[Pain perception of adolescents with chronic functional pain : adaptation and psychometric validation of the Pain Perception Scale (SES) by Geissner]. / Schmerzempfindung bei Jugendlichen mit chronischen funktionellen Schmerzen : Adaptation und psychometrische Uberprüfung der Schmerzempfindungsskala (SES) nach Geissner.

BACKGROUND: Pain perception is a central aspect of the multidimensional model of chronic pain. Up to now, validated measurement tools are lacking in the German language for measuring pain perception in adolescents. The aim of this study was to examine and adapt the well-established Pain Perception Scale for Adults by Geissner (SES) for use in adolescents with chronic pain to provide a measure for clinical diagnosis and evaluation of treatment effects. MATERIAL AND METHODS: Principal component, reliability and item analyses were conducted on a sample with 139 adolescents. To test validity, age and sex effects, correlations with pain-related constructs, differences between treatment groups (inpatients vs outpatients) and concordance between adolescents and their parents were analysed. RESULTS: Findings support a two-factor solution with one affective and one sensory factor; three additional sensory items were included in the final version. The scales show good internal consistency. Consistent with hypotheses, we found significant correlations with pain characteristics, emotional and cognitive variables as well as pain-related disability. Inpatients and outpatients show a significant difference in affective pain perception. Concordance between parents and adolescents was high. CONCLUSION: With this questionnaire there is now a validated German assessment tool to measure pain perception in adolescents with chronic pain (Pain Perception Scale for Adolescents, SES-J). Due to its practicability it is suitable for clinical application.

[German Pain Questionnaire for Children, Adolescents and Parents (DSF-KJ). A multimodal questionnaire for diagnosis and treatment of children and adolescents suffering from chronic pain]. / Deutscher Schmerzfragebogen für Kinder, Jugendliche und deren Eltern (DSF-KJ). Entwicklung und Anwendung eines multimodalen Fragebogens zur Diagnostik und Therapie chronischer Schmerzen im Kindes- und Jugendalter.

BACKGROUND: A multidimensional assessment of chronic pain is the most important tool for diagnosis and treatment. While the German Pain Questionnaire is routinely implemented in the treatment of adults with chronic pain, similar questionnaires are scarce for children and adolescents. It was the aim of the present study to report on the development and quality of a multimodal questionnaire assessing all relevant aspects of chronic pain in children and adolescents. The quality of the questionnaire was assessed (1) by implementing the questionnaire in a sample of children and adolescents suffering from chronic pain (aged 4-18 years), (2) by analysing missing items in the child, adolescent and parent version and (3) by analysing experts' ratings of the questionnaire. MATERIAL AND METHODS: The German Pain Questionnaire for Children, Adolescents and Parents (DSF-KJ) was developed on the basis of the biopsychosocial model of chronic pain in experts' meetings. The DSF-KJ entails an assessment of sociodemographic variables, pain characteristics, triggering factors, previous pain treatment, pain-related disability and cognitive and emotional factors related to the pain experience. A total of 284 children and adolescents who presented for pain treatment in our tertiary institute completed the DSF-KJ. Eleven pain experts rated the questionnaire regarding its utility for diagnosis and treatment. RESULTS: With the use of the DSF-KJ, a detailed sample description was derived on the basis of the biopsychosocial model. More adolescent girls than boys presented to the institute. The majority of the children and adolescents suffered from headache and were severely affected by their chronic pain. Children and adolescents displayed similar pain characteristics. However, adolescents were more disabled due to chronic pain and had already undergone a variety of pain treatments. These differences may reflect an ongoing chronification in adolescents. Children, adolescents and their parents filled in the questionnaire thoroughly with very few missing items. The experts rated the questionnaire as very useful for diagnosis and treatment. CONCLUSION: The DSF-KJ provides a standardized assessment and comprehensive description of paediatric chronic pain problems and facilitates medical and psychological diagnostic and therapeutic decisions. The preliminary results suggest that the questionnaire is a clinically useful and practical assessment tool for children and adolescents with chronic pain.

[Pain-related disability in adolescents suffering from chronic pain. Preliminary examination of the Pediatric Pain Disability Index (P-PDI)]. / Schmerzbezogene Beeinträchtigung bei Jugendlichen mit chronischen Schmerzen. Erste Uberprüfung des Pediatric Pain Disability Index (P-PDI).

BACKGROUND: Pain-related disability affects many children and adolescents suffering from chronic pain and may exert an impact on all areas of their lives. Reduction of pain-related disability is, therefore, a fundamental aim of treatment; however, no validated means exist to assess pain-related disability in children and adolescents. The aim of this study was to translate the Pediatric Pain Disability Index (P-PDI) of Varni into German and to investigate its psychometric qualities. METHODS: Principal component and item analyses were conducted on outpatient (n=163) and inpatient samples (n=167) of adolescents suffering from chronic pain. Changes in pain-related disability 3 months after starting treatment were analysed in an outpatient sample of 110 adolescents. Correlations between pain-related disability, emotional variables and school absence as well as concordance with parents' ratings were investigated. RESULTS: The P-PDI is a one-dimensional assessment tool with sufficient reliability. There were significant correlations between pain-related disability and pain intensity and school absence but not with pain duration, fear and depression. Parents and adolescents ratings correlated significantly, but 57% of parents underestimated the pain-related disability of their children. CONCLUSION: There is now a validated German version of the P-PDI to measure pain-related disability in adolescents suffering from chronic pain, which can be used in studies investigating treatment effectiveness.

Ifosfamide plus etoposide combined with regional hyperthermia in patients with locally advanced sarcomas: a phase II study.

From July 1986 to July 1989, 40 patients (92% pretreated) with deep-seated, advanced soft tissue sarcomas (STS, 25 patients), Ewing's sarcomas (ES, eight patients), osteosarcomas (OS, three patients) and chondrosarcomas (ChS, four patients) were treated at the University of Munich in a protocol involving regional hyperthermia (RHT) combined with ifosfamide plus etoposide. A total of 265 RHT treatments (mean, 6.6 RHT per patient) were applied including 33 pelvic, four extremity, and three abdominal sites. The mean tumor volume was 537 cc (range, 50 to 2,980 cc). For systemic chemotherapy, all patients received ifosfamide (1.5 g/m2, days 1 to 5), etoposide (100 mg/m2, days 1, 3, and 5), and mesna (300 mg/m2 x 4, days 1 to 5) with RHT given only on days 1 and 5 in repeated cycles every 4 weeks. Acute toxicity consisted primarily of pain (57%) combined with local discomfort within the annular phased array applicator (AA) of the BSD hyperthermia system (BSD Medical Corp, Salt Lake City, UT). The average maximum systemic temperature was 37.4 +/- 0.5 degrees C, and there was no indication of enhanced bone marrow toxicity due to the addition of RHT to the systemic chemotherapy. Detailed thermal mapping by invasive thermometry was performed in all patients. In 38 assessable patients, the overall objective response rate was 37%: six complete responses (CRs), four partial responses (PRs), and four favorable histologic responses (FHRs) (95% confidence limits, 22% to 54%). Complete responders are alive and disease-free at 40, 35, 23, 19, 19, and 8 months. Of patients with PR and FHR, two died from metastatic disease after 4 and 17 months and one died from other disease after 27 months. The remaining five patients are stable at 37, 25, 21, 13, and 8 months. Eleven patients showed no change (NC), and 13 patients showed local tumor progression (PD). The mean observation time for all patients was 11.6 months. The time-averaged temperatures (Ts) of all RHT treatments calculated as 20% (T20), 50% (T50), or 90% (T90) of measured tumor sites differed significantly between responders and nonresponders (T20, P = .003; T50, P = .006; and T90, P = .004; respectively). These data support activity for ifosfamide-etoposide combined with RHT in pretreated patients with advanced sarcomas.

Esophageal carcinoma: prognostic features and comparison between blunt transhiatal dissection and transthoracic resection.

Among 86 patients who underwent resection for thoracic esophageal carcinoma between 1982 and 1989, 49 were resected by a transhiatal blunt esophagectomy (THE) and 37 underwent a transthoracic-abdominal esophagectomy (TTE). The two groups were statistically comparable with respect to preoperative characteristics. Overall morbidity and respiratory complications were high for both groups (71% vs 62% and 45% vs 46%; P = NS). The rate of cardiac, renal, neurological and bleeding complications, as well as recurrent nerve injuries was similar in both groups. An anastomotic leak occurred in 39% (19/49) of THE patients and in 11% (4/37) (P < 0.05) of TTE patients. Hospital mortality was 16% (8/49) in the THE group (4 resulting from cervical anastomotic leaks, 4 from respiratory complications) and 13% (5/37) in the TTE patients (1 from myocardial infarction, 4 from respiratory failures; P = NS). Actuarial survival curves for all THE and TTE patients (5-year survival rate: 20% vs 22%) and separate analysis for N0 and N1 tumors revealed no significant difference between these two techniques. Of the different preoperative variables, only tobacco addiction, beside lymph node involvement, was an independent predictor of outcome. Respiratory complications and hospital mortality were significantly lower for the non-smokers and long term survival was significantly higher for the N0 stages.

[Carcinoid tumor of the stomach--aspects of surgical therapy]. / Das Carcinoid des Magens--Aspekte zur chirurgischen Therapie.

Carcinoid tumors of the stomach are rare (0.4% of all malignancies of the stomach). Long-lasting hypergastrinemia, most often due to chronic atrophic gastritis, leads to hyperplasia of ECL-cells in the gastric fundic mucosa with consequent dysplasia or neoplasia. Between 1974 and 1988 four patients underwent surgical treatment after diagnosis of a gastric carcinoid tumor. One patient was treated by local excision, two by subtotal resection and one patient underwent complete gastrectomy. None of the patients had local or distant metastases or died in the follow-up period due to tumor progression. The different approaches to surgical therapy are discussed.