[Uncommon solid abdominal tumor]. / Seltener solider abdominaler Tumor.

HISTORY AND ADMISSION FINDINGS: A 67-year-old female patient got ill during holidays in USA with acute abdominal pain. She was discharged after symptomatic treatment and presented afterwards in Germany for further clarification and treatment. INVESTIGATIONS, TREATMENT AND COURSE: Following abdominal sonography, gastroscopy and CT scan with contrast medium, a gastrointestinal stromal tumor (GIST) was assumed. Thereupon a tumor extirpation with cholecystectomy and liver resection was performed. After laparotomy a solid fibrous abdominal tumor could be diagnosed histologically. There was no indication for an adjuvant treatment. CONCLUSION: In the international literature reports about these tumors are rare. A complete resection is essential; there is no data for an adjuvant treatment.

Titration of synaptotagmin I expression differentially regulates release of norepinephrine and neuropeptide Y.

Synaptotagmin (syt) I is a Ca(2+) sensor that has been thought to trigger all vesicle secretion with similar mechanisms. However, given the calcium and stimulation requirements of small clear, and large dense core vesicles, we hypothesized that syt I expression differentially regulates vesicle release. Therefore, in this study, we generated multiple stable cell lines of PC12 cells that each had a different and stable level of syt I expression. We determined the functional effects of titrated syt I expression on transmitter release from the two vesicle types, and showed that the transmitters, norepinephrine (NE) and neuropeptide Y (NPY), each have a threshold level of syt I expression required for their release that is different for the two transmitter types. We used carbon fiber amperometry to measure release of NE from single vesicles, and found that release ranged from 50% to 100% in the syt I-targeted cells compared to release from control cells. We used an immunoassay to measure NPY release and found that NPY release was abolished in cells that had abolished syt I expression, but cell lines that expressed 50-60% of control levels of syt I exhibited NPY release levels comparable to release of NPY from control cells. Furthermore, the vesicle fusion pore exhibited a reduced open duration when syt I was abolished, but a longer open duration time for 50% syt I expression than control cells. Therefore, vesicles have a threshold for syt I that is required to control opening of the fusion pore, expansion, and full fusion to release large dense core proteins, but not for full fusion of the small molecules like NE.

[Knowledge and experience of palliative medicine among general practitioners in Germany]. / Palliativmedizinische Erfahrungen deutscher Hausärzte.

BACKGROUND AND OBJECTIVES: Levels of experience and competence in palliative medicine vary considerably among physicians. The aim of the study was to collect information from specially interested general practitioners on education, pivotal lectures and experience regarding the delivery of palliative care. SUBJECT AND METHODS: 92 general practitioners (41 women and 22 men) attending a basic course in palliative medicine were asked to fill in a standardized questionnaire relating to their knowledge and experience of palliative medicine. 63 responded (68%), 54 in general private practice, nine worked in a hospital. The same number worked in urban and in rural health care facilities. RESULTS: The majority of those questioned (53%) gained their first experience in palliative medicine as junior hospital doctors about a quarter (26%) only after starting in private practice. Many of the doctors (31%) admitted to taking more interest in palliative medicine only after having made mistakes, a significant percentage (20%) after the death of a relative. 28% expressed the view that practical courses were an important part in learning about palliative medicine. CONCLUSIONS: The implementation of practice-based c tuition of medical students and of continuing education of established general practitioners and hospital physicians in palliative medicine is indispensable.

High efficacy and low toxicity of weekly docetaxel given as first-line treatment for metastatic breast cancer.

BACKGROUND: Docetaxel is one of the most effective antitumor agents currently available for the treatment of metastatic breast cancer (MBC). This phase II multicenter study prospectively analyzed the efficacy and toxicity of docetaxel given on a weekly schedule as first-line treatment of metastatic breast cancer. PATIENTS AND METHODS: All patients received docetaxel, 35 mg/m(2) weekly for 6 weeks, followed by 2 weeks of rest. Subsequent cycles (3 weeks of treatment, 2 weeks of rest) were given until a maximum of 5 cycles or disease progression. Premedication consisted of 8 mg dexamethasone intravenously 30 min prior to the infusion of docetaxel. RESULTS: Fifty-four patients at a median age of 58 years with previously untreated MBC were included in the study. A median of 10 doses (median cumulative dose 339 mg/m(2)) was administered (range: 2-18). The overall response rate was 48.1% (95% CI: 34-61%, intent-to-treat). Median survival was 15.8 months and median time to progression was 5.9 months (intent-to-treat). Hematological toxicity was mild with absence of neutropenia-related complications. Grade 3 neutropenia was observed in 3.7% of patients and grade 3 and 4 anemia was observed in 5.6 and 1.9% of patients, respectively. CONCLUSION: The weekly administration of docetaxel is highly efficient and safe as first-line treatment for MBC and may serve as an important treatment option specifically in elderly patients and patients with a reduced performance status.

[Recurrent tetany as the first symptom of late manifesting celiac disease]. / Rezidivierende Tetanien als Erstsymptom einer spätmanifestierten Zöliakie.

BACKGROUND: The diagnostic classification of a malabsorption is often made more difficult, particularly in oligosymptomatic forms. CASE REPORT: A female patient is presented, where the diagnosis of malabsorption syndrome was concluded because of recurring tetanias. This could be traced back to an oligosymptomatic celiac disease. Diagnostic course of action, differential diagnosis as well as further observation during therapy are discussed. CONCLUSION: Oligosymptomatic developments of celiac disease are common amongst adults and present a diagnostic challenge. The existence of a malabsorption should be considered, even if the momentary individual symptoms are unclarified.

[New aspects of the pharmacokinetics of ethanol]. / Neuere Aspekte zur Pharmakokinetik des Ethanols.

In the paper a survey on new results in the pharmacokinetics of ethanol is given. Resorption follows the rules of diffusion and is influenced by a lot of factors, this results in a high interindividual variation. Distribution is influenced by a first-pass-effect and the tissue contents of water. Metabolism is performed by alcohol dehydrogenase and microsomal ethanol oxidizing system. The kinetics of ADH is undependent on concentration, the MEOS is inducible. Results of acute and chronic ethanol treatment are discussed, clinical consequences are reviewed.

[Characteristics of the occurrence of hematotoxic side effects of cytostatic drugs--results of a retrospective 10 year study of a district hospital]. / Charakteristika des Auftretens hämatotoxischer Nebenwirkungen von Zytostatika--Ergebnisse einer retrospektiven Zehnjahresstudie eines Kreiskrankenhauses.

From 1978 to 1988 in 77 patients of a district hospital, 58 females and 19 males, with malignant tumours or haemoblastoses a therapy with cytostatic agents was finished. A retrospective study analyses characteristics of haematotoxic side effects of cytostatic agents, which despite usual dosage according to the valid guide-lines have appeared in this patient population. According to this the granulocytopoiesis is injured most frequently and most severely. In one third of all patients under influence of cytostatic agents the number of the segment-nuclear granulocytes in the peripheral blood decreased deeper than 0.5 Gpt/l (severe neutropenia). In toxic influences on the thrombopoiesis slight and medium degrees of severity are dominating. Lesions of the erythropoiesis are apparently more infrequent, though they are more difficult to be proved. Further characteristics in the occurrence of severe neutropenias (date, dependence on age, pharmacological aspects) are demonstrated and discussed.

[Severe neutropenia following cytostatic drug therapy--clinical symptoms, follow-up and prognosis in 26 patients of a district hospital]. / Schwere Neutropenie nach Zytostatikatherapie--klinische Symptomatik, Verlauf und Prognose bei 26 Patienten eines Kreiskrankenhauses.

The clinical courses of 26 patients with severe neutropenia after application of cytostatic agents are demonstrated. The symptomatology reaches from complete freedom of complaints to severe and most severe clinical appearances. In all 7 asymptomatic patients a complete remission of the changes of the blood picture occurred. Patients with lacking or partial remission of the blood picture after severe neutropenia induced by cytostatic agents have in general a bad prognosis quoad vitam. Infections are the most important complication of a severe neutropenia. Conclusions for the clinical practice concerning the prophylaxis and the early recognition of severe neutropenias as well as of neutropenic complications are derived. Irreversible lesions of the bone marrow by cytostatic agents are notifiable unwished effects of drugs.

[Primary malignant teratoma of the spleen]. / Primäres malignes Teratom der Milz.

It is reported on the unusually rare case of a primary malignant teratoma of the spleen. Course of diagnosis and therapy are discussed.

[Alcohol-induced hypertension]. / Alkoholinduzierte Hypertonie.

The frequency of hypertension in a group of alcoholics and the incidence of alcohol abuse in a group of patients with hypertension was compared with a collective with type-II-diabetes. There is a high relationship between alcoholics and hypertension, a lower one between alcohol abuse in the hypertension group. Chronic alcohol abuse seems to be a more important risk factor for the development of hypertension than diabetes. Genesis and therapeutic consequences of alcohol-induced hypertension are discussed.

[Cimetidine and ethanol]. / Cimetidin und Ethanol.

Cimetidine inhibits hepatic drug metabolism, but its effect on ethanol elimination is less well established. The influence of cimetidine on the kinetics of ethanol is studied with three standardized drinking experiments. Cimetidine had no influence on the absorption or elimination of ethanol. There were significant differences in distribution of ethanol in consequence of inhibition of vascular histamine receptors after cimetidine application.

[Alcohol-induced cardiomyopathy]. / Beitrag zur alkoholtoxischen Kardiomyopathie.

Because of increasing alcoholism the importance of alcoholic organ lesions is also increasing. The alcoholic cardiomyopathy, which is the result of toxicity of alcohol, but also of alcohol-induced hypertension, coronary sclerosis and toxic destroyed nervous system, is demonstrated with a the keep of case. Stages, diagnosis, therapy and prognosis are described. The most important consequence is abstinence.

[Acute cerebrovascular disease in patients of employable age-- results of a staged therapy program]. / Die akute zerebrovaskuläre Erkrankung bei Patienten im arbeitsfähigen Alter--Ergebnisse eines Stufentherapieprogramms.

The authors take position to distribution of age, sex and stadium, risk factors and therapeutic possibilities in 85 patients with cerebrovascular disease under 65 years. 80 percent have had hypertension, 34 percent diabetes and 15 percent had overweight. Ischemic forms of CVI prevailed with 62 percent. Within the stadia the age distribution is equal. In Stadium II and III mortality is small independent of age. The therapeutic success seems to be independent of therapeutic program. In stadium IV an oncoosmotic and brain metabolism promoting program seems to be superior to an only oncoosmotic acting. An ordered therapy-program after CVI-stadia is proposed.

[Clinical anatomy of the inferior wall of the orbit and its neighboring structures]. / Uber die klinische Anatomie des Paries inferior orbitae und dessen Nachbarstrukturen.

The development and size of the maxillary sinus, its septums and its cstium are measured. The nasolacrimal canal and duct and the foramina alveolaria superior are included. The thickness of the orbit floor (roof of maxillary sinus) is estimated. The angles of the inferior, medial, lateral rectus muscles, and the inferior oblique muscle with the median plane are determined. The results are discussed with those of earlier researchers. The clinical importance of the results are discussed.