[Problems of randomized studies in complementary medicine demonstrated in a study on mistletoe treatment of patients with breast cancer]. / Problematik randomisierter Studien in der Komplementärmedizin dargestellt am Beispiel der Misteltherapie bei Patientinnen mit Mammakarzinom.

BACKGROUND: Prospective randomized studies on mistletoe therapy repeatedly demonstrated that there is a basic problem in the matter of enrolling the appropriate number of patients within a reasonable amount of time. Most studies have to face this problem. However, recent experience suggests that this problem is more pronounced in the case of mistletoe treatment of cancer patients. OBJECTIVE: Possibility of recruitment and randomization of breast cancer patients for a mistletoe study. PATIENTS: During a period of 28 months every patient was registered who was admitted to the Gynecological Hospital of the University of Heidelberg because of suspected cancer. RESULTS: Out of 1,922 patients who were operated on for breast tumor, 521 first met the inclusion and exclusion criteria. 154 out of these 521 patients agreed to take part in the study. After availability of the final results on tumor staging and the therapy plan for conventional treatment, 80 out of the 154 women had to be excluded from the study. From the remaining 74 patients (48%), however, only 29 (39%) would have agreed to take part in a randomized mistletoe study. CONCLUSIONS: This confirms our suspicion that the difficulties of enrollment and randomization in the case of mistletoe studies exceed those of studies conducted in conventional oncology. The reasons for this dramatic effect and the possibility of alternative study designs are discussed.

Measurements of IL-6, soluble IL-6 receptor and soluble gp130 in sera of B-cell lymphoma patients. Does viscum album treatment affect these parameters?

Interleukin-6 (IL-6) can be involved in several diseases including lymphoid malignancies. This cytokine binds to soluble IL-6 receptor (sIL-6R) circulating in blood, leading to signal transduction via gp130. Soluble IL-6R shows agonistic activity for IL-6, and the soluble form of gp130 (sgp130) an antagonistic effect against the complex IL-6/sIL-6R. Viscum album extract (Iscador) as an immunomodulator is used in the treatment of malignant disorders. In this study we investigated the effect of this treatment on the serum levels of IL-6, sIL-6R and sgp130 in B-cell lymphoma patients (n = 27), in comparison to healthy controls (n = 28). Twenty-one of 27 patients had been treated previously with chemo/radiotherapy. The patients were divided into two groups; those with short-term (investigated before and during treatment) or those with long-term Viscum album (VA) therapy (investigated during therapy). The serum levels of the three parameters were determined by ELISA. In patients having short-term treatment IL-6 values were similar to those of controls. During long-term therapy the values were significantly lower (P<0.05). The values of sIL-6R were elevated only in long-term treated patients (P<0.05), the values of sgp130 in both short-term (P<0.05) and in long-term treated patients (P=0.001). There is a significant correlation (P<0.05) between levels of sIL-6R and sgp130 in both therapy groups at 24 hours after injection. This indicates that the potent effect of sIL-6R on the biological activity of IL-6 could be inhibited by sgp130 as antagonist. Clinical data show that half of the patients (6/12) with long-term treatment had a continuous complete remission, whereas only 2/15 patients with short-term treatment had a complete remission.

[Favorable long-term outcome with mistletoe therapy in a patient with centroblastic-centrocytic non-Hodgkin lymphoma]. / Langfristig guter Verlauf unter Misteltherapie bei einem Patienten mit einem zentroblastisch-zentrozytischen Non-Hodgkin-Lymphom.

HISTORY AND ADMISSION FINDINGS: Follicular non-Hodgkin lymphoma had been diagnosed in a 44-year-old man. Physical examination revealed several cervical, axillary, inguinal and infrainguinal lymphomas, maximally 1.5 x 1.2 cm in diameter. ADDITIONAL INVESTIGATIONS: Computed tomography showed multiple thoracic, abdominal and inguinal lymphoma, which--according to the Ann Arbor classification--were follicular non-Hodgkin stage IV (low grade) lymphoma with bone marrow infiltration. TREATMENT AND COURSE: Treatment with an extract of mistletoe (Iscador) was initiated and has been continued to-date (12 years). Quality of life throughout ths period has remained good. Phases of uninterrupted treatment resulted in lymphoma regression (regionally complete), while cessation of treatment led to progression. CONCLUSION: This case report demonstrates the efficacy of treating lymphoma with extract of mistletoe (Iscador). This therapeutic success confirms the result obtained in other patients with this disease. Thoughts of contraindication to mistletoe therapy belong to the realm of unfounded speculation.

End-user programs in medical school libraries: a survey.

A questionnaire was sent to all medical school libraries listed in the Annual Statistics of Medical School Libraries in the United States and Canada (1983-1984) asking librarians to describe their end-user programs. Of the 113 responding libraries, 78 had an end-user program. All provided some kind of formal instruction, 39 made equipment available to end users, and 22 provided and administered passwords. The reasons most cited for starting a program were staff interest and patron requests. The two most frequently taught systems were NLM/MEDLINE and BRS/Colleague. In general, respondents felt positive about the programs and planned to continue them. The most frequently mentioned problem was need for more equipment.