Qualitätssicherung an der Schnittstelle zwischen Anästhesie und Transfusionsmedizin

Background

The current situation in hospitals is characterized by financial limitations and simultaneously by increasing demands on quality and safety. The operative interface between anesthesia and transfusion medicine affects both factors.

Aim

A detailed analysis was performed to evaluate the process quality at this operative interface at the University Hospital of Göttingen. The aim of the project was to revise und develop the structures and responsibilities at this interface, to dispose of weak points and to realize the optimization potential in the supply of blood products.

Material and methods

A databank-based electronic data processing solution was established with the clear definition of responsibilities for the various workflow procedures and the written documentation of these definitions in standard operating protocols. In order to guarantee the necessary transparency a routine reporting system to the department of surgery was established. In addition, a continuous further development of the blood supply standard based on electronic report data was implemented.

Results

By implementing the above named measures the rate of supplied to transfused blood products could be increased from 43.1?% to 55.7?%. The compliance with the blood supply standard improved continually over the first 18 months from 60.3?% to 92.3?%. The rate of supplied blood product deliveries without subsequent operation could be reduced from 9.0?% to 4.6??%. As a result of this optimization the supply costs in the internal cost allocation were reduced from 9,406 € to 3,544 €.

Conclusion

The measures described are appropriate to cost-effectively improve quality and patient safety. The optimization measures presented in this article can be implemented in other hospitals to increase quality and safety after individual adjustment to the local circumstances.     

Asplenia in two father-son Pairs

We report on two father-son pairs with isolated nonsyndromal asplenia. This may represent autosomal dominant inheritance of a mutation in a gene involved with spleen development and determination of laterality. The incidence of hereditary isolated asplenia is unknown; therefore, screening for asplenia in first degree relatives of individuals with (poly)asplenia should be considered. © 1995 Wiley-Liss, Inc.     

Neufassung der Empfehlungen der Kommission Pharmakotherapie der DGRh

Zusammenfassung Entzündlich-rheumatische Erkrankungen sind mit eine Vielzahl von Schmerzen und Einschränkungen verbunden. Die zu ihrer Behandlung eingesetzten so genannten Basistherapeutika sind bei vielen Patienten nicht ausreichend wirksam oder werden wegen Nebenwirkungen abgesetzt.Hier liegt das Einsatzgebiet von Tumornekrosefaktor- (TNF-) Blockern. Sie führen in vielen Fällen zu einer deutlichen Besserung der Krankheitssymptome, einem Abfall der labormedizinischen Parameter der Krankheitsaktivität, zur Verbesserung der Lebensqualität bis hin zum Stillstand der Destruktionen bei raschem Wirkungseintritt. Häufigkeit und Schwere der Nebenwirkungen sind eher gering, allerdings gibt es noch wenige Daten zum Langezeitverlauf.Der folgende Beitrag gibt Empfehlungen, unter welchen Voraussetzungen bei welchem Krankheitsbild der Einsatz von TNF-Blockern erfolgen kann.     

The electrochemical proton gradient in the bloodstream form of Trypanosoma brucei is dependent on the temperature.

The membrane potential and pH gradient over the plasma membrane of the protozoan parasite Trypanosoma brucei were measured with radioactive indicators in combination with the silicone oil centrifugation technique over a range of temperatures. At 37 degrees C a small membrane potential and pH gradient of similar magnitude, but of opposite polarity, were measured. The resulting electrochemical proton gradient was almost zero. However, when the temperature was lowered from 37 degrees C to 22 degrees C, the internal pH was kept constant independent of the external pH and a membrane potential of between -100 and -150 mV was measured, depending on the external pH. Measurements at various temperatures between 15 degrees C and 37 degrees C revealed that above 26 degrees C the membrane potential collapsed and that this collapse correlated with a sudden increase in membrane fluidity. The uptake of 2-deoxy-D-glucose and of pyruvate, which are both mediated by facilitated diffusion carriers in the plasma membrane of the trypanosome, were also affected by this sudden increase in fluidity of the membrane. The overall rate of the conversion of glucose into its metabolites, which is independent of the plasma membrane, varied only gradually. We conclude (i) that major changes occur in the plasma membrane of T. brucei around 26 degrees C, that affect all membrane related processes; (ii) that the electrochemical proton gradient plays a minor role in the energy metabolism of T. brucei when it resides in the bloodstream of the mammalian host at 37 degrees C; and (iii) that below 26 degrees C an electrochemical proton gradient is maintained over the plasma membrane.     

Familial cavernous malformations of the central nervous system and retina

We studied a family in which 4 persons from three generations had multiple cavernous malformations ("angiomas") of the central nervous system (CNS) and/or retina and found accounts in the literature of sixteen other families with this condition. In these families with familial cavernous malformation of the CNS and retina, 92% of pathologically documented vascular malformations were cavernous; 50% of those subjects affected had multiple CNS and/or retinal vascular malformations and 68% (excluding probands) were symptomatic. Cutaneous vascular lesions were an inconsistant manifestation. Autosomal dominant inheritance with high penetrance was confirmed.     

Distal myasthenia gravis: case report

We report the case of a 30-year-old woman with a 7-year history of distal lower limbs weakness that evolved to upper limbs weakness. On neurological examination, she presented normal cranial nerves, bilateral quadriceps and feet interosseous atrophy, normal muscular tonus, muscular weakness more severe in dorsal feet interosseous and anterior tibial, and decreased deep tendon reflexes. Repetitive nerve stimulation of the ulnar and fibular nerves showed a decrement greater than 10% of the compound muscle action potential. Antibody against acetylcholine receptor titer was positive. Computed tomography scan of the thorax was normal. Thyroid function tests showed evidence of hyperthyroidism. Distal muscular weakness is a rare onset presentation of myasthenia gravis. However, myasthenia gravis must be considered in the differential diagnosis of distal limb weakness.