Prospective assessment of quality of life of female cancer patients.

OBJECTIVE: The aims of this study were to compare the quality of life (QOL) of women with different cancer sites; to identify predictors of QOL; and to examine the agreement between patient self-reported QOL and QOL ratings provided by clinicians and significant others. METHODS: A prospective study was conducted including 248 patients with gynecologic and breast cancer. QOL data were collected at six time points before, during, and after treatment, using the EORTC QLQ-C30 and the Spitzer QL index (QL-I). RESULTS: Baseline assessments showed comparable QOL scores among patients with different gynecologic malignancies and breast cancer. During active treatment breast cancer patients had significantly higher mean scores in physical functioning compared to women with gynecologic cancers and higher scores in role functioning compared to patients with cervical cancer. After completion of treatment there were no statistically significant differences in QOL among the groups. For all women, global QOL and emotional functioning were mostly affected during and after treatment. Regression analysis showed that patients' global QOL was significantly predicted by severity of surgery (t = 3.903, P < 0.01) and pretreatment performance status (t = 3.116, P = <0.01). Comorbidity, family support, number of treatments, age, and stage of disease were not predictive. The comparison of patient self-rated QOL and observer-rated QOL showed that the QL-I mean scores of health providers and relatives were generally in close agreement with those of patients. Intraclass correlations were moderate to high during active treatment and excellent after completion of treatment. CONCLUSION: In female cancer patients, global QOL and emotional functioning are mostly affected during the course of disease, independent of their diagnosis. Significant others and health professionals are able to provide useful information on QOL of patients recovering from cancer.

[Cerebral infarct and hemorrhage in patients with sickle cell disease]. / Zerebrale Infarkte und Blutungen bei Patienten mit Sichelzellerkrankungen.

Two sickle cell patients with cerebral accidents, infarct and bleeding, are presented. Up to 15% of all sickle cell patients suffer cerebral events, 75% of which are infarcts, 25% intracranial hemorrhages. Infarcts occur predominantly in children with a clustering around age 7, while bleeding predominates in adult life. Cerebral events are due to intimal changes, proliferation and finally occlusion of both small and large cerebral arteries. Infarcts present with hemiparesis, aphasia, loss of vision and seizures whereas intracranial bleedings are associated with severe headache and/or loss of consciousness and coma. When cerebral infarct is suspected, magnetic resonance imaging is the diagnostic method of choice. Intracranial bleeding is best diagnosed by computed tomography or angiography. Partial exchange transfusion is indicated in both events to be followed by a chronic transfusion program of as yet undetermined length. Routine magnetic resonance angiogram and/or transcranial doppler sonography in young asymptomatic sickle cell patients may make it possible in the future to detect patients at risk and institute treatment prior to a cerebral accident.

[A case of strabismus concomitans convergens alternans acutus]. / Ein Fall von Strabismus concomitans convergens alternans acutus.

In the present paper the authors report on a case of acute concomitant squint in a 14-year-old girl. A study of the patient's history revealed only psychosomatic factors as possible causes.

[Limbus-based flap versus fornix-based flap in goniotrepanation]. / Limbus based flap versus fornix based flap bei Goniotrepanation.

In a prospective, randomized study 61 eyes in which goniotrepanation had been performed using fornix-based or limbus-based conjunctival flaps were followed up for 4 to 18 months. No differences were found in the results of filtration, nor in the form and frequency of filtering blebs or the frequency of complications. In view of the easier technique and better visualization, the present authors prefer the fornix-based flap.

[Gas permeable contact lenses in the management of problem cases and in prolonged wearing time]. / Gaspermeable Kontaktlinsen zur Versorgung von Problemfällen und bei verlängerter Tragzeit.

The continuous improvement of contact lenses (copolymers with high gas permeability) makes better care possible in problem cases. They can also be used for continuous wear. The present authors report upon 104 cases in which a contact lens made of P3, was tested. This is a hard, flexible contact lens with a DK value of 33, which is produced without additional treatment of the surface.

[Clinical, morphological and biochemical studies on muscle carnitine deficiency (author's transl)]. / Klinische, morphologische und biochemische Befunde bei Carnitinmangelmyopathien.

This report deals with two sisters who died with eight, respectively ten weeks under the signs of respiratory failure caused by progressive muscular weakness. Only an elevated cerebrospinal fluid protein was suspicious of an additional disturbance of the central nervous system. Muscle biopsy revealed a vacuolar myopathy. Histochemistry showed lipid storage, increased mitochondrial enzyme activity, and to a lower degree, glycogen accumulation especially in type I muscle fibers. Electron microscopy confirmed elevated lipid content in combination with increased, enlarged and abnormally structured mitochondria. Biochemical studies on muscle biopsy, in comparison with normal children, showed a significant decrease of carnitine content and an increased activity of carnitine palmityltransferase. Retrospectively from a clinical point of view this disease is suggestive of "systemic carnitine deficiency", even if some symptoms (hepatomegaly, cardiomyopathy) were not present and serum- and liver carnitine was not measured because the children died before the diagnosis of muscle carnitine deficiency was confirmed. The clinical picture of these two fatal cases is compared with another observation of muscle caritine deficiency. This child shows only a mild course of muscle disorder, but very similar morphological changes in muscle biopsy. Biochemically, there was a clear decrease in muscular carnitine, while the serum levels were in the normal range. The activity of muscular carnitine palmityltransferase was also normal.

[Specific points of view on the education and psychological developement in children with cystic fibrosis]. / Spezifische gesichtspunkte der erziehung und psychischen entwicklung mucoviscidose-kranker kinder

A sample of 21 parents were interviewed about the psychological development of their Cystic Fibrosis children and their way of education. Additionally 18 children - 6 to 15 years old - were examined by means of psychological tests. The results of the interviews demonstrate favourable behaviour in education, the parents being tolerant and consequent. The children were often described as reasonable and mature. There were seldom complaints about problems in education and behaviour. Some families are exercising an overprotecting way of education. The positive general impression with regard to the emotional and social develoment of these children was confirmed by the applied personality tests. Concerning the factor ""emotional stability'' there were no important statistical discreptancies to healthy children of the same age; examination phobias, aversion against school and conscious fears were found significantly more seldom in comparison to other children. It was stated, however, that aggressive emotions were inhibited. Finally there was a marked sense for responsibility beside a deficit in the development of independance.