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Steigende Anforderungen an die Hygiene in Krankenhausern erfordern verbesserte systematische Methoden der Uberwachung durch den Offentlichen Gesundheitsdienst. Die Hygienekompetenz von mindestens 20% der in den Krankenhausern beschaftigen Mediziner und Pflegekrafte wurden durch eine systematische Befragung und Beobachtung uberpruft. Die Ergebnisse wurden den Krankenhausern vorgestellt. Insgesamt wurden 184 Personen in 5 Krankenhausern uberpruft. Durchschnittlich wurden sieben von zehn Fragen zum Hygienewissen richtig beantwortet, 74% der Personen fuhrten eine korrekte Handedesinfektion durch und 66% trugen keinen Schmuck an den Handen. Es gab keine signifikanten Unterschiede zwischen Arzten und Pflegekraften bei der Hygienekompetenz. Die geringen Unterschiede zwischen den 5 Krankenhausern wurden in eine Rangfolge ubertragen. Die Anwendung der Methode liefert zusatzliche Daten zur Hygiene in Krankenhausern und ermoglicht einen Vergleich der Hygienekompetenz der Mitarbeiter. Die Ergebnisse bilden die Grundlage fur einen Dialog zwischen Krankenhaus und Offentlichem Gesundheitsdienst.

Increasing demands on hygiene in hospitals require improved methods of systematic monitoring by the Public Health Service.The hygiene skills of at least 20% of the hospital physicians and nurses were evaluated by structured interviews and observation. The results were presented to the hospitals.In total, 184 persons were reviewed in 5 hospitals. On average, 7 out of 10 questions on hygiene knowledge were answered correctly, 74% of the persons asked demonstrated proper hand hygiene and 66% of them were not wearing any jewellery on their hands. There were no significant differences between physicians and nurses. The slight differences between the 5 hospitals were transferred into a ranking.The application of the method provides additional information on hygiene in hospitals and allows a comparison of the hygiene skills of their staff members. The results form the basis for a dialogue between hospital and Public Health Service.

PURPOSE, MATERIAL AND METHODS: The aim of this study was to investigate the influence of direct intraarterial application of the contrast agents Iodixanol-270 and Iopentol-150 on the capillary perfusion. This was accomplished through continuous recording of the capillary perfusion in the nailfold capillaries of the right hand before and after a bolus injection of 20 ml of contrast agent into the right axillary artery.After injecting 20 ml of Iodixanol-270, which has a high viscosity compared to the plasma viscosity, a statistically significant decrease in the erythrocyte velocity of 60.8% from 0.439+/-0.273 mm/s to 0.172+/-0.090 mm/s was observed already 10 s after the injection (p = 0.0001). The decreased velocity was maintained until the end of the observation period of 6 min. In contrast to this finding, no change in the erythrocyte velocity was observed after injection of 20 ml of the low-viscous Iopentol-150 (p = 0.1508).The erythrocyte velocity in cutaneous capillaries therefore strongly depends on the viscosity of the contrast agent.

In this study, the regulation of mitochondrial Ca2+ transport by polyamines structurally related to spermine and by analogous polycationic compounds was characterized. Similar to spermine, a number of amino groups containing cationic compounds exerted a dual effect on Ca2+ transport of isolated rat liver mitochondria: a decrease in Ca2+ uptake velocity and an enhancement of Ca2+ accumulation. In contrast to the effects of spermine and other aliphatic polyamines, however, the accumulation-enhancing effect of aminoglucosides, basic polypeptides, and metal-amine complexes turned into an inhibition of Ca2+ accumulation at higher concentrations. Within groups of structurally related compounds, the potency to decrease Ca2+ uptake velocity and to enhance Ca2+ accumulation correlated with the number of cationic charges. The presence of multiple, distributed cationic charges was a necessary, but not sufficient criterion for effects on mitochondrial Ca2+ transport, because cationic polyamines and basic oligopeptides which did not enhance mitochondrial Ca2+ accumulation could be identified. Spermine was not able to antagonize the blocking of Ca2+ uptake by ruthenium red, but rather showed an apparent synergism, which can be explained as a displacement of membrane-bound Ca2+ by spermine. The aminoglucosides, gentamicin and neomycin, but not the inactive polyamine bis(hexamethylene)-triamine, inhibited the binding of spermine to intact mitochondria. Apparently, the binding of spermine, gentamicin, and a number of polyamine analogues to low-affinity binding sites at mitochondria, which have low, but distinct structural requirements and which may correspond to phospholipid headgroups, indirectly influences the activity state of the mitochondrial Ca2+ uniporter. The ability of aminoglucosides to displace spermine from the mitochondria and to inhibit mitochondrial Ca2+ accumulation may contribute to the mitochondrial lesions, which are known to occur early in the course of aminoglucoside-induced nephrotoxicity.

In the period October 1993-February 1994, we performed three distal stomach resection operations laparoscopically (two Billroth-II anastomoses, one Billroth-I anastomosis combined with truncal vagotomy). The first patient, 83-year old, presented a stenosing, bleeding, prepyloric, malignant Non-Hodgkin lymphoma. The second patient, 84-year old, presented an ulcerated, non-malignant leiomyoblastoma of the antrum. Due to the histological type of the tumors a radical lymphadenectomy was not performed. The partially resected stomach (two thirds) was removed in a lap sac through a 3.5 cm infraumbilical incision. The third patient presented a persisting, prepyloric ulcer combined with an almost complete stenosis of the pylorus. In all three cases, it was possible to follow the principles of conventional open surgery. The anastomoses were all stapled intracorporally, no intraabdominal complications occurred. However, the first patient died on the 21st postoperative day from cardiopulmonary failure, the remaining two patients were discharged on day 11/day 12 postoperatively.

It is reported on the practicability and the results of therapeutic embolizations in 7 patients with pulmonary av-malformations. The embolizations were carried out by detachable balloons. In all cases there were immediate and well-defined occlusions. In direct fistulas the embolization represents a curative procedure. However, in cases of angiomatous malformations with slow flow character, only a reduction of shunt or decreasing of size is obtained.

Imaging procedures in patients suffering from portal hypertension and the problems arising from this condition are limited to the demonstration of the morphology of the collateral circulation towards the superior and the inferior vena cava. Imaging is essential prior to elective and emergency treatment of bleeding varices. Non-invasive and invasive imaging procedures are available. Acute hemorrhage of varices usually can not be demonstrated with any of the methods. Important is the preoperative evaluation of the portal system and the angiographic demonstration of the anatomy.

Die bildgebenden Verfahren beim Patienten mit portalem Hochdruck beschranken sich auf die Darstellung der morphologischen Zeichen der Umgehungskreislaufe uber die praformierten Anastomosen zum Abstromgebiet der Vena cava superior und inferior. Die Darstellung der Kollateralkreislaufe ist aus elektiv-praventiven und aus notfallmasigen Grunden indiziert.

Bei einem mit multiplen Anomalien geborenen, bereits nach 15 min gestorbenen Knaben wurde in kultivierten Fibroblasten eine Triploidie (69,XXY) nachgewiesen. Die Schnittflachen von Leber- und Placentazellkernen sind gegenuber Kontrollzellen vergrosert. Fast 50% der Leber- und der fetalen Placentazellkerne sind einfach chromatinpositiv.

A baby of 5 months had an incomplete aortic ring (arcus aortae circumflexus) in combination with a ligamentum arteriosum. Even in infancy specific symptoms may occur. Carefull angiographic investigation can avoid misjudging the symptoms (stridor, dysphagia) and can contribute to an exact diagnosis thus preventing unnecessary operation.

Report on the application of a new (valve equipped) detachable balloon for percutaneous transvasal embolization therapy in 372 patients with (noncerebral) curative preoperative and palliative indications.

Analysis of 1,104 non-surgical biliary drainages (600 ERCD, 531 PTCD) from 1983 to 1988 concerning changing frequency, indications and success rates. With a continuous increase of the total numbers, the fraction of percutaneous-transhepatic drainages has decreased to 28%. With increasing degree of difficulty and risk PTCD (90.9% success) is indicated primarily in case of impossible ERCD (85.9% success) and hilar benign and malign biliary obstruction for temporary or permanent biliary drainage. Both methods are complementary and are increasingly used for combined palliative drainage.

Within one year 15 women suffering from unexplained abdominal pain in the right upper quadrant were examined by sonography and hepatic arteriography. Ten benign liver tumours were detected. Symptoms, diagnostics and therapy are dealt with.

Alle perkutanen Behandlungsmethoden an den Nieren und ableitenden Harnwegen lassen sich auch bei der besonderen Risikogruppe der nierentransplantierten Patienten einsetzen. Fur Funktionsstorungen von Nierentransplantaten, wie Harntransportstorungen und Leckagen, sind urologische Komplikationen in 5—10% verantwortlich [4].

In vivo microscopic (video) investigations on the variability of flow conditions in the myocardium and intestines of anaesthesized normal tension rats after application of various ionic and non-ionic contrast media (Amidotrizoate, Ioxaglate, Iopromide, Iohexol, Iotrolan). Amidotrizoate causes heterogeneous microperfusion and functional shunt vessels (distribution disorder) with the typical symptoms of disturbed microcirculation. Ioxaglate, Iopromide, Iohexol and Iotrolan influence microcirculation differently but always to a far less degree.

After application of various ionic and non-ionic contrast media in the myocardium and intestine of rats, significant changes of flow conditions in the terminal vascular bed were observed with intravital microscopy: Amidotrizoate causes severe disorder in microcirculation distribution (heterogeneous perfusion, functional shunts), while Ioxaglate, Iopromide, Iohexol, Iotrolan cause significantly less microcirculation reactions.

For 50 sucklings and small infants with cyanotic and acyanotic heart defects the non-ionic contrast medium Iopromide was tested against the ionic contrast medium Amidotrizoate in angiography. With consideration to the applied method the tested cardiospecific enzymes (CK MB, alpha-HBDH, lactate) as well as hematocrit, oxygen content of central venous blood, heart rate, systolic pressures in both ventricles and ECG showed no significant differences. The different end-diastolic pressures in both ventricles and the average pressure in the right atrium, however, showed the cardiotoxicity of Amidotrizoate. Conclusively the use of Iopromide is demanded for infants, small infants and sucklings.