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Biomedical subjects

W Schreml

Publications and source records attributed to W Schreml.

At least 19 recordsLinked to original sources
PubMed2000

Integrated palliative care within a general hospital.

The goal of the project was to integrate essential elements of palliative care into the regular duties of an internal ward located in a general hospital serving a rural area. To achieve this goal, the medical and nursing staff was moderately expanded, which was made possible by a grant from the Deutsche Krebshilfe, and training and supervision were instituted. Patients with malignant diseases in advanced and terminal phases were enrolled in the project and evaluated using a specifically designed documentation system. On average, 8.5 (18%) of the 46 beds on the ward were occupied by patients being cared for as part of the project at any one time. Effective relief of pain, nausea and respiratory distress were documented. For those dying in the hospital, a single room and the presence of family members were possible in the majority of cases. A high impact on the team became apparent through an anonymous questionnaire given during supervision. The project shows that it is possible to integrate palliative care into the work of a regular internal medical ward, with positive consequences for the patients and the team.

Delivery of Health Care, Integrated↗
PubMed1987

[Concept of treatment of metastatic breast cancer outside university clinics: description of the method and evaluation of efficacy].

It has been recognized during the past decade that it may be advantageous to develop complex strategies for treatment of metastatic breast cancer (MBC). In these strategies the type and efficacy of preceding therapies and the compliance of the patients have to be considered. Since about 80% of all patients with MBC are treated outside university hospitals it should be tested if a complex strategy for treatment of MBC can be realized in these institutions. The method was based on three principles: There was an exchange of data between participating institutions and study center after each visit of a patient. Second, there was one data sheet for admission of a patient to the study and fifteen sheets for follow-up documentation each with a different bottom line; in the bottom line of these sheets two therapies according to the strategy were proposed, one in case of 'no progression' and another in case of 'progression' of the disease. Third, a copy of completed sheets had to be returned to the study center; the study center provided the next sheet with the appropriate treatment recommendation. 335 evaluable patients were prospectively recruited from 27 participating institutions between January 1983 and December 1985. Based on the estimated incidence of MBC in the region, it was calculated that 45% of all MBC patients of the region had been admitted to the study. Only 27% of these patients were treated at the university hospital indicating that 85% of all MBC patients of the region were treated outside university hospitals.(ABSTRACT TRUNCATED AT 250 WORDS)

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1986

Chronic gonadal toxicity in patients with testicular cancer after chemotherapy.

Forty-five patients with disseminated testicular cancer treated with cisplatin, vinblastine and bleomycin +/- adriamycin (PVB +/- A) were studied to establish the impact of chemotherapy on hormonal and reproductive functions. Data on FSH, LH, testosterone, prolactin, semen analyses and sexual functions were obtained before, during and 1-6 yr after chemotherapy. Mean LH, testosterone and prolactin levels were within normal limits before, during and after chemotherapy. Twenty per cent (4/20) of the patients revealed pathologically elevated FSH levels due to pretreatment gonadal dysfunction. Germinal aplasia occurred in all patients in the first year after chemotherapy, as 100% rendered azoospermic and 95% showed statistically significant elevated FSH values (P = 0.001). In the third year after chemotherapy 80% (8/10) of the patients showed normalization of FSH levels and 100% (7/7) recovery of sperm production but with a high degree of immotile sperms. Although these results emphasize the restitution of spermatogenesis in the third year after cessation of PVB-regimen, the minority of these patients fathered children, probably due to reduced sperm motility.

Adolescent↗
PubMed1985

[Fibrin pleurodesis in malignant pleural effusions].

Fibrin pleurodesis was performed on 30 patients with malignant pleural effusions. A pleural catheter was inserted to empty the pleural space and effect the pleurodesis. When the pleural space was dry, 20 000 U of aprotinin were instilled intrapleurally for local fibrinolysis inhibition. 10 ml fibrinogen concentrate and 10 ml thrombin (500 U/ml) and 3000 KI U/ml aprotinin were then applied. Complete success was achieved in 19 of 27 patients, partial success in two. The results could not be evaluated in three patients. The only side-effect of the treatment was a subfebrile temperature in three of the 30 patients. Fibrin pleurodesis thus proved itself as an effective form of treatment with few side-effects (10%).

Adult↗
PubMed1985

Bulky germinal tumors: comparison of different induction regimens and significance of residual disease.

In order to study the efficacy of three different chemotherapy regimens and the prognostic significance of residual disease after chemotherapy, we analyzed 84 patients with bulky germinal tumors. Chemotherapy, consisting of vinblastine, bleomycin/adriamycin, cisplatin (VB/AP) was administered sequentially to 37 patients. 19 patients were treated with the cisplatin, vinblastine, bleomycin (PVB) regimen and 17 patients with cisplatin, vinblastine, bleomycin, ifosfamide (PVBI). The initial complete remission (iCR) was 71% (52 of 73) with a relapse rate of 29% (15 of 52). 10 of 73 (14%) patients achieved partial response and 11 of 73 (15%) showed progression due to multidrug resistance. There was no statistically significant difference in iCR, continuous complete remission (cCR), relapse and survival between the PVB, PVBI and VB/AP regimens. In 50 patients, the residual tumor after chemotherapy was examined histologically. cCR was achieved in 75% (15 of 20) of patients with necrosis or fibrosis, in 50% (5 of 10) with adult teratoma and in 25% (5 of 20) with malignant tumor. Comparison of survival curves according to residual histology revealed statistically significant differences (p = 0.02). Our findings suggest that in patients with germinal bulk disease PVBI-regimen and VB/AD-therapy are not superior to the standard regimen. Residual disease seems to be an important prognosticator.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1985

Stem cell defects after cytoreductive therapy in man.

The study of stem cell defects in man after cytoreductive therapy appears to be of particular importance since hematotoxicity represents the major limiting side effect in many instances. On the other hand, such studies are met by difficult methodological problems. In particular, bone marrow sampling in man cannot be done on a quantitative basis. Furthermore, ethical considerations restrict the sampling of serial bone marrow specimens. We have studied the reaction of hematopoiesis including stem cells in man with the available methods, in particular CFU-GM (CFU-C), CFU-E, and BFU-E in bone marrow (BM) and peripheral blood (PB) during the course of various cytostatic regimens given for adjuvant and palliative chemotherapy of human cancer. Major findings of these studies were The acute reaction of BM stem cells and differentiated BM precursor pools corresponds to the mechanisms known to be effective in animal experiments. The PB CFU-GM may be of particular importance in man in demonstrating long-term derangements. In an attempt at quantification of human BM data, an index was developed from BM spicule morphometry and from standardized BM aspirate cellularity. Stem cell defects in BM and PB were observed that did not show up in the PB counts, in particular after nitrosoureas. Indication of prolonged derangements in stem cells up to five years after chemotherapy were observed after adjuvant therapy for breast cancer. From these data, it appears advisable to study stem cell data in man for newly developed chemotherapeutic regimens in order to minimize early and late side effects on hematopoiesis.

Animals↗
PubMed1983

Adjuvant chemo(immuno-)-therapy of primary breast cancer with adriamycin-cyclophosphamide (and levamisole)--six-year evaluation.

In a phase II-type study 52 patients with no signs of metastases but with a high risk of recurrence were treated with 6 courses of adriamycin-cyclophosphamide as adjuvant systemic therapy following modified radical mastectomy of primary breast cancer. Half of the patients were randomized to receive additional immunotherapy with levamisole for 2 yr. The scheduled dose and time regimen could be achieved in over 90% of patients. A comparison of the actuarial disease-free and overall survival with data reported in the literature indicates a similar positive effect of adjuvant systemic therapy as described in adjuvant studies using polychemotherapy regimens. Immunotherapy with levamisole has no effect on disease-free and overall survival but added to general toxicity. Particular attention was paid to psychological consequences of adjuvant systemic therapy; consistent attention by one specifically trained physician during the whole therapy and follow-up period was effective in coping with the emotional problems. The difficulties in treating recurrences after adjuvant therapy became apparent. A high rate of loco-regional recurrences and of cerebral metastases was noted.

Breast Neoplasms↗
PubMed1982

Effect of fibroblast interferon on colony tumor growth of miscellaneous solid human tumors.

The antiproliferative effect of fibroblast interferon (IF-beta) on the colony tumor growth of 42 miscellaneous carcinomas (15 gastric, 11 breast, eight colon, five ovarian, three bronchial) and two malignant melanomas were assayed in a semisolid, double-layered agar culture system. Of the 44 evaluable experiments only four tumor specimens (three breast-, one gastric carcinoma) showed at least a 30% inhibition of colony formation due to application of interferon at concentration of 1,000 IU/ml or less. In these cases, a dose response relationship of the interferon effect was obvious. Yet, in the majority of carcinomas investigated, interferon had no antiproliferative influence on colony tumor growth and was markedly inferior to a simultaneously tested cytostatic agent (adriamycin). Our in vitro results contradict a general direct cytotoxic action of interferon on human solid carcinomas.

Cell Transformation, Neoplastic↗