Psychische Probleme von Patienten unter Knochenmarktransplantation während der Isolation

Zusammenfassung Patienten mit Tumorerkrankungen sind extremen psychischen Belastungen ausgesetzt. Ungef?hr 50 % aller Krebspatienten erfüllen die diagnostischen Kriterien einer psychischen St?rung. Neben den bekannten Belastungsfaktoren k?nnen neuere intensive Behandlungssettings, wie z. B. die Knochenmarktransplantation unter Isolationsbedingungen, einen weiteren Stressor darstellen. Im Verlauf eines seit ca. 2 Jahren bestehenden Liaisondienstes der Univ.-Klinik für Psychiatrie in Innsbruck an der Station für Knochenmarktransplantation an der Univ.-Klinik für Innere Medizin wurden 40 Patienten psychoonkologisch betreut. Das Auftreten einer krankheitswertigen psychischen St?rung wurde nach den Kriterien von DSM III-R diagnostiziert. Die vorliegende Arbeit gibt Aufschlu?über die Diagnosenverteilungen und beleuchtet die jeweiligen spezifischen therapeutischen Interventionen.      

Evaluation of Noncompletion Bias and Long-Term Adherence in a 10-Year Patient-Reported Outcome Monitoring Program in Clinical Routine

Background

Currently there is little knowledge on real-life sustainability of routine patient-reported outcome (PRO) measurement and the representativeness of collected data.

Pathology of renal cancer and its metastases

The pretherapeutic classification of renal carcinomas includes the assessment of the tumor stage, the histological gross pattern, the cytological features, and the histopathological grading. As to the local tumor extension the perinephric invasion and renal vein involvement are the most important prognostic features. The presence of metastases dramatically alters survival. Histologically, compact, tubular, and papillary growth patterns are differentiated. Furthermore, the verification of the cell types in renal carcinomas is of prognostic significance. The clear cell carcinomas are opposed to the granular cell and spindle-shaped/pleomorphic types with poor prognosis. Rarely tumors consist of so-called "chromophobe" cells with finely reticular cytoplasms. They closely resemble clear cell carcinomas and exhibit a similar biological behaviour. According to the grade of atypia in renal carcinomas three grades of malignancy are distinguished. Conclusively, the tumor grade and the tumor cell type are the most reliable indicators of the malignant potential of renal carcinomas.     

German value sets for the EORTC QLU-C10D,a cancer-specific utility instrument based on the EORTC QLQ-C30

Quality of Life Research - The EORTC QLU-C10D is a new multi-attribute utility instrument derived from the EORTC QLQ-C30, a widely used cancer-specific quality of life questionnaire. It covers ten...     

EORTC QLQ-C30 and FACT-BMT for the measurement of quality of life in bone marrow transplant recipients: a comparison

The purpose of the study was to compare two different quality-of-life self-rating instruments, namely the EORTC QLQ-C30, developed by the quality-of-life study group of the European Organisation for Research and Treatment of Cancer, and the FACT-BMT (version 3), the Functional Assessment of Cancer Therapy - Bone Marrow Transplantation scale, which is the FACT-G(eneral measure) in combination with a module developed specifically for evaluating quality of life of bone marrow transplant (BMT) patients. Fifty-six BMT recipients completed both the EORTC QLQ-C30 and the FACT-BMT (German language version) during the same session. Questionnaire data were analyzed on a subscale basis using correlation analysis and multiple linear regression. Correlations between corresponding subscales of EORTC QLQ-C30 and the FACT-BMT ranged from r=0.30 for the emotional domain (poor agreement) to r=0.77 for global QOL (good agreement). This suggests that the instruments, despite considerable overlap, possibly focus on different aspects of QOL, in particular in addressing emotional and social issues of BMT patients. It appears that the FACT-BMT gives a more comprehensive overview regarding the multidimensional construct of quality of life. The EORTC QLQ-C30 gives more insight into the physical aspects of quality of life and helps to identify symptoms which effectively decrease quality of life from the patient's perspective. The QLQ-C30 might be improved by the incorporation of a BMT-specific module currently under development. We therefore conclude that neither of the two instruments can be replaced by the other in the assessment of QOL of BMT patients and that a direct comparison of results obtained with the two instruments is likely to be misleading.     

Outcome after repeat resection of liver metastases from colorectal cancer

Introduction

Although advances in multimodal treatment have led to prolongation of survival in patients after resection of colorectal liver metastasis (CRC-LM), most patients develop recurrence, which is often confined to the liver. Repeat hepatic resection (RHR) may prolong survival or even provide cure in selected patients. We evaluated the perioperative and long-term outcomes after RHR for CRC-LM in a single institution series.

Patients and methods

Since 1999, 92 repeat hepatic resections (63 % wedge/segmental, 37 % hemihepatectomy or greater) for recurrent CRC-LM were performed in 80 patients. Median interval from initial liver resection to first RHR was 1.25 years. Any kind of chemotherapy (CTx) had been given in 88 % before RHR. Neoadjuvant CTx was given in 38 %.

Results

Hepatic margin-negative resection was achieved in 79 %. Mortality was 3.8 %. Overall complication rates were 53 %, including infection (17 %), operative re-intervention (12 %), and hepatic failure (5.4 %). Overall 5-year survival after first RHR was 50.3 %. Univariately, primary tumor stage, the extent of liver resection, postoperative complications, and the overall resection margin correlated with survival. By multivariate analysis, primary T stage, size of metastasis, and overall R0 resection influenced survival. Survival was not independently influenced by hepatic resection margins or (neoadjuvant) CTx.

Conclusions

Repeat hepatic resection for recurrent CRC-LM can be performed with low mortality and acceptable morbidity. Survival after repeat hepatic resection in this selected group of patients is encouraging and comparable to results after first liver resections.     

Elasto-inertial turbulence

Turbulence is ubiquitous in nature, yet even for the case of ordinary Newtonian fluids like water, our understanding of this phenomenon is limited. Many liquids of practical importance are more complicated (e.g., blood, polymer melts, paints), however; they exhibit elastic as well as viscous characteristics, and the relation between stress and strain is nonlinear. We demonstrate here for a model system of such complex fluids that at high shear rates, turbulence is not simply modified as previously believed but is suppressed and replaced by a different type of disordered motion, elasto-inertial turbulence. Elasto-inertial turbulence is found to occur at much lower Reynolds numbers than Newtonian turbulence, and the dynamical properties differ significantly. The friction scaling observed coincides with the so-called “maximum drag reduction” asymptote, which is exhibited by a wide range of viscoelastic fluids.