Prevalence of Candida species in Psoriasis.

BACKGROUND: Psoriasis patients are more frequently colonised with Candida species. The correlation between fungal colonisation and clinical severity is unclear, but may exacerbate psoriasis and the impact of antipsoriatic therapies on the prevalence of Candida is unknown. OBJECTIVES: To examine the prevalence of C species in psoriasis patients compared to an age- and sex-matched control population, we investigated the influence of Candida colonisation on disease severity, immune cell activation and the interplay on psoriatic treatments. METHODS: The prevalence of C species was examined in 265 psoriasis patients and 200 control subjects by swabs and stool samples for fungal cultures. Peripheral mononuclear blood cells (PBMCs) were collected from 20 fungal colonised and 24 uncolonised patients and stimulated. The expression of interferon (IFN)-γ, IL-17A, IL-22 and tumour necrosis factor (TNF)-α from stimulated PBMCs was measured by quantitative real-time polymerase chain reaction (qPCR). RESULTS: A significantly higher prevalence for Candida was detected in psoriatic patients (p ≤ .001) compared to the control subjects; most abundant in stool samples, showing Candida albicans. Older participants (≥51 years) were more frequent colonised, and no correlation with gender, disease severity or systemic treatments like IL-17 inhibitors was found. CONCLUSIONS: Although Candida colonisation is significantly more common in patients with psoriasis, it does not influence the psoriatic disease or cytokine response. Our study showed that Candida colonisation is particularly more frequent in patients with psoriasis ≥51 years of age. Therefore, especially this group should be screened for symptoms of candidiasis during treatment with IL-17 inhibitors.

Long-term cosmetic results after minimally invasive video-assisted thyroidectomy.

BACKGROUND: Minimally invasive video-assisted thyroidectomy (MIVAT) has been performed in the authors' department since 2004. Many authors have described some of its advantages over conventional surgery in terms of cosmetic results. The published literature on this topic variously describes the average central incision as 1 to 3 cm. The end point of the cosmetic results (e.g. the question of keloids) cannot be documented during the inpatient stay. This report describes the long-term cosmetic results for this method and analyzes the subjective and objective outcomes after MIVAT. METHODS: From January 2004 until March 2010, 116 patients underwent MIVAT in the authors' department. The authors included 96 patients in their subsequent examination, with a follow-up period of 22.4 months (range, 1-64 months). RESULTS: The measurable cervical scar length was 1.9 cm (range, 1-3 cm). The measurable wideness of the cervical scar was 0.17 cm (range, 0.05-1.5 cm). Keloids in 10 female patients (10.4%) had diverse proliferation. Of the 116 patients, 93 (96.8%) were very satisfied or satisfied with the cosmetic result. The Patient Scar Assessment Scale score was 9.7, and of the Observer Scar Assessment Scale score was 8.1. CONCLUSION: In terms of long-term results, MIVAT appears to provide excellent cosmetic outcomes. The problem with the development of keloids in the region of the cervical incision, especially in female patients, remains unresolved. The satisfaction of patients with the long-term outcome of MIVAT is high.

Current analysis of endoloops in appendiceal stump closure.

BACKGROUND: An inadequate closure of the appendix stump leads to intra-abdominal surgical site infection. The effectiveness of various appendiceal stump closure methods, for instance, staplers or endoloops, was evaluated. Many analyses show that the use of a stapler for transection and closure of the appendiceal stump lowers the risk of this infection but a statistically significant risk of postoperative intra-abdominal abscess or wound infection was not considered in any randomized study. The aim of this study was to evaluate the complications after using endoloops in a high-volume center. METHODS: The data of 1,790 patients who underwent laparoscopic appendectomy between January 1998 and December 2006 and a single center was prospectively acquired. The standard procedure used was an appendiceal stump closure using endoloops and a selective use of staplers. The outcome criteria for inclusion in the study were intra-abdominal abscess formations, other specific intraoperative and postoperative complications, and the different costs of the operation. RESULTS: Laparoscopic appendectomy was performed in 1,790 (80.8%) patients and open appendectomy in 425 (19.2%) patients. Conversion to open surgery occurred in 74 (4.13%) patients. Laparoscopic appendectomy with stump closure using endoloops was performed in 1,670 (97.3%) patients and stump closure using a stapler in 46 (2.7%) patients. Among 851 patients with acute appendicitis, 284 patients with perforated appendicitis, and 535 patients with other or no pathology, the rate of intra-abdominal abscess after using an endoloop or a stapler was not significantly different (1.5 vs. 0%, p = 0.587; 3.5 vs. 4.2%, p = 0.870; 0.7% vs. 0, p = 0.881, respectively). There were no significant differences between the endoloop group and the stapler group with respect to the other specific intraoperative and postoperative complications. CONCLUSION: This study shows the safety of the endoloop for clinical daily routine. A selective procedure for stump closure has been established. Appendiceal stump closure using an endoloop is an easy, safe, and cost-effective procedure.

Susceptibility testing of amorolfine, bifonazole and ciclopiroxolamine against Trichophyton rubrum in an in vitro model of dermatophyte nail infection.

Antimycotic nail lacquers are effective and safe for the treatment of onychomycosis. To assess the efficacy of three topical agents we studied the minimum inhibitory and fungicidal concentration of amorolfine, bifonazole and ciclopiroxolamine. Amorolfine showed the most effective fungistatic and fungicidal activity in vitro against seven clinical Trichophyton rubrum nail isolates, followed in descending order by ciclopiroxolamine and bifonazole. To mimic a nail infection more appropriately, the nail minimum fungicidal concentration (Nail-MFC) was determined in an onychomycosis model. Amorolfine and ciclopiroxolamine had Nail-MFCs ranging from 2-32 microg/ml and 16-32 microg/ml, respectively. In contrast, bifonazole was unable to kill T. rubrum in this model. Statistical analyses of the results show a significant difference between the two treatments with amorolfine and ciclopiroxolamine (P<0.001). For amorolfine a mean concentration of 12.28 microg/ml (95%-CI=[8.66, 17.41]) was sufficient to kill all strains, while for ciclopiroxolamine about twice that concentration was needed, i.e., 24.13 microg/ml (95%-CI=[17.06, 34.13]). The individual sensitivity of six of the seven T. rubrum strains was higher for amorolfine. These data demonstrate that both amorolfine and ciclopiroxolamine effectively kill T. rubrum growing on nail powder and suggest a better cidal action for amorolfine. Further investigation would be required to determine if these in vitro data can partially explain the clinical observation of significantly higher cure rates in onychomycosis following a therapy with an amorolfine-containing nail lacquer formulation.

Rate of dyspareunia after delivery in primiparae according to mode of delivery.

OBJECTIVES: The purpose of this study was to evaluate the influence of mode of delivery on sexual function. DESIGN: One thousand six hundred and thirteen questionnaires containing 16 questions about sexual behavior and dyspareunia before, during and after pregnancy were sent out to primiparous, ethnically homogeneous (fluent in German) patients who delivered in a large tertiary referral center between 6 months and 2(1/2) year before. The returned questionnaires were merged to clinical data from our obstetric database in an anonymous fashion. The patients were subdivided into four groups (A) "spontaneous without injuries (except minor labial laceration)", (B) "c-section", (C)"episiotomy or perineal laceration", and (D) "operative vaginal delivery". RESULTS: The response rate of primiparae was 41% (655/1613). Forty-seven percent of women resumed sexual intercourse (SI) within 8 weeks after delivery. Altogether 31% of the women did not experience any pain during the first SI post-partum whereas 49% of all patients noted significant pain (medium, considerable or severe), depending on the mode of delivery (p = 0.007). Persistence of dyspareunia longer than 6 months was 3.5% (4/115; group A), 3.4% (2/58; group B), 11% (34/316; group C), and 14% (20/114; group D). CONCLUSIONS: Recently, female sexuality may not have been prominent in any discussion concerning possible advantages and disadvantages of different modes of childbirth. Our results should be taken into consideration when counseling patients antenatally regarding mode of delivery.

Effective management and intrauterine treatment of congenital cytomegalovirus infection: review article and case series.

OBJECTIVE: Human Cytomegalovirus (CMV) infection during pregnancy is the most frequent viral cause of intrauterine infection and responsible for various cerebral and other ultrasound abnormalities of the fetus. It is the leading infectious cause of mental retardation and sensorineural deafness in affected newborns and infants. We present three cases of primary cytomegalovirus infection in pregnancy and demonstrate three different scenarios of the disease with regard to clinical outcome and therapy options. We first report on CMV related phospho- and glycoprotein-specific antibody reactivities in amnion fluid that have not been reported earlier in literature. CASE PRESENTATION: Case 1: A 33-year-old Gravida II Para I was referred for primary CMV infection at 15 weeks gestation presenting with a history of fever. HIG therapy was performed resulting in good neonatal outcome. Case 2: A 23-year-old Gravida I was referred for targeted ultrasound at 23 weeks of gestation presenting with intrauterine growth retardation, multiple fetal hepatic echodensities and thickened placenta. Termination of pregnancy was initiated. Case 3: A 29-year-old Gravida II Para I was referred for primary CMV infection at 16 weeks gestation presenting with no clinical symptoms of CMV. HIG therapy was performed, resulting in good neonatal outcome. CONCLUSION: We want to stress the potential benefit of an off label use of CMV-specific hyperimmune globulin (HIG) therapy, present an algorithm for the management of affected pregnancies and review current literature on this issue.