[Intracerebrally localized sarcoma NOS--an interdisciplinary challenge]. / Intrazerebral lokalisiertes Sarkom NOS--eine interdisziplinäre Herausforderung.

BACKGROUND: In the literature, surveys of malignant intracerebral nerve sheath tumors are very rare (Table 1). Therapeutic guidelines do not exist. CASE REPORT: A 28-year-old female patient presented with a tumor in the postcentral region of the left parietal lobe (Figures 1 and 2). The specimen could not be categorized into a common tumor entity and was classified as sarcoma NOS. Shortly after surgery, a recurrence occurred (Figures 3 to 5) followed by a further excision. Due to the rapid tumor growth irradiation with CT-aided treatment planning (Figure 6) has been started immediately afterwards. A dose of 5,400 cGy in 22 fractions was administered. RESULT: 2 weeks after treatment, the patient presented with a noticeable tumor regression (magnetic resonance imaging; Figures 7 to 9). She developed pulmonary metastases. A partial remission could be achieved by systemic chemotherapy. Unfortunately, the patient died because of an exacerbation of a hepatic encephalopathy. CONCLUSION: In cases of intracerebrally localized sarcomas NOS, the earliest possible start of radiotherapy after surgery seems useful because of the noticed radiosensitivity of these tumors. In regard of the local control, this tumor entity shows a documented excellent response to radiotherapy. Expectedly, distant metastases cannot be influenced. Interdisciplinary cooperation is mandatory to enhance the diagnostic process, the treatment decisions, and the results.

Attitudes of patients with schizophrenia toward placebo-controlled clinical trials.

BACKGROUND: Despite the fact that the efficacy of antipsychotic treatment in patients with schizophrenia has been demonstrated in numerous double-blind studies, placebo-controlled studies are still commonly performed. Although much is known about the opinions of professionals concerning this issue, so far nothing is known about the opinions of patients who are most affected by the realization of placebo-controlled clinical trials. METHOD: In a cross-sectional study from June 2000 to January 2001, 100 inpatients and outpatients with ICD-10 schizophrenia or schizophreniform disorder were investigated by using a questionnaire specifically developed to survey patients' attitudes concerning possible participation in placebo-controlled clinical trials. Psychopathology and side effects were physician-rated. RESULTS: 56% of patients would not be willing to participate in a placebo-controlled clinical trial. On the other hand, only about 16% of the patients are against clinical trials in principle. Gender, treatment, severity of psychopathology (Positive and Negative Syndrome Scale), adverse events (UKU Side Effect Rating Scale), and attitude toward medication (Drug Attitude Inventory) had no statistically significant influence on the decision. Most of the patients (76%) stated that they would not lose trust in their physician if asked to participate in a placebo-controlled clinical trial. CONCLUSION: The opinions and fears of patients who are most affected by the debate need to be considered when deciding whether a placebo-controlled clinical trial is necessary.