Das Mammakarzinom

Zusammenfassung Patientinnen mit fortgeschrittenem Mammakarzinom werden heute als chronisch erkrankt angesehen. Aufgrund verbesserter Therapiemöglichkeiten verläuft die Erkrankung meistens schubweise und wellenförmig über einen längeren Zeitraum. Erst spät kommt es zu einer relativ kurzen, für eine Krebserkrankung typischen Terminalphase. Erhaltung der Lebensqualität und Verlängerung des Überlebens sind gleichberechtigte Ziele eines multimodalen Therapieansatzes. Bei der Therapieplanung gilt das Motto so wenig wie nötig. Überwiegend werden medikamentöse und damit systemisch wirkende Therapien eingesetzt. Nur so kann man dem Problem der in diesem Stadium immer anzunehmenden disseminierten Multiorganerkrankung gerecht werden. Lokale operative Therapien oder Bestrahlungen von Metastasen erfolgen vor allem zur akuten Linderung einer ausgeprägten Symptomatik und im Allgemeinen zusätzlich zur systemischen Therapie.     

Gesichtspunkte bei der Therapieplanung von Gebißanomalien

Ohne ZusammenfassungMit 11 AbbildungenHerrn Professor Dr. Dr. Dr. h. c. E. Reichenbach zum 70. Geburtstag     

Bronchial artery embolization in the management of hemoptysis: technical aspects and long-term results

Seventy-five patients with hemoptysis were treated with bronchial artery embolization (BAE). The procedure was performed with Hexabrix (sodium methylglucamine ioxaglate), Mikaelson catheters, and Gelfoam particles. Angiographic evaluation of the bronchial artery anatomy revealed ten different configurations, which are described. The embolization attempt failed in three cases (4%); eight additional patients (10.7%) were excluded from the series because of inadequate data. In the remaining 64 patients, 41 underwent BAE alone and 23 underwent either chemotherapy or surgery in addition to embolization. Immediate control of hemoptysis was achieved in 49 of 64 patients (76.6%). Long-term control of hemoptysis was achieved in 46 of the 56 patients included in the long-term follow-up (82.1%). Eight of the 64 patients were lost to follow-up, which ranged from one to 47 months (mean 24.8 months). Hemoptysis recurred in 12 of 56 patients (severe in 10, mild in 2) (21.4%). Twelve patients died (21.4%), five of them due to hemoptysis (8.9%). None of the patients who died of hemoptysis had responded to initial BAE. It is concluded that BAE is an effective treatment for immediate control of life-threatening hemoptysis, allowing long-term control of bleeding in the majority of patients.     

Mechanismen der Schmerzentstehung

The interaction between neurons, tissue cells and inflammatory cells is of major importance for the development of pain in the periphery. In this interaction a variety of inhibitory and activating circuits has been identified in recent years. In addition to the receptors for classical inflammatory mediators on the sensory terminals like bradykinin, axonal ion channels have been identified as major modulators of pain and sensitization apart from their traditional role in conduction of action potentials. Sensitization of spinal nociceptive processing is crucial for the expansion of pain beyond the initially injured site and contributes to chronic pain. Learning processes and extinction of aversive memory are of major importance for the development, but also the therapy of chronic pain states.     

Kranielle Bildgebung und Serologie bei Pupillotonie nicht hilfreich

BACKGROUND: Tonic pupil (TP) is a common disorder of parasympathetic innervation. In contrast to textbook recommendations, cranial imaging is still being performed in most of the patients with TP. The intention of the present study is to show that cranial imaging is of no benefit. PATIENTS AND METHODS: The medical records of 33 patients with TP were analyzed retrospectively. All patients had undergone a complete ophthalmological, orthoptic, and neurological investigation. Cranial imaging was performed by computed tomography or magnetic resonance imaging. Serology tests were carried out in some of the patients. RESULTS: Diagnostic imaging provided no additional data revealing the underlying cause of TP. CONCLUSIONS: Cranial imaging in isolated tonic pupil is not helpful. Because of therapeutic implications, diagnostic evaluation can be recommended only in patients older than 50 years to exclude giant cell arteritis and syphilis.     

Sp?tabendlicher Sport, Schlaf, Schlafhygiene und psychisches Wohlbefinden bei adoleszenten Fu?ballern

Objectives

Recent studies have demonstrated different effects of physical activity on sleep and the results ranged from positive over negative effects to no influence at all. The aim of this pilot study was to assess the sleep behavior of adolescent footballers, sleep hygiene and other psychological parameters compared to a less sportive control group. According to the literature it was to be expected that late night football would be negatively associated with sleep behavior.

Method

A total of 11 adolescents took part in this study, the 6 footballers and 5 controls kept a sleep diary and answered further questionnaires about anxiety, depressiveness and sleep hygiene.

Results

Analysis of the sleep diaries showed no differences between the groups although the footballers were physically active more often and later in the evening. Furthermore, the results of the subjective perception of normal routine performance and anxiety were equal for both groups. However, a tendency to better sleep hygiene and less depressiveness was found in the sport group.

Conclusions

The results of this pilot study showed no negative effects of late night football on sleep in adolescents; however, it has to be taken into account that not only different mediator variables might control the effect of physical activity on sport, e.g. time, intensity, duration and regularity but also aspects of the mental well-being and should be considered in future experiments.