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INTRODUCTION: Knowledge on potentially pathogenic microbes including characteristics of their antibiotic resistance in septic patients as well as on the ward- and department-specific microbial spectrum can be considered essential for an efficient initiation of an adequate antimicrobial treatment, which turns out to become pivotal for patient outcome. Permanent changes in microbial patterns and antibiotic resistance can only be identified by a continuous investigation of various microbiological specimens. AIM: Based on the retrospective evaluation of prospectively collected data on microbiological investigations of the surgical ICU in 1996, 2002, 2004 and 2005, the short- and long-term changes by trend of microbial spectrum and antibiotic resistance following reorganisation and restructuring of the University Hospital from the more traditional pavillon-based system to a multidisciplinary complex building in 2003 were investigated. MATERIAL AND METHODS: Twice a week, routine microbiological testing of blood and urinary cultures as well as swabs from wound areas and endotracheal swabs were initiated in septic patients (suspect, manifestation) or in case of their clinical impairment. The microbial spectrum was sub-divided according to Gram-staining (Gram-posi-tive / -negative), various species and fungi with descriptive absolute and relative data values. -Various groups and time periods were statisti-cally compared using χ 2 test as appropriate. P val-ues < 0.05 were considered statistically significant. RESULTS: In total (n Total = 4 899), microbiological testing resulted in the detection of microbes in 699 and 833 blood and urinary cultures (14.3 % and 17 %, respectively) as well as 1 232 wound swabs (25.1 %) together with 2 135 samples from the endotracheal sites (43.6 %). During the short- (2002 vs. 2004) and long-term analyses (1996 vs. 2005), the proportion of Gram-positive microbes increased. Al-though Gram-positive bacteria can be considered the most frequent microbes for bacteriemia, there was a shift onto urinary and wound infections as well as pneumonias through the observation period. Despite the decreasing incidence of Enterococcus and the consistent proportion of MRSA, the increase of resistant Enterococcus strains (0 % vs. 43.2 %; P < 0.05) is critical. However, in the Gram-negative microbial spectrum there was an increase of the bacteraemia rate but a fall of the detection rate in wound and endotracheal swabs. In parallel, an increase of the detection rate of E. coli in blood (6.5 % vs. 45.5 %; P < 0.05) and endotracheal swabs (9.2 % vs. 16.2 %; P < 0.05) is associated with an increase of multiresistant Enterobacteriaceae strains (0 % vs. 30.7 %; P < 0.05). The portion of multiresistant strains of Pseudomonas with 31 % stayed the same through the 10-year time period. While Candida-based colonisation showed a decreased incidence (25 % vs. 15 %; P < 0.05) during the whole investigation period, there was a relative rise in the frequency of candidemia. CONCLUSION: ICU relocation from the pavillon-based system to a new complex clinic building was not associated with any significant alteration of the microbial spectrum on the surgical ICU. Increasing incidences of resistant Enterococcus and Gram-negative problematic microbes may indicate a general spread of multi-resistant microbes under the steady selecting pressure of a not always adequately initiated antibiotic / antimicrobial therapeutic regimen and underline the required but specific and selected microbiological screening.

INTRODUCTION: Infections belong to the most frequent and dangerous complications in surgery. In addition to the medical aspects, these infections may have a significant impact on the costs and the overall economic efficacy of medical treatment under the present circumstances of DRG. AIM: A systematic, prospective collection and retrospective evaluation of all consecutive microbiological analyses in specimens from the 3 medical floors (except the ICU) of the Department of Surgery at the University Hospital, Magdeburg (Germany) was performed in 1995, 2002 and 2004 to characterise i) the 10-year course (1995 vs. 2004) and ii) possible alterations due to changes in the previously existing pavillon system (2002 vs. 2004). PATIENTS AND METHODS: The microbial spectrum was determined in the 3 most frequent specimen types (blood culture, urine sample, wound swab) including number and percentage of the single microbial groups such as gram-positive and gram-negative Enterobacteriae, pseudomonades and fungi. In addition, the antibiotic resistance of selected microbes was analysed. The primary data were registered in a database and evaluated according to the various questions. RESULTS: Overall, 2 979 microbes were identified in 1995 (2002, 1 338; 2004, 915). On comparing 1995 with 2004, the percentage of gram-positive microbes did not change (50.5 vs. 50.3 %), whereas the percentage of gram-negative enterobacteriae increased: 37.4 vs. 29.1 %. The percentage of detected fungi was only half of that in 1995: 6.2 vs. 12.2 %. In blood cultures, the Klebsiella spp. portion in the group of gram-negative enterobacteriae distinctly increased: 29.6 vs. 18.8 %. While in 2004, MRSA was found in 24.4 % of all detected Staphylococcus aureus strains in swab specimens amounting to a considerable increase compared to 2002 (17.6 %), in 1995, MRSA was not isolated at all in this material. In the fungi group, there was a decrease of the Candida albicans portion vs. the non-C. albicans strains, which was associated with an increasing resistance against fluconazol. This requires treatment with caspofungin, resulting in increased costs vs. those necessary for fluconazol treatment. CONCLUSION: A systematic, microbiological, long-term monitoring is indispensable since i) microbial detection plays a growing role to include the various types of infections in the spectrum of diagnosis for DRG, ii) alterations of the microbial spectrum can only be detected through a long-term observation period (MRSA, fungi) and iii) simultaneously developing antibiotic resistances can be determined (MRSA, ESBL strains in Enterobacteriae, fluconazol-resistant fungi). This can have an infectious, biological, hygienic and cost-determining as well as a health policy relevance among others, with considerable additional costs (e. g., isolation of patients, cost-intensive substitutional medication) with necessary reimbursement.

The incidence of infection following arterial reconstruction using synthetic graft materials varies from less than 1 to 5%. One of three mechanisms is thought to be responsible: 1. intraoperative contamination, 2. extension from adjacent infected or colonized tissue, or 3. hematogenous or lymphogenous seeding. We present ultrastructural data of a patient with a polymicrobial graft infection due to a prostheto-enteric fistula 16 years after reconstruction of an aortobifemoral graft. The polymer surface showed signs of biodegradation and was completely covered with a layer of plasma proteins. Disrupted fibroblasts on the intersegmental graft surface were surrounded by bundles of collagen. Gramnegative rods and grampositive cocci were embedded in an extracellular EPS matrix. Bacterial culture confirmed growth of Eikenella corrodens, Fusobacterium nucleatum and Peptostreptococcus species. Fibrin and granulation tissue from the neoadventitia started to mark off the inflammatory process. Transmission electron microscopy is a valuable tool for the investigation of alloplastic arterial devices. After 16 years of implantation the graft shows different signs of biodegradation.

Introduction: This work presents initial experimental results obtained with co-incubation of human neutrophilic granulocytes from patients with various diseases (5 patients each group) and collagen- or silver-coated polyester grafts (25 patients each graft). Methods: After two-hour co-cultivation of the graft with human granulocytes of different patients (normal controls; peripheral occlusive vascular disease; diabetes mellitus; carcinoma/chemotherapy; sepsis), the following parameters were determined by flow cytometry: CD11b, CD62L, fMLP, CXCR2. Results: The change in the receptor expression was taken as a measure of responsiveness, with statistically significant differences seen within and between the groups. For the silver-coated graft, such differences were mainly noted for the fMLP receptor (p=0.01). For the two-hour incubation with collagen coating, the receptors CD62L and CXCR2 were indicative of differences between the various diseases (CD62L p = 0.01; CXCR2 p = 0.01). Comparison between the grafts revealed statistically significant differences for the CXCR2 and the fMLP receptors (CXCR2 p=0.00; fMLP p = 0.03). Conclusions: The differences noted between the grafts and between the patients groups are suggestive of an altered responsiveness of the granulocytes to the grafts. This enables new aspects with respect to the genesis of accompanying clinical symptoms.

Over the past 35 years, Jurgen Gartner has made seminal contributions to probability theory and analysis. In this brief laudatio, I describe what I consider to be his five most important lines of research: (1) Gartner-Ellis large deviation principle; (2) Kolmogorov–Petrovskii–Piskunov equation; (3) Dawson–Gartner projective limit large deviation principle; (4) McKean–Vlasov equation; (5) Parabolic Anderson model. Each of these lines is placed in its proper context, but no attempt is made to fully trace the literature. What characterizes the papers of Jurgen is that they all deal with hard fundamental problems requiring a delicate combination of probabilistic and analytic techniques. A red thread through his work is the symbiosis of large deviation theory and potential theory, which he masterfully combines to reach powerful and elegant solutions.

Posttraumatic and postoperative infections which may be either localized or turn into sepsis are a major cause of morbidity and mortality in surgical patients. They derive from the imbalance between microbial pathogenicity factors and the host defense system. The virulence mechanisms include adhesion, chemotaxis, invasion, resistance, and production of toxins. In addition, local and/or systemic immune functions in these patients are altered. Unspecific as well as specific cellular and humoral defense mechanisms are affected. The interaction of defined microbial pathogenicity factors with immune effector cells results in the activation of a variety of inflammatory mediators; they are a prerequisite for protective immunity but also induce local or systemic damage in the host when they occur in excessive amounts or when their metabolism is inadequately controlled. The analysis of the pathophysiological events during infection in surgical patients by taking advantage of modern molecular and cell biological methods may contribute to the development of novel therapeutic strategies.

The HADES (High Acceptance Di-Electron Spectrometer) is a tool designed for lepton pair (e+e-) spectroscopy in pion, proton and heavy ion induced reactions in the 1-2 A GeV energy range. One of the goals of the HADES experiment is to study in-medium modifications of hadron properties like effective masses, decay widths, electromagnetic form factors etc. Such effects can be probed with vector mesons (ρ, ω, Φ) decaying into e +e- channel. The identification of vector mesons by means of a HADES spectrometer is based on invariant mass reconstruction of e +e- pairs. The combined information from all spectrometer sub-detectors is used to reconstruct the di-lepton signal. The recent results from 2.2 GeV p + p, 1 A GeV and 2 A GeV C+C experiments are presented. 37 139 151 Sponsors: National Atomic Energy Agency Conference code: 67031

An experimental in vitro model has been developed in order to determine whether Blastocystis hominis is able to trigger inflammatory cytokine response in colonic epithelial cells. After 24 h incubation of B. hominis with the cell lines HT-29 and T-84, B. hominis cells were not able to cause cytopathic effects, but significant increases in the release of the cytokines IL-8 and GM-CSF could be observed. However, after the first 6 h of co-incubation, the production of IL-8 was not increased in HT-29 cells, and even reduced when Escherichia coli (bacteria or lipopolysaccharide) was present during co-incubation. Similar effects were observed using supernatants of B. hominis culture. These data indicate that B. hominis induces as well as modulates the immune response in intestinal epithelial cells, and we conclude that different pathophysiological events may occur during B. hominis infection.

The generation and release of lipoxygenase factors and leukotrienes from human polymorphonuclear granulocytes is demonstrated during bacterial phagocytosis and interaction with bacterial exotoxins (α-toxin, enterotoxin, lipase from Staph. aureus; Streptolysin O; cytotoxin from Pseudomonas aeruginosa). The leukotrienes released during stimulation exert chemotactic properties for human neutrophils and guinea pig eosinophils (leukotriene B4) and show the characteristic profile of slow reacting substance activity which is induced by leukotriene C4, D4 and E4. The toxin induced spasmogenic activity obtained from human PMNs was inhibited in the presence of the SRS-antagonist FPL 55712. The generation of lipoxygenase factors is also demonstrated by autoradiography using 14C arachidonic acid prelabelled granulocytes.

Cardiomyotomy and fundoplication were performed in 7 children with achalasia of the oesophagus. They were followed up clinically, radiologically and manometrically from 7 to 18 years. Virtually all clinical symptoms and complaints disappeared immediately postoperatively and the patients remained free from symptoms well into adolescence except for very mild intermittent dysphagia in two of them. The residual mega-oesophagus and the disturbances of motility were least apparent in those operated on in early infancy. It may, therefore, be assumed that the motility pattern is more likely to return to normal in the oesophagus of the infant due to the relatively short period of dilatation. Fundoplication after Nissen did not alter the existing motility but was able to prevent gastro-oesophageal reflux and its possible grave consequences in all cases.

Our experimental data of the past seven years cover the generation of a non-preformed lipid-mediator which primarily assayed with guinea pig eosinophils proved to be eosinophil chemotactic. The analysis of the various stimuli led in 1978 to the concept of the phospholipase-arachidonic sequence as a common link for membrane activation. Immunopharmacological studies using either arachidonic acid as stimulus or arachidonic acid analogues provided an early evidence that the lipid chemotactic factor was a lipoxygenase product. These results were supported by analytical studies using thin layer chromatography, reversed phase HPLC, mass spectrometry, the comparison of the lipid chemotactic factor with endogeneous HETEs and by the synthesis of mono- and di-HETEs. It became also evident that mono- and di-HETE are not only mediators but also modulators of inflammatory reactions as was demonstrated for the C5a induced eosinophil chemotactic response. A less pronounced effect on the C5a induced eosinophil and neutrophil chemotactic response was exerted by PAF and its structural analogues. It is also demonstrated that isolated bacterial exotoxins trigger the cells via the phospholipase-arachidonic acid sequence thus generating mono- and di-HETEs leading to the amplification of an inflammatory response.

In recent years major interest has been addressed to the functional behavior of polymorphonuclear granulocytes (PMNs) in patients suffering from severe burns. It was observed that serious PMN dysfunctions were associated with acquired immunological abnormalities including impairment of chemotaxis, phagocytosis, and bacterial killing (Arturson 1985; Deitch et al. 1984). Granulocytes are not only involved in host defense against microbial infections, but also as effector cells in inflammatory reactions. One of the early responses after their stimulation is the release of biologically active mediators such as the leukotrienes (Bray 1986). Leukotrienes represent a family of hydroxy fatty acids which were generated from arachidonic acid by the activity of a 5-lipoxygenase. The enzymatic conversion of LTA4 leads to the formation of LTB4, which is a chemo- tactic and chemokinetic agent for granulocytes, monocytes, and macrophages. A further hydroxylation of LTB4 leads to metabolites with minor biological activities, e.g., omega-oxidation products (Hansson et al. 1981). The leukotrienes C4, D4, and E4 (together constituting the slow-reacting substance, SRS) are potent constrictors of smooth muscles and lead to an increase in vasopermeability. In addition, the involvement of leukotrienes in the regulation of cell-mediated reactions has recently been demonstrated (Rola-Pleszczynski 1987). The purpose of the present study was to analyze the generation of leukotrienes in vitro from granulocytes of severely burned patients in comparison to the granulocytes of normal healthy donors.

Die Mastzelle kann im Rahmen der immunologischen und nichtimmunologischen Aktivierung akute, subakute und chronische Entzundungsprozesse einleiten. Zu den immunologischen Stimuli der Mastzellaktivierung gehoren das Immunglobulin E, die Komplementbruchstucke C3a, C4a, C5a wie C3b und fernerhin kationische Proteine aus Granulozyten. Es ist erwiesen, das Mastzellen neben den Rezeptoren fur IgE auch Rezeptoren fur Immunkomplexe auf der Oberflache tragen. Diese modulieren je nach ihrer Grose die IgE induzierte Mediatorenfreisetzung. Die Herstellung monoklonaler antigenspezifischer IgE-Antikorper in der Maus erlaubt exaktere Untersuchungen zur Rezeptorenanalyse und Affinitat. Die Aktivierung der Mastzelle uber das IgE-Signal erfolgt uber die Vernetzung von juxtaponierten IgE-Molekulen. Offenbar ist die Aggregation (Clustering) von Rezeptormolekulen in der Membran entscheidend fur die Induktion der Sekretion. Es wird zur Zeit diskutiert, das die Rezeptorvernetzung eine membranstandige Esterase und Methyltransferase aktiviert. Bei der Membranperturbation wird Lysophosphatidylcholin vermehrt gebildet. Ober die Phospholipase-Arachidonsaure-Sequenz wird das Membransignal transduziert. Es erfolgt die Ausschuttung praformierter (Histamin, lysosomale Enzyme, neutrophil chemotaktischer Faktor) und neugenerierter Mediatoren (Leukotriene mit chemotaktischer und spasmogener Wirkqualitat, thrombozyten-aggregierender Faktor-PAF). Es wird gezeigt, das das Anaphylatoxin induzierte Membransignal ebenfalls uber die Phospholipase-Arachidonsauresequenz weitergeleitet wird. Hemmer der Phospholipase A2 oder der Lipoxygenase inhibieren die C5a induzierte Histaminfreisetzung. Die Vielzahl der freigesetzten Mediatoren fuhrt zu einem interzellularen Wechselspiel und konnte an den verspatet auftretenden mastzellinduzierten Entzundungsreaktionen beteiligt sein.

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The HADES (High Acceptance Di-Electron Spectrometer) is a tool designed for lepton pair (e+e-) spectroscopy in pion, proton and heavy ion induced reactions in the 1-2 A GeV energy range. One of the goals of the HADES experiment is to study in-medium modifications of hadron properties like effective masses, decay widths, electromagnetic form factors etc. Such effects can be probed with vector mesons (rho , omega , phi ) decaying into e+e- channel. The identification of vector mesons by means of a HADES spectrometer is based on invariant mass reconstruction of e+e- pairs. The combined information from all spectrometer sub-detectors is used to reconstruct the di-lepton signal. The recent results from 2.2 GeV p+p, 1 A GeV and 2 A GeV C+C experiments are presented.

Background. In line with the World Health Organization (WHO) guideline on chloroquine (CQ) resistance, CQ was withdrawn as the first-line antimalarial drug in Nigeria in 2005 as a result of widespread resistance. It was expected that its sensitivity and clinical usefulness ould be restored with time. This study therefore aimed to determine the level of CQ resistance in Nigerian children aged less than 60 months. Methods. We monitored the resistance pattern 5 years after withdrawal of CQ, using the pfcrt K76T mutation as a molecular marker for CQ resistance. Results. Of 98 Plasmodium falciparum-positive blood samples, 95 (96.9%) showed the K76T mutation. Twenty-seven (27.6%) of the children had been treated with CQ at home before presentation at the clinic, while 50 (51.0%) had taken other antimalarials. Conclusion. Our results indicate that there is an urgent need to re-evaluate antimalarial drug policy in Nigeria, especially when 27.6% of our study population still use CQ at home despite its withdrawal as first-line antimalarial. This may require effective legislation against the manufacture, importation and use of CQ in Nigeria, if the purpose behind its withdrawal is to be achieved.

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We prove that a self-avoiding random walk on the integers with bounded increments grows linearly. We characterize its drift in terms of the Frobenius eigenvalue of a certain one parameter family of primitive matrices. As an important tool, we express the local times as a two-block functional of a certain Markov chain, which is of independent interest.