Prozessoptimierung im „kranken Haus“

Starting January 1st 2004 the German diagnosis-related group (DRG) system was established for in-patient cases. Consequently, the detection and realization of cost-saving potentials are becoming more and more important. For a successful future, efficient allocation of resources is essential. Economically, anaesthesia-related time delays during perioperative work-flow should be minimized. Since numerous entities contribute to perioperative care, it is extremely complex to analyze and optimize this process flow. In this publication single steps leading to an optimized perioperative process flow will be presented: documentation of predefined time points, calculation of relevant time intervals and analysis of key numbers for complex settings. Single steps of the given process analysis will be demonstrated using data from surgical patients at the University Hospital Schleswig-Holstein, Campus Kiel. The attached data collection sheets can be used by interested hospital departments and are meant to serve as a template for further process analyses. Based on the shown analysis, an example will be given to develop an optimized work-flow as a standard operating procedure (SOP). The implementation of the SOP module in an interdisciplinary clinical pathway (CP), which defines efficient medical care from admission to discharge, is mainly responsible for decreased process costs but increased quality of care.     

Immortalization and characterization of human myometrial cells from term-pregnant patients using a telomerase expression vector

An examination of cellular processes involved in myometrial function has been greatly assisted by the use of human myometrial cells in primary culture. However, these cells can be used only for several passages before they senesce, and responses to various agents change with time in culture. The use of transformed cells is limited, as they can be polynucleated and can lose or gain chromosomes. We have developed three telomerase-immortalized cell lines from term-pregnant human myometrium to eliminate variability between passage numbers and allow genetic manipulations of myometrial cells to fully characterize signal pathways. These cells have a normal karyotype and were verified to be uterine smooth muscle by immunocytochemical staining for smooth muscle cell-specific alpha-actin and high affinity oxytocin antagonist binding sites. The three cell lines and the cells in primary culture from which they were derived were examined by cDNA microarray analysis. Of >10 000 expressed genes, there were consistent changes in the expression of approximately 1% in the three immortalized cell lines. We were unable to detect any significant differences between primary and immortalized cells in signal pathways such as epidermal growth factor-stimulated epidermal growth factor receptor phosphorylation, insulin-stimulated Akt phosphorylation, oxytocin and lysophosphatidic acid-stimulated extracellular signal-regulated kinase 1 and 2 phosphorylation, myosin light chain phosphorylation, and interleukin-1 induction of IkappaBalpha degradation. The immortalized cells should be useful for a range of studies, including high throughput analyses of the effects of environmental agents on the human myometrium.     

Anatomical MRI study of borderline personality disorder patients

Hippocampal volume reduction has been reported in patients with borderline personality disorder (BPD), and is hypothesized to be associated with traumatic childhood experiences. We extended this investigation to explore additional brain regions and other potential clinical correlates of structural brain changes in BPD. Ten unmedicated BPD subjects and 20 healthy controls were assessed for current and past Axis I and II comorbidities and histories of childhood abuse. All had magnetic resonance imaging (MRI) studies with a 1.5 T GE Signa Imaging System, performing three-dimensional-gradient echo imaging (SPGR) with the following parameters: TR=25 ms, TE=5 ms, and slice-thickness=1.5 mm. Compared with healthy controls, BPD subjects had significantly smaller right and left hippocampal volumes, most marked in subjects with childhood abuse, and significantly increased right and left putamen volumes, especially in subjects with substance use disorders. No significant differences between groups were found for caudate, amygdala, temporal lobes, dorsolateral prefrontal cortex and total brain volumes. This study replicated prior findings of diminished hippocampal volumes in subjects with BPD. Also, increased putamen volumes were found in BPD, a finding that has not been previously reported. Early traumatic experiences may play a role in hippocampal atrophy, whereas substance use disorders may contribute to putamen enlargement.     

Leserbrief Zum Beitrag von W. Harth und R. Linse: “Botulinophilie” Der Hautarzt (2001) 52:312–316

Ohne Zusammenfassung     

白三烯抑制剂在哮喘治疗中的进展

目的：介绍白三烯抑制剂治疗哮喘的进展。方法：综述近年来国外有关文献,介绍和评价白三烯抑制剂的临床疗效,不良反应和用法用量。结果：白三烯抑制剂有效地治疗哮喘发作,且副作用较少。结论：白三烯抑制剂临床使用安全有效,是一类新的哮喘治疗药物。     

Aminoglycoside-associated hypomagnesaemia in children with cystic fibrosis

Hypomagnesaemia in children with cystic fibrosis (CF) is under-recognized. We report a child with CF who developed significant hypomagnesaemia following intravenous (i.v.) treatment with aminoglycosides for exacerbations of Pseudomonas aeruginosa infection. Three additional cases have also been observed. Investigations in two patients have revealed excessive renal loss of magnesium. It is postulated that renal tubular damage secondary to the cumulative effects of repeated courses of aminoglycosides resulted in hypomagnesaemia, and we suggest screening for this problem by monitoring serum magnesium regularly in all patients with CF receiving multiple courses of aminoglycosides.     

The double puncture: an effective percutaneous technique for removing complex, multiple renal calculi

Percutaneous nephrostolithotomy, which can require a double puncture, is presently the method of choice in our institution for the removal of renal stones. Patients that underwent this procedure were evaluated to identify the possible reasons for the double puncture. Of 200 patients evaluated, 14 needed a second tract. The three variables that determined whether a second puncture was needed, in order of importance, were number and size of the stones, with second tracts needed in patients with multiple stones and staghorn calculi; anatomical variations of the renal collecting system itself, with bifid systems the most significant anatomic variation; and the dexterity of the radiologist in performing the puncture and the ability of the urologist to extract the stone. Second tracts were needed more frequently in patients who presented with stones in both the lower and middle poles of the collecting systems.