[Symposium: Pneumonia 2010 - state of the art]. / Symposium: Pneumonie 2010 - State of the Art.

Community-acquired pneumonia (CAP) is associated with significant morbidity and mortality. It ranks as the fourth leading cause of death in the Western industrialized countries. New insights in the epidemiology and pathogenesis, recent developments in diagnosis and risk-stratification, and current recommendations on prevention and therapy were presented at the symposium "Pneumonie 2010 - State of the Art", held in Kassel, Germany, on the 4. - 5. November 2010. This symposium was organized by the CAPNETZ STIFTUNG. More than 70 experts from medical research, academia, and industry participated. This report provides an overview of issues, insights, and conclusions that were discussed during the meeting.

Influenza vaccination is associated with reduced severity of community-acquired pneumonia.

Pneumonia is an important cause of influenza-associated morbidity and mortality. Influenza vaccination has been shown to reduce morbidity and mortality during influenza seasons. Protection from severe pneumonia may contribute to the beneficial effect of influenza vaccination. Therefore, we investigated the impact of prior influenza vaccination on disease severity and mortality in patients with community-acquired pneumonia (CAP). Analysis from an observational, multicentre cohort study initiated by the German competence network for CAP was performed. Patients were analysed separately as an influenza season and off-season cohort. Associations between vaccination status and outcome parameters were evaluated by multivariate analyses. In the season cohort (2,368 patients) CAP in vaccinated patients was significantly less severe according to most analysed parameters (CURB index ≥ 1: OR 0.76, 95% CI 0.60-0.98; procalcitonin ≥ 2.0 ng·mL(-1): OR 0.53, 95% CI 0.35-0.81; procalcitonin ≥ 0.5 ng·mL(-1): OR 0.71, 95% CI 0.51-0.99) and these patients showed a significantly better overall survival within the 6-month follow-up period (HR 0.63, 95% CI 0.45-0.89). Within the off-season cohort (2,632 patients) there was no significant influence of vaccination status on CAP severity or disease outcome. In conclusion, prior influenza vaccination was associated with less severe clinical course and improved overall long-term survival in patients with CAP during influenza seasons.

Positive effect of balneotherapy on post-PID symptoms.

OBJECTIVE: The aim of this study was investigation of effect of balneotherapy after antibiotic treatment of PID. PATIENTS AND INTERVENTIONS: Fifty-seven patients with PID, diagnosed by laparoscopy, were treated by the same antibiotic scheme (oxytetracycline and metronidazole). After treatment of the acute phase, we studied the effect of balneotherapy (mud baths or mud packs, mineral baths, electrotherapies, and gynecological exercises) under sanatorium conditions in 30 patients. Twenty-seven patients without balneotherapy served as a control group. Second-look laparoscopy with dye insufflation was carried out about 12 weeks after the first operation. RESULTS: The rate of tubal occlusion after balneotherapy was 31% vs. 28% in patients without balneotherapy (P > .05). Moderate or severe adhesions seen at first look were similar in both groups (40.7% vs. 46.7%) and were nearly unchanged during second-look laparoscopy (44.4% vs. 46.6%). Twelve of 27 (44.4%) control patients had subjective or objective complaints compared to only 2 of 30 (6.7%, P < .05). CONCLUSION: Although balneotherapy after antibiotic therapy for acute PID does not improve fallopian tube patency, it is useful to reduce the frequency of lower abdominal pain.

[Treatment of acute salpingitis with tetracycline/metronidazole with or without additional balneotherapy, Augmentin or ciprofloxacin/metronidazole: a second-look laparoscopy study]. / Zur Behandlung der akuten Salpingitis mit Tetracyclin/Metronidazol mit oder ohne zusätzliche Heilbadkur, Augmentan oder Ciprofloxacin/Metronidazol: Eine second look-Laparoskopie-Studie.

110 patients suffering from laparoscopical verified salpingitis and desire for a baby, were treated with tetracycline (oxytetracycline or doxycycline; TC)/metronidazole (n = 67), augmentan (n = 22) or cipropfloxacin/metronidazole (n = 21). After an average period of 11.6 weeks, all patients underwent second-look laparoscopy with dye insufflation. In 34 patients treated with TC/metronidazole, the effects of additional physio-therapeutical measures were examined under conditions as they prevail in a Spa. 33 patients without balneotherapy served as controls. All the 4 groups were comparable (p greater than 0.05) in respect of mean age, percentage, share of nulliparous women, salpingitis gonorrhoica, contraceptive behaviour and also of the stage of salpingitis. All antibiotic regimens used resulted in a prompt decrease of inflammatory clinical signs after five days (temperature, blood sedimentation rate, leukocytes). Only 2 of 34 patients treated by additional cure at a Spa reported complaints, whereas complaints were reported by 14 of 33 control patients (p less than 0.01), 7 of 22 (p less than 0.01) treated with augmentan and to 7 of 21 (p less than 0.01) treated with ciprofloxacin/metronidazole. The tubal occlusion rates amounted to 33.3% (TC/metronidazole), 32.3% (TC/metronidazole and balneotherapy), 22.7% (augmentan) and 23.8% ciprofloxacin/metronidazole. The differences did not attain statistical significance (p greater than 0.05). With regard to adhesions, there were, likewise, no significant differences between findings at first laparoscopy and second look-laparoscopy, respectively. It is concluded, that additional physiotherapeutic measures, after antibiotic therapy of acute salpingitis, reduce the frequency of lower abdominal pain, but do not result in an improvement of tubal occlusion and reduction of adhesions.(ABSTRACT TRUNCATED AT 250 WORDS)

[Infectious genital diseases and their significance in the development of cervix cancer and its precancerous conditions]. / Infektiöse Genitalerkrankungen und ihre Bedeutung bei der Entstehung des Zervixkarzinoms und seiner Vorstufen.

Basis of this trial are examinations of 100 Patients with colposcopic and/or cytologic suspicion for precancerous or early stages of cancer of the uterine Cervix and of 100 patients in the same age with normal cervical findings. Infections conditions vulvitis and condylomata acuminata could be found twice frequent in the cervical group in the control one. Significant differences could be calculated between the two groups with regard to bacterial infections of the vagina (60/22), bacterial vaginosis (54/38) and trichomoniasis (35/22). Sexual transmitted diseased are risk factors in the development of cervical cancer. Patients with those infections have to be supervised exactly.

[What is the role of cigarette smoking and various methods of contraception in the development of cervix cancer and its precancerous conditions?]. / Welche Rolle spielen "Zigarettenrauchen" und die verschiedenen kontrazeptiven Methoden bei der Entstehung des Zervixkarzinoms und seiner Vorstufen?

Basis of this trial are examinations of 100 patients with colposcopic and/or cytologic suspicion for precancerous or early stages of cancer of the uterine cervix and of 100 patients in the same age with normal cervical findings. The meaning discussed in literature about cigarette smoking as cofactor for developing cervical cancer and its prestages can be confirmed by our results. The portion of smoking patients with 74 per cent in the cervical groups was higher than in control group (42 per cent). Three times so much patients of the cervical group than in the controls smoked 20 cigarettes per day or more. More than 20 years smoking patients could be found only in the cervical group. 97 patients of the cervical group compared with 55 of the controls had been in the pill. Patients with cervical lesions on the average had been 3 years younger starting with hormonal contraception than the controls. The portion of pill users more than 10 years had been twice frequent in cervical group. The use of condoms was significantly more frequent in the control groups than in the cervical one (22/6). Therefore condoms are to be preferred be cause of protection against sexual transmitted diseases and indirectly cervical carcinom.

[The role of sexual activity in the development of precancerous and early stages of cervix cancer]. / Die Rolle der sexuellen Aktivität bei der Entstehung der Vor- und Frühstadien des Zervixkarzinoms.

100 women average age 30.7 years with colposcopic and/or cytologic suspicion on preinvasive or early invasive cervical carcinoma and 100 women in the same age and with normal cervical tissue as a control group have been compared with regard to their sexual activity. In this study risk factors are early onset of sexual activity combined with frequent change and insufficient sexual hygiene. These women should be screened intensively.

[Colposcopic, cyto- and histologic signs of papilloma virus infection in precancerous and early stages of cervix cancer]. / Kolposkopische, zyto- und histologische Zeichen einer Papillomvirusinfektion bei Vor- und Frühstadien des Zervixkarzinoms.

Basis of present study are examinations in 100 women with colposcopic and/or cytologic abnormalities suspect of preinvasive or early invasive carcinoma of the uterine cervix. We found 76 colposcopic abnormal findings in 100 women examined. In 36 women there was a colposcopic suspicion on a papilloma virus infection, in 32 cases combined with abnormal colposcopic findings. All 100 patients had cytologic smears group III and/or IV according to Papanicolaou. In 71 women cytologic signs of a papilloma virus infection was detected in the cervical smears. We found histologic signs of a papilloma virus infection in 69 cases in the specimen of biopsy, conization or hysterectomy (5 times condylomata acuminata, 53 times flat condylomata and 11 times inverted condylomata). Preinvasive respectively invasive and papillomavirus caused lesions of the cervix are coexisting in 59 cases. Our examination demonstrates that also in GDR in about 70 per cent of the precancerous or invasive cervical lesions signs of an infection with human papilloma viruses are present histologically and/or cytologically.

[Follow-up in cervix intra-epithelial neoplasia and condylomatous lesions of the uterine cervix]. / Verlaufskontrollen bei CIN und kondylomatösen Läsionen der Cervix uteri.

77 women with colposcopic and/or cytologic suspicious signs had been followed up 6 to 46 months. In 23 (44 per cent) out of 52 women with CIN we could observe progredience, in 19 (37 per cent) cases dysplasias and carcinoma in situ remained unchanged and in 10 (19 per cent) there was a regression. From 18 benign condylomatous lesions 8 were regredient and sones were progredient. Only in 1 out of 7 cases with benign lesions without papilloma virus infection a CIN II developed. Follow up of pregnant women demonstrated twofold more regredient findings compared with nonpregnant women. Follow up over a period of several years with colposcopic, cytologic and histologic examination in young women with CIn and childwish is possible without risk if definite management will be secured.

[Ultrastructural papilloma virus detection in precancerous and early stages of cervix cancer]. / Ultrastruktureller Papillomvirusnachweis bei Vor- und Frühstadien des Zervixkarzinoms.

100 women with pathologic findings in the uterine cervix are the basis of this study. To assess papilloma virus articles methods of electron microscopy have been used in specimens of 59 women if koilocytes were present. Inside the nucleus of koilocytes in 51 cases virus particles could be detected, in 31 cases isolated and in 20 cases agglomerated between the chromatin. In all 10 condylomas without nuclear atypia we could assess virus particles. With increasing atypia the detection of papilloma virus decreases.

[The incidence of borderline and pathologic findings in young females within the scope of gynecologic-cytologic screening studies]. / Zur Häufigkeit kontrollbedürftiger und pathologischer Befunde bei jungen Frauen im Rahmen gynäkologisch-zytologischer Vorsorgeuntersuchungen.

The frequency of Pap III-V findings in cytological screening examinations in Rostock-City was estimated for the age groups 16-20, 21-25 and 26-30 years. Two 3-year periods (1972-1974 and 1981-1983) were compared. A significant 9-fold increase of cytological results of Pap groups III-V was found during this time. Possible causes of this changing pattern, especially papillomavirus infections were discussed. In the age group 26-30 years there was the highest progression rate with almost 10%, in contrast to 1% in the age group 16-20 years. In the three investigated age groups a regression rate of 46% and a persistence rate of 38% were found. The results underline the increasing importance of gynecocytological screening examinations in young women.

[Detection of carcinoembryonic antigen (CEA) in cervico-vaginal irrigation fluids]. / Nachweis des carcinoembryonalen Antigens (CEA) in Zervikovaginalspülflüssigkeiten.

CEA estimations are effected in serum samples and in cervico vaginal fluids (n = 144) of patients with cervical condylomas, cytological undecided and cytological positive findings and in follow up performed histology. 21 healthy women were used as a control group. For taking cervico-vaginal fluids 5 ml isotonic NaCl solution were instilled in the fornix vaginae. After that 5 ml of the solution mixed with cervico vaginal fluids were aspirated. A polyclonal anti-CEA-antiserum was applied to radioimmunoassay. Remarkable high concentrations were found in cervico vaginal fluids compared with serum values. (Table: see text). In cases of cervical condylomas and cervical intraepithelial neoplasia significant increased CEA levels were determined in fluids compared with the control group. These results must be seen in consideration that the local CEA concentrations are scattered over a brand range. Regarding to CEA serum concentrations only slight increased values were found in cases of CIN I/II. (table; see text) Therefore CEA-serum estimations are not a diagnostic tool in CIN. The normal range of 10 micrograms/l was exceeded in only one sample of CIN II.

[Incidence, causes and follow-up of doubtful smear findings (Papanicolaou group III)]. / Häufigkeit, Ursachen und Verlauf zweifelhafter Abstrichbefunde (Gruppe Papanicolaou III).

Suspect smears of 622 patients from 1977-1986 were analysed for their causes and followed up until the definite cytologic or histologic result. In relation to the overall material of 97,963 cases the rate of suspect smears (group Pap. III) was between 1.18 and 0.27%, i.e. an average of 0.68%. The most frequent reasons for the classification "suspect" were inflammatory (42.4%), metaplastic or degenerative changes (16.1%) and doubtful pre-cancer (30.6%). 58% of all cases became negative under cytological control and antimicrobial therapy or hormonal substitution; of these 91.4% converted into negative within 6 months. The histological examination carried out on 230 patients revealed pre-cancer (CIN I-III) in 201 cases; cancer was proved in 5 cases. Compared to the whole population that is a rate of 33.1%. 24 cases were to be found negative. 139 Multiparae (67.6%) were to be found in the group of the 206 histological positive cases. 151 women (74%) had taken hormonal contraceptives. The rate of suspect smears should not exceed one per cent.

[Recurrence of choriocarcinoma following methotrexate monotherapy]. / Rezidiv eines Chorionkarzinomas nach Methotrexat-Monotherapie.

Clinical course, diagnosis and therapy of a recurrence of an intramural choriocarcinoma in a women of 26 years are explained. Primary treatment of the patient was only methotrexate. In addition to the clinical findings the results of the HCG determinations are important for the follow-up.

[Detection of human papillomavirus in a cervix precancerous condition. Initial report]. / HPV-Nachweis bei zervikaler Präkanzerose. Erste Mitteilung.

Case report of a 21 years old woman with cervical, vaginal and vulvar condyloma. We have demonstrated the presence of human papilloma viruses (HPV) with help of in-situ-hybridisation.

[Local treatment of cervical intraepithelial neoplasia with a 5 percent fluorouracil ointment]. / Lokale Behandlung der cervikalen intraepithelialen Neoplasie (CIN) mit einer 5%igen 5-Fluorourazil-Salbe.

The results of treatment of histologically proven cervical intraepithelial neoplasia (CIN) in 10 women are described. Two of them had CIN I and 8 CIN III. All patients had a application of 5 g 5 per cent 5-fluorouracil cream in a cervical cup daily over a period of 12 hours for one week. All 10 patients have been examined colposcopically, cytological and by biopsy following therapy. In 8 women cone biopsie were done 6-12 months afterwards for having a final diagnosis 2 patients having CIN I pretherapeutically were follow up for 16 months with cytology, colposcopy and punch biopsy. In 6 cases we found better findings (Twice complete healing, twice only CIN I and twice CIN II as residues). In 4 cases severe dysplasia and carcinoma in situ could be found in endocervix. Based on these results were recommended more (not only one) treatment cycles for local efficient chemotherapy using 5 per cent 5-fluorouracil cream.

[Bacterial vaginitis within the scope of gynecologic consultation]. / Untersuchungen zur Frage der Bakteriellen Vaginose im Rahmen einer gynäkologischen Sprechstunde.

Examinations about bacterial vaginosis have been done in 384 fertile women according the following diagnostic criteria: Homogenous gray flour, typical fish smelling, clue cells and pH of 5 in vaginal content. Clue cells could be detected in 233 (60.6 per cent) women. Bacterial vaginosis with three of the above mentioned criteria could be found in 40.4 per cent. The cure rate following oral metronidazole therapy (twice daily 500 mg metronidazole for 5 days) was 75.2 per cent. In cases with therapy failure or frequent recurrences treatment of sexual partners is indicated, because bacterial vaginosis is a sexually transmitted disease.

[Vulvar cancer originating from pointed condylomas--case report]. / Vulvakarzinom aus spitzen Kondylomen hervorgegangen--Falldemonstration.

A vulvar cancer is demonstrated. Its origin from condylomata acuminata is discussed. The ultrastructural evidence of papillomavirusparticles within the nucleus of koilocytes are hints at a possible human papillomavirus etiology of vulvar carcinoma. Because of the malign transformation of condylomata acuminata described we recommend a consequent treatment and histologic examination of condylomata acuminata.