[Biomarkers in Diagnosis, Treatment and Prognosis of Infectious Lung Diseases]. / Biomarker in der Diagnostik, Therapie und Prognose infektiöser Lungenerkrankungen.

Biomarkers play an important role in the management of infectious pulmonary diseases, even though there is only limited evidence that biomarker-guided therapies are superior to clinical strategies.Well-established indications for the use of biomarkers are the guidance of the duration of antibiotic therapy in community-acquired pneumonia (CAP) by PCT, the decision against the use of antibiotics by CRP or PCT in ambulatory settings, and the evaluation of CAP treatment by CRP or PCT kinetics.In the prognostic assessment of CAP, the standard biomarkers of acute organ dysfunction should be given priority, e. g. leukocyte and platelet counts, creatinine/urea and lactate, in combination with clinical signs and symptoms.MR-pro-ADM could enrich diagnostics in the future. Genetic transcriptome analysis is a completely new and promising concept.

[Criteria for treating MRSA in sputum]. / Kriterien zur Behandlung von MRSA im Sputum?

Methicillin-resistant strains of Staphylococcus aureus (MRSA) are of particular significance for the management of patients with airway infections, since the disease course is often complicated and treatment rendered difficult by multiple resistance. Their prevalence is now slowly declining, but still alarmingly high. Hospital-acquired infections are predominant, but hospital-associated and community-acquired infections do occur, as do rare infections with livestock-acquired strains. Non-nosocomial strains are characterized by different pathogenic factors and a different spectrum of antibacterial resistance; they often have a threatening disease course. Anti-infectives with activity against MRSA are unusual and have particular toxicity profiles. On the other hand, MRSA colonization is eliminated spontaneously in healthy people and acute bronchitis is treatable by common oral antibiotics. However, chronic airway infection in bronchiectasis and other forms of structural airway damage requires a complex systemic and local treatment approach for pathogen elimination.

[A practically orientated clinical HIV update for ENT physicians]. / Praktisch orientiertes klinisches HIV-Update für HNO-Ärzte.

Basic knowledge concerning the human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) is useful for ENT physicians. Although HIV patients are usually stably asymptomatic nowadays due to modern therapy, HIV often manifests in ENT symptoms, such as neck lumps, sore throat, difficulty swallowing and dysgeusia. After infection, an initial increase in viral load can cause, among other symptoms, oral ulcers and pharyngitis. Once the immune system is compromised by the attack on CD4 lymphocyte cells, HIV-related diseases can occur: oral mycoses (particularly candidosis) and viral infections (including warts), aphthous ulcers, gingivitis, salivary gland diseases and malignancies (e. g. intraoral Kaposi's sarcoma). Neck lymphadenopathy is frequent. Markers of disease severity are the clinical symptoms, viral load and CD4 helper cell count. HIV treatment (antiretroviral therapy, ART) is a combination of at least three antiviral drugs.

Fracture properties of the human mandible.

A total of seven human mandibles were struck to breaking point under standardised conditions using a pendulum. The cortical deformation for two impact directions was measured with strain gauge strips located at eight defined sites. Fronto-median impacts led to mostly bilateral and always multiple fractures in the posterior area of the bone, especially in the collum and the condyle. The fracture threshold was between 2.5 and 3.1 kN. Lateral impact caused fractures near the impact area as direct fractures of the ipsilateral corpus. Mainly single and double fractures were observed. For lateral impact the fracture threshold was between 0.6 and 0.8 kN.

Deformation characteristics of the human mandible in low impact experiments.

A total of 11 human mandibles were subjected to physical impacts under standardised conditions. Two impact sites and directions were tested and the impact load was varied in four steps. Two occlusional strengths were applied and the influence of simulated soft tissue covering was recorded. The deformation of the bones was measured using strain gauge strips located at eight defined sites. In a series of frontal to occipital impacts the frontal areas and the collum showed the largest length changes. Increasing impact intensities led to a proportional increase of the length changes. An increase of the occlusional strength was either protective (at the collum) or it increased the deformation (frontal area). The soft tissue covering was only partly protective. Lateral impact was characterised by a compression on the side of the impact and stretching on the other side only. The intensity and speed of deformation increased with increasing distance from the site of impact. A fixed occlusion caused an increase of compression at the site of impact and an increasing stretching in the frontal part of the bone and at the opposite collum.

[Prognosis of malignant melanoma following dissection regional lymph node metastases]. / Prognose beim malignen Melanom nach Dissektion regionärer Lymphknotenmetastasen.

BACKGROUND: Malignant melanomas usually metastasize in the regional lymph nodes. This generally leads to a worsening of prognosis. Survival probability after extirpation of the tumorous regions is conditioned by various factors. Until now, the basis for differentiated therapy has been the precise understanding of the TNM classification. Clinical parameters are also relevant to therapy and of decisive importance to the further course of disease. QUESTION: Which clinical parameters are important to the prognosis of patients with regional melanoma and lymph node disease? PATIENTS AND METHODS: This study is a retrospective analysis of patients at the Clinic and Polyclinic of General Surgery of the University Hospital in Münster,Germany, together with a review of the literature. Included were 137 patients who received curative resection of lymph node metastases from malignant melanomas between 1974 and 1996. From the literature, 6,694 cases were found which allowed the establishment of 13 different prognosis parameters following lymph node metastasis resection These parameters were compared with our own results concerning established, relevant parameters. RESULTS: The cumulative 5-year survival rate for patients studied was 50.7%. The 5-year survival rates relating to characteristics varied between 12.9% and 80.0%. Of the 13 variables from the literature relevant to prognosis that were included in this analysis, four were found to be significant: Breslow penetration depth, standardized age and age at primary tumor diagnosis, recurrence, and location of the primary tumor. Considering these significant characteristics, one can arrive at a detailed prognostic classification of patient and history. This is indispensable for correctly tailoring therapy to disease stage.

[Sex specific action of insulin on the glucose metabolism of lymphatic tissue of rats and humans (author's transl)]. / Geschlechtsspezifische Wirkung von Insulin auf den Glucosemetabolismus lymphatischer Gewebe von Ratte und Mensch.

Glucose metabolism of lymphoid cells isolated from thymus and spleen of Wistar rats, weighing 140-150 g, was found to be sensitive to insulin. The influence of insulin on glucose uptake by isolated cells from both lymphoid tissues displayed a significant sex specificity. Insulin at 0.1-10 nmol/1 stimulated glucose uptake of cells from male rats, whereas in cells from females, inhibition of glucose uptake was observed. However, lactate production was enhanced in lymphoid cells of both sexes. Cortisol (100 nmol/1) displayed a significant anti-insulin action on glucose uptake and lactate release by thymocytes of male rats. In contrast, in cells from females, cortisol and insulin both exhibited an inhibitory action on glucose uptake, whereas the hormones were found to antagonise lactate production. The sex specific stimualtory influence of insulin on glucose uptake by thymocytes of male rats was reversed and the hormone became inhibitory when animals were castrated. The action of insulin on glucose uptake was also shown to be age-dependent. In experiments with rats weighing either about 10 g or 40 g, sex-specific effects on glucose influx were found, that were similar to those of rats weighing 140-150 g. However, stimulation of glucose uptake was found with thymocytes from rats of both sexes weighing about 80 g. Comparable results were obtained with isolated thymocytes from immature humans (2 months-10 years old). Incubation of thymocytes from males with insulin (10 nmol/1) stimulated glucose uptake and lactate release, whereas insulin caused an inhibition of glucose uptake and an enhancement of lactate production in thymocytes from female. Age dependence and sex specificity of insulin action on glucose metabolism in lymphoid cells and tissues may explain the contradictory results reported by other authors.