Weichteilemphysem ungewöhnlichen Ausmaßes

Streptococcus agalactiae, known as a pathogen that causes meningitis and septicemia in neonates, emerges as an invasive organism in nonpregnant adults. This case report describes the fulminant course of a necrotizing fasciitis (NF) with streptococcal toxic shock-like syndrome (STSS) in a 76-year-old diabetic patient caused by S. agalactiae, serotype V. Chronic diseases and immunodeficiency are considered to be risk factors for the acquisition of group B streptococcal disease. Since early surgical treatment in conjunction with antimicrobial and intensive care therapy is critical for the outcome of patients with NF and/or STSS, clinicians should be aware of invasive S. agalactiae infections in adults with subcutaneous emphysema.     

Fas and Fas-ligand are expressed in the uteroplacental unit of first-trimester pregnancy

PROBLEM: Fas and Fas-ligand (FasL) are thought to provide a strategy for reducing graft rejection in immunologically 'privileged' tissues by controlling injurious lymphocyte reactions. As the uteroplacental unit is often defined as an immune-privileged site, we investigated the expression of Fas and FasL in this tissue in the first trimester of pregnancy. METHOD OF STUDY: Western blotting, immunohistochemistry, and double immunofluorescence were used for this examination. RESULTS: Western blotting with purified first-trimester trophoblast cells revealed one specific band for FasL. The presence of FasL on different trophoblast populations could be confirmed by immunohistochemistry and double immunofluorescence. In the villous part of the placenta, FasL is mostly located on cytotrophoblast cells with no access to maternal blood flow, whereas in trophoblast-invaded uterine tissue, interstitial trophoblast cells, which are in close contact with maternal leukocytes, revealed a strong signal for FasL, but no staining for Fas on these cells. However, Fas was found on CD45+ maternal leukocytes. CONCLUSION: Based on our experimental findings, we speculate that the abundant presence of FasL on trophoblast cells within the maternal decidua may play an important role in the maintenance of immune privilege in the pregnant uterus by endowing fetal trophoblast cells with a defense mechanism against activated maternal leukocytes, whereas in the villous part of the placenta, the Fas FasL system seems to be involved in the regulation of placental growth.     

Double traumatic abdominal wall hernia and colon laceration due to a pelvic fracture

A traumatic abdominal wall hernia was observed in association with a colonic laceration due to a pelvic fracture. The presence of this specific combination of injuries is a rare clinical entity. CT evaluation with intravenous and bowel contrast media identified the traumatic abdominal wall hernia and the bowel entrapment.     

Pathologische Anatomie (Sektionstechnik) und Physiologie

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Leichenerscheinungen

Ohne Zusammenfassung     

Entwicklungen und Perspektiven der Notfallpflege in Deutschland

Background

During the last few years, emergency care has moved into the center of educational and political interest. Reinforced by the Krankenhausstrukturgesetz (KHSG), which focuses on strengthening the nursing profession and on improving emergency care, there are many efforts to recognize emergency care as an independent specialty.

Results

The DGINA recommendation for specialist training in emergency care is based on the number of hours recommended by the DKG for nursing training. The number of hours required in the Charité curriculum is similar. Two German states have continuing education programs in the area of emergency care that are legally recognized, but with greatly reduced hours. Moreover, emergency medical technicians (Notfallsanitäter) and academically qualified graduates represent new professional groups in the emergency room.

Conclusions

Many of the latest developments reinforce the professionalization of emergency care. The federal structures in the field of education and policy and the lack of superordinate care structures are a disincentive with regard to professionalization. A consensus catalog of learning objectives must be developed. Care-relevant quality indicators must be defined to reflect the quality of emergency care.