[Inpatient rehabilitation of breast carcinoma patients]. / Stationäre Rehabilitation bei Mammakarzinompatientinnen.

Aim of a holistic in-patient rehabilitation program for female breast cancer patients is to strengthen the air overall health and help them to overcome the sometimes severe therapeutic side effects. In addition it is important for the patient to learn how to compensate with any residual physical effects and last but not least psychological support for coping with the malignant disease. Furthermore, a major target is, aside from improving the general state of health, the patient's reintegration into working life, if the disease is in a potentially curable state with a good chance for survival. If vocational reintegration fails due to the advanced state of the cancer or therapy induced damage or handicaps, which unfortunately applies to most of the patients, at least reintegration into private and social life should be achieved. To realize these objectives effective methods of treatment have been developed which can best be performed in specialized rehabilitation centres which are closely affiliated to cancer centres.

[Primary extragonadal germ cell tumors in man. 2. Therapy and prognosis]. / Primär extragonadale Keimzelltumoren des Mannes. Teil 2. Zur Therapie und Prognose.

Of the 23 males with primary extragonadal tumours of the germ cells observed from 1980 to 1989 9 males survived. These were 5 out of 14 primary retroperitoneal, 2 out of 5 primary mediastinal and 2 out of 4 primary intracranial tumours of the germ cells. Histologically in these cases were concerned 8 seminomas (among them 2 germinomas) and 1 primary retroperitoneal chorionepithelioma. The better prognosis of the seminomas is to be explained from the radiosensitivity and the higher chemosensitivity. The strategy of therapy was not always uniform, however, it made great efforts to reach the surgical removal of the tumour. Even in primary intracranial tumours of the germ cells this is the therapy of choice. The antineoplastic polychemotherapy following after this in retroperitoneal and mediastinal tumours of the germ cells was as a rule the PVB-schema according to Einhorn. In partial remission and non-response, respectively, various second-line schemes were used. At present a combination of cisplatin, etoposide and ifosfamide promises the best results, particularly when a bulky disease is existing. In seminomas the chemotherapy was followed as a rule by the locoregional telecobalt irradiation. Only the intracranial germinomas were irradiated postoperatively. A preventive telecobalt irradiation of the spinal canal should be taken into consideration in the individual case. An adjuvant antineoplastic polychemotherapy with 3 PVB-cycles was carried out in 2 patients with primary intracranial germinomas. They are in a permanent complete remission.

[Primary extragonadal germ cell tumors in men. 1. Frequency, morphology and clinical aspects]. / Primär extragonadale Keimzelltumoren des Mannes. Teil 1. Zur Häufigkeit, Morphologie und Klinik.

Though primary extragonadal germ cell tumours of man are rare, they always should be involved into the differential diagnosis in the clarification of abdominal, thoracic or cerebral symptoms. Typical for such localisations are unspecific complaints and the in most cases late establishing of the diagnosis so that in spite of potent multimodal therapeutic approaches the prognosis is frequently unfavourable. In the years from 1980 to 1989 in various clinics of the Medical Academy Erfurt altogether 453 males were treated on account of malignant germinal tumour diseases. In 23 cases (5.1%) these occurred primarily extragonadally. Among them 14 retroperitoneal, 5 mediastinal and 4 cerebral manifestations were found. Seminomas dominated with 52.2%. In 2 cases each we observed embryonic carcinomas, chorionic carcinomas and tumours of the vitelline sac and in 5 cases combined tumours of the germ cells.

[Acute cor pulmonale as a sequela of tumor embolism]. / Akutes Cor pulmonale als Folge einer Tumorembolie.

It is reported on a 22-year-old female patient with a chondroplastic osteosarcoma in the sacrum in whom in the course of her disease a massive embolism due to a tumour developed under the clinical picture of an acute pulmonary embolism. The clinical tentative diagnosis of a massive pulmonary embolism was confirmed by means of lung perfusion scintigram and pulmonary angiography. All efforts for a rapid recanalisation of the left pulmonary trunk by means of mechanical alteration, use of balloon catheter and subsequent thrombolysis were without success. Pathologo-anatomically a recurred tumorous thrombus embolism with an extensive pulmonary infarction in the left inferior lobe of the lung was found. The incidence as well as diagnostic viewpoints of embolisms due to tumour are discussed.

[Clinical significance of the level of circulating immune complexes in patients with small cell bronchial carcinoma]. / Klinische Relevanz der Bestimmung zirkulierender Immunkomplexe bei Patienten mit kleinzelligem Bronchialkarzinom.

In the sera of 58 bronchial cancer patients with different TNM progression stage the relative 125I-C1q binding activities (BA) were determined before, after an induction of polychemotherapy and after a simultaneous polychemo- plus X-rays therapy. Only a statistically non-significant decrease of the 125I-C1q-BA was measured in the sera of patient groups with a stronger metastatic spread in the regional lymph nodes or distant metastasis. The tumor therapy cycles changed the serum 125I-C1q-BA differently and non significantly. The determination of serum 125I-C1q-BA of bronchial cancer patients is not relevant clinically.

[Value of carcinoembryonic antigen (CEA) in assessing therapeutic success in small cell bronchial cancer]. / Stellenwert des karzinoembryonalen Antigens (CEA) bei der Therapieerfolgseinschätzung des kleinzelligen Bronchialkarzinoms.

UNLABELLED: The determination of the carcino-embryonal antigen (CEA) for the assessment of the therapeutic success and course in colorectal tumours is at present an established diagnostic method. In other solid tumours, e.g. in bronchial carcinomas, the therapy monitoring by means of CEA was less tested. 92 Patients were examined, 31 of them with limited disease (l. d.) and 61 with extensive disease (e. d.). The determination of the CEA was performed before and during the combined radiation therapy and polychemotherapy with 2 different protocols of treatment: ACO (adriblastin, vincristine, cyclophosphamide), FOMC (5-fluoruracil, methotrexate, vincristine, cyclophosphamide) with the OPIDI-radioimmunoassay. Normal values: 0-10 micrograms/l. Limiting area: 11-20 micrograms/l. Pathological area: greater than 20 micrograms/l. RESULTS: patients with limited disease: 8 normal, 14 in the limiting area, 9 in the pathological area (29%). Patients with extensive disease: 17 normal, 19 in the limiting area, 25 in the pathological area (42%) before the beginning of the therapy. With 54 and 60 micrograms/l, respectively, the mean values of the two groups, however, did not differ significantly. Altogether 39 of the 92 patients examined (42%) showed changes of the CEA-values during the course of the disease. For the 31 patients with limited disease 26 (84%) achieved a CR. Of these 26 patients the CEA-values were increased in 7 patients, 5 of them showed a clear decrease, in 3 patients a normalization of the CEA appeared with further existing remission, which lasts for 28, 24 and 14 months. In the remaining 2 patients in the CEA-values decreased into the limiting area.(ABSTRACT TRUNCATED AT 250 WORDS)

[Paraneoplastic endocrinopathies]. / Paraneoplastische Endokrinopathien.

After the presentation of the definition and of several historical data the present pathophysiological imaginations concerning the problems of the ectopic hormone production are sketched which nowadays not yet have accepted a definitive form. A survey of the at present ascertained paraneoplastic endocrinopathies and several own findings allow a valuation of the significance of these phenomena in practice, taking into consideration the literature.

[Staging of inoperable small cell bronchial cancer]. / Stadieneinteilung beim inoperablen kleinzelligen Bronchialkarzinom.

This paper compares two staging regimes for the inoperable small-cell carcinoma of the lung. It reveals that at present the differentiation in two classes of the Veterans Administration Lung Cancer Study Group (VALCSG) is preferred to the TNM-classification of the World Health Organization (WHO), as it includes an orientation of prognosis and enables consequences of therapy relevant to practice. If studies of therapy of the small-cell carcinoma of the lung are compared, the uniform application of the classification should be considered.

[Mature teratoma following chemotherapy in bilateral testicular tumors--a critical contribution]. / Reifes Teratom nach Chemotherapie bei einem bilateralen Hodentumor--ein kritischer Beitrag.

The histological treatment of preparations of the retroperitoneal lymphadenectomy (RLA) after chemotherapy of non-seminomatous testicular tumours results in about 25% of the cases in the evidence of the "mature teratoma". An own observation suggests that a prognostically favourable valuation of this diagnosis is justified not without restriction.

[Results of combined antineoplastic polychemo- and radiotherapy in small cell bronchial cancer and implications for optimizing therapy]. / Ergebnisse einer kombinierten antineoplastischen Polychemo- und Strahlentherapie beim kleinzelligen Bronchialkarzinom und Schlussfolgerungen für die Therapieoptimierung.

It is reported on 60 patients (48 males and 12 females) who since 1977 have undergone a combined chemotherapy with 5-fluorouracil, vincristine and vinblastine , respectively, methotrexate and cyclophosphamide. After 1--2 initial cycles simultaneously to the chemotherapy a radiotherapy was performed under telecobalt conditions. In the patients with a limited disease 83% full remissions and 17% partial remissions were achieved. In those cases in which an extensive disease was present 19% full remissions and 65% partial remissions could be achieved. A tumour progression was observed in 16%. The mean survival time in complete remissions is 15.5 months and in partial remissions 10.8 months. Three patients are to be estimated as long-term survivors. Thus, the results are not more unfavourable than in other therapy strategies. Despite the progress in the past these results of the treatment cannot satisfy. Better results are possible by the application of cisplatin and etoposide, by which means, however, the danger of the threatening side-effects of the therapy increases. The strategy of treatment favoured nowadays provides an aggressive induction polychemotherapy, which at an interval of 4 weeks is followed by the loco-regional radiotherapy. Following this a chemotherapy is again performed. With regard to them there are no unique conceptions. Polychemotherapy regimes with not cross-resistant cytostatics administered alternatingly give theoretically the prerequisites for more favourable results, which, however, need stil confirmation in clinical oncology. Apart from other questions it is above all necessary to clarify the kind of therapy after full remission.

Continuous ambulatory peritoneal dialysis and pulmonary function.

Ten end-stage renal disease patients treated by continuous peritoneal dialysis were investigated by means of spirography, compliance tests, body plethysmography, and blood oxygen analysis. The ventilatory function was compared with abdomen empty and abdomen filled with 2L of peritoneal dialysis solution. Only a mild ventilatory restriction occurred (vital capacity -3.5%, thoracic gas volume -7.9%) as well as a mild decrease of static absolute compliance (-8.8%) and of dynamic absolute compliance (-6.2%). There was no significant alteration of the specific compliance tests, or of the Tiffeneau test as a parameter of bronchial obstruction, and no reduction of blood oxygen. These results were obtained from probands without bronchopulmonary illnesses. But problems with CAPD and ventilatory function may arise in patients with diseases of the respiratory tract including fluid lung, or in patients with 'space problems' in the abdomen (polycystic renal disease).

[69. Significance of work load electrocardiographic studies with reference to coronarographic findings]. / Die Aussage belastungselektrokardiographischer Untersuchungen unter Berücksichtigung koronarographischer Befunde

The electrocardiography after work is assumed as an essential diagnostic aid in the evaluation of the chronic ischaemic heart disease. Differences in the diagnostic relevance of the results are related to the test method used. Therefore, comparison with the findings of selective coronary angiography is necessary, though the subject of ECG after work are functional changes, but that of coronary angiography are morphological ones. This study gives the comparison of both methods in 84 patients. In patients with coronary artery construction (greater than 75%) the diagnostic possibilities of ECG after work are limited. With regard to these patients it is pointed out that except of the obstruction of coronary arteries, as it is to be documented by selective coronary angiography, there are several further factors favourising coronary insufficiency, such as diminished perfusion of the peripheral coronary vessels, high levels of catecholamines, metabolic disturbances, diminished oxygen transport capacity or oxygen delivery. This may also explain the relatively low specifity of 60% of the ECG after work in the recognition of obstructive coronary artery disease.

[Mechanocardiography as a screening method in chronic ischemic heart disease]. / Mechanokardiographie als Screening bei chronisch ischämischer Herzkrankheit

On 121 patients with ischaemic heart disease mechanocardiographic examinations were carried out on conditions of rest and partly under conditions of ergometric load and were compared with a group of healthy persons. It was shown that in the patients with ischaemic heart disease there appeared a significant shortening of the ejection time (LVETk), prolongation of the frequency-corrected preejection time (PEPk) as well as of the isovolometric contraction time (ICT and ICTk), an enlargement of the quotient (see article) and reduction of (see article) in rest. Under load the differences between healthy persons and patients with ischaemic heart disease became more clearly with regard to the quotients (see article) as well as (see article) and proved as favourable for the judgment of the cardiomechanics. With the help of the above mentioned mechanocardiographic parameters in connection with the usual diagnostic methods according to our opinion patients with ischaemic heart disease may be diagnosed for the greatest part.