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Die Dermatochirurgie spielt eine wesentliche Rolle in Leistungsspektrum der Dermatologie. Obwohl in absoluten Zahlen gering,sind Wundinfektionen und Blutungskomplikationen die wesentlichen Ursachen für komplizierte Heilungsabläufe. Der gezielte Einsatz einer antibiotischen Prophylaxe dient der Endokarditis Prävention sowie der Vermeidung hämatogener Gelenksinfektionen bei Gelenksersatz. Auch die Rate postoperativer Wundinfektionen hoffen wir durch diese Vorgehensweise weiter zu reduzieren. Bei guter Einstellung ist die Beibehaltung der bestehenden Antikoagulation mit einem nur gering erhöhten Blutungsrisiko verbunden, bei gleichzeitigem Schutz vor thromboembolischen Ereignissen.Von der Praxis des „bridgings“ muss, vor allem beim niereninsuffizienten Patienten, wegen des hohen Blutungsrisikos abgeraten werden. Dermatologic Surgery plays a central role in a wide variety of dermatological services. The overall risk of healing complications is low, but wound infection and bleeding range on top of the list. A targeted application of perioperative antibiotic prophylaxis can prevent endocarditis and hematogenous prosthetic joint infection. In addition antibiotic prophylaxis also might be helpful in avoiding postoperative wound infection. Skin surgery under ongoing anticoagulation bears only a slightly increased bleeding risk as long as anticoagulants are in the therapeutic range. In addition optimal protection against thromboembolic events is supported. Bridging of oral anticoagulants with heparin should be avoided due to a significant increase of bleeding risk, in particular in patients suffering from renal insufficiency.

OBJECTIVE--To evaluate whether quantitative or qualitative IgA deficiencies in cervicovaginal secretions can be identified in patients with recurrent vulvovaginal candidiasis. DESIGN--Prospective and controlled study. SETTING--Department of Dermatology, University of Vienna. SUBJECTS--30 patients with symptomatic and recurrent vulvovaginal candidiasis at the time of their presentation. 30 healthy women as a control group. INTERVENTION--Blood samples were drawn for measurement of serum IgA levels. Smears of the cervix and vagina were taken for direct microscopy and microbiological culture. Lavage of the vagina and ectocervix was performed with sterile saline solution for measurement of cervicovaginal IgA levels. MAIN OUTCOME MEASURES--IgA levels of serum and cervicovaginal secretion evaluated by Single Radial Immunodiffusion. IgA labelling was demonstrated on fungal elements in vaginal smears and subcultured blastospores after incubation with vaginal secretions by immunohistochemistry. RESULTS--We could not find any significant difference of IgA levels in serum and cervicovaginal secretions between the symptomatic group and healthy controls (p value for serum = 0.5796, p value for secretion = 0.2381). In vaginal smears yeasts revealed IgA coating on their surfaces, whereas three of the 61 subcultures were negative. Negative subcultures were assigned to three patients with recurrent candidiasis. No correlation was found between IgA levels of cervicovaginal secretions and staining intensity of subcultured blastospores after incubation with vaginal secretions (r = -0.0578). IgA levels of serum and vaginal secretion showed no correlation (r = -0.00012). CONCLUSION--Recurrent vulvovaginal candidiasis cannot be attributed to IgA deficiency. In some cases an IgA coating defect of yeasts might be involved. In addition inactivation of the IgA molecule by candida proteases might be of pathogenetic importance. [ABSTRACT FROM PUBLISHER]

OBJECTIVE--To determine whether zinc deficiency in serum or vulvovaginal secretion is a risk factor for recurrent vulvovaginal candidiasis. DESIGN--Prospective and controlled study. SETTING--Department of Dermatology, University of Vienna. SUBJECTS--21 women who had experienced at least three documented episodes of acute vulvovaginal candidiasis within the previous 12 months. Fifteen women without anamnesis of vulvovaginal candidiasis as a control group. INTERVENTIONS--Blood samples were drawn for measurement of plasma zinc levels. Lavage of the vagina and ectocervix was performed with sterile saline solution for measurement of cervicovaginal zinc levels. MAIN OUTCOME MEASURES--Zinc levels of serum and cervicovaginal secretions were determined by flame atomic absorption spectrophotometry. RESULTS--We found no significant difference in the mean zinc concentration of plasma and cervicovaginal secretions between the recurrent vulvovaginal candidiasis and the control group. (p value for serum = 0.71, p value for secretion = 0.80). Zinc levels of plasma and cervicovaginal secretions showed no correlation (patient group: r = -0.05, control group: r = -0.07). CONCLUSION--It is well known that zinc not only exerts a major impact on different immune functions, but also participates in growth and morphogenesis of Candida albicans. Our results could not confirm the previous hypothesis that zinc deficiency of serum is a risk factor in recurrent vulvovaginal candidiasis. It is possible that the local zinc level of cervicovaginal secretions essentially influences antifungal activity of third generation azole antimycotics. [ABSTRACT FROM PUBLISHER]