Health-related quality of life in oropharyngeal cancer survivors - a population-based study.

OBJECTIVE: The aim of this study was to compare QoL of oropharyngeal cancer survivors who had received different treatments. SUBJECTS AND METHODS: We contacted 954 survivors. Each survivor received the QoL questionnaires EORTC QLQ-C30 and EORTC QLQ-H&N35. RESULTS: A total of 263 survivors completed the questionnaires (28% responses). Forty-five of them had undergone surgery, 20 had received definitive radiotherapy or chemo-radiotherapy, 85 surgery plus adjuvant radiotherapy, and 111 surgery plus adjuvant chemo-radiotherapy. Survivors who had received adjuvant radiotherapy and surgery reported significantly more problems with swallowing (B=13.43 [95% Confidence Interval (CI) 1.83-25.03]), senses (B=24,91 [CI 11.86-37.97]), eating (B=16.91 [CI 3.46-30.36]), dry mouth (B=26.42 [CI 12.17-40.67]), sticky saliva (B=22.37 [CI 6.23-38.50]) and nutritional supplements (B=18.59 [CI 0.62-36.56]) than those who had received surgery only. Survivors who had received adjuvant chemo-radiotherapy and surgery reported significantly many more problems with dry mouth (B=34.15 [CI 18.91-49.39]) and sticky saliva (B=22.90 [CI 5.65-40.16]), and fewer problems with physical functioning (B=-12.07 [CI 0.49-23-64]). CONCLUSION: Survivors who participated in this survey and who had undergone surgery alone reported in some head- and neck-specific domains a better health-related quality of life than patients who had undergone multi-modal treatment or adjuvant radiotherapy.

[Quality of life after primary radiation/radiochemotherapy vs. operation therapy in an oropharyngeal cancer]. / Lebensqualität nach primärer RT/RCT vs. operativer Therapie bei Oropharynxkarzinom.

Not only in oropharyngeal carcinoma, but particularly in head and neck cancer the evaluation of quality of life does not only belong to the clinical trials but also finds its way into everyday clinical life. Research findings of numerous clinical trials of the last 20 years demonstrate that EORTC Core Questionnaire QLQ-C30 and in addition QLQ-H&N35 asserted themselves as outstanding base. A tendency of improved quality of life of operated patients with oropharyngeal carcinoma compared to advanced states of disease of primary radiochemotherapy can be ascertained.

[Simvastatin-induced dermatomyositis]. / Simvastatin-induzierte Dermatomyositis.

Dermatomyositis is a rare inflammatory autoimmune disease. The association between a lipid-lowering drug like pravastatin and the development of a musculocutaneous syndrome has been reported in single case reports only. We present the first report of a simvastatin induced dermatomyositis in a 71-year-old woman with positive Mi-2-Antibodies to point out this rare side effect of the increasingly prescribed statins. In future simvastatin should be considered as a possible trigger of dermatomyositis.

Polymorphonuclear granulocytes induce myocardial dysfunction during ischemia and in later reperfusion of hearts exposed to low-flow ischemia.

Polymorphonuclear granulocytes (PMNs) are known to contribute to reperfusion injury of the heart. However, whether PMNs compromise myocardial function of hearts exposed to a low-flow ischemia has not been determined. Moreover, not much is known about deleterious effects of PMNs at different times during ischemia and reperfusion. Isolated, working guinea pig hearts were subjected to 30 min of low-flow ischemia and reperfusion. Homologous PMNs were applied as 1-min boluses in the presence of thrombin during either ischemia or the first or fifth minute of reperfusion, and postischemic recovery of external heart work (REHW) and intracoronary PMN retention (PMNR) were quantified. In further experiments, the radical scavenger superoxide dismutase (SOD) was added. Compared with controls without PMNs (REHW, 92.4%), application of PMNs led to a significant loss of myocardial function, which was detected at all three examination times. Moreover, intracoronary PMNR increased significantly in comparison with that of controls with hearts not exposed to ischemia or reperfusion. On the other hand, addition of SOD significantly increased REHW. Intracoronary PMNR was not significantly changed by coapplication of SOD. We conclude that thrombin-stimulated PMNs applied at different times during ischemia and reperfusion significantly impaired cardiac function in hearts exposed to a low-flow ischemia.

A thrombocyte-induced myocardial dysfunction in the ischemic and reperfused guinea pig heart is mediated by reactive oxygen species.

In recent investigations, we could demonstrate that thrombocytes are able to contribute to ischemia- and reperfusion-induced injury of the heart. The aim of the current study was to investigate whether reactive oxygen species are responsible for induction of myocardial dysfunction under these conditions. Isolated, perfused, and pressure-volume work-performing guinea pig hearts were exposed to a 30-min low-flow ischemia (1 ml/min) and were reperfused (5 ml/min). Washed, homologous blood platelets were administered as a 1-min bolus (20,000 per microliter of perfusion buffer), either during the 15th minute of ischemia or in the first or fifth minute of reperfusion in the presence of thrombin (0.3 U/ml perfusion buffer)). The radical scavengers superoxide dismutase (SOD; 10 U/ml perfusate) and catalase (30 U/ml perfusate) were added during ischemia or in the first or fifth minute of reperfusion, respectively. Intracoronary platelet retention (in percentage of platelets applied) and recovery of EHW (postischemic EHW in percentage of preischemic EHW) were quantified. Ischemic and reperfused hearts with time-matched application of platelets but without administration of SOD or catalase served as controls. Interestingly, both administration of SOD during ischemia and in reperfusion significantly improved recovery of EHW (88.4 +/- 2%, 82. 6 +/- 1%, and 90 +/- 3%, respectively) as compared with the case of controls (56.2 +/- 3%, 42 +/- 2%, and 75 +/- 2%, respectively). Platelet retention, however, was not significantly influenced by administration of SOD during ischemia or reperfusion (26 +/- 2%, 31 +/- 2%, and 26 +/- 2%) compared with controls (30.5 +/- 3%, 33 +/- 2%, and 22 +/- 3%, respectively). Coadministration of catalase, on the other hand, exhibited some cardioprotective potential only in the first minute of reperfusion (recovery, 61% +/- 4%) as compared with the case of control (42 +/- 2%). We conclude that thrombocytes under conditions of ischemia and reperfusion are able to induce a myocardial dysfunction mediated by reactive oxygen species. Superoxide seems to play a major role in this respect.

[Physiopathology and therapy of severe cerebral hypoxia]. / Pathophysiologie und Therapie der schweren zerebralen Hypoxie.

The pathophysiological mechanisms of severe cerebral hypoxia (in men) are discussed: disturbance of autoregulation, vasoparalysis, luxury perfusion, cytotoxic and vasogenic brain swelling, rise of intracranial pressure (ICP), stop of cerebral circulation. Possible trials of therapy are presented: restitution of cardiovascular circulation, controlled hyperventilation, control of ICP, dexamethason bolus, early high-dose barbiturates.

[Problems of disinfection of breathing apparatus (author's transl)]. / Zur Problematik der Desinfektion von Beatmungsgeräten

Report on the problems of disinfection of breathing apparatus. As a new means of avoiding bacterial contamination of the humidified and warmed inhaled gas mixture for 48 hours Rivanol in solution 1:1000-1:5000 is recommended as humidifier. For this, however, only those breathing systems are suited which work on the evaporation principle, not on atomizers or spraying. The good bacteriologic results are explained by the certain inhibition of bacteria by Rivanol in the humidifying fluid. It is understood that--in addition--there must be regular (every 24 hours) disinfection of tubes and the valves which ought to be as simple as possible. As humidifying fluid only sterile water, possibly fresh tap water, are recommended.