclusion of patients with seminoma, the 3 parameters independently predictive of necrosis were alpha-fetoprotein before chemotherapy less than 20 ng/ml, and tumor volume before and after chemotherapy. A mathematical model to predict necrosis yielded a test accuracy of 75%, a sensitivity to predict necrosis of 52% and a specificity of 87%. CONCLUSIONS: Patients with pure seminoma should not undergo residual tumor resection because 97% of patients who received adequate chemotherapy were found to have no residual seminoma. In cases of nonseminoma alpha-fetoprotein values before chemotherapy less than 20 ng/ml and a high percentage of shrinkage during chemotherapy reliably predicted only 19% of cases of necrosis. Therefore, this model is clinically irrelevant and patients with minimal residual disease should undergo surgery. New methods are necessary to improve the preoperative selection of patients after chemotherapy.     

Die Therapie des fortgeschrittenen Peniskarzinoms

Zusammenfassung Die kutane und lymphogene Metastasierung von Peniskarzinomen führt zu großen Weichteildefekten im Bereich der Inguinal- und Dammregion. Die Ergebnisse einer systemischen Polychemotherapie basierend auf den Substanzen Cisplatin, Methotrexat und Bleomycin (CMB-Schema) sind mit Ansprechraten bis zu 30% begrenzt. Die obligat superinfizierten Defekte bedürfen nach Resektion der spannungsfreien, großflächigen Deckung mit myokutanen Schwenklappen.Zur Defektdeckung werden Schwenklappen, bestehend aus Haut, Faszie, Muskulatur und dem versorgenden Gefäßsystem, verwandt. Auf dem Gebiet der operativen Uroonkologie haben sich die nachfolgenden myokutanen Schwenklappen mit dem jeweils aufgeführten ernährenden Gefäßsystem bewährt: M.-tensor-fasciae-latae-Lappen (A. circumflexa femoris lateralis), M.-rectus-abdominis-Lappen (A. epigastrica inferior), M.-glutaeus-maximus-Lappen (A. glutaea inferior).Präsentiert werden Daten einer prospektiven Erhebung zur neoadjuvanten Polychemotherapie mit 2–4 Kursen CMB gefolgt von einer Tumorresektion mit konsekutiver plastischer Deckung. 15 Patienten (mittleres Alter, 69,7 Jahre) sind infolge eines Plattenepithelkarzinom des Penis (TX, N3, M1-Cutis) nach antibiotischer Vorbehandlung und systemischer Chemotherapie mit 2.4-Kursen CMB tumorexzidiert worden. Bei 3 von 15 Patienten ist eine partielle Remission nach CMB ermittelt worden.Alle Patienten erhalten beidseitig eine Deckung der Femoralgefäße durch den M. sartorius (Sartoriusplastik, n=30). Eine großflächige (bis zu 45×30 cm) spannungsfreie Weichteildeckung erfolgt bei 2 Patienten über einen einseitigen M.-tensor-fasciae-latae-Lappen, bei 8 Patienten über einen beidseitigen M.-tensor-fasciae-latae-Lappen, bei 1 Patienten über einen beidseitigen Glutaeus-maximus-Lappen, bei 3 Patienten über die Kombination aus Rektuslappen und M.-tensor-fasciae-latae-Lappen sowie bei einem Patienten über die Kombination aus je 2 M.-tensor-fasciae-latae-Lappen, je 2 Glutaeus-maximus-Lappen sowie 1 Rektuslappen.Bei 30 muskulären und 32 myokutanen Schwenklappen sind 2 distale Lappennekrosen aufgetreten, wobei je ein Glutaeus-maximus-Lappen und je ein M.-tensor-fasciae-latae-Lappen betroffen ist. Eine komplette Nekrose eines Schwenklappens ist nicht aufgetreten. 30 von 32 Schwenklappen sind primär eingeheilt.Die Deckung großer Weichteildefekte durch Verwendung myokutaner Schwenklappen, wie den Tensor-fasciae-latae-rectus- und -glutaeus maximus-Lappen stellt ein sicheres Verfahren in der primären Versorgung auch kontaminierter oder strahlentherapierter Befunde dar. Die Lappentechniken finden gleichermaßen Anwendung in der Onkologie wie Traumatologie.     

Chemotherapy of advanced urological tumors

The indication for chemotherapy is quite different in urological malignancies. In case of testicular tumors the availability of chemotherapy is one of the milestones in their successful treatment. Patients with low-volume metastases will be cured in nearly 100% and even far advanced disease can be cured in more than 50%. Contrarily in renal cell carcinoma chemotherapy is without any significance, response rates are <8%. Comparable is the situation in penile cancer. Though in hormone-refractory prostate cancer chemotherapy also can not prevent further disease progression, it shows good palliative effects.     

Excel97在药物分析中的应用

目的：在药物分析中,电子表格软件ＭｉｃｒｏｓｏｆｔＥｘｃｅ１９７ｆｏｒ Ｗｉｎｄｏｗｓ。方法：利用Ｅｘｃｅｌ的数据处理功能,进行药物的图表绘制、数据计算和统计处理,回归分析,特别是计算分析,并可建立分析数据库。结果和结论：Ｅｘｃｅｌ操作简单,功能强大,数据分析工作直观。     

辛伐他汀(舒降之)治疗原发性高胆固醇血症的临床比较研究

目的：比较国产辛伐他汀与进口辛伐他汀治疗原发性高胆固醇血症的疗效及安全性。方法：采用开放区组随机对照、多中心的临床设计。１５０例高胆 固醇血症病人分为验证组（５０例）、对照组（４８例）和开放组（５２例）,剂量均为每晚顿服１０ｍｇ,服药８周。结果：验证组与对照组服药前后比较,血清总胆 固醇（ＴＣ）分别降低２６．３６％和２８．３％,低密度脂蛋白胆固醇（ＬＤＬ－Ｃ）分别降低３３．１７％和３５．５１％;验     

Diet and cancer prevention: the fiber first diet

Diet can play a major role in cancer prevention. The international differences in cancer incidence are largely accounted for by lifestyle practices that include nutrition, exercise, and alcohol and tobacco use. About 50% of cancer incidence and 35% of cancer mortality in the U.S., represented by cancers of the breast, prostate, pancreas, ovary, endometrium, and colon, are associated with Western dietary habits. Cancer of the stomach, currently a major disease in the Far East, relates to distinct, specific nutritional elements such as excessive salt intake. For these cancers, information is available on possible initiating genotoxic factors, promoting elements, and prophylactic agents. In general, the typical diet in the United States contains low levels of the potent carcinogenic agents, heterocyclic amines, formed during the cooking of meats. It provides only about half the potent appropriate fiber intake and is high in calories. About twice as many calories as would be desirable come from fat, certain kinds of which enhance the development of cancers. Other foods with functional properties, such as soy products and tea, can be beneficial. To achieve reduction in risk of certain cancers, diet must be optimized, primarily to reduce caloric intake and the fat component. The latter should be 20% or less of total caloric intake and fiber should be increased to 25- 35 g per day for adults. One approach to achieving these goals is the Fiber First Diet, a diet designed around adequate fiber intake from grains, especially cereals, vegetables, legumes, and fruits, which thereby reduces both calorie and fat intake. Such dietary improvements will not only reduce cancer and other chronic disease risks, but will contribute to a healthy life to an advanced age. A corollary benefit is a lower cost of medical care.