Viszeral- und thoraxchirurgische Eingriffe bei über 80-Jährigen

Due to the higher incidence of malignant tumours with increasing age, cancer is the second most common cause of death among those aged over 65 years old. Consequently, demographic changes in Germany have resulted in a rising demand for oncological operations in elderly patients which is more cost-intensive. Objective of the present study in the setting of a university surgical department is whether oncological operations on patients over 80 years old is cost-effective in the era of diagnosis-related groups. The revenue and expenditure of 116 cases of patients over 80 years old documented for the years 2005–2007 were collated and evaluated. The calculated average proceeds were compared with cases of patients under 80 years old. The average return was ?1493.50 EUR/case for over 80-year olds and was not cost-effective. The presence or absence of complications had a significant impact on proceeds, because the mean return/case without complications was profitable (1297.30 EUR). Medical care of patients over 80 years old was on average cost-effective and generated a profit. Oncological operations in patients under 80 years old were not sufficiently remunerated by the current DRG system. Therefore, there is an economical risk associated with oncological operations in elderly patients.     

Insulintherapie bei Intensivpatienten

Critically ill patients frequently have raised blood glucose levels, irrespective of pre-existing diabetes. However, the definition of such stress hyperglycemia is unclear. Proposed threshold values are between 110 and 140 mg/dl. Thus the prevalence of “stress diabetes” varies between 50% and 90%. Historically, increased blood glucose levels in intensive-care patients were considered physiologic. Stress hormones such as cortisol and noradrenaline play a key etiological role. Increased blood glucose values have a pathophysiological effect on inflammatory reactions. A direct correlation between increased blood glucose levels and mortality and morbidity has been established. The number of complications could be reduced, as well as hospitalization and ventilation times shortened, by lowering blood glucose levels. Blood glucose goals and strategies to achieve this, however, cannot be formulated in a standardised manner. Practical implementation depends on the patients being treated and their underlying disease on the one hand, and the basic parameters on the other.     

A clinical study of intubating conditions under vecuronium bromide.

The drug vecuronium bromide, a short acting, non-depolarising agent with little side-effects, has brought much promise in the field of muscle relaxants. Fifth healthy patients were induced with injection thiopentone sodium 4 mg/kg and vecuronium bromide, 0.1 mg/kg was given IV. The earliest time at which the largest percentage of patients could be intubated satisfactorily was noted. The intubating conditions were estimated by scoring method. The duration of clinical relaxation was decided from the time of IV injection of vecuronium bromide to the return of muscle power of the non-respiratory muscles requiring repeat dose of the drug. The ideal intubating condition was achieved at 120 seconds and the duration of clinical relaxation ranged from 11-15 minutes.     

Protein kinase C delta stimulates antigen presentation by Class II MHC in murine dendritic cells

Maturation of dendritic cells (DCs) regulates protein sorting in endosomal compartments to promote the surface expression of molecules involved in T cell activation. MHC Class II complexes are mobilized to the surface via intracellular effector molecules that remain largely unknown. We here show that protein kinase C (PKC) stimulates Class II antigen surface expression, using knock-in mice that express a Class II-green fluorescent protein fusion protein as a read out. Selective inhibition of PKCdelta counteracts the ability of DCs to stimulate Class II MHC-restricted antigen-specific T cells. Activation of PKC does not affect antigen uptake, peptide loading and surface display of Class I MHC and transferrin receptor in DCs. We show that activation-induced Class II MHC surface expression is dependent on activation of PKCdelta and conclude that this event is pivotal for optimal CD4 T cell activation.     

Gesundheits-Monitoring-Einheiten (GME) in Bayern

Starting in 2004, health monitoring units (GME) were established in three rural and three urban regions of the federal state Bavaria, Germany. The GME s aim is to gain current and relevant health data especially of children in Bavaria and to evaluate health promotion and prevention strategies. The first survey 2004/2005 was a cross-sectional study of the environmental health of children aged 5 to 7 years. There are data available from 3030 girls and 3319 boys (response rate 78%). This paper describes the study regions and the sociodemographic characteristics of the study population which differed substantially between urban and rural regions. The thematic focus of the survey was: (1) Social disparities in housing conditions, related environmental exposures, and children's health, (2) accidents and injuries, (3) environmental tobacco smoke exposure of children and precautionary measures of their parents, (4) nutrition, physical activity and obesity, and (5) temporal trends of the prevalence of asthma and allergies. The insights gained within the health monitoring units will contribute to the identification and quantification of health risks as well as to the establishment of intervention strategies with special focus on the needs of the public health service.     

Epidemiologie von Schilddrüsenerkrankungen in Deutschland

Background

Germany is an iodine-deficient region. Iodine deficiency was classified as moderate in the North and as severe in mountain regions in Southern Germany. Improved legislation involving the iodization of table salt became effective during the 1990s. This legislation has contributed considerably to an increase in the use of iodized salt for food production.

Current results

The population is currently supplied with iodine at a lower recommended level. From an epidemiological point of view, Germany is a region characterized by the change from iodine deficiency to iodine sufficiency. Typical for this transformation, one might expect a low prevalence of goitre among children and adolescents, while there would still be a high prevalence of goitre, thyroid nodules, and subclinical hyperthyroidism among the elderly. In a representative German sample of children and adolescents, however, relatively large thyroid volumes have been found.

Conclusion

Systematic monitoring programs for thyroid disorders, including measurements of urinary iodine excretion in population samples, allow the detection of deviations in the iodine supply and are thus an obligatory precondition for the effective prevention of iodine deficiency.