Subcutaneous low dose arabinosyl-cytosine and oral idarubicin in high risk adult acute myelogenous leukemia.

In order to further explore low dose chemotherapy for high risk acute myelogenous leukemia (AML), low dose Ara-C and oral idarubicin (LAI) were given to 33 patients of 24-84 (median 66) years with AML after myelodysplastic syndrome (MDS) (12 patients), refractory AML (13 patients), and AML with contraindications to intensive chemotherapy (8 patients). Patients received 1 to 4 cycles of Ara-C 10 mg/m2 q 12 h s.c. inject. on days 1-14 and idarubicin 20 mg/m2/d orally days 3, 4, 5. Three Three patients attained complete remission, four patients partial remission and one patient minor response, whereas 11 patients succumbed to early mortality from hemorrhage (two patients) and/or infections (10 patients). Three of 13 patients with heavily pretreated refractory AML went into remission compared to 3/12 with AML after MDS and 1/8 with AML and contraindications against intensive treatment. Median duration of CR is 102 (70-488 +) days. Thirty-two of 33 patients developed grade 4 hematological toxicity requiring platelet transfusions. The non-hematologic toxicity was acceptable. LAI provides a standardized therapeutic option especially for heavily pretreated patients with AML.

[Psychological and somatic factors in the disease course of Crohn disease]. / Psychische und somatische Faktoren des Krankheitsverlaufes bei Morbus Crohn.

Crohn's Disease is a severe chronic illness. It is only a little known about which factors determine its course. In this study we investigate 3 somatic (firstly diagnosed vs. repeated inflammation, Crohn's Disease Activity (CDAI), anatomic localization) and 6 psychic (coping-patterns) factors in relation to the duration of the acute inflammatory phase. The sample consists of 90 patients from internistic clinical departments. Under a nomothetic perspective we apply a survival analysis and supplement this by a comparison of two single cases. The results support the thesis, that the course of Crohn's Disease is multifactorially determined. The somatic as well as the psychic (coping) factors allow an at least modest prediction. But there is a marked tendency that an "active-problemorientated", a "not-trivializing" coping and a well established compliance are the more promising predictors.

[Coping of patients with Crohn disease in relation to differential perspectives: a contribution to the discussion of specificity]. / Coping bei Morbus Crohn-Patienten unter differentieller Perspektive: Ein Beitrag zur Spezifitätsdiskussion.

The present study may be seen as a contribution to the theory to coping with an illness. The concept of "specificity" is extended to entail a differential psychological perspective. The influence of various illness-related (extent and severity) and patient-related variables (age, sex, housing) toward coping are investigated. Methodologically, a group statistical strategy is applied which allows the variability of the investigated subsamples to be the object of research. It can be shown that experience with the illness (new vs. chronically ill) represents an important factor in coping with MC.

[Pregnancy in Crohn disease and ulcerative colitis. Maternal and fetal risks]. / Schwangerschaft bei Morbus Crohn und Colitis ulcerosa. Mütterliche und kindliche Risiken.

Familial occurrence in chronic inflammatory bowel disease is well established. Recurrence risks for first degree relatives range from 1 to 5%. A pregnancy is usually not negatively influenced by the disease. The risks for miscarriages are slightly increased, if conception takes place during periods of inflammatory activity. In the case of first manifestation during pregnancy, however, mother and child are exposed to increased risks. The course of the disease is usually not negatively influenced by pregnancy. The rate of relapse is similar to that of comparable samples without pregnancy. In women with an active disease, the prognosis is considerably poorer. The risk to children as a result of drug therapy can be regarded as low. Family planning, pregnancy and birth entail an increased psychological demand, which, in turn, necessitates specific therapy in some cases.

Autoimmunity to pancreatic juice in Crohn's disease. Results of an autoantibody screening in patients with chronic inflammatory bowel disease.

The sera of 59 patients with Crohn's disease (CD) and of 46 patients with ulcerative colitis (UC) were tested for autoantibodies (Aab) by indirect immunofluorescence with modern histochemical techniques using 19 different human tissues as antigenic substrates. Control collectives consisted of 19 patients with coeliac disease and of 100 healthy subjects. It was possible to demonstrate a specific marker for CD: Aab against exocrine pancreas (Pab) were present in 39% of the CD sera (UC 4%, coeliac disease 0%, healthy controls 3%). High Pab titres were only detectable in CD sera (29%). The CD-related autoantigen was demonstrated to be a component of normal pancreatic juice. Pab in CD were fundamentally different from those sometimes occurring in chronic and acute pancreatitis. It is suggested that CD is caused by autoimmune reactions against a component of pancreatic juice. Pab in CD correspond to Aab against intestinal goblet cells (Gab), which occurred exclusively in UC (28%). Pab and Gab, but obviously none of the other Aab investigated in this study, are of diagnostic value in chronic inflammatory bowel disease.

[Autoantibodies against the exocrine pancreas and against intestinal goblet cells in the diagnosis of Crohn's disease and ulcerative colitis]. / Autoantikörper gegen exokrines Pankreas und gegen intestinale Becherzellen in der Diagnostik des Morbus Crohn und der Colitis ulcerosa.

It was demonstrated by indirect immunofluorescence that Crohn's disease and ulcerative colitis are serologically distinct. In 59 patients with Crohn's disease, confirmed by endoscopy and histology, 23 (39%) had serum autoantibodies against exocrine pancreas; in 17 (29%) the titre was 1 : 100 or higher. In 46 patients with confirmed ulcerative colitis pancreas antibodies were demonstrated only twice, in 100 healthy control subjects only 3 times, with titres less than 1 : 100. Pancreas antibodies do not occur in high concentrations in pancreatitis; titres higher than 1 : 100 therefore suggest Crohn's disease. The pancreas antibodies of patients with Crohn's disease were predominantly immunoglobulins IgA and IgG, twice they were IgD and once IgM, never IgE. In 6 patients the pancreas antibodies fixed complement. Autoantibodies against intestinal goblet cells were found only in patients with ulcerative colitis (13 of 46 = 28%). The titres range was from 1 : 10 to 1 : 1000. The goblet-cell antibodies consisted only of IgA and IgG, never reacting with complement. These results indicate that determining pancreas and goblet-cell antibodies alone will make it possible to diagnose either Crohn's disease or ulcerative colitis in more than a quarter of patients with chronic inflammatory intestinal disease.