Was das Unterhaltungsfernsehen zur Vermittlung von medizinischem Wissen an Studierende und Laien beitragen kann – Sensibilisierung für seltene Erkrankungen

Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz - Menschen mit komplexen und seltenen Erkrankungen haben es in unserem Gesundheitssystem oft schwer. Bis zur Diagnosefindung kann...     

3D conformal HDR brachytherapy and external beam irradiation combined with temporary androgen deprivation in the treatment of localized prostate cancer.

PURPOSE: To evaluate treatment outcome of 3D conformal high dose rate (HDR) brachytherapy and external beam irradiation (EBRT) combined with temporary androgen deprivation for patients with localized prostate cancer. PATIENTS AND METHODS: Between January 1997 and September 1999 we treated 102 patients with stage T1-3 N0 M0 prostate cancer. Stage T1-2 was found in 71, T3 in 31 patients. Median pretreatment PSA level was 15.3 ng/ml. After ultrasound-guided transrectal implantation of four afterloading needles, CT based 3D brachytherapy planning was performed. All patients received four HDR implants using a reference dose per implant of 5 or 7Gy. Time between each implant was 14 days. After brachytherapy EBRT followed up to 39.6 or 45.0 Gy. All patients received temporary androgen deprivation, starting 2-19 months before brachytherapy, ending 3 months after EBRT. RESULTS: Median follow-up was 2.6 years (range 2.0-4.1 years). Actuarial biochemical control rate was 87% at 2 years and 82% at 3 years. In 14 patients we noted biochemical failure, in five patients clinical failure. Overall survival was 90%, disease specific survival 98.0% at 3 years. Acute grade 3 toxicity occurred in 4%, late grade 3 toxicity in 5%. One patient developed a prostatourethral-rectal fistula as late grade 4 toxicity. The conformal quality of 300 HDR implants was analyzed using dose volume histograms. CONCLUSIONS: 3D conformal HDR brachytherapy and EBRT combined with temporary androgen deprivation is an effective treatment modality for prostate cancer with minimal associated toxicity and encouraging biochemical control rates after a median follow-up of 2.6 years.     

Serious adverse effects of amifostine during radiotherapy in head and neck cancer patients

Background and purpose: Amifostine has been shown to protect against xerostomia induced by radiotherapy for head and neck cancer, but its impact on the therapeutic index is unknown. This is the first report focusing on amifostine related adverse effects leading to discontinuation of amifostine treatment.

Patients and methods: Thirty-nine patients from two centers irradiated for head and neck cancer received i.v.-infusions of amifostine prior to each radiation fraction. In a phase III study, two daily amifostine doses, 200 mg/m² (n=21) and 340 mg/m² (n=18), were compared for protection against radiation induced toxicity. Total radiation dose was 60–70 Gy (2 Gy per fraction), nine patients received concurrent chemotherapy with cisplatin/5-FU. amifostine was usually discontinued after >1 episode of serious toxicity during subsequent treatment sessions.

Results: In 16/39 patients (41%) amifostine was discontinued due to severe adverse effects, which led to discontinuation of the phase III study. In four of 16 patients radiotherapy was delayed due to amifostine related adverse effects for 1–3 days. Discontinuation occurred more often in patients receiving chemotherapy. The results led to a literature review for amifostine treatment during radiotherapy in head and neck cancer patients. Regarding our series and published series using an amifostine schedule comparable to ours, total discontinuation rate was 27% (57/214). Discontinuation was significantly influenced by chemotherapy (P=0.007), but not by amifostine dose (P=0.156).

Conclusion: Daily i.v. administration of amifostine during radiotherapy in head and neck cancer is associated with a high rate of serious adverse effects leading to discontinuation of amifostine treatment and sometimes delay of radiotherapy.     

Abmessung und Analyse der Bezugsfl(a)che von Acetabulum-Prothese-Transplantation in unterschiedlichen K(o)rperlagen

Ziel ist die Analyse der Neigungslage des Beckens im Liegen und im Stehen bzw.die Beobachtung der Stabilit(a)t der Beckenfl(a)che als Beckenfl(a)che für die Acetabulum-Prothese Transplantation. 72 Testpersonen wurden je nach Status ihres Pfannengelenks in 3 Gruppen eingeteilt:Gruppe 1 "mit gesundem Pfannengelenk", Gruppe 2 "mit Arthritis" und Gruppe 3 "nach Implantation der Hüftendoprothese". Unter dem Einsatz von 3D- Digital-Instrument wurde die Fl(a)chen-Neigung vor dem Becken jeweils im Liegen und im Stehen gemessen und die Messwerte wurden verglichen. Die Fl(a)chen-Neigungen vor dem Becken bei allen 3 Gruppen (mit gesundem Pfannengelenk/mit Arthritis/nach Operation) im Liegen sind: 6.37°± 3.70°, 6. 47°± 3.52° und 4.56°±2.39°. Im Stehen sind es 7.33°±3.08°, 6.60°±3.45° und 6.74°±3.43°. Der Fl(a)chen-Neigungsunterschied vor dem Becken im Liegen und im Stehen hat keine grosse Bedeutung (P＞0.05).Die (A)nderung der Fl(a)chen-Neigung vor dem Becken vom Liegen bis zum Stehen ist kleiner als 2.5°.Die Fl(a)che vor dem Becken (pelvic anterior plane, PAP) als Bezugsfl(a)che für Hüftpfanne-Prothese Transplantation bei klinischer Operation ist stabil und verlaβlich.     

Consensus on melanonychia nail plate dermoscopy

This statement, focused on melanonychia and nail plate dermoscopy, is intended to guide medical professionals working with melanonychia and to assist choosing appropriate management for melanonychia patients. The International Study Group on Melanonychia was founded in 2007 and currently has 30 members, including nail experts and dermatopathologists with special expertise in nails. The need for common definitions of nail plate dermoscopy was addressed during the Second Meeting of this Group held in February 2008. Prior to this meeting and to date (2010) there have been no evidence-based guidelines on the use of dermoscopy in the management of nail pigmentation.