[The Strategic-Aeromedical-Evacuation-System of the German Armed Forces : Long-distance air transport as a challenge for intensive care nurses]. / Das Strategic-Aeromedical-Evacuation-System der Bundeswehr : Langstreckenlufttransport als intensivpflegerische Herausforderung.

This article presents the German Armed Forces Strategic Aeromedical Evacuation system. The following factors are described in detail: the path of alert, the used aircrafts, the medical equipment, the medical care personnel with its associated training as well as the aeronautical and medical issues. This military system for long haul intensive care transport offers many medical possibilities in critical care repatriations from deployment areas, as well as disaster relief missions. It has been successfully proven in numerous military and civil operations and continues to have high recognition among all military allies until today. Different priorities and readiness levels build the base for flexible use of various aircraft types and associated personnel, so that almost every scenario can be covered. The ever-changing tasks and needs of the German armed forces require constant adjustment of this air transport system. For the specialist nurse the intensive care of a patient during air transport is a technical and physical challenge.

[Swollen parotid gland and lower leg erythema. Presentation of differential diagnosis and therapy based on a case report]. / Parotisschwellung und Unterschenkel-Erythem. Darstellung von Differentialdiagnose und Therapie anhand einer Fallbeschreibung.

A 20-year-old woman developed erythema of the lower legs and swelling of both parotid glands. Her lung function parameters were initially unremarkable, and only discrete pulmonary-hilar changes were visible on the chest X-ray, and acute sarcoidosis was considered as one of the possible differential diagnoses. The paper describes in detail the diagnostic approach and the establishment of the differential diagnosis. The first attempts at therapy with the non-steroidal antiinflammatory drug diclofenac were unsuccessful, but treatment with glucocorticoids that was thereupon tried proved effective.

Detection of soluble adhesion molecules in pleural effusions.

PURPOSE: Multiple immune functions such as activation of T cells and monocytes or cytolysis of tumor cells are mediated via the adhesion receptor/ligand pairs CD2/LFA-3 and LFA-1/ICAM-1. Because soluble forms of LFA-3 (sLFA-3) and ICAM-1 (sICAM-1) can interfere with these functions, we asked whether increased levels of sLFA-3 and/or sICAM-1 can be found in malignant or inflammatory effusions compared with transudates. METHODS: sLFA-3 and sICAM-1 levels were measured by enzyme-linked immunoassays in pleural effusions from 70 patients (6 transudates, 10 inflammatory, 47 malignant, and 7 other effusions). Twenty pleural fluid samples were tested in parallel for the complete sLFA-3 molecule or sLFA-3-domain 1 only. RESULTS: Increased levels of sICAM-1 were found in all types of exudates compared with transudates. Highest levels of sICAM-1 were measured in malignant exudates, particularly in effusions caused by mesotheliomas, non-small lung cancers, and gynecologic malignancies. This was also true for sLFA-3. However, sLFA-3 levels were not increased in inflammatory effusions. sLFA-3 levels correlated significantly with protein, cholesterol, lactate dehydrogenase, and sICAM-1 levels. Comparison of sLFA-3-domain 1 and the complete sLFA-3 molecule revealed identical sLFA-3 levels, suggesting the absence of nonfunctional split products. CONCLUSIONS: Elevated levels of the complete sLFA-3 molecule were found in malignant pleural effusions, while sICAM-1 level was elevated in both inflammatory and malignant effusions. Secretion of sICAM-1 and sLFA-3 by tumor cells might block T-cell-mediated immune functions such as tumor cytotoxicity. Alternatively, secretion of soluble adhesion molecules might reflect the generalized inflammation within the pleural space.

Elevated surfactant protein A in bronchoalveolar lavage fluids from sarcoidosis and hypersensitivity pneumonitis patients.

Interstitial lung diseases often are accompanied by histopathologic evidence of alveolar type 2 cell alterations. In the alveolar milieu, the surfactant-specific protein A (SP-A) is a secretory product of alveolar type 2 cells. Therefore, we measured SP-A levels in bronchoalveolar lavage (BAL) fluids from patients with untreated sarcoidosis (n = 35) and hypersensitivity pneumonitis (HP [n = 10]) and compared the results with those from 21 healthy control subjects. In sarcoidosis patients, SP-A was markedly higher than in control subjects with a mean of 8.0 micrograms/ml of recovered BAL fluid +/- 0.7 SEM (p < 0.0001 compared with control subjects). In HP, SP-A values were comparable with those in sarcoidosis with a mean of 9.0 micrograms/ml +/- 1.7 SEM. Mean SP-A in the control group was 4.0 micrograms/ml +/- 0.3 SEM. These results suggest that SP-A secretion is stimulated in sarcoidosis and HP. Further studies seem justified to investigate the role of the surfactant system in interstitial lung diseases as well as the potential clinical usefulness of SP-A measurements in BAL.