[Blood loss and absorption in TURP vs. TUVRP under low pressure and high pressure conditions]. / Blutverlust und Einschwemmung bei TURP vs. TUVRP unter Niederdruck- bzw. Hochdruckbedingungen.

This study analyzes the causes of different fluid absorption and loss of blood in TURP (transurethral resection of the prostate) and also compares TURP with TUVRP (transurethral vaporesection of the prostate). Continuous intraoperative, intravesical pressure measurement and registration of the extent of fluid absorption (measurement of C(2)H(5)OH in the patient's expiratory air) and precise intra- and postoperative analysis of serum and ASTRUP analysis made it possible to differentiate between high- and low-pressure TUR. In addition positive and negative characteristics of TUVRP could be examined. When fluid absorption was registered, a clear correlation between C(2)H(5)OH absorption and decrease in serum concentration of sodium could be seen, making sodium in serum a good marker of fluid absorption. Neither the duration of the operation nor the size of the adenoma had an influence on fluid absorption and loss of blood, but sinus bleeding and capsular lesions, especially in high-pressure TUR, had a significant influence. An advantage of low-pressure TUR, especially in "low compliance bladder," could be clearly seen. No benefit concerning fluid absorption and loss of blood was seen in cases of total resection by TUVRP. In cases of palliative, planned TUR (elderly patients with multiple risk factors) a TUVRP is recommended.

Psychosocial adjustment of pediatric patients after allogeneic stem cell transplantation.

The purpose of this study was to assess the psychosocial adjustment of patients who had been treated with allogeneic stem cell transplantation (SCT) in our clinic. Selection criteria for patients were to be aged 14-30 years at the time of the follow-up, to be at least 2 years post-SCT and to have a very good knowledge of German. Among 31 eligible patients, 26 participated (84% response rate). The patients were between 15 and 27 years old and were on average 7 years (range 2-13) post-SCT. Research instruments consisted of a demographic questionnaire and various subscales of established psychological measures for which data from a sample of bone cancer survivors and population norms were available. About 35% of patients showed high levels of anxiety, 62% appeared to be extremely sensitive and vulnerable, and 35% showed strong, unfulfilled needs in their love lives. In the other domains tested (self-esteem, family and peer relationships, school/vocational performance, etc), no noticeable differences were found between the subjects and comparable populations. There was no significant association between psychosocial outcome and demographic features or clinical data. Our results suggest that patients who underwent SCT in their childhood or adolescence are at risk of developing long-term emotional or social problems. Due to the retrospective design of our study and the small sample size, no predictive factors for psychosocial distress could be identified.

Organ toxicity and quality of life after allogeneic bone marrow transplantation in pediatric patients: a single centre retrospective analysis.

One hundred and fifty five pediatric patients underwent allogeneic bone marrow transplantation between 1980 and 1996 in the St Anna Children's Hospital in Vienna with an overall survival of 52.3% (81 patients). Seventy-three patients with a minimum observation time of 1 year (1-13 years, median: 4.6) were analyzed retrospectively for chronic GVHD, organ toxicity (WHO score), growth and pubertal development. Chronic GVHD was diagnosed in 20 patients (27.3%), being extensive in 17 cases. Maximum organ toxicity was WHO III in two patients (3%) and WHO II in 11 patients (15%) 1 year after BMT and WHO III in one patient (2%) and WHO II in five patients (11%) 3 years after BMT. Impaired growth and pubertal development were detected in more than 30% 3 years after BMT. As all patients presented with a Karnofsky or Lansky score of more than 80%, they were asked to complete a questionnaire comprising 12 questions concerning physical state of health and psychosocial state of health. Restricted contacts were classified as imposing a severe handicap by six patients (8%), restriction in mobility and 'normal life activities' by three patients (4%) and two patients classified themselves as severely physically handicapped. Most patients (75%) reported no physical or psychical impairment.