Kaempferol-3,4'-di-O-beta-glucopyranoside-7-O-alpha-rhamnopyranoside as a new flavonoid from Iberis amara L.

A new flavonol glycoside, kaempferol-3,4'-di-O-beta-glucopyranoside-7-O-alpha-rhamno-pyranoside, was isolated from the ethanolic extract of the whole fresh plant of Iberis amara L., an European plant used in gastrointestinal medicine. The structure was established by a combination of 1D and 2D NMR techniques (COSY, HSQC, HMBC, NOESY) as well as UV, IR and mass spectral data.

Ex vivo/in vitro absorption of STW 5 (Iberogast) and its extract components.

To correlate the pharmacological effects of the fixed herbal combination STW 5 (Iberogast) containing nine extract components with its confirmed clinical efficacy, ex vivo/in vitro absorption tests were performed. For the investigation, the everted gut sac technique and, in a pilot study, the Caco-2-cell model were used. The absorption rate of the extracts was determined by measuring characteristic marker substances of each of the individual extracts using HPLC or GC techniques. The results allow us to conclude that the investigated substances from STW 5 possess a good bioavailability, which is in accordance with the rapid onset of the therapeutic efficacy and explains its known pharmacological effects and clinical efficacy in terms of multiple drug action and multi-target therapy, respectively.

Pharmaceutical prerequisites for a multi-target therapy.

The quality of a phytomedicine is defined by the quality of the herbal drug, the manufacturing of the drug preparations and the properties of the finished product, taking into account the special requirements of the individual herbal species in accordance with Good Manufacturing Practice (GMP) standards [2003. Medicinal Products for Human and Veterinary Use. Eudralex, vol. 4 (2003/94/EC)]. The quality control of the complete process is based on pharmacognostic methods, characteristic fingerprint chromatograms, defined amounts of marker substances, physicochemical characteristics and microbiological monitoring. For a herbal multi-component preparation used in multi-target therapy, these pharmaceutical prerequisites have to be ensured for all components and for their combination, as is exemplified by Iberogast((R)) (STW 5) a fixed combination of hydroethanolic extracts of bitter candytuft (Iberis amara), angelica root (Angelicae radix), milk thistle fruit (Silybi mariani fructus), celandine herb (Chelidonii herba), caraway fruit (Carvi fructus), liquorice root (Liquiritiae radix), peppermint herb (Menthae piperitae folium), balm leaf (Melissae folium) and chamomile flower (Matricariae flos) using in the therapy of gastrointestinal complaints (Rösch et al., 2006). The prerequisites for the quality of each of its components according to actual standards are at first the cultivation of the plant material according to the Guidelines for Good Agricultural Practice (GAP) conditions of Medicinal and Aromatic Plants [1998. Z. Arzn. Gew. Pfl. 3, 166-178] to yield a defined raw material of high quality. Characteristic compounds of the extracts had to be identified and different analytical methods such as HPLC, with low coefficients of variation had to be developed to analyze each of the standardized ethanolic extracts and the finished product. At the example of the extract of I. amara these necessary investigations are described. The variability of the plant material in its natural habitats, the identification of characteristic compounds and exemplary chromatograms for fingerprint evaluation and quantification are shown. These data are required for characterization of the profile of the active substances in the finished product.

[Clinical value of FDG PET for therapy monitoring of malignant lymphoma--results of a retrospective study in 72 patients]. / Klinische Wertigkeit der FDG-PET zur Therapiekontrolle bei malignen Lymphomen--Ergebnisse einer retrospektiven Studie an 72 Patienten.

AIM: Of the present retrospective study was to validate the clinical value of FDG-PET for therapy control of malignant lymphoma. METHOD: 72 patients (41 non-Hodgkin lymphomas, 29 Hodgkin's disease, 2 unclassified) received static FDG-PET scans of initially involved regions (n = 53) or of the entire neck and trunk (n = 19) after therapy. CT imaging (n = 70) and serum LDH measurement (n = 64) were also performed. Results were validated either by biopsy (n = 7) or by clinical follow-up (n = 65). The predictive value of PET was analysed in relation to different prognostic factors (stage, recurrence status, number of prior therapy regimen). RESULTS: PET obtained a sensitivity of 88%, a specificity of 83% and an overall accuracy of 85% for detection of residual disease. The values for CT were 84%, 31% resp. 54%, and for serum LDH 50%, 92% and 73%. The predictive value of PET was related to the prevalence of residual disease. PET predicted complete remission in more than 90% of patients with moderate risk (stage I-III, no relapse, no more than two different therapy regimens). In high risk patients, however, the negative predictive value of PET was 50-67%. CONCLUSION: FDG-PET is more accurate than CT imaging and LDH measurement for therapy monitoring of malignant lymphoma. Therapy success can be reliably predicted in patients with moderate risk.

[Tuberculous spondylitis--a contribution to the differential diagnosis of space-occupying lesions of the posterior mediastinum]. / Spondylitis tuberculosa--Ein Beitrag zur Differentialdiagnose der Raumforderungen des hinteren Mediastinums.

This report describes a 27-year-old male patient with advanced spondylitis tuberculosa, who, being suspected of having a malignant tumour, was submitted to a CT-guided biopsy. Treatment comprising CT-controlled insertion of a permanent drain, and antituberculous chemotherapy and dorsal stabilisation, was administered. A high-risk intervention (diagnostic and therapeutic thoracotomy with the attendant acute danger of paraplegia was avoided through the use of the most up-to-date imaging procedures available.

Psychotherapy services outside the National Health Service.

With the help of an Upjohn Travelling Fellowship, I visited 15 units providing services for people under stress. There were nine residential units and six non-residential units, all were Christian charitable organisations and in all there was close co-operation with the medical profession.All these organisations accept referrals from general practitioners and deserve to be more widely known.

Eroded cervix.

During a six-year period 1,808 women aged 20 to 59 underwent gynaecological examination at a well-woman clinic. Cervical erosions were found in 269. Nine patients had cervical carcinoma, confirmed by biopsy; of these eight had eroded cervices. The remaining patients with non-malignant erosions were examined at six-monthly intervals. Of these, roughly 39% showed spontaneous healing within a year, 31% responded to medical treatment, 17% healed only after surgical treatment, 9% remained unhealed when reviewed six months after the last active treatment, and 4% relapsed after originally healing well.The difficulties of getting patients to return for cytological examination increase with the interval between the original examination and recall. It is suggested that patients should be re-examined initially at an interval not exceeding six months, so that false negative results are minimal.