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The admission of patients with minor injuries, such as contusions is a regular practice in acute care hospitals. The pathophysiological changes resulting from the accident are seldom the primary reason for hospitalization. The aim of this retrospective monocentric study was therefore to examine the etiology as well as the cost-causing factors and refinancing on admission.Patients were identified due to a retrospective query in the hospital information system (HIS) according to the ICD-10 German modification codes at discharge. A total of 117 patients were enrolled over a period of 2 years. The classification was carried out according to the accident mechanism and the division into age groups. In addition, the cost calculation was based on department and clinic-specific daily rates.In terms of etiology low impact falls in the domestic environment were the most common cause (48.7%), followed by high-energy trauma (22.8%). Within the group with domestic falls, the mean age was 77.8 years. This group also showed the longest length of stay (LOS) with 5.2 days. As part of the calculated costs, the group of domestic falls showed the highest costs of 2596.24 € with an average DRG cost revenue of 1464.51 €.The evaluation of the clinic internal data confirmed the subjective perception that the majority of patients admitted with the diagnosis of contusions came from the age group65 years. Admission is primarily based on the increasing comorbidities and to avert secondary diseases and the consequences of immobilization. It could also be shown that the resulting costs are relevant to health economics and that the treatment does not appear to cover the costs.HINTERGRUND: Die stationäre Aufnahme von Patienten mit Prellungen wird in Kliniken der Akutversorgung regelhaft praktiziert. Dabei stehen die pathophysiologischen Unfallfolgen oft im Hintergrund. Ziel dieser retrospektiven monozentrischen Untersuchung war die Untersuchung der Ätiologie sowie der kostenverursachenden Faktoren und Refinanzierung bei Aufnahmen durch Prellungen.Es erfolgte die Abfrage der Patienten entsprechend den Entlassdiagnosen aus dem krankenhausinternen Informationssystem (KIS). Eingeschlossen wurden 117 Patienten in einem Zeitraum von 2 Jahren. Es erfolgten hier die Klassifizierung nach Unfallmechanismus sowie die Einteilung in Altersgruppen. Des Weiteren erfolgte die Kostenkalkulation anhand von abteilungs- und klinikspezifischen Tagessätzen.Bezüglich der Ätiologie war der häusliche Sturz die häufigste Ursache (48,7 %), gefolgt von dem Hochrasanztrauma (22,8 %). Innerhalb der Gruppe des häuslichen Sturzes lag das Durchschnittsalter im Mittel bei 77,8 Jahre. Diese Gruppe zeigte die längste Verweildauer (VWD) mit 5,2 Tagen. Im Rahmen der kalkulierten Kosten zeigte die Gruppe nach häuslichem Sturz die höchsten Kosten mit 2596,24 € bei einem mittleren DRG-Erlös von 1464,51 €.Die Auswertung der klinikinternen Daten bestätigte die subjektive Wahrnehmung, dass ein Großteil der nach Prellung aufgenommenen Patienten aus der Altersgruppe65 Jahre stammt. Die Aufnahme erfolgt hier vor dem Hintergrund der in dieser Altersgruppe zunehmenden Komorbiditäten sowie zur Abwendung von Folgeerkrankungen und Folgen der Immobilisierung. Ebenfalls konnte gezeigt werden, dass die Versorgungskosten gesundheitsökomisch relevant sind und die Behandlung in diesen Fällen nicht kostendeckend ist.

There are currently no reliable data on the differential use of renal replacement therapy (RRT) options for critically ill patients with acute renal failure in Germany.A questionnaire-based survey was delivered to 2265 German intensive care units. The questionnaire contained 19 questions regarding RRT.A total of 423 German intensive care units participated in the survey. The offered modalities of RRT varied significantly: the smaller the facility, the fewer different RRT options were available. Intermittent dialysis procedures were available in only 35% of hospitals with up to 400 beds. In university hospitals, hemodynamically unstable patients were exclusively treated by continuous RRT, whereas in hospitals with up to 400 beds, intermittent RRT was also used. In addition, treatment practice was also dependent on the specialization of the treating physicians: Isolated acute renal failure was treated more often intermittently by nephrologists compared to anesthesiologists (79.7 vs. 43.3%). Nephrologists also used extracorporeal RRT more often in cardiorenal syndrome (54.3 vs. 35.8%), whereas anesthesiologists preferred them in sepsis (37.3 vs. 23.1%). The choice of anticoagulant varied as well: Hospitals with up to 400 beds offered regional citrate anticoagulation in only 50% compared to 90% of university hospitals.Currently, RRT treatment in acute renal failure on German intensive care units seems to be dependent on the size, local structures, and education of the intensivists rather than patient needs. Our results demonstrate the necessity to establish cross-disciplinary standards for the treatment of acute renal failure in German intensive care units.

There are no reliable data on the structure and practice of the care of critically ill patients with acute renal failure in Germany.We carried out a detailed survey by sending a questionnaire to 2265 German Intensive Care Units. The questionnaire contained 19 questions regarding renal replacement therapy.423 German intensive care units participated in the survey. Most of the ICUs are headed interdisciplinary (47%) or by anesthesiologists (30%), with significant differences depending on the size of the clinic, with primarily interdisciplinary management in smaller clinics. The offered type of renal replacement therapy varies significantly, the smaller the house the fewer methods are available. Thus, intermittent dialysis procedures are offered only in 35% of hospitals with up to 400 beds. The indication for the initiation of acute renal replacement therapy in intensive care is provided predominantly (53%) by an anesthesiologist. A nephrologist is only involved in 22% of all intensive care units. The indication is based primarily on a "clinical criteria", but these are poorly defined.Our results demonstrate the need for cross-disciplinary standards for the treatment of acute renal failure in German intensive care units.

Bathing is possible without any epidemic risk in Southbavarian lakes. Limit values according to the water monitoring by the EC-Directive 76/160/EC were rarely exceeded and occurred only in 0.3 to 2.1 % of the samples from 1990 to 1998. In river waters, however, limit values occurred in 17 to 35.3 % of the samples and one should beware of bathing there. In 1999 some lakes became fecally polluted by overflows which could be documented by high numbers of total coliforms but not by Escherichia coli. Subsequently total coliforms functioned as an important hygienic parameter. Therefore, total coliforms should not be abolished in the revision of the EC-Directive. Water monitoring of little lakes further revealed that the future limit value of 100 fecal streptococci in 100 ml was exceeded in more than 50 % of the samples. Enterohaemorrhagic E. coli were demonstrated in 2 % of the surface water samples. Thermophilic campylobacters could be isolated from 17.4 % of bathing water samples which were faultless according to the hygienic parameters of the EC-Directive. In this respect all possibilities should be utilized to minimize fecal pollutions at bathing places.

Whereas coliform bacteria rank first, non-coliform enterobacteria can be isolated second in frequency from bottled mineral, spring and table waters in South Bavaria. Escherichia coli were found in 8, coliforms in 44 and non-coliform enterobacteria in 41 of 54 manufactories with hygienic problems. 11 different bacterial species were determined from coliforms with Enterobacter cloacae occurring most numerous in 19, Citrobacter freundii in 12 and Enterobacter amnigenus in 7 manufactories. From non-coliform enterobacteria 18 different species could be determined. Again Enterobacter cloacae was found most frequently in 17 manufactories followed by Enterobacter amnigenus in 11 and Serratia liquefaciens in 7 manufactories. The investigation of total Enterobacteriaceae is suggested as a suitable quality criterion for bottled mineral, spring and table waters.

The relative linear relationships of creatine phosphate/gamma-adenosine triphosphate (PCr/ATP) and of phosphodiester (PDE)/ATP were measured in 38 normals and 27 patients with cardiac insufficiency using cardiac 31P-MR-spectroscopy. There was no significant difference between normals and those with dilated cardiomyopathy (19 cases) and severe aortic valve lesions (8 cases), irrespective of the clinical stage of the cardiac abnormality. Within subgroups of insufficiency there was a correlation between PCr/ATP and the severity of the disease with significant differences between mild and severe cardiac insufficiency. In 6 patients a significant rise in PCr/ATP could be demonstrated following clinical improvement under drug therapy. There was no correlation between the relative linear relationship and the left ventricular ejection fraction.

The CSF volume of 45 patients with HIV infection was measured at various clinical stages and the results compared with 24 normals. 60% of all patients showed increased CSF spaces as an indication of cerebral atrophy. Serial measurements were particularly valuable during the early stages of atrophy since there is marked variation in the normal CSF volume. Conventional measurements, with the exception of the width of the third ventricle, were much less sensitive than these quantitative measurements. Classification of HIV infection according to the clinical stage was useful since CSF volume and volume increase correlated with the stage of HIV infection.

The T1 relaxation times of the phosphorus metabolites in human heart muscle measurable by 31P-MR spectra were determined in 12 individuals using a 1.5 Tesla system. Several spectra were recorded consecutively with a pulse repetition time of 1.6 s to 24 s. The T1 times of creatine phosphate (CP), of gamma-, alpha-, beta-adenosintriphosphate (ATP), 2,3-diphosphoglycerate (2,3-DPG) together with anorganic phosphate) and phosphodiester (PDE) showed mean measurements of 6.1 +/- 0.5, 5.4 +/- 0.5, 5.0 +/- 0.5, 5.8 +/- 1.0, 7.6 +/- 1.0, and 5.0 +/- 1.0 s (M +/- SE). The accuracy of the ISIS technique was tested with a special phantom. T1 times were also measured in standard solutions (20 mM CP, 10 mM ATP); CP was 8.7 +/- 0.2 s and gamma-ATP was 9.9 +/- 0.7 s. Corrections for partially saturated 31P-MR spectra--at least for CP/ATP ratios--are relatively small.

31P-magnetic resonance (MR) spectra of the heart can be obtained from well-defined myocardial regions by combined MR imaging and variable selected volumes for spectroscopy. 31P-spectra of 33 volunteers and of 43 patients with dilated and hypertrophic cardiomyopathy and with coronary artery disease were quantified using a curve-fitting routine. To optimize our technique, we recorded unsaturated and partially saturated spectra in several volunteers. Relative peak areas and signal-to-noise ratios showed significant changes with varying pulse repetition times. Saturation factors were applied to correct spectra from volunteers and patients for the effects of partial saturation. Under resting conditions, peak areas of volunteers and patients from the various groups were statistically indistinct.

Salmonella could be isolated from nine of 596 samples from lakes and from 195 of 1,549 river water samples from South Bavaria between 1986 and 1990. In correlation with the classification of bathing waters the Salmonella occurrence ranged from 0.3% to 2.9% and 4.3% in lakes and from 1.0% to 7.8% and 23.8% in rivers with regard to water samples which were satisfactory or which were not satisfactory in respect of the guide values and the limit values as determined by the densities of faecal coliforms and total coliforms. In these studies it was seen for the first time that Salmonella enteritidis exceeded Salmonella typhimurium in frequency in 1988, increasing to 63.5% of Salmonella-positive surface water samples in 1990. Salmonella could also be isolated from six of 132 drinking water samples containing Escherichia coli as well and from three of 129 drinking water samples containing coliforms.

To estimate the danger of infection by a mud bath, especially in group baths, 51 mud samples were analysed before and 80 after application for faecal and total coliforms (FC, GC), Pseudomonas aeruginosa. Staphylococcus aureus and Candida albicans. The latter two germs were not identified in any of the samples. Pseudomonas aeruginosa was found in about 11% of the samples of both groups. FC and GC were also found before as well as after the bath. Besides E. coli, 9 other strains could be identified. It can be concluded from the data on FC and GC before and after bath, firstly, that a slight faecal contamination is possible, secondly, that the mud can be considerably contaminated with faecal germs even before application. The risk of faecal germs in mud baths causing an epidemic can be neglected, because the bath mud is not swallowed. Therefore, the use of a large-scale mud bath for several patients can be recommended.

In the monitoring of bathing waters according to the EC-guideline, total coliform and faecal coliform bacteria were obtained from 97 samples of river waters by the comparison of two fluorogenic assays using MUG-Lauryl Sulfate Broth and MUG-BRILA Broth with an usual method with MacConkey Broth, Tryptophane Broth and BRILA Broth. MUG-BRILA Broth had the lowest average counts and proved to be not an appropriate medium. Compared with the usual method, however, MUG-Lauryl Sulfate Broth yielded similar high counts, reduced the investigation period from four to two days and diminished the expenditure of work by one third. In addition, the indole test for the confirmation of presumptive faecal coliforms might be abolished. Therefore, the examination with MUG-Lauryl Sulfate Broth can be recommended.

MR-spectroscopy of the heart is a relatively new technique for the study of various aspects of cardiac metabolism. The majority of results has so far been obtained with the isolated perfused heart. Here, 31P-MR spectroscopy can be employed to measure high-energy phosphate metabolism and intracellular pH repeatedly and non-invasively. Using a technique called saturation transfer, velocities of enzymatic reactions, such as the creatine kinase reaction, can be measured. Intra- and extracellular Na+ and K+ concentrations can be registered with 23Na- and 39K-MR in conjunction with shift reagent. 13C-MR can be used to tackle carbohydrate metabolism. In-situ-R-spectroscopy allows determination of high-energy phosphates in intact large mammals. Clinical applications of MR-spectroscopy remain to be defined; preliminary results indicate high diagnostic and prognostic potential for patients with coronary artery disease and congestive heart failure.

653 11 beer mugs rinsed mechanically by conveyor belt dishwashing machines and 182 mugs cleaned in open vats were investigated for their content of faecal and total coliforms. Ten and more faecal coliform germs could be detected in 4.7% of the mechanically rinsed tankards and in 12.1% of those cleaned in open vats. Respectively, ten and more total coliforms were found in 30.3% and in 67.6%. Altogether 213 coliform strains as defined by the German drinking water regulation were characterised biochemically by the API 20 E-system and by their susceptibility to 15 antimicrobial agents. A total of 19 different species from eight genera could be differentiated, whereas 12 strains were unidentifiable by the applied system. Klebsiella oxytoca was the most frequently encountered germ, followed by Enterobacter cloacae, K. pneumoniae and Ent. sakazakii. 59 of the 213 strains were fully susceptible to all antibiotics used. 44 strains, however, revealed complete or moderate resistance against three and more agents. These results indicate that unhygienic dishwashing procedures may play a decisive role in the epidemiology of clinically relevant and multiresistant germs.

Cardio-MRT provides complex diagnostic information (morphology, function, biochemistry) with little stress for the patient and is therefore used increasingly for clinical diagnosis. There is great need for interdisciplinary studies concerning function, the use of contrast media and spectroscopy.

Forty hands of 39 patients with rheumatic joint disease were examined by MRT. The method differentiates between inflammatory exudative and proliferative processes in soft tissues and bone. T2-weighted images provided criteria for judging the activity of the disease. MRT provided better demonstration of the soft tissues than just conventional radiography. The methods were of equal value for showing bone lesions. MRT is suitable as a means of diagnosing rheumatoid changes in the hand.

During the year 1977 we examined 2226 samples of swimming pool waters for colony counts, Escherichia coli and coliforms according to the German standards for drinking water. In addition, Pseudomonas aeruginosa was isolated out from 180 of those samples. This microorganism was found in 4.7% of samples from public municipal swimming pools, in 4.1% from swimming pools in schools, in 13.1% from swimming pools in hotels, boarding-houses, hydropathic establishments, sanatoria, blocks of flats and private dwellings as well as in 38% (!) from swimming pools in hospitals. P. aeruginosa could rarely be isolated together with E. coli or coliforms. However, it was often found in samples, which were faultless according to the bacteriological standards for drinking water. Its necessity as an additional important hygienic parameter will be discussed.

Samples of liver sausage and liver tissue from slaughtered animals were analysed for pre-formed vitamin A. A sensitive reversed phase HPLC method with fluorescence detection was used to determine the amount of free and esterified retinol in extracts of these samples. Under our chromatographic conditions retinyl myristate and linoleate run together as do retinyl palmitate and oleate. The contents of all forms of vitamin A were expressed in milligrams of all-trans retinol per 100 g wet weight. The average concentrations of total vitamin A for turkey, pig, calf, beef, and chicken liver were 42.31, 38.15, 22.74, 14.98, and 13.22, respectively. In addition to these differences, the fatty acid composition of liver retinyl esters, as well as the amount of retinol, also varied considerably among species. Approximately 95% of the hepatic vitamin A was present as retinyl ester with retinyl palmitate/oleate as the main ester fraction. The second most abundant fatty acid in the retinyl ester fraction of calf, beef, and chicken liver was stearic acid followed by myristic/linoleic acid. An increment of retinol, however, was also found in these tissue samples. By contrast, in turkey liver the retinol fraction was increased and therefore both retinyl stearate and retinol were present in nearly equal amounts, whereas the retinyl ester fatty acids from pig liver contained relatively more myristate/linoleate and less stearate than those from liver of the other domestic animals (apparently a hallmark of pig liver). The retinol and retinyl ester pattern present in liver sausage was similar to, but not identical with, that of pig liver.(ABSTRACT TRUNCATED AT 250 WORDS)

The author compares his own schizophrenic patients treated by him and his co-workers at the Vienna Psychiatric University Clinic between the years of 1949 and 1959 by 'bifocal family therapy', a method developed by him with a control group. In his own patients he has carried out a 20-year follow-up study assessing a subsequent course of their lives. The control group consisted of schizophrenic patients treated in 1970 at the Vienna Psychiatric Hospital along routine lines by pharmacotherapy. The psychotherapy group (n = 116) assessed by social criteria such as work record, partner relationships, children, or social isolation, invalidism at home or in hospital is clearly superior and approaches normality. Yet even they show ongoing signs of dynamic disturbance in the sense described by Janzarik expansive derailment, instability, emptiness) which have statistical relationships with the types of breakdowns in their life history and the kinds of later partner relationships. The author interprets this socially successful psychotherapy as a help in achieving emancipation in relation to a certain situation which arose in its development, but sees in the continued affinity to the basic dynamic disturbance and its influence on partner choice a risk factor of the newly formed family and the issuing children.

By using surface coils and a high resolution matrix, the images from MR tomography of small objects can be greatly improved. Normal subjects have been examined in order to demonstrate the usefulness of MR tomography for the examination of bones and soft tissues in the normal hand.

Though chronicity in psychiatry seems to have undergone a favorable modification, it has, nevertheless, increased and evolved so to adopte itself to a more liberal society (group techniques having no doubt contributed to this modification). Chronicity is no longer the end result of the asylum and solitude. Stades of chronicity are found in each and every branch of medicine, its development being parallel to the expressive of medicine itself. Due to intensification of preventive medicine and post-cure, chronicity touches not only patients undergoing long-term treatment, but also those attending ambulatories and post-cure institutions, and individuals who are considered ill in their environmental interactions, living recluded lives in order to avoid contact, friction and treatment. Chronification, deriving from the interaction with the therapeutic system, can be avoided if the patient and his milieu, in a common effort, give up the idea of illness and allow confrontation to the aggressive stimuli of society. The lack of understanding on the therapist's side, concerning the above-mentioned effort, in the demonstration that the therapist has a preconceived position in the system. This fact is not surprising since chronification is a target in medicine which defines health as a sort of negative of the illness it treats. On the other hand Freudian psychology should enable us to renounce all absolute idealization and help us seek health conceived as a libidinal blend of Eros and Thanatos. The question is not, therefore, how to avoid chronicity, but how to find a chronicity adapted to the patients biography and not to our own.

2429 samples of drinking water supplies in South Bavaria were examined for Yersinia between October 1982 and March 1983. Yersinia enterocolitica was isolated from 82 of 1650 samples of central water supplies and from 42 of 779 samples of decentralized water supplies. Only three of these strains were serotype O3 but indole-positive and different by that from the indole-negative human pathogenic serotype O3 which is most frequent in Western Europe. No strain was serotype O9. Y.e. was more often isolated from water samples which were objected according to the German drinking water decree to contain Escherichia coli, coliforms or increased colony counts. This points thereupon that Y.e. do not originally belong to the saprophytic soil bacteria but reaches the drinking water subsequently by fecal pollution. As compared with ENDO-Agar, CIN-Agar was found the preferable medium with a three times higher isolation rate. In addition, Y. intermedia and Y. frederiksenii were isolated from 20 and 23 samples respectively.