Nutritional care of cancer patients: a survey on patients' needs and medical care in reality.

PURPOSE: Cancer patients represent a patient group with a wide-range of nutrition related problems which are often under-recognized and undertreated. In order to assess the status quo of nutritional care in Germany, we conducted a survey among patients with different types of cancer. METHODS: A standardized questionnaire was distributed online by two national umbrella organizations for self-help groups. RESULTS: 1335 participants completed the questionnaire. 69 % of the participants reported having received information on nutrition and/or specific nutrition-related symptoms. Most often this information was derived from print media (68.5 %) or from within self-help groups (58.7 %). 57.0 % of participants reported having had questions concerning nutrition and/or problems with food intake. most frequently named topics of interest were "healthy diet" (35.0 %) weakness/fatigue (24.3 %), dietary supplements (21.3 %) and taste changes (19.8 %). Nutrition information was most often provided by dietitians (38.7 %) followed by physicians (9.8 %). Women reported receiving nutrition counseling in the hospital nearly twice as often as men (12.5 % versus 5.7 %; p < 0.001). A quarter of the patients (24.1 %) reported using dietary supplements and patients who had received some sort of nutrition information more often reported using supplements (p < 0.001). CONCLUSION: Nutrition is an essential element in cancer care and patients report a high interest and need: Yet, many patients do not have access to high quality nutrition therapy during and after cancer therapy. IMPLICATIONS FOR CANCER SURVIVORS: With respect to survival and quality of life, increasing the availability and resources for provision of evidence based nutrition information seems mandatory.

Results in using the Freiburger monosyllabic speech test in noise without and with hearing aids.

The Freiburger Speech Test (FST) has been the gold standard in speech testing by word recognition score in Germany for many years. Recently, it has been demonstrated that for an amount of 104 test-persons there is no significant deviation within the lists. The objective of this study was to determine the percentiles of the distinct measuring situations in quiet and with noise (e.g. applied in hearing aid fitting) and the average benefit using hearing aids. In this prospective study, 623 patients with SNHL and equipped with hearing aids for at least 3 months have been investigated by means of the Freiburger monosyllabic test (FBE) without and with hearing aids and in quiet or with noise (CCITT noise, 65/60 dB signal-noise ratio) in free field conditions at 65 dB to determine the ratio of intelligibility. To investigate the different diagnostic conditions a linear mixed model was applied. The dependent binary variable corresponds to the number of understood syllables. The average age of all subjects was about 72.6 years. The average rate of understanding in the FBE without hearing aids and in quiet was 38.5 %, with hearing aids and in quiet 67.7 %, without hearing aids and with noise 22.4 %, and with hearing aids and with noise 39.8 %. All results were presented with the depending confidence intervals. The extent of hearing loss and the quality of hearing aid fitting can be successfully measured using the FST in quiet and with background noise (CCITT noise). In quiet, an average hearing improving gain of 29.2 % points and with noise a gain of 17.4 % points could be estimated with a successful hearing aid fitting.

[Prevalence of abnormal mucosal findings in patients in HNO practices]. / Prävalenz auffälliger Schleimhautbefunde bei Patienten in HNO-Praxen.

OBJECTIVE: To date, no secondary prevention program is in place for patients carrying an increased risk for developing head and neck cancer (HNSCC). In terms of successful, long-term curative therapy and increased quality of life, it would be useful to detect such diseases at an early stage. PATIENTS AND METHODS: A total of 370 patients with at least one risk factor such as "smoking", "alcohol", or "reflux disease" and without any symptoms were examined during a 1-year period using standard HNO methods (e. g. endoscopy) for suspicious alterations of the mucosa of the upper aerodigestive tract. RESULTS: In 13 (3.5%) of all 370 cases a biopsy was taken for further diagnosis. Squamous cell carcinoma was found in eight cases, while one further patient was suffering from non-Hodgkin lymphoma. CONCLUSIONS: It is simple and safe to examine patients at risk of developing HNSCC by standard HNO methods. The rate of detected carcinomas is much higher than in former investigations, likely because our survey focused only on patients with specific risk factors.

[Falls and fall risk factors. Are they relevant in ENT outpatient medical care?]. / Stürze und Sturzrisikofaktoren. Von Bedeutung in der ambulanten HNO-Versorgung?

BACKGROUND AND OBJECTIVE: The risk of falling increases with age. The problem of falls in medical care constantly rises in priority due to demographic changes in Germany. Therefore, the risk of falling should be assessed in all patients. The present study was intended to evaluate the frequency of falls in daily ENT outpatient medical care and the importance of risk factors. PATIENTS/METHODS: A multicentre study was performed in six outpatient facilities based on a survey of falls and fall risk factors in patients living at home (n = 673) aged 60 years and older. RESULTS: Falls are a frequent problem in the elderly. A total of 23% had one and 13.7% more than one fall within the previous year. Of these, 15% suffered injury, while only 13% used some form of fall prevention. Joint pain and problems of the hip and lower extremities (42.6%), abnormal gait (41.3%), dizziness and balance disorders (38%) as well as impaired activities of daily living (35%) are the most common risk factors for falls and multiple falls in all age groups. Impaired hearing is a fall risk factor in elderly patients. CONCLUSIONS: Falls are a frequent problem in patients in ENT outpatient medical care. Fall prevention is advisable in the context of an interdisciplinary approach.

Endothelin-1(1-31) induces spreading depolarization in rats.

BACKGROUND: The vasoconstrictor endothelin-1(1-21) (ET-1) seems to induce cerebral vasospasm after aneurismal subarachnoid hemorrhage (aSAH). Moreover, ET-1 causes spreading depolarization (SD) via vasoconstriction/ischemia. ET-1(1-31) is an alternate metabolic intermediate in the generation of ET-1. Our aim was to investigate whether endothelin-1(1-31) causes SD in a similar fashion to ET-1. METHOD: Increasing concentrations of either ET-1, ET-1(1-31) or vehicle were brain topically applied in 29 rats. Each concentration was superfused for one hour while regional cerebral blood flow (rCBF) and direct current electrocorticogram (DC-ECoG) were recorded. FINDINGS: In response to the highest concentration of 10(-6) M, all animals of both ET groups developed typical SD. At concentrations below 10(-6) M only ET-1 induced SD (n=14 of 19 rats). Thus, the efficacy of ET-1(1-31) to induce SD was significantly lower (P<0.001, two-tailed Fisher's Exact Test). CONCLUSIONS: Our findings suggest that ET-1(1-31) less potently induces SD compared to ET-1 which implicates that it is a less potent vasoconstrictor. Speculatively, it could be interesting to shift the metabolic pathway towards the alternate intermediate ET-1(1-31) after aSAH as an alternative strategy to ETA receptor inhibition. This could decrease ET-induced vasoconstriction and SD generation while a potentially beneficial basal ETA receptor activation is maintained.

Preserved decision making ability in early multiple sclerosis.

BACKGROUND: The purpose of this study was to assess decision making in patients with multiple sclerosis (MS) at the earliest clinically detectable time point of the disease. METHODS: Patients with definite MS (n = 109) or with clinically isolated syndrome (CIS, n = 56), a disease duration of 3 months to 5 years, and no or only minor neurological impairment (Expanded Disability Status Scale [EDSS] score 0-2.5) were compared to 50 healthy controls using the Iowa Gambling Task (IGT). RESULTS: The performance of definite MS, CIS patients, and controls was comparable for the two main outcomes of the IGT (learning index: p = 0.7; total score: p = 0.6). The IGT learning index was influenced by the educational level and the co-occurrence of minor depression. CIS and MS patients developing a relapse during an observation period of 15 months dated from IGT testing demonstrated a lower learning index in the IGT than patients who had no exacerbation (p = 0.02). When controlling for age, gender and education, the difference between relapsing and non-relapsing patients was at the limit of significance (p = 0.06). CONCLUSION: Decision making in a task mimicking real life decisions is generally preserved in early MS patients as compared to controls. A possible consequence of MS relapsing activity in the impairment of decision making ability is also suspected in the early phase of MS.

[Spherulocytosis (myospherulosis) of the paranasal sinuses]. / Sphärulozytose (Myosphärulose) der Nassennebenhöhlen.

Spherulocytosis (myospherulosis is a disease resulting from the physical emulsion phenomenon between lipid-containing materials and blood. It can be caused by the application of lipid-based ointments with or without antibiotics to wounds. This "foreign-body" reaction appears as a granulation tissue that will cause symptomatic when developing under closed wounds or in such cavities as the middle ear or paranasal sinuses. Poor healing after paranasal sinus surgery may be due to spherulocytosis. This occurred in several cases managed at the University Hospital in Kiel as the result of postoperative nasal packs sensitizing sinus mucosa. These experiences led the authors to conclude the nasal ointment packs should be avoided in paranasal sinus surgery.

[Late results following partial and total colectomy in infancy]. / Spätergebnisse nach partieller und totaler Colektomie im Säuglingsalter.

26 children were investigated on an average 11.5 years after partial (n = 13) and total (n = 13) colonic resection. Total colectomy was followed by an increased frequency of gastrointestinal symptoms such as recurrent abdominal pain, flatulence, attacks of diarrhoea, frequent and pasty or liquid stools with strange smell. An increased salt or fluid intake was observed in one half of these patients. Their height and bone age was slightly but significantly reduced. Laboratory investigations revealed no significant deficiencies of electrolyts, vitamins or trace elements. However Renin (mean and 2s-range = 5.2; 2.7-6.8 ng/ml.h, normal values (NV) 1.3; 0.5-4.0 ng/ml.h, p less than 0.02), aldosterone (242.1; 168.4-357.8 pg/ml, NV 78.9; 39.4-168.4 pg/ml, *p less than 0.02), conjugated bile acids (11.3; 5.2-20.0 mumol/1, NV 4.2; 1.5-7.0 mumol/1, p less than 0.01) and serum urea concentration (32.5; 20.8-48.7 mg/dl, NV 14.6; 6.0-22.5 mg/dl, p less than 0.01) were significantly elevated. Three postprandial plasma levels of gastrin, VIP and neurotensin were within normal limits. In patients with partial large bowel resection all signs were less pronounced. According to our results a special diet in children years after colectomy seems not to be required.

[Goethe and the mal de rosa]. / Goethe und die "mal de rosa".

Goethe described at his first Italian journey in 1786, a disease of lombardic peasants which without doubt, unknown in Germany, was Pellagra. He suspected, based on his observations, that with high probability a wrong or deficient nutrition might be the cause of this illness.

[Ehrlich's benzaldehyde reaction (with urobilinogen) 80 years later]. / Uber Ehrlichs Benzaldehyd-Reaktion (auf Urobilinogen) nach 80 Jahren.

The colour reaction of di-methyl-amido-benzaldehyde with metabolites in urine (especially with urobilinogen), discovered and published by Paul Ehrlich 80 years ago has lost nothing of its significance as a simple, practical, quick, qualitative test. It provides a diagnostic means in liver diseases, hemolytic processes, occlusion of the common bile duct, carcinoid and porphyrinopathies--of course, within the framework of the whole clinical picture. Despite the technical simplicity of the test, certain rules have to be adhered to. Ehrlich's aldehyde reagent has also won importance in chromatography. The modern test-strip technique permits an easy and rapid examination for urobilinogen (and bilirubin).

Studies on the morphology of human uric acid stones.

Human uric acid acid renal stones are easily distinguished from other urinary calculi by their globular or spherical shape, their colour and their hardness. Investigations of uric acid crystals grown in the presence of a variety of pigments indicate that a disordered layer structure of the uric acid dihydrate is responsible for the colour of such crystals, caused by the inclusion of pigment molecules into the crystal lattice. This in turn may help to explain the other special properties of uric acid stones.