[Renaissance of mouse favus : Retrospective analysis of Trichophyton quinckeanum infections at Jena University Hospital in the period 2015-2020]. / Renaissance des Mäusefavus : Retrospektive Analyse der Trichophyton-quinckeanum-Infektionen am Universitätsklinikum Jena im Zeitraum 2015 bis 2020.

The number of Trichophyton quinckeanum infections has increased significantly in recent years. In 2020 in particular, the number of cases increased fivefold compared to 2015. Infections multiplied, especially in the second half of the year, which correlated with the upsurge in field mouse populations. Typical vectors are mice and rats as well as dogs and cats, which hunt the rodents. The animals are usually asymptomatic. In humans, on the other hand, the course is usually more inflammatory corresponding to other zoophilic mycoses. Typical clinical manifestations of the infections are tinea corporis and tinea capitis. Treatment of T. quinckeanum infections is similar to other dermatophyte infections, depending on the severity, location and age of the patient as well as the immune status, previous illnesses and medication. The duration of local therapy should be at least 4 weeks and continued for up to 14 days after the normalization of the skin presentation. Systemic treatment should take place with terbinafine 250 mg once a day orally (in adults). Alternatives are itraconazole, fluconazole and griseofulvin. Only the preparation griseofulvin, which is no longer available in Germany, is approved for children. Alternatively, terbinafine, itraconazole or fluconazole can also be used in children as an "off-label" treatment in an individual healing attempt.

Mating analyses of Trichophyton benhamiae offspring reveals linkage of genetic markers used in taxonomy.

Mating experiments were conducted with four clinical Trichophyton benhamiae isolates, genetically similar to the Trichophyton benhamiae CBS 112371, featuring the plus mating type and with two minus type strains. One minus type strain belonged to the white subgroup, and the other minus type strain, DSM 6916, showed genetic kinship to the yellow subgroup. Only two plus type strains were able to form mature, pigmented gymnothecia with DSM 6916. These two plus type strains demonstrated dark pigmentation and powdery mycelium on Takashio agar, whereas the other three strains exhibited a low degree of pigmentation on the same medium. All five plus strains were able to mate with the minus type strain of their own white subgroup. Cultures from single ascospore isolates showed highly variable morphology and pigmentation. Three genetic markers (ITS, mating type, EF1 alpha) were analyzed in polymerase chain reaction (PCR) experiments with optimized primers and PCR conditions to discriminate between subgroups. Furthermore, RAPD-PCR was used to generate a DSM 6916-specific DNA-fragment which served as an additional genetic marker. Assessing the isolates with recombinant genotypes, it was found that three genetic markers behave like linked genes. The recombination of plus mating type went together with ITS, EF1 alpha and RAPD marker of the DSM 6916 parental strain and was most frequently isolated, whereas plus types recombinants in this case were completely missing. This shows a high imbalance in mating type distribution of recombinants.

[Dermatophytosis caused by rare anthropophilic and zoophilic agents]. / Dermatophytosen, verursacht durch seltene anthropophile und zoophile Erreger.

The basis for effective treatment of any dermatomycosis is the correct and timely identification of the pathogen, which allows the targeted choice of the most suitable antimycotic and is important for the prevention of repeated infections. In recent years, infections with dermatophytes seem to have increased. In fact, from 2007 to 2018, there was an increase in the number of samples processed in the Mycology Laboratory of the Department of Dermatology at the University Hospital Jena. The most common isolated dermatophytes between 2007 and 2018 were Trichophyton (T.) rubrum, T. interdigitale, Microsporum (M.) canis and T. benhamiae. However, dermatophytoses may also be caused by rare anthropophilic agents such as Epidermophyton floccosum, zoophiles such as T. verrucosum, T. quinckeanum or Nannizzia (N.) persicolor as well as by geophiles such as N. gypsea. Therefore, these dermatophytes should at least be known, so that in case of unusual observations investigations can be performed accordingly. Changes in the pathogen spectrum of dermatophytoses have taken place over time and it is expected that the occurrence of dermatophytes will be subject of continuous fluctuations, which may mean that the incidence of some of these "rare" dermatophytes, as described here in five clinical examples, may be changing.

[Infection with a rare geophilic dermatophyte]. / Infektion mit einem seltenen, geophilen Dermatophyten.

There are 12 dermatologically relevant Microsporum (M.) species. The most frequent species are M. canis, M. audouinii and M. gypseum. We report an infection of the right forearm with the rare dermatophyte M. fulvum. A KOH examination of scales revealed a tinea corporis. The scales were cultured on Dermasel(R) agar with the identification of the geophilic dermatophyte M. gypseum. However, ITS sequencing and mass spectrometry revealed M. fulvum as the correct pathogen.

Electromotive drug administration for treatment of therapy-refractory overactive bladder.

PURPOSE: Evaluate the benefits of electromotive drug administration (EMDA) as an alternative technique in patients with chronic overactive bladder in terms of improvement of symptoms, quality of life, and sexuality. MATERIAL AND METHODS: A total of 72 patients with therapy-refractory overactive bladder according to the ICS (International Continence Society) definition, were treated by EMDA. The regimen consisted of three treatment cycles, each with 3 instillations at 2-week intervals. The solution instilled consisted of 100 mL 4% lidocaine, 100 mL distilled water, 40 mg dexamethasone, and 2 mL epinephrine. Peri-interventionally, a urine test and close circulatory monitoring were performed. All women underwent urodynamic testing and cystoscopy and kept a voiding diary. A comprehensive history was obtained, a quality of life questionnaire administered, and a gynecologic examination performed before initiation of therapy. The women underwent follow-up at 12 months after the end of therapy. RESULTS: The patients had a mean age of 63 (+/- 11.2) years. Bladder capacity improved significantly by 109 mL (+/- 55 mL) in 51 (71%) patients (p = 0.021). The number of micturitions/day decreased significantly to 7 (+/- 2) (p = 0.013). Quality of life was improved in 54 patients (75%); p = 0.024) and sexuality in 39 (54%); p = 0.020). CONCLUSIONS: The results suggest that EMDA can improve both quality of life and sexuality in patients with therapy-refractory chronic overactive bladder.

[Management of female stress urinary incontinence. Endoscopic extraperitoneal artificial urinary sphincter--early experience]. / Therapie der weiblichen Belastungsinkontinenz. Endoskopische extraperitoneale Implantation des artifiziellen Blasenhalssphinkters--erste Erfahrungen.

Implantation of an artificial urinary sphincter (AUS) is an established surgical option for treating female stress urinary incontinence due to internal sphincter deficiency (ISD). However, this operation is often performed as an open surgical procedure. Here, we introduce an endoscopic extraperitoneal approach for implanting an artificial urinary sphincter. Two women (ages 22 and 79 years) underwent endoscopic extraperitoneal implantation of the AMS 800 artificial sphincter. In both cases, neurogenic bladder disease was the underlying cause of ISD. The endoscopic extraperitoneal approach allowed excellent preparation and mobilisation of the bladder neck and implantation of the AUS. The overall operating time was <120 min. Both patients were mobilised on the same day and could be discharged from the hospital after 5-6 days. The AUS were activated after 6-9 weeks. However, after an average of 6 months, total continence was achieved in both patients. Laparoscopic extraperitoneal implantation of AUS in women with moderate to severe stress urinary incontinence is safe and might be less traumatic to neighbouring organs than the open operation. However, more implantations are needed to evaluate the long-term feasibility of this method.

Changes in the MRI morphology of the stress continence control system after TVT (tension-free vaginal tape) insertion.

OBJECTIVE: Magnetic resonance imaging (MRI) was used to investigate whether tension-free vaginal tape (TVT) insertion (according to Ulmsten) leads to morphologic changes of the stress continence control system. METHODS: Twenty women (mean age 53.4 years) with clinically and urodynamically proven stress urinary incontinence without prolapse were examined by MRI before and 13 months after TVT insertion. RESULTS: Postoperative MRI showed a signal intensity loss of the suburethral portion of the endopelvic fascia in the area of the anterior vaginal wall in 9/20 women with additional signal loss of the paraurethral portion of the fascia in 3/20 women. No morphologic changes of the levator ani muscle and the urethra were seen postoperatively. CONCLUSIONS: TVT insertion does not damage the structures of the stress continence control system or impact on their topographic relationships. MRI identified no excessive scar formation resulting from integration of the TVT.

[Management of postoperative objectified intravesical position of the TVT tape--two case reports]. / Management bei postoperativ diagnostizierter intravesikaler TVT-Bandlage anhand zweier Kasuistiken.

Recurrent urinary tract infections and symptoms of a hyperactive bladder in women having undergone a TVT (tension-free vaginal tape) procedure may be due to intravesical position of the tape. Urogenital ultrasound can provide early preliminary diagnostic evidence, which can then be confirmed by subsequent urethrocystoscopy. Minimally invasive revision can be achieved by transurethral resection of the intravesical TVT portions. Tape portions near the wall can be removed after stretching of the tape with grasping forceps inserted through a suprapubically placed trocar. This simple procedure can spare the patient a more extensive repeat operation for removal of the intravesical TVT that may even require a combined abdominovaginal approach.

[Transarterial embolization for uterine fibroids: clinical success rate and results of magnetic resonance imaging]. / Transarterielle Embolisation bei Uterus myomatosus: klinische Erfolgsrate und kernspintomographische Ergebnisse.

PURPOSE: To analyze the clinical success rate and the findings of magnetic resonance imaging (MRI) after uterine artery embolization of symptomatic leiomyomas (fibroids) of the uterus. MATERIALS AND METHODS: This is a prospective single-center case study of 80 consecutively treated patients, followed for 3 - 6 months (group I), 7 - 12 months, (group II), and 13 - 25 months (group III). MRI was used to determine the uterine volume and size of the dominant leiomyoma. Symptoms and causes requiring repeat interventions were analyzed. RESULTS: Significant (p < 0.01) volume reduction of the uterus (median: 34.95 % confidence interval [CI]: 30.41 - 41.76 %) and dominant leiomyoma (median: 52.07 %, CI: 47.71 - 61.57 %) was found. The decrease in uterine volume (I-III: 22.68 %, 33.56 %, 47.93 %) and dominant leiomyoma volume (I-III: 41.86 %, 62.16 %, 73.96 %) progressed with the follow-up time. Bleeding resolved significantly (p < 0.0001) in all three follow-up groups (groups I-III: 92.86 %, 95.23 %, 96.67 %). Furthermore, urinary frequency (groups I-III: 70 %, 75 %, 82.35 %) and sensation of pelvic pressure (groups I-III: 42.86 %, 60 %, 93.75 %) improved, which was statistically significant in group III (p < 0.01). The number of leiomyomas correlated (p < 0.05) with improvement of the bleeding and the pelvic pressure. Repeat therapy was necessary for complications in four patients (5 %) and for therapeutic failure in three patients (3.8 %). Permanent amenorrhea was observed in four patients (5 %) of age 45 years or older. CONCLUSION: Uterine artery embolization of uterine leiomyomas has a high clinical success rate with an acceptable incidence of complications and repeat interventions.

[Urinary and fecal incontinence in the aged from gynecologic proctologic viewpoint]. / Harn- und Analinkontinenz im Alter aus gynäkoproktologischer Sicht.

Three to four million women suffer from urinary incontinence (UI) in Germany. This number will rise further as life expectancy increases, and there is an annual incidence of newly occurring UI of about 1%. Two thirds of all women with UI suffer additional symptoms of fecal incontinence. The type of incontinence present is diagnosed on the basis of patients history, clinical findings, and functional testing. The findings should be interpreted in an age-adjusted manner to avoid over-rating (e.g. urethral closure pressure at rest=100-age in cm H(2)O). The management of elderly patients focuses on conservative approaches with bladder and intestinal training as well as dietary measures serving to counteract the age-related loss of intellectual abilities. Local estrogen application has a positive effect on all forms of incontinence. Surgical approaches aim at improving symptoms since forced restoration of incontinence in elderly patients frequently induces voiding disorders.

[Uterine fibroid embolization - a new therapeutic option for symptomatic leiomyomata of the uterus]. / Transarterielle Embolisation von Uterusmyomen - Eine neue Therapieoption bei symptomatischem Uterus myomatosus.

Uterine fibroid embolization (UFE) is a new minimal-invasive therapy for the treatment of symptomatic leiomyomata of the uterus and a uterine-sparing alternative to surgical procedures. Short-term and mid-term results indicate a high clinical success rate with improvement of fibroid-related bleeding symptoms in 80 - 100 % of cases, improvement of bulk symptoms in 60 - 100 % of cases and reduction in fibroid volume at an average of about 36 - 78 % combined with a low rate of complications and side effects. This review discusses indications and contraindications, technique and pathophysiology, choice of material, results and complications of UFE on the basis of the current literature and our own results.

[Technical success rate, peri-interventional complications and radiation exposure of the transarterial embolization for leiomyomas of the uterus]. / Technische Erfolgsrate, peri-interventionelle Komplikationen und Strahlenexposition der transarteriellen Embolisation bei Uterus myomatosus.

PURPOSE: To analyze the technical success rate, incidence and type of peri-interventional complications, and radiation exposure of uterine artery embolization (UAE) in symptomatic leiomyomas of the uterus. MATERIALS AND METHODS: This prospective study includes 75 patients consecutively treated with UAE from October 2000 through August 2002, with all interventions performed by the same radiologist. Technical success rate, interventional material, and incidence and type of peri-interventional complications (length of hospitalization) were recorded and categorized according to the definitions of the Society of Interventional Radiology (SIR). Fluoroscopy time (FT), dose-area product (DAP), and effective dose (ED) were determined for each intervention and the influence of the radiologist's experience on the radiation exposure analyzed. RESULTS: UAE was technically successful in 97.3 % of the cases. Peri-interventional complications occurred in 14.7 %. Four complications (5.3 %) were classified as major class C according to the SIR (post-embolization syndrome requiring prolonged drug treatment and hospitalization [n = 3] perforation of the uterine artery [n = 1]). None of the complications led to discontinuation of the intervention, subsequent surgical intervention, or permanent sequelae. FT decreased significantly (p < 0.05) until the 35th intervention. The median FT decreased from 18.8 min (13.4 - 28 min [25th to 75th percentile]) to 11.8 min (9.7 - 13.3 min [25th to 75th percentile]). The DAP decreased by 25.3 % to a median of 8.547 (6.527 - 11.590 cGy*cm (2) [25th to 75th percentile]). The median ED was 31.5 mSv from the 36th intervention onward. CONCLUSION: UAE has a high technical success rate with a low rate of peri-interventional complications. The study showed a statistically significant learning effect with a decrease in radiation exposure for the first 35 interventions. The effective dose of UAE is comparable to that of 1 to 2 small bowel enema.

Analysis of the gene for the elongation factor 1 alpha from the zygomycete Absidia glauca. Use of the promoter region for constructions of transformation vectors.

The complete genomic DNA sequence was determined for one of the gene for the elongation factor 1 alpha (TEF), isolated from the zygomycete Absidia glauca. Sequence comparison with TEF genes from other fungi show the highest similarity to TEF-genes of the closely related zygomycete Mucor racemosus (Sundstrom et al. 1987). Southern-blot analysis of genomic DNA from A. glauca with the TEF gene reveals six chromosomal copies in the genome. In transformation experiments of A. glauca, vector constructions were used which allow targeting of one of the TEF loci. Several transformants of A. glauca were analyzed at the DNA level. In most cases, rearranged forms of autonomously replicated plasmids could be found in these isolates. However, some transformants show a different restriction pattern of the TEF loci if compared with the parental strains. From Southern-blot data it could be concluded that in one case the rearrangement lies downstream of one TEF locus. In a second case genetic parts following the 3'-end of the TEF gene are moved towards the 5'-end of the gene.

[External anal sphincter repair using the overlapping technique in patients with anal incontinence and concomitant pudendal nerve damage]. / Analsphinkter-repair mit einer überlappenden nahttechnik bei patientinnen mit analinkontinenz und nervus-pudendus-schaden.

BACKGROUND: No single surgical technique has so far emerged as the optimal approach to treat defects of the anal sphincter in patients with postpartum fecal incontinence. Our approach is to repair the external sphincter using the overlapping technique to optimize morphological and clinical outcome. The results were correlated with preoperatively determined pudendal nerve function. METHODS: Thirty-five patients were followed up for three years after repair of the external anal sphincter. The patients had grade 2 (n = 29) or grade 3 (n = 6) fecal incontinence. Nineteen (54 %) patients had a concomitant defect of the internal anal sphincter and 28 (80 %) had abnormal pelvic floor EMG findings. Before surgery, all patients underwent conservative treatment with biofeedback and electrostimulation. The muscle ends were overlapped with Vicryl 4-0 sutures. A standardized protocol was used for the perioperative management in all patients. RESULTS: Of the 35 patients who underwent overlapping repair of the external anal sphincter, 32 (91 %) had a satisfactory result at 3-year follow-up based on sonomorphological criteria. These 32 patients were continent for solid and liquid stools. Six of the 35 patients (17 %) continued to have flatus incontinence. Two (6 %) patients were improved and one patient (3 %) had unchanged incontinence. Pudendal nerve damage had no effect on the outcome of surgery. CONCLUSIONS: Our findings at 3-year follow-up show good results for the overlapping repair of the external anal sphincter in terms of morphology and clinical symptoms. This outcome depends on an adequate preoperative pelvic floor conditioning, optimal perioperative management, and use of a standardized operative technique. Surgical repair of the morphological defect is recommended even in patients with pudendal nerve damage.

Sonomorphological evaluation of polypropylene mesh implants after vaginal mesh repair in women with cystocele or rectocele.

OBJECTIVE: To investigate whether the sonographically measured size of the mesh implant in women who had undergone vaginal polypropylene mesh repair 6 weeks previously correlates with the original size of the mesh and whether the mesh ensures complete support of the anterior or posterior compartment. METHODS: Forty postmenopausal women with anterior or posterior vaginal wall prolapse and sonographically proven cystocele (n = 20) or rectocele (n = 20) were evaluated preoperatively and 6 weeks after vaginal mesh repair. Introital ultrasound was performed to identify the polypropylene mesh and measure its distal to proximal length and configuration as well as its thickness. The initial mesh length was compared with that measured by ultrasound 6 weeks postoperatively. Vaginal length was measured pre- and postoperatively. RESULTS: The mean +/- SD age of the women was 68 +/- 7 years. The 20 women with cystocele underwent repair by means of anterior transobturator mesh implantation; the initial mesh length was 6.8 +/- 1.1 cm versus 2.9 +/- 0.6 cm postoperatively. The 20 women with rectocele underwent repair by posterior transischioanal mesh implantation; the initial mesh length was 9.9 +/- 0.8 cm versus 3.3 +/- 0.5 cm postoperatively. The mesh supported 43.4% of the length of the anterior vaginal wall and this value was 53.7% for the posterior wall (P = 0.016). CONCLUSION: Sonography is recommended for postoperative evaluation of the anterior and posterior mesh positions after prolapse surgery. There is a considerable discrepancy between the implanted mesh size and the length measured 6 weeks later by postoperative ultrasound. Published by John Wiley & Sons, Ltd.

Follow-up after polypropylene mesh repair of anterior and posterior compartments in patients with recurrent prolapse.

To retrospectively analyze the outcome of surgery in women followed up for 1 year after vaginal repair with the Apogee (support of posterior vaginal wall) or Perigee (support of anterior vaginal wall) system. A total of 120 patients with recurrent cystocele and/or rectocele or with combined vaginal vault prolapse were treated by either posterior or anterior mesh interposition depending on the defect. Follow-up after 1 year (+/-31 days) comprised a vaginal examination with prolapse grading using the POP-Q system, measurement of vaginal length, evaluation of the vaginal mucosa, and exploration for mesh erosions. Postoperatively, 112 (93%) women were free of vaginal prolapse, whereas 8 (7%) had level 2 defects. Erosions occurred significantly more often (p = 0.042) in patients treated with the Perigee system. Our results suggest that the Apogee and Perigee repair systems (monofilament polypropylene mesh) yield excellent short-term results after 1 year.

[Treatment of overactive bladder with sodium chondroitin sulphate]. / Der Einsatz von Natrium-Chondroitinsulfat bei der Behandlung der "Uberaktiven Blase".

OBJECTIVE: It is not always possible to clearly differentiate the symptoms of overactive bladder and interstitial cystitis. A prospective randomized study was performed to determine whether instillation of sodium chondroitin sulphate for treatment of interstitial cystitis is also effective in treating overactive bladder. The expected benefit of this therapeutic approach in overactive bladder is based on the assumption that the glycosaminoglycan layer may be damaged in overactive bladder as well. MATERIAL AND METHODS: Patients with chronic overactive bladder were randomized to one of two study groups each including 41 patients. Group A was treated with an anticholinergic agent (tolterodine), group B with sodium chondroitin sulphate (Uropol S). The diagnosis was established on the basis of a gynecologic examination and history, urodynamic testing, introital ultrasound, and cystoscopy. Patients were treated for 12 months. RESULTS: An improvement of symptoms was reported by 15/35 (43 %) of the patients in group A (p = 0.000) as compared with 23/32 (72 %) of the patients in group B. The subjective outcome was corroborated by means of urodynamic testing, number of pads used, voiding frequency, and nycturia (voiding diary). Quality of life increased significantly in both groups in the course of treatment but there was no significant difference between both groups. CONCLUSION: The results of the study presented here suggest that restoring the glycosaminoglycan layer also improves or cures the symptoms in patients with overactive bladder. Patients clearly benefit from instillation of sodium chondroitin sulphate. These results must be confirmed in larger studies before a wider use of this therapeutic option can be recommended.

Visibility of the polypropylene tape after tension-free vaginal tape (TVT) procedure in women with stress urinary incontinence: comparison of introital ultrasound and magnetic resonance imaging in vitro and in vivo.

OBJECTIVE: To determine whether introital sonography and magnetic resonance imaging (MRI) after TVT (tension-free vaginal tape) insertion can depict the polypropylene tape, and thus be used for patient follow-up. METHODS: The study comprised an experimental part, which investigated in-vitro visualization of the polypropylene tape in a model (phantom), and a clinical part, in which 20 women (mean age, 53.4 years) with clinically and urodynamically proven stress urinary incontinence without prolapse were investigated by introital ultrasound and MRI before and 13 months after the TVT procedure. RESULTS: In the phantom, the polypropylene tape was depicted with a low signal intensity by MRI and as a highly echogenic structure by ultrasound. In the clinical study, introital ultrasound in a mediosagittal orientation depicted the vaginal tape in all patients: it was located under either the midurethra (n = 16) or the lower urethra (n = 4), and in either the muscular coat of the urethra (n = 8) or in the urethrovaginal space (n = 12), the tape was either flat (n = 6) or curled up (n = 14), and there was no retropubic visualization of the tape. Overall, depiction by MRI was limited, and was poorer in comparison with ultrasound, especially when the tape had a sub- or paraurethral location. Retropubically, however, MRI identified the tape near the periosteum of the pubic bone (55% of cases), in the retropubic space (37.5% of cases), or near the bladder wall (7.5% of cases). CONCLUSION: Sonography is recommended for evaluation of the suburethral and paraurethral tape portions, while MRI is suitable for retropubic evaluation after the TVT procedure.

[Paraurethral abscess developing after mid-urethral Zuidex-injection in women with stress urinary incontinence -- management of complications and retrospective comparison with bladder neck located injection technique]. / Paraurethrale Abszesse nach mid-urethraler Zuidex-Injektion bei Frauen mit Belastungsharninkontinenz -- Komplikationsmanagement und retrospektiver Vergleich mit blasenhalsnaher Injektionstechnik.

PURPOSE: To evaluate the cause and management of paraurethral abscess developing after injection of a mixture of hyaluronic acid and dextranomer (Zuidex) for treating stress urinary incontinence. PATIENTS AND METHOD: A total of 127 women having undergone midurethral Zuidex injection and 34 women after endoscopically guided Deflux injection into the tissue around the bladder neck were followed up 1 to 24 months after the intervention. At follow-up, the paraurethral tissue was evaluated clinically by gynecologic examination and by introital ultrasound. RESULTS: Thirteen of 127 women (10 %) having undergone midurethral Zuidex injection had a sterile paraurethral abscess that was treated by transvaginal puncture (1 to 3 punctures with removal of 10-60 ml of fluid per patient). No case of postoperative paraurethral abscess formation was demonstrated in the control group treated by Deflux injection into the area around the bladder neck. CONCLUSIONS: Paraurethral abscess must be excluded in the postinterventional follow-up of patients after Zuidex injection. Patients in whom an abscess is demonstrated can be treated by transvaginal puncture. Abscess formation can be avoided by injecting dextranomer/hyaluronic acid into the area around the bladder neck.