Dissemond, Joachim; Assenheimer, Bernd; Bültemann, Anke; Gerber, Veronika; Gretener, Silvia; Kohler-von Siebenthal, Elisabeth; Koller, Sonja; Kröger, Knut; Kurz, Peter; Läuchli, Severin; Münter, Christian; Panfil, Eva-Maria; Probst, Sebastian; Protz, Kerstin; Riepe, Gunnar; Strohal, Robert; Traber, Jürg; Partsch, Hugo
Wund-D.A.CH. ist der Dachverband deutschsprachiger Fachgesellschaften, die sich mit den Thematiken der Wundbehandlung beschäftigen. Experten verschiedener Fachgesellschaften aus Deutschland, Österreich und der Schweiz haben nun einen aktuellen Konsens der Kompressionstherapie für Patienten mit Ulcus cruris venosum erstellt. In Europa ist das Ulcus cruris venosum eine der häufigsten Ursachen für chronische Wunden. Neben der konservativen und interventionellen Wund- und Venentherapie, ist die Kompressionstherapie die Basis der Behandlungsstrategien. Die Kompressionstherapie kann heute mit sehr unterschiedlichen Materialien und Systemen durchgeführt werden. Während in der Entstauungsphase insbesondere Verbände mit Kurzzugbinden oder Mehrkomponentensysteme zur Anwendung kommen, sind es anschließend überwiegend Ulkus-Strumpfsysteme. Eine weitere, bislang wenig verbreitete Alternative sind adaptive Kompressionsbandagen. Insbesondere für die Rezidivprophylaxe werden medizinische Kompressionsstrümpfe empfohlen. Durch die Vielzahl der heute zur Verfügung stehenden Behandlungsoptionen, kann für nahezu alle Patienten ein Konzept entwickelt werden, dass sich an den individuellen Bedürfnissen und Fähigkeiten orientiert und daher auch akzeptiert und durchgeführt wird. Die Kompressionstherapie ist für die Behandlung von Patienten mit Ulcus cruris venosum essentiell. In den letzten Jahren sind viele verschiedene Therapieoptionen verfügbar, die in den deutschsprachigen Ländern unterschiedlich angewendet oder durchgeführt werden. Daher soll dieser Expertenkonsens dazu beitragen, konkrete Empfehlungen für die praktische Durchführung der Kompressionstherapie von Patienten mit Ulcus cruris venosum darzustellen. © 2016 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.
Protz, Kerstin; Heyer, Kristina; Dissemond, Joachim; Temme, Barbara; Münter, Karl-Christian; Verheyen-Cronau, Ida; Klose, Katharina; Hampel-Kalthoff, Carsten; Augustin, Matthias
Eine Säule der kausalen Therapie bei Patienten mit Ulcus cruris venosum ist die Kompressionstherapie. Sie unterstützt die Abheilung, reduziert Schmerzen und Rezidive und steigert die Lebensqualität. Bislang existieren kaum wissenschaftliche Daten zu dem Versorgungsstand und fachspezifischem Wissen von Patienten mit Ulcus cruris venosum. Standardisierte Fragebögen wurden bundesweit in 55 Pflegediensten, 32 Arztpraxen, vier Wundzentren und -sprechstunden sowie einem Pflegetherapiestützpunkt von Patienten mit Ulcus cruris venosum bei Erstvorstellung anonym ausgefüllt. Insgesamt nahmen 177 Patienten (Durchschnittsalter 69,4 Jahre; 75,1 % Frauen) teil. Ein florides Ulcus cruris venosum bestand im Mittel 17 Monate. 31,1 % hatten keine Kompressionstherapie, 40,1 % Binden und 28,8 % Strümpfe. Bei der Bestrumpfung hatten 13,7 % Kompressionsklasse III, 64,7 % Kompressionsklasse II und 19,6 % Kompressionsklasse I. 70,6 % legten die Strümpfe nach dem Aufstehen an, 21,1 % trugen sie Tag und Nacht. 39,2 % bereiteten die Strümpfe Beschwerden. Lediglich 11,7 % hatten eine An- und Ausziehhilfe. Die Binden wurden im Mittel 40,7 Wochen getragen und bei 69 % nicht unterpolstert. Bei 2,8 % wurde der Knöchel- und Waden-Umfang zur Erfolgskontrolle gemessen. Venensport machten 45,9 %. Ein Drittel hatte keine Kompressionsversorgung, obwohl diese eine Basismaßnahme der Therapie des Ulcus cruris venosum ist. Zudem ist deren korrekte Auswahl und Anwendung angesichts der langen Bestandsdauer der Ulzerationen zu hinterfragen. Weiterführende Fachkenntnisse bei Anwendern und Verordnern sowie Patientenschulungen sind erforderlich. © 2016 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.
Kinyó, Ágnes; Nagy, Nikoletta; Oláh, Judit; Kemény, Lajos; Bata-Csörgő, Zsuzsanna
Ulcus vulvae acutum Lipschütz or acute genital ulcer is a distinct clinical entity characterized by sudden painful genital ulceration occurring mostly in young and virgin girls with malaise, fever and other systemic symptoms. This distressing syndrome is rare and may be presented to dermatologists, gynecologists or pediatricians. Its diagnosis and therapy can be challenging. We present two young female patients with ulcus vulvae acutum. The cause of the disease could not be confirmed in our patients, but, interestingly, both patients had partial IgA deficiency. In the last 100 years, after its first description by Lipschütz, many case reports and series have aimed to identify a specific cause of the disease, without success. These studies mainly focused on infectious agents as causative factors, however, in most cases connection with infection could not be confirmed. Our opinion is that the decreased level of IgA could be a possible explanation for the cause of this syndrome. With our cases we would like to emphasize the possible role of local immunological mechanisms rather than several infectious agents in the development of this little-known disease.
Brinca, Ana; Canelas, Maria Miguel; Carvalho, Maria João; Vieira, Ricardo; Figueiredo, Américo
Lipschütz Ulcer, or ulcus vulvae acutum, is a rare and probably underdiagnosed entity that usually presents as an acute painful vulvar ulcer in young women. The etiology is unknown, although recent reports have associated it with the Epstein-Barr virus. The diagnosis is made by exclusion after ruling out sexually transmitted diseases, autoimmune causes, trauma, and other etiologies of genital ulcerations. We report a case of a young woman who developed flu-like symptoms and painful vulvar ulcers. Complementary examinations ruled out sexually transmitted diseases and the other usual causes of genital ulcers; lesions healed with no sequelae or recurrences. This case represents a rare important differential diagnosis of genital ulceration.
Danelisen, D; Zigić, B; Rac, S
Contemporary way of living accompanied by everday frustrations, a frequent use of medicaments, an easy application of corticosteroids, complexity of an opeation, so as an increased incidence of polytraumas --those are the factors responsible for an increasing rate of stress ulcus. The rate of 54 verified stress ulcus in the period from 1969-1979 in Regional Medical Centre of Banja Luka, at Surgical Department, are very often indicative of this disease. Thirty eight operatively treated patients are indicative of severity of this disease. The authors are reporting their experiences in resolving this disease by method of vagotomy with partial gastrectomy in comparison to simple sutures of acutely developed ulcus in addition to PS vagotomy. Perforation, which has, usually, been bigger than the chronic ulcus, we had in 31 cases. If the reports of the world authors are reliable, perforation occurs in 5% of cases only, therefore it is clear how many such conditions has remained undetected or treated under various other "working" diagnoses: (DIC, consumer coagulopathy, fibrinolysis, etc.". The stress ulcus is the disease which is a danger to any patient at Surgical Department.
Alés-Fernández, M; Rodríguez-Pichardo, A; García-Bravo, B; Ferrándiz-Pulido, L; Camacho-Martínez, F M
A Lipschütz ulcer or 'ulcus vulvae acutum' is an acute simple ulceration of the vulva or vagina of non-venereal origin which can be associated with lymphadenopathy. Three cases are described with accompanying clinical photographs. Two cases refer to adolescents, one an infant, all without any history of sexual contact. The cases serve to illustrate a little known but potentially important differential diagnosis of vulval ulceration.
Van der Molen, H R; Ritter, K E; Vriezen, J
After a short exposition of the meaning and the technique for determination of immune complexes in circulating blood (after Hashkova, with polyethylene glycol) our first experience with phlebological patients is exposed. Positive reactions in a variety of cases (N = 122) includes atypical ulcus cruris, ulcerated vasculitis, Pyoderma gangrenosum, discoid lupus erythematodes, chronic rheumatoid polyarthritis (with, or without ulcus cruris), monoarthritis of the knee, pernicious anemia, chronic lymphedema (elephantiasis), some cases of sclerosis multiplex. In such positive cases the sedimentation rate of citrate blood may, or may not be elevated. Negative or uncertain reactions (below 10) were seen in 141 cases, in common's ulcus cruris cases, in vasculite nodulaire, in discopathy and most spondylarthroses and other arthrosis cases, in vasculite nodulaire, in discopathy and most spondylarthroses and other arthrosis cases, in various patients with rheumatoid complaints in coxarthrosis, osteoporosis and in a group of healthy young persons. Negative reactions were the rule in atherosclerotic and diabetic old persons with claudication or gangrene, in most dermatological cases, in necrobiosis lipoidica, in psoriasis, in postthrombotic phlebitis and in chronic rheumatism in a quiet stage. In vasculitis cases the reaction is often only slightly positive (between 10 and 20) but should be repeated as the values may vary. The determination of circulating immune complexes with polyethylenglycol is a useful screening method in the policlinic. Treatment is often directed in the right way sometimes prednisone, more often nivaquin (chloroquin) or other anti-inflammatory drugs and in pernicious anemia hepatotherapy can be of great help in the healing of complicated phlebological cases.
Moll Harboe, Kirstine; Midtgaard, Helle; Wewer, Vibeke; Cortes, Dina
Since perforated peptic ulcer is uncommon in children proton pump inhibitor prophylaxis is not routinely recommended when children are treated with high dose steroids. We describe a case of perforated ulcer in a six-year-old patient with nephrotic syndrome treated with high dose prednisolone. Initially, ulcer was not suspected due to uncharacteristic symptoms. The child developed peritoneal signs and surgery revealed a perforated peptic ulcer in the stomach. We recommend treatment with proton pump inhibitors if children, who are treated with high dose steroids develop abdominal symptoms, which can be caused by an ulcus.
Delgado-García, Silvia; Palacios-Marqués, Ana; Martínez-Escoriza, Juan Carlos; Martín-Bayón, Tina-Aurora
Acute genital ulcers, also known as acute vulvar ulcers, ulcus vulvae acutum or Lipschütz ulcers, refer to an ulceration of the vulva or lower vagina of non-venereal origin that usually presents in young women, predominantly virgins. Although its incidence is unknown, it seems a rare entity, with few cases reported in the literature. Their aetiology and pathogenesis are still unknown. The disease is characterised by an acute onset of flu-like symptoms with single or multiple painful ulcers on the vulva. Diagnosis is mainly clinical, after exclusion of other causes of vulvar ulcers. The treatment is mainly symptomatic, with spontaneous resolution in 2 weeks and without recurrences in most cases. We present a case report of a 13-year-old girl with two episodes of acute ulcers that fit the clinical criteria for Lipschütz ulcers.
Santler, Bettina; Goerge, Tobias
Die chronische Venenerkrankung ist eine weit verbreitete Krankheit, die in späteren Stadien mit einer Vielzahl an Symptomen, aber auch Komplikationen wie dem Ulcus cruris, einhergeht. Dies wiederum hat weitreichende Auswirkungen auf die Lebensqualität der Patienten wie auch auf das Gesundheitssystem. Für die Diagnostik der chronischen Venenerkrankungen steht eine Auswahl an Verfahren zur Verfügung, wobei sich die farbkodierte Duplexsonographie als Goldstandard etabliert hat. Im Bereich der Therapie kam es in den letzten Jahrzehnten zu großen Fortschritten, sodass heute auch Alternativen zum klassischen Stripping durch die endoluminalen Verfahren zur Verfügung stehen. Die Wahl der Therapieoption ist jedoch weiterhin stark abhängig von mehreren Faktoren, unter anderem von den anatomischen Gegebenheiten und dem Krankheitsstadium. Im folgenden Artikel werden die Anatomie und Pathophysiologie, sowie die aktuellen Standards der Diagnostik und Therapie zusammengefasst. © 2017 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.
König, Karsten; Bückle, Rainer; Weinigel, Martin; Elsner, Peter; Kaatz, Martin
We report on applications of high-resolution clinical multiphoton tomography based on the femtosecond laser system DermaInspectTM with its flexible mirror arm in Australia, Asia, and Europe. Applications include early detection of melanoma, in situ tracing of pharmacological and cosmetical compounds including ZnO nanoparticles in the epidermis and upper dermis, the determination of the skin aging index SAAID as well as the study of the effects of anti-aging products. In addition, first clinical studies with novel rigid high-NA two-photon 1.6 mm GRIN microendoscopes have been conducted to study the effect of wound healing in chronic wounds (ulcus ulcera) as well as to perform intrabody imaging with subcellular resolution in small animals.
Mambrini, P; Giovanini, M; Seitz, J F; Perrier, H; Allemand, I; Rabia, I; Monges, G; Lebreuil, G
We report a case of metastasis to the uterine corpus revealing a primary gastric adenocarcinoma. A 26-year-old woman suffered from weight loss, vaginal bleeding, abdominal pain. An endometrial curettage showed apparently metastatic adenocarcinoma. The primary site of the tumour was gastric. The upper gastrointestinal endoscopy revealed an ulcus and aspect of linitis plastica in the fundus. Biopsies showed diffuse type adenocarcinoma. Because of extensive disease, laparotomy was not performed and exclusive palliative chemotherapy was started. The patient died 10 months after the diagnosis. Metastasis from primary gastric cancer to the female genital tract are rare and are usually observed in young premenopausal women with diffuse type gastric adenocarcinoma. This case report underlines the interest, for those patients of careful gynaecologic examination at the initial staging and after treatment.
Windemuth, D; Stücker, M; Altmeyer, P
Studies about the personality of dermatological patients are numerous. The results are inconsistent and peculiarities of the personality are rarely confirmed. Contrary to the usual procedure, this study asks for the impressions physicians have about their patients. To elicit associations dependent on a dermatological diagnosis, 27 physicians filled in a three-dimensional differential asking for their impressions about patients with atopic dermatitis, leg ulcer, malignant melanoma, or psoriasis vulgaris in order to quantify these impressions. The dimension valence (good-bad) did not differ between the groups. The dimensions of excitation (active-passive) and potency (strong-weak) showed the biggest differences between patients with atopic dermatitis and ulcus cruris. The latter get significantly lower values on both dimensions. The correlations between the impression and the duration of employment in dermatology were low. In our opinion it is necessary to raise the impression of medical personal about their patients because these impressions affect the interaction of the personal with the patient.
Delgado-García, Silvia; Palacios-Marqués, Ana; Martínez-Escoriza, Juan Carlos; Martín-Bayón, Tina-Aurora
Acute genital ulcers, also known as acute vulvar ulcers, ulcus vulvae acutum or Lipschütz ulcers, refer to an ulceration of the vulva or lower vagina of non-venereal origin that usually presents in young women, predominantly virgins. Although its incidence is unknown, it seems a rare entity, with few cases reported in the literature. Their aetiology and pathogenesis are still unknown. The disease is characterised by an acute onset of flu-like symptoms with single or multiple painful ulcers on the vulva. Diagnosis is mainly clinical, after exclusion of other causes of vulvar ulcers. The treatment is mainly symptomatic, with spontaneous resolution in 2 weeks and without recurrences in most cases. We present a case report of a 13-year-old girl with two episodes of acute ulcers that fit the clinical criteria for Lipschütz ulcers. PMID:24473429
Kundaković, Tatjana; Milenković, Marina; Zlatković, Saša; Nikolić, Vesna; Nikolić, Goran; Binić, Ivana
Venous ulcers (ulcus cruris venosum) are a common chronic disease that requires continuing treatment and significantly influences a patient's way of life. The therapeutic effects of the ointment Herbadermal on epithelialization and microbial flora of venous ulcers in 25 patients (10 men and 15 women) were tested over a 7-week period. The major components of the ointment are extracts of garlic, St. John's wort, and calendula. The patients were over 18 years of age, with ulceration of the lower leg no longer than 2 months or recurrent ulceration during the last 6 months. The involved patients did not use any other phytomedicines or supportive therapies. Parameters were evaluated before the treatment and every 2 weeks during the period of 7 weeks. The total treatment response was evaluated on the basis of epithelialization, granulation, fibrin deposits, exudation, and edema. The percentage of epithelialization was 99.1% after 7 weeks, without significant effects on the microbial flora. This combination of extracts can be recommended as topical treatment for wound healing because of its epithelizing, anti-erythematous, and anti-edematous properties. Copyright © 2012 S. Karger AG, Basel.
Kamphausen, Thomas; Schadendorf, Dirk; von Wurmb-Schwark, Nicole; Bajanowski, Thomas; Poetsch, Micaela
The successful analysis of weak biological stains by means of highly sensitive short tandem repeat (STR) amplification has been increased significantly over the recent years. Nevertheless, the percentage of reliably analysable samples varies considerably between different crime scene investigations even if the nature of the stains appears to be the same. It has been proposed that the amount and quality of DNA left at a crime scene may be due to individual skin conditions (among other factors). Therefore, we investigated DNA from handprints from 30 patients acutely suffering from skin diseases like atopic dermatitis, psoriasis or skin ulcer before and after therapy by STR amplification using the new and highly sensitive Powerplex® ESX17 kit in comparison to 22 healthy controls. Handprints from atopic dermatitis patients showed a correct and reliable DNA profile in 90% and 40% of patients before and after therapy, respectively. Regarding psoriasis patients, we detected full DNA profiles in only 64% and 55% of handprints before and after therapy. In contrast, in ulcus patients and controls, full DNA profiles were obtained in much lower numbers. We conclude that active skin diseases like atopic dermatitis or psoriasis have a considerable impact on the amplificable DNA left by skin contact with surfaces. Since up to 7% of adults in European countries suffer from one of these diseases, this could explain at least partially the varying quality of DNA from weak stains.
Gogoi, Jyotchna; Chattopadhayay, Pronobesh; Kumar Rai, Ashok; Veer, Vijay
The study was designed to evaluate the effects of hydromethanolic extract of tuberous root of M. jalapa and its terpenoid and flavonoid fractions on cutaneous wound healing in Wistar Albino rats. The hydromethanolic extract was subfractionated by sequential extraction in solvents (moderately nonpolar to polar). The extract and its (terpenoid and flavonoid) fractions were used for cutaneous wound healing studies by using excision wound model on rat. Their effects on wound contraction rate, biochemical and histological changes, and expression of growth factors such as collagen 3A, basic fibroblast growth factor, and vascular endothelial growth factor were investigated. The results indicated that flavonoid treated group showed significant decrease (P < 0.05) in antioxidant enzyme level as compared to control in wound healing process, whereas terpenoid fraction showed significant increase (P < 0.05) in expression of growth factor levels but regeneration and remodeling stages were delayed due to formation of thicker ulcus layer and also there were no hair follicle-like blood capillaries formation which ultimately may lead to formation of hypertrophic scar of wound. Therefore, from this study, it can be concluded that terpenoid fraction prolongs proliferation phase and hence may have tendency to convert the wound into hypertrophic wound. PMID:27379322
Kröpil, Feride; Raffel, Andreas M; Schauer, Matthias; Rehders, Alexander; Eisenberger, Claus F; Knoefel, Wolfram T
Rectovaginal fistulae (RVF) are a serious and debilitating problem for patients and a challenge for the treating surgeons. We present our experiences in the surgical treatment of these patients. Study population consisted of 22 consecutive patients (range 26-70 years) with RVF treated in our department between 2003 and 2009. 13 RVF were observed after colorectal or gynaecological surgery, 3 occurred after radiotherapy, 2 due to tumour infiltration, 4 because of local inflammation (3x diverticultis, 1x ulcus simplex recti). The RVF was classified in all patients before treatment as either 'low' or 'high'. Local procedures (transvaginal excision, preanal repair) as initial treatment were performed in 9 patients with low fistula. In 13 cases with high fistula an abdominal approach was performed to close the fistula. A recurrence was observed in 8/22 cases (36%), which were treated by a gracilis flap (n=2), a bulbospongiosus composite (n=1), a second abdominal approach (n=4), and a re-local excision (n=1). Ultimatively, in 19 cases the defect healed but in 3 patients the RVF persisted. Most important predictor of healing/failure is etiology followed by localization and recurrence of the RVF. Local (preanal, transvaginal) procedures are suitable for low RVF, whereas abdominal surgery is necessary in high RVF. In recurrent RVF, muscle flaps are promising procedures.
Berndt, Rolf-Dietrich; Takenga, Mbusa Claude; Kuehn, Sebastian; Preik, Petra; Dubbermann, Daniel; Juenger, Michael
The increasing number of elderly and chronically ill patients is currently stressing healthcare systems. One of the solutions for reaching an economically and socially viable solution is exploiting the benefits of modern technologies. This article presents an innovative mobile teledermatology program for assisting both the therapy and the aftercare of patients suffering from skin diseases. The system is based on store-and-forward teledermatology and consists of two main components: (1) an application implemented on the mobile phone in order to enable patients to transmit both skin image data and biofeedback information and (2) an online portal for the care providers. The key idea is to ensure a sufficient involvement of the patients in the therapy process and to motivate them through their active cooperation. Smartphone applications with features as well as the online Web-based portal for medical care providers are presented. The entire system is embedded on a secure telematics platform. The system was tested at the Clinic for Skin Diseases of the University of Greifswald, Greifswald, Germany, by patients with skin diseases such as ulcus cruris, postoperative wound documentation, eczema, psoriasis, and pemphigus for a period of 1 year. Medical care providers could also analyze patients' data from the developed online Web-based application during that test period. Positive feedback from both medical care providers and patients confirms a high potential for mobile teledermatology as a means of dermatological healthcare delivery.
Curová, K; Kmeťová, M; Siegfried, L
Cytolethal distending toxins (CDT) are intracellularly acting proteins which interfere with the eukaryotic cell cycle. They are produced by Gram-negative bacteria with affinity to mucocutaneous surfaces and could play a role in the pathogenesis of various mammalian diseases. The functional toxin is composed of three proteins: CdtB entering the nucleus and by its nuclease activity inducing nuclear fragmentation and chromatin disintegration, CdtA, and CdtC, the two latter being responsible for toxin attachment to the surface of the target cell. Cytotoxic effect of CDT leads to the cell cycle arrest before the cell enters mitosis and to further changes (cell distension and death, apoptosis) depending on the cell type. Thus, CDT may function as a virulence factor in pathogenic bacteria that produce it and thus may contribute to the initiation of certain diseases. Most important are inflammatory bowel diseases caused by intestinal bacteria, periodontitis with Aggregatibacter actinomycetemcomitans as the aetiologic agent and ulcus molle where Haemophilus ducreyi is the causative agent.
Longeac, M; Lapeyre, M; Delbet Dupas, C; Barthélémy, I; Pham Dang, N
Basal cell carcinomas with symptomatic perineural invasion are rare entities. We report the case of a 60year-old man (with a grafted kidney), surgically treated in 2007 for a sclerodermiform basal cell carcinoma infiltrating the left nostril. Five years later, a painful left hemifacial hypoesthesia associated with an ulcus rodens of the nasolabial fold appeared. A biopsy confirmed a recurrence. MRI showed an enhancement of the trigeminal ganglion. The patient had a trigeminal perineural invasion secondary to a cutaneous basal cell carcinoma. He received a local intensity-modulated radiotherapy alone (70Gy in 33 sessions), administered from the skin tumour to the skull base. Three years after the end of treatment, the patient is in radiological and clinical remission, with partial recovery of the hypoesthesia. Evolution was marked by iterative corneal ulcers and decreased visual acuity. Modalities of treatment by surgery and/or radiation therapy and complications are poorly described in the literature. Copyright © 2016. Published by Elsevier SAS.
Lackner, Franz X
In infectious diseases we can discern a cause and effect chain, which in particular offers the practicable perspectives of prophylaxis and treatment. However, to date we have not been able to control them. Apart from new epidemics, such as those caused by HIV and SARS, long-forgotten scourges like TB are enjoying a comeback. Furthermore, the advances made in clinical medicine mean that induced immunosuppression, for instance as a result of major surgery or organ transplantation, has become a serious problem in intensive care units. The body's natural barriers are breached through medical interventions while, on the other hand, immunocompromising therapeutic agents such as cytostacis and glucocorticoids ensure that invading microorganisms will be able to multiply. Drugs administered as stress ulcus prophylaxis give rise to a shift in the bacterial flora of the throat, thus laying the foundation for a lower respiratory tract infection. With regard to bacterial resistance, antibiotic therapy, especially when used as prophylaxis, results in the bacteria becoming less sensitive to the drugs, while reinforcing selective pressures. The hands of personnel as well as the therapeutic devices ranging from the respirator to the catheter are the chief sources of infection in intensive care units. Disinfection, antibiotic therapy and, possibly, extracorporeal elimination methods can be contemplated to selectively prevent the establishment and multiplication of microorganisms. However, only disinfectants are able to unleash their full destructive might against microbes, especially when used for medical devices that are not amenable to sterilization, even if their subsequent removal and, possibly, the issue of staff hand protection, can be a problem. While it is not easy to furnish proof of a direct link between efficient control and prevention methods and the incidence of infection, there is by now a consensus on the role of hand hygiene and of disinfection of the human body and
Böhmler, G; Gerwert, J; Scupin, E; Sinell, H J
In man suffering from diseases of the stomach and the duodenum (gastritis, ulcus, enteritis, neoplasms), Helicobacter pylori (H..pylori) is frequently detected in the mucous membrane of the stomach. Up to now the spread of this agent is not quite clear. Since the direct transmission in humans can be taken for granted, the following study was to find out whether and for how long the agent mentioned above is able to survive in selected food and whether an infection of the consumer by these contaminated food is possible. 376 samples of secretions from the udder of healthy cows and those with mastitis where tested for the presence of H. pylori along with 100 stomachs of chicken from different flocks. In no case H. pylori could be detected. H. pylori was inoculated in high concentrations into milk and some milk-products. From cooled milk samples the agent could still be reisolated after six days in a density up to 10(3) CFU/ml of milk. At room-temperature or 37 degrees C resp. the pathogen could be detected in milk for three to four days only. In yoghurt the agent kept viable for three hours only, whereas in kefir for 24 hours. Mean survival time of then hours was found in pH-neutral curd cheese. The incubation of H.pylori in sterile drip from chicken and in physiologic saline resulted in maximal survival time of at least 48 hours at room temperature. But in H.pylori-broth the number of microorganisms had dropped below the limit of detectability only after 72 hours. At refrigerator-temperature (7 degrees C) H. pylori could still be detected within these three media after 72 hours in high concentrations. In drip from chicken kept at-20 degrees C before thawing H. pylori showed a considerable survival time. After four weeks its number had only dropped by one to two log cycles, whereas in saline and in broth the agent could not be detected anymore after one week at the most. Experiments concerning tenacity showed: On culture-media with different pH-values the growth