[Biotechnological therapies for the treatment of back pain: alternatives to corticosteroids]. / Biotechnologische Konzepte zur Behandlung von Rückenschmerzen : Erste Erfahrungen mit Alternativen zu Glukokortikoiden.

In recent years, it is increasingly clear that back pain is not only caused by biomechanical problems. Currently, biologically-based local therapy concepts for the treatment of affected spinal regions as an alternative to the standard treatment with steroids are in development or in early stages of clinical application. The common features of these new therapies are to intervene in the regulation of homeostasis at various key points at the affected region and specifically to suppress or block catabolic influences as well as to provide with anti-inflammatory substances and growth factors. These include on one hand the genetically produced Biologicals such as TNF-α inhibitors and cytokine antagonists and on the other hand therapies with autologous blood preparations (Autologous Conditioned Serum [ACS], and Platelet Rich Plasma formulations [PRP]). This article presents the individual methods, gives an overview of developments and results of various studies and discusses current recommendations.

Psychological characteristics of patients with normal-tension glaucoma.

BACKGROUND: A study was carried out to evaluate the extent of psychosomatic complaints in patients with normal-tension glaucoma. METHODS: Twenty-four patients (M:F=3:21; mean age 58+/-15.3 years) with normal-tension glaucoma were rated according to the von Zerssen Symptom List (psychosomatic discomfort), the Maudsley Personality Inventory (MPI-N, emotional status and MPI-E, extroverted-introverted), the Beck Depression Inventory (BDI), and the Sixteen Personality Factor Questionnaire (16PF). An age- and sex-matched control group (n=24; M:F=3:21; mean age 56+/-13 years) without any ocular or other general chronic disease was selected. RESULTS: In comparison with the control group the patients with normal-tension glaucoma showed significantly more complaints (von Zerssen Symptom List) and were more emotionally unstable (MPI-N). No group differences were found regarding extroversion-introversion (MPI-E) and depression (BDI). In the 16PF, patients with normal-tension glaucoma were remarkable, only for a significant negative correlation between the duration of illness and psychic endurance. CONCLUSION: The results demonstrate that patients with normal-tension glaucoma show evident psychosomatic involvement. However, the sequence of the pathogenetic development remains unclear. Therefore, it is not known whether these psychological disturbances are factors contributing to the development of normal-tension glaucoma or whether they are a result of normal-tension glaucoma. Nevertheless, some patients with normal-tension glaucoma had these disturbances. Besides reduction of intraocular pressure and improvement of vascular condition, those who display psychological disturbances should receive psychological support, such as autogenic training.

Diode array as fixation light to reduce unwanted globe movements.

In ocular surgery complications can occur from eye movements during topical anesthesia or insufficient retrobulbar anesthesia. To minimize eye movements during surgery a fixation light was designed consisting of a diode array embedded in an eye patch, and a keyboard, which will be positioned on the patient's thorax. The patient focuses with the unoperated eye at a flashing diode which is part of the diode array. The operated eye is guided by conjugated eye movements. With the keyboard, the surgeon can change the diode signal all over the array. As a result, the eye is kept still or moved in the appropriate direction to facilitate the surgical process. The flat and lightweight design of the device enables its use under sterile surgical covers or in an upright position of the patient during laser applications.

[Psychosomatic aspects of patients with primary keratoconjunctivitis sicca]. / Psychosomatische Aspekte bei Patienten mit primärer Keratoconjunctivitis sicca.

PURPOSE: To evaluate the extent of psychosomatical complaints in patients with primary keratoconjunctivitis sicca (pKCS). METHODS: 20 patients (m:f = 1.19; mean age 49 +/- 7 years) with pKCS were rated according to the von Zerssen Symptom List (psychosomatical discomfort), the Maudsley Personality Inventory (MPI)-N (emotional status) and -E (extroverted-introverted) and to Beck Depression Inventory (BDI). 54 subjects (m:f = 35:17; mean age 46 +/- 17 years) without any ocular or general chronic disease were used as control group. RESULTS: In comparison to the control group the patients with pKCS showed significantly (p < 0.0001) more complaints (von Zerssen Symptom List), were more (p < 0.0001) emotionally unstable (MPI-N) and more (p < 0.0001) depressive (BDI). No group differences were found regarding extroversion-introversion (MPI-E). CONCLUSION: Our results demonstrate that many patients with pKCS showed psychological problems and disturbances. We therefore recommend an additional psychological treatment (e.g. autogenic training) for these patients to stabilize their emotional condition, which may even have a positive effect on their dry eye problems.

Malnutrition and the role of nutritional support for radiation therapy patients.

The nutritional status of a tumor patient can be negatively influenced by the local and systemic effects of the malignant tumor (tumor cachexia, anorexia, difficult oral food intake), by the effects of the various antitumoral therapy modalities (surgery, radiotherapy, chemotherapy), and by the complications associated with such modalities (anorexia, nausea, vomiting, mucositis, xerostomia, alterations of the smell and taste sensations, odynophagia, dysphagia, maldigestion, malabsorption, diarrhea, steatorrhea, conditioned aversions, radiogenic late effects), as well as by the psychological reactions of the patient to the real or feared existence of his tumor. The radiation-induced nutritional disorders depend on the tumor localization, the region irradiated, the dose and length of radiotherapy, the fractionation, the volume irradiated, and the combination with other therapeutic modalities ("combined modality therapy"). The acute radiation-induced reactions are usually of limited duration and for this reason tend to interfere with the nutritional status to a lesser extent than the permanent chronic consequences of irradiation. Weight loss and malnutrition tend to develop particularly in patients in whom segments of the gastrointestinal tract are subjected to irradiation. The incidence and severity of deficient nutrition depend not only on the region irradiated (head-neck region, thorax, abdomen, pelvis) but also, and most particularly, on the volume of the digestive tract irradiated. Chemotherapy and radiotherapy combined act very strongly on rapidly proliferating cell populations (skin, mucosa, epithelium of the gastrointestinal tract). In this context, actinomycin D and adriamycin act like real sensitizers, whereas the majority of the other drugs are likely to produce only an additive effect. The first named cytostatics give rise to the so-called recall phenomenon, i.e., the reactivation of latent radiation effects in response to the subsequent administration of the drug. Malnutrition impairs organ function and ultimately results in increased morbidity and mortality. For this reason it has proven mandatory and reasonable that the organism of all tumor patients suffering from malnutrition is provided with the missing essential nutrients (especially amino acids for protein synthesis). This tends to clearly improve the Karnofsky performance status, with a positive effect on response rates, toxicity, and survival rates in retrospective studies.(ABSTRACT TRUNCATED AT 400 WORDS)

[Principles, indications and results of radiotherapy of spinal tumors]. / Grundlagen, Indikationen und Ergebnisse der Strahlentherapie von Wirbelsäulentumoren.

In primary and secondary tumors of the spinal column, radiotherapy is used to effect a cure, but mainly the goal is palliative. In the latter case, the course is either accelerated over less than 2 weeks (e.g., 1 dose of 10 Gy, 5 X 4 Gy, 10 X 3 Gy) or extended over 3 or more weeks (e.g., 40-50 Gy over 4-5 weeks). For teletherapy, megavolt radiotherapeutical devices are mainly used. In addition, supplementary brachytherapy is available with iodine-125 or iridium-192 seeds.

[Computer tomographically guided stereotactic interstitial therapy of brain tumors using temporary or permanent 125iodine seed implantation]. / Die computertomographisch geleitete stereotaktische interstitielle Therapie von Hirntumoren mittels temporärer oder permanenter Implantation von 125Jod-Seeds.

Therapy resistance of inoperable malignant gliomas is an unsolved problem for radiotherapy. A combination of interstitial therapy and percutaneous high voltage therapy is described which should improve the prognosis of brain tumours when it has been perfected. For all tumours of low malignancy we recommend the permanent implantation of 125iodine seeds of low activity (10-60 mCi 125I, DO = 6-10 rad/h.) as the primary form of treatment, possibly supplemented by high voltage therapy. For tumours of higher malignancy, temporary implantation of high activity 125I is indicated (more than 200 mCi, DO = 25-100 rad/h.) as local boost before or after total volume irradiation of brain. Our experience of 30 patients up to date is encouraging.

[Nutritional therapy of tumor patients before, during and after radiotherapy with a new promoter system--Nutromat]. / Die Ernährungstherapie von Tumorpatienten vor, während und nach Radiotherapie mit einem neuen Fördersystem--Nutromat.

Nutrition and metabolism are vital functions just as respiration and cardio-vascular function which influence general well-being, physical and mental capacity, immunocompetence and wound healing. Malnutrition is a high-risk factor and carries a high morbidity and mortality. 30-50% of our patients nowadays are malnourished. Particularly tumor patients suffer from malnutrition which is still aggravated by radiotherapy and its side effects. Therefore the accompanying alimentary guidance and treatment are very important factors. A plan comprising several degrees from dietary guidance, forced oral and enteral nutrition to intravenous hyperalimentation has proved to be practicable. For the ambulatory radiotherapy of our ORL-patients, we have recently been applying a Nutromat, a promoter system operating according to the Bakey pump system and serving for continuous or discontinuous enteral nutrition therapy with formula or elementary diets. The authors describe principle and function of the device and present their first experiences. By using early and consequently this device for our irradiated patients, we hope to prevent or heal malnutrition, ameliorate the tolerance of tumor therapy and the patient's energy, increase the physical and psychical health, reduce the incidence of complications, reestablish the immunocompetence, and improve the survival and life quality of the patients.

[Nutromat-Pfrimmer, a new transporting system for the enteral nutrition therapy of tumor patients before, during and after radiotherapy (author's transl)]. / Nutromat-Pfrimmer, ein neues Fördersystem zur enteralen Ernährungstherapie von Tumorpatienten vor, Während und nach Radiotherapie.

Tumor patients generally suffer from malnutrition which is still aggrevated by radiotherapy and its side effects. Therefore the accompanying alimentary guidance and treatment are very important factor. A plan comprising several degrees from dietary guidance, forced oral and enteral nutrition to intravenous hyperalimentation has proved to be practicable. For the ambulatory radiotherapy of our ORL-patients, we have recently been applying a Nutromat-Pfimmer, a promoter system operating according to the Bakery pump system and serving for continuous or discontinuous enteral nutrition therapy with formula or elementary diets. The authors describe principle and function of the device and present their first experiences. By using early and consequently this device for our irradiated patients, we hope to prevent or heal malnutrition, ameliorate the tolerance of tumor therapy, reduce the incidence of complications, re-establish the immunocompetence, and improve the life quality of the patients.

[Generalized sarcoidosis with brain and eye participation]. / Generalisierte Sarkoidose mit Gehirn- und Augenbeteiligung

A 34-year-old patient was treated four weeks before his death for a recurrent binocular iritis. He died with clinical symptoms of a cerebral respiratory paresis. The diagnosis of epithilial cells sarcoidosis was made only after histological post mortem examination. It was a cerebral form of chronic disseminated encephalomeningitis with a vascular component. Typical granulomes were found in several organs and also in conjunctiva, ciliary body, choroid and optic nerve.