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Die Aufbereitung thermolabiler flexibler Endoskope findet derzeit sowohl in den zentralen AEMP, in der AEMP der Endoskopie als auch in dezentralen AEMP statt. Bei der Entscheidung, wo die Aufbereitung durchgeführt wird, sind baulich-technische Bedingungen, personelle Ausstattung sowie organisatorisch-logistische Strukturen zu prüfen. Unabhängig vom Aufbereitungsort sind die gleichen Qualitätsanforderungen an die Aufbereitung zu stellen. Die Aufbereitung von flexiblen Endoskopen sollte nach manueller Vorreinigung und Reinigung vorzugsweise maschinell in Reinigungs-Desinfektionsgeräten für Endoskope (RDG-E) mit validierten Verfahren erfolgen (DIN EN ISO 15883-4 [5]). Je nach Eingriff und verwendetem Endoskoptyp werden verschiedene Anforderungen an die validierten Aufbereitungsprozesse gestellt, die die manuelle Vorreinigung, die maschinelle Reinigung und Desinfektion im RDG-E, Trocknung, ggf. die Sterilisation sowie die Aufbewahrung und Lagerung beinhalten. Dies macht spezielles Fachwissen und entsprechende Qualifikationen des Personals erforderlich. Die baulich-technische Ausstattung legt den Grundstein für eine konsequente Trennung von unreinen und reinen Arbeitsschritten, für eine entsprechende Aufbereitungssicherheit und Infektionsprävention. Bei thermolabilen Komponenten ist gemäß den Herstellerinformationen ein geeignetes Niedertemperaturverfahren zu wählen, falls die Sterilisation medizinisch und hygienisch indiziert ist. [ABSTRACT FROM AUTHOR]

Background: Botulinum neurotoxin (BoNT), a toxin of the anaerobic spore-forming bacterium Clostridium botulinum is used as a drug for alleviating muscle spasticity. Other indications include the cosmetic application in facial muscles, hyperhidrosis and neurogenic bladder disorders. It has been approved since 2010 as the first prophylactic treatment for chronic migraine. The analgesic effect of BoNT was observed early on and is currently the subject of intensive research. Painful postherpetic neuralgia is a common complication of an infection with herpes zoster virus. Despite modern treatment algorithms and medication, satisfactory pain treatment is not achieved in all patients. The use of BoNT could represent a new treatment option., Aim: The aim of this article is to provide an overview of the current evidence for the use of BoNT for postherpetic neuralgia., Material and Methods: We conducted a systematic literature search with the keywords "botulinum" and "neuropathic" and included original articles in which BoNT was used subcutaneously or intradermally for the treatment of postherpetic neuralgia., Results: The initial search yielded 212 results. After a title and abstract screening, the number was reduced to 11 relevant publications (5 case reports or series and 6 prospective studies)., Discussion: The results in the currently available literature show that BoNT is an effective therapeutic option for postherpetic neuralgia. In all studies, a significant effect on the pain and also on relevant patient-oriented secondary variables, such as the quality of life and especially the quality of sleep was shown. The only reported side effect was pain during administration.

Agitation is a severe clinical state which represents a therapeutic challenge and often forms part of manic or mixed episodes. Therapeutic options for acute mania have been limited for many years to lithium and typical antipsychotics. Besides anticonvulsants, atypical antipsychotics have been increasingly introduced in the last decade after proving their efficacy in this indication. To avoid intramuscular administration and excessive sedation, a therapeutic contact to the often agitated patient is required. De-escalation techniques can be helpful in this respect but also reduce aggressive behaviour on the ward, improve compliance, reduce relapse rates and lead to a better outcome in the long-term course of the illness. Therefore, a basic knowledge about de-escalation techniques in acute manic patients is an important clinical tool which will be critically reviewed. Furthermore, the efficacy and tolerability of atypical antipsychotics in acute mania, such as olanzapine, zotepine, risperidone, quetiapine, ziprasidone, aripiprazole, paliperidone and asenapine are discussed., (© Georg Thieme Verlag KG Stuttgart · New York.)

Bipolar disorders constitute a group of frequent, chronic psychiatric illnesses with a most severe impact on the patient's life. The course can be very individual and heterogeneous, the best known and most frequent manifestations include the classical bipolar I and bipolar II disorders. However, in Germany even typical bipolar I disorders are underdiagnosed and, consequently, undertreated. This is true despite the fact that the number of pharmacological treatment options has rapidly increased during recent years, both in the field of anticonvulsants and atypical antipsychotics. This supplies us today with new therapeutic strategies, not only for acute mania, but also for bipolar depression and maintenance treatment, and it is feasible to assume that there will be more options available within the next few years., (© Georg Thieme Verlag KG Stuttgart · New York.)

Venous disorders have a high prevalence and require approximately 1% of health budgets of industrialized countries. The postthrombotic syndrome (PTS) is defined by subjective symptoms and morphologic trophical skin changes following deep venous thrombosis. Prevention of venous thromboembolism in risk situations, easy availability of diagnostic tools (D-dimers, colour-coded duplex sonography) and early detection of deep venous thrombosis, as well as immediate therapeutic anticoagulation along with leg compression during the acute phase and over a two year period of time significantly reduce the incidence of PTS. Chronic venous insufficiency (CVI) includes trophical skin and soft tissue pathologies of the lower leg due to venous hypertension in the distal venous system of the lower extremity. Roughly, two main causes can be distinguished. (A) Deep venous insufficiency (A1 in postthrombotic syndrome; A2 in primary deep venous insufficiency) and (B) superficial venous reflux, usually varicose veins. Compression therapy, surgical ablation of superficial venous reflux, and tangential ablation with split skin graft (shave treatment) of refractory venous ulcers are the mainstays in the treatment of CVI.

Background: Bone marrow cell transplantation has been shown to induce angiogenesis and thus improve ischaemic artery disease. This study evaluates the effects of intramuscular bone marrow cell transplantation in patients with limb-threatening critical limb ischaemia with a very high risk for major amputation., Methods and Results: After failed or impossible operative and / or interventional revascularisation and after unsuccessful maximum conservative therapy, 51 patients with impending major amputation due to severe critical limb ischaemia had autologous bone marrow cells (BMC) transplant-ed into the ischaemic leg. Patients 1-12 received Ficoll-isolated bone marrow mononuclear cells (total cell number 1.1 +/- 1.1 x 10(9)), patients 13-51 received point of care isolated bone marrow total nucleated cells (3.0 +/- 1.7 x 10(9)). Limb salvage was 59 % at 6 months and 53 % at last follow-up (mean: 411 +/- 261 days, range: 175-1186 days). Perfusion measured with the ankle-brachial-index (ABI) and transcutaneous oxygen tension (tcpO2) at baseline and after 6 months increased in -patients with consecutive limb salvage (ABI 0.33 +/- 0.18 to 0.46 +/- 0.15, tcpO2 12 +/- 12 to 25 +/- 15 mmHg) and did not change in patients eventually undergoing major amputation. No differences in clinical outcome between the isolation methods were seen. Clinically most important, patients with limb salvage improved from a mean Rutherford category of 4.9 at baseline to 3.3 at 6 months (p = 0.0001). Analgesics consumption was reduced by 62 %. -Total walking distance improved in non-amputees from zero to 40 metres. Three severe peri-procedural adverse events resolved without sequelae, and no unexpected long-term adverse events occurred., Conclusions: In no-option patients with end-stage critical limb ischaemia due to peripheral -artery disease, bone marrow cell transplantation is a safe procedure which can improve leg perfusion sufficiently to reduce major amputations and permit durable limb salvage., (Georg Thieme Verlag Stuttgart.New York.)

Until recently, the psychopharmacological treatment alternatives for bipolar maintenance treatment were limited to lithium, which seems of special usefulness in a classical manifestation of the illness with mood-stabilising and anti-suicidal properties. With atypical features like psychotic symptoms or rapid cycling, lithium seems to be less useful. This led to further research into alternative options as carbamazepine, valproate or lamotrigine as well as atypical neuroleptics, thyroid hormones or innovative substances like omega fatty acids. This article summarises the current state of knowledge on treatment options for maintenance therapy.

In the actual version of the WHO diagnostic guidelines, the ICD-10, subtypes of bipolar disorder are not specified, in contrast to the American DSM-IV, where bipolar disorder has already been differentiated in bipolar I (severe manic and depressive episodes) and bipolar II disorder (depressive and hypomanic episodes). Furthermore, aspects of the longitudinal course of the illness, like rapid cycling (RC), are reflected as well. Rapid cycling is defined as four or more affective episodes within one year of the illness. It has been postulated that rapid cycling is related with a poor response to lithium, to the same extent as mixed episodes or an atypical onset (depressive episode first) of the disease. Here, the current status of alternative pharmacological and supportive therapy of rapid cycling is presented and discussed. Furthermore, the article also displays biological parameters associated with rapid cycling like higher prevalence in women, hypothyreoidism, subtype of bipolar disorder, COMT-allele, influence of sleep or risk of antidepressant induced cycling.

Unlabelled: Valproate has recently emerged as a drug of first choice in treating acute mania because of its efficacy and relative safety. It can be administered as an intravenous, oral non-sustained release or oral sustained release loading therapy. A new sustained release formulation of valproate consists of "mini-tablets" with the possible advantage of a less problematic and more reliable administration of the drug. We report on eleven patients with an acute manic exacerbation who were investigated for sufficient control of manic symptoms and the duration of building up and maintaining sufficient blood levels of valproate in once/d versus twice/d administration of valproate delayed release mini-tablets (VPA mrt.). Acute and prophylactic effectiveness in mania were rated with the Young-Mania Rating Scale (YMRS), respectively the Global Clinical Impression Scale for Bipolar Disorder (CGI-BP)., Results: Within a short period of time sufficient blood levels in both groups (once/d versus twice/d administration) were built up. Seven of eleven patients were responders according to a reduction of 50% of the YMRS. In respect of prophylactic treatment all of the ten patients showed satisfactory results and no re-exacerbation of manic symptoms or depression.

We present the case of a 60-year old bipolar-I-patient showing a rapid antimanic response to gabapentin after having been non-responsive to lithium and perazine. This case encouraged us to further evaluate the antimanic potency of gabapentin in an open label trial. 20 patients with acute mania were treated for up to 21 days with gabapentin in a dose range from 1200 to 4800 mg/day. Ten patients were treated with gabapentin as add-on medication and ten patients were treated with a high dose of gabapentin alone. The BRMAS score declined significantly in patients with moderate mania, whereas gabapentin alone was not efficacious in patients with very severe mania. Keeping in mind the limitations of an open study, it can still be said that gabapentin as add-on medication with other effective mood stabilizers appears to be safe and efficacious in the treatment of moderate mania.

A 60-year old female patient was referred to our University hospital with the diagnosis of severe treatment-resistant major depression to perform electroconvulsive therapy (ECT). For almost two years the patient had been treated with several antidepressants and, temporarily, neuroleptics. After showing no favourable response to ECT, the diagnosis of idiopathic Parkinson's disease was made and the patient was treated with L-dopa plus benserazide and pergolide in combination with the monoamine oxidase inhibitor moclobemide. Both depressed mood and motor symptoms showed dramatic improvement under this therapy.

The frequency of occurrence of Helicobacter pylori in the antral mucosa was investigated prospectively in a group of 66 patients (17 men, 49 women, mean age 58 +/- 8.4 years) who had been treated with nonsteroidal anti-rheumatic drugs and 33 controls (14 men, 19 women, mean age 60.7 +/- 6.6 years) who had not received these drugs. In the first group the indication for gastroscopy was ingestion of nonsteroidal antirheumatic drugs for at least 8 weeks, irrespective of dyspeptic symptoms (present in 25 patients), while in the second group the reason for endoscopy was either clinical symptoms (n = 18) or the presence of blood in the faeces. Helicobacter pylori was demonstrated by culture in 36 out of the 66 patients who had received nonsteroidal antirheumatics (54.5%); these comprised 24 out of 46 patients (52.2%) with chronic inactive gastritis and 12 out of 15 patients (80%) with chronic active gastritis. In the control group H. pylori was detected by culture in 22 out of 33 patients (66.7%); these included 11 out of 19 patients (57.9%) with chronic inactive gastritis and 11 out of 12 patients (91.7%) with chronic active gastritis. H. pylori was not demonstrated in any of the seven patients who had histologically normal gastric mucosa. In both groups there was significant correlation between demonstration of the microorganism and severity of inflammation. There is hence no evidence that nonsteroidal antirheumatic drugs have any influence on the colonisation of the antral mucosa by Helicobacter pylori.