[Complementary therapy in palliative medicine]

Even in the palliative context complementary therapy has a high value for patients and their relatives. In contrast to the methods of conventional medicine naturopathy as a holistic system has positive meanings for patients and their family. Complementary medicine in the palliative setting can be used as a supportive therapy in carefully selected cases. Doctors and patients should be careful regarding effect and side effects and should make sure that supportive therapy is given adequately and in effective doses. Complementary therapy should not be used in order to avoid the question of life and death. An adequate approach to the topic is mandatory, which acknowledges the needs of patients but also looks for their safety. Patients following alternative therapies sometimes neglect helpful therapeutic options. Carefully providing information on these therapies is mandatory. Physicians should avoid losing patients' confidence in their competence and attention in their final course of disease. Also in palliative medicine a sensitive approach to the topic of complementary medicine is mandatory, which accounts for the eligible wishes of patients and their relatives but puts the patients safety first.

[Lymphedema in patients with breast cancer--a consensus regarding diagnostics and therapy in patients with postoperative lymphedema after primary breast cancer]

Secondary lymphedema is one of the most frequent long-term side effects affecting up to 30% of all breast cancer patients after local surgical and radiation treatment. Destruction of the lymphatic system causes a progressive and chronic condition with functional impairments and disabilities limiting patients in their daily activities and involving nearly all aspects of their quality of life. Also, problems in the occupational area may be caused by lymphedema. The need for improving oncological management for early diagnosis and referral for effective treatment of lymphedema is a major goal of breast cancer heath care while survival improves.

METHOD

A systematic consensus process was performed involving all relevant partners and providers of lymphedema health care to develop a practical documentation concept and make recommendations according to the evidence of clinical studies and currently available guidelines.

RESULTS

A practical concept of documentation with defined assessment points was developed for evaluation and monitoring of lymphedema, which included the assessment of quality of life parameters with recognised instruments by the patient themselves. Consensus recommendations for the postoperative management, prevention, treatment and follow-up of breast cancer patients along a clinical algorithm for in- and outpatient care were finalized.

CONCLUSION

With improved survival, long-term side effects with major impact on quality of life become a most important end point criteria of oncological treatment. The clearly defined documentation concept and the comprehensive recommendations for lymphedema management may assist clinicians and patients to make timely decisions about in- and outpatient health care practice to optimize the interface between acute medicine and rehabilitation. Patients' compliance with treatment and prevention routines will be as important as ensuring the continuity of care. A longitudinal prospective study evaluating the effectiveness and efficacy of the consensus recommendation is currently being implemented.

Spin noise spectroscopy in semiconductors

Spin noise spectroscopy in semiconductors is an optical method that allows nearly perturbation free measurements of the spin dynamics of electrons in thermal equilibrium. The article explains the basic principles of spin noise spectroscopy and introduces an optimized experimental setup which promotes spin noise spectroscopy to an extraordinary sensitive tool. Exemplary measurements on n-doped bulk GaAs yield the temperature dependence of the electron spin relaxation time and the electron Landé g factor and reveal a dependence of the spin relaxation time on the laser probe wavelength. The magnitude and wavelength dependence of the measured spin noise signal compares well to basic calculations.

Eye movement abnormalities in spinocerebellar ataxia type 17 (SCA17)

BACKGROUND

Spinocerebellar ataxia type 17 (SCA17) is associated with an expansion of CAG/CAA trinucleotide repeats in the gene encoding the TATA-binding protein. In this quantitative characterization of eye movements in SCA17 mutation carriers, we investigated whether eye movement abnormalities originate from multiple lesion sites as suggested by their phenotypic heterogeneity.

METHODS

Eye movements (saccades, smooth pursuit) of 15 SCA17 mutation carriers (mean age 36.9 years, range 20 to 54 years; mean disease duration 7.3 years, range 0 to 20 years; 2 clinically unaffected, 13 affected) were compared with 15 age-matched control subjects using the video-based two-dimensional EYELINK II system.

RESULTS

Smooth pursuit initiation (step-ramp paradigm) and maintenance were strongly impaired, i.e., pursuit latency was increased and acceleration decreased, whereas latency and position error of the first catch-up saccade were normal. Visually guided saccades were hypometric but had normal velocities. Gaze-evoked nystagmus was found in one-third of the mutation carriers, including downbeat and rebound nystagmus. There was a pathologic increase in error rates of antisaccades (52%) and memory-guided saccades (42%). Oculomotor disorders were not correlated with repeat length. Smooth pursuit impairment and saccadic disorders increased with disease duration.

CONCLUSIONS

Several oculomotor deficits of spinocerebellar ataxia type 17 (SCA17) mutation carriers are compatible with cerebellar degeneration. This is consistent with histopathologic and imaging (morphometric) data. In contrast, increased error rates in antisaccades and memory-guided saccades point to a deficient frontal inhibition of reflexive movements, which is probably best explained by cortical dysfunction and may be related to other phenotypic SCA17 signs, e.g., dementia and parkinsonism.

[Recommendations for the post-procedure care of cervical carcinoma]

Post-procedure care for cervical carcinoma patients has an impact on not only survival, but also on the quality of life. After surgery, infections, seroma and lymphocysts are of immediate concern. In contrast, urethral strictures first develop after weeks or months. Chronic sequelae of surgical or radiation therapy include lymphatic oedema, problems during sexual intercourse, bladder disorders, fistula, cystitis, urethral stenosis and also fatigue syndrome and menopausal symptoms. In addition to medical care, psychooncological support is an important component of post-procedure care.

Ultrafast deflection of spatial solitons in AlxGa(1-x)As slab waveguides

We demonstrate ultrafast all-optical deflection of spatial solitons in an AlxGa(1-x)As slab waveguide, using 190 fs, 1550 nm pulses to generate and deflect the spatial soliton. The steering beam is focused onto the top of the waveguide near the soliton pathway, and the soliton is steered by refractive-index changes induced by optical Kerr, or free-carrier (Drude), effects. Angular deflections up to 8 mrad are observed.

Design and evaluation of novel blood incubation systems for in vitro hemocompatibility assessment of planar solid surfaces

Success in the development of hemocompatible biomaterials depends on adequate equipment and procedures for standardized analysis of blood-materials interactions in vitro. In view of the limited standard of knowledge on that important aspect, two novel incubation systems were designed, built, and evaluated for the in vitro assessment of the hemocompatibility of planar solid surfaces: A screening setup was introduced for the comparison of up to 12 different samples. A perfusion setup was developed to model the directed blood flow in the vascular system during incubation by a recirculation circuit, allowing the variation of the wall shear rate at the sample surface. The incubation procedures utilized freshly drawn, heparinized whole human blood. Hemocompatibility in terms of selected aspects of coagulation, thrombogenicity, and immune responses was quantified through plasma levels of characteristic molecules (immunoassays), cell counting, and analysis of adherent cells and fibrin formation (scanning electron microscopy), respectively. Prevention of blood-air contact and mechanical stress, constant temperature and blood pH during incubation, and the suitable choice of reference materials were found to be crucial for reliable testing. Considering those requirements, screening and perfusion system both provided sensitive discrimination between a given set of planar solid surfaces. In conclusion, the suggested methods for an in vitro hemocompatibility assessment permit versatile, sensitive, and efficient analysis of important blood-material interactions despite the unavoidable variability of blood characteristics in different experiments.

Direct observation of optically injected spin-polarized currents in semiconductors

Quantum interference of one- and two-photon excitation of unbiased semiconductors yields ballistic currents of carriers. The magnitudes and directions of the currents and the spin orientations of the carriers are controlled by the polarization and relative phase of the exciting femtosecond laser fields. We provide direct experimental evidence for the spin polarization of the optically injected spin currents by detecting a phase-dependent spatial shift of the circularly polarized photoluminescence in cubic ZnSe.