Integrated care in ovarian cancer "IgV Ovar": results of a German pilot for higher quality in treatment of ovarian cancer.

INTRODUCTION: Late-stage ovarian cancer patient's survival depends on complete cytoreduction and chemotherapy. Complete cytoreduction is more often achieved in institutions with a case volume of >20 cases per year. The Integrated care program Ovar (IgV Ovar) was founded in 2005 and started recruiting in 2006 with 21 health insurances and six expert centers of ovarian cancer treatment as a quality initiative. Results of the pilot and outcomes of patients of three participating centers will be presented here. METHODS: Data of 1038 patients with ovarian cancer were collected. Adjuvant patients (n = 505) stage FIGO IIB-IV (n = 307) were analyzed for cytoreduction and survival. FIGO IIIC patients were analyzed separately. RESULTS: Median follow-up was 32.7 months. Progression-free survival (PFS) was 23.1 months and overall survival (OS) was 53.6 months for stage IIB-IV. Patients with FIGO IIIC were completely cytoreduced in 48 %. PFS was 21, 29 months if completely cytoreduced. OS was 47.4, 64.9 months if completely cytoreduced.D ISCUSSION: Although the IgV Ovar Rhineland proved to have some structural problems with recruitment and prospective data collection, cytoreduction rates and outcome of patients prove treatment of patients in expert centers is superior to the national and international mean. Therefore, a new quality initiative will be started to bring more awareness to women and to their gynecologists and general practitioners of just how important a good referral strategy is.

[Diagnosis and treatment of the Essex-Lopresti lesion. Literature review and four case reports]. / Diagnostik und Behandlung der Essex-Lopresti-Verletzung. Literaturanalyse und 4 Fallbeispiele.

BACKGROUND: A fracture of the radial head in combination with a rupture of the interosseous membrane and lesion of the distal radioulnar joint known as Essex-Lopresti lesion is a rare injury. Usually it is caused by a high-energy trauma. Initially unrecognized distal radioulnar dislocations often show poor results. MATERIAL AND METHOD: Four case reports are presented to discuss the trauma mechanism together with diagnostic and treatment options. Especially the accuracy of ultrasound to diagnose an interosseous membrane disruption was evaluated. RESULTS: After an average of 35 months all patients were examined using the Morrey score and the modified score of Green and O'Brien. Initially the extent of the injury was not diagnosed in three cases. According to the score values the average results have been fair. CONCLUSIONS: An early diagnosis is the key for the correct treatment of an Essex-Lopresti lesion based on the classification of Edwards and Jupiter. In addition to the clinical and radiological assessment ultrasound should be used to diminish the rate of unrecognized interosseous membrane disruptions.

[Suspected neurological side-effects of tick-borne meningoencephalitis vaccination: experiences of the Swiss Adverse Drug Reaction Reporting Center]. / Vermutete neurologische Nebenwirkungen der FSME-Impfung: Erfahrung der Schweizerischen Arzneimittel-Nebenwirkungs-Zentrale (SANZ).

The number of patients affected by tick-born encephalitis (TBE) in Switzerland has increased in the last years and an extension of the endemic foci of TBE has been observed. Therefore, active immunization by TBE vaccination has become more important. The possible adverse vaccine reactions have to be known as exactly as possible. The Swiss Drug Monitoring Center SANZ received from 1987 until June 2000 33 spontaneous cases reporting on 39 neurological adverse reactions in a close temporal relationship with a TBE vaccination and a suspected causal relationship. The following adverse reactions were reported most frequently: headache in 36%, neuropathy in 18% and meningeal irritation in 13%. Twelve out of 33 patients were hospitalized due to the adverse reaction. All neurological reactions were reversible. The spontaneous reporting scheme of the SANZ does not allow to calculate the incidence of neurological reactions after TBE vaccination. In general, adverse neurological reactions after TBE vaccination seem to be rare. According to the experiences of SANZ all reported neurological reactions were reversible.

Postmarketing safety information: how useful are spontaneous reports?

UNLABELLED: From 1995 until June 1998 123 new chemical entities (NCEs) were launched in Switzerland. In this time period 250 reports of adverse reactions (ADRs) involving 56 different NCEs were reported to the Swiss Drug Monitoring Center SANZ directly by physicians within the voluntary spontaneous reporting scheme (SRS). No cases from observational or clinical postmarketing studies were included. Of the reports 88% were suspected to be drug-related and 20% of them were serious. In 64% the ADRs were unlabelled and not notified to the health professionals. Disorders of the central nervous system (CNS) were reported in 32% and cardiovascular disorders in 26% of the unlabelled and serious cases. The non-serious cases accounted for 80% of the reported NCE-ADRs and 60% of them were unlabelled. Skin reactions were reported most frequently (18%), followed by psychic (15%), gastrointestinal (10%), cardiovascular and CNS disorders (8% each). In the labelled non-serious cases gastrointestinal and skin reactions were reported in 25% and 24% respectively. The other system organ classes were involved to a much smaller extent (<8%). CONCLUSIONS: (1) Spontaneous reports are of great value in optimizing postmarketing safety information. (2) Early reports give rise to a different ADR profile than expected from premarketing safety information. (3) Spontaneous reports have a strong signalling function especially for drugs used by general practitioners. (4) Sensitive signal detection systems are of great value in detecting non-labelled and serious ADRs in an early phase.