[Longitudinal study on quality of life after gastrectomy for gastric cancer and starting points for intensified care]. / Longitudinaluntersuchung zur Befindlichkeit von Magenkarzinompatienten mit Gastrektomie: Ansatzpunkte zur Intensivierung der Betreuung?

UNLABELLED: This prospective longitudinal study on gastric carcinoma patients with gastrectomy was designed to answer the question about changes in several determinants of the quality of life (QL) at various times before and after surgery and to obtain evidence for specific approaches of therapeutic intervention. METHODS AND PATIENTS: 36 patients were given a questionnaire structured according to Eypasch et al. (self- assessment) before surgery, at discharge from the hospital, and after 3 and 6 months. The dual structure of the questions makes it possible to determine whether a single item is present at all (prevalence) and to what extent it impairs the quality of life (no impairment/some/moderate/strong impairment--corresponding to 0-3). The data were evaluated per domain of QL as well as item-related. RESULTS: Postoperatively, 14 patients had to be excluded from the study because of non-radical surgery, complications, recurrences, etc. After 6 months the items of all QL-determinants showed the lowest prevalence with the exception, however, of the somatic determinants, the items of which showed a prevalence of 27 % preoperatively, 64 % at discharge from the hospital, 58 % after 3 months, and 46 % after 6 months. The average degree of QL-impairment increased continuously from 1.17 preoperatively to 1.61 after 6 months. Preoperatively the psychic domain was predominantly impaired, postoperatively the somatic domain. CONCLUSION: Analysis of the subjective quality of life can reveal care deficits. Gastrectomy-associated symptoms seem to influence the quality of life considerably in the first 6 months after surgery. More attention has to be paid to the sequelae of surgery. The high pre- and postoperative frequency of psychic impairment makes it desirable to provide special psychooncological offers of care.

[On the clinical relevance of the dimensional behavior of silver amalgam. A comparative in vitro and in vivo study]. / Klinische Relevanz des Dimensionsverhaltens von Silberamalgamen. Eine vergleichende in-vitro- und in-vivo-Studie.

The clinical relevance of the dimensional behavior of six different gamma-2-free silver amalgam products was examined in comparative in vitro and in vivo trials. Dye penetration tests, roughness measurements, and inspection of the marginal fit using a scanner electron microscope all showed that the results of the in vivo and the in vitro trials were in good agreement and that there was no significant difference between the various products tested, despite the fact that they differed both in morphology and in composition. Copalite exerts a favorable influence on the marginal fit of amalgam restorations, not only in laboratory trials, but also clinically. The results obtained show that the behavior of an amalgam with respect to changes in volume is not the sole criterion by which its quality is to be judged. Amalgams with a pronounced contraction tendency will seal the marginal gap with their corrosion products (SnCl). Here copalite serves as a temporary stand-in. There was no leakage of metal ions from the restoration into the dentin for any of the products tested, including those with a high copper content.

Blockade of FG 7142 kindling by anticonvulsants acting at sites distant from the benzodiazepine receptor.

Repeated administration of the beta-carboline FG 7142 results in sensitisation to its convulsant effects (chemical kindling); acutely FG 7142 is not convulsant, but following several treatments full seizures develop. It has been suggested that the increased sensitivity results from changes in benzodiazepine (BZ)/GABA receptor function. The present experiments studied the ability of BZ receptor ligands and anticonvulsant drugs with diverse mechanisms of action to block the expression and development of kindling to once daily injection of FG 7142 (40 mg/kg, i.p.) in mice. In fully kindled mice, the BZ receptor agonists clonazepam, ZK 93,423 and CL 218,872, and the antagonists flumazenil and ZK 93,426 prevented FG 7142 convulsions, as did 2 anticonvulsants, sodium valproate, possibly acting by influencing GABAergic transmission, and ethosuximide. A further two substances, MK 801 and 2-chloradenosine which act respectively via glutamatergic and purinergic mechanisms were also effective. When administered concomitantly with repeated FG 7142, all of these substances prevented or strongly reduced the development of kindling. Phenytoin and carbamazepine were ineffective in protecting against FG 7142 convulsions in kindled mice, and in preventing the development of kindling when administered repeatedly together with FG 7142. Since MK 801 and 2-chloradenosine prevented kindling, these results suggest that an interaction of FG 7142 with BZ receptors is not sufficient to induce kindling, which may instead result from secondary changes in sites distant from BZ/GABA receptors.

Does the excitatory amino acid receptor antagonist 2-APH exhibit anxiolytic activity?

The activity of 2-amino-7-phosphonoheptanoic acid (2-APH), an antagonist of the NMDA subtype of glutamate receptor, was tested in several animal models of anxiolytic activity in rats and mice and compared with the activity of the standard benzodiazepine anxiolytic, diazepam. 2-APH was effective, but about 100 times less potent than diazepam in antagonising the suppressive effects of punishment on locomotor activity in the four-plate test in mice. 2-APH was also effective in enhancing exploration of the open, exposed arms of a plus maze, without altering exploration of the enclosed arms. Again 2-APH was about 100 times less effective than diazepam. In contrast to diazepam, 2-APH was ineffective in antagonising the pro-punishment properties of the anxiogenic beta-carboline DMCM in a modified four-plate test, and in antagonising the discriminative stimulus provided by pentylenetetrazol. These results are discussed in the context of the equivalence of the antagonism of excitatory mechanisms and the enhancement of inhibitory systems as anxiolytic treatments.

Reversal learning in senescent rats.

The ability of old (24 months) and young (3 months) male rats to reverse a previously acquired discrimination was compared in 5 experiments. The old rats did not need more trials to learn a position habit in a T-maze to obtain water reward, but required more trials to reverse the position habit. The old rats showed a similar deficit in a second, but not in subsequent reversals of the position habit. In a second experiment, old rats were slower in learning to operate one of two levers in an operant chamber to obtain food reward on a CRF schedule, but by the session prior to reaching criterion for acquisition they showed response rates similar to the young animals. When the rats were required to operate the alternative lever to obtain reward, the young rats emitted 70% of their responses during the first reversal session on the newly-correct lever, but the old rats only 35%. Nevertheless, the groups were similar in the number of sessions required to reach a criterion of 95% of responses on the correct lever. In 3 subsequent reversals, old and young rats did not differ nor were there differences in the number of responses in 4 extinction sessions in the rats which had received reversal training. In experiment 3 with old and young rats which had received only acquisition training, old rats emitted fewer responses than young animals during extinction. From these experiments it was hypothesized that the apparent difficulty of old rats in learning a reversal task was due to the low probability of their emitting spontaneously a novel or previously unrewarded response, and not to a difficulty in forming a new association. This hypothesis was tested in two further experiments in which rats were required to learn a brightness discrimination in a T-maze. Old and young rats which had learned and reversed position habits in the T-maze in experiment 1, did not differ in either acquisition or reversal of the brightness discrimination, suggesting that old rats do not differ from young animals in reversal tasks when the motor response requirements for the task are already within the animals' behavioural repertoire. Consistent with this hypothesis, naive old rats were slower than young rats in acquiring a similar brightness discrimination but did not differ in the reversal task.

[Hysterectomy in young women]. / Hysterektomie bei jungen Frauen.

It is reported upon 1345 hysterectomies on patients up to 35 years of age between 1966 and 1981. Proportionately these young women were 16% of all hysterectomies. 69.4% of the patients were between 31 and 35 years of age. 77.4% were operated vaginally. The preoperative morbidity was 46.3%, adipositas was the most frequent one of these with 15.6%. The most frequent indication to operate was uterus myomatosus (33%) followed up by premalignant and malignant change of the uterus (13.8%). The rate of intraoperative complications was 4.2% and the postoperative one was 21.2%. The mortality was 0.37%.