[Dyspnea in the terminal stage]. / Dyspnoe in der Terminalphase.

From all symptoms in palliative medicine those concerning respiration are most excruciating and most difficult to treat. No other symptom is more dependent on psychosocial circumstances and on the atmosphere around the patient. Therefore the relief of respiratory problems is as important as the therapy of pain. A consequent therapy comprises besides drug therapy (adrenocortical steroids, brochodilators, opioids, sedatives and sometimes antibiotics) also physiotherapy and in special cases oncological treatment and radiotherapy. A team present twenty-four hours a day, the training of relatives and friends, the frank dealing with the patient's anxiety of suffocation are the basis of all therapeutic measures. Dyspnea often is the reason for a longer stay in a palliative care unit.

[Rehabilitation of patients with malignant germ cell tumor]. / Rehabilitation von Patienten mit malignem Keimzelltumor.

The progress achieved in the treatment of the malignant germ cell tumor of the male is based on the introduction of cisplatin in polychemotherapy and of consistent interdisciplinary cooperation (including surgery). Thus more than 70% of testicular cancer patients are now cured long term. Early diagnosis and consistent therapy increase the chances of survival additionally. The chances of successful therapy are markedly higher in early tumor stages (90%) than in late tumor stages (less than 50%), where intensive therapy modalities are being tried (bone marrow transplantation, cytokines). After reaching complete remission, consistent follow up programmes are important in order to detect a relapse (10-15%), and to enable the patient to return to his profession. Psychosocial care is also an important factor. The patient should under no condition be pensioned off, more than 90% of the mainly very young patients (median age 20-35) can return to work after the phase of intensive therapy (3-6 months). In the case of our 222 patients, only 13 had to be pensioned and 7 received new professional training. A disabled pass should be issued, whereby the extent of the disability is reduced from at first 80%-100% to 20% after a period of 5 years. The entry into civil service and a life insurance policy are also usually possible after 5 years. To aid in the consistent and necessary follow up of this group of hopeful and highly curable patients, we have had good experiences in Bavaria with a follow up calendar.

[What importance do tumor markers have in life insurance medicine?]. / Welchen Stellenwert haben Tumormarker in der Lebensversicherungsmedizin?

From the whole host of older and new tumour markers a short description is given of the most important in clinical practice. Nowadays no tumour marker fulfills the criteria which must be demanded of a screening test for an unselected population. Owing to insufficient specificity and sensitivity and with the low prevalence of individual tumour diseases in the population, screening tests would lead to an irresponsibly high number of wrong findings, i.e. particularly of false positive results with all the diagnostic consequences while, moreover, because of the number of false negative results nowhere near all tumour diseases would be recognized. The significance of tumour markers in insurance medicine is as in clinical medicine in the supplementing of oncological aftercare programmes. Here they have become an essential part of the parameters to be checked regularly. It must remain open at present whether owing to the development and new discovery of monoclonal tumour antibodies a reassessment will also be possible in insurance medicine.

Carcinoma-associated hemolytic-uremic syndrome in a patient receiving 5-fluorouracil-adriamycin-mitomycin C combination chemotherapy.

A patient receiving the antitumor agent mitomycin C (MMC) in combination with 5-fluorouracil and adriamycin because of adenocarcinoma of Vater's papilla manifested hemolytic-uremic syndrome (HUS) after five cycles of 5-fluorouracil-adriamycin-MMC combination chemotherapy. The syndrome most likely was caused by MMC, since an association between HUS and the use of MMC has been observed. We report on the clinical course in such a patient and review the pertinent literature.

[Cytostatic polychemotherapy in the aged]. / Zytostatische Polychemotherapie im höheren Lebensalter.

Adherence to the dose or the need for dose reduction and the duration of treatment intervals were determined retrospectively for 1446 chemotherapy courses in 291 patients with malignant lymphoma and breast cancer. In patients over 60 years of age treated with the COP and COPP regimes there was a significantly higher frequency of deviation from the standard regime than in younger patients; a similar situation was seen in patients with breast cancer. The cause in the elderly patients was presumably due to the higher incidence of non-oncological diseases. In a group treated using the CHOP-scheme there was no difference in comparison with the reference group. In this group patients with severe pre-existent diseases were excluded before treatment. The results indicate that age itself is not a major risk factor for a combination chemotherapy. Pre-existent diseases play a substantial role in the toxicity of cytostatics.

Protein C antigen in prothrombin complex concentrates: content, recovery and half life.

Protein C, a potent anticoagulant, has been detected in large amounts in some prothrombin complex concentrates (PCC). We extended these findings to eight PCC commercially available in West Germany detecting 0.82 to 1.92 plasma equivalent units of protein C antigen (PC:Ag) per unit factor IX. Infusion of PCC in four patients on stable oral anticoagulation resulted in a recovery of 58.6 +/- 10.9%. Estimated from the decrease in plasma levels of PC:Ag half life was 7.9 +/- 0.6 h.

[Heparin level determination during extracorporeal circulation in open heart surgery]. / Heparin-Spiegel-Bestimmung während exkorporalem Kreislauf bei Operationen am offenen Herzen.

Because of the high dosages which have to be given during extracorporal circulation it is often impossible to measure the end point of coagulation for both thrombin time and aPTT. A correct determination of the heparin level has become possible with synthetic substrates with the help of the "Protopath proteolytic enzyme detection system" (AHS, Munich). With a fluorogenic synthetic substrate in a one-way cuvette and calibrated fluorometer the heparin and AT III levels can easily be measured. Very high levels of heparin which averaged 6,9 U/ml +/- 1,0 10 minutes after heparinization and 4,4 U/ml +/- 1,0 60 minutes later were found in ten patients with open heart surgery during extracorporal circulation. AT III decreased to less than 50% possibly due to dilutional effects. Ten minutes after protamine neutralization heparin levels were less than 0,1 U/ml. After two hours AT III levels returned to 70%. Measurement of heparin blood levels adds to the quality of anticoagulant control in situations where high dosages of heparin are given.

Levonantradol for the treatment of chemotherapy-induced nausea and vomiting.

Twenty patients with cancer previously unresponsive to antiemetic treatment of chemotherapy-induced nausea and vomiting were treated with the new tetrahydrocannabinoid Levonantradol. 15 patients experienced substantial relief and 10 of them preferred the drug for further courses. These observations suggest that Levonantradol can be beneficial to patients refractory to conventional antiemetic therapy.