[Prognostic advantage for defined risk groups by lymphocyte dissection. Long-term study of 3,616 melanoma patients]. / Prognosevorteil für definierte Risikogruppen durch die Lymphknotendissektion. Langzeitstudie an 3616 Melanompatienten.

Nine medical centres with different practices in elective lymph node dissection (ELND) but comparable standards regarding diagnosis, excision of the primary tumour, classification, and follow-up, have collected their data on 3616 patients with primary melanoma of the skin (tumour category pT 2 to pT 4a, N 0, M 0 [UICC 1987] with the aim of producing an unbiased analysis of the prognostic benefit of ELND. The multivariate risk analysis (Cox's proportional hazard model) revealed tumour thickness (Breslow or alternative pT categories), sex, anatomic site of the primary tumour, and ELND therapy ("yes" or "no") as independent prognostic factors. Observed survival curves (Kaplan-Meier) show a significant difference of prognosis with regard to ELND therapy in the following risk groups: women with melanomas over 2.5 to 4 mm thick on head, neck, thorax, and in acral locations; men with melanomas over 1.5 to 4 mm thick on head, neck, thorax, and in acral locations; and finally men with melanomas over 2.5 to 4 mm thick on abdomen and extremities. Further investigations and the discovery of additional prognostic factors would help in more precisely formulation of guidelines for ELND.

Benefit of elective lymph node dissection in subgroups of melanoma patients. Results of a multicenter study of 3616 patients.

BACKGROUND: The benefit of elective lymph node dissection (ELND) for the treatment of the nonmetastasized malignant melanoma has been assessed differently until today. METHODS: Nine medical centers with a different ELND practice but comparable standards regarding diagnosis, excision of the primary tumors, classification, and follow-up, have collected their data (primarily ascertained prospectively) of 3616 patients of the tumor categories pT2 to pT4N0M0 to produce an unbiased analysis of the prognostic benefit of ELND, and to find the indications for its application. The data are based on patients 70 years of age and younger with a primary melanoma of the skin, who have been followed for at least 4 years (median, 9.6 years). The stratification (according to pT category [alternatively, tumor thickness], sex, anatomic site) was in accordance with the results of the multivariate risk analysis (Cox hazard model). Imbalances of other criteria such as ulceration, type, and age were excluded by chi-square tests of the individual strata. The results are based on the observed survival rates according to Kaplan-Meier analysis of the different strata. RESULTS: A prognostic benefit of the ELND group (improvement of the 5-year survival rate of about 20%) can be claimed for male patients with axial and acral melanomas (excluding lentigo maligna melanoma [LMM] and ulcerated tumors) of the categories pT3a up to pT4a (tumor thickness of > 1.5-4.5 mm, respectively) (P < 0.001). As to the rest of the nonulcerated tumors of male patients, only those of the categories pT3b and 4a benefited from ELND (P < 0.01). A benefit from ELND for women was statistically verified (improvement of the 5-year survival rate of about 5%-10%) only for the subgroup with a tumor thickness > 2.5-5 mm, excluding LMM) (P = 0.016). CONCLUSIONS: This retrospective study strongly suggests the efficacy of ELND in subgroups of melanoma patients.

[Treatment of a high-grade pain syndrome in partial paralysis by series of paravasalic sympathetic nerve blockade.].

Because of distinct pain symptoms in the presence of an ascending partial paralysis-Brown-Sequard Syndrome-from T 5/6 upward in a 56-year-old patient, therapy with paravasalic injections of bupivacaine 0.125% in the area of the femoral artery (right) was given. The patient kept a pain diary with entries every 2 h for 61 weeks. Evaluation of the documentation demonstrates the success of the therapy and shows the possibilities of different kinds of evaluation of well-documented pain data.

[Ranitidine in stomach ulcer. Controlled clinical trial of a comparison of administration after the evening meal or before bedtime]. / Ranitidin beim Ulcus ventriculi. Kontrollierte klinische Prüfung zum Vergleich der Einnahme nach dem Abendessen oder vor dem Schlafengehen.

In a randomized, double-blind comparative trial, 44 patients with gastric ulcer received one dose of ranitidine 300 mg following the evening meal (between 17.30 and 20.00 hours), and a placebo tablet just before retiring for the night (21.30 to 23.00 hours) (R-P group). In the comparative group, 43 patients received the same substances in the reverse order (P-R group). After four weeks' treatment, the endoscopic follow-up examinations revealed a 76% healing rate in the R-P group and a 63% healing rate in the P-R group. After six weeks, cumulative healing rates of 98% and 81%, respectively (p less than 0.05) were obtained, showing a better healing effect after early evening ingestion of ranitidine. The number of symptoms recorded at the start of treatment had, after four weeks of treatment, decreased considerably more following early-evening ingestion of ranitidine than after late-evening ingestion (p = 0.05). The results of this trial suggest that, in the treatment of gastric ulcers, the early-evening administration of ranitidine 300 mg is more effective than other modes of ingestion.

Setting up a decision support system with decision tables.

The aim of our study was to develop a decision support system using a conventional method which can be used as a shell for different applications. So it was necessary to find a method which allows separation of decision principles and decision algorithms. In addition, documentation of the patient records should be simplified. This could be attained by using the decision table technique and the programming language MUMPS. The general system developed was applied to the therapy decision for patients with liver metastases. The application system was clinically evaluated in a randomized group of patients. In 84% of the study group the therapy proposal of the system concurred with the therapy actually applied. Representation of knowledge in the form of tables is easily understandable by physicians. Since decision tables can be seen as a medium of communication between physician and system manager, knowledge acquisition is simplified.

[Analysis of the periodical Strahlentherapie from 1920 to 1984]. / Analyse der Zeitschrift "Strahlentherapie" 1920 bis 1984.

The part of medical science, radiotherapy and radiology, and its outstanding publication organ, Strahlentherapie, in its development in the last sixty years is evaluated in form of a publication analysis. From every decennium the first five years from 1920 to 1984 are taken to analyse the articles by formal facts and contents. Especially the habit of citing is evaluated in detail. Dependences among the factors (especially time dependences) are worked out in detail.

Analysis of citations in four MIE proceedings.

Scientific work in medical informatics has been going on for more than 25 years; the results of this work are published in one way or another. How are these publications used to avoid the invention of the wheel for the second and third time? To get an overview of this, four proceedings of the Medical Informatics Europe conferences out of the last eight years have been analysed, to show the behaviour of authors in different countries and in different years in respect of citations.

Multivariate prediction model of kidney transplant success rates.

An excellent correlation of predicted and observed cadaver kidney graft survival rates was obtained using a nine-factor computer model. A total of 924 recipients for whom a greater than 80% 1-year survival rate was predicted had an observed rate of 84.6%, whereas 179 recipients with a predicted 1-year success rate of less than 40% had an observed rate of 38.2%. Our model gives improved results as compared with previously published methods. We anticipate that the model's predictive power can be further refined, and that patient selection and organ sharing will benefit from the application of sophisticated computer models for the prediction of transplant success.

[Diurnal dependence of skin reactions in the administration of external substances]. / Zur tageszeitlichen Abhängigkeit von Hautreaktionen bei externer Wirkstoffapplikation.

In order to investigate the influence of the application time of the day on skin reactions, test persons were treated with various substances inducing experimental inflammation in human skin. Additional tests provided us with data regarding the antiinflammatory activity of topical glucocorticoids on the experimental inflammation as well as the vasoconstrictive activity dependent on the application time of the day. Although all tests showed great individual scattering ranges, statistical evaluation did not reveal any clear evidence for the supposition that pharmacological responses of the skin may be influenced by the hour of the topical application. Thus, it seems not likely that the success of topical treatment of toxic dermatitis by means of glucocorticoids depends on the hour of application.

[A new method for the transcutaneous measurement of deep body temperature during anaesthesia and intensive care (author's transl)]. / Ein neues Verfahren zur transkutanen Messung der Körperkerntemperatur in Anästhesie und Intensivpflege.

A new method for monitoring deep body temperature is described. It is based on the establishment, by means of electronic appliances, of a zone without heatflow from the deep tissues. The method is simple and the results compare favourably with those obtained by other procedures for measuring core temperature. The uses of this transcutaneous mehtod are discussed and its advantages and reliability in the operating theatre and intensive care unit are emphasized. It becomes less reliable if it is employed during and after extracorporeal circulation in hypothermia on account of the temperature gradient.

[Psychological and sexual acceptance of vaginal hysterectomy for sterilization (author's transl)]. / Die vaginale Uterusexstirpation als Methode der definitiven Schwangerschaftsverhütung. Eine Untersuchung der psychischen und sexuellen Reaktion nach Hysterektomien bei 1007 Patientinnen

Psychological and sexual sequelae of hysterectomy were studied in 1007 cases between 1 1/2 and 8 years following the operation. Younger women had more often vaginal and older women more ofter abdominal hysterectomies. 78% of the patients thought they had been fully informed about the operation. 4.1% of the patients regretted the hysterectomy. 8% of the patients regretted the loss of menstruation. Most of these did not think they were fully informed. Full information on the type of operation can reduce negative postoperative sequelae. As many patients gained as lost weight following the hysterectomy. Postoperative coital difference did not show any relationship to the type of hysterectomy. In 57% of the cases, improvement occured one year later and in 10% of the cases improvement occurred 2 years later. Sexual relationships were not adversely affected by hysterectomy. Deterioration of the sexual relationship regarding libido and frequency of orgasms was a more frequent complaint in the control group. Improvement of libido and frequency of organsms can still occur 2 years following hysterectomy. Covert and overt depression was as frequent in the hysterectomized group as in the control group. The adverse effects of sterilization by tubal ligation were identical to those found in our group of hysterectomies according to the literature. Therefore we prefer vaginal hysterectomy for voluntary sterilization to tubal ligation.