Operationsrisiko nach neoadjuvanter Therapie gastrointestinaler Karzinome

Zusammenfassung Viele gastrointestinale Tumoren werden im Rahmen multimodaler Therapiekonzepte behandelt. Für den Chirurgen ist die neoadjuvante, präoperative Behandlung von besonderem Interesse, da sie durch therapiebedingte Nebenwirkungen und Komplikationen zu einer Beeinflussung des postoperativen Verlaufs führen kann. Die neoadjuvante Radiochemotherapie ist fester Bestandteil der Therapie beim primären T4-Rektumkarzinom, beim Rektumkarzinomrezidiv und bei tief sitzenden primären Rektumkarzinomen. Durch Erhöhung der R0-Resektionsrate können die lokale Tumorkontrolle verbessert und die Überlebenszeit verlängert werden. Die postoperative Komplikationsrate ist dabei nicht wesentlich erhöht. In der Behandlung des primär resektablen Ösophaguskarzinoms deutet sich ein Vorteil der neoadjuvanten Radiochemotherapie im Vergleich zur alleinigen Chirurgie an. Beim lokal fortgeschrittenen Ösophaguskarzinom bietet die präoperative Radiochemotherapie häufig die einzige Chance zur Resektion, jedoch mit einer deutlich erhöhten postoperativen Morbidität und Mortalität. Die Wirksamkeit und Sicherheit einer neoadjuvanten Chemo- oder kombinierten Radiochemotherapie beim fortgeschrittenen Magenkarzinom wird derzeit im Rahmen von Studienprotokollen untersucht.     

Modern wound dressings: Making and properties. II. Wound dressings containing immobilized proteolytic enzymes (a review)

Published data devoted to making and characterization of the properties of polymeric wound dressings with proteolytic action are reviewed. These data are indicative of individual dependence of the physicochemical properties, activity, and stability of each particular enzyme on the type of polymer matrix and the method of immobilization. In order to obtain wound dressings, which are active in physiological medium and retain their activity upon sterilization, it is necessary to optimize the composition and characteristics of a polymer matrix and the enzyme included into its structure. __________ Translated from Khimiko-Farmatsevticheskii Zhurnal, Vol. 40, No. 8, pp. 24–28, August, 2006.     

Comparison of asthma treatment given in addition to inhaled corticosteroids on airway inflammation and responsiveness.

There is increasing evidence that the assessment of eosinophilic airway inflammation using induced sputum and measurement of airway hyperresponsiveness provides additional, clinically important information concerning asthma control. The aim of this study was to directly compare the effects of different treatments on these markers in patients with asthma and persistent symptoms, despite the use of low-dose inhaled corticosteroids. A double-blind four-way crossover study was performed, which compared a 1-month treatment with budesonide 400 mug b.i.d., additional formoterol, additional montelukast and placebo in 49 patients with uncontrolled asthma despite budesonide 100 mug b.i.d., with each treatment separated by a 4-week washout period. The change in sputum eosinophil count with formoterol (2.4 to 3.8% change, 0.6-fold reduction, 95% confidence interval (CI) 0.5-0.9) differed significantly from placebo (2.8 to 2.5% change, 1.1-fold reduction, 95% CI 0.7-1.6) and high-dose budesonide (2.7 to 1.6% change, 1.6-fold reduction, 95% CI 1.2-2.2). The effects of montelukast did not differ from placebo. The changes in methacholine airway responsiveness were small and did not differ between treatments. High-dose budesonide had the broadest range of beneficial effects on other outcomes, including symptom scores, morning peak expiratory flow and forced expiratory volume in one second. In conclusion, treatment given in addition to low-dose inhaled corticosteroids results in modest benefits. Formoterol and high-dose budesonide have contrasting effects on eosinophilic airway inflammation.     

A profile of invasive cutaneous malignant melanoma in Malta: 1993–2002

BACKGROUND: The incidence of malignant melanoma of the skin has risen in every part of the world where reliable cancer registration data are found. OBJECTIVE: Our study aims to describe the changing incidence of and survival from invasive cutaneous malignant melanoma in Malta, by analysing the data from the 211 cases that were registered at the Malta National Cancer Registry between 1993 and 2002. RESULTS: The age standardized incidence rates for invasive cutaneous malignant melanoma rose from 3.7 per 100,000 population per year for males and 5.1 for females in the first 5-year period, to 8.0 per 100,000 population per year for males and 5.9 for females in the second 5-year period. In both sexes, numbers of thin (< or = 1.0 mm) invasive melanomas increased significantly between 1993 and 2002; males also registered a significant increase in intermediate-thickness (1.01-4.0 mm) melanomas. The increase in numbers of thin and intermediate-thickness melanomas between the two 5-year periods was greatest in patients aged 60 years and over. The overall absolute 5-year survival rate for the first period was 74% and for the second period 92%. CONCLUSION: Numbers of reported cases of invasive cutaneous malignant melanoma in Malta have more than doubled during the 10-year study period. This is mostly due to a marked rise in the diagnosis of thin melanomas in both sexes, occurring mainly in patients aged 60 years and over. As thin melanomas are of low metastasizing potential, this has resulted in an increase in survival between the two 5-year study periods.