Praxis
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Review Randomized Controlled Trial Multicenter Study Clinical Trial
[Neoadjuvant chemotherapy and chemoradiotherapy in locally advanced stage IIIA and IIIB of non-small-cell bronchial carcinoma (the Essen concept)].
Induction chemotherapies followed by concurrent chemoradiotherapy and definitive surgery have been tested in Essen since 1991 in a large phase-II study for patients with locally (far) advanced non-small cell lung cancer (NSCLC) stages IIIA (N2) and IIIB (T4, N3). After a median follow-up time of 43 months, mature long-term survival data for this intensive multimodality treatment program can now be reported. With nearly 1/3 of these patients experiencing long-term survival at 4 and 5 years after this approach, a significant improvement of long-term prognosis seems to have been achieved, because retrospective comparisons have demonstrated a rather unfavourable prognosis for these disease stages. ⋯ For stage IIIB (excluding patients with malignant pleural effusion or supraclavicular nodes) a further prospective randomized trial is on its way testing chemotherapy followed by a definitive concurrent chemoradiation approach up to 65 Gy radiation dose versus a multimodality program similar to our phase-II protocol with the inclusion of definitive surgery. Smaller phase-I and -II trials will search for alternative possibilities to improve the induction protocol first of all by the inclusion of new active drugs and secondly by increasing the chemotherapeutic dose intensity of the substances used so far. Due to the promising long-term results of the multimodality treatment programs published so far, these unfavourable patients with locally advanced NSCLC have now gained particular interest due to the development of now curatively intended treatment approaches.
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Complementary medical methods are increasingly offered by physicians as well as other members of the health services and numerous therapists and they are sought and used by a majority of the population. From the point of view of health care authorities the question of acceptance or admission of methods and offering persons is raised. Unfortunately Switzerland lacks an uniform federal curriculum for practitioners of natural cures of other therapists in complementary medicine. ⋯ Whether complementary (paramedical) medicine will really reduce costs of health care remains unproven so far. According to several surveys most alternative methods are used in addition to "school medicine" (academic medicine). Health insurance companies should subject reimbursement of costs to the fulfillment of standards regarding efficacy, appropriateness and economy equal to all other medications and therapies.
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Comparative Study
[Trials with gabapentin monotherapy in patients with complex partial or secondary generalized seizures].
Neurontin (Gabapentin) is indicated as an add-on treatment of partial epileptic seizures. Clinical studies demonstrating the efficacy of Neurontin as monotherapy are currently on going. This article describes the design of 2 clinical trials of Gabapentin as monotherapy for epileptic seizures.