[Evaluation and Utilization - Quality Management in a Paediatric University Outpatient Department]. / Evaluation und Inanspruchnahme - Qualitätssicherung in der pädiatrischen Ambulanz einer Universitätsklinik.

BACKGROUND: Based on an increasing number of outpatient treatments, an extensive demand planning is necessary to ensure the quality of medical care. University outpatient clinics are special parts of this sector and therefore it is necessary that a research demonstrates the nearly uninvestigated position of a paediatric outpatient clinic. PATIENTS: The research at the university hospital for children and adolescents in Leipzig started in 2009 to survey 2283 of in total 9391 patients and the physicians. METHODS: Sociodemographic data as well as economic and medical facts were determined by using questionnaires. In each case a questionnaire was answered by the children or their accompanying persons and a separate one was completed by the respective doctor. RESULTS: The results created a foundation, on the basis of patient volume per day and per daytime. Less than 20% of the children admitted to consult the clinic for their first time. The majority of patients visit them because of a letter of referral. Most of the patients (58%) were younger than 6 years old. Approximately 35% of patients did not come from the city region of Leipzig. CONCLUSION: The investigation evidenced the necessity of a day and night operating institution for children in the region of Leipzig as well as the high specialisation of the outpatient clinic. In need of further investigation is the cooperation between several physicians to find out if this lots of medical examination are necessary or if there took place overlapping.

Leukemia in pregnancy.

Validated data from which conclusions may be drawn about the management of leukemia during pregnancy are sparse. Cytotoxic agents should generally be avoided during the first trimester, when there is an approximately 17% chance of fetal malformation, particularly with folate antagonists. However, acute leukemias demand prompt institution of cytotoxic chemotherapy to maximize the chances of maternal survival. Treatment beyond the first trimester is generally safe if appropriate monitoring and obstetric care are available. Treatment of chronic leukemias can usually be delayed until delivery without compromising maternal health. Treatment of leukemia during pregnancy does not appear to have a significant impact on the future growth and development of the child.

Phase II trial of recombinant human interleukin-2 and interferon-alpha-2a: implications for the treatment of patients with metastatic melanoma.

BACKGROUND: An intensive in-patient Phase II study of continuous infusion recombinant human interleukin-2 (rhIL-2) 3 X 10(6) Roche units (9 MIU/m2)/day plus intramuscular injection of interferon-alpha-2a (rIFN-alpha-2a) 5 x 10(6) U/m2/day, four consecutive days per week, was performed to determine whether four consecutive weeks of treatment every 6 to 8 weeks might yield a response rate of 30 to 40%, supporting an additive or synergistic effect of these agents in patients with metastatic melanoma. METHODS: Eligibility was limited to otherwise healthy metastatic melanoma patients with no brain metastases. Tumor sites were measured at six-week intervals. Toxicity was recorded using the National Cancer Institute's common toxicity criteria. RESULTS: From 1988 through 1989, 23 patients received 47 courses of rhIL-2 plus rIFN-alpha-2a. Fifteen patients (65%) had visceral metastases. Eight patients (35%) had prior systemic chemotherapy. There were two partial responses, both after one course, for a response rate of 8% (95% confidence interval: 1% to 28%). A previously untreated patient had more than 90% diminution in extensive liver, adrenal, duodenal, and soft tissue metastases lasting 9 months. A second patient, who had failed prior chemotherapy, had a 50% reduction in lymph node metastases lasting 8 months. Median overall survival was 10.4 months (21 and 70+ months for the two responders). Cumulative reversible toxicities of debilitating fatigue, malaise, depression, poor appetite, and acute toxicities of hypotension, oliguria, infection, and cortical dysfunction were responsible for dose modifications in 16% of 188 anticipated weeks of treatment, usually near the end of the second or subsequent treatment courses. CONCLUSIONS: This study demonstrates a low response rate and lack of additive benefit for rhIL-2 and rIFN-alpha-2a administered intensively in metastatic melanoma patients. Since this biotherapy regimen, in the same dose and weekly schedule, has yielded substantial clinical activity with chemotherapeutic agents, this activity cannot be significantly attributed to the independent activity of rhIL-2 plus rIFN-alpha-alone.