R. Gross - Böcker

Das Gugginger Modell einer sozialpsychiatrischen Versorgungsstruktur, welches Alois Marksteiner in die Wege geleitet hat, bietet günstige Voraussetzungen für eine längerfristige Arbeit mit psychiatrischen Patienten. Das Modell sieht eine Organisation in Sektorteams vor, mit den zentralen Institutionen des Sektorarztes und des Sektorsozialarbeiters, die für die stationäre Behandlung der Patienten ihres Sektors und auch für deren ambulante Nachbetreuung zuständig sind. Den Patienten bietet dies eine kontinuierliche Behandlung über längere Zeit und Krisensituationen hinweg, ermöglicht andererseits den Betreuern, Phasen der Wechselbeziehungen mit ihren Patienten über einen längeren Zeitraum zu erleben und zu bearbeiten. - Eine faszinierende Aufgabe und anstrengende Arbeit zugleich.

Held at Boppard, Germany, October 3-6, 1984

E. GRUNDMANN The question as to whether cytostatic drugs might be carcinogenic has been presented and discussed in three experimental studies. The most extensive in- vestigations were by J. H. WEISBURGER and coll. (New York, Alabama, Bethesda). They started with an exact determination of rate and localization for spon- . taneous tumors in their animal strains. Thirteen cytostatic compounds current- ly in clinical use were then given in the maximally tolerated dose (MTD) to groups of 25 male and 25 female animals (rats and mice) three times weekly, in most assays over a period of 6 months. Other identical groups of animals received 0. 5 of the MTD. Each test involved 50 male and 50 female mice and the same number of rats. As positive controls, identical groups were given diethylnitrosamine, which induced tumors of liver, lungs and kidneys in the expected rates. The direct alkylating agents (Actinomycin 0, Melphalan, Mito- mycin 0, Uracil mustard, Dibromomannitol and Dibromodulcitol) induced cancer in the peritoneal cavity, the site of the injections. Rats appeared to be more susceptible than mice. Other drugs (e. g. the cyclohexamide salt of phos- phorodiamidic acid derivative, Natulan, DIC and streptozotocin) had a broad spectrum of carcinogenicity affecting a variety of organs.Several agents led to tumors in the hematopoietic and lymphatic systems in mice or rats or both. The correlation to the general immunosuppressive action is not quite clear. 6-Mercaptopurine induces lymphosarcomas in mice.

Our present knowledge in the fields of both experimental and clinical hematology has rapidly progressed because of the complementary aspect one offers the other. In light of the above, basic research is a prerequisite for both diagnostic and therapeutic advances. Thus it would seem justified to review the pathogenesis of hemoblastoses and the experiences resulting from those animal experiments which are trans- ferable to human conditions. The association of Epstein-Barr virus infection with Burkitt's lymphoma appeared to be a model for the viral etiology of human neoplasias, the subject of many decades discussion. Although there is evidence for the correlation, the exact role of the virus in the etiology of the disease still remains to be clarified. In public, attention has been focused on the induc- tion of neoplasia by environmental factors. For the hema- tologist the induction ofhemoblastoses by immunosuppressive and cytostatic drugs gains increasing significance as a result of the wider use of these agents - not only cytotoxic cancer therapy, but also in treating autoimmune diseases and in managing transplantation problems.Physiology of the human stem cell has been intensively studied, and the presently available in vitro tests are of clinical use and enable greater understanding of pathophysiology, especially that of aplastic anemias and leukemias. Immunologic and biochemical mark- ers have been of value in leukemias and malignant lym- phomas, both as diagnostic tools and as prognostic parameters.