Assessing the efficacy of treatments for panic disorder and agoraphobia. I. Methodological problems.

An assessment of the efficacy of treatments in panic disorder and agoraphobia (PDA) is complicated by methodological problems resulting from the complexity of these disorders. In this paper, commonly used anxiety scales are discussed with regard to their relevance in the assessment of PDA. Although there are already many scales for assessing anxiety and agoraphobia, a qualified instrument for measuring the severity of PDA is still lacking. A survey of the instruments used in recent treatment studies of PDA shows that rather inhomogeneous efficacy criteria were applied. Most often, panic attack frequency was taken as a severity criterion, although this measure showed little power to differentiate between treatments. To deal with the special features of PDA, a battery of different scales was usually employed and non-standardized scales were sometimes used additionally. A new rating scale designed to overcome the methodological problems associated with the assessment of severity in PDA was introduced. The use of the psychiatrist-rated Panic and Agoraphobia (P&A) scale in patients with DSM-III-R panic disorder and/or agoraphobia (n = 235) shows that this scale has the highest correlation with the psychiatrists' clinical global impression of PDA patients (r = 0.79, p < 0.0001), compared with other commonly used observer-rated anxiety scales. The self-rating version of the P&A again had the highest correlation with a patient-rated clinical global impression (r = 0.82, p < 0.0001), whereas the other patient-rated anxiety questionnaires correlated only moderately or poorly. By means of logistic regression, it was shown that the five subscores of the scale contribute independently and almost equally to the prediction of PDA severity.

[Treatment of obstructive sleep apnea syndrome by ambulatory, comprehensive, behavior therapy oriented weight reduction (Optifast program)]. / Die Behandlung des obstruktiven Schlafapnoesyndroms durch eine ambulante, ganzheitliche, verhaltenstherapeutisch orientierte Gewichtsreduktion (Optifast-Programm).

We investigated the therapeutic effect of marked body weight reduction on the predominantly obstructive sleep apnea syndrome by the application of an out-patient, behaviour therapy based body weight reduction program (Optifast-program) in 5 of our obese apnea patients. Mean body weight reduction was 32.7 +/- 15.8 kg after 6 months. The mean apnea-index of 34.5 +/- 23.1/h prior to the weight reduction dropped to 7.8 +/- 6.1/h after therapy. The mean apnea-hypopnea-index could be reduced from 45.7 +/- 25.9/h to 14.0 +/- 11.4/h. The best therapeutic effect on the sleep related respiratory parameters, was seen in patients who reached their normal weight. Our results shows that even severe, predominantly obstructive sleep apnea syndromes could be treated successfully with a marked body weight reduction.

[Immunohistochemical demonstration of L- and M2-pyruvate kinase in primary renal cell carcinomas and their metastases]. / Immunhistochemische Darstellung der L- und M2-Pyruvatkinase in primären Nierenzellkarzinomen und deren Metastasen.

Seventeen renal cell carcinomas (RCC) were classified histologically and investigated for their expression of L- and M2-pyruvate kinase (PK) immunohistochemically. Using monoclonal antibodies we were able to demonstrate L-PK within 15 RCC and two metastases (in thyroid gland and bone) after fixation with aceton and paraffin embedding. In normal renal tissue the enzyme was localized within proximal tubules selectively. No enzyme reaction of L-PK could be demonstrated in renal oncocytoma, thyroid carcinoma, and in carcinomas of renal pelvis and lung. In contrast to this the M2-PK was detectable in all tumors and metastases investigated in this study. The results presented in this paper are able to show that (1) RCC derive from the proximal renal tubules, but not the renal oncocytoma, (2) the detection of L-PK may be helpful for identification of metastases of RCC even if they are undifferentiated and (3) there is an enzyme shift from L-PK to M2-PK within tumor cells of RCC resulting in alteration of glucose utilization from energy supply to syntheses of substrates essential for tumor cells.