[Improvement of lasting effects in outpatient pulmonary rehabilitation with special regard to exercise therapy and sports]. / Verbesserung von Nachhaltigkeitseffekten in der ambulanten pneumologischen Rehabilitation unter besonderer Berücksichtigung der Sporttherapie.

BACKGROUND: The aim of this study was to evaluate the effects of outpatient medical rehabilitation (OMR) mainly composed of exercise therapy and sports for patients with asbestosis. Following the Hamburg model, the OMR focuses on keeping up lasting effects. METHOD: In the frame of a pre-experimental study, 113 male asbestosis patients aged 66.1+/-5.8 years participated 6 hrs. a day five times a week over a period of three weeks in phase 1 of the OMR consisting of evidence-based contents of the pulmonary rehabilitation. Directly after that further therapeutic applications with the main focus on exercise therapy and sports were applied for 3 hrs. once a week over a period of twelve weeks (phase 2). After phase 2 the rehabilitation centre led the patients into sports groups near their places of residence (phase 3). The effects of the OMR were evaluated at the beginning (T1), at the end of phase 1 (T2) and phase 2 (T3) as well as 6 (T4) and 18 months (T5) after T3 by means of a suitable assessment. RESULTS: Compared to T1 physical fitness (6-minute Walk Test, Hand-Force Test) as well as health-related quality of life (SF-36), dyspnea (BDI/TDI) and oxygen partial pressure (pO2) were significantly improved in T2. These positive effects could be confirmed in T3. 89 patients (79%) were doing health-related sports regularly 6 and 18 months after T3 and could preserve their health outcome in T4 and T5, while the effects of rehabilitation of the 24 patients breaking off any sporting activities wore off again down to and even below the starting condition at T1. CONCLUSIONS: In spite of a restrictive pulmonary disease, specific exercise therapy and sports are able to mobilize physical reserves of performance and induce an increasing quality of life as well as a higher resilience in activities of daily living. These positive effects could be stabilized persistently by a regular training once a week. Thus, the results emphasize the necessity to include strategies of aftercare in the concept of rehabilitation.

[Short- and long-term effects of the outpatient medical rehabilitation for patients with asbestosis]. / Kurz- und langfristige Effekte der Ambulanten Medizinischen Rehabilitation für Patienten mit Asbestose.

BACKGROUND: The aim of this study was to evaluate the effects of an outpatient medical rehabilitation (OMR) mainly composed of exercise therapy and sports for patients with asbestosis. Following the model of Hamburg the OMR focuses on keeping up lasting effects. METHODS: In the frame of a pre-experimental study 104 male patients aged 65.7 +/- 5.5 years suffering asbestosis carried out over a period of three weeks 5 times weekly 6 h at a time phase 1 of the OMR consisting of evidence-based contents of the pulmonary rehabilitation. Directly after that further therapeutic applications with the main focus on exercise therapy and sports were applied over a period of 12 weeks one time weekly 3 h at a time (phase 2). After phase 2 the rehabilitation centre led the patients into sports groups near at place of residence (phase 3). The effects of the OMR were evaluated at the beginning (T1), at the end of phase 1 (T2) and phase 2 (T3) as well as 6 (T4) and 18 months (T5) after T3 by means of a suitable assessment. RESULTS: Compared to T1 physical fitness (6-minute Walk Test, Hand-Force Test, PWC Test) as well as health-related quality of life (SF-36) of the patients were significantly improved in T2. Whereas the parameter "vital capacity" and "forced expiratory volume" showed no change over the period of investigation data of "oxygen partial pressure" was significantly increased, too. These positive effects could be confirmed in T3. 82 patients (79%) were doing sports due to health regularly still 6 and 18 months after T3 and could preserve their health outcome in T4 and T5, while the effects of rehabilitation of the 22 patients breaking off any sporting activities wore off again to and even below starting condition in T1. CONCLUSIONS: In spite of a restrictive pulmonary disease specific exercise therapy and sports are able to mobilize physical reserves of performance and induce an increasing quality of life as well as a higher resilience in activities of daily living. These positive effects could be stabilized persistently by a regular training one time weekly. That way the results emphasize the necessity to put strategies of aftercare into the concept of rehabilitation.

Ifosfamide, carboplatin and etoposide combined with 41.8 degrees C whole body hyperthermia for malignant pleural mesothelioma.

We performed a phase II study combining 41.8 degrees C whole body hyperthermia with ICE chemotherapy, i.e. ifosfamide (5 g/m(2)), carboplatin (300 mg/m(2)) and etoposide (150 mg/m(2) on days 2 and 3), administered every 4 weeks, for patients with malignant pleural mesothelioma. Of 27 chemonäive, non-metastatic patients enrolled, 25 patients were evaluable for response. Overall response rate was 20% (five partial remissions; 95% CI 8.9-39.1%). Median survival time from the start of treatment for all patients was 76.6 weeks (95% CI 65.4-87.8 weeks). Progression free survival for all patients measured 29.6 weeks (95% CI 24.4-34.7 weeks). One year overall survival was 68% and 2 year overall survival was 20%. Major treatment toxicities included grade 3/4 neutropenia and thrombocytopenia in 74 and 33% of treatment cycles, respectively. One patient died due to sepsis. These promising results are consistent with continued clinical investigation; a phase III clinical trial with whole body hyperthermia as the independent variable has been initiated.