[Wound treatment in diabetes patients and diabetic foot ulcers]. / Wundbehandlung bei Diabetes und diabetischem Fußulkus.

Diabetes mellitus (DM) is a paramount and rising medical challenge in both industrial and emerging nations. For Germany, 6.9 million out of 64.9 million insured persons in 2010 were reported to suffer from DM and approximately 5.8 million suffered from type 2 DM. The prevalence of diabetic foot ulcer (DFU) or diabetic foot syndrome (DFS) is 2-10% and the incidence is 2-6%. In addition, patients with DM present associated skin disorders with chronic wound healing, e.g., pyoderma gangrenosum or lecrobiosis lipoidica. Knowledge of the pathogenesis and skills for treatment of chronic wounds in diabetic patients are important for dermatologists. Patients with diabetes and wound healing disorders and accompanied unspecific skin disorders like eczema, cellulitis or contact dermatitis are often primarily or secondarily treated by dermatologists. In this article, practical hints for the treatment of DFS and other chronic wound in patients with DM are presented.

["Baby cradle coop slots" for abandoned (anonymous) babies: legal problems]. / Rechtsprobleme von Babyklappen und anonymen Geburten.

It is illegal to propagate or offer anonymous births or to "cradle" abandoned babies in anonymous coop slots ("Babyklappen" in German). Such offers must be rescinded. Offers concerning anonymity of births are ill-suited, since they do not save life. They are unnecessary, because women and children can be assisted even if they are in dire straits, by utilising available help as offered by statutory German child and adolescent aid institutions. Those illegal offers do not solve any problems but create new difficulties and result in lifelong misery for children and parents. Offers for anonymousness create a previously non-existent demand and discredit legal help facilities. Persons assisting anonymous deliveries or recovering "baby cradle" ("Babyklappen") children are obliged to report this to the local registrar's office (in hospitals by the hospital director). Anonymous babies must be immediately reported by hospitals or institutions to local police authorities, and they should be reported to the municipal Youth Office.

Rituximab therapy of patients with B-cell chronic lymphocytic leukemia.

Rituximab (IDEC-C2B8) is a chimeric antibody that binds to the B-cell surface antigen CD20. Rituximab has significant activity in follicular non-Hodgkin lymphomas. Much less is known about the effects in chronic lymphocytic leukemia (CLL). We have initiated a phase II trial to evaluate the efficacy and safety of rituximab in patients with CD20+ pretreated CLL. To avoid the rituximab-associated toxicity, we restricted the tumor cell load, as measured by the number of circulating lymphocytes and the spleen size, in the first 2 cohorts of patients included in the study. Patients received 4 intravenous infusions of 375 mg/m2 once a week over a period of 1 month. Of the 28 patients evaluable for response, 7 patients showed a partial remission (National Cancer Institute criteria) lasting for a median of 20 weeks, with 1 patient still in remission after 71 weeks. Based on lymphocyte counts only, we found at least a 50% reduction of lymphocyte counts lasting for at least 4 weeks in 13 (45%) of 29 patients. Fifteen patients from 3 institutions were monitored for the immunophenotype profile of lymphocyte subsets. The number of CD5+CD20+ cells decreased significantly and remained low until day 28 after therapy. T-cell counts were not affected. With the exception of one rituximab-related death, adverse events in the remaining patients were mild. The results suggest that rituximab has clinical activity in pretreated patients with B-CLL. Toxicity is tolerable. Response duration after withdrawal of rituximab is rather short. Therefore, other modes of application and the combination with other agents need to be tested.

[Diagnostic value of the tumor markers TPA-M, CYPFRA 21-1 and CEA in pleural effusion. Prospective comparison of thoracoscopic investigations in patients with pleural effusion]. / Diagnostischer Wert der Tumormarker TPA-M, CYFRA 21-1 und CEA bei Pleuraergüssen. Prospektiver Vergleich bei thorakoskopisch untersuchten Patienten mit Pleuaerguss.

The diagnostic value of tumour markers in pleural effusion is not yet clearly defined. CEA (Carcinoembryonic Antigen), CYFRA 21-1 (Cytokeratin 19-Fragment) and TPA-M, a new monoclonal-based radioimmunoassay for TPA (Tissue Polypeptide Antigen), were measured in pleural fluid and sera of 125 consecutive patients who underwent medical thoracoscopy. The group consisted of 79 patients with malignant and 45 with non-malignant pleural effusion and 1 patient without definitive diagnosis, and hence 124 patients were available for assessing the diagnostic value. In pleural fluid based on a specificity of 90% versus benign diseases the sensitivity for CEA was 52.5%; with the maximum achievable specificity of 80% for CYFRA 21-1 the sensitivity was 68% and for TPA-M with 67% the sensitivity was 67%. Based on the cut-off values for these specificities the combined use of the three tumour markers resulted in a sensitivity of 85.7% but with a lower specificity of 59.1%. There is only a limited value for tumour markers in the diagnosis of pleural effusion.

[Combined alternating radiochemotherapy in stage III (TNM) (limited disease) small cell bronchial carcinoma: a phase II study with carboplatin/etoposide/vincristine and alternating radiotherapy]. / Kombinierte alternierende Chemo-Strahlentherapie beim kleinzelligen Bronchialkarzinom im Stadium III (TNM) (limited disease): Eine Phase-II-Studie mit Carboplatin/Etoposid/Vincristin und alternierender Strahlentherapie.

BACKGROUND: The combination of radio-chemotherapy is accepted standard in limited-disease small cell lung cancer, but the best way of combining the two modalities is still unknown. To test an alternating regime of early radiotherapy with hypofractionated radiotherapy we performed a phase II study in stage III small cell lung cancer. METHOD: 32 SCLC patients (n = 7 IIIa, n = 25 IIIb) were treated with a weekly alternating regime with either chemotherapy or radiotherapy. Chemotherapy included carboplatin (AUC5), etoposide (3 x 120 mg/m2) and vincristine (2 mg), repeated on day 28 for six cycles. Radiotherapy started one week before chemotherapy and was applied weekly 1 x 4 Gy, using a split-course regimen. RESULTS: Combined radio-chemotherapy was well tolerated with dose-limiting hemotoxicity and very few cases of oesophagitis. Overall response was 75%, median survival 14.5 months and the 2-year survival was 34.4%. 5 patients are still living now for more than 29 months. Treatment failure was local and systemic in 34% of the patients. Systemic failure included 6 patients with brain metastases. CONCLUSION: Combined radio-therapy in small-cell lung cancer using an alternating hypofractionated regimen is well tolerated. Response rate and 2-year survival are promising. Local and systemic failure is an ongoing problem and requires better local and systemic control of the disease.

[Foreign body granuloma of the head of the pancreas caused by a fish bone--a rare differential diagnosis in head of the pancreas tumor]. / Fremdkörpergranulom des Pankreaskopfes durch eine Fischgräte--eine sehr seltene Differentialdiagnose des Pankreaskopftumors.

Despite highly developed scanning methods there is no absolute certainty of delineating malignant pancreatic tumor from chronic pancreatitis. Pancreatitis caused by foreign bodies has occasionally been mentioned in literature. Our report is on the first case of a foreign body granuloma of the pancreatic head caused by a fish-bone transduodenally perforating the pancreas. On preoperative CT and ultrasound as well as by intraoperative inspection and palpation the lesion appeared malignant, so we saw the indication for Whipple's operation. Although the histological examination showed a benign state, taking into account the generally bad prognosis, in case of suspected malignant pancreatic tumor we plead for resection as the only possible form of curative therapy.

[Immunohistochemical studies of the synovial membrane in rheumatoid arthritis and osteoarthrosis for quantifying lysozyme and alpha-1-antitrypsin positive mononuclear cells]. / Immunhistochemische Untersuchungen an der Synovialmembran bei Rheumatoid-Arthritis und Osteoarthrose zur Quantifizierung Lysozym- und Alpha-1-Antitrypsin-positiver mononukleärer Zellen.

The exact number of lysozyme- and alpha-1-antitrypsin-positive macrophages in the synovial membrane in rheumatoid arthritis and osteoarthrosis was investigated by the PAP-technique. There is a positive correlation between the number of macrophages in the intima, as well as in the adventitia of the synovial membrane, and the local immunological activity of rheumatoid arthritis. However, there exist significantly less positive macrophages in osteoarthrosis. The significant increase of macrophages in cases of rheumatoid arthritis is an expression of immunopathological mechanisms that have a pathogenetic importance for the induction and recidivity of arthritis. These facts justify therapy with antirheumatica to influence macrophages.