[Acral necrosis in metastatic ovarian carcinoma. A single episode of Moschowitz syndrome during gemcitabine chemotherapy]. / Akrale Nekrosen bei metastasiertem Ovarialkarzinom. Ausdruck eines singulären Moschkowitz-Syndroms unter Gemcitabin-Chemotherapie.

For some time now, there have been reports of acral necrosis as a paraneoplasia that may occur in association with a number of different malignant tumours. There have also been a series of reports about acral necrosis associated with chemotherapy with various cytostatics. The treatment of choice if these lesions occur is plasmapheresis. Ultimately, the occurrence of thrombotic microangiopathy (TMA) can only be prevented by close monitoring through regular laboratory controls before each new cycle of chemotherapy. In the differential diagnosis, Raynaud's syndrome should be considered as a premonitory paraneoplasia, a risk factor for the occurrence of acral necrosis in patients with a malignant tumour undergoing chemotherapy, particularly patients with ovarian carcinoma receiving gemcitabine treatment.

[Dignity in the care of terminal ill and dying patients. Definitions and supportive interventions in palliative care]. / Würde in der Begleitung schwer kranker und sterbender Patienten. Begriffsbestimmung und supportive Interventionen in der palliativen Versorgung.

Most patients, family members, health care professional as well as volunteers would agree that dignified care and being allowed to die with dignity are superior and unquestionable goals of palliative care. Although the majority of people have a more or less vague concept of dignity and despite its significance for palliative care, only a few empirical approaches to describe the sense of dignity from patients' and health care professionals' perspectives have been undertaken. However, individual descriptions of the dignity concept and definitions can serve as an impetus to improve the current palliative care practice by the development and evaluation of psychotherapeutic interventions for patients near the end of life and the allocation of resources. This article considers an internationally developed empirical-based model of dignity in severe and terminal ill patients by Chochinov et al. Furthermore, it illustrates the understanding of dignity as well as self-perceived exertions of influence on a patient's dignity from the perspective of health care professionals and volunteers. Psychotherapeutic interventions and strategies are introduced that can help conserve the sense of dignity of patients during palliative care.

[Sentinel node biopsy in breast cancer]. / Wächterlymphknotenbiopsie beim Mammakarzinom.

The international consensus conference from St. Gallen concerning the treatment of early breast cancer concluded in 2003, that sentinel node biopsy was now accepted as method allowing axillary staging in breast cancer. This procedure may avoid complete lymph node dissection in appropriate cases. Since numerous questions associated with the technique are still not defined and the procedure itself is not yet standardized, the German Society of Senology defined the conditions for the routine clinical use of sentinel node biopsy in an interdisciplinary consensus meeting.

Adjuvant treatment of clinical stage I seminoma: is a single course of carboplatin sufficient?

OBJECTIVES: Adjuvant radiotherapy produces excellent disease-free rates in clinical Stage I seminoma. However, concern is growing about side effects and late hazards of this treatment. Carboplatin has been suggested to supplant radiotherapy. To date, there is little experience with this drug in the adjuvant treatment of seminoma. In particular, it is unclear whether one or two courses should be administered. METHODS: In a nonrandomized study, 125 patients with pure clinical Stage I seminoma were given adjuvant carboplatin treatment (400 mg/m2). Ninety-three patients received one course and 32 two courses. The median follow-up time was 48 months. To assess gonadal toxicity, serial measurements of follicle-stimulating hormone (FSH) levels were done. To assess myelotoxicity, platelet counts at 3 and 4 weeks after treatment were monitored. RESULTS: There were no relapses after two courses of carboplatin. After one course of carboplatin, eight relapses occurred (8.6%; 95% confidence interval [CI] 3.79% to 16.2%). All the relapses were located in the para-aortic region, and all the patients were rescued with cisplatin-based chemotherapy. The median time to recurrence was 16 months. The 5-year actuarial progression-free survival rate after one course was 91.1% (95% CI 85.25% to 97.01%). Younger patients (age groups: less than 30 years and 31 to 38 years) had relapses more frequently (P = 0.038) than those in the older age group (greater than 38 years). After 3 weeks, 32% of the patients had platelet counts below 150/nL. The median FSH level increased immediately after treatment, reaching a peak of 13.6 U/L. After 20 months, the median FSH level had returned to the normal range. CONCLUSIONS: One adjuvant course of carboplatin was associated with low myelotoxicity and low gonadal toxicity; however, the recurrence rate was almost 9% and thus unsatisfactory. After two courses of carboplatin, no relapse was observed. Thus, the two-course regimen of carboplatin appears to be equivalent to radiotherapy, and because of its favorable toxicity profile, this regimen should be investigated in randomized trials.

A case of adult ALL with +i(13q) as the sole anomaly.

A case of ALL with +i(13q) as the sole anomaly in a 77-year-old patient is reported. The clinical and cytogenetic findings are discussed.

Treatment of metastatic colorectal carcinoma with a combination of fluorouracil and recombinant interferon alfa-2b: preliminary data of a phase II study.

From March 1990 to January 1991 52 previously untreated patients with metastatic colorectal carcinoma were enrolled in a phase II study with the combination of interferon alfa-2b and fluorouracil (5-FU). 5-FU 750 mg/m2 per day was administered as continuous infusion for 5 days, then weekly in a dose of 750 mg/m2 as IV push injection starting on day 15. Interferon alfa-2b (Intron A, ESSEX Pharma) 9 x 10(6) units was given subcutaneously three times per week. Response to therapy was evaluated after 3 and 6 months. So far, data on response rates and toxicity are available in 32 patients: partial remission, 10 patients (31%); stable disease, nine patients (28%); progressive disease, 12 patients (37%); toxic deaths, two patients (6%). Projected median survival has not been reached after 11 months. In about one third of the patients severe side effects occurred with leukopenia grade 3 and 4, diarrhea, mucositis and septic complications being the clinically most important. We think that this combination is an effective but toxic regimen in advanced colorectal carcinoma. Further studies must reevaluate both the schedule and the doses of the drugs administered.

Phase II trial of 5-fluorouracil and recombinant interferon alfa-2B in metastatic colorectal carcinoma.

Between February 1990 and April 1991, 59 previously untreated patients with progressive and/or symptomatic metastatic colorectal carcinoma were enrolled in a phase II study of 5-fluorouracil (5-FU) and interferon alfa-2b (IFN-alpha). 5-FU 750 mg/m2/day was administered as continuous infusion for 5 days, then weekly in a dose of 750 mg/m2 as intravenous push injection starting on day 15. IFN-alpha 9 MU was given subcutaneously three times a week. Treatment was given for a maximum of 6 months. 55 patients are evaluable for response and 51 for toxicity. 17 patients (31%) achieved a partial remission, 15 (27%) had stable disease and 21 patients (38%) had progressive disease. Median duration of remission was 5 months and median survival for all patients 10 months. Toxicity was important with two treatment-related deaths and severe leukopenia, fever, diarrhoea and mucositis in about one third of the patients. In our opinion, this regimen is effective but rather toxic in metastatic colorectal carcinoma.

[Prognostic value of serum CEA and therapy-induced nonspecific CEA levels in metastasizing breast carcinoma]. / Prognostische Aussage des Serum-CEA und therapiebedingte unspezifische CEA-Verläufe beim metastasierenden Mammakarzinom.

In 57 patients with metastasized breast carcinoma, serum CEA levels (CEA-Ria-Kit, Abbot) were correlated with the clinical course under endocrine or cytostatic therapy. In 20 patients, CEA was determined at intervals of 1 to 3 days over the first 4 weeks of treatment and in 21 patients at intervals of 1-3 weeks. In 16 patients, CEA was determined prior to treatment. The clinical development was judged according to the program of UICC. We found pretreatment CEA values higher than 25 ng/ml serum mostly in patients with liver involvement and in patients with progression under the following therapy. In 22 patients, progress or remission of the disease were correlated with CEA increase or decrease of more than 20% during the first 8 weeks. In 11 patients, we found no correlation between CEA and clinical course. From the remaining 8 cases, CEA levels were out of the measuring range in 6 patients, in 2 patients we were unable to interpret the clinical course doubtlessly. There were no short-termed CEA alternations after the start of the treatment rendering a possible early estimation of the therapy effect. In 5 of 23 patients treated with methylprogesteronacetate and aminoglutethimide a continuous CEA increase developed despite clinical remission. This was not found in 10 patients treated with cytostatic chemotherapy. The pretreatment CEA is a useful prognostic parameter in patients with metastasizing breast cancer. CEA should be determined weekly in patients with increasing CEA levels under therapy and monthly in patients with decreasing CEA levels. The possibility of a tumor-independent CEA rise as a side-effect of treatment must be taken into consideration.

[Possible prevention of adriamycin-induced cardiomyopathy by verapamil. Results of a pilot study]. / Mögliche Prävention der Adriamycin-induzierten Kardiomyopathie durch Verapamil. Ergebnisse einer Pilotstudie.

An increased cytoplasmatic calcium level seems to play an important role in the pathogenesis of Adriamycin (ADM)-induced cardiomyopathy. Experiments have shown that calcium channel blockers such as verapamil may prevent this type of cardiomyopathy in animals, but data are contradictory. In a clinical pilot trial, the left ventricular function of 22 patients undergoing ADM-chemotherapy in combination with verapamil was examined. M-mode echocardiograms were performed parallel to every chemotherapy course. Left ventricular function was determined by fractional shortening rate (FS) and peak fibre shortening velocity (V ef max.). Three 40-mg doses of verapamil were given p.o./day continuously. Data of these patients were compared with a control group of 61 patients treated and checked equally without additional verapamil therapy. In the course of therapy parameters of left ventricular function remained almost constant in the verapamil group but decreased significantly in the control group. In the verapamil group FS changed by -0.05 FS %/100 mg ADM/m2, V ef max. by +0.015 circ./s/100 mg ADM/m2 compared with -2.31 FS % and -0.33 circ./s in the control group (P 0.01 and 0.001, respectively). In the verapamil group no congestive heart failure occurred and no patient showed FS below 30%, whereas in the control group in 23% (14) of the cases ADM therapy had to be stopped because FS fell below 30%. One congestive heart failure was observed. These clinical results suggest that verapamil may be a useful drug for preventing ADM-induced cardiomyopathy but further investigations are necessary.

[Hyperlipoproteinaemia during additional methenolone administration in the treatment of metastasizing carcinoma of the breast]. / Hyperlipoproteinämie bei additiver Behandlung des metastasierenden Mammakarzinoms mit Metenolonönanthat.

The effect of additive administration of methenolone oenanthate (Primobolan) on lipid metabolism was studied in 28 menopausal women with metastasizing carcinoma of the breast. In ten women hyperlipoproteinaemia type IIa was demonstrated in the course of treatment, while in two there was hyperlipoproteinaemia type IIb. One of the latter patients had a myocardial infarction in the course of treatment. There was no relationship between the level of hypercholesterolaemia and the methenolone dosage. Nor was it possible to classify the type of cholesterolaemia as a bile stasis syndrome. The hyperlipoproteinaemia regressed in every case once methenolone treatment was discontinued.

[Abnormal left-ventricular contraction and filling in patients receiving adriamycin for solid tumours (author's transl)]. / Abnormes Kontraktions- und Füllverhalten des linken Ventrikels bei Tumorpatienten unter Adriamycin-Therapie. Eine echokardiographische Studie.

Various ventricular functions, as obtained by echocardiography (M-mode), were measured on 14 patients with solid tumours receiving adriamycin (mean total dosage 330 +/- 188 mg/m2 body surface area), the results being compared with those on 14 normal subjects of similar ages. There were statistically highly significant differences between the two groups. In those receiving the drug there was (1) a decrease in the percentage shortening fraction and (2) a reduction in the maximal velocity of endocardial circumferential fibre shortening, as expression of reduced contractility. The abnormal filling was characterized by a marked decrease in maximal velocity of endocardial fibre stretch, diminution of diameter increase during the rapid filling phase, and a shortened duration of the rapid filling phase. There was no electrocardiographic or radiological evidence of myocardial damage. The findings suggest that it will be possible by serial echocardiography to recognize a higher tolerance to the drug in some individuals and, at the same time, reveal abnormal contractility and filling due to adriamycin before irreversible heart failure has occurred.