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Background: Paediatric community-acquired pneumonia (CAP) is a leading cause of paediatric morbidity. However, particularly for outpatients with paediatric CAP, data on aetiology and management are scarce., Methods: The prospective pedCAPNETZ study multicentrically enrols children and adolescents with outpatient-treated or hospitalised paediatric CAP in Germany. Blood and respiratory specimens were collected systematically, and comprehensive analyses of pathogen spectra were conducted. Follow-up evaluations were performed until day 90 after enrolment., Results: Between December 2014 and August 2020, we enrolled 486 children with paediatric CAP at eight study sites, 437 (89.9%) of whom had radiographic evidence of paediatric CAP. Median (interquartile range) age was 4.5 (1.6-6.6) years, and 345 (78.9%) children were hospitalised. The most prevalent symptoms at enrolment were cough (91.8%), fever (89.2%) and tachypnoea (62.0%). Outpatients were significantly older, displayed significantly lower C-reactive protein levels and were significantly more likely to be symptom-free at follow-up days 14 and 90. Pathogens were detected in 90.3% of all patients (one or more viral pathogens in 68.1%; one or more bacterial strains in 18.7%; combined bacterial/viral pathogens in 4.1%). Parainfluenza virus and Mycoplasma pneumoniae were significantly more frequent in outpatients. The proportion of patients with antibiotic therapy was comparably high in both groups (92.4% of outpatients versus 86.2% of hospitalised patients)., Conclusion: We present first data on paediatric CAP with comprehensive analyses in outpatients and hospitalised cases and demonstrate high detection rates of viral pathogens in both groups. Particularly in young paediatric CAP patients with outpatient care, antibiotic therapy needs to be critically debated., Competing Interests: Conflict of interest: M. Wetzke received funding from the Young Academy Clinician/Scientist foundation Hannover Medical School, Germany and the Clinical Leave Clinician/Scientist program of the German Center for Infection Research (DZIF). K. Schütz and G. Hansen received funding from the Deutsche Forschungsgemeinschaft for the Cluster of Excellence EXC2155 “RESIST” project (ID 39087428). C. Happle received funding from the Young Academy Clinician/Scientist foundation and HiLF funding of Hannover Medical School, Germany, and the Excellence Cluster RESIST in infection research. M.V. Kopp, G. Hansen and T. Welte received funding from the German Center for Lung Research (DZL). The other authors received no additional funding. The authors have no conflicts of interests for this article to disclose., (Copyright ©The authors 2023.)

Background: Pediatric community acquired pneumonia (pedCAP) is one of the leading causes for childhood morbidity accounting for up to 20% of pediatric hospital admissions in high income countries. In spite of its high morbidity, updated epidemiological and pathogen data after introduction of preventive vaccination and novel pathogen screening strategies are limited. Moreover, there is a need for validated recommendations on diagnostic and treatment regimens in pedCAP. Through collection of patient data and analysis of pathogen and host factors in a large sample of unselected pedCAP patients in Germany, we aim to address and substantially improve this situation., Methods: pedCAPNETZ is an observational, multi-center study on pedCAP. Thus far, nine study centers in hospitals, outpatient clinics and practices have been initiated and more than 400 patients with radiologically confirmed pneumonia have been enrolled, aiming at a total of 1000 study participants. Employing an online data base, information on disease course, treatment as well as demographical and socioeconomical data is recorded. Patients are followed up until day 90 after enrollment; Comprehensive biosample collection and a central pedCAPNETZ biobank allow for in-depth analyses of pathogen and host factors. Standardized workflows to assure sample logistics and data management in more than fifteen future study centers have been established., Discussion: Through comprehensive epidemiological, clinical and biological analyses, pedCAPNETZ fills an important gap in pediatric and infection research. To secure dissemination of the registry, we will raise clinical and scientific awareness at all levels. We aim at participating in decision making processes for guidelines and prevention strategies. Ultimately, we hope the results of the pedCAPNETZ registry will help to improve care and quality of life in pedCAP patients in the future.

Pneumonia is an important cause of influenza-associated morbidity and mortality. Influenza vaccination has been shown to reduce morbidity and mortality during influenza seasons. Protection from severe pneumonia may contribute to the beneficial effect of influenza vaccination. Therefore, we investigated the impact of prior influenza vaccination on disease severity and mortality in patients with community-acquired pneumonia (CAP). Analysis from an observational, multicentre cohort study initiated by the German competence network for CAP was performed. Patients were analysed separately as an influenza season and off-season cohort. Associations between vaccination status and outcome parameters were evaluated by multivariate analyses. In the season cohort (2,368 patients) CAP in vaccinated patients was significantly less severe according to most analysed parameters (CURB index ≥ 1: OR 0.76, 95% CI 0.60-0.98; procalcitonin ≥ 2.0 ng·mL(-1): OR 0.53, 95% CI 0.35-0.81; procalcitonin ≥ 0.5 ng·mL(-1): OR 0.71, 95% CI 0.51-0.99) and these patients showed a significantly better overall survival within the 6-month follow-up period (HR 0.63, 95% CI 0.45-0.89). Within the off-season cohort (2,632 patients) there was no significant influence of vaccination status on CAP severity or disease outcome. In conclusion, prior influenza vaccination was associated with less severe clinical course and improved overall long-term survival in patients with CAP during influenza seasons.

Objective: The aim of this study was investigation of effect of balneotherapy after antibiotic treatment of PID., Patients and Interventions: Fifty-seven patients with PID, diagnosed by laparoscopy, were treated by the same antibiotic scheme (oxytetracycline and metronidazole). After treatment of the acute phase, we studied the effect of balneotherapy (mud baths or mud packs, mineral baths, electrotherapies, and gynecological exercises) under sanatorium conditions in 30 patients. Twenty-seven patients without balneotherapy served as a control group. Second-look laparoscopy with dye insufflation was carried out about 12 weeks after the first operation., Results: The rate of tubal occlusion after balneotherapy was 31% vs. 28% in patients without balneotherapy (P > .05). Moderate or severe adhesions seen at first look were similar in both groups (40.7% vs. 46.7%) and were nearly unchanged during second-look laparoscopy (44.4% vs. 46.6%). Twelve of 27 (44.4%) control patients had subjective or objective complaints compared to only 2 of 30 (6.7%, P < .05)., Conclusion: Although balneotherapy after antibiotic therapy for acute PID does not improve fallopian tube patency, it is useful to reduce the frequency of lower abdominal pain.

110 patients suffering from laparoscopical verified salpingitis and desire for a baby, were treated with tetracycline (oxytetracycline or doxycycline; TC)/metronidazole (n = 67), augmentan (n = 22) or cipropfloxacin/metronidazole (n = 21). After an average period of 11.6 weeks, all patients underwent second-look laparoscopy with dye insufflation. In 34 patients treated with TC/metronidazole, the effects of additional physio-therapeutical measures were examined under conditions as they prevail in a Spa. 33 patients without balneotherapy served as controls. All the 4 groups were comparable (p greater than 0.05) in respect of mean age, percentage, share of nulliparous women, salpingitis gonorrhoica, contraceptive behaviour and also of the stage of salpingitis. All antibiotic regimens used resulted in a prompt decrease of inflammatory clinical signs after five days (temperature, blood sedimentation rate, leukocytes). Only 2 of 34 patients treated by additional cure at a Spa reported complaints, whereas complaints were reported by 14 of 33 control patients (p less than 0.01), 7 of 22 (p less than 0.01) treated with augmentan and to 7 of 21 (p less than 0.01) treated with ciprofloxacin/metronidazole. The tubal occlusion rates amounted to 33.3% (TC/metronidazole), 32.3% (TC/metronidazole and balneotherapy), 22.7% (augmentan) and 23.8% ciprofloxacin/metronidazole. The differences did not attain statistical significance (p greater than 0.05). With regard to adhesions, there were, likewise, no significant differences between findings at first laparoscopy and second look-laparoscopy, respectively. It is concluded, that additional physiotherapeutic measures, after antibiotic therapy of acute salpingitis, reduce the frequency of lower abdominal pain, but do not result in an improvement of tubal occlusion and reduction of adhesions.(ABSTRACT TRUNCATED AT 250 WORDS)

Basis of present study are examinations in 100 women with colposcopic and/or cytologic abnormalities suspect of preinvasive or early invasive carcinoma of the uterine cervix. We found 76 colposcopic abnormal findings in 100 women examined. In 36 women there was a colposcopic suspicion on a papilloma virus infection, in 32 cases combined with abnormal colposcopic findings. All 100 patients had cytologic smears group III and/or IV according to Papanicolaou. In 71 women cytologic signs of a papilloma virus infection was detected in the cervical smears. We found histologic signs of a papilloma virus infection in 69 cases in the specimen of biopsy, conization or hysterectomy (5 times condylomata acuminata, 53 times flat condylomata and 11 times inverted condylomata). Preinvasive respectively invasive and papillomavirus caused lesions of the cervix are coexisting in 59 cases. Our examination demonstrates that also in GDR in about 70 per cent of the precancerous or invasive cervical lesions signs of an infection with human papilloma viruses are present histologically and/or cytologically.

100 women with pathologic findings in the uterine cervix are the basis of this study. To assess papilloma virus articles methods of electron microscopy have been used in specimens of 59 women if koilocytes were present. Inside the nucleus of koilocytes in 51 cases virus particles could be detected, in 31 cases isolated and in 20 cases agglomerated between the chromatin. In all 10 condylomas without nuclear atypia we could assess virus particles. With increasing atypia the detection of papilloma virus decreases.

77 women with colposcopic and/or cytologic suspicious signs had been followed up 6 to 46 months. In 23 (44 per cent) out of 52 women with CIN we could observe progredience, in 19 (37 per cent) cases dysplasias and carcinoma in situ remained unchanged and in 10 (19 per cent) there was a regression. From 18 benign condylomatous lesions 8 were regredient and sones were progredient. Only in 1 out of 7 cases with benign lesions without papilloma virus infection a CIN II developed. Follow up of pregnant women demonstrated twofold more regredient findings compared with nonpregnant women. Follow up over a period of several years with colposcopic, cytologic and histologic examination in young women with CIn and childwish is possible without risk if definite management will be secured.

Basis of this trial are examinations of 100 Patients with colposcopic and/or cytologic suspicion for precancerous or early stages of cancer of the uterine Cervix and of 100 patients in the same age with normal cervical findings. Infections conditions vulvitis and condylomata acuminata could be found twice frequent in the cervical group in the control one. Significant differences could be calculated between the two groups with regard to bacterial infections of the vagina (60/22), bacterial vaginosis (54/38) and trichomoniasis (35/22). Sexual transmitted diseased are risk factors in the development of cervical cancer. Patients with those infections have to be supervised exactly.

100 women average age 30.7 years with colposcopic and/or cytologic suspicion on preinvasive or early invasive cervical carcinoma and 100 women in the same age and with normal cervical tissue as a control group have been compared with regard to their sexual activity. In this study risk factors are early onset of sexual activity combined with frequent change and insufficient sexual hygiene. These women should be screened intensively.

Basis of this trial are examinations of 100 patients with colposcopic and/or cytologic suspicion for precancerous or early stages of cancer of the uterine cervix and of 100 patients in the same age with normal cervical findings. The meaning discussed in literature about cigarette smoking as cofactor for developing cervical cancer and its prestages can be confirmed by our results. The portion of smoking patients with 74 per cent in the cervical groups was higher than in control group (42 per cent). Three times so much patients of the cervical group than in the controls smoked 20 cigarettes per day or more. More than 20 years smoking patients could be found only in the cervical group. 97 patients of the cervical group compared with 55 of the controls had been in the pill. Patients with cervical lesions on the average had been 3 years younger starting with hormonal contraception than the controls. The portion of pill users more than 10 years had been twice frequent in cervical group. The use of condoms was significantly more frequent in the control groups than in the cervical one (22/6). Therefore condoms are to be preferred be cause of protection against sexual transmitted diseases and indirectly cervical carcinom.

In this epidemiological, cytological and histological study signs of papillomavirus infections were found in 128 cases (16,6 per cent) and dysplasia or carcinoma in situ in 713 cases in a series of 773 cone biopsies. Epithelial changes caused by papillomavirus were combined with preneoplastic lesions in 116 cases. Pretherapeutic cytologic examinations of the condylomatous epithelial changes secured histologically later on referred to cervical papillomavirus infections in 64 per cent. Epidemiological inquiries of patients with cervical papillomavirus infection correspond extensively to those with invasive carcinoma of the cervix and premalignant cervical lesions.

9 normal pregnant women in the active phase of labor were treated with 500 ml low molecular dextrane with a pH of 4,5 under standardised external conditions. Before and after this infusion simultaneous estimations of the maternal and fetal acid-base status were made. There was neither a maternal nor a fetal acidosis.

Suspect smears of 622 patients from 1977-1986 were analysed for their causes and followed up until the definite cytologic or histologic result. In relation to the overall material of 97,963 cases the rate of suspect smears (group Pap. III) was between 1.18 and 0.27%, i.e. an average of 0.68%. The most frequent reasons for the classification "suspect" were inflammatory (42.4%), metaplastic or degenerative changes (16.1%) and doubtful pre-cancer (30.6%). 58% of all cases became negative under cytological control and antimicrobial therapy or hormonal substitution; of these 91.4% converted into negative within 6 months. The histological examination carried out on 230 patients revealed pre-cancer (CIN I-III) in 201 cases; cancer was proved in 5 cases. Compared to the whole population that is a rate of 33.1%. 24 cases were to be found negative. 139 Multiparae (67.6%) were to be found in the group of the 206 histological positive cases. 151 women (74%) had taken hormonal contraceptives. The rate of suspect smears should not exceed one per cent.

Pathomorphology, clinic and therapy of endodermal sinus tumor in pregnancy are explained and discussed by means of a women of 25 years. The importance of estimation of alpha-fetoprotein with regard to diagnosis and follow up is referred, too. The prognosis in former times very bad could be improved by a combination of radical surgery and polychemotherapy.

The results of treatment of histologically proven cervical intraepithelial neoplasia (CIN) in 10 women are described. Two of them had CIN I and 8 CIN III. All patients had a application of 5 g 5 per cent 5-fluorouracil cream in a cervical cup daily over a period of 12 hours for one week. All 10 patients have been examined colposcopically, cytological and by biopsy following therapy. In 8 women cone biopsie were done 6-12 months afterwards for having a final diagnosis 2 patients having CIN I pretherapeutically were follow up for 16 months with cytology, colposcopy and punch biopsy. In 6 cases we found better findings (Twice complete healing, twice only CIN I and twice CIN II as residues). In 4 cases severe dysplasia and carcinoma in situ could be found in endocervix. Based on these results were recommended more (not only one) treatment cycles for local efficient chemotherapy using 5 per cent 5-fluorouracil cream.

The frequency of Pap III-V findings in cytological screening examinations in Rostock-City was estimated for the age groups 16-20, 21-25 and 26-30 years. Two 3-year periods (1972-1974 and 1981-1983) were compared. A significant 9-fold increase of cytological results of Pap groups III-V was found during this time. Possible causes of this changing pattern, especially papillomavirus infections were discussed. In the age group 26-30 years there was the highest progression rate with almost 10%, in contrast to 1% in the age group 16-20 years. In the three investigated age groups a regression rate of 46% and a persistence rate of 38% were found. The results underline the increasing importance of gynecocytological screening examinations in young women.

In this paper results in diagnostics and therapy are presented of 185 patients with breast diseases obtained during special consultation hours. The greatest part of the breast diseases are fibrocystic mastopathies. Very good therapeutic results have been achieved using the phytotherapeutic agent Mastodynon. Emphasis is laid on the increasing importance of the histological findings and hormon receptor determination.

A vulvar cancer is demonstrated. Its origin from condylomata acuminata is discussed. The ultrastructural evidence of papillomavirusparticles within the nucleus of koilocytes are hints at a possible human papillomavirus etiology of vulvar carcinoma. Because of the malign transformation of condylomata acuminata described we recommend a consequent treatment and histologic examination of condylomata acuminata.