Schädigung der vegetativen Hirnzentren durch Kopftrauma

Ohne Zusammenfassung     

Conventional radiograms for assessment of salm-calcitonin therapy for bone metastases from breast carcinoma

The effects of salm-calcitonin on breast cancer osteolytic skeletal metastases have been studied on conventional radiographs. Radiographic criteria for positive response have been defined. It is concluded that radiographs are inadequate for assessing the effects of salm-calcitonin.     

A phase III trial of topotecan and whole brain radiation therapy for patients with CNS-metastases due to lung cancer

Brain metastases represent an important cause of morbidity in patients with lung cancer and are associated with a mean survival of less than 6 months. Thus, new regimens improving the outcome of these patients are urgently needed. On the basis of promising data raised in a phase I/II trial, we initiated an open, randomised, prospective, multicentric phase III trial, comparing whole brain radiation therapy (WBRT; 20 × 2 Gy) alone with WBRT+topotecan (RCT; 0.4 mg m⁻² day⁻¹ × 20). A total of 320 patients with CNS-metastases due to SCLC or NSCLC were projected. The primary end point was overall survival, whereas second end points were local response and progression-free survival. However, until the cutoff date of study completion (i.e., a study duration of 34 months), only a total of 96 (RCT:47, WBRT:49) patients had been recruited, and so an analysis was performed at that time point. Although the numbers of grade 3/4 non-haematological toxicities (besides alopecia 115 (RCT/WBRT: 55 out of 60) were evenly distributed, the 25 haematological events occurred mainly in the combined treatment arm (24 out of 1). Local response, evaluated 2 weeks after treatment, was assessable in 44 (RCT/WBRT: 23 out of 21) patients, showing CR in eight (3 out of 5), PR in 17 (11 out of 6), SD in 14 (8 out of 6) and PD in five (1 out of 4) patients (all differences n.s.). Neither OAS (RCT/WBRT: median (days)): 87 out of 95, range 3–752/4–433; HR 1.32; 95% CI (0.83; 2.10)) nor PFS (median (days)): 71 out of 66, range, 3–399/4–228; HR 1.28, 95% CI (0.73; 2.43) differed significantly. On the basis of these results and the slow recruitment, a continuation of the study did not seem reasonable. The available data show no significant advantage for concurrent radiochemotherapy for patients with lung cancer; however, the recruited number of patients is too low to exhibit a small advantage of combined treatment.     

Die ohrenärztliche Begutachtung Schädelverletzter

Ohne Zusammenfassung     

Hemodynamic effect of norepinephrine and serotonin with and without indomethacin

Injections of serotonin (5-HT) into the aortic arch of rats caused greater reductions of blood pressure (BP) and less increases in renal vascular resistance (RVR) than that into jugular veins, in contrast to norepinephrine (NE) which tended to cause larger increases in BP and RVR by the intra-aortic route. Indomethacin (INDO) enhanced renal vasoconstrictor responses to NE, but did not affect those of 5-HT. These data support a central nervous system (CNS) hypotensive effect of 5-HT not shared by NE, and a less interaction with vasodilator prostaglandins for 5-HT, when compared with NE.     

Diagnostik und Therapie der hämorrhagischen Diathese in der perioperativen Situation

In surgical procedures associated with high blood loss, such as vascular and cardiac operations, differential diagnosis and therapy of perioperative hemorrhage are of special importance. Preoperative screening for patients at high risk of bleeding and in particular for those with qualitative platelet disorders [drug-induced platelet disorders (in particular ASS), von Willebrand's disease and other congenital platelet disorders] is effective in minimizing blood loss. Bleeding in acute medical emergencies or during emergency operations may require treatment without specific investigations being performed in advance. Therefore, simple schemes are essential for the rapid management of acute hemostatic problems. The aim of this paper was to address the diagnostic and therapy of hemorrhagic diathesis focusing mainly on diagnosis and therapy of hemorrhagic diathesis due to blood platelet disorders and blood coagulation disorders and preoperative identification of patients at increased risk of bleeding.     

Serotonin formation in nonblood-perfused rat kidneys

Infusion of the aromatic L-amino acid decarboxylase substrate L-5-hydroxytryptophan (L-5-HTP) at 1.5, 3.0 and 15 micrograms/min into isolated Krebs-Henseleit-perfused rat kidneys was associated with serotonin output in the urinary and venous effluents. Serotonin was measured by high-performance liquid chromatography using electrochemical detection. Infusion at the two higher doses of L-5-HTP caused marked increases in renal vascular resistance (RVR) of over 80 and 490%, respectively. Administration of the aromatic L-amino acid decarboxylase inhibitor carbidopa (20 micrograms) decreased serotonin output and RVR to base-line levels despite continued infusion of L-5-HTP. Infusion of the D-isomer of 5-HTP at 3 micrograms/min did not significantly alter RVR and produced minimal increases in serotonin output relative to L-5-HTP. These results are consistent with the stereospecific formation of serotonin from its amino acid precursor 5-HTP by whole rat kidney.     

Calciphylaxis in end‐stage liver and renal disease patients before and after transplant

Calciphylaxis is a rare vascular disorder characterized by calcification of arterioles which causes tissue inflammation and necrosis. It is associated with the metabolic disturbances seen in end‐stage renal disease (ESRD) and has also been described in patients with cirrhosis with preserved kidney function. Characteristic calciphylaxis lesions are black eschars surrounded by retiform purpura, and the gold standard for diagnosis is skin biopsy. Reported 1‐year mortality rates range between 45% and 80%. No treatment modality has been evaluated in a prospective randomized trial, and reports of treatment efficacy vary. Kidney transplant has been reported as a successful therapy for calciphylaxis; however, cases exist of the initial onset of calciphylaxis following kidney transplant as well as simultaneous liver‐kidney (SLK) transplant. The decision to maintain a patient with end‐stage renal and liver disease on the waiting list for SLK transplant following the onset of calciphylaxis must consider the high 1‐year mortality associated with this condition. More research is necessary to understand how to allocate donor allografts to manage patients with calciphylaxis and ESRD and/or cirrhosis effectively.