Establishment of Personalized Pain Goals in Oncology Patients to Improve Care and Decrease Costs.

Purpose: Cancer-related pain is common, negatively affects quality of life and survival, and often requires treatment with opioid analgesics. Patient-reported data that describe the incidence and severity of pain, medication use, and patient satisfaction with care are lacking.

Methods: We analyzed 18 months of outpatient oncology clinic encounters from the electronic medical record to obtain data on pain levels and opioid and nonopioid treatments.

Inpatient hospitalization of oncology patients: are we missing an opportunity for end-of-life care?

Introduction: Despite advances in the care of patients with cancer over the last 10 years, cancer remains the second leading cause of death in the United States. Many patients receive aggressive, in-hospital end-of-life care at high cost. There are few data on outcomes after unplanned hospitalization of patients with metastatic cancer.

[Public education in recognizing melanoma].

We report on the first German "melanoma screening week" (Offenbach Melanoma Week). According to the model of the Melanoma/Skin Cancer Detection Week in Dayton/Ohio, the population of Offenbach (100.000 inhabitants) were informed about cutaneous malignant melanoma and its early recognition by means of public media, in particular the local press; the people were asked to participate in a voluntary screening including examination of the entire skin.

Diagnostic excision of the Rosenmüller's node. Screening for occult metastases before elective regional lymph node dissection in patients with lower limb melanoma?

Elective radical groin dissection was performed on 297 consecutive patients with high-risk melanoma of the leg, Anderson Stages I, IIA, IIIA. By separate histologic examination of the so-called "Rosenmüller's node," the other inguinal, and the external iliac lymph nodes, the diagnostic excision of the Rosenmüller's node was tested as a suitable mode of screening for metastases before a planned elective regional lymph node dissection. Eighty patients (27%) presented with what was histologically determined to be occult groin metastases.

Epidemiologic aspects of malignant melanoma (review).

The incidence of malignant melanoma has increased worldwide, the rate in Germany being about 12 per 100,000. Geographic variations are due to genetic or racial factors rather than to excess sun exposure. A white complexion with freckles or multiple dysplastic nevi are important danger signs.

Incidence of malignant melanoma in Central Hesse, Germany.

The incidence of melanoma in Central Hesse, the catchment area of the Dermatological Clinic of the University of Giessen, was 11.1 per 100,000 inhabitants in 1984. The incidences in the different districts are relatively equa, varying only between 9.

Congenital nevi less than or equal to 10 cm as precursors to melanoma. 52 cases, a review, and a new conception.

Fifty-two congenital melanocytic nevi (CMN) as precursors to melanoma or severe melanocytic dysplasia were reviewed macroscopically and microscopically. Forty-eight "small" CMN measured less than 10 cm in diameter. Histologically, only five reached to the lower third of the dermis or subcutis ("deep type"); the remaining 47 were limited to the upper two thirds of the corium ("superficial type").

[Isolated hyperthermic extremity perfusion with vindesine, dacarbazine and cisplatin in the treatment of malignant melanomas].

A three drug combination consisting of dacarbazine, vindesine and CDDP (DVP) was used for isolated extremity perfusion in 26 patients with stage I, II and III melanomas of the limbs. Dosages of 100 mg/l dacarbazine, 0.4 mg/l vindesine and 20 mg Cis-Platinum/l extremity volume have been tolerated without major side effects.

Epifocal dinitrochlorobenzene therapy in malignant melanoma (experience during the last eight years).

A total of 50 patients with primary malignant melanomas received epifocal DNCB therapy. In 46 cases the tumors disappeared completely. Therefore, we partly refrained from excision of the treated area.

[Allergic and pseudoallergic reactions of the urticaria skin and mucous membranes due to food components with special reference to food and RAST].

Among 1.000 consecutive cases of urticaria with suspicious food history and positive oral exposition, 12 patients showed an acute recurrent course. The result of the Prick or rub test was mainly positive in analogy, the RAST later determined in 5 of these patients remained four times "false negative" to the rub test in 4 of 5 allergens.

Isolated extremity perfusion with DTIC. An experimental and clinical study.

Dacarbazine (DTIC) was used for isolated perfusion of extremities in dogs and man. In the animal experiment perfusions with DTIC at dosages up to 100 mg per kg of extremity weight were well tolerated. The concentration of DTIC in the perfusate ranged from 70 to 400 micrograms/ml without evidence for formation of metabolites.

Fluorescence-histochemical and electron-microscopical investigations in melanoma patients after isolated cytostatic perfusion.

The effect of isolated cytostatic perfusion was determined in in-transit metastases from malignant melanomas at various times after therapy. Fluorescence-microscopically positive tumor cells (formalin-induced fluorescence) were regarded as viable and possibly capable of dividing. Most of the metastases examined showed fluorescent cells even after perfusion, and these were often found at characteristic sites within the metastases.

[Urticaria and "aspirin intolerance"--part of an interdisciplinary pathogenetic principle? (author's transl)].

Like the so-called "aspirin asthma", the aspirin-induced provocation of chronic urticaria is a symptom of the intolerance syndrome. This may also be induced by various other drugs, particularly by indomethacin and food additives. The intolerance syndromes of the "Aspirin type", however, must be assigned to the "anaphylactoid reactions" in man which also include the non-immunologic reactions to radiographic contrast media and colloids in blood substitutes.

Experimental investigations on the trigger mechanism of the generalized type of heat and cold urticaria by means of a climatic chamber.

The physical conditions of challenge were investigated in a climatic chamber on 8 patients with cholinergic urticaria and 10 patients with generalized cold urticaria. The cholinergic urticaria was induced by passive or active (physical exercise) heating and psychological stimulation; the generalized cold urticaria was induced by general cooling at rest and during physical effort. The ambient temperature was varied, and the mean body temperature was recorded continuously at different measuring points.

[Treatment of psoriasis vulgaris with external sulfur mustard gas with particular reference to its potential carcinogenic risk. III. Clinical and experimental studies on the extent of percutaneous and inhalational uptake of sulfur mustard gas].

Concerning the often discussed carcinogenic risk of psoriasis treatment with 0.005% S-mustard-vaseline (so-called Russian Ointment) -- especially by inhalation -- 19 patients were treated with a radioactive labeled S-mustard-ointment and examined. The patients' whole bodies were inuncted for 1--2 days with about 50 g of radioactive S-mustard vaseline (U14C, 3 muCi/g).

[Positive side-effects of antibiotic and antimicrobial drugs in therapy (author's transl)].

Since about 1950 especially, dermatologists world-wide have been utilizing the positive side-effects, discovered by chance, of all groups of antibiotic and antimicrobial drugs. These drugs are used to treat certain non-microbially induced dermatoses, without any knowledge of the mechanisms involved. A short history is given and the most important drugs and the indications for their use are described.