Correction to: Curative radiation therapy for very elderly bladder cancer patients with localized disease.

In the original version of this article the figure captions of Figs. 1 and 2 were interchanged.

Curative radiation therapy for very elderly bladder cancer patients with localized disease.

PURPOSE: To report the outcomes of a cohort of very elderly muscle-invasive bladder cancer (MIBC) patients treated with contemporary 3D-conformal radiation therapy (3D-CRT) with or without concurrent chemotherapy, after transurethral resection of bladder tumor (TURBT). METHODS: From February 2010 to January 2014, a total of 41 patients older than 75 years, with T2-3 N0-1 high-grade MIBC, a Karnofsky index (KI) of at least 90% and/or a Barthel scale score of at least 95, were treated with TURBT followed by radiotherapy (RT) with or without chemotherapy, and were prospectively followed-up. RESULTS: The mean age of patients was 82 years (range 76-88). Median follow-up was 47 months for surviving patients. Mean Charlson Comorbidity Index (CCI) score was 5 points. 28 patients (68.29%) were T2N0. All received 3D-CRT to a mean dose of 60 Gy (range 48.6-66 Gy), and chemotherapy was delivered to 34 patients (83%). Cause-specific survival (CSS) was 86 and 78.8% at 1 and 5 years, respectively. Patients achieving a complete response lived longer (48 vs 14 m, p = 0.036) than those with a progressive disease, who were more likely to die from cancer than from other causes (HR 3.865, IC95% 1.562-9.562). Dead patients had a longest treatment time (mean 56.78 vs 48.91 days, p = 0.019) than survivors. CONCLUSION: RT with contemporary 3D-CRT techniques after TURBT for MIBC in elderly patients is feasible and well-tolerated. Achieving a maximal response and shortening the total radiation treatment time may improve outcomes and quality of life.

High resolution ultrasound investigation of the temporomandibular joint in patients with chronic polyarthritis.

40 patients with chronic polyarthritis were investigated prospectively. The TMJ was investigated to detect clicking, crepitation, and pain. High resolution ultrasound (HR-US) assessed destructive changes, effusion, and disc dislocation. The results of the clinical investigation and the HR-US investigation were compared using the χ(2) test. The statistical calculation of the correlation between the HR-US results and the clinical TMJ investigation by the χ(2) test showed a significant correlation between TMJ sounds, destructive changes and disc dislocation. A significant correlation between TMJ joint effusion, TMJ pathology and TMJ pain was detected using the χ(2) test. Pain on palpation of the masseter and temporal muscle correlated significantly with TMJ effusion. There was significant correlation between TMD and the HR-US diagnosis of destructive changes and effusion. The significant correlation between TMJ effusion and actual TMJ pain and TMJ pain on palpation shows the ability of HR-US to detect acute TMJ affection with high significance. There was a significant correlation between effusion and pain on palpation of the masticatory muscles, which could be interpreted as the ability of HR-US to determine acute TMD. That any TMD correlated significantly with destructive changes and TMJ effusion suggests that HR-US could detect chronic and acute TMD.

Cosmetic outcome of breast conservative treatment for early stage breast cancer.

PURPOSE: To evaluate the cosmetic outcome of breast conservative therapy and to examine the degree of agreement between the patients' and oncologists' ratings. We also analyze the influence of several factors on cosmesis. METHODS AND MATERIALS: We retrospectively evaluated 145 patients with primary breast cancer treated by local excision and radiotherapy between January 2000 and May 2001. Cosmetic outcome was evaluated by doctors and patients and was scored as excellent, good, fair or poor. RESULTS: 73% of patients rated cosmesis as excellent or good while the percentage was 71% when rated by radiation oncologists. The degree of cosmesis concordance evaluated by oncologists and patients was low (kappa = 0.3). In our study the variables which significantly influence on the cosmetic outcome were concomitant adjuvant chemotherapy (p = 0.04) and radiation therapy boost, either by electron beam or brachytherapy (p = 0.013). CONCLUSION: The cosmetic outcome of breast conserving therapy was good. There was a similar rating by the patient and radiation oncologist, but the level of concordance between patients and doctors was low. Factors that significantly influence the cosmesis appear to be concomitant adjuvant chemotherapy and radiation therapy boost.

Bilateral and subcutaneous palmar nodules in a 2-year-old child suggesting deep granuloma annulare.

Granuloma annulare is a benign, relatively common dermatosis in childhood. The subcutaneous form is rare, and lesions typically occur on the legs, buttocks and scalp. We report a case of a deep granuloma annulare confined to the palms of the hands in a 2-year-old child.

Efficacy of an EMG-biofeedback therapy in fibromyalgia patients. A comparative study of patients with and without abnormality in (MMPI) psychological scales.

OBJECTIVE: The aim of the present study was to investigate the efficacy of EMG-biofeedback in female fibromyalgia patients with and without abnormality in the MMPI. METHODS: According to their MMPI profile out of a total of 24 patients, 12 patients were classified as 'psychologically abnormal' (at least one scale with a T-score higher than 70) and 12 as 'normal'. In a quasi-experimental setting, all patients underwent EMG-biofeedback therapy (12 sessions, twice weekly), after a waiting period of six weeks. Clinical symptoms (pressure point sensitivity, secondary symptoms), subjective pain dimensions as well as quality of life were assessed before and after the waiting period, immediately after the biofeedback training and at a three month follow up. RESULTS: Within the 'psychologically abnormal' patients primarily depressive, hypochondriacal and hysterical symptoms were found. Statistical evaluation showed that 'psychologically normal' patients experience long-term relief from pain measured in terms of pressure point sensitivity; vitality and mental health. 'Psychologically abnormal' patients, on the other hand, showed improvements in all the measured parameters (clinical symptoms, sensory and affective pain components, quality of life) after EMG-biofeedback. Long-term improvement, however, was observed only in pressure point sensitivity and the sensory pain dimension. CONCLUSION: The results suggest, that assessment of FM-patients should not only consist of commonly used ACR diagnostic criteria but should also include psychodiagnostic criteria, as these may co-determine treatment outcome. One approach to treating FM patients with additional psychological abnormality might be combining EMG-biofeedback that enhances self-efficacy with psychotherapy that helps patients to become aware of their basic psychological problems.

Aspergillus osteoarthritis in acute lymphoblastic leukemia.

We report an unusual case of arthritis of the right wrist due to Aspergillus fumigatus without evidence for a generalized infection, following chemotherapy for acute lymphoblastic leukemia. The diagnosis was made by surgical biopsy. Amphotericin-B (Am-B) was not tolerated by the patient. Liposomal preparations of Am-B penetrate poorly into bone and cartilage. Therefore, oral itraconazole was given; the arthritis improved and chemotherapy was continued without infectious complications. Two weeks after complete hematopoietic recovery, an intracranial hemorrhage from a mycotic aneurysm of a brain vessel occurred, although the patient was still receiving itraconazole. We emphasize the importance of prompt and thorough efforts to identify the causative agent in immunocompromised patients with a joint infection. Itraconazole is effective in Aspergillus osteoarthritis but, due to its poor penetration into the brain, the combination with a liposomal formulation of Am-B is recommended.

[Changes of renal blood flow during organ-associated foot reflexology measured by color Doppler sonography]. / Anderung der nierenduchblutung durch organassoziierte reflexzonentherapie am fuss gemessen mit farbkodierter Doppler-sonographie.

Using colour Doppler sonography blood flow changes of the right kidney during foot reflexology were determined in a placebo-controlled, double-blind, randomised study. 32 healthy young adults (17 women, 15 men) were randomly assigned to the verum or placebo group. The verum group received foot reflexology at zones corresponding to the right kidney, the placebo group was treated on other foot zones. Before, during and after foot reflexology the blood flow of three vessels of the right kidney was measured using colour Doppler sonography. Systolic peak velocity and end diastolic peak velocity were measured in cm/s, and the resistive index, a parameter of the vascular resistance, was calculated. The resistive index in the verum group showed a highly significant decrease (p

[Electromyography biofeedback therapy in fibromyalgia]. / EMG-Biofeedback-Therapie bei Fibromyalgie.

Nineteen patients with fibromyalgia underwent a course of treatment with EMG-biofeedback (EMG-BFB) technique. On completion of treatment, there was a statistically significant lowering of sensitivity to pain at pressure points typical for fibromyalgia (p = 0.017), which could be observed also 2 months after completion of treatment. In addition, there was a reduction both in the affective (p = 0.04) and in the sensory (p = 0.007) components of pain. Furthermore, there was a statistically significant improvement in the accompanying disease parameters of sleep disturbance (p = 0.004) and head ache (p = 0.031). Since EMG-BFB training might contribute not only to a reduction of pain and muscle tension but also to an improvement of quality of life, it can be recommended as part of a multimodal pain therapy in fibromyalgia patients.

Oxidative burst of neutrophils in patients with rheumatoid arthritis: influence of various cytokines and medication.

OBJECTIVE: Toxic oxygen products are believed to be implicated in tissue damage in some complex-mediated diseases such as rheumatoid arthritis. In the present study we compared the superoxide (O2) production of polymorphonuclear leukocytes (PMNs) in 21 patients with rheumatoid arthritis (RA) with that of 9 healthy controls, examining the effect of different stimulants and cytokines on the oxidative burst (OB). Since many drugs used in the treatment of RA may alter O2 metabolism, the effects of antirheumatic medication were also studied. METHODS: Generation of superoxide anions was analysed by a flow cytometric method, using the fluorochrome dihydro-rhodamine. As stimulants for OB, we used N-formyl-methionyl-leucyl-phenylalanine (fMLP), which acts via a membrane receptor, and phorbol-myristate acetate (PMA), which acts in a membrane receptor-independent manner. As preactivating substances, TNF-alpha, G-CSF and GM-CSF were applied. RESULTS: In RA patients under treatment with antirheumatic medication, fMLP-induced OB (+/- cytokines) was significantly reduced, while O2 production after stimulation with PMA was similar compared to controls. GM-CSF showed the highest level of preactivation in controls, whereas in RA patients TNF-alpha proved to be most potent. In both controls and RA patients, a combination of GM-CSF or G-CSF with TNF-alpha further enhanced OB. No correlation between OB and clinical data or treatment could be established in RA patients. CONCLUSIONS: There is a reduced cytokine priming capacity for OB in RA patients under antirheumatic medication in spite of the presence of an intact enzyme system of OB. Antirheumatic medication combining multiple drugs capable of decreasing OB might effectively modulate oxidative metabolism.

The safety profile of low-dose cladribine in refractory rheumatoid arthritis. A pilot trial.

Cladribine (2-chlorodeoxyadenosine, 2-CdA) is a newer purine analog with specific toxicity to lymphocytes. As lymphocytes play a major role in rheumatoid arthritis (RA), we assessed the safety profile of low-dose 2-CdA in patients who were refractory to more than three disease-modifying drugs. Five patients were given a subcutaneous dosage of 0.05 mg/kg 2-CdA weekly over a period of 8 weeks. Of the lymphocyte subsets, both T and B cells decreased below the normal range, whereas natural killer cells remained stable. These changes were the only side-effects noted during treatment and 4 weeks afterwards. In one patient a pacemaker was implanted for reasons unlikely to be related to 2-CdA administration. We conclude that even low-dose 2-CdA (0.05 mg/kg) can decrease T and B cell populations in patients with refractory RA, but other side-effects are unlikely. For assessing the possible clinical efficacy of low-dose 2-CdA further studies are warranted.

Fibromyalgia--the effect of relaxation and hydrogalvanic bath therapy on the subjective pain experience.

In the present study, two established non-medicinal treatment methods are compared with regard to their effect on various psychological pain parameters in patients with fibromyalgia. Twelve patients underwent hydrogalvanic baths, 13 patients the Jacobson relaxation training. Statistical evaluation showed only one significant difference in the different dimensions of pain measured at the beginning and end of the therapy. In comparison with patients receiving Jacobson-therapy, there is a significantly higher decrease in pain intensity in the period from breakfast till lunch in patients receiving bath-therapy. Apart from this, no differences between the two treatment groups could be found, either in the quality of pain, the psychological symptoms accompanying it, in sleep quality or in pain behaviour.

Decreased immunoreactive beta-endorphin in mononuclear leucocytes from patients with rheumatic diseases.

The neuroendocrine polypeptide hormone beta-endorphin (beta-END), which is released from various tissues including the anterior pituitary gland and cells of the immune system, has recently been implicated as having an immunoregulatory role. We used a radioimmunoassay to measure beta-END levels in circulating mononuclear leucocytes from normal subjects and patients with various rheumatic diseases. Levels of beta-END in leucocytes from patients were lower than in leucocytes from healthy subjects (P less than 0.001). Whereas levels of beta-END in leucocytes from patients with the various rheumatic disorders were not significantly different, an inverse correlation was found between beta-END levels in leucocytes and expression of rheumatoid factor (P less than 0.025) and erythrocyte sedimentation rate (P less than 0.025). This study demonstrates decreased content of beta-END in cells of the immune system related to parameters of inflammatory activity in rheumatic diseases.

[Alternating chemotherapeutic treatment in patients with localized undifferentiated small-cell carcinoma of the lung]. / Tratamiento quimioterápico alternante en pacientes con carcinoma indiferenciado de célula pequeña de pulmón localizado.

The results obtained from 23 patients suffering small cell lung carcinoma limited to the thorax, treated with 4 cycles of cyclophosphamide, adriamycin, vincristine alternating with cisplatin and VP/16, followed by mediastinal and holocranial prophylactic radiotherapy in patients with a complete response (CR) are here presented. An 87% of global responses were obtained with a 64% rate of RC. The average survival rate was 12 months with an 18% of patients alive two years after treatment. The main toxicity was hematologic and neurologic. Even if this alternating regime produces a high response rate, the results are not superior to those obtained with conventional chemotherapy.