[Testicular adrenal rest tumors (TART) in adult men with classic congenital adrenal hyperplasia (CAH)]. / Testikuläre adrenale Resttumoren (TART) bei erwachsenen Männern mit klassischem adrenogenitalen Syndrom (AGS).

BACKGROUND: Information about treatment of adult male patients with congenital adrenal hyperplasia (CAH) and testicular adrenal rest tumors (TART) is scarce. Diagnostic and therapeutic guidelines do not exist. The aim of this review is to evaluate the current state of therapeutic options in adult male patients with CAH. METHODS: We performed an extensive search of the literature of the last 10 years by using PubMed/MEDLINE. RESULTS: The aims of treatment in adult male patients with CAH are prevention of adrenal crisis and TART, improvement of general well-being, good quality of life and sexual well-being, fertility, and prevention of side effects of gluco- and mineralocorticoid therapy. However, fertility is impaired in these patients and correlates with TART. The current therapeutic concepts are discussed. CONCLUSIONS: A future system of regular follow-up visits and standards in therapeutic concepts is needed to guarantee an improved fertility and lifelong good quality of life in adult male patients with CAH.

Reduction in Staphylococcus aureus wound colonization using nasal mupirocin and selective decontamination of the digestive tract in extensive burns.

Following the introduction in 1988 of a regimen of selective decontamination of the digestive tract (SDD) for extensively injured patients in our burns centre, colonization rates with Gram-negative organisms declined significantly, but colonization with Staphylococcus aureus was unaffected. In an effort to reduce staphylococcal colonization, the SDD regimen has been supplemented with intranasal mupirocin since 1991. In this paper, 33 consecutive patients with burns of > 30 per cent TBSA who were treated with the supplemental regimen (SDD + M) in 1991 and 1992, were compared with 34 consecutive patients admitted in the previous 2 years who were treated with SDD only. Staph. aureus colonization of wounds, sputum and gastric aspirates was significantly reduced in the SDD + M group. Gram-negative colonization rates and the incidence of clinical infections remained low in both groups. Our experience suggests that decontamination of endogenous bacterial reservoirs, in combination with isolation measures to prevent exogenous colonization, effectively prevents infectious complications in patients with severe burns.

[Treatment of adult men with congenital adrenal hyperplasia syndrome due to 21-hydroxylase deficiency]. / Behandlung des klassischen adrenogenitalen Syndroms mit 21-Hydroxylase-Defekt bei erwachsenen Männern.

Information about the treatment of males with congenital adrenal hyperplasia (CAH) is scarce and there are no therapeutical guidelines. The aim of this review is to provide a survey of the current data. An extensive literature research was performed in PubMed for relevant articles published in the last ten years. The aim in the treatment of adult male CAH patients is preservation of fertility, prevention of an addisonian crisis, blood pressure management, prevention of testicular adrenal rest tumors (TART), maintaining well-being and good quality of life, satisfactory sexual function and prevention of long-term side effects of gluco- and mineralocorticoid therapy. The change from paediatric to adult medicine should be handled in a transition outpatient clinic organized by paediatric and adult endocrinologists. Most studies have included only small numbers of patients. The steroid therapy is usually orientated on an individual basis; but, general guidelines are lacking. It is reported that fertility is often impaired and related to the occurrence of TART. Some of these tumors are responsive to altered glucocorticoid therapy. However, glucocorticoid-resistant TART have been described, and testis-sparing surgery seems to be a treatment option. A future system of regular follow-up visits and standardized therapy guidelines are essential to provide a better medical care and a higher quality of life for male patients with CAH.

Prevention of infection in burns: preliminary experience with selective decontamination of the digestive tract in patients with extensive injuries.

Evidence from studies of trauma patients suggests that selective decontamination of the digestive tract (SDD) might also be of value in preventing colonization and infection by enteric organisms in burn patients. In a retrospective study, 31 consecutive patients with burns of greater than 30% of total body surface area, admitted over a 2-year period, who were treated with an SDD regimen, were compared with a similar group of 33 consecutive patients admitted in the 2 years immediately preceding the introduction of SDD. Fewer SDD-treated patients developed wound colonization with Pseudomonas species (29% vs. 61%), or with Enterobacteriaceae (10% vs. 73%). Similar reductions in colonization with gram-negative organisms were found in urine and gastric aspirates. There were fewer respiratory infections in the SDD group (6.5% vs. 27.3%), and only one patient developed septicemia, compared with eight in the control group (3.2% vs. 24.2%). Fewer SDD-treated patients died (one death, compared with seven in the non-SDD group). These results suggest that SDD may be of value in the management of patients with severe burn injuries, but further studies are required to test the validity of this conclusion.

Computed tomography as an adjunct to chest x-rays of intensive care unit patients.

An analysis of 23 CT scans performed on 20 patients was carried out in an approximate 2-yr period. In 15 patients, CT scans were judged useful by subsequent clinical course when they indicated maintenance or alteration of existing treatment strategies. CT scans in five patients were not helpful. When judged by eventual outcome, the impact of CT scans remains uncertain. The influence of transportation is difficult to assess; it requires experienced team work and is contraindicated in cases where respiratory or circulatory stability might be seriously impaired.