Wiener medizinische Wochenschrift
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Wien Med Wochenschr · Jan 1995
Randomized Controlled Trial Clinical Trial[The European experience with megadose therapy and autologous bone marrow transplantation in solid tumors with poor prognosis Ewing sarcoma, germ cell tumors and brain tumors)].
Since 1984 a total of 2085 patients with solid tumors have been registered in the European Bone Marrow Transplantation Registry for Solid Tumors (EBMT-STR). The major aim of this registry is to supply data by retrospective analysis for the innovation of prospective, randomized studies. 104 Ewing's sarcoma patients received megatherapy followed by autologous bone marrow transplantation (MGT/ABMT). The 2-year overall survival was 31% in 14 patients with multifocal disease in first complete remission (CR1) and was 37% for 15 patients in second CR (CR2). (6 patients with local disease in CR1 have been excluded.) These results are better than observed under conventional dose chemotherapy. 67 patients were grafted with measurable disease showing a response rate of 72%. ⋯ Based on these results and a French randomized trial a prospective, randomized study is underway comparing MGT versus conventional chemotherapy in chemosensitive patients. 219 adults with malignant brain gliomas underwent a program consisting of surgery, MGT (BCNU in the majority)/ABMT and radiotherapy. The overall survival at 3 years was 12%, the median survival was 11 months after ABMT. Life quality after ABMT was good, but no major improvement in terms of prolonged survival was achieved.(ABSTRACT TRUNCATED AT 250 WORDS)
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Fibromyalgia, also called (primary) fibromyalgia syndrome or fibrositis (syndrome), is a chronic soft tissue pain syndrome characterized by the presence of widespread musculosceletal aching, tender points at characteristic sites, fatigue, and poor sleep. The etiology of this common and painful condition is incompletely understood, non-restorative sleep, which has been correlated with an electroencephalic abnormality called alpha-delta sleep (intrusion of alpha rhythms in the non-REM sleep EEG), may be important. ⋯ A lower than normal threshold for pain can often be observed. The newly proposed criteria for the classification of fibromyalgia syndrome (widespread pain in combination with tender points at 11 or more of 18 specific tender point sites) are important for the differential diagnosis and to compare results in international studies.
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Wien Med Wochenschr · Jan 1995
[Clinical diagnosis in sleep laboratory patients based on ICD-10, DSM-III-R and ICSD classification criteria].
For the diagnosis of sleep disorders, 3 different standardized classification systems are available: the International Statistical Classification of Diseases and Related Health Problems (ICD-10), the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R/DSM-IV) and the International Classification of Sleep Disorders (ICSD). These 3 classification schemata were comparatively evaluated in 50 sleep-disturbed patients who were admitted within 1 year to a non-specialized sleep laboratory for diagnostic evaluation and treatment. 17 female and 33 male sleep-disturbed patients, aged 54 +/- 12 years, were recorded polysomnographically in 3 subsequent nights (adaptation night, baseline/diagnosis night, treatment night) for measuring objective sleep quality. The subjective sleep quality as well as the subjective and objective awakening quality was assessed by means of rating scales, as well as psychometric and psychophysiological test battery. ⋯ Based on the DSM-III-R, 46% of the patients were diagnosed as insomnias based on another mental disorder, 38% as organic hypersomnias and 14% as parasomnias. Based on the ICSD Classification, sleep disorders associated with anxiety disorders were leading (30%), followed by sleep disorders based on affective disorders (16%), obstructive snoring (14%), primary snoring (8%) and sleep disorders based on neurological disorders (6%). While the broader ICD-10 and DSM-III-R diagnoses are syndrome-etiologically oriented and may be easily utilized by the practicing physician, the more narrowly defined, extensive, pathogenetically oriented polysomnographic features including ICSD diagnoses are suited better for the specialist.
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Wien Med Wochenschr · Jan 1995
[Polysomnographic structure of subjective "awake" and "asleep" nocturnal segments].
8 patients being diagnosed as having periodic limb movements in sleep and 14 patients with the diagnosis of psychophysiological insomnia (PI) were studied. They indicated their subjective time of sleep onset, final awakening and wake episodes during the night in a time scale. ⋯ There were no significant differences--concerning the polysomnographic structure--between sections indicated as "wake" or "sleep" or between the 2 groups. Patients with PI had less frequent awakenings but of longer duration, which can be seen as a reason for the negative subjective judgement of the night quality.
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In Physical Medicine and Rehabilitation structural and functional disorders in the genesis of back pain are of great importance. From an epidemiological point of view this has great consequences. Active and passive forms of physical therapy are available. ⋯ Sometimes a combination of active and passive forms are of benefit. Every treatment concept has to pay regard to the actuality of pain, the load of every day life and the physical and social situation of the patient. Last but not least one has to learn to cope with the pain.