Die periorale Dermatitis wird auch im Kindesalter regelmäßig beobachtet. Auslösende Faktoren können Kortikosteroide, topisch oder auch inhalativ angewendet, sein. Aber auch eine zu reichhaltige Anwendung von Hautpflegeprodukten oder Lichtschutzpräparaten mit physikalischen UV-Filtern spielt eine pathogenetische Rolle. Wie Sie die richtige Diagnose stellen und auch ausgeprägte Verläufe therapieren können, erfahren Sie im folgenden Beitrag.

GreenLight HPS™ laser PVP is a relatively new technology for the treatment of lower urinary tract symptoms (LUTS) secondary to BPH. We review our experience using the GreenLight HPS™ laser system.

Secondary procedure rates of surgical therapy for BPH ranges between 1 and 14%. We evaluate GreenLight HPS™ laser PVP as a treatment for symptomatic BPH previously treated with surgical management.

5α-reductase inhibitors reduce angiogenesis in benign prostatic tissue. This has been postulated to affect the efficiency of the potassium-titanyl phosphate (KTP) laser during PVP, which has hemoglobin as its primary chromophore. Whether this effect of 5α-reductase inhibitors applies to GreenLight HPS™ laser PVP is not clear. We evaluate GreenLight HPS” laser PVP as treatment for benign prostatic hyperplasia (BPH) in patients on long-term 5α-reductase inhibitors.

Lactobacillus plantarum FST 1.7 was screened for in vitro antimicrobial activity and was shown to be active against spoilage moulds and bacteria. Isolation of antimicrobial compounds from cell-free supernatant identified lactic acid, phenyllactic acid and the two cyclic dipeptides cyclo (l-Leu-l-Pro) and cyclo (l-Phe-l-Pro) as the major components responsible for this activity. L. plantarum FST 1.7 was tested for the ability to produce the antifungal compounds during sourdough fermentation and to produce bread of good quality and increased shelf-life. A rheofermentometer was used to examine the gaseous release and development characteristics of the dough. A range of parameters was determined including pH, TTA and specific loaf volume. The results were compared with those obtained using Lactobacillus sanfranciscensis, a chemically acidified and a non-acidified dough. The quality of sourdough and bread produced using L. plantarum FST 1.7 was comparable to that obtained using common sourdough starters, e.g. L. sanfranciscensis. Sourdoughs and breads were evaluated for the ability to retard growth of Fusarium culmorum and Fusarium graminearum two fungi found on breads. Sourdough and bread produced with strain FST 1.7 showed consistent ability to retard the growth of both Fusarium species, thus indicating that L. plantarum FST 1.7 has also the potential to improve the shelf-life of wheat bread.

A new tool using the interventional radiology technique of transjugular intrahepatic portosystemic shunt (TIPS) is presented as a method to recanalize a failed esophageal anastomosis in a premature infant. Case Report: The 1.5-kg patient was born at 31 weeks with esophageal atresia (EA) and a distal tracheoesophageal fistula (TEF). Because of a long gap, division of the TEF and gastrostomy were performed. Two months later, she underwent a delayed primary esophageal anastomosis. The contrast study showed the proximal pouch to be connected to a false lumen. Endoscopic recanalization was unsuccessful. Under fluoroscopic control, the needle used for TIPS was introduced through the gastrostomy, pushed through the membrane of the false channel, and grabbed by a snare introduced through the mouth. A wire was left in place. The lumen was sequentially dilated by means of a combination of pneumatic and bougie dilations to 36F. The patient required a total of 12 dilations during a period of 2 months after the initial recanalization. She expired 2 months after the last dilation of unrelated sepsis. At the time of her death, no clinical evidence of stricture was found. Conclusions: Obliteration of the anastomosis by a false lumen is a rare complication of EA repair. Spontaneous fistulization did not occur. Applying our technique, we were able to recanalize the lumen and dilate it to an adequate size, sparing the patient a third thoracotomy. This technique can be applied to cases of severe stricture when a lumen cannot be established by standard methods.

Zusammenfassung Fünf Kinder mit der Diagnose einer rekurrierenden palmoplantaren Hidradenitis werden vorgestellt. Die Pathogenese der sehr charakteristischen Hautveränderungen, die als schmerzhafte nodöse Erytheme sowohl palmoplantar, jedoch auch isoliert plantar oder palmar imponieren können, ist bislang nicht eindeutig geklärt. Der ursächlich diskutierte Zusammenhang mit Exposition der betroffenen Areale gegenüber feuchter Kälte konnte auch bei 4 der hier beschriebenen Kinder herausgearbeitet werden. Die selbstlimitierende Erkrankung neigt zu Rezidiven. Nach ausführlicher Aufklärung der Kinder und ihrer Eltern hinsichtlich des Meidens ursächlicher Faktoren kam es bei keinem Kind innerhalb eines Nachbeobachtungszeitraumes von einem Jahr zum Auftreten eines Rezidivs.

We describe five cases of recurrent palmoplantar hidradenitis in children. The pathogenesis of this highly characteristic disease presenting with painful erythematous papules and nodules involving palms of the hands, soles of the feet, or both is not clear at the moment. One possible mechanism is a temporal relationship between exposure to dampness and cold, which also applied in four of these children. The self-limited disease tends to reappear. After thoroughly informing the children and their parents on avoiding provoking factors, all children experienced freedom from the disease during a 12-month follow-up.

CONTENTSMethods . . . 1344Results 1345Geographical distribution and typeof units . . 1345Location . 1345Type of intervention according to differentlevels of care . . 1345Patient population and infectivecomplications. . 1346Discussion 1347Appendix: Items of the questionnaire. ........1348Name of institution . . 1348Hospital characteristics 1348Structural characteristics of the respiratoryintermediate care unit . 1348Technical equipment. . 1348Facilities . . . . . . 1349Staff . . 1349Characteristics of patients andintervention . . . . 1349Severe chronic obstructive pulmonary disease (COPD)patients, especially those with chronic respiratoryfailure, may frequently require periods of intensivetreatment, monitoring, nursing and, occasionally,ventilatory assistance in order to overcome acuteexacerbations. Ventilatory assistance is only rarelyprovided in the conventional ward [1], thereforeadmission to an intensive care unit (ICU) is oftenneeded [2]. ICU, however, are very precious and expen-sive resources where nursing costs represent a majorexpense [3]. Patients with acute on chronic respiratoryfailure may experience a prolonged stay in the ICUnot only because of the severity of their illness whichprecipitates the underlying acute respiratory failure(ARF) [2], but also because of ICU-related complica-tions [4]. For these reasons the treatment of acute onchronically ill patients in these areas creates ethical [5]and economic concerns [6, 7].It has been reported that y40% of the patientsadmitted to ICUs never received active intensive care,including mechanical ventilation [8–10]. Onlyy40% ofpatients with ARF due to pulmonary disease neededto be invasively ventilated [11, 12]. However, in somecountries, such as the UK, with a severe ICU bedshortage, the vast majority of ICU admissions requiremechanical ventilation.A recent Italian survey carried out on 99 ICUsshowed that COPD was the dominant underlyingchronic disease in patients admitted to the Italian ICU,and the need for cardiorespiratory monitoring was themost frequent indication for admission (31.2%) [13].These studies clearly indicate that in some centresthere is an overutilisation of ICU resources formonitoring purposes, and that acute on chronic res-piratory failure could be managed in many patientswithout invasive ventilation.Patients with chronic respiratory failure, especiallythose with underlying COPD, very often suffer from ahigh frequency of acute exacerbations, which, whenrequiring invasive mechanical ventilation, may beassociated with life-threatening complications [4].Furthermore, it has been reported that in COPDpatients with ARF the greater part of their ICU staywas devoted to weaning the patient from mechanicalventilation, and this weaning period accounted for59% of the total duration of mechanical ventilation [14].

ABSTRACT We have isolated a Lactobacillus plantarum strain (MiLAB 393) from grass silage that produces broad-spectrum antifungal compounds, active against food- and feed-borne filamentous fungi and yeasts in a dual-culture agar plate assay. Fusarium sporotrichioides and Aspergillus fumigatus were the most sensitive among the molds, and Kluyveromyces marxianus was the most sensitive yeast species. No inhibitory activity could be detected against the mold Penicillium roqueforti or the yeast Zygosaccharomyces bailii . An isolation procedure, employing a microtiter well spore germination bioassay, was devised to isolate active compounds from culture filtrate. Cell-free supernatant was fractionated on a C 18 SPE column, and the 95% aqueous acetonitrile fraction was further separated on a preparative HPLC C 18 column. Fractions active in the bioassay were then fractionated on a porous graphitic carbon column. The structures of the antifungal compounds cyclo( l -Phe- l -Pro), cyclo( l -Phe- trans -4-OH- l -Pro) and 3-phenyllactic acid ( l / d isomer ratio, 9:1), were determined by nuclear magnetic resonance spectroscopy, mass spectrometry, and gas chromatography. MIC values against A. fumigatus and P. roqueforti were 20 mg ml −1 for cyclo( l -Phe- l -Pro) and 7.5 mg ml −1 for phenyllactic acid. Combinations of the antifungal compounds revealed weak synergistic effects. The production of the antifungal cyclic dipeptides cyclo( l -Phe- l -Pro) and cyclo( l -Phe- trans -4-OH- l -Pro) by lactic acid bacteria is reported here for the first time.

BACKGROUND:Most treatment protocols for vitiligo require a long treatment duration and usually do not result in complete repigmentation. Therefore, cosmetically acceptable and easily to handle alternatives are warranted.OBJECTIVE:To evaluate the properties of dihydroxyacetone (DHA) in a new formulation for the treatment of vitiligo on exposed areas.METHODS:We treated 10 patients suffering from vitiligo affecting the face and/or hands with a newly introduced, commercially available self-bronzing cream containing DHA 5%. DHA was applied every second day.RESULTS:The characteristic pigmentation showed very satisfactory cosmetic results in 8 out of 10 patients after 2 weeks of treatment.CONCLUSION:The new DHA formulation is a practical and well-accepted treatment modality.

Optimal treatment of patients with atopic dermatitis requires the knowledge of its pathogenetic factors and the often time-consuming attention to the course of the disease in each individual patient. In the therapeutic attempt, altered skin barrier function, possible provocation factors and psychological matters have to be taken into account. Basic therapy should comprise optimal skin care and the strict avoidance of triggering factors if possible. During periods of acute exacerbation, topical glucocorticosteroids in combination with classic antihistamines with sedative effects are still the drugs of first choice and will result in the rapid relief of symptoms in most patients. UVA1 phototherapy has proven to be a glucocorticoid-equivalent alternative therapy for exacerbated atopic dermatitis. If superinfection with Staphylococcus aureus is evident, topical antiseptics are useful in treating localized lesions, while a general superinfected eczema should be treated with systemic staphylococcal-effective antibacterials. Cyclosporin or extracorporeal photochemotherapy are reserved for patients with very severe atopic dermatitis that is unresponsive to conventional treatment protocols. Promising future therapeutic approaches consist of an improvement in the antipruritic treatment options, the topical application of immunomodifying treatment modalities or phosphodiesterase inhibitors, and possibly Chinese herbal therapies and psychological intervention strategies.

Background Tinea capitis is the most common dermatophytosis of childhood with increasing incidence. Whereas griseofulvin is considered by many as the mainstay of treatment, newer oral antifungal agents, including fluconazole, itraconazole and terbinafine have demonstrated higher efficacy, resulting in shorter treatment durations.Objectives We aimed to determine the optimum regimen for the treatment of childhood tinea capitis with itraconazole.Methods A mycological culture outcome-dependent combination of a 28-day continuous and facultative additional 14-day courses with itraconazole was used in 42 children (20 girls; 22 boys) aged 12-140 months (mean 66) with tinea capitis due to Microsporum canis (n = 26) and Trichophyton violaceum (n = 16). The drug was given orally according to the patients' body weight (50 mg daily for < 20 kg; 100 mg daily for greater than or equal to 20 kg) over 4 weeks. Direct microscopy and fungal culture as a parameter for efficacy were repeated 2 weeks after termination of treatment. Assessment of efficacy was based on the evaluation of results from light microscopy and culture at 8 weeks after initiation of treatment, and in the case of a further positive mycological culture at 14 and 20 weeks, respectively. A positive fungal culture at these times resulted in an additional course for 2 weeks with the initially chosen itraconazole dosage.Results In 34 of 42 patients a single 4-week course of itraconazole resulted in a complete mycological cure of lesions as demonstrated by light microscopy and mycological culture. Four of 42 patients had to be treated by a second itraconazole course for 2 weeks, and four children received a third course of itraconazole for 2 weeks until all lesions showed negative direct microscopy and mycological culture. No abnormal haematological or biochemical results occurred. Apart from transient, completely reversible indigestion in two children, no side-effects were observed.Conclusions A culture-based 28-day continuous therapeutic regimen plus facultative cultural outcome-dependent additional 14-day courses of a body weight-adapted dosage of itraconazole in tinea capitis due to M. canis and T. violaceum is discussed; this offers the advantage of an effective therapy with complete negative direct microscopy as well as negative cultural results, within a shorter active treatment period (cf. previous studies with continuous administration of itraconazole).

Background: UVA1 (340-400 nm) therapy proved to be highly effective in patients with severe atopic dermatitis. The optimal dose regarding therapeutic efficacy and possible side effects is still to be evaluated. In vitro cell culture as well as in vivo animal studies recently indicated that a correlation between UVA irradiation and photoaging, skin carcinogenesis, or melanoma induction may exist. Therefore it seems appropriate to focus research activities on reducing the UVA1 dose applied during phototherapeutic regimens minimizing nonbeneficial side effects. Objective: The present study was performed to evaluate the therapeutic effectiveness and long-term efficacy of medium-dose UVA1 irradiation in patients treated for acute exacerbated atopic dermatitis. Methods: Thirty-two patients underwent a medium-dose UVA1 therapy consisting of 15 treatments applied from Monday to Friday for a period of 3 weeks. The applied dose per treatment was 50 J/cm2 resulting in a cumulative dose of 750 J/cm2. Clinical severity was assessed according to the SCORAD index before and after irradiation as well as in monthly intervals up to 3 months after cessation of phototherapy. Results: Medium-dose UVA1 phototherapy is effective for alleviating acute exacerbated atopic dermatitis as shown by a significant reduction of SCORAD ratings (P < .001) at the end of the active UV treatment period. A significant skin improvement was still present 1 month later (P < .001). However, at the end of the 3-month posttreatment observation period the skin condition had reached the pretreatment level. Conclusion: According to our data, medium-dose UVA1 phototherapy is a highly effective, nonsteroidal, therapeutic alternative for treatment of acute exacerbated atopic dermatitis. However, effectiveness is merely short term, limited, and is followed by recurrence of symptoms within a 3-month observation interval. (J Am Acad Dermatol 2000;42:254-7.)

The existence of a second IgG-binding protein, protein Sbi, in Staphylococcus aureus has been reported previously. Later data indicated that protein Sbi also bound another serum component. This component has now been affinity-purified on immobilized protein Sbi and identified as beta2-glycoprotein I (beta2-GPI), also known as apolipoprotein H. The minimal beta2-GPI-binding domain was identified by shotgun phage display and the binding was shown to be mediated by a region of 57 amino acids, clearly separated from the IgG-binding domain. It is also shown that protein Sbi, and thus the beta2-GPI-binding activity, is expressed on the staphylococcal cell surface at levels varying between strains.

Two children are described with the combination of aplasia cutis congenita (ACC) and transverse limb defects known as Adams-Oliver syndrome. Whereas in the first child the typical features of ACC, syndactyly and transverse nail dystrophy were only mildly expressed and associated defects of the central nervous system and cardiac malformations were absent, the second child suffered from a very severe expression of the syndrome, with a combination of ACC, syndactyly, cutis marmorata telangiectatica congenita and multiple cardiac and central nervous system malformations which resulted in fatal central respiratory insufficiency.