Psoriasis confined strictly to vitiligo areas – a Koebner‐like phenomenon?

Vitiligo and psoriasis are both common skin disorders. However, psoriasis strictly confined to pre-existing vitiligo areas is rare and suggests a causal relationship. We report here on two patients with a strict anatomical colocalization of vitiligo and psoriasis. The histopathological examinations showed typical changes for both diseases together with a dense infiltrate of CD4+ and CD8+ T cells. By immunohistochemistry, intracytoplasmatic granzyme B and tumour necrosis factor alpha (TNF-alpha) were detected within the T-cell population, suggesting the functional activity of these cells and the creation of a local T helper 1 (Th1)-cytokine milieu. Additionally, in one patient we could identify anti-melanocytic T cells by tetramer staining and enzyme-linked immunospot (ELISPOT) analysis. These skin-infiltrating lymphocytes might trigger, by the local production of Th-1 cytokines such as TNF-alpha and interferon-gamma (IFN-gamma), the eruption of psoriatic plaques in patients with a genetic predisposition for psoriasis.     

Spezifische Immuntherapie

Ohne Zusammenfassung     

Aktualisierte Kurzfassung der Leitlinien zur Pr?vention, Diagnostik und Therapie der nosokomial erworbenen Pneumonie

Hintergrund:  

Die nosokomiale Pneumonie gehört zu den häufigsten nosokomialen Infektionen und ist die häufigste auf der Intensivstation. Die nosokomiale Pneumonie ist mit einer signifikanten Mortalität und Morbidität assoziiert, und ihr Auftreten verschlechtert die Prognose des Patienten deutlich. Nach der Definition der DRGs auch im deutschen Krankenhaussystem ist die nosokomiale Pneumonie überwiegend Sache des Krankenhauses und kann somit nicht nur das Ergebnis der Patientenbehandlung, sondern auch das finanzielle Ergebnis des Krankenhauses beeinträchtigen.     

Tubal manometry: the question of normal values, values in chronic mesotympanic purulent middle ear infections

We investigated tubal function by equalization manometry in 68 patients with unilateral traumatic perforation of the tympanic membrane, and in 116 patients with chronic mesotympanic suppuration (85 dry and 31 discharging ears). Our criterion of normal tubal function is the ability to equalize a difference in pressure of +/- 30 hPa by means of at most 7 swallowings. This result was achieved in only 25% of the dry perforations and in none of the patients with discharging ears. Normal tubal function may only be expected in 25% of patients with chronic otitis media.     

Intraoperative radiotherapy (IORT) is an option for patients with localized breast recurrences after previous external-beam radiotherapy

Background  

For patients suffering of recurrent breast cancer within the irradiated breast, generally mastectomy is recommended. The normal tissue tolerance does not permit a second full-dose course of radiotherapy to the entire breast after a second breast-conserving surgery (BCS). A novel option is to treat these patients with partial breast irradiation (PBI). This approach is based on the hypothesis that re-irradiation of a limited volume will be effective and result in an acceptable frequency of side effects. The following report presents a single center experience with intraoperative radiotherapy (IORT) during excision of recurrent breast cancer in the previously irradiated breast.     

Coagulation alterations due to local fibrinolytic therapy with recombinant tissue-type plasminogen activator (rt-PA) in patients with peripheral arterial occlusive disease

Purpose To determine the systemic effects of local fibrinolytic therapy with low-dose recombinant tissue-type plasminogen activator (rt-PA). Methods Ten patients received intrathrombal infusion of 20 mg rt-PA and heparin for local thrombolysis and had subsequent percutaneous transluminal angioplasty (PTA). Eight controls underwent PTA and received heparin alone. We measured t-PA, D-Dimer, and fibrinogen levels before, directly after, and 20, 40, and 60 min and 24 hr after therapy. Results In the thrombolysis group the t-PA level peaked immediately after infusion and then declined within 1 hr. D-Dimer increased and remained elevated, whereas in the control group only t-PA levels increased, and only after 24 hr. Fibrinogen remained within the normal range in both groups. Eight of ten patients in the thrombolysis group and seven of eight with PTA had clinical improvement after the procedure. Conclusions The increase in D-Dimer in the rt-PA group indicates a good local fibrinolytic effect. The fact that fibrinogen levels remained unchanged indicates that there is a lack of systemic fibrinogenolysis.