[Cutaneous form of sarcoidosis at the auricle]. / Kutane Manifestation einer Sarkoidose an der Ohrmuschel.

Sarkoidosis is a disease of so far unknown etiology that can affect potentially every organ. Sarcoidosis of the lung is the most common form, nevertheless in more than one third of the cases the head and neck area is affected. Manifestations of the disease can be present in lymph nodes of the neck, the middle ear, the pars petrosa of the temporal bone and in the paranasal sinuses as well as in the larynx and pharynx. We would like to present two rare manifestations of sarkoidosis of the ear lobe. The cutaneous form of sarcoidosis is characterized by a spectrum of skin changes. Aside from the physical presentation and observation of the disease progress the diagnosis is confirmed histologically. A multidisciplinary care of the affected patients is needed to diagnose the systemic extend of the disease on one side and to provide the patient with an effective therapeutic regimen that includes surgical and conservative measures on the other.

[Therapy with nasal CPAP (continuous positive airway pressure) in patients with obstructive sleep apnea syndrome (OSAS). I: Long-term acceptance of nasal CPAP]. / Therapie mit nasalem CPAP (continuous positive airway pressure) bei Patienten mit Obstruktivem Schlafapnoe Syndrom (OSAS). Teil I: Langzeitakzeptanz von nasalem CPAP.

BACKGROUND: Nocturnal ventilation with nCPAP has been established as the safest and most efficient nonsurgical treatment for OSAS. Long-term results, however, are determined by the patients' compliance with therapy. The aim of this study was the objective measurement of long-term acceptability of nCPAP therapy in all patients receiving this treatment in our sleep laboratory between January 1990 and March 1995. METHODS: We prospectively investigated 41 patients (36 male, 5 female) with moderate to severe OSAS who received nCPAP therapy. Mean time of follow-up was 20.6 months, ranging from 1.2 to 53.5 months. Therapy was indicated when OSAS was confirmed by cardiorespiratory polygraphy and either (1) the patient complained of daytime sleepiness or (2) the patient possessed an apnea-hypopnea index greater than 30/h or when the mean oxygen desaturation was below 80% regardless of the presenting symptoms. The compliance with treatment was defined as a mean rate of use of over 5 hours per night calculated from the time counter on the nCPAP machine. RESULTS: 33 patients (88.5%) have continued using nCPAP until the present time but only 24 patients (59%) met our criteria for long-term acceptance and this group was identified as responders. We found no significant differences in age, body mass index, apnea-hypopnea index, and nCPAP-pressure between responders and non-responders. CONCLUSION: Although nCPAP is the safest treatment for OSAS, there is still a large group of patients with moderate to severe OSAS who are not efficiently treated with nCPAP because of the low long-term acceptability of this therapy. With respect to this group of patients, surgical approaches have to be considered as an alternative therapy.

[Therapy with nasal CPAP (continuous positive airway pressure) in patients with obstructive sleep apnea syndrome (OSAS). II: Side-effects of nCPAP therapy. Effect on long-term acceptance]. / Therapie mit nasalem CPAP (continuous positive airway pressure) bei Patienten mit Obstruktivem Schlafapnoe Syndrom (OSAS). Teil II: Nebenwirkungen der nCPAP-Therapie. Einfluss auf die Langzeitakzeptanz.

BACKGROUND: nCPAP is a well established method for the management of OSAS. The aim of this study was to evaluate long-term side effects and complications of nCPAP therapy and their influence on the patients compliance with treatment. PATIENTS AND METHODS: Forty-one patients with OSAS were interviewed by questionnaire to elucidate the problems and adverse effects of their nCPAP therapy. The patients were divided into responders and non-responders. Non-responding OSAS patients were using their nCPAP devices less then 5 hours each night by definition. RESULTS: The number of side effects and type of complication during nCPAP therapy were the same in both the responding and non-responding groups. The most frequently reported problems were a tender region on the bridge of the nose and discomfort associated with a dry nasal mucosa. Although nCPAP treatment was initially accepted by most patients, adverse effects and other difficulties decreased patient compliance, with time, in many cases. CONCLUSIONS: Despite there being no difference between responders and non-responders with respect to the number and severity of complications, it should not be presumed that these side effects do not influence long-term patient compliance with nCPAP therapy. Patients who suffer from symptoms of OSAS tend to accept these adverse effects, while those who do not feel limited by their disease are less persistent in their use of this treatment modality. Identification and elimination of the problems associated with the use of nCPAP equipment may increase longterm patient compliance. Close monitoring in the outpatient department combined with intermittent inpatient assessment in the sleep laboratory will also help to improve acceptance of nCPAP therapy.

[Necrotizing mucosal ulcers cause by anaerobic bacteria. Fusiform bacterial and spirochete infections]. / Nekrotisierende Schleimhautulzera durch Anaerobier. Fusospirochätosen.

Vincent's angina (Plaut-Vincent) is the most prominent disease caused by coinciding infections from fusibacteria and spirochaeta both belonging to obligate anaerobic bacteria. A possible symbiotic infection of both anaerobics may become manifest on the mucous membranes of the oral cavity and the oropharynx beside the tonsillas. The clinical outcome may be different and pose difficulties in the differential diagnosis. We report the case of a 29 year old female patient with necrotizing ulcera of the soft palate suspicious for stomatitis ulceromembranacea. In case necrotizing inflammations of the oral cavity area were to be found infections due to anaerobic bacteria should be considered mostly occurring as mixed infections. The correct identification by cultivation turns out to be difficult in that it requires special conditions. Furthermore, reliable detection of these bacteria necessitates careful collection and transport of patients specimens. In case of Fusospirochaetosis (Fusotreponematose) a specimen should be prepared for microscopic examination beside setting up a special culture. This is because the staining is the most suitable procedure for bacteril identification to support the clinical diagnosis of stomatitis ulceromembranacea.