[Current dermatology guidelines in Germany and Europe : A selection of clinically relevant recommendations]. / Aktuelle dermatologische Leitlinien in Deutschland und Europa : Eine praxisorientierte Übersicht ausgewählter Empfehlungen.

Clinical practice guidelines are systematically developed decision aids for specific medical conditions. In Germany, national dermatology guidelines are developed chiefly under the aegis of the German Dermatological Society in collaboration with the Professional Association of German Dermatologists. European and international dermatological guidelines also exist and are developed by a range of organisations, such as the European Centre for Guidelines Development, which was founded by the European Dermatology Forum in 2018. In the years 2019 and 2020, new or updated German national guidelines were published on topics such as pathological scars (hypertrophic scars and keloids), cutaneous lupus erythematosus, pyoderma grangrenosum, anal pruritus, anal eczema, anal canal and anal rim carcinomas, as well as the prevention of HPV-associated neoplasms through vaccination, syphilis and the systemic treatment of neurodermitis. A new European guideline on lichen planus closes a gap in the spectrum of guidelines available in Germany. Key recommendations and relevant changes in the guidelines are presented in this article.

EuroGuiDerm Guideline on the systemic treatment of Psoriasis vulgaris - Part 2: specific clinical and comorbid situations.

This evidence- and consensus-based guideline on the treatment of psoriasis vulgaris was developed following the EuroGuiDerm Guideline and Consensus Statement Development Manual. The second part of the guideline provides guidance for specific clinical and comorbid situations such as treating psoriasis vulgaris patient with concomitant psoriatic arthritis, concomitant inflammatory bowel disease, a history of malignancies or a history of depression or suicidal ideation. It further holds recommendations for concomitant diabetes, viral hepatitis, disease affecting the heart or the kidneys as well as concomitant neurological disease. Advice on how to screen for tuberculosis and recommendations on how to manage patients with a positive tuberculosis test result are given. It further covers treatment for pregnant women or patients with a wish for a child in the near future. Information on vaccination, immunogenicity and systemic treatment during the COVID-19 pandemic is also provided.

[Current guidelines in dermatology : A selection of clinically relevant recommendations]. / Aktuelle dermatologische Leitlinien : Eine praxisorientierte Übersicht ausgewählter Empfehlungen.

Guidelines are systematically developed decision aids for specific medical conditions. The German Dermatological Society, together with the German Professional Association of Dermatologists, takes the lead in the development of the guidelines for dermatology in Germany. In addition to national guidelines, European and international guidelines also exist. In 2014 and 2015 German guidelines on the following topics were newly developed or updated: cutaneous larva migrans, anticoagulation during dermatosurgery, pemphigus vulgaris and bullous pemphigoids, Mohs surgery, anal dysplasia, and anal carcinoma in HIV-infected patients. European guidelines on psoriasis vulgaris and hand eczema were updated among others. An international guideline on actinic keratosis was also published. The guidelines are available at www.awmf.org and www.euroderm.org .

[QR-Code based patient tracking: a cost-effective option to improve patient safety]. / QR-Code Patienten-Tracking: eine kostengünstige Möglichkeit zur Verbesserung der Patientensicherheit.

BACKGROUND: Hospitals are implementing a risk management system to avoid patient or surgery mix-ups. The trend is to use preoperative checklists. This work deals specifically with a type of patient identification, which is realized by storing patient data on a patient-fixed medium. MATERIAL AND METHODS: In 127 ENT surgeries data relevant for patient identification were encrypted in a 2D-QR-Code. The code, as a separate document coming with the patient chart or as a patient wristband, has been decrypted in the OR and the patient data were presented visible for all persons. The decoding time, the compliance of the patient data, as well as the duration of the patient identification was compared with the traditional patient identification by inspection of the patient chart. RESULTS: A total of 125 QR codes were read. The time for the decrypting of QR-Code was 5.6 s, the time for the screen view for patient identification was 7.9 s, and for a comparison group of 75 operations traditional patient identification was 27.3 s. Overall, there were 6 relevant information errors in the two parts of the experiment. This represents a ratio of 0.6% for 8 relevant classes per each encrypted QR code. CONCLUSION: This work allows a cost effective way to technically support patient identification based on electronic patient data. It was shown that the use in the clinical routine is possible. The disadvantage is a potential misinformation from incorrect or missing information in the HIS, or due to changes of the data after the code was created. The QR-code-based patient tracking is seen as a useful complement to the already widely used identification wristband.

[Intraoperative use of electronic patient records by the surgeon. An evaluation of the "MI Report" in ENT surgery]. / Intraoperative Bedienung einer elektronischen Patientenakte durch den Operateur. Einsatzbeurteilung des MI-Reports in der HNO-Chirurgie.

MOTIVATION: Surgeons often wish to view patient data during surgical procedures. To achieve this, the surgeon normally has to get unsterile to view the record himself, or request a nurse to do so. This procedure results in a time delay, longer anesthesia and higher treatment costs. MATERIAL AND METHODS: The "MI Report" (Karl Storz, Tuttlingen, Germany) was evaluated for its impact in ENT surgery in daily routine. The system consists of a sensor for gesture recognition and a large 52-in. display positioned centrally in the operating room. Usage of the system by the surgeon was recorded in 51 surgical procedures. RESULTS: Information was retrieved from the display on average 1.2 times per procedure. The system was not used at all in 20% of operations. The operation with the highest usage rate was tympanoplasty (1.6 views per operation). In 86% of cases, the system was used to confirm the therapy underway or make a decision on how to proceed with therapy. When trying to activate the system by making a particular hand gesture, the surgeon cancelled activation in 31% of attempts. CONCLUSION: A relation between the type of operation and information viewed could be shown. A benefit for the patient may be assumed on the basis of the reduced effort required to retrieve patient data as well as increased intraoperative consultation of patient records. The system provides the surgeon with greater flexibility and may reduce operating time.

Variations in cell surfaces of estrogen treated breast cancer cells detected by a combined instrument for far-field and near-field microscopy.

The response of single breast cancer cells (cell line T-47D) to 17beta-estradiol (E(2)) under different concentrations was studied by using an instrument that allows to combine far-field light microscopy with high resolution scanning near-field (AFM/SNOM) microscopy on the same cell. Different concentrations of E(2) induce clearly different effects as well on cellular shape (in classical bright-field imaging) as on surface topography (atomic force imaging) and absorbance (near-field light transmission imaging). The differences range from a polygonal shape at zero via a roughly spherical shape at physiological up to a spindle-like shape at un-physiologically high concentrations. The surface topography of untreated control cells was found to be regular and smooth with small overall height modulations. At physiological E(2) concentrations the surfaces became increasingly jagged as detected by an increase in membrane height. After application of the un-physiological high E(2) concentration the cell surface structures appeared to be smoother again with an irregular fine structure. The general behaviour of dose dependent differences was also found in the near-field light transmission images. In order to quantify the treatment effects, line scans through the normalised topography images were drawn and a rate of co-localisation between high topography and high transmission areas was calculated. The cell biological aspects of these observations are, so far, not studied in detail but measurements on single cells offer new perspectives to be empirically used in diagnosis and therapy control of breast cancers.

Affinities at the verapamil binding site of MDR1-encoded P-glycoprotein: drugs and analogs, stereoisomers and metabolites.

OBJECTIVES: The multidrug transporter P-glycoprotein (P-gp) appears to play a significant role in drug absorption and disposition. Hence, it is of interest to evaluate structure-affinity relationships for the purpose of making predictions. METHODS: The affinity to P-gp of related molecular structures from various groups of drugs was determined using competitive radioligand-binding assays. Structural analogs, stereoisomers and metabolites of verapamil-type calcium antagonists, beta-adrenoceptor antagonists as well as omeprazole, omeprazole enantiomers and the sulfone metabolite of omeprazole were investigated. RESULTS: Whereas some stereoselectivity was detected for the high-affinity P-gp substrates verapamil and carvedilol, little or no differences were observed in the case of other beta-blockers. One of the 4 labetalol stereoisomers, the R,R-isomer dilevalol, had an IC50 value half that of labetalol. CONCLUSIONS: Metabolites of verapamil, gallopamil, carvedilol and omeprazole are characterized by having higher IC50 values (lower P-gp affinity) than the respective parent compounds. Only the acebutolol metabolite, diacetolol, had a P-gp affinity comparable to that of the parent compound.

Photodynamic Therapy of Malignant Ovarian Tumours Cultivated on CAM.

The disappointing results with either surgery alone and/or chemotherapy in the treatment of malignant ovarian tumours have led to an increased interest in additional treatment schedules. Photodynamic therapy (PDT), a modality involving the use of a photosensitising drug and activating light, is being used increasingly as a local treatment for neoplastic lesions. The synthesis and evaluation of new photosensitisers for the treatment of gynaecological lesions and malignancies continues to be an active area of investigation for proper application of the photodynamic process in the gynaecological field. The effect of PDT using methylene blue (free and combined with liposomes) as a photosensitiser for treating human ovarian malignant tumours cultivated on the chorioallantoic membrane was evaluated. Two days after PDT, the treated implanted tumours were markedly decreased in size. Areas of necrosis with black coloration, dryness and eschar formation were observed. Five days after PDT, tumour remission was clearly observed in all the treated tumours. Photodynamic therapy using methylene blue (aqueous and coupled with liposomes) is effective for treating the ovarian malignancies and it will be capable of achieving complete eradication of visible tumours in patients with superficial lesions.

13(2)-hydroxy-bacteriopheophorbide a methyl ester pharmacokinetics measurements with fluorescence versus absorption spectroscopy. Is there a difference?

OBJECTIVE: Quantification of photosensitizer concentration in tissue improves the planning and, subsequently, the outcome of photodynamic therapy. This study was designed to determine if the method of photosensitizer evaluation influences the accuracy of pharmacokinetic results. MATERIALS AND METHODS: In vivo 13(2)-Hydroxy-bacteriopheophorbide a methyl ester (13(2)-OH-BPME) pharmacokinetics in mice bearing LEWIS lung carcinoma was studied using fluorescence in situ and absorption spectroscopy (following photosensitizer chemical extraction) as photosensitizer quantification methods. The correlation of 13(2)-OH-BPME fluorescence intensity and its concentration using the absorption spectroscopy were determined for each tissue. RESULTS: The parenchymatous organs showed maximum 13(2)-OH-BPME concentration and fluorescence intensity at 2 h post-injection (lung, liver, spleen), and at 2 h post-injection in the kidney with both quantification methods (identical correlation). There was a difference in the time of maximum photosensitizer fluorescence intensity and its concentration in tumor, muscle, and skin (low correlation). The time of maximum fluorescence intensity in muscle, skin, and tumor was at 4 h, 12 h, and 12 h post injection respectively while its maximum concentration was at 2 h, 4 h, and 8 h post-injection. CONCLUSION: The method of photosensitizer evaluation affects the accuracy of its pharmacokinetic results.

Pharmacokinetic analysis of octa-alpha-butyloxy-zinc phthalocyanine in mice bearing Lewis lung carcinoma.

OBJECTIVE: In this study, the pharmacokinetics of octa-alpha-butyloxy-zinc phthalocyanine (8-alpha-bo-ZnPc) was studied with regard to Lewis lung carcinoma in mice after intravenous administration of 7.8 mumole/kg body weight at different incubation intervals. SUMMARY BACKGROUND DATA: The newly synthesized potential photosensitizer 8-alpha-bo-ZnPc is characterized by a high absorption coefficient at the far red wavelength (735 nm) with a good singlet oxygen quantum yield. METHODS: After intravenous administration of 7.8 mumole/kg body weight in mice bearing Lewis lung carcinoma, the accumulated photosensitizer was chemically extracted (at incubation intervals of 2, 6, 12, 24, 48, and 168 hours) from selected tissues, and the concentrations were measured by absorption spectroscopy. RESULTS: The parenchymatous organs, liver, and spleen showed maximum 8-alpha-bo-ZnPc concentrations after 6 hours of incubation. An extensive uptake was detected in lung extracts taken at 6, 12, 24, and 48 hours. The malignant tissue did not accumulate high 8-alpha-bo-ZnPc during the entire investigation period. The photosensitizer extracted from muscle, representing normal tumor-surrounding tissue and skin, was even lower. CONCLUSIONS: Because of the extremely low accumulation rate of the tumor, 8-alpha-bo-ZnPc is suggested to be administered topically or in combination with a suitable carrier system in order to increase the photosensitizer concentration in the target tissue, as well as to decrease the loss of dye to other tissues.

Modulation of 5-ALA-induced PpIX xenofluorescence intensities of a murine tumour and non-tumour tissue cultivated on the chorio-allantoic membrane.

Exogenous administration of 5-aminolaevulinic acid (5-ALA), an early precursor in haem synthesis, induces accumulation of endogenous photo-active porphyrins, particularly protoporphyrin IX (PpIX). Modulation of 5-ALA-induced PpIX-xenofluorescence intensities of a murine tumour and normal (non-tumour) tissue was studied in vivo on the chorio-allantoic membrane (CAM) of fertilized chicken embryos. Tumours were grown from the murine fibrosarcoma cell line SSK II. Murine 3T3 fibroblasts (clone A31) were used for cultivating normal tissue. The autofluorescence and xenofluorescence intensities of 5-ALA-induced PpIX xenofluorescence were compared. After administration of 5-ALA to the CAM inoculated tissues, the SSK II tumours exhibited higher xenofluorescence intensities than the 3T3 tissues. Autofluorescence intensities of both types of tissue were not distinguishable. The effects of several biochemical reagents on the xenofluorescence intensities of the fibrosarcoma and fibroblast tissues were investigated. In both tissue types, the intensities increased after incubation with glucose and antimycin A, while nicotine-adenine-dinucleotide increased the 3T3 fibroblast xenofluorescence more than the SSK II fibrosarcoma xenofluorescence. Incubation with dimethyl sulphoxide (DMSO) attenuated 5-ALA-induced PpIX xenofluorescence, while oxamic acid attenuated the 3T3 fibroblast xenofluorescence more effectively than the xenofluorescence of SSK II fibrosarcoma. Ethanol and 2-iodoacetamide drastically decreased xenofluorescence intensities in both tumour and normal tissue.

[The characteristics of colloid osmotic pressure and hematocrit following human albumin substitution as an indication of permeability disorders in septic complications]. / Das Verhalten des kolloidosmotischen Druckes und des Hämatokrits nach Humanalbumin-Substitution als Hinweis auf das Vorliegen von Permeabilitätsstörungen bei septischen Komplikationen.

Out of a pool of the postoperative intensive care patients in Anaesthesiological and Intensive Care Clinic, Berlin-Friedrichshain, 26 patients with hypoalbuminaemia after major abdominal surgery were selected. Septic complications occurred in 13 patients. In a comparative study we analysed colloid osmotic pressure and haematocrit after substitution of human serum albumin. In cases of septic complications, human serum albumin substitution did not lead to an increase of colloid osmotic pressure and in all cases the haematocrit persisted at the initial value or rose. It is discussed that both parameters can be early references to permeability disturbances. Uncritical use of human serum albumin in septic patients can be the cause of disturbances of organ functions, especially of the lungs. An alternative for improving the oncotic situation is the use of high molecular weight hydroxy-ethyl-starch (molecular weight 200,000).

[The substitution effect of human albumin in postoperative aseptic and septic disease courses]. / Der Substitutionseffekt von Humanalbumin bei postoperativen aseptischen und septischen Krankheitsverläufen.

Under standardized conditions in 102 patients the necessity and the efficiency of human albumin addition in the postoperative phase following abdominal and vascular operations was examined by measuring the colloid osmotic pressure in plasma (COPp). After vascular operations in 3 of the patients (8.6%) and after abdominal operations in 49 of the patients (73.1%) human albumin had to be substituted. During aseptic courses 3 hours and 24 hours after substitution with 5% or 20% solutions of human albumin significant increase of COPp was measured compared to the initial values. Since in septic courses a positive effect of human albumin addition using a 5% solution is uncertain and because the hereby necessary addition of relatively large fluid volume increases the danger of an "overload", only 20% solutions of human albumin should be used in such cases if indicated.

Neuroblastoma: a rare primary intrathoracic neurogenic tumor in adults.

Mediastinal neuroblastomas, which are common malignancies of childhood, are extremely rare in adults. This article presents a case of mediastinal neuroblastoma in a 57-year-old man. To the authors' knowledge, this is only the second recorded case of such a tumor in an adult. The patient's clinical course is described and is compared with other cases (in children, except for one instance) cited in the literature. The authors discuss the early diagnosis and surgical management of these uncommon lesions, which tend to be quite extensive and rapidly fatal, and which should be suspected in adults who present with a mediastinal mass.