Phase I-II study of escalating doses of amifostine combined with high-dose cyclophosphamide.

PURPOSE: To evaluate the feasibility and clinical effects of increasing doses of amifostine administered four times in 1 day with high-dose (HD) cyclophosphamide (CTX). METHODS: A group of 16 patients with a diagnosis of lymphoma were treated with HD-CTX given at a total dose of 7 g/m2 subdivided into four doses, each preceded by increasing doses of amifostine. A group of 12 lymphoma patients previously treated with the same HD-CTX regimen was used as historical controls. RESULTS: The dose of amifostine was escalated in cohorts of three patients each from 4x570 mg/m2 to 4x910 mg/m2 without severe toxic effects. Further patients were treated at the highest dose level. Side effects included a fall in blood pressure (always less than 20% of baseline value), asymptomatic hypocalcemia (from a median value of 2.4 to 1.7 mmol/l) and a decrease in creatinine clearance (from a median value of 102 to 85 ml/min). The parameters of hematotoxicity for patients treated in the study were not significantly different from those of the historical control patients. CONCLUSIONS: Amifostine can be given safely at a dose of 910 mg/m2 four times in 1 day in combination with HD-CTX. With this schedule amifostine did not show a myeloprotective effect.

[Unimaginable violence in psychiatry--some reflections after a visit to Poland]. / Unvorstellbare Gewalt in der Psychiatrie. Nachgedanken zu einer Reise nach Polen.

What was the situation of the staff, when the Germans began, in the autumn of 1939, to murder systematically the patients in Polish clinics? A documentation of a fact-finding committee and a novel by Lem are studied for answers to this question. The patients themselves tried to resist. Whereas the staff are described as having been in the hopeless position of being unable to take any action. However, in very special situations the possibility of resistance was found.

[Long-term patients also need their history. The socio-geographic reconstruction of the life history as social pedagogic method for work with long-term patients]. / Auch Langzeitpatienten brauchen ihre Geschichte.Die sociogeographische Rekonstruktion der Lebensgeschichte als socialpädagogische Methode für die Arbeit mit Langzeitpatienten.

"Socio-geographic reconstruction" means to recall important places and stations of life, accompanied by another interested person. Students of social paedagogics have created these reconstructions together with long-term psychiatric patients. The method is based on social science participation studies. The aim is the rediscovering and reacquiring the prepsychiatric biography of the patients as well as the understanding of this history by the students. The focus of interest is not the "history of illness" but the "history of life" as it was connected with family, school, work and leisure time.

[Addiction in women. Observations on the psychic and social situation of women admitted to the addicts ward of a provincial government mental hospital (Landeskrankenhaus) (author's transl)]. / Süchtige Frauen. Beobachtungen zur psychischen und sozialen Situation der Frauen auf einer Suchtaufnahmestation im LKH.

The article describes a ward for the admittance of female addicts in a provincial government mental hospital (Landeskrankenhaus). Addiction is interpreted as the sequel of a severe psychic disturbance (manifested as depression in most of the women) in conjunction with socially disturbed conditions (lack of social function, familial upsets). Possibilities of treatment in a provincial government hospital are limited. The essential therapeutic chance is offered by a firmly patterned ward structure and by creating an "antidepressive environment" which meets to a certain extent the patient's innate craving for security and her need "to belong", while at the same time promoting her own initiative and sense of responsibility.