Rückblick auf 10 Jahre Infektionsschutzgesetz

In 2001, the German Protection against Infection Act came into force, implementing a variety of new regulations. For the first time, obligatory infection control visits of the public health departments in surgical ambulatory practices were implemented, as well as optional infection control visits in all medical, dental and paramedical practices using invasive methods. Based on the data of the public health department of the city of Frankfurt am Main, Germany, an evaluation of this new regulation is given in this paper. First, prioritization of these new tasks was mandatory. First priority was given to the obligatory visits in surgical practices, second priority to the hygiene visits in practices performing endoscopy in gastroenterology as well as in urology and in practices of traditional healers, and third priority was given to all other doctors’ practices. After receiving preliminary information and further training of the doctors etc., the control visits were performed by members of the public health department, using a checklist based on the guidelines of the German Commission on Hospital Infection Prevention (“Kommission für Krankenhaushygiene und Infektionsprävention”). Since 2001, more than 1100 infection control visits in medical practices in Frankfurt am Main were documented. Not only in surgical, but also in gastroenterological and urological practices great improvement could be achieved, regarding not only hand hygiene and reprocessing surface areas, but especially in reprocessing medical devices. In practices for internal medicine and those of general practitioners, errors in hand hygiene, skin antiseptic and surface disinfection also decreased. According to our results, especially regarding the improved quality of structure as well as quality of process and with regard to the public discussion on this hygiene topic, our evaluation is absolutely positive. The new regulation proved worthwhile.     

Posterior spinal cord block: a dosimetric study

To determine the optimal width of a midline posterior spinal block (MPSB) (to avoid delivering too great a dose to the cord and too small a dose to adjacent tissue), the authors determined with magnetic resonance (MR) imaging normal ranges of cord depth and width and correlated them with film dosimetric data. In 59 randomly selected patients there was a wide range for both depth and width. The average depths of the anterior and posterior surfaces of the cord were 6.7 cm +/- 1.4 and 5.4 cm +/- 1.3, respectively. The average cord width was 1.6 cm +/- 0.4. Optimal cord block width as a function of cord width was determined for a 6-MV photon beam. The optimal cord block width at the surface (half-value layer [HVL] thickness = 6) varied from 1.5 to 3.0 cm for cord widths of 0.8-2.4 cm, which correspond to two standard deviations from the average. There was no significant dependence on depth of the cord. For optimal treatment outcome, the MPSB width may have to be determined for each patient individually.     

Ballonkyphoplastie

Kyphoplasty is a reliable, minimally invasive method to stabilize fractured vertebral bodies. Under economic aspects kyphoplasty seems advantageous compared with conservative treatment in patients with osteoporotic fractures as well as in younger persons after traumatic spine fractures. Both groups show a better outcome after kyphoplasty regarding pain, function and recovery of height of the treated vertebral body. Specifically young trauma patients benefit from this technique with short hospitalization and early return to work.     

Pathophysiologie der Leberfibrose

Chronic liver injury, such as viral hepatitis, alcohol, metabolic syndrome or other toxic damages, leads to an inflammatory response including the infiltration and activation of immune cells and to the proliferation and transdifferentiation of mesenchymal cells within the liver, especially of hepatic stellate cells. These cells produce an excess of extracellular matrix proteins that are deposited in the liver. Hepatic fibrosis may progress to liver cirrhosis and liver failure. This review aims at summarizing the current view on the pathogenic sequence during fibrogenesis highlighting the essential role of cytokines and chemokines. Understanding the complex cellular interactions in liver fibrosis may help to develop novel antifibrotic therapies in the near future.     

Immunologie der Harnwege

The human urinary tract represents an impressive mechanical barrier against infection. Its immediate anatomical proximity to the gastrointestinal tract predisposes it to invasion and infection by enteric bacteria. Thus the immune system of the urinary tract represents an essential and powerful means to repel bacterial, viral and parasitic intruders, protecting sensitive organ systems such as the kidneys. The innate immune system comprises specific urothelial surface receptors named Toll-like receptors that sense small molecules derived from pathogens and initiate an early immune response. The adaptive immune system encompasses both cellular (T-lymphocytes) and humoral effectors (antibodies). Secretory immunoglobulin A, which mediates the mucosal immune response, is of particular importance. The complex cross-linking for innate and adaptive immune response as well as humoral and cellular effectors is the key to the urinary tract immune system and to its defense against pathogenic microorganisms.     

Gefäße aus Papier?

Tissue engineered blood vessels (TEBV) represent an innovative approach for overcoming reconstructive problems associated with extended vascular diseases by providing small calibre vascular grafts. The aim of this study was to evaluate a novel biomaterial of bacterially synthesized cellulose (BC) as a potential scaffold for TEBV. On the basis of the work, we conclude that the innovative BC engineering technique results in the production of stable vascular conduits, which exhibit attractive properties for the use in future TEBV programs for vascular surgery.     

Psychosoziale Aspekte bei Infertilität

The last few years have brought huge advances in the consideration of psychosocial aspects of infertility. This review begins with a presentation of the important demographic and medical preconditions involved. This is followed by an overview of psychosocial features typical of infertile couples and a discussion of the connections between distress and infertility. The psychological effects of reproductive medical treatment are described, and the long-term impact of involuntary childlessness is outlined. The basic principles, aims, and effects of counselling and psychotherapy with infertile couples are set out in detail, together with urgent requirements for the future.