Acta medica Austriaca. Supplement最新文献

We used MTX as single drug treatment on the basis of an incremental dosage schedule, with doses increased from 250 mg/m2 to 750 mg/m2 or from 5 to 10 g, at intervals of 10 days. Moderately high MTX doses (750 mg/m2 at most) plus citrovorum factor rescue, failed to result in objective tumor regression in all of the 18 patients thus treated. High-dose MTX with CF rescue, by contrast, was found to produce partial remissions in 3 of the 19 cases treated thus far. Meticulous clinical monitoring and MTX serum level determinations are imperative for minimizing complications, if this drastic treatment regimen is employed.

A new combined modality treatment in advanced squamous cell carcinoma of the head and neck, is presented. It consists of surgery, or radiotherapy, followed by adjuvant chemotherapy with MTX and CF rescue, cis-DDP, Bleomycin, Cyclophosphamide, given sequentially. Toxic effects were not very severe and did not cause an interruption of therapy.

Two types of vasodilators are used for treatment of acute myocardial infarction: Nitrates on the one hand with predominant venodilation and agents like Phentolamie and Nitroprusside on the other hand with venodilation as well as arteriolar vasodilation. Different opinions exist with respect to indication of these vasodilators. They are used for reduction of arterial blood pressure, for reduction of left ventricular filling pressure and for increase of cardiac output. A marked decrease in ejection fraction is the hemodynamic basis of application of vasodilators in the latter indication. By reduction of peripheral vascular resistance emptying of the left ventricle in these patients is enhanced.) As a working hypothesis in clinical situation elevated filling pressure indicates a decreased ejection fraction. The first part of this investigation deals with relation of left ventricular and diastolic pressure to ejection fraction. A good correlation between these two parameters was found in 717 patients with coronary artery disease. However variability was so wide that regression from enddiastolic pressure to ejection fraction in the individual seemed impossible. In 26.6% of patients with ejection fraction over 0.6%, filling pressure was 20 mm Hg or more. On the other hand, in 34.7% of patients with ejection fraction below 0.3% filling pressure was 20 mm Hg or less. As a consequence of practical value, reduced ejection fraction has to be assumed, if a patient presents elevated filling pressure and reduced cardiac output. In the second part, the hemodynamic effects of Phentolamine in 12 patients with acute myocardial infarction and elevated filling pressure (PCV resp. PADP greater than 18 mm Hg) are described. Maximal effects on hemodynamic variables were: reduction of peripheral vascular resistance by 31.4%, of left ventricular filling pressure by 16.2%, and of mean arterial pressure by 17.0%. Cardiac output increased by 25.8% and heart rate rose by 14.8%. At optimal efficacy, stroke volume increased by 23.7%. Further increase of infusion rate with concomitant fall of peripheral vascular resistance resulted in decrease of stroke volume and tachycardia. Most serious side effects consisted in sudden fall of blood pressure. Therefore intraarterial monitoring of blood pressure is demanded. The third part deals with hemodynamic effects of nitrates (Isosorbiddinitrate 10 mg p.o.) in patients with acute myocardial infarction and elevated filling pressure. One hour after application peripheral vascular resistance decrease by 16.5%, filling pressure by 20.8%, and mean arterial pressure by 9.0%. Cardiac output stroke volume and heart rate did not change significantly. No side effects were observed with Isosorbiddinitrate although two cases of nitrate syncope occurred with Nitroglycerin, resulting in bradycardia and hypotension. Indications for vasodilator therapy therefore has to be handled as follows: Nitrates should be given to patients with elevated fil

Successful rehabilitation can only be carried out by the precise teamwork of doctors, nurses and therapeutic personnel whereby, especially in cancer patients, importance of psycho-somatic aspects are emphasized. Under all circumstances, rehabilitation must immediately follow acute therapy. Especially, the rehabilitation of cancer patients convince them, that they are not lost. It is desirable that rehabilitation of cancer patients should increase, preferably in specialized oncology rehabilitation centers - similar to the cardiological or rheumatic rehabilitation centers. The main purpose of general rehabilitation in oncology should be the somatic and psychological revitalization of the patient under the motto: Don't merely prolong life, add worthwhile living for each life.

In 60 patients with iron deficiency anemia of chronic disorders serum iron, an iron absorption test, serum transferrin, serumferritin and stainable non-heme iron in erythropoiesis and reticuloendothelial system, were evaluated. Intercorrelations of these parameters were studied in different diagnostic groups. Pathogenetic principles and the clinical value of the applied diagnostic methods are discussed.

After presentation of morphological and clinical characteristics concerning megaloblastic anemias, the differential diagnostic possibilities of these anemia, ase discussed. Finally a short survey concerning the therapeutic procedure is presented.

As erythrokinetic studies are time consuming and costly, this technique should only be done to provide information which is unavailable through simpler tests. By means of discussion concerning the methodological procedure and obtainable information, the indications for erythrokinetic investigations with Cr 51 and Fe 59 are derived. Since the results should be interpreted together with the clinical and haematological findings, a close cooperation of the departments of nuclear medicine and haematology would be essential.

Plasma concentrations of immune-reactive trypsin (IRT) were determined in 212 patients with juvenile-onset, insulin-dependent diabetes (Type I) and in 158 patients with maturity onset diabetes (Type II) in comparison to 121 healthy individuals. Significantly increased IRT levels were obtained in the type I diabetics, whereas IRT concentrations were normal or increased in the type II diabetic patients. Hypotrypsinemia occurred predominantly in type I diabetics with high IgG-insulin antibodies or islet-cell antibodies. No correlation was noted between the IRT-levels and the beta-cell residual capacity in the type-I diabetics.

After inhalation of prostaglandin I2 minimal effects on lung function and the cardiovascular system could be observed in healthy volunteers. Platelet function, however, decreased significantly. In the future the application of the prostaglandin I2 may be a new approach in the treatment of thromboembolic disorders in man.

Cis-Dichlorodiammineplatinum (II) was administered in 23 patients with far advanced solid malignancies using a dose schedule of 50 mg/m2 every 3 weeks. All patients had previously progressive disease using conventional cytotoxic therapies. More than 50% of the patients had been pretreated with at least 4 different drugs. 9 patients, additionally, had been irradiated. In 4 instances there was objective tumor regression (duration: 1 to 4 months), in 7 patients tumor progression could be stopped for at least one month, 12 patients did not respond. By sufficient fluid administration combined with electrolyte substitution, furosemide and mannitol, no severe toxic side effects could be observed.