In situ identification of lymphoreticular cells in benign and malignant infiltrates by membrane receptor sites.

Immunologic membrane markers have been utilized for the in situ identification of lymphoreticular cells within lymphoreticular tissues and in inflammatory and neoplastic lymphoreticular infiltrates of the skin. Frozen sections were layered with untreated sheep red blood cells (SRBC) for the detection of the E receptor on T cells, SRBC coated with 7S antibody for the detection of the Fc receptor (IgGEA) and SRBC coated with 19S antibody and complement (IgMEAC) for the detection of the C3 receptor. In normal lymphoreticular tissue, IgGEA selectively bound to areas colonized by macrophages, IgMEAC to B-dependent areas, whereas E showed no adherence. In chronic lymphatic leukemia, a predominant and selective adherence of IgMEAC was found in lymphoreticular organs which supports the B-cell nature of the neoplastic cells; in leukemic reticuloendotheliosis a selective IgMEAC adherence was observed and this favors a monocytoid origin of the hairy cells. Adherence of any indicator cell was practically absent from skin infiltrates of mycosis fungoides, which represents an additional piece of evidence for the T-cell nature of this disease process. In psoriasis, a considerable binding of IgGEA was observed, whereas IgMEAC did not adhere at all. This result indicates that the lymphocytic part of the infiltrate in this disease consists mainly of T cells.

[The radiological and scintigraphic findings in psoriatic arthropathy (author's transl)]. / Röntgen- und szintigraphische Befunde bei Psoriasis arthropatica

The radiological and scintigraphic findings in the skeletons of patients with psoriasis and psoriatic arthropathy are described. The results indicate that is it possible to detect inflammatory disease in joints by scintigraphy in patients who have not yet developed symptoms. The effect of treatment can be satisfactorily followed by serial scans. Further investigations and observations will be required to show whether the paravertebral calcification and syndesmophyte formation which has been described is really pathognomonic for psoriatic arthropathy.

Functional reconstruction of the upper eyelid after excision of squamous cell carcinoma in xeroderma pigmentosum.

This paper describes a technique for excision of a squamous cell carcinoma of the upper eyelid and subsequent functional reconstruction of the lid in a patient with xeroderma pigmentosum. By applying the modified technique of temporalis muscle flap, the upper eyelid was reconstructed by a skin graft from non-sun-exposed skin and a muscle pocket of the temporalis muscle. For the mucosal layer of the upper eyelid, a transplant of oral mucosa was used. An effective functional and aesthetic outcome has been achieved by this technique.

[Free skin grafts in plastic surgery. Transplantation techniques and indications (author's transl)]. / Die freien Hauttransplantationen in der Dermato-Chirurgie; Technik und Indikationsstellung

Basic techniques and indications for free split and full-thickness grafts are outlined on the basis of experience gained in surgical management of selected cases at the First Department of Dermatology, University of Vienna. A well-prepared wound bed, correct choice of procedure, good operative and dressing technique and careful follow-up therapy lead to good results which are also aesthetically acceptable to the patient.

[Treatment of burned children--current therapeutic principles (author's transl)]. / Fortschritte der Medizin in Einzeldarstellungen, XXI.

This paper deals with the working plan of immediate care, parenteral nutrition and surgery in burned children according to experience gained in the treatment of these children at the specialist Burns Unit of the Department of Dermatology (I) of the University of Vienna. Features peculiar to this age group lie in the appropriate recommendations for shock therapy and prophylaxis as well as parenteral nutrition. The guidelines for surgical treatment of burns are basically similar in adults and children.

[Management of the critically burned geriatric patient (author's transl)]. / Der Verbrennungsunfall beim alten Menschen.

This paper deals with the specialised therapeutic needs regarding immediate care, parenteral nutrition and surgery in burned geriatric patients according to the experience gained in the treatment of these patients at the Burns Treatment Division of the Department of Dermatology (I) of the University of Vienna.

[Systemic candidiasis in the severely burned patient (author's transl)]. / Die systemische Candidose bei schweren Verbrennungen

As a result of progress in the modern treatment of burns, systemic candidosis (CA), in the sense of "surviving mycoses", has become increasingly frequent. The site of entry is not usually the wound, but the intestinal tract, which becomes overgrown by the yeasts as a consequence of the requisite therapy with antibacterial antibiotics in high dosage. Passage of the organism into the circulation occurs by persorption. In view of the bad prognosis of systemic CA, it is essential to recognize its incipient development and counteract by timely prophylactic measures, primarily sterilization of the intestine. In a developed case os systemic CA, the chances of cure improve with rapidity of recognition of the infection and initiation of treatment. Early diagnosis of the infection is achieved by the regular quantitative determination of the organism in the faeces, in urine and blood, as well as in swabs of mucous membranes and the wounds and, above all, by serological examination (movement of titre). The practical problems of the disease are demonstrated and discussed on the basis of 2 cases treated in this department.

[Early repeated, limited excision of deep burns with immediate meshed autografting (author's transl)]. / Die partielle frühe und tiefe Nekrosenexzision bei drittgradigen Verbrennungen mit sofortiger autologer Netztransplantation

A case is reported of the successful treatment of severe, third-degree burns by early limited, but repeated electrocautery excision and immediate meshed autografting. The concept of such attempts to convert large areas of full-thickness burns into a clean closed wound by means of the described techniques if discussed. A decrease in morbidity and mortality can be anticipated when this procedure is carried out for the correct indications by an experienced specialist team. Particular attention must be paid to the optimum, patient-geared timing of each surgical stage.

[The present stand of knowledge in the general treatment of burns: a review (author's transl)]. / Zum gegenwärtigen Stand der Verbrennungsbehandlung. Allgemeintherapeutische Gesichtspunkte

This review article reports the present stand of knowledge in regard to recent therapeutic developments in the general management of severe burns. Especial emphasis is placed on the importance of parenteral nutrition, qualitatively and quantitatively correct fluid replacement and acidosis phrophylaxis or early, specific treatment of acidosis for survial.

[Penicillin-induced acute renal failure as a rare severe complication of erysipelas treatment]. / Penicillin-induziertes akutes Nierenversagen als seltene schwere Komplikation der Erysipelbehandlung.

Penicillins are the most commonly used antibiotics in dermatology owing to their bacteriocidal effect and the high responsiveness of most bacterial dermatoses to penicillin treatment. Although there is a wide range of adverse reactions to penicillins, severe complications are seen very rarely. We report on two cases of penicillin-induced acute interstitial nephritis and summarize the characteristic features of this serious adverse reaction to penicillin administration.

[Local therapy of extensive severe burns: an illustrative review (author's transl)]. / Zur Lokaltherapie ausgedehnter, tiefer Verbrennungen unter Berücksichtigung eigener Erfahrungen

Apart from improvements in general management, the implementation of modern local therapy of burns, including topical chemotherapy and early surgical coverage of the burned surface, has significantly reduced the morbidity and mortality of severely burned patients. Furthermore, the average time of hospitalization has decreased (for example: 3rd degree burn, 60% of body surface involved, hospitalization in 1953: 11 months; in 1974: 5 1/2 months) and the rehabilitation period has also been shortened. This paper deals with current management at this department in respect to the local treatment of extensive 3rd degree burns. Special consideration is given to the different possibilities of wound closure and their indications, to therapeutic problems inherent in the special localization of certain burns and to the importance of physical therapy for early rehabilitation. In severe burns additional injuries should be considered and excluded by careful examination.

[Treatment of metastatic malignant melanoma (author's transl)]. / Klinische Erfahrungen mit DTIC beim metastasierenden Melanom.

24 patients with metastatic malignant melanoma were treated with DTIC applied alone or in combination with other cytotoxic agents (Oncovin, Bleomycin, Adriblastin). Treatment resulted in objective improvement (3 patients), subjective improvement (2 patients), stable state (5 patients). The other patients showed further progression of their disease.

Balancing relationship and discipline: the pressing concern of mothers of early-adolescent girls.

Mothers of early-adolescent girls (10-14 years) often experience difficulties in dealing with their daughters. This study explored the mother-daughter relationship from the perspective of the mothers, to identify their most pressing concern and the strategies that might help them address this concern. A qualitative design employing a feminist participatory approach was used with 2 groups of mothers living in low socioeconomic status (SES) areas of a small city in Ontario, Canada, over a 10-week period. The most pressing concern of both groups was balancing relationship and discipline. Through the use of questioning to explore their issues, the mothers gained the reassurance, knowledge, skill, and confidence to deal with their daughters. This introductory study should contribute to nurses' understanding of the mother-daughter relationship during adolescence, and it offers a small-group strategy that shows promise in assisting mothers to address their concerns.

[Basalioma]. / Das Basaliom.

The basal cell carcinoma (BCC) is one of the most frequent tumours. The entire destruction of the BCC is the aim of the therapy. The different methods of treatment have to respect the biological type, the histologic form of the BCC. Tumours at critical localizations (face, hands and feet) should be controlled microscopically, if the tumour has been excised totally. By the microscopic control fatal destructive recurrence can be avoided. The dermatologic treatment of BCC offers different methods in respect to the biological type and localization of BCC and also in respect to the age of the patient.

Looking beyond caseload numbers for long-term home-care case managers.

Determining the best use of case managers' time is difficult both because of the great variability in the factors and the lack of outcome studies. In place of the outcome studies, the responses to focus group questions of 89 experienced case managers from across Canada were used to indicate a value for case management functions in the areas of direct care, indirect care management, and program management. The case managers identified greater value for direct care with clients and families who are new to home care or who have complex problems in comparison to clients in more stable or manageable situations. Case managers were frustrated by the lack of agency and community policies and resources to allow case managers to properly support people in their homes. The case managers valued addressing problems on a program or community basis rather than the usual case-by-case. Although preliminary, the approach could be useful in assessing the efficient and effective use of a scarce resource, case managers' time.

Non-return valves do not prevent backflow and bacterial contamination of intravenous infusions.

Non-return valves (NRVs) are designed to avoid backflow of infusion fluid against the designated direction of flow (DDF) when more than one infusion is delivered via one venous access. We tested in vitro whether NRVs reliably prevent flow against the DDF at clinically relevant low flow rates. Since catheter-related infections caused by the infusion of contaminated fluids represent a relevant problem in patient care, we tested whether NRVs preclude bacterial contamination of infusions proximal to the NRVs and thus might play a role in preventing healthcare-associated infections. Additionally, the incidence of bacterial contamination of drips and infusion fluids in our intensive care unit (ICU) was quantified. In vitro, a low flow against the DDF of ten examples each of five different NRV models was applied and the integrity for fluid and transmigration of three different indicator micro-organisms was tested. Second, we investigated whether contamination of intravenous infusion tubing collected from patients treated on our ICU occurred. Largely independent from the model, 40% of the tested NRVs were not leak-tight for fluids when a pressure against the DDF was built up slowly. In 30%, bacteria migrated against the DDF and were detected proximal to the valve. In 6.7% of the tubing samples collected from ICU patients we detected bacterial contamination. In conclusion, contamination of drips is a relevant problem on ICU. NRVs neither reliably prevent backflow of fluids nor serve as micro-organism filters. Therefore they cannot be recommended as a way of reducing healthcare-associated infections.

Prediction of non-sentinel node status and outcome in sentinel node-positive melanoma patients.

AIMS: Sentinel lymph node (SLN) -positive melanoma patients are usually recommended completion lymph node dissection (CLND) with the aim to provide regional disease control and improve survival. Nevertheless, only 20% these patients have additional metastases in non-sentinel lymph nodes (NSLN), indicating that CLND may be unnecessary in the majority of patients. In this retrospective study, we (i) sought to identify clinico-pathological features predicting NSLN status, as well as disease-free (DFS) and -specific (DSS) survival and (ii) evaluated the applicability of previously published algorithms, which were able to define a group of patients at zero-risk for NSLN-metastasis. METHODS: This analysis included 504 consecutive melanoma patients stage I and II who underwent successful SLN-biopsy (SLNB) at our institute between 1998 and 2005. Metastatic SLN were re-evaluated for tumor burden and categorized according to two different micro-anatomic classifications and the S/U-score (Size of the sentinel node metastasis > 2 mm/Ulceration of the primary melanoma) was assessed. DFS and DSS were calculated for all analyses. RESULTS: Out of 504 melanoma patients stage I or II, 85 (17%) were SLN-positive and 18 of 85 (21%) were found with positive NSLN in the CLND specimen. Median follow-up was 31 months. Neither primary tumor characteristics (age, gender, Clark level, Breslow thickness, ulceration of the primary melanoma, site and histological subtype of the primary melanoma), nor features of the sentinel node tumor (number and site of draining lymph node basins, number of positive sentinel nodes and size of sentinel node tumor (< 2 mm vs. > or = 2 mm) were able to predict additional positive lymph nodes in the CLND specimen. Likewise the implementation of published algorithms was not able to identify patients at negligible risk for harboring NSLN metastases. Upon univariate analysis, disease-free survival in SLN-positive patients was correlated with Breslow thickness, sentinel node tumor size > 2 mm and S/U score. In respect to disease-specific survival the significant prognostic parameters were Breslow thickness, ulceration, sentinel node tumor size > 2 mm and the S/U score. After a median follow-up of 31 months recurrence rates (37% vs. 78%, p=0.02) and death from disease (24% vs. 50%, p<0.01) were significantly different in patients with SLN-metastasis only as compared to patients with NSLN-metastasis. CONCLUSION: NSLN status cannot be predicted in this data analysis by using clinico-pathological characteristics. Therefore, CLND is recommended for all patients after positive SLNB pending the results of the second Multicenter Selective Lymphadenectomy Trial.

Expression of RPE65, a putative receptor for plasma retinol-binding protein, in nonmelanocytic skin tumours.

BACKGROUND: In a recent report we described RPE65, a protein originally characterized in retinal pigment epithelium, to be expressed in normal human epidermis. RPE65 is suspected to be involved in cellular uptake of retinol which is transported in the bloodstream complexed with plasma retinol-binding protein. OBJECTIVES: To evaluate protein and mRNA expression of RPE65 in actinic keratosis (AK), squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) compared with normal skin. METHODS: RPE65 mRNA expression in skin tumours relative to normal skin of the respective donor was studied by real-time polymerase chain reaction in AK (n = 15), invasive SCC (n = 30) and BCC (n = 18). A peptide-specific anti-RPE65 antibody was used for immunohistochemical staining of formalin-fixed and paraffin-embedded tissue sections of the respective tumours. RESULTS: RPE65 mRNA expression was reduced in AK. A highly significant reduction of RPE65 mRNA was observed in invasive SCC relative to normal skin of the respective donors. Immunohistochemistry revealed a continuous staining of basal and suprabasal keratinocytes in normal human epidermis. RPE65 in AK shown by immunohistochemical staining was reduced and quite irregular, whereas invasive SCC revealed no staining of tumour cells with the anti-RPE65 antibody. RPE65 mRNA values were elevated, whereas immunohistochemical staining for RPE65 protein was heterogeneous in BCC. CONCLUSIONS: These results suggest progressive downregulation of RPE65 from AK to invasive SCC.

Sentinel node status in melanoma patients is not predictive for overall survival upon multivariate analysis.

Sentinel lymph node biopsy (SLNB) has become a widely accepted standard procedure in the staging of patients with cutaneous melanoma and absence of clinical lymph node metastases, although there is no final proof that SLNB influences overall survival in these patients. This study investigated the accuracy of SLNB and the clinical outcome of patients after a mean follow-up of 22 months. Between 1998 and 2003, SLNB was performed in 309 consecutive patients. Patients with one or more positive sentinel lymph nodes (SLNs) were subjected to selective lymphadenectomy (SL). Survival analyses were performed using the Kaplan-Meier approach. A Cox proportional-hazard analysis was used for univariate and multivariate analysis to explore the effect of variables on survival. Sentinel lymph nodes were identified in 299 of 309 patients (success rate: 96.8%). Of these, 69 (23%) had a positive SLN. The false-negative rate was 9.2%. Recurrence of disease to the regional lymph node basin (3.0%) and to the locoregional skin (2.6%) was rare in SLN-negative patients in contrast to SLN-positive patients (7.2 and 17.4%, respectively). The 3-year overall survival was 93 and 83% for SLN-negative and SLN-positive patients, respectively. Upon multivariate analysis, SLN status (P<0.001), Breslow thickness (P<0.02) and ulceration (P<0.026) were all found to be independent prognostic factors with respect to disease-free survival, whereas Breslow thickness proved to be the only significant factor with respect to overall survival.