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We report the case of a healthy young man who presented to our clinic with itchy skin lesions in the area of a tattoo on the back of the left hand. Bioptic and cultural confirmation of the pathogens led to the diagnosis of Mycobacterium chelonae infection. We initiated antibiotic therapy using azithromycin and linezolid with good response. Our case underlines that besides allergic skin reactions, infections as a complication after tattooing should also be included in the differential diagnosis., (© 2023. The Author(s).)

Background: The development of evidence-based guidelines for the prevention of infectious diseases through vaccination requires an understanding of populations that most likely may obtain an infection, severe illness or disease. Targeted vaccination recommendations are made possible by identifying risk groups, as is the case with meningococcal infections. Despite falling case numbers, meningococcal sepsis and meningococcal meningitis remain a major health problem., Method: A systematic literature search was carried out on the research platform Ovid., Results: Vulnerable groups of people whose immune system is limited by primary and secondary immunodeficiency, such as asplenia, renal failure, human immunodeficiency virus (HIV) infection, diabetes, complement deficiency, organ and stem cell transplants, or immunomodulatory therapy (e.g., in rheumatic, hematological or oncological diseases), are exposed to an increased risk of infection and more severe courses of disease. Despite adequate medical care, the mortality rate is high and patients that survived the infection are often suffering from severe long-term sequelae. In such cases, the vaccination recommendations of the Standing Committee on Vaccination (STIKO) for indication vaccinations and the application instructions for vaccination in the case of immune deficiency should be consistently implemented in Germany., Conclusions: Increased responsibility for comprehensive protection must be assumed for persons with underlying diseases. Reducing invasive meningococcal infections can be achieved through widespread education of patients and contacts, as well as practicing physicians on available vaccinations., (© 2023. Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

An 83-year-old woman presented to our outpatient clinic with bullous pemphigoid with a unilateral sparing of the left arm after axillary lymphadenectomy because of breast cancer. Cases of localized manifestations of bullous pemphigoid are mainly caused by lymphedema or radiation. The absence of blistering after lymphadenectomy is a rare and interesting manifestation. Pathophysiologically, blister formation may be attenuated or absent altogether due to decreased T‑cell activation and thus reduced inflammatory infiltrate because of the absence of peripheral lymph nodes., (© 2021. The Author(s).)

For many colleagues, the job of anesthesia technical assistant (ATA) is a new - previously unknown - job description in the healthcare sector. The anesthesia departments currently employ qualified nurses (3 years of training) or specialist nurses (5 years of training). However, there has been a known shortage of skilled workers in the care industry for many years. Vacancies are often difficult or impossible to fill. The result is a higher service burden for existing employees. It can also happen that operating theaters have to be closed because no staff is available - this has not only economic effects on the respective provider, but also in particular on patient care.The independent basic training of the technical assistant for anesthesia was not only created to counteract the shortage of skilled workers. At the same time, this new field of work was supposed to be attractive and to train specialists - directly. In the future, the anesthesia departments will be supported by anesthesia technical assistants. This article explains the training structure and areas of responsibility., Competing Interests: Die Autorinnen/Autoren erklären, dass kein Interessenkonflikt vorliegt., (Thieme. All rights reserved.)

The paper tries to situate Freud's theory historically by referring it to a paradigm of psychological theory that Marcel Gauchet describes as the "Golden Age" of psychophysics and reflex theory, and that he situates between 1870 and 1900. I will show that until 1900 Freud thinks, in fact, in categories that correspond to this type of thought. His texts On the Psychical Mechanism of Hysterical Phenomena (1893, with Josef Breuer) and A Project for a Scientific Psychology (1895) still follow the conception of a psychological subject on the basis of the stimulus and response model, which can be found in numerous contemporaneous authors. In this model, the psyche is just a place of transit open to the exterior, and its unity can only be a sum of elements of consciousness having a physiological substrate. Nevertheless, Freud's early texts--although appertaining to the reflex paradigm--already contain elements that serve to construct another basic model of the psychic apparatus, which is finally introduced by The Interpretation of Dreams. Those new elements are the separation between interior and exterior, the introduction of endogenous energy, which is linked to the importance of emotions instead of sensations, and the problem of the adaptation to outer reality that results from it. Nevertheless, once more Freud is not the only theorist in whose thought the new paradigm can be found; I again refer his new premises to other contemporary psychologists. The question that arises from Freud's passage from one paradigm to another is how he handles the continuity of his own thought. I describe the difficult compromise between contradictory concepts he finds in his Project for a Scientific Psychology; but certain concepts that derive from the reflex paradigm subsist even during the later development of psychoanalysis. This is especially the case for the concept of the unconscious itself: As I argue, this concept originates in the reflex paradigm, and, in contrast to contemporary psychology, Freud only maintains it longer than other authors do.

Unlabelled: SUBJECT MATTER: Following clinical diagnosis of a recurrent tumor, curative treatment is seldom available. Depending on the size of the recurrent tumor and the patient's general health condition, extensive surgical resections and reconstructions are avoided in favor of nonsurgical treatment modalities with palliative intent. According to the literature, location of the tumor, tumor size and R-1 and R-2 resection rates are the most frequent reasons for the development of recurrent tumors., Patients and Methods: In a retrospective evaluation, a population of 1000 patients who had been treated for primary head and neck cancer during the period from 1979 to 1996 were analyzed descriptively. Survival probabilities of patients with recurrent tumors were calculated according to the Kaplan-Meier product-limit method, and different treatment concepts were compared and analyzed with the log-rank test for significant differences., Results: The largest proportion of primary tumors involved the floor of the mouth (n=369, 36.9%). A total of 198 patients (19.8%) developed recurrent cancer; 79.8% of patients experienced recurrent cancer within 2 years following primary treatment. Within the group of T1/T2 tumors the incidence of recurrent tumors was 28.9%, whereas the incidence in the T3/T4 group was 44.6%. Tumor infiltration of the resection margins was detected in 12.9%., Conclusions: In line with the literature, tumor infiltration of the resection margins is a relevant prognostic factor; therefore, intraoperative frozen section must be recommended. Treatment with curative intention, in particular extensive surgical resections, is seldom possible and always requires a very intensive discussion with the patient.