[Liver dysfunctions in intensive care patients--consequences for the treatment of invasive Candida infections]. / Leberfunktionsstörungen in der Intensivmedizin - Konsequenzen für die Therapie invasiver Candidainfektionen.

Liver dysfunction is common among patients on intensive care units (ICU) due to sepsis, chronic liver disease, ischemic hepatitis, drug toxicity and intensive care measures. Critically ill patients with invasive fungal infections should therefore be treated with antifungals that are not metabolized by the liver. This may help to avoid therapeutic complications by drug accumulation, inadequate dosages or drug-drug interactions. Echinocandins are established as the antifungal class of choice in the treatment of invasive Candida infections. Anidulafungin is not hepatically metabolized and may be used without dose adjustments in patients with severe liver dysfunction. It has no known clinically relevant drug interactions. In the primary endpoint of the randomized pivotal trial in patients with candidemia or invasive candidiasis, anidulafungin was statistically superior versus the former standard therapy (fluconazole), with a favourable overall safety profile. More recent study data particularly in ICU patients confirm the efficacy of anidulafungin for these patient groups. Therefore, anidulafungin is an important antifungal treatment option for patients with liver dysfunction.

[Sonography and scintigraphy in the diagnosis of cystadenolymphomas (warthin tumor)]. / Wertigkeit der Szintigraphie und der Sonographie in der Diagnostik der Zystadenolymphome der Glandula parotis.

BACKGROUND: Is scintigraphy in the preoperative diagnosis of cystadenolymphomas dispensable? PATIENTS AND METHODS: In this prospective study 35 patients with tumors of the parotid gland were examined sonographically and scintigraphycally and the results were compared with the histological findings. RESULTS: By means of sonography 88 % (22/25) of the cystadenolymphomas were correctly diagnosed and by means of scintigraphy 80 % (20/25). CONCLUSIONS: Sonography is recommendable as the first-line diagnostic procedure in cystadenolymphomas because it is without radiation load, the free choice of the echographic plane, and it can be repeated as often as desired. Scintigraphy adds in selected cases, as in elder patients, additional informations. The combination of sonography and scintigraphy confirms the presence of cystadenolymphoma and allows the surgeon to make a decision and to avoid surgery especially in high-risk patients.