Stine Lutze

Skin and wound decontamination of multidrug-resistant bacteria by cold atmospheric plasma coagulation

Novel concepts to limit the spread of multidrug‐resistant bacteria (MDR) are urgently needed. Since treatment with cold atmospheric plasma (CAP) has shown significant antibacterial properties, the purpose of this study was to evaluate the ability of CAP to eliminate MDR‐ compared to non‐MDR‐pathogens in chronic wounds.

Comparison between cold plasma, electrochemotherapy and combined therapy in a melanoma mouse model.

The study was undertaken to compare antitumor efficacy of electrochemotherapy (ECT) with cold plasma therapy (CP) in a melanoma mouse model. After melanoma implantation into the flank of C57BL/6N mice, CP by two different plasma sources (APPJ and DBD) was applied directly to the tumor surface. ECT was performed with bleomycin intravenously at a field strength of 1000 V/cm without or combined with CP. Primary endpoints were tumor growth acceleration (TGA), daily volume progression (DVP) and survival after treatment. Both plasma sources as single treatment showed a significant TGA delay, which proved less effective than ECT. CP (APPJ) combined with ECT (ECJ) significantly improved per cent mouse survival, with significant superiority compared with ECT. Plasma therapy alone albeit less effective seems a potential alternative to ECT in patients with melanoma and can be applied manifold in a session without general anaesthesia. Accordingly, CP alone and combined with ECT may serve as new option in palliative skin melanoma therapy.

Psychosoziale Belastung und Unterstützungswunsch ambulanter Hauttumorpatienten

Eine wichtige Basis für eine adäquate psychoonkologische und soziale Betreuung von Tumorpatienten bildet die regelmäßige Evaluation der psychosozialen Belastungen und somit der Betreuungsbedürftigkeit. Hierfür stehen zahlreiche Fragebögen zur Verfügung. Ziel der Untersuchung war es, zu ermitteln, ob belastete Patienten Unterstützung wünschen und welches Screening‐Instrument ambulante Hauttumorpatienten präferieren.

Repetitive Immunoadsorption Cycles for Treatment of Severe Atopic Dermatitis

The purpose of the study was to investigate the clinical efficacy of repetitive IgE immunoadsorption (IA) cycles in severe atopic dermatitis (AD) with high serum IgE levels. A total of seven patients with severe AD with a history of no significant or longterm Scoring Atopic Dermatitis (SCORAD) reduction and total serum IgE levels >700 IU/mL were enrolled. The patients received one to five series of IA (Ig‐Therasorb adsorber columns; Miltenyi Biotec, Teterow, Germany) each consisting of five consecutive treatments which were performed on a monthly regimen. Overall, one patient received one, two patients two, one patient three, two patients four and one patient five cycles of IA. IA was well tolerated in all the studied AD patients and led to a significant decrease of SCORAD and IgE levels during each IA cycle in all the patients. The relative decrease of SCORAD and serum IgE levels after treatment was 11.1% and 80%, respectively, after five immunoadsorption series, 24.1% and 83.6%, respectively, after four series, 37.6% and 75.9%, respectively, after three series, 27.9% and 74.2%, respectively, after two series, and 25.1% and 74.8% after the 1st IA cycle. One of the patients exhibited a long lasting clinical benefit over more than 12 months after the 5th IA cycle. Repetitive IA with more than two cycles at intervals of 4 weeks induces a profound and persisting IgE reduction which is remarkable clinical efficacy improving SCORAD in severe AD with high serum IgE levels.

Stationäre Hauttumorpatienten - Psychosoziale Belastung und Unterstützungswunsch: Psychosoziale Belastung und Unterstützungswunsch

Eine wichtige Basis für adäquate psychoonkologische und soziale Betreuung von Tumorpatienten bildet die regelmäßige Erhebung der psychosozialen Belastung. In entsprechende Studien mit Hauttumorpatienten wurden bisher hauptsächlich Melanompatienten eingeschlossen.

Compression in the treatment of chronic venous insufficiency: Efficacy depending on the length of the stocking

BACKGROUND Below knee two-component compression stockings (AD) have revealed as effective for compression treatment of venous leg ulcers. Upto groin, thigh length stocking (AG) may enhance clinical effects, however wear comfort of these stocking may be affected. OBJECTIVE venous haemodynamic in relation to the length of compression stockings. METHODS A two-component AD stocking (37 mmHg) and two thigh length stockings (AG 37, with an interface pressure of 37 mmHg; AG 45, with an interface pressure of 45 mmHg) were tested by 16 patients with CVI. Leg volume changes and venous ejection fraction and venous filling index were measured, whilst quality of life and wear comfort were surveyed by questionnaires. RESULTS Volume of both the lower limb and the thigh was reduced by AG stockings, whereas AD stockings reduced only the volume of the lower limb and increased thigh volume. Venous hemodynamic, ejection fraction and filling index were improved by AG and AD stockings, AG, however, was superior to AD. Quality of life and comfort of the stockings was assessed as good for AG 37 mmHg, AG 45 mmHg and AD 37 mmHg. CONCLUSIONS Thigh length two component stockings (AG) were shown to be superior to below knee stocking (AD) with regard to volume reduction and venous hemodynamic, yet wear comfort was not impaired. These results imply that healing of trophic skin changes e.g. ulcers will be faster when thigh length two component stocking will be worn.

Psychosocial distress and desire for support among inpatients with skin cancer: Psychosocial distress and desire for support

Regular assessment of psychosocial distress is an important component of adequate psycho‐oncological and social support in cancer patients. To date, relevant studies on skin cancer patients have primarily included individuals with melanoma.

Treatment of recalcitrant actinic keratosis (AK) of the scalp by cold atmospheric plasma

Abstract Background and objectives: Actinic keratosis (AK) is a frequent cutaneous lesion usually developing on sun-exposed skin and may be evolving into invasive squamous cell carcinoma requiring expensive therapy. Size, site or number of lesions limits the efficacy and/or acceptability of surgical and chemical therapies. Up to now photodynamic therapy (PDT) is recommended as treatment of choice. Material and methods: A patient (75y, m) suffered from recalcitrant AK lesions on the scalp, forearms and face for more than 20y. Various treatments including PDT, ablative laser and cryotherapy or chemical treatments failed to eradicate these lesions especially on the scalp. We used a CE-certified cold atmospheric plasma (CAP) jet, the Maxium® electrosurgery unit with maxium® beamer (KLS Martin GmbH + Co. KG), to treat one scalp lesion in one session (60 s, 20 W, 6 L/min). Results: CAP was able to eradicate AK of the patient in one session and was well tolerated. Histologic examination showed complete cure of AK. Control histology and visits up to 26 months after treatment do not show relapse or other skin deterioration. Conclusion: CAP seems to be an effective, curative and economic (one single treatment) alternative to conventional treatment of recalcitrant AK with field cancerization with excellent tolerability.

Mikrobielle Belastung von Haut und Wunden in Klinik und Praxis

The antibiotic treatment of microbial pathogens of the skin and wounds could so far not fulfil the expectations of an effective and permanent elimination of pathogens so that local treatment with antiseptic agents as a flanking measure to wound cleansing and debridement has become increasingly more established. Because an antiseptic treatment does not actually represent a treatment of infections, the current antimicrobial treatment strategy for infections in skin and wound areas consists of combined antibiotic and flanking antiseptic administration following debridement. However, the combined therapy is not always successful. There is an urgent need for new forms of therapy particularly to combat multiresistant pathogens in biofilms in infections of chronic and other complicated wounds.ZusammenfassungDie antibiotische Behandlung mikrobieller Erreger auf Haut und Wunden konnte die Erwartungen an eine wirksame und nachhaltige Keimelimination bisher nicht erfüllen, sodass sich in den letzten Jahren die lokale Behandlung mit antiseptischen Wirkstoffen als flankierende Maßnahme von Wundreinigung und Débridement mehr und mehr durchgesetzt hat. Da eine antiseptische Behandlung keine eigentliche Infektionstherapie darstellt, besteht die aktuelle antimikrobielle Behandlungsstrategie bei Infektionen im Haut- und Wundbereich in kombinierter Antibiotika- und flankierender Antiseptikaapplikation nach adäquatem Débridement. Dennoch gelingt auch die kombinierte Therapie nicht immer zuverlässig. Es besteht daher dringender Bedarf nach neuen Therapieformen, vor allem für die Bekämpfung multiresistenter Erreger in Biofilmen bei Infektionen chronischer und anderer komplizierter Wunden.AbstractThe antibiotic treatment of microbial pathogens of the skin and wounds could so far not fulfil the expectations of an effective and permanent elimination of pathogens so that local treatment with antiseptic agents as a flanking measure to wound cleansing and debridement has become increasingly more established. Because an antiseptic treatment does not actually represent a treatment of infections, the current antimicrobial treatment strategy for infections in skin and wound areas consists of combined antibiotic and flanking antiseptic administration following debridement. However, the combined therapy is not always successful. There is an urgent need for new forms of therapy particularly to combat multiresistant pathogens in biofilms in infections of chronic and other complicated wounds.

Stellenwert moderner physikalischer Behandlungsverfahren bei infizierten und kolonisierten Wunden in der Dermatologie

In the coming years increasing numbers of patients with chronic ulcers and tumor wounds are to be expected, both of which are typically multifaceted diseases requiring complex and increasingly long-term ambulatory therapy. Therefore, in recent years special medical emphasis has been placed on efficacious therapies with good tolerability and also suitability regarding feasibility for outpatient treatment. Some of these methods, such as cold plasma therapy, extracorporeal shock wave therapy (ESWT), water-filtered infrared therapy (wIRA), electrostimulation (ES) and low level laser therapy (LLLT) have a good chance of success when applied as an adjuvant method in the multimodal treatment concept for patients with recalcitrant wounds. All of these methods have at least indirect antimicrobial properties which can be advantageous in cases of microbial infiltration of wounds. As for all other methods for treating recalcitrant wounds, the promising application of the aforementioned methods requires great expertise in wound healing together with a broad and continuous interdisciplinary diagnostics and therapy (wound center).ZusammenfassungIn den kommenden Jahren ist eine Zunahme von Patienten mit chronischen Ulkuswunden, aber auch mit Wunden bei Tumorerkrankungen zu erwarten – beides typischerweise Erkrankungen, die eine komplexe Therapie erfordern und zunehmend und über zum Teil lange Strecken ambulant versorgt werden müssen. Damit rücken in den letzten Jahren immer mehr Behandlungsverfahren in den Vordergrund, die nicht nur effektiv sind und gut vertragen werden, sondern auch ambulant problemlos angewandt werden können. Hier liegen die Chancen für die Kaltplasmatherapie, die extrakorporale Stoßwellentherapie (ESWT), die wassergefilterte Infrarot-A-Therapie (wIRA), die Elektrostimulation und auch für die Low-Level-Laser-Therapie (LLLT) als adjuvante Verfahren im Rahmen des multimodalen Behandlungskonzeptes von Problemwunden. Alle Verfahren wirken mindestens indirekt antimikrobiell, was bei Keimbelastungen in der Wunde von Vorteil sein kann. Wie auch die anderen Behandlungsmethoden bei Problemwunden erfordert auch der Erfolg versprechende Einsatz der genannten Methoden große Erfahrung in der Wundheilkunde und weitgehende sowie kontinuierliche interdisziplinäre Diagnostik und Therapie (Wundzentrum).AbstractIn the coming years increasing numbers of patients with chronic ulcers and tumor wounds are to be expected, both of which are typically multifaceted diseases requiring complex and increasingly long-term ambulatory therapy. Therefore, in recent years special medical emphasis has been placed on efficacious therapies with good tolerability and also suitability regarding feasibility for outpatient treatment. Some of these methods, such as cold plasma therapy, extracorporeal shock wave therapy (ESWT), water-filtered infrared therapy (wIRA), electrostimulation (ES) and low level laser therapy (LLLT) have a good chance of success when applied as an adjuvant method in the multimodal treatment concept for patients with recalcitrant wounds. All of these methods have at least indirect antimicrobial properties which can be advantageous in cases of microbial infiltration of wounds. As for all other methods for treating recalcitrant wounds, the promising application of the aforementioned methods requires great expertise in wound healing together with a broad and continuous interdisciplinary diagnostics and therapy (wound center).