Strahlentherapie des Uterussarkoms

For patients with a leiomyosarcoma or an endometrial stroma sarcoma the use of adjuvant radiation is questionable. Radiation therapy potentially increases the rate and severity of surgical complications in patients with recurrent disease. In patients with a carcinosarcoma postoperative radiation should be considered as adjuvant radiotherapy decreased the rate of local recurrences but not overall survival in retrospective studies and the randomized EORTC study. Therapy-related toxicity is mild and tolerable. A dose of at least 45 Gy conventionally fractionated should be used. A whole abdominal irradiation is not indicated. Due to early distant metastases effective and well tolerable systemic therapies need to be developed. It is absolutely necessary that the extent of surgery should be internationally standardized, a systematic lymphonodectomy should be carried out for carcinosarcomas and molecular prognostic markers should be established in order to estimate risks and prognosis of the patient.     

Adjuvante und definitive Radio-Chemo-Therapie des Vulvakarzinoms

Vulvar cancer is a relatively rare disease with an incidence of 4% of all gynaecologic cancers. Early vulvar cancers are treated by radical local excision of the tumour and inguinal lymph node dissection. The most important prognostic factors are the presence of lymph node metastasis and the magnitude of surgical margins. In high-risk cases, adjuvant radiotherapy can reduce the local recurrence rate and may improve survival. In advanced stages, combined chemoradiation reduces tumour size and improves the chance of partial or complete remission.     

Effect of adding albumin to solutions of somatostatin on inhibiting pentagastrin-stimulated acid secretion in dogs

In five conscious dogs with chronic gastric fistulas we studied the effect of somatostatin solutions on pentagastrin-stimulated acid secretion. Somatostatin was dissolved in 0.154 M NaCl alone or in the same amount of saline to which dog albumin had been added to give a 0.5% solution. Somatostatin produced a dose-dependent inhibition of pentagastrin-stimulated gastric secretion. However, the inhibition was significantly less when somatostatin was dissolved in saline as compared to saline plus albumin. This study suggests that albumin should be added to somatostatin solutions to preserve biological activity, and it confirms previous reports indicating that, without albumin, basic peptides have a tendency to stick to infusion systems.     

Molekulare Therapie in der Gastroenterologie und Hepatologie

Zusammenfassung Mittels molekularer Techniken gewonnene Erkenntnisse haben in den letzten Jahren erheblichen Einfluss auf die Behandlung gastrointestinaler und hepatologischer Erkrankungen gewonnen. Die Diagnose bestimmter Erkrankungen wird nicht mehr allein phänotypisch, sondern aufgrund des Genotyps gestellt. Dies betrifft sowohl monogene Erkrankungen als auch die Identifikation von genetischen Risikokonstellationen (z. B. NOD2/CARD15-Mutation bei M. Crohn). Auch für die Therapieplanung bei viralen Erkrankungen wird eine erweiterte molekulare Diagnostik eingesetzt. Die Versuche, die Lebertransplantation in der Behandlung hereditärer Lebererkrankungen durch gezielte genetische Eingriffe (z. B. mittels viraler Vektoren) zu ersetzen, sind noch in der experimentellen Phase, aber die verwendeten Methoden haben bereits wegweisende Verbesserungen erfahren. Mit der molekularen Identifikation neuer Zielstrukturen war die Entwicklung maßgeschneiderter Therapien möglich. Diese finden insbesondere in der Behandlung chronisch entzündlicher Darmerkrankungen und gastrointestinaler Tumorerkrankungen Anwendung.     

Cholangiopathien nach Lebertransplantation

Biliary complications occur in up to 30% of liver transplantations. Bile leaks can be treated successfully by transient endoscopic stenting. A severe complication is hepatic artery thrombosis, which can often lead to bile duct necrosis with consecutive liver abscess and sepsis. Bile duct strictures can occur at the anastomosis (anastomotic strictures – AS) or at the hilar and/or intrahepatic levels as ischemic type biliary lesions (ITBL). AS can be treated successfully with a combination of balloon dilatation and insertion of endoprostheses. In ITBL available data is more ambiguous, but repeated balloon dilatation seems to be successful and can at least considerably delay mandatory retransplantation. First results show that the challenging anastomotic strictures after living donor liver transplantation can be treated endoscopically with considerable success.     

Foscarnet and ganciclovir combination therapy for CMV disease in HIV-infected patients

Summary An open prospective trial of combined ganciclovir and foscarnet therapy for 3 weeks was initiated in 14 episodes of severe CMV-disease in 13 HIV-infected patients (all CDC class IV, age 30–42, median 34 years, CD4+ cell count 0–80, median 10/µl). In seven episodes of gastrointestinal disease (five colitis, two esophagitis) remission of symptoms and mucosal changes was achieved in five. In seven episodes of retinitis, scarring was achieved in six. Renal toxicity was seen in two patients, moderate hematologic toxicity in eight patients. Overall efficacy was comparable to monotherapy; no new toxicities were seen with the combination of these two drugs.

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Kombinationstherapie mit Ganciclovir und Foscarnet bei schwerer CMV-Erkrankung bei HIV-infizierten Patienten

Zusammenfassung In 14 Episoden einer CMV-Erkrankung bei 13 HIV-infizierten Patienten wurde eine Kombinationstherapie mit Ganciclovir und Foscarnet in einer offenen, prospektiven, nicht randomisierten Studie durchgeführt. Alle Patienten (n=13, Alter 30–42, Median 34 Jahre; CD4+Lymphozyten 0–80, Median 10/µl; alle Stadium IV CDC) wurden über 3 Wochen mit 2 × 5 mg/kg/d Ganciclovir und 2 × 90 mg/kg/d Foscarnet behandelt. In sieben Episoden einer gastrointestinalen CMV-Erkrankung (Colitis fünf, Ösophagitis zwei) wurde eine Remission in fünf Episoden erzielt, bei CMV-Retinitis in sechs von sieben Fällen. Nephrotoxizität trat bei zwei Patienten auf, mäßige Hämatotoxizität bei acht Patienten, sämtlich reversibel. Die Wirksamkeit der Therapie ist ähnlich der Monotherapie, die Nebenwirkungen sind additiv.