Modern Concepts Of Treatment Research Articles

Immuntherapie von Tumoren – Moderne immunologische Strategien in der Onkologie

Immunotherapies have become an integral part of modern treatment concepts in oncology. The complexity of the regulation of the immune system gives rise to a multitude of different treatment approaches. Antibody based strategies are already used routinely in clinical day to day practice. Identification of new target antigens and the analysis of broader immunologic implications of antibody therapy are recent developments in this field. Antigen selection is also of high importance in the field of vaccination strategies. Vaccination strategies are now being investigated in adjuvant treatment settings but also the combination of vaccination and other treatment modalities show promising results in clinical trials. Another promising emerging field are T cell based therapies, with the clinically successful adoptive T cell transfer now being complemented by T cell receptor transfer strategies. This review summarizes the current concepts and future perspectives in immunotherapies for cancer.

Das Konzept der fachübergreifenden funktionsorientierten urologischen Rehabilitation nach Operation eines Prostatakarzinoms

Die stationäre funktionsorientierte fachspezifische urologische Rehabilitation ist integraler Bestandteil moderner uro-onkologischer Behandlungskonzepte. Nach radikaler Prostatovesikulektomie auf Grund eines Prostatakarzinoms stehen die suffiziente Therapie von Belastungsharninkontinenz, von Miktionsstörungen, der erektilen Dysfunktion sowie das Wiedererlangen von physischer und psychischer Gesundheit an erster Stelle. Ein ganzheitlicher rehabilitativer Therapieansatz umfasst das Kontinenztraining, die Elektrotherapie und Biofeedback, verschiedene Entspannungsverfahren, die medizinische Trainingstherapie, balneologische Maßnahmen, die Schwellkörperrehabilitation sowie Maßnahmen zur Gesundheitsbildung und sekundären Prävention. Mittels einer komplexen stationären multimodalen fachspezifischen urologischen Rehabilitation gelingt zeitnah eine deutliche Reduktion Therapie-assoziierter funktioneller Defizite, im Falle der Belastungsharninkontinenz um bis zu 80%.

Radiotherapy for localized rectal cancer

Surgical resection alone was the standard treatment modality for localized rectal cancer until the early 1990s. Total mesorectal excision (TME) has become the actual standard of care for patients with rectal cancer which greatly reduces local recurrences. Despite the introduction of TME, radiotherapy and chemotherapy have prevailed as integral components of modern treatment concepts. The management of localized rectal cancer requires a multi-disciplinary approach with specialist surgeons, gastro-enterologists, and medical and radiation oncologists. The sequence of treatments is more important than ever. Recent studies have highlighted the central role of radiation therapy associated with surgery to optimize local control, especially in stages II and III rectal cancer, and neo-adjuvant radiochemotherapy (RCT) is now considered to be the standard. However, important questions about preoperative diagnosis, fractionation and dosing of shortand long-term radiation therapy, whether shortand long-term radiotherapy are comparable, and which chemotherapeutic drugs should be used in which combination and sequence remain to be answered. This article focuses on the indications of radiotherapy in the setting of rectal cancer, the benefits of concurrent chemoradiation and the integration of novel drugs into the strategy.

Lokale Chemotherapie oraler und oropharyngealer Plattenepithelkarzinome

Modern treatment concepts for patients suffering from oral and oropharyngeal cancer include more and more adjuvant therapeutic options. Local chemotherapy offers the possibility to apply an extremely high drug concentration at the tumor site while minimizing possible side effects by systemic neutralization at the same time. A total of 289 patients with histologically proven carcinoma of the oral cavity and the oropharynx underwent neoadjuvant intra-arterial chemotherapy with high-dosage cisplatin within a multimodal therapeutic setting. Concerning the TNM classification, more than 70% of the patients were classified as stages III and IV. The mean age at the time of intervention was 60 years, and 71% of the patients were male. After the first cycle 19.3% of the patients presented with complete remission (grade I); 35.4% and 41.5% showed partial remissions (grade II) or stable disease (grade III), respectively. The mean observation time after treatment was 28 months (median: 24.2 months). Of the 137 patients who completed the full multimodal therapeutic scheme, 11% developed local recurrence, and 12.4% developed lymph node or distant metastasis. At the time of evaluation, 72.5% of these patients were still alive. Intra-arterial chemotherapy is a safe and highly effective procedure that should be considered as an important option in multimodal therapeutic concepts for oral and oropharyngeal cancer.

Public Awareness of Warning Symptoms, Risk Factors, and Treatment of Stroke in Northwest India

This study assessed public awareness of warning symptoms, risk factors, and treatment of stroke in Ludhiana, Punjab, North West India. A hospital-based survey was conducted between February 2002 and September 2002 by the Stroke section of Christian Medical College. The study subjects were relatives of patients without history of stroke, attending the outpatient department of the hospital. Trained medical students, interns, and a nurse interviewed subjects using a structured, pretested, open-ended questionnaire. Nine hundred forty-two individuals were interviewed during the study period (56.4% men, mean age 40.1 years, age range 15 to 80 years). Forty-five percent of the subjects did not recognize the brain as the affected organ in stroke. In the multivariate analysis, higher education (P<0.001; odds ratio 2.6; 95%, CI 1.8 to 3.8) and upper socioeconomic status (P<0.005; odds ratio 1.6; CI, 1.1 to 2.2) correlated with a better knowledge of which organ was affected in stroke. Twenty-three percent of the participants did not know a single warning symptom of stroke. Twenty-one percent of the subjects could not identify even a single risk factor for stroke. Seven percent of the study population believed that oil massage would improve stroke victims. A small proportion of subjects believed in witchcraft, faith healing, homeopathic, and ayurvedic treatment (3%). This hospital-based survey reveals a better awareness of stroke warning signs and risk factors. However, knowledge regarding the organ involved, etiology, and treatment of stroke is lacking. Considerable education is needed to increase public awareness in modern concepts of stroke treatment.

Modern Concepts of Treatment and Prevention of Lightning Injuries

Lightning is the second most common cause of weather-related death in the United States. Lightning is a natural atmospheric discharge that occurs between regions of net positive and net negative electric charges. There are several types of lightning, including streak lightning, sheet lightning, ribbon lightning, bead lightning, and ball lightning. Lightning causes injury through five basic mechanisms: direct strike, flash discharge (splash), contact, ground current (step voltage), and blunt trauma. While persons struck by lightning show evidence of multisystem derangement, the most dramatic effects involve the cardiovascular and central nervous systems. Cardiopulmonary arrest is the most common cause of death in lightning victims. Immediate resuscitation of people struck by lightning greatly affects the prognosis. Electrocardiographic changes observed following lightning accidents are probably from primary electric injury or burns of the myocardium without coronary artery occlusion. Lightning induces vasomotor spasm from direct sympathetic stimulation resulting in severe loss of pulses in the extremities. This vasoconstriction may be associated with transient paralysis. Damage to the central nervous system accounts for the second most debilitating group of injuries. Central nervous system injuries from lightning include amnesia and confusion, immediate loss of consciousness, weakness, intracranial injuries, and even brief aphasia. Other organ systems injured by lightning include the eye, ear, gastrointestinal system, skin, and musculoskeletal system. The best treatment of lightning injuries is prevention. The Lightning Safety Guidelines devised by the Lightning Safety Group should be instituted in the United States and other nations to prevent these devastating injuries.

Modern Concepts of Treatment and Prevention of Electrical Burns

Electric injuries account for 1,000 deaths in the United States, with a mortality rate of 3--15%. As the widespread use of electricity and injuries from it increase, all health professionals involved in burn care must appreciate its physiological and pathological effects as well as management of electrical current injury. Electric current exists in two forms: alternating current and direct current. The effects of electricity on the body are determined by seven factors: (1) type of current, (2) amount of current, (3) pathway of current, (4) duration of current, (5) area of contact, (6) resistance of the body, and (7) voltage. Electrical accidents can be divided into less than 1,000 V (low-voltage accidents) and greater than 1,000 V (high-voltage accidents). In any electrical accident, the witness must turn off the power source and initiate treatment at the scene of the injury. Low-voltage electric burns almost exclusively involve either the hands or oral cavity. Surgical treatment will vary with the severity of the injury. Burns caused by contact with a high-voltage alternating electric circuit conforms to two types: burns from an electric arc and burns from an electric current. High-voltage electric current injuries have a wide variety of systemic manifestations, including neurologic complications, cardiovascular and pulmonary manifestations, vascular damage, and abdominal, bone, eye and joint complications. An organized approach to the management of these complications is outlined in this article. The best treatment of burn injuries remains prevention. Because the majority of burn injuries are due to occupational electrical injuries, the regional burn centers must work effectively with industry to prevent these potentially life-threatening accidents.

Modern Concepts of Treatment and Prevention of Chemical Injuries

Chemical injuries are commonly encountered following exposure to acids and alkali, including hydrofluoric acid, formic acid, anhydrous ammonia, cement, and phenol. Other specific agents that cause chemical burns include white phosphorus, elemental metals, nitrates, hydrocarbons, and tar. Even though there are more than 65,000 chemicals available on the market, and an estimated 60,000 new chemicals produced each year, the potential deleterious effects of these chemicals on humans are still unknown. The Superfund Amendments and Reauthorization Act contains extensive provisions for emergency planning and the rights of communities to know about toxic chemical releases. Since 1990, the Agency for Toxic Substances and Disease Registry (ATSDR) has maintained an active, state-based Hazardous Substances Emergency Events Surveillance (HSEES) system to describe the public health consequences risked by access to hazardous chemicals. Most chemical agents damage the skin by producing a chemical reaction rather than hyperthermic injury. Although some chemicals produce considerable heat as a result of an exothermic reaction when they come in contact with water, their ability to produce direct chemical changes on the skin accounts for the most skin injury. Specific chemical changes depend on the agent, including acids, alkalis, corrosives, oxidizing and reducing agents, desiccants, vesicants, and protoplasmic poisons. The concentration of toxic agent and duration of its contact primarily determine degree of skin destruction. Hazardous materials (hazmats) are substances that may injure life and damage the environment if improperly handled. HAZMAT accidents are particularly dangerous for responding personnel, who are in danger from the moment of arrival on the scene until containment of the accident. Consequently, the Superfund Amendment and Reauthorization Act mandates community preparedness for dealing with hazmat accidents. Paramedics and members of the hazmat response team (usually firefighters) must work together to identify toxic chemicals and assess hazardous environments. The contingency plan for hazmat management can be divided into two parts: initiation of the site plan and evacuation. In coping with hazmat incidents, two distinct goals must be achieved concomitantly. First, hazmats must be contained, fire and explosions must be extinguished, and the site eventually must be cleaned. Second, those exposed to hazmats must be treated at the scene of contamination as well as in the hospital and rehabilitation setting.

Critical Review of European Experience with Neoadjuvant Therapy

The use of primary systemic therapy (PST) is being increasingly investigated and not limited to inoperable breast cancer any more. Breast cancer research in Europe has played a crucial role in implementing this concept and continues to be a major contributor to the international scientific landscape with several actively recruiting PST-trials. After the proof of equivalency between PST and adjuvant chemotherapy, numerous trials have been conducted already. Since the treatment can be monitored by individual tumor response, PST is a tool for in vivo chemosensitivity testing and shows pathohistologic complete remission (pCR) to be a good surrogate marker for improved survival. Actively recruiting trials (e.g. trials of the AGO PREPARE and TECHNO) integrate modern concepts of treatment like dose-dense, dose-intensified, sequential therapy and tumor targeting with trastuzumab in PST. The rate of breast conserving therapy after PST is increased by reduction of the tumor size and surgery in the outlines of the tumor does not seem to impair patients outcome. Further trials are needed to elucidate the role of PST in primary breast cancer. The aim of tailoring therapy for the individual patient is consequently pursued by correlation of therapy response to the genetic profile of the tumor with new technologies and will allow improved selection of treatment options in the multimodal approach of modern breast cancer treatment.

Endodontics: Part 1. The modern concept of root canal treatment.

Root canal treatment has changed considerably since the hollow tube theory was first postulated in 1930. Research continues into the elaborate anatomy of root canal systems, and also into the microbial causes of endodontically related diseases. Only by understanding these aspects in detail can the practitioner quickly and effectively shape the main root canals to facilitate thorough cleaning of the entire system, and easy and effective filling.

Modern treatment concepts in schizophrenia.

On the basis of available practice guidelines for schizophrenia, contemporary treatment principles for schizophrenia leading to phase- or stage-oriented, multidimensional treatment approaches are described. Additionally, based on current research programmes, future treatment developments are presented.

Acute cerebral infarct: physiopathology and modern therapeutic concepts

This review focuses on the pathophysiological changes in acute cerebral ischemia, with special emphasis on disturbances of the cerebral blood flow (CBF) and the associated penumbra concept. Alternatively, the model of peri-infarct depolarization is demonstrated. Metabolic and molecular changes caused by cerebral ischemia and reperfusion are discussed, namely energy failure, release of glutamate with an excitatoric burst, calcium influx in neurons, generation of free radicals, activation of different proteases, disturbances of protein synthesis, induction of gene expression and apoptosis, loss of membrane integrity, edema formation and microvascular disturbances. In summary, the pathophysiological changes after focal cerebral ischemia and reperfusion are most adequately described by a network of interacting different mechanisms of tissue alterations. The simple concept of a cascade of ischemic effects which would be easy to block seems to be less applicable. A time window of approximately 6 h for the acute stroke therapy is postulated on the base of the above mentioned pathophysiological changes. The recently introduced treatment regimen with optimized basic treatment, recanalization using thrombolysis and neuroprotection by different agents is presented. Different modes of a possible intervention are discussed. Modern concepts of stroke therapy including stroke-unit care and thrombolysis with add-on neuroprotection seem to have potential for improving the outcome of acute stroke patients.

Die Urethralklappenbehandlung mit und ohne Klappenresektion im ersten Lebensjahr

25 infants of a total of 72 child patients, who were treated between 1967 and 1987 in the Department of Paediatric Surgery of the Paediatric Hospital of the City of Cologne and were suffering from congenital urethral valves, had been transferred to the hospital for in-patient treatment within their first year of life. In accordance with a change in the treatment concept the patient material was divided into two groups: 1. Treated children up to 1978 These patients were subjected to a prolonged transurethral bouginage treatment of the urethra. Valve resection was performed subsequently at an average age of 13 months only. 2. Treated children after 1978 In these children valve resection was performed as soon as possible after birth. These two patient groups were compared with each other. It was found that both the survival times and the long-term renal function results of the children treated after 1978 had markedly improved compared with those treated before 1978, thanks to the modern treatment concept. That is true both for the incidence of secondary correction operations at the upper part of the urinary tract and for the frequency of nephrectomy.

Pagetic Arthritis

A review of the records of 112 patients demonstrate modern concepts of pathogenesis and treatment of Paget's disease. Pain from Pagetic arthritis should initially be treated by medical treatment aimed at modulation of bone blood flow. Patients, even with impressive arthritic reactions, can respond dramatically. Pain persists in patients with end-stage destruction of articular cartilage and/or stress microfractures. Patients with deformity without joint space loss may be candidates for osteotomy. Advanced cartilage destruction is treated by total arthroplasty and continuation of anti-Pagetic therapy after surgery, possibly to reduce the incidence of component loosening. Articular cartilage erosion and subchondral bone destruction are attributable to the disease process. Vascular invasion and joint surface collapse are associated with cartilage thinning and sequestration.

Malignant Solid Tumors in Children

In this volume, the author has drawn on his many years of experience in the treatment of children with cancer. In the preface, he acknowledges that the attitudes expressed in the volume reflect author bias and, to some degree, a limitation of discussion to tumor studies with which he has had the most direct personal experience. Dr Sutow has devoted almost half of this volume to some general considerations of childhood cancer and its treatment. There are useful, albeit brief discussions of incidence, the special nature of childhood neoplasms in comparison with those in adults, and those factors of apparent importance in cause. He has also provided some interesting background discussion concerning the strategy and tactics of cancer therapy for those unfamiliar with modern treatment concepts. The discussion of specific tumors is limited to five of the more common childhood neoplasms: neuroblastoma, Wilms' tumor, rhabdomyosarcoma, Ewing's sarcoma, and osteosarcoma. The

All-Russian conference on hearing loss

The agenda of the conference included the following questions: 1) physiology and pathology of the acoustic apparatus; 2) etiopathogenesis of hearing loss; 3) research methods of the acoustic analyzer; 4) prevention and treatment of hearing loss. The conference was opened with a report by prof. V. I. Voyachek (Leningrad) "The Evolution of Innovation in Cofology". The term "cofology" combines the modern concept of treatment, mainly surgical, persistent or progressive forms of hearing loss. In the evolution of the improvement of surgical technique, the author noted a number of patterns of innovation, the influence of one discovery on another. The discovery of antibiotics contributed to the success of the surgical treatment of hearing loss.

Ununited Fractures of the Neck of the Femur: Modern Concepts of Treatment

Ununited Fractures of the Neck of the Femur: Modern Concepts of Treatment