[Stage classification of non-Hodgkin's lymphoma].
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Biomedical subjects
Publications and source records attributed to R Ihle.
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International cooperative clinical trials require a multilingual quality of life questionnaire. The 'International Society for Chemo- and Immunotherapy' therefore designed a study to develop and test a 'health accentuated' quality of life questionnaire in the eight languages spoken in this society. The objective was to examine practicability, reliability and interlingual homogeneity. Versions of the questionnaire in Czech, German, Hungarian, Italian, Kroatian, Polish, Romanian and Slovakian have been prepared. The results are based on data of 1,104 adult patients. They demonstrate that the developed questionnaire is practicable. Patients need 10-15 min to answer it, usually without assistance. The proportion of missing values is for all but two questions less than 3%. The questionnaire also found high acceptance reflected by only 2.7% refusals. It is reasonably reliable in each language. Interlingual homogeneity could be shown by demonstration of strong structural similarities between the different versions using multidimensional scaling, factor analysis and comparison of mean profiles.
Within the diagnostics of lymphoma the indication for cytodiagnosis and the coice of gaining material and its preparation (punction and exstirpation of lymph nodes with making smears in a squeezing manner to effect simulated tissue pattern) are the basis of an appropriate and effective work of the cytologist. The good diagnostic efficiency of the cytodiagnosis of lymph nodes is in no proportion to the totally insufficient application of those methods by physicians of various medical disciplines in the hospitals and outpatient departments. The lack of an adequate teaching of students and postgraduates is a main reason for the described situation. In order that each physician may have the possibility to apply the cytodiagnosis of lymph nodes within his diagnostic programms, some special references are given for the gaining and preparation of lymph node material.
In non-secernent plasmocytomas there are no characteristic changes of serum protein. Diagnostic difficulties may be overcome by cytomorphological examinations, immunofluorescence and electron microscopy. By referring to 4 own observations the value of the electron microscopic characteristics of plasma cells is demonstrated. Subtile investigations in protein diagnostics are required for avoiding incomplete monoclonal immunoglobulins which may greatly enter the kidneys to be overlooked. Generally the prognosis of non-secernent plasmocytomas is not worse than that of other forms.
In a survey the definition of the notions insufficiency of the bone marrow, panmyelopathy, panmyelophthisis and aplastic anaemia, the subdivision into congenital and acquired forms as well as to the clinical course, the epidemiologic situation as well as the distribution according to age and sex are described. More in detail the author enters the etiological factors, in which cases the etiological classification of the individual case may be connected with considerable difficulties. Exogenic noxae are subdivided into factors dependent on dose and independent on dose as pathogenetic principles. In this connection professional noxious substances as well as unwished side-effects of medicaments are discussed more in detail. Despite all variety the possibilities of therapy are limited.
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In the diagnosis of Hodgkin's disease the histological investigation of the spleen, liver and abdominal lymph nodes in connection with exploratory laparotomy are necessary for staging and planning the therapy.
The functional tests in form of tolerance tests allow an insight into the adaptibility of the organism to changed inner and outer conditions. The majority of haematological functional tests demands a temporary and economic expediture which excludes it a priori as screening test. According to a previously published phase program for the haematological functional diagnosis a report is given on simple methods for judging the disturbed partial functions of the blood.
A survey is given on the value of the haematologo-morphological examination methods, especially the differential counting of leucocytes, the smear of a concentrate of leucocytes and the cytomorphological judgment of the bone marrow. None of these methods is suitable for the search for cases in the sense of a preliminary diagnosis. This is also of importance especially for the differential counting of leucocytes. However, with aimed methods of proceeding these methods are of great diagnostic value, so that they may be very much in front in a graduated diagnostic program. The diagnostic evidence of a cytomorphological preparation of the bone marrow must highly be estimated concerning a situation of deficiency of iron, a diffuse or small nodular metastasizing of the bone marrow or lesion of the bone marrow by exogenic factors.