Haut- und Schleimhautinfektionen bei Immunsuppression

The skin has several physical, chemical and immunological properties which help to protect the internal organs. In addition, there is a physiological colonisation of commensal microbes which help to suppress the expansion of pathogenic germs on the skin. Genetic or acquired immunodeficiency will have an impact to these factors. Drug induced immunodeficiency is common in organ transplanted patients with the aim to prevent organ rejection. HIV infection most commonly leads without therapy to marked immune suppression. Such patients with prolonged immunodeficiency often develop atypical manifestation of mucocutaneous infections. Therefore such patients should be biopsied liberally and besides the conventional histology a part of the biopsied tissue should be used for microbiological cultures. In addition to acute infections of the skin, long-term effects of oncogenic viruses have to be taken in account which can lead to epithelial cancers (HPV), Kaposi sarcomas (HHV8) and lymphomas (EBV). There are mucocutaneous markers for immunosuppression such as oral hairy leukoplakia, which are commonly seen in AIDS patients but may also be observed in otherwise chronically immune suppressed patients. This work gives an overview to the pathophysiology of skin protection and describes typical mucocutaneous infections in immune suppressed patients.     

Schwere Haut- und Weichgewebsinfektionen

Skin and soft tissue infections are common and account for 10% of all cases of severe sepsis. Complicated infections are defined as involving deeper layers of soft tissue, requiring substantial surgical intervention or occurring in an immunocompromised host. Distinguishing characteristics include the etiological agents, clinical presentation, depth of invasion, and local and systemic progression. Necrotizing soft tissue infections comprise a group of extremely aggressive diseases with an almost uniform diagnostic and therapeutic approach. Following a short diagnostic course, the affected patients need urgent and radical debridement and redebridement in order to achieve source control. Surgical treatment is accompanied by simultaneous application of broad spectrum antibiotics and management of septic complications in an intensive care unit. The overall mortality is about 30%. Only an aggressive approach can save the patient’s life and limb.     

Haut- und Schleimhauttyp des Plattenepithelcarcinoms der oberen Luft- und Speisewege; ihre Beziehungen zur Strahlenempfindlichkeit

Ohne ZusammenfassungMit 6 Textabbildungen.Dissertation der Universität Zürich.     

Screening auf Typ-2-Diabetes

Background

The National Plan for Action on Diabetes proposed screening for impaired glucose tolerance (IGT) using an oral glucose tolerance test (oGTT) as IGT is associated with increased total mortality. Approximately 7?% of the population in Germany has undiagnosed diabetes and IGT.

Aim

The study aimed at investigating whether recognition of this“hidden group” with IGT is of benefit to those affected, whether the oGTT is suitable for this purpose, whether general oGTT screening can cause secondary problems and what alternative strategies could be used for identification of affected persons.

Material and method

A selective search on diabetes screening and test characteristics as well on the predictive power of the oral glucose tolerance test was carried out.

Results

The evidence for the benefits of diabetes and IGT screening regarding mortality and cardiovascular morbidity is inconclusive. Interventions concerning IGT could only show a delay in the occurrence of manifest diabetes. An advantage of screening compared to case finding could not be found. The reliability and validity of the oGTT are poor. The oGGT is of little relevance in general practice because of the high proportion of false positive findings and subsequent lack of resulting changes in lifestyle.

Conclusion

False positive findings in oGTT count as negative side effects of an intervention in the life of actually healthy people. Negative findings in the test can give rise to a motivation for an unhealthy lifestyle.     

Stress und Burnout auf Intensivstationen

Occupational stress is a well-known phenomenon in ICUs; in fact, a relatively high percentage of intensivists and intensive care nurses lose the ability to recover. Personal, relational, and institutonal conditions can lead to burnout. The establishment of Heavy Case Conferences as a communication forum in the ICU is a readily accepted instrument for team development and supervision.