[A retrospective analysis of the treatment results in Hodgkin's disease in a radiotherapy clinic]. / Retrospektive Analyse der Behandlungsergebnisse bei Morbus Hodgkin in einer strahlentherapeutischen Klinik.

PURPOSE: Treatment results were reviewed in a retrospective analysis and compared with literature data. Prognostic factors for freedom from relapse and overall survival were identified. PATIENTS AND METHODS: We analyzed the history of 183 patients treated for Hodgkin's disease between 1977 and 1989 at the Department of Radiation Therapy at the University of Würzburg. There were 100 males and 83 females between 16 and 86 years of age. 70.5% of patients presented with early stage Hodgkin's disease (23.5% stage I and 47.0% stage II) and 29.5% had advanced stages (25.1% stage III and 4.4% stage IV). All patients were treated initially with radiotherapy, 114 had radiotherapy alone and 69 patients received combined modality treatment. RESULTS: Hundred and sixty-one patients (88.0%) reached a complete remission. Freedom from relapse was 73.7% at 5 years and 70.3% at 10 years for these patients, overall survival was 74.3% and 62.8% at 5 and 10 years for all patients. Prognostic factors for freedom from relapse were stage IV, B symptoms, age greater than 35 years and more than 3 involved lymph node regions. These factors also were relevant for overall survival, in addition mixed cellularity or lymphocyte depleted subtype, high erythrocyte sedimentation rate, failure to achieve a complete remission following initial treatment and relapse of Hodgkin's disease were identified as negative prognostic factors. Laparotomy staged patients who received radiotherapy only for stage I and II Hodgkin's disease had better outcome than clinically staged patients. Our data suggest that adequate therapy is able to reduce the impact of unfavourable prognostic factors. The outcome for patients with bulky mediastinal disease was similar to that in patients without a mediastinal mass. CONCLUSIONS: The optimal choice of treatment for patients with early stage Hodgkin's disease--combined modality treatment/radiotherapy alone/chemotherapy alone?--and for patients with advanced stages--consolidation radiotherapy?--remains an unresolved issue and needs further testing in large randomized trials considering acute and late complications. Staging laparotomy may be used only for a small group of patients who would receive radiotherapy alone as definitive treatment. Modifications of therapy clearly reduce the impact of negative prognostic factors.

Marketing in home health care. A practical approach.

Home health marketing brings special problems and opportunities. One cannot rely on physical factors such as the physical plant and food service of a hospital or on the durability of a consumer product to judge home health. Opportunities exist within home health to identify activities that carry marketing value. Applying marketing principles to activities such as intake, customer service and public relations allows the home health agency to build referrals by meeting the wants and needs of the market. The home health organization needs to consider different wants and needs of those involved in the home health transaction: the decision maker, the purchaser, and the user. The success of the marketing function in meeting the organization's objectives will be aided by the placement of marketing at the senior management level.

[Study on the normal mercury concentrations of human organs (author's transl)]. / Untersuchung zur normalen Quecksilberkonzentration menschlicher Organe.

Organ samples of the right kidney the right and left lobe of liver, the cerebellum, and the left cerebrum (cortex and marrow separately) from 51 autopsies were analysed on their mercury content. A special high pressure-digestion was used for the sample preparation. The quantitative determination of the mercury concentrations was performed by the so-called cold vapour technique. In the organs the following median mercury concentrations were found: a) left lobe of liver: 58 microgram/kg b) right lobe of liver: 54 microgram/kg c) right kidney: 96 microgram/kg d) cerebellum: less than 5 microgram/kg e) cerebrum cortex: less than 5 microgram/kg f) cerebrum marrow: less than 5 microgram/kg. All values were below the internationally discussed range. No sex differences were detectable in the median mercury concentrations of the analysed organs. The positive correlation between age and the mercury concentration in the cerebellum could reflect an accumulation over the life. But most likely the concentrations still stay considerably below the critical limits. The negative correlations between age and the mercury concentrations of the liver lobes as well as of the kidneys indicates a change in the distribution of mercury in the body with increasing age.