[Autoinflammatory diseases as cause of wound healing defects]. / Autoinflammatorische Erkrankungen als Ursache von Wundheilungsstörungen.

Ulcerations of the skin and mucosal membranes are a common feature of autoinflammatory diseases. They can give raise to chronic wound healing defects and should be considered in the differential diagnosis of chronic skin ulcers. The increased activation of the innate immune system in the absence of an apparent provocation for inflammation is a hallmark of autoinflammatory diseases. Mutations and alterations of signaling pathways regulating the innate immune response to physical trauma/tissue damage result into an unrestrained activation of the inflammasome, which leads to increased activation of Interleukin-1. Uncontrolled recruitment and activation of myeloid effector cells within the wound site lead to the release of potent proteases that cause the degradation of structural components of the skin. The majority of these diseases respond well to immunosuppressive and immunomodulatory treatment regimes. Therapeutic resistance converts the acute inflammatory response into a chronic and non-resolving inflammatory process that leads to tissue degeneration. In this article we will focus on the review of those autoinflammatory diseases that often display ulcerative cutaneous and aphthous lesions including pyoderma gangrenosum, Behçet disease, PAPA syndrome and hyperimmunoglobulinemia D with periodic fever syndrome (HIDS). Furthermore, the article will be complemented by an overview of those inflammatory diseases that are associated with non-ulcerative cutaneous manifestations.

[Chronic wounds. Novel approaches in research and therapy]. / Chronische Wunde. Neue Wege in Forschung und Therapie.

Underlying disease may impair normal wound healing, leading to chronic, poorly healing wounds. Efficient treatment strategies require identification and treatment of the underlying disease as well as directed correction of the wound healing defect. A thorough knowledge of tissue repair mechanisms at the cellular and molecular level will help to achieve these goals. This review focuses on new developments in wound healing research and the resulting non-operative therapeutic implications.

[Folliculitis barbae in herpes simplex infection]. / Folliculitis barbae bei Herpes-simplex-Infektion.

A 60-year-old male athlete developed a folliculitis in the beard region after several competitions. After identification of herpes simplex antigen within the lesions, systemic therapy with acyclovir led to rapid improvement. In folliculitis resistant to antibiotic and anti-inflammatory therapy, viral and mycotic infections as well as eosinophilic folliculitis should be considered as differential diagnostic possibilities.

Internal carotid artery blood flow velocities before, during, and after extracorporeal membrane oxygenation.

Blood flow velocities in the internal carotid arteries were studied with pulsed Doppler in 25 neonatal patients (birth weight range, 2600 to 4100 g) who had extracorporeal membrane oxygenation (ECMO). Time averaged mean systolic, mean diastolic, and mean blood flow velocities were calculated. Five infants had right common carotid artery reconstruction. Blood flow velocities measured in 15 healthy full-term infants were used as controls. Findings during ECMO included the following: (1) forward flow in the right internal carotid artery in 50% of the infants; (2) significant increase in the mean diastolic and the mean flow velocities (48% and 128%, respectively) in the left internal carotid artery when compared with pre-ECMO and control infants' values; (3) the elevation in the mean and the mean diastolic velocities was associated with changes in the PaCO2 and with an increase in the diastolic blood pressure; and (4) forward blood velocities in the right internal carotid artery were comparable with blood velocities in the left internal carotid artery and with the blood velocities of control infants. After ECMO, the mean diastolic velocity in the left internal carotid artery decreased significantly, but it remained elevated when compared with pre-ECMO values. Infants with right common carotid reconstruction had blood velocities in the right internal carotid artery comparable with the simultaneous blood velocities in the left internal carotid artery and to the blood velocities of control infants. Twenty-eight percent of the infants had major neuroanatomic lesions. Right or left preponderance was not noted. No association between blood velocity values in the internal carotid arteries or flow direction and the presence or the absence of brain lesions was noted.

The influence of extracorporeal circulation and hemoseparation on red cell deformability and membrane proteins in coronary artery disease.

Extracorporeal circulation and hemoseparation may lead to coupled mechanical and chemical blood trauma and thus influence red cell deformability. Ten patients with coronary artery disease underwent coronary bypass. Patients' blood samples were drawn preoperatively, after extracorporeal circulation, and after hemoseparation. Ten healthy adults served as control subjects. Red blood cell deformability was determined by direct microscopic observation of red blood cells subjected to shear stresses of 1.2 to 13.3 Pa with a counter-rotating rheoscope. Red cell membrane proteins were separated by one-dimensional polyacrylamide gel electrophoresis in the presence of sodium dodecyl sulfate. At 1.2 Pa, preoperative red cell deformability was significantly greater in patients with coronary artery disease than in control subjects. Neither extracorporeal circulation nor hemoseparation changed red cell deformability significantly. Electrophoretic separation of membrane proteins failed to show any quantitative or qualitative differences between patients and control subjects. Moreover RBC membrane proteins of red blood cells in the patients were not altered as a result of extracorporeal circulation or hemoseparation. The preoperatively increased red cell deformability in the patients may be drug-induced. Our data suggest that the extracorporeal circulation and hemoseparation techniques used in this study do not lead to red blood cell damage.

Bacterial endophthalmitis in neonates.

Invasive bacterial eye infections in the neonate range from perforating keratitis to panophthalmitis. These infections have gained clinical and therapeutic importance since mortality rates are high and prognosis concerning preservation of vision is poor. Effective antibiotics against the infective agents are now available. Risk factors for developing invasive bacterial eye infections are mainly prematurity and colonisation with Pseudomonas aeruginosa.

[Fructose-1,6-diphosphatase deficiency. Clinical aspects and diagnosis based on a case report]. / Fruktose-1,6-Diphosphatasemangel. Klinik und Diagnosestellung anhand eines Fallbeispieles.

In a 2-year-old boy the enzyme defect of fructose-1,6-diphosphatase deficiency could be demonstrated in liver tissue, jejunal mucosa and leukocytes. During the neonatal period the boy had suffered from transient metabolic acidosis and hypoglycemia. At the age of 2 years, during a febrile infection, he developed a hyperkinetic-hypotonic syndrome, which disappeared by fructose-free diet and avoidance of prolonged periods of fasting.

[Pasini and Pierini idiopathic and progressive atrophoderma in childhood]. / Atrophodermia idiopathica et progressiva Pasini et Pierini, eine wenig bekannte Form der zirkumskripten Sklerodermie im Kindesalter.

In an eleven year old girl Atrophodermia idiopathica et progressiva Pasini et Pierini, a rare variety of localised scleroderma developed within six months as well outlined, reddish-brown, patchy lesions without induration on her right side. The histological examination revealed perivascular inflammatory infiltrations in all corium layers, and discrete sclerosis radiating into fat tissue cells. The levels of antinuclear antibodies and C-reactive protein were both elevated. During intravenous therapy with penicillin G the skin alterations faded but did not disappear.