Sleep habits and sleep complaints in Austria: current self-reported data on sleep behaviour, sleep disturbances and their treatment.

OBJECTIVES: To acquire current information on sleep habits, disturbances and treatment options in the adult population of Austria and compare results with previously collected data. MATERIALS AND METHODS: A representative sample of the Austrian population (women: n = 522, men: n = 478). RESULTS: Seventy-five percent reported daily sleep-duration between 6 and 8 h. In 76%, sleep latency was <30 min, 15% described difficulties in sleep maintenance. Longer sleep on weekends was prevalent in 54%, 23% took a nap. Concerning sleep environment, 31% reported sleeping alone; the rest had a constant or occasional bed partner. Sleep disturbances such as sleep disruption or prolonged sleep latency were reported by 18%. Predominant symptoms included snoring/apneas (22%), nightmares (22%) and restless legs (21%). Daytime tiredness was reported by 17% and sleepiness by 20%. Twenty-four percent did not take treatment. Only 7% asked for medical help: 96% consulted their physician; 47% tried to change their way of living. Sleep promoting drugs were taken by 7%. Sleep improving measures were: sleep promoters (45%), general measures (20%), consultation of general practitioner (20%), psychotherapy (6%), and technical tools (3%). Comparison with a dataset of 1993 revealed only a slight increase in short sleepers and a slight decrease in long sleepers. CONCLUSIONS: Subjectively reported sleep disorders proved to be relatively stable between 1993 and 2007.

Continuous hyperfractionated accelerated radiotherapy with/without mitomycin C in head and neck cancer.

PURPOSE: To evaluate the effect of mitomycin C to an accelerated hyperfractionated radiation therapy. The aim was to test a very short schedule with/without mitomycin C (MMC) with conventional fractionation in histologically verified squamous cell carcinoma of the head and neck region. METHODS AND MATERIALS: From October 1990 to December 1996, 188 patients entered the trial. Tumors originated in the oral cavity in 54, oropharynx in 82, larynx in 20, and hypopharynx in 32 cases, respectively. Patients' stages were predominantly T3 and T4 (158/188, 84%) and most patients had lymph node metastases (144/188, 77%) at diagnosis. Only 22 patients were female, 166 were male, the median age of patients was 57 years (range 34 to 76 years). Patients were randomized to one of the following three treatment options: conventional fractionation (CF) consisting of 70 Gy in 35 fractions over 7 weeks (65 patients) or continuous hyperfractionated accelerated radiation therapy (V-CHART; 62 patients) or continuous hyperfractionated accelerated radiation therapy with 20 mg/sqm MMC on day 5 (V-CHART + MMC; 61 patients). By the accelerated regimens, the total dose of 55.3 Gy was delivered within 17 consecutive days, by 33 fractions. On day 1, a single dose of 2.5 Gy was given, from day 2 to 17 a dose of 1.65 Gy was delivered twice: the interfraction interval was 6 hours or more. RESULTS: Mucositis was very intense after accelerated therapy, most patients experiencing a grade III/IV reaction. The mucosal reaction did not differ whether MMC was administered or not. Patients treated by accelerated fractionation experienced a confluent mucosal reaction 12-14 days following start of therapy and recovered (no reaction) within 6 weeks. The skin reaction was not considered different in the three treatment groups. Those patients treated with additional chemotherapy experienced a grade III/IV hematologic toxicity in 12/61 patients. Initial complete response (CR) was recorded in 43% following CF, 58% after V-CHART, and 67% after V-CHART + MMC, respectively (p < 0.05). Actuarial survival (Kaplan-Meier) was significantly improved in the combined treated patients. Local tumor control was 28%, 32%, and 56% following CF, V-CHART, and V-CHART + MMC, respectively (p < 0.05). CONCLUSION: We conclude that our continuous hyperfractionated accelerated radiation therapy regimen is equal to conventional fractionation, suggesting that by shortening the overall treatment time from 7 weeks to 17 days a reduction in dose from 70 Gy to 55.3 Gy is possible, with maintenance of local tumor control rates. The administration of MMC to the accelerated regimen is tolerable and improves the outcome for patients significantly.

Electron beam therapy in treatment of parotid neoplasm.

In a retrospective analysis, 42 patients with malignant primary tumor of the parotid gland were evaluated considering survival, local recurrence and tolerance of treatment. All patients referred to radiotherapy were treated by electron beam (10-15 MeV) and followed for more than 5 years. Postoperative radiotherapy after radical operation, with no macroscopic disease, was performed in 18 patients, 7 of whom were treated by radical re-operation and radiation of a recurrent parotid neoplasm. In these groups, the local recurrence rate was 4/18 (22%) and 2/7 (29%), the 5-year survival rate was 9/18 (50%) and 5/7 (71%). In 17 patients, radiotherapy started with gross tumor left behind. This group showed a local recurrence rate of 10/17 (59%) and a 5-year survival of 7/17 (41%). Treatment was well tolerated with no major sequelae. Local tumor control and its impact on survival is discussed.

Sonography of the tongue and floor of mouth. Part II: Neoplasms of the tongue.

Frequently, correct evaluation of space-occupying lesions in the tongue is not possible with clinical methods only. In an attempt to assess the value of sonography in the detection of tongue lesions, we used submental sonography to examine 62 patients with suspicious palpatory findings upon physical examination of the tongue. Ultrasound detected 45 out of 47 tumours that were eventually confirmed either by surgery or by biopsy. Inadequate technique was the only factor that affected the detection rate. Sonography appears to be a reasonable guide in determining size and site of a tumour of the tongue. Thus, more precision in therapy planning may be achieved.

[Sonography in malignant tonsillar tumors]. / Sonographie bei malignen Tonsillentumoren.

In this retrospective study the value of sonography in the preoperative staging of malignant tumours of the tonsils was evaluated in 36 patients. According to our results sonography is indicated in small tumours. In greater tumours, especially if bone destruction could be expected, MR or CT should be performed additionally to sonography. Good results were achieved in assessing the infiltration of the tongue with or without crossing the midline (accuracy 92 to 97%) and the detection of cervical lymph node metastasis (accuracy 94%).

[CT staging of laryngeal carcinoma]. / CT-Staging des Larynxkarzinoms.

In the pre-operative staging of laryngeal carcinoma CT is of great clinical importance. We examined 20 cases of laryngeal cancer. In 20% of the cases, the CT evaluation indicated more advanced stages, thereby correcting the results of clinical staging. In 65% of the cases, clinical staging showed the same results as CT. 3 glottis tumours (15% of the patients) could not be identified by CT.

[Realtime sonography in the diagnosis and follow-up of malignant tongue tumors. II. Detection and staging]. / Real-time-Sonographie in Diagnostik und Verlaufskontrolle maligner Zungentumoren.Teil II: Nachweis und Staging.

92 sonographic examinations performed in 62 patients were evaluated to determine the possible application of sonography in the diagnosis and follow-up of malignant tumours of the tongue. Squamous cell carcinomas were by far dominant and proved to be hypoechoic, mainly inhomogeneous and ill-defined masses. In most cases, they ranged between 2 and 4 cm. in diameter. In 50% of the lesions an infiltration of the pharynx wall was confirmed, and exulcerations were correctly detected by sonography in 75%. In preoperative determination of the size of the tumour, sonography correctly detected the size in 93% of the cases and was thus markedly superior to the clinical palpatory examination, which determined a mere 43% correctly. Sonography should be included in the pretherapeutic staging of tumours of the tongue to objectify the clinical findings. It is also adequate to document tumour behaviour during radiation.

Interstitial radiotherapy with Ir-192 as a palliative treatment modality in head and neck cancer.

In selected patients with advanced head and neck cancer interstitial radiotherapy with Ir-192 can be used as a palliative treatment. Using two cases as examples, we report on our experiences with 19 patients.

[Clinical experience with danazol treatment of endometriosis and mastopathy]. / Klinische Erfahrungen mit Danazoltherapie bei Endometriose und Mastopathie.

26 women presenting with internal and external endometriosis and 27 women with chronic cystic mastopathy and mastodyny received 400 mg danazol-a 17-ethinyltestosterone derivate-daily for 3 to 6 months. Before, during and after completion of treatment clinical and endocrinological investigation as well haematological examinations and determinations of blood and urinary chemistry were carried out. In cases of mastopathy plate thermography and mammography were performed; in endometriosis the diagnosis was verified by laparoscopy or-tomy. An improvement in, or disappearance of dysmenorrhoea and pelvic pain was observed in the endometriosis group. At laparoscopy or -tomy a decrease in, but not a complete disappearance of endometriotic foci was seen. A most favourable effect of danazol was seen in mastodyny. A change in plate thermographic or mammographic findings was observed on only a few patients. A significant fall in 17 beta-oestradiol after one month and a slight decrease in basal LH levels (statistical trend) were observed. FSH and HPRL levels were not significantly affected. Ovulation was mostly suppressed, but serum progesterone values were found several times to be in the range characteristic of severe luteal insufficiency (100 to 1500 pg/ml). Hence, not only amenorrhoea, but also breakthrough bleeding occurred. The observed side affects can be ascribed to anabolic (weight gain), androgenic (acne, hirsutism) and hypoestronic (atrophic vaginitis, hot flushes, restlessness) symptomatology.

[The influence of socio-economic factors on the results of a prematury-Dysmaturity prevention programme (author's transl)]. / Einfluss sozialer Faktoren auf die Ergebnisse eines gezielten Frühgeburtenpräventionsprogrammes

All high-risk gravidae with regard to prematurity and dysmaturity (PDP programme) were collected over a time-limited period. More than two thirds (n = 72) of these women were submitted to intensive care (PDP group); one third (n = 33) (control group) refused intensive care. Furthermore, socio-economic factors were taken into consideration in this study and appropriate classification into 4 groups was undertaken. Gravidae of a higher social class were more often willing to undergo intensive care than gravidae of a lower class. In the PDP group 75% of the gravidae were delivered after the end of the 36th gestational week and 51% of the gravidae in the control group. A similar relationship was found in regard to the birth weight of the newborn infants: in the PDP group 74.4% of the babies weighed over 2500 g at birth in contrast to the respective figure of 42.9% in the control group. However, this socio-economic study shows that the results of intensive care are much more successful in women from a lower social stata than in women from a higher social class.

[Immunoglobulin A serum antibodies against the capsid antigen of Epstein-Barr virus in the differential diagnosis and follow-up of nasopharyngeal cancer]. / Immunglobulin-A-Serumantikörper gegen das Kapsidantigen des Epstein-Barr-Virus zur Differentialdiagnose und Verlaufskontrolle des Nasopharynxkarzinoms.

IgA antibodies to Epstein-Barr virus capsid antigen (IgA anti-VCA) can be detected in sera of patients with certain types of nasopharyngeal carcinoma (NPC). IgA anti-VCA titres were determined by the indirect immunofluorescence technique. 17 control patients with benign diseases or carcinomas of the head and neck other than NPC had negative IgA anti-VCA titres less than or equal to 1:16. NPC was diagnosed histologically according to the Cologne modification of the WHO classification. Among 16 cases of untreated or recurrent NPC, a rare disease in Europe, seen over the past three years, those with undifferentiated carcinomas with and without lymphoid stroma and the non-keratinizing carcinomas with lymphoid stroma were IgA anti-VCA positive (1:32 to 1:512), whereas patients with squamous cell carcinomas were negative. In four cases the primary tumour had not been diagnosed by other ENT doctors in spite of known regional or distant metastases consisting of undifferentiated carcinomas with or without lymphoid stroma. IgA anti-VCA antibodies in the sera of these patients indicated the probable site of the primary tumour. NPC was verified by biopsy in all these cases. In 2 serologically negative patients the original diagnosis of undifferentiated NPC with lymphoid stroma had to be revised to malignant Non-Hodgkin lymphoma. In the follow-up of 6 NPC patients the trend of changes in IgA anti-VCA titres correlated with the course of the disease, but the minute tumour-related changes could be detected only when at least two previous sera of the same patient were included in every test.(ABSTRACT TRUNCATED AT 250 WORDS)

[Comparative morphological investigations of human ovarian follicles and their oocytes (author's transl)]. / Vergleichende morphologische Untersuchungen der Wand von Bläschenfollikeln des menschlichen Ovars und deren Eizellen

During gynaecological operations on 27 women aged 20 to 52 years, all visible follicles were punctured and 42 oocytes removed for investigation partly by phase-contrast microscope and partly by semi-thin slides. specimens of the walls of the follicles WERE REMOVED AND EXAMINED HIstologically. Furthermore, the activity of steroid-3 beta-ol dehydrogenase was demonstrated histochemically in 14 cases. Comparative investigations of the walls of the follicles and their oocytes gave the following results: 1. In non-ovulatory tertiary follicles (3 to 12 mm in diameter) with no, or very little luteinization of the theca interna and a granulosa of 3 to 10 cell layers, steroid-3 beta-ol dehydrogenase activity was only found in the theca interna. In 5 out of 23 follicles, the oocytes showed early or advanced signs of degeneration. Thus, atresia of the follicles probably occurs after degeneration of the oocytes. 2. 12 follicles (8 to 30 mm in diameter) showed distinct luteinization of the theca and steroid-3 beta-ol dehydrogenase activity in the theca interna, as well as in the granulosa. 4 of these follicles (all at least 20 mm in diameter) showed oocytes with typical pre-ovulatory changes. In 3 other cases with a similar morphological picture of the follicular wall specimens, the oocytes showed no preovulatory changes. The conclusion is drawn that the functional differentiation of the wall of the follicle induces the preparation of the oocyte for ovulation. On the other hand, 5 similar follicles already had degenerating oocytes. It remains doubtful whether such follicles can reach ovulation. 3. In follicles with early or advanced atresia, the oocytes were completely degenerated.

[Changes in obstetric management over the past decade (author's transl)]. / Uber den Wandel der geburtshilflichen Aspekte im letzten Dezennium.

Over a observation period of 10 years (1969-1979) developments in perinatal control techniques, mostly started in the 1st Department of Obstetrics and Gynaecology, University of Vienna, at the beginning of that period, and their effect on the obstetric management are presented. In contrast to a trend of decreasing birth rate for the whole of Austria the annual numbers of deliveries in this hospital remained -after a temporary increase-unchanged. Subpartial cardiotocographic monitoring is presently applied in about 95% of all cases. The frequency of Caesarean sections has risen from below 4% to approximately 8% over the past years. Simultaneously, a shift was observed from vital to preventive fetal indications in Caesarean sections, with a parallel tendency to relatively fewer vaginal-operative deliveries. The uncorrected perinatal mortality rate has been lowered to 1.35%. This decrease is partly due to our efforts to select high-risk pregnancies in order to control them intensively. Thus, ultrasound examinations have been liberally put into practice, e.g. leading to an early diagnosis of multiple pregnancy. Use of tocolytic drugs, as well as surgical closure of the cervix together with intensive prenatal care of pregnant women with a high risk of prematurity have proved their worth as compared with control groups. Due to early and special interest in research and in monitoring of placental insufficiency, hormone determinations and measurements of placental perfusion by isotopes took a fixed place in monitoring of high-risk pregnancies early on during the observation period. Evaluation of fetal lung maturity by amniocentesis now enables us to make well-grounded decisions to stop tocolytic measures or to induce labour. In the latter field the local application of prostaglandins to the cervix by an adaptor has recently opened up new aspects. Attention has also been paid to the emotional aspect by new techniques of psychprophylactic preparation for childbirth and by a policy of rooming-in of mother and child.

[Hormonal and functional parameters in hyperprolactinaemia (author's transl)]. / Hormon- und Funktionsprofile bei Hyperprolaktinämie.

58 women with raised serum prolactin levels and normal hypophyseal-X-ray parameters were subdivided into three groups according to the serum prolactin level (16 to 40, 41 to 80, greater than 80 ng/ml). In addition to the determination of LH, FSH, oestradiol, progesterone and testosterone in the serum and thyroid diagnostic procedures the following hormonal tests were performed: 1. response to gestagen; 2. response to clomiphene; 3. Gn-RH-test for hypophyseal function; 4. ovarian response to administered gonadotropins (only in cases with prolactin levels greater than 80 ng/ml). The grade of menstrual cycle disorders depends on the severity of the observed hyperprolactinaemia. Slight disorders like luteal phase insufficiency, anovulatory cycle and oligomenorrhoea are associated with low- or medium-grade hyperprolactinaemia. Mainly secondary, but also primary amenorrhoea is found in cases with higher serum prolactin levels (greater than 80 ng/ml). In these cases the hypophyseal response to Gn-RH is frequently found (61%) to be negative and, moreover, the ovarian response to administered gonadotropins seems to be diminished. Increasing HPRL levels often appear to be associated with a negative response to the other above-mentioned tests.

[Hormonal and functional parameters in hyperprolactinaemia (author's transl)]. / Hormon- und Funktionsprofile bei Hyperprolaktinämie.

58 women with raised serum prolactin levels and normal hypophyseal X-ray parameters were subdivided into three groups according to the serum prolactin level (16 to 40, 41 to 80, greater than 80 ng/ml). In addition to the determination of LH, FSH, oestradiol, progesterone and testosterone in the serum and thyroid diagnostic procedures the following hormonal tests were performed: 1. response to gestagen; 2. response to clomiphene; 3. Gn-RH-test for hypophyseal function; 4. ovarian response to administered gonadotropins (only in cases with prolactin levels administered gonadotropins (only in cases with prolactin levels greater than 80 ng/ml). The grade of menstrual cycle disorders depends on the severity of the observed hyperprolactinaemia. Slight disorders like luteal phase insufficiency, anovulatory cycle and oligomenorrhoea are associated with low- or medium-grade hyperprolactinaemia. Mainly secondary, but also primary amenorrhoea is found in cases with higher serum prolactin levels (greater than 80 ng/ml). In these cases the hypophyseal response to Gn-RH is frequently found (61%) to be negative and, moreover, the ovarian response to administered gonadotropins seems to be diminished. Increasing HPRL levels often appear to be associated with a negative response to the other above-mentioned tests.

[Mesenteric venous thrombosis--a shift in therapeutic strategy?]. / Mezenteriální zilní trombózy--posun v lécebné strategii?

The authors present a group of nine patients suffering from mesenteric venous thrombosis, which were treated in three hospitals with participation of the first author. Basic principles of diagnostic and therapeutic procedure are summarized and a shift in the treatment strategy over the last 10 years is pointed out. The patient after a very radical intestinal resection may expect to survive and entertain an acceptable quality of life, provided the surgery is followed by an extensive team care in the post-operation period, later accompanied by the care of specialists in modern ways of nutrition.

Abdominal decompression. An approach towards treating placental insufficiency.

The effects of abdominal decompression applied over a period of several weeks (mean 4 weeks) in late pregnancy on biochemical and haemodynamic parameters as well as fetal growth and cardiotocogram patterns were studied in a group of 64 pregnant women with identified placental insufficiency. A statistically significant improvement was demonstrated in the following findings after treatment: placental perfusion measurements 113mIn and unconjugated oestriol and human placental lactogen, both in serum. A positive influence on antepartum cardiotocogram was observed only immediately after therapy. An acceleration of fetal growth (biparietal diameter) could not be demonstrated. Frequency and severity of EPH gestosis did not change after abdominal decompression. Abdominal decompression seems to be a valuable aid in the still unsatisfactory treatment of placental insufficiency.