Die ungarische Uralistik an der Jahrtausendwende (ein kritischer Rückblick)

Abstract

Intrathecal drug delivery systems for cancer pain

Introduction: A substantial number of patients with cancer suffer considerable pain at some point during their disease, and approximately 25% of cancer patients die in pain. In cases of uncontrolled pain or intolerable side effects, intrathecal drug delivery system (IDDS) is a recognised management option. Indeed, IDDS offer rapid and effective pain relief with less drug side effects compared to oral or parenteral administration. The aim of this study is to retrospectively review our series of cancer patients treated with IDDS. Method: Data was extracted from the institutional neuromodulation registry. Patients with cancer pain treated with IDDS from 01.01.1997 to 30.12.2009 were analysed for subjective improvement, changes in pain intensity (VAS) and survival time after implantation. Measurements were available for a decreasing number of patients as time since baseline increased. Results: During the studied period, 78 patients were implanted with IDDS for cancer pain. The mean survival time was 11.1 months (median: 3.8 months) and 14 patients (18%) were still alive at the end of the studied period. Subjective improvement was graded between 55 and 83% during the first year. Mean VAS during the first year remained lower than VAS at baseline. Discussion: IDDS has been shown to be cost-effective in several studies. Although initial costs of implantation are high, the cost benefits favour analgesia with implanted intrathecal pumps over epidural external systems after 3 to 6 months in cancer patients. Improved survival has been associated with IDDS and in this series both the mean and median survival times were above the cut-off value of three months. The mean subjective improvement was above 50% during the whole first year, suggesting a good efficacy of the treatment, a finding that is consistent with the results from other groups. Changes in pain intensity are difficult to interpret in the context of rapidly progressive disease such as in terminal cancer. However, mean VAS from 1 thru12 months were lower than baseline, suggesting improved pain control with IDDS, or at least a stabilisation of the pain symptoms. Conclusion: Our retrospective series suggests IDDS is effective in intractable cancer pain and we believe it should be considered even in terminally ill patients with limited life expectancies.

Die Schweizer Gemeinden im Wandel : politische Institutionen und lokale Politik

Seit 1988 finden in regelmässigen Abständen gesamtschweizerische Gemeindeschreiberbefragungen statt. In dieser Studie werden die Ergebnisse der Erhebung 2005 vorgestellt. Im Zentrum stehen dabei die Ausgestaltung der politischen Systeme der Gemeinden und verschiedene Aspekte der lokalen Politik. Es zeigt sich, dass die grossen Unterschiede hinsichtlich der politischen Organisation der Gemeinden auch in Zukunft kaum kleiner werden dürften. Es lässt sich keine, alle anderen überragende Organisationsform ausmachen. Vor allem in den kleineren Gemeinden ist die Bedeutung der politischen Parteien in den letzten Jahren stark zurückgegangen. Dies könnte dazu führen, dass ein neuer Pragmatismus Einzug in die Lokalpolitik nimmt. Depuis 1988 et par la suite à des intervalles réguliers, des enquêtes auprès des secrétaires municipaux de la Suisse ont eu lieu. Cette étude présente les résultats de l'enquête 2005 et se focalise sur l'organisation politico-administrative des communes ainsi que sur différents aspects de la politique locale. En ce qui concerne l'organisation des communes, nous pouvons constater que de grandes différences entre les municipalités persistent : aucune forme organisationnelle ne prime sur les autres. Par rapport aux partis politiques, leur importance a fortement reculé surtout dans les petites communes. Un nouveau pragmatisme pourrait ainsi marquer la politique locale à venir.