Noninferiority of Local Control and Comparable Toxicity of Intensity Modulated Radiation Therapy With Simultaneous Integrated Boost in Breast Cancer: 5-Year Results of the IMRT-MC2 Phase III Trial

PURPOSE

The IMRT-MC2 trial was conducted to demonstrate the noninferiority of conventionally fractionated intensity modulated radiation therapy with a simultaneous integrated boost to 3-dimensional conformal radiation therapy with a sequential boost for adjuvant breast radiation therapy.

METHODS AND MATERIALS

A total of 502 patients were randomized between 2011 and 2015 for the prospective, multicenter, phase III trial (NCT01322854). Five-year results of late toxicity (late effects normal tissue task force-subjective, objective, management, and analytical), overall survival, disease-free survival, distant disease-free survival, cosmesis (Harvard scale), and local control (noninferiority margin at hazard ratio [HR] of 3.5) were analyzed after a median follow-up of 62 months.

RESULTS

The 5-year local control rate for the intensity modulated radiation therapy with simultaneous integrated boost arm was non-inferior to the control arm (98.7% vs 98.3%, respectively; HR, 0.582; 95% CI, 0.119-2.375; P = .4595). Furthermore, there was no significant difference in overall survival (97.1% vs 98.3%, respectively; HR, 1.235; 95% CI, 0.472-3.413; P = .6697), disease-free survival (95.8% vs 96.1%, respectively; HR, 1.130; 95% CI, 0.487-2.679; P = .7758), and distant disease-free survival (97.0% vs 97.8%, respectively; HR, 1.667; 95% CI, 0.575-5.434; P = .3601). After 5 years, late toxicity evaluation and cosmetic assessment further showed no significant differences between treatment arms.

CONCLUSIONS

The 5-year results of the IMRT-MC2 trial provide strong evidence that the application of conventionally fractionated simultaneous integrated boost irradiation for patients with breast cancer is both safe and effective, with noninferior local control compared with 3-dimensional conformal radiation therapy with sequential boost.

CBCovid19EC: A dataset complete blood count and PCR test for COVID-19 detection in Ecuadorian population

In this work, we present the complete blood count data and PCR test results of a population of Ecuadorians from different provinces, primarily residing in the Andean region, especially in Quito. PCR was the standard test to detect Covid-19 during the pandemic since 2020. The data were obtained between March 1st and August 12th, 2021. Segurilab and Previne Salud laboratories performed the tests. The dataset contains about 400 clinical cases. Each patient agreed to participate in the study by sharing the results of their PCR (reverse transcription polymerase chain reaction) tests and CBC (complete blood count). CBC test measured several components and features of the blood, including red blood cells, white blood cells, hemoglobin, hematocrit, and platelets. The shared data are intended to provide researchers with input to analyze various events associated with the diagnosis of Covid-19 linked to potential diseases identified in the components measured in the CBC test. These data are helpful for pattern analysis of blood components in modeling prediction and clustering problems. The components measured in the complete blood count and CRP together can be helpful for the analysis of different medical conditions using machine learning algorithms.

Methods of Esthetic Assessment after Adjuvant Whole-Breast Radiotherapy in Breast Cancer Patients: Evaluation of the BCCT.core Software and Patients' and Physicians' Assessment from the Randomized IMRT-MC2 Trial

Simple Summary

To validate the BCCT.core software, the present analysis compares the esthetics assessment by the software in relation to patients’ and physicians’ rating in breast cancer patients after surgery and adjuvant radiotherapy. Agreement rates of the different assessments and their correlation with breast asymmetry indices were evaluated. The assessments of the software and the physicians were significantly correlated with all asymmetry indices, while for patients’ self-assessment, this general correlation was first seen after 2 years. Only a slight agreement between the BCCT.core software and the physicians’ or patients’ assessment was seen, while a moderate and substantial agreement was detected between the physicians’ and the patients’ assessments. The BCCT.core software is a reliable tool to measure asymmetries, but may not sufficiently evaluate the esthetic outcome as perceived by patients. It may be more appropriate for a long-term follow-up, when symmetry seems to increase in importance.

Abstract

The present analysis compares the esthetics assessment by the BCCT.core software in relation to patients’ and physicians’ ratings, based on the IMRT-MC2 trial. Within this trial, breast cancer patients received breast-conserving surgery (BCS) and adjuvant radiotherapy. At the baseline, 6 weeks, and 2 years after radiotherapy, photos of the breasts were assessed by the software and patients’ and physicians’ assessments were performed. Agreement rates of the assessments and their correlation with breast asymmetry indices were evaluated. The assessments of the software and the physicians were significantly correlated with asymmetry indices. Before and 6 weeks after radiotherapy, the patients’ self-assessment was only correlated with the lower breast contour (LBC) and upward nipple retraction (UNR), while after 2 years, there was also a correlation with other indices. Only a slight agreement between the BCCT.core software and the physicians’ or patients’ assessment was seen, while a moderate and substantial agreement was detected between the physicians’ and the patients’ assessment after 6 weeks and 2 years, respectively. The BCCT.core software is a reliable tool to measure asymmetries, but may not sufficiently evaluate the esthetic outcome as perceived by patients. It may be more appropriate for a long-term follow-up, when symmetry appears to increase in importance.

Evaluation of a self-management patient education programme for fibromyalgia-results of a cluster-RCT in inpatient rehabilitation

The objective was to evaluate the effectiveness of a self-management patient education programme for fibromyalgia syndrome (FMS) as compared with usual care education in inpatient rehabilitation. In a multicentre cluster-randomized controlled trial, 583 inpatients in 3 rehabilitation centres received an advanced self-management patient education programme or usual care education. Patients completed questionnaires at admission, discharge and after 6 and 12 months. Primary outcomes were disease- and treatment-specific knowledge at discharge, and self-management-competencies after 6 months. Secondary outcomes included satisfaction, attitudes, coping competencies, psychological distress and health impairment. We found a medium-sized effect on disease- and treatment-specific knowledge at discharge (P < 0.05, Cohen's d = 0.45, 95% CI = 0.27-0.63), and small effects for subjective knowledge, pain-related control, self-monitoring and insight, communication about disease, action planning for physical activity and treatment satisfaction (all P < 0.05). Only the effect on knowledge persisted for 6 and 12 months. This advanced education programme seemed to be more effective in the short term than usual education. However, intermediate- and long-term effects did not emerge. While superior long-term effects on knowledge as well as short-term effects on self-management skills may suggest implementation, additional long-term effects on other patient-relevant outcomes would be desirable. Trial registration: German Clinical Trials Register, DRKS00008782, Registered 8 July 2015.

Illness representations, pain and physical function in patients with rheumatic disorders: between- and within-person associations

OBJECTIVES

Rehabilitation for patients with rheumatic diseases improves both illness representations (IR) and clinical outcomes such as pain and physical functioning (PF). However, it is unclear whether IR may affect and, in turn, are affected by pain and PF. In this study, we examined both between-person associations and within-person associations between IR and pain/PF over time on three measurement occasions. Furthermore, cross-lagged relationships were examined.

DESIGN AND MAIN OUTCOME MEASURES

This secondary analysis is based on data from N = 186 patients with rheumatic diseases. Data on pain, PF and IR were assessed using self-report questionnaires at the beginning, the end and three months after a 3-week inpatient rehabilitation.

METHODS

To separate between- and within-person level, data were analysed using random-intercept cross-lagged panel models.

RESULTS

On both the between-person level (r = |0.21| - |0.44|) and the within-person level (r = |0.15| - |0.46|), pain and PF were related to cognitive and emotional IR. In addition, we found within-person bidirectional cross-lagged effects between emotional IR and PF.

CONCLUSION

IR show complex relationships with pain and PF. Improving PF might improve subsequent illness-related emotional distress and vice versa.

Atypical twin-to-twin transfusion syndrome: prevalence in a population undergoing fetoscopic laser ablation of communicating placental vessels

BACKGROUND

The diagnosis of twin-to-twin transfusion syndrome (TTTS) usually relies the presence of polyhydramnios in one sac with concomitant oligohydramnios in the other sac in a monochorionic diamniotic twin pregnancy. However, TTTS does not always show a linear progression and may present with cardiac compromise or critically abnormal Doppler velocimetry in either fetus before fluid measurements meet the typically used cutoff.

OBJECTIVE

The aim of this study was to investigate the prevalence of atypical presentations of TTTS in a population undergoing laser fetoscopy.

STUDY DESIGN

We performed a retrospective review of our database of TTTS laser fetoscopy from 2003 to the present. Our center is the regional referral center in the Pacific Northwest for minimally invasive treatment of complicated monochorionic twin pregnancies. Cases were labeled as "atypical" if fluid discordance did not meet formal TTTS criteria (oligohydramnios defined as maximum vertical pocket [MVP] <2 and polyhydramnios defined as MVP >8 before 20 weeks and >10 after 20 weeks). The rationale for consideration of laser fetoscopy was other evidence of severe TTTS such as significant cardiac compromise, evidence of twin anemia polycythemia sequence (TAPS), or persistent critically abnormal cord Dopplers.

RESULTS

Three hundred seventy-nine cases of fetoscopic laser ablation for TTTS and its variants were available for review. Sixteen cases were excluded for a triplet pregnancy, 4 due to septostomy prior to referral to our center, 3 for monoamniotic pregnancy, and 11 for previous laser fetoscopy. Three hundred forty-five cases remained for evaluation. Among these, 25 cases were identified as "atypical," equaling 7.24% of our population. Eleven of these were for stage 3 recipient disease, 3 were for stage 4 recipient disease, 4 were for stage 3 both in recipient and donor, 4 were for stage 3 donor disease, and 3 were for spontaneous TAPS.

CONCLUSION

In TTTS, severity of fetal compromise does not consistently correlate with fluid abnormalities meeting established criteria. This may be especially true in rapidly progressing cases. Attempts at rigid diagnostic amniotic fluid criteria may underestimate the severity and incidence of TTTS. This underscores the importance of careful surveillance, including arterial and venous Doppler velocimetry, of all monochorionic pregnancies.

[Work-related medical rehabilitation for patients with rheumatic diseases]

In recent years work-related rehabilitation has been intensified. Several studies have shown the effectiveness of work-related interventions in medical rehabilitation by improving participation in the work force and reducing sick leave. The German pension insurance fund has developed standardized requirements for medical work-related rehabilitation which include diagnostic procedures to identify patients with specific occupational problems and vocation-related interventions. These requirements address patients across different indications and diagnoses. Rehabilitation centers are assigned to different levels of work-related interventions depending on the intensity and specificity of the profile. Centers providing the complete range of work-related interventions offer differentiated work-related diagnostics, job training and occupational groups in addition to general social advice. In this article four case studies with different priorities regarding vocational interventions are presented.

Impact of cold ischemia on mitochondrial function in porcine hearts and blood vessels

The effects of cold storage using Custodiol^® (Histidine-Tryptophan-Ketoglutarate, HTK) or isotonic saline solution on mitochondrial function in hearts (left and rights ventricles) and various blood vessels of pigs were investigated. Hearts, saphenous veins, internal-mammary-arteries and aortas of male landrace pigs were harvested and exposed to cold ischemia in either saline or Custodiol-HTK solution. Mitochondrial function was measured in situ in permeabilized fibers by high-resolution respirometry. Mitochondrial respiratory capacities (maximal respiration rates) were similar in the right and left ventricle in controls and after 14 h of cold storage were significantly better preserved in Custodiol-HTK than in saline solution. Mitochondrial respiration rates in various blood vessels including aorta, arteries and veins were less than 5% of myocardium rates. In contrast to the pig heart, in some blood vessels, like veins, mitochondrial function remained stable even after 24 h of cold ischemia. HTK-Custodiol protection of mitochondrial function after prolonged cold ischemia was observed in the myocardium but not in blood vessels. HTK-Custodiol solution thus offers significant protection of myocardial mitochondria against cold ischemic injury and can be used as efficient preservation solution in organ transplantation but probably has no benefit for blood vessels preservation. Analysis of mitochondrial function can be used as a valuable approach for the assessment of cold ischemic injury in various tissues including pig heart and various blood vessels.

["Vocational perspective"--short-term efficacy of a group treatment for patients with extensive work-related problems during medical rehabilitation]

AIM OF THE STUDY

To analyze the short-term efficacy of the Vocational Perspective programme for patients identified as having extensive work-related problems during rheumatology or orthopaedic inpatient rehabilitation. The primary objectives of the programme on patient level are to convey information about the legal provisions regarding earning incapacity and occupational reintegration, to suggest strategies for dealing with one's own occupational situation, and to strengthen the motivation to stay employed. The programme is explicitly designed for patients who wish to retire or have applied for a pension. On the systemic level, the main goals are to facilitate doctor-patient communication and to increase rehabilitation teams' awareness of occupational problems.

METHODS

In a controlled quasi-experimental design, 359 subjects were consecutively assigned to either the control group (CG, n=177) or the intervention group (IG, n=182). The control group received standard care only, whereas the intervention group additionally participated in the 5-part Vocational Perspective programme. Evaluation criteria were assessed by questionnaire at the beginning (t1) and at end of rehabilitation (t2). Survey participation was 92.2% at t2. The socio-medically relevant knowledge status was objectively documented using a specially designed knowledge questionnaire. Aspects of treatment satisfaction were evaluated using individual items, and the subjective prognosis of gainful employment was assessed using the Subjective Prognosis of Gainful Employment (SPE) scale. Facilitation of communication between doctor and patient was operationalized at patient level in terms of patient satisfaction with medical care, and increased awareness of the rehabilitation team was operationalized in terms of the rate of recommendations to apply for vocational reintegration (LTA) services at discharge. Emotional and functional parameters were exploratively analyzed (anxiety and depression using the IRES 3.1 scales, and subjectively experienced pain-related impairment using the Pain Disability Index).

RESULTS

Scores for subjective satisfaction with job-related information, medical care, socio-medical assessment, and the overall benefits of rehabilitation were significantly higher in the intervention group than in the control group. IG subjects moreover were better able to use the rehabilitation measure to clarify their occupational situation and exhibited significantly greater improvement of socio-medically relevant knowledge. Age proved to be an important predictor of change in a patient's subjective prognosis for gainful employment (SPE): A positive change in SPE was observed in both groups in subjects under 50, in those aged 50 and older, however, only in the intervention group. No differences between the two groups were observed in terms of functional and emotional parameters (e. g., disability through pain, anxiety, and depression). A total of 60% of the subjects received a recommendation at discharge to apply for vocational reintegration services, the proportion however was significantly higher in the IG.

CONCLUSIONS

The Vocational Perspective programme met the patients' high demand for information on relevant socio-medical facilities and services regarding career change and facilitated communication between the doctor and patient by creating greater transparency. The improvement of subjective prognosis for gainful employment observed in the subgroup of older patients indicates that specialized interventions are needed in precisely this disadvantaged group in order to improve their own vocational expectations and thus to improve their chances of reintegration into work life. The high rate of recommendations to apply for vocational reintegration services suggests that rehabilitation teams already have a high awareness of job-related problems even under “usual care” conditions.

Replication of single macromolecules with graphene

The electronic properties of graphenes depend sensitively on their deformation, and therefore strain engineered graphene electronics is envisioned. In order to deform graphenes locally, we have mechanically exfoliated single and few layer graphenes onto atomically flat mica surfaces covered with isolated double stranded plasmid DNA rings. Using scanning force microscopy in both contact and intermittent contact modes, we find that the graphenes replicate the topography of the underlying DNA with high precision. The availability of macromolecules of different topologies, e.g., programmable DNA patterns, render this approach promising for new graphene based device designs. On the other hand, the encapsulation of single macromolecules offers new prospects for analytical scanning probe microscopy techniques.

["Vocational perspective" - concept and acceptance of a group treatment for patients with extensive work-related problems]

BACKGROUND

The treatment programme "Vocational Perspective" was developed for patients with health-related social problems, e. g. long-term sick leave, job loss due to disability, job insecurity and psychosocial disabilities. It intends the patient-oriented imparting of information referring to social system, legal rights, earning capacity and occupational reintegration as well as an early feedback of the sociomedical assessment by the physicians. Participants during in-patient rehabilitation are supported to deal with their occupational situation; motivation to stay employed is strengthened. The group programme contains five psychoeducative modules and an additional sociomedical "ward round". The aim of the study was to examine the acceptance of the newly developed sociomedical vocational therapy module.

METHOD

A total of 179 patients participated in 21 "vocational perspective" seminars within the scope of a controlled quasi-experimental trial. In the experimental group the data on acceptance of the treatment was assessed by questionnaire at the end of the intervention. Experiences with implementation of the programme are described in order to complete the patient-related perspective.

RESULTS

The identification of a demand for work-related interventions in medical rehabilitation seemed successful: Sociodemographic and socioeconomical parameters of the sample proved high risk in view of the social-medical perspective (poor education, high unemployment rates and long-term sick leave). Self-estimations revealed high suffering of the participants, e. g. due to the occupational situation, anxiety and depression, and confirmed high interest in work-related issues. The patients showed quite high acceptance of the programme (regarding importance of seminar, comprehensibility, usefulness of information, atmosphere of the group, mode and extent of the programme). 82.7% of the participants would recommend the programme to other people with work-related problems. Altogether, the experiences during the implementation of the programme can be described as positive. Nevertheless, organizing took much effort and the treatment was very demanding for the therapists. Finally, it is also necessary that the physicians agree to realize high transparency in the process of sociomedical assessment.

CONCLUSION

The sociomedical programme "Vocational Perspective" helps patients to deal with relevant information referring to social system and occupational reintegration. Problematical sociomedical issues can be handled in a therapeutic way during rehabilitation process. Therefore, the programme can be used as meaningful supplement in regular medical rehabilitation. For final conclusions, the results of short-term and follow-up evaluations described elsewhere have to be considered.

High-protein nutrition during pregnancy and lactation programs blood pressure, food efficiency, and body weight of the offspring in a sex-dependent manner

Maternal low-protein diet during pregnancy is a risk factor for cardiovascular disease of the offspring in later life. The impact of high-protein diet during pregnancy on the cardiovascular phenotype of the offspring, however, is still unknown. We examined the influence of a high-protein diet during pregnancy and lactation on the renal, hemodynamic, and metabolic phenotype of the F1 generation. Female Wistar rats were either fed a normal protein diet (20% protein: NP) or an isocaloric high-protein diet (40% protein: HP) throughout pregnancy and lactation. At weaning, the offspring were fed with standard diet, and they were allocated according to sex and maternal diet to four groups: normal-protein male (NPm, n = 25), normal-protein female (NPf, n = 19), high-protein male (HPm, n = 24), high-protein female (HPf, n = 29). During the experiment (22 wk), the animals were characterized by repeated measurement of body weight, food intake, blood pressure, glucose tolerance, energy expenditure, and kidney function. At the end of the study period histomorphological analyses of the kidneys and weight measurement of reproductive fat pads were conducted. There were no differences in birth weight between the study groups. No influence of maternal diet on energy expenditure, glucose tolerance, and plasma lipid levels was detected. Blood pressure and glomerulosclerosis were elevated in male offspring only, whereas female offspring were characterized by an increased food efficiency, higher body weight, and increased fat pads. Our study demonstrates that a high-protein diet during pregnancy and lactation in rats programs blood pressure, food efficiency, and body weight of the offspring in a sex-dependent manner.

[Long term change in quality of life after adenotonsillectomy for pediatric obstructive sleep disorders]

BACKGROUND

To study short-term and long-term changes in quality of life (QOL) in children before and after adenotonsillectomy (T and A) for obstructive sleep disorders (OSDs).

MATERIALS AND METHODS

Prospective study of 20 children underwent T and A for OSDs at the University hospital of Ulm/Germany. Caregivers were asked to complete the Brouillette-Score (BS) and OSA-18 survey, validated instruments for detecting symptoms and QOL change in children with OSDs, at the initial office visit prior to surgery (BS/1 and OSA-18/1) within 7.5 +/- 1.14 weeks after surgery (BS/2 and OSA-18/2), and 14.8 +/- 1.98 months after surgery (BS/3 and OSA-18/3). The BS comprises 3 items including: difficulty breathing during sleep, apnea observed by the caregivers and snoring. The OSA-18 survey comprises 18 items in 5 domains of sleep disturbance, physical suffering, emotional distress, daytime problems, and caregiver concerns. Scores from the preoperative and postoperative surveys were compared using the paired T-test and SPEARMAN-RANK test.

RESULTS

13 children were male (65 %). The mean age at the time of inclusion in the study was 6.2 +/- 1.63 years, mean preoperative body mass index (BMI) was 17.4 +/- 1.24 kg/m(2). Brouillette-Score: The mean Brouillette-Score before T and A (2.72) was significantly higher ( P = or < .001) than in the short-term (- 2.19) and in the long-term. (- 3.54). OSA-18 SURVEY: The mean total score for OSA-18/1 (83.4) was significantly higher ( P = or < .001) than the mean total score for OSA-18/2 (29.8) and OSA-18/3 (25.6). The overall correlation between BS and OSA-18 was R = .887 ( P = or < .001).

CONCLUSION

Children with suspicious OSDs demonstrate significant short term and long-term improvement in the Brouillette-Score and OSA-18 survey. Caregivers perceive a long-term improvement for a minimum of one year in QOL after T and A for OSDs, although these improvements are not uniform across all domains of the OSA-18 survey. Use of the Brouillette-Score and the OSA-18 survey should decrease the need for polysomnographic monitoring and facilitate selection of children for T and A, whereas the OSA-18 questionnaire permits the more differentiated finding.

Depth profile of uncompensated spins in an exchange bias system

We have used the unique spatial sensitivity of polarized neutron and soft x-ray beams in reflection geometry to measure the depth dependence of magnetization across the interface between a ferromagnet and an antiferromagnet. The net uncompensated magnetization near the interface responds to applied field, while uncompensated spins in the antiferromagnet bulk are pinned, thus providing a means to establish exchange bias.

[Controlled clinical testing of an antidiarrheal]

AIM

To identify the efficacy and tolerance of activated charcoal in acute, nonspecific diarrhea.

METHOD

Randomized, double-blind study on 100 adults with nonspecific diarrhea, performed in two general practices. 94 were included in the final analysis, 6 patients - all from the placebo group abandoned treatment because of the absence of an effect.

RESULTS

The major outcome parameters - reduction of stool frequency and curtailment of the duration of the diarrhea - were unequivocally achieved. Differences between the agent and placebo were great. Stool frequency decreased significantly from the third day in the drug group, and highly significantly from the fourth day. The superiority of the antidiarrheal was also clearly evident in terms of the numbers of days with diarrhea, the clinical findings tympania, nature of the stool and of eight individual symptoms, the summed score of which was improved highly significantly by the test substance.

CONCLUSION

The substance tested proved rapidly and reliably effective in the treatment of nonspecific diarrhea, and was well tolerated. Activated charcoal, together with oral rehydration, can therefore be recommended as an initial measure for treating diarrhea with the aim of rapidly and effectively preventing loss of fluid and electrolytes and relieving symptoms.

[Tolerance and effectiveness of oxymetazoline and xylometazoline in treatment of acute rhinitis]

BACKGROUND

Local alpha-sympathomimetics in hydrous solution are well known in the therapy of acute rhinitis and sinusitis. However, added preservatives like benzalkonium chloride have a negative effect on compatibility.

PATIENTS AND METHOD

A total of 307 patients with acute rhinitis entered the study. The treatment with oxymetazoline with preservative, oxymetazoline without preservative and xylometazoline with preservative was evaluated.

RESULTS

This randomised, double-blind, multi-centered, verum-controlled tolerance study confirmed that the local sympathomimetics oxymetazoline and xylometazoline are well tolerated in the treatment of acute rhinitis. When evaluated according to the parameters "feeling of dryness in nasal mucosa" and "burning sensation", the Nasivin sanft 0.05% spray, which contains the active agent oxymetazoline without preservatives, proved to be considerably superior to preparations containing the preservative benzalkonium chloride.

CONCLUSION

Preparations without preservatives should be the preferred choice of treatment for acute rhinitis.

[Postoperative management following rhinosurgery interventions in severe obstructive sleep apnea. A pilot study]

BACKGROUND

Patients with severe obstructive sleep apnea (OSA) treated by nasal continuous positive airway pressure (CPAP) often undergo rhinosurgery to improve nasal ventilation and comply with CPAP therapy. The use of nasal packing postoperatively may worsen the severity of their sleep-related breathing disorders, even leading to death. For this reason, postoperative surveillance with CPAP ventilation is recommended. An oral connection piece offers the possibility to continue CPAP therapy.

PATIENTS AND METHOD

Five patients with OSA were enrolled in this pilot study. All patients underwent a septorhinoplasty with nasal packing for 2 days. CPAP ventilation was guaranteed postoperatively by using an oral connection piece. The object of the study was to evaluate the feasibility, effectiveness, and acceptance of CPAP ventilation with this oral connection piece in patients with nasal packing. Therefore, the blood oxygenation of the patients was observed by pulse oximetry pre- and postoperatively.

RESULTS

None of the patients with nasal packing showed apneas or hypopneas with arterial blood oxygen saturation below 92%. Application of oxygen was not necessary. Cardiorespiratory or neurological complications were not observed.

CONCLUSION

The oral connection piece offers a feasible and effective opportunity to continue CPAP ventilation therapy after rhinosurgery in patients with OSA. The acceptance of the method is satisfactory.

[Efficacy and tolerability of Baldrian versus oxazepam in non-organic and non-psychiatric insomniacs: a randomised, double-blind, clinical, comparative study]

OBJECTIVE

To show better improvement of sleep quality when treating non-organic insomniacs with extractum Valerianae radix siccum instead of oxazepam.

DESIGN

Randomised, double blind, comparative study.

SETTING

Out-patients of 8 general practitioners.

PATIENTS

Non-organic and non-psychiatric insomniacs aged between 18 and 70 years were included into the trial. Persons with known hypersensitivity to valerian or benzodiazepines, other psychotropic drugs and various contraindications/limitations for benzodiazepines were excluded.

INTERVENTION

75 patients were randomly allocated either to the index group (2 x 300 mg extractum Valerianae radix siccum dragées LI 156) or control group (2 x 5 mg oxazepam dragées). The patients took study medication daily over a period of 28 days 30 min before going to bed.

OUTCOMES

The factor sleep quality of the SF-B was defined as primary outcome. Secondary outcomes were other sleep characteristics of the SF-B, well-being (Bf-S) and anxiety (HAMA). Controls were performed before treatment as well as after 1, 2 and 4 weeks. Vital and laboratory parameters as well as unexpected events were assessed for safety and tolerability.

STATISTICS

For all outcomes effect sizes between groups were calculated. For the main outcome criteria significance was tested by repeated-measures ANOVA considering all cases for which data of at least one follow-up existed (n = 70).

RESULTS

Baseline characteristics were well balanced. 70% (54/75) of the patients were females, over 53% (40/75) reported insomnia for more than 1 year. Mean age was 52 +/- 12 years. In both groups sleep quality improved significantly (p <0.001), but no statistically significant difference could be found between groups (p = 0.70). Effect sizes between groups varied between 0.02 and 0.25. Five persons withdrew due to possibly adverse drug reactions (2 ( valerian, 3 ( oxazepam). No serious adverse events happened.

CONCLUSIONS

The study showed no differences in the efficacy for valerian and oxazepam. Because of the more favourable adverse effect profile of valerian compared to oxazepam, this hypothesis should be analysed confirmatorily in an equivalence study.

Inversion errors in Arabic number reading: is there a nonsemantic route?

This article reports on a mildly aphasic patient with major disorders in reading, writing, and number processing. His predominant error type in reading aloud Arabic numbers and in matching heard numerals with Arabic numbers was the violation of the inversion rule of the German Arabic number reading system. According to this rule most of the two-digit numbers or numbers in the final and prefinal position of longer digit strings have to be read beginning with the final digit (e.g. 26-->sechsundzwanzig (literally translated: six-and-twenty)). It is argued that AT's inversion errors (e.g., 26-->zweiundsechzig (literally translated: two-and-sixty)) are not consistent with the predictions of single route models of Arabic number reading but are in agreement with proposals of a visually based asemantic reading routine in addition to a semantically mediated reading routine.

Congenital multiple plaquelike glomus tumors

We encountered two patients with congenital multiple plaquelike glomus tumors. These lesions were present at birth and enlarged with body growth, attaining a diameter of up to 13 cm. The diagnosis was confirmed by histologic and electron-microscopic examination, which revealed the typical changes of glomus tumors. Immunocytochemistry findings demonstrated the tumor cells to be vimentin- and alpha-smooth muscle-actin-positive and desmin-negative. On ultrastructural examination, typical dense bodies and attachment plaques were easily found within the tumor cells. Glomus cells were coated by a thick basal lamina.

[Cooperation between dentists, teachers and parents in effective prevention of oral diseases in pupils in lower classes]

The oral conditions of pupils on three schools with different levels of teachers public relation to the problems of dental service and oral health education were observed before and after a program of dental care and education for 6 months. The best results were reached in the school with highest standard of cooperation and communication between dentists and teachers.

[Photosensitizing properties of nonsteroidal antirheumatic drugs in the photopatch test]

The non-steroidal anti-inflammatory drugs, aspirin, carprofen, diclofenac, ketoprofen, piroxicam, and tiaprofenic acid, were tested in a standard photopatch test series. The routine irradiation dose was 15 J/cm2 UV-A; in most patients additional test series were exposed to non-erythematogenic doses of UV-B and a combination of UV-B and UV-A. In the photopatch test, there were reactions to tiaprofenic acid in 43 of 175 (24.6%), to carprofen in 21 of 86 (24.4%), to aspirin in 7 of 76 (9.2%), to piroxicam in 7 of 84 (8.3%), to diclofenac in 5 of 75 (6.7%), and to ketoprofen in 2 of 53 (3.8%). In 16 patients positive photopatch test results did not start to develop until after the 3rd test day (between day 7 and day 34). In some cases there were positive reactions within the non-irradiated control series. Most of the positive photopatch test reactions could be elicited by UV-A alone; in some cases, however, combined irradiation with UV-B plus UV-A was necessary to yield positive results; only rarely did positive reactions occur exclusively with UV-B. The high incidence of positive photopatch test reactions to non-steroidal anti-inflammatory drugs is a possible indication of a phototoxic action. However, in some cases a photoallergic pathomechanism seems probable with regard to the development of reactions after the 3rd test day, a high UV-sensitivity in the photopatch threshold test, and the results of the histological evaluation of test reactions in some patients.(ABSTRACT TRUNCATED AT 250 WORDS)

[Light-induced postherpetic erythema exsudativum multiforme]

A 37-year-old man had erythema multiforme over a period of 20 years following recurrent herpes simplex infections. On the basis of the results of provocative UV-A tests as well as histological findings a diagnosis of photosensitive erythema multiforme was made. The erythema multiforme exsudativum like variant of polymorphous light eruption is discussed in the differential diagnosis.

[Pigment demarcation lines in pregnancy]

A 37-year-old female patient from Indonesia is reported, who developed pigmentary demarcation lines during the last trimenon of her first pregnancy. The lines resolved spontaneously after delivery.

[Granuloma formation in test and treatment sites caused by intracutaneously administered, injectable collagen]

Within 24 h of intracutaneous administration of an injectable collagen implant, a 34-year-old woman developed reddish-yellow nodules at two test implantation sites as well as at treatment sites. These nodules have persisted for more than 8 months. Histological findings seem to be consistent with an allergic reaction of the granulomatous type (type V).

[Erythema scarlatiniforme desquamativum recidivans localisatum]

Two patients are reported who had the clinical picture of localized erythema scarlatiniforme desquamativum recidivans. The lesions were thought to be drug induced in a 56-year-old female patient. In the other 54-year-old male patient, staphylococcal infections may have caused the rash.

[Experimental induction of skin manifestations in hydroa vacciniforme]

In a 34-year-old patient who had been suffering from hydroa vacciniforme since he was 4 years old, typical skin lesions were induced on his arm, back and in the oral mucosa by means of repeated UV-A exposure. His eyes were found to have intracorneal scars.

[UV-ray sensitivity of patients with malignant melanoma]

In 77 patients with malignant melanoma and 74 control subjects without skin tumors caused by sunlight, the minimal erythema dosage (MED) in the UV-C and UV-B areas, immediate pigment darkening (IPD), and minimal tanning dose (MTD) were determined according to skin type. Direct (MED-UV-B, MED-UV-C) and inverse (IPD, MTD) correlations were established according to skin type. These parameters showed no differences between patients with malignant melanoma and the control group.

Ketoconazole concentrations in human skin blister fluid and plasma

To investigate ketoconazole penetration into skin, a single oral dose of 200 mg was administered to six healthy subjects. Plasma and cantharides blister fluid (CBF) levels were measured for 11 to 24 hours. In suction blister fluid (SBF) ketoconazole was determined 3, 6, and 9 hours after administration. Mean peak plasma levels of ketoconazole were found at 1 hour, they amounted to 3.03 +/- 0.55 micrograms/ml (n = 5). Apparent half-life of elimination was 1.8 hours. In cantharides blister fluid maximum ketoconazole concentrations were obtained at 6 hours being 1.05 +/- 0.32 micrograms/ml and declined rather slowly (half-life 4.2 hours; n = 3). Maximum concentrations in suction blister fluid were obtained 3 hours after administration (0.914 +/- 0.123 micrograms/ml). After 9 hours ketoconazole levels had declined to 0.216 +/- 0.044 micrograms/ml (n = 3). These concentrations exceed the ketoconazole concentrations proven to be effective in vitro up to 25 fold.

[Morphologic studies in the treatment of nevus flammeus with argon laser]

Immediately after the argon laser impact one finds necrosis of epidermis and superficial dermis. Dilated vessels down to a depth of 0.8 mm are filled with coagulated erythrocytes. After 2 days there is initial restoration of epidermis, and dilated vessels are filled with agglutination thrombi. With and after the 6th day fibroblasts and capillary blood vessels grow into the thrombi, and later on vessels are completely replaced by granulation tissue and after 2-4 weeks by newly formed fibrous tissue.