[Progressive systemic sclerosis - treatment results of extracorporeal photopheresis]. / Progressive systemische Sklerodermie. Behandlungsergebnisse unter extrakorporale Photopherese.

The treatment of progressive systemic sclerosis (PSS) is still unsatisfactory. We report on clinical, laboratory and immunological findings in 26 patients with PSS (6 males, 20 women) treated with extracorporeal photopheresis (ECP) for 8 cycles in a nonrandomized, uncontrolled study. ECP was performed on two consecutive days once a month. 8-methoxypsoralen concentrations in plasma and buffy coat were monitored by HPLC. We performed a standardized examination programme and determined parameters of inflammation and immune function. Global assessment revealed a partial remission in 18 patients, a stable disease in 8 patients and a slight progression in one patient. In the peripheral blood count a significant increase of CD3-positive NK cells was noted (p=0.03) although the leukocyte count decreased from 2,255 to 1,156 cells/microl. There was a non-significant decrease of elastase (102. 9 vs. 90.4 ng/ml), sulfidoleukotriens (2,255.4 vs. 1,688.9 pg/ml), ICAM-1 (301.9 vs. 276.6 ng/ml), soluble IL-2 receptor (609.0 vs. 422. 3 U/ml), and IL-10 (164.7 vs. 138.7 pg/ml). IL-6 and IL-8 did not show significant changes. The ECP treatment of patients with PSS shows immunomodulatory effects changing levels of pro-inflammatory and cytokine substances. Even after 8 cycles partial remission or stable disease is seen in patients as shown by global assessment and certain clinical symptoms. On the other hand, sufficient data on the long-term outcome are still missing.

Correlations between subjective compliance, objective compliance, and factors determining compliance in geriatric hypertensive patients treated with triamterene and hydrochlorothiazide.

There are correlations between objective and subjective compliances on the one hand and factors determining compliance (3 times drug intake per day, no support by the family to get over the disease and no nicotine abuse). In agreement with the literature, mainly subjective criteria (due to disease, therapy, doctor, and environment) influence compliance strongly. To realize their personal psychological task to help the patients even better it is of importance for the doctors to analyze the variability of these parameters. Measures to improve compliance, such as better psychological guidance for the patient taking these factors and the patient's personality into consideration, can be helpful to improve the relatively poor compliance reported in the literature to be as little as 20-50%.