Search

Ziel: In Deutschland gibt es grose regionale Unterschiede beim prozentualen Anteil von Kaiserschnittentbindungen an den Geburten. Da Faktoren auf Krankenhausebene eine Rolle spielen konnten, die anhand der strukturierten Qualitatsberichte der Krankenhauser (sQBK) analysierbar waren, wurde untersucht, inwieweit sQBK-Daten geeignet sind, die Kaiserschnittrate auf Ebene der Geburtskliniken zuverlassig darzustellen. Methode: Beispielhaft wurde fur 94 von 97 Geburtskliniken in Baden-Wurttemberg mit Diagnose- und Prozeduren-Codes aus den sQBK des Jahres 2008 die absolute Anzahl von Geburten und Kaiserschnitten sowie die Kaiserschnittrate berechnet. Aus 80 von 97 Geburtskliniken wurden auf Anfrage zusatzlich klinikinterne Daten (KID) aus Grunddatenstatistik, Geburtenbuch, Standesamtsmeldungen oder Perinatalerhebung ubermittelt, mit denen diese Zahlen verglichen wurden. Ergebnis: Die Zahl der dokumentierten Geburten unterschied sich nicht signifikant zwischen sQBK und KID, wohl jedoch Kaiserschnittzahl und -rate (p Schlussfolgerung: Es bestehen signifikante und relevante Abweichungen der uber KID ermittelten Kaiserschnittraten von den aus sQBK extrahierten Zahlen. Die Qualitatsberichte 2008 ­erscheinen damit als Datenquelle fur die auf einzelne Krankenhauser bezogenen Kaiserschnittraten nicht ausreichend zuverlassig.

BACKGROUND In the year 2009 the Federal Joint Committee (G-BA) obliged neonatal units in Germany to publish yearly data on the number of preterm infants treated and their outcome in the internet. At the same time annual minimum volumes were introduced for each level of perinatal care. The exact numbers of compulsory minimum volumes are heavily discussed both scientifically and politically. METHODS 28 perinatal centres (PNC) in the state of Baden-Wurttemberg published data on mortality and short-term morbidity of preterm infants with a birth weight (BW)

We examined the distribution of hematological parameters in 186 adults (89 female, 97 male) living in Nouna, Burkina Faso. Median (5 th - 95 th percentile) hemoglobin concentration was 12.6 (10.3-15.3) g/dl, which was lower than reported from other populations in Africa. Iron deficiency may be the most important reason for this observation.

Eine Analyse der gutachtlichen Empfehlungen des Medizinischen Dienstes der Krankenversicherung (MDK) zur Eingruppierung von Kindern und Jugendlichen in Pflegestufen gemas dem Gesetz uber die soziale Pflegeversicherung sollte Hinweise auf mogliche Masnahmen zur Verbesserung der Begutachtungsqualitat liefern.

INTRODUCTION The introduction of Diagnosis Related Groups in Germany (G-DRG) has brought forward the obligation for physicians to take into account an intricate system of medical, economical and legal implementations. Mistakes in the process of encoding the principal diagnosis or procedures may have financial consequences. Problems to determine the correct ICD-code will be most prominent for diseases with poorly defined or even inconsistent diagnostic criteria as is the case for neonatal septicemia. We decided to evaluate whether the introduction of G-DRG resulted in a change of frequency of the diagnosis "neonatal septicemia". METHODS We analysed data derived from the quality assurance program "Neonatalerhebung" in the state of Baden-Wurttemberg during the years of 2001 through 2004, i. e., 2 years before and 2 years during the introduction of G-DRG. During this period an annual number of 12,316 up to 13,172 newborns were admitted to the participating hospitals. RESULTS The mean number of diagnoses per patient increased from 2.2 to 3.8. The frequency of the diagnosis of septicemia remained constant. The percentage of newborns receiving antibiotic therapy did not change. The ratio of cases with "septicemia yes" over "antibiotics yes" did not change. Although it is difficult to determine the diagnosis of neonatal septicemia and in spite of the economic implications of this diagnosis, no change in the frequency of this diagnosis occurred during the introduction of DRG. CONCLUSIONS Assuming that the participating hospitals used an identical database for the quality assurance program "Neonatalerhebung" and for accounting, we conclude that the DRG system is stable with respect to neonatal septicemia.

During the years 1997 to 2003 the medical services of the statutory health insurance in the German Federal State of Baden-Wurttemberg carried out a total survey regarding structure, process and outcome with regard to the quality of care of outpatients in the German long-term care insurance system. This survey provides information on the development of the quality of care. All outpatient nursing services licensed by the statutory long-term care insurance funds in Baden-Wurttemberg (n (1997 - 2000) = 863; n (2000 - 2003) = 779) were subjected to a uniform assessment based on a consented concept applied in all German Federal States. Our results demonstrate a tendency to fewer but larger nursing services providing care for an increasing number of patients. Qualification of head nurses and of caregiving staff in general has significantly improved. Information for the patient/consumer on the conditions of contracts which have to be made between a nursing service and the patient is still deficient in more than 20 % of cases. Adherence to proper procedures in the process of nursing has improved, especially with respect to taking a complete medical/nursing history and defining the individual resources of a patient and aims for therapy/nursing. However, only in (1/3) of the cases could we find a documentation of continuous adaptation of the planning of therapy. Efforts of in-house quality management and internal quality assurance by the outpatient nursing services have improved. Regarding the outcome of nursing there has been a decrease in the provision of stimulating care from 87 % of cases to 75 %. The majority of patients of outpatient nursing services do not receive benefits of the long-term care insurance system but of the statutory health insurance. This fact underlines the importance of a general conceptual framework for internal and external quality assurance.

Background: In Germany, 9 tol2% of all children between five and seven years of age have been shown to be overweight at school entry; 2.5 to 3.5% of them are obese. Therapeutic intervention for obese children and adolescents is considered to be indicated especially in cases where an increased body mass index (BMI) is accompanied by a disease the effective treatment of which requires weight loss. Furthermore, the child and its family must be willing to actively change their habits. Objective: A multitude of health care providers have begun to offer multidisciplinary group programme for prevention and treatment of obesity to affected individuals and their families. The Medical Service of the Statutory Health Insurance (MDK) has therefore developed a list of quality and assessment criteria for such programme. Methods: A systematic search for information in international and national publications was performed using standard methodology of evidence-based medicine. Data were extracted and assessed according to pre-defined criteria taking into consideration previously published clinical guidelines and opinions of expert panels. Results: Nearly all available studies were of low internal validity and mostly of poor methodological quality. Therefore, no binding recommendations for the design of health education programme for overweight and obese children and adolescents can be given. Potentially successful intervention should combine the following 4 modules: nutrition, physical activity, change of eating habits, physical activity habits and life style using methods of behavioural therapy, and involvement of parents. Such combinations may have the potential to reduce or stabilise the BMI at least during a defined period of time. In younger children, the beneficial effect will be more pronounced if the parents are actively involved. Conclusion: Up to now informative studies have not reliably shown that the effect of ambulatory health education programmes for overweight and obese children and adolescents and their parents may last for more than one or two years. Therefore, a controlled clinical trial determining the long-term effectiveness of such programme is imperative. The decision whether a defined programmes should be included in such a study could be taken on the basis of the quality indicators and assessment criteria described here.

Adipositas gilt als Folge individuellen Verhaltens bei gegebener genetischer Grundausstattung und mangelnder Anpassung an eine „obesigene“ Umwelt. Adipositas kann aus sozialrechtlicher Sicht als Krankheit angesehen werden, wenn neben einer statistischen Normabweichung in Form eines erhohten Body-Mass-Index (BMI) Krankheiten bestehen, die mit dem erhohten Korpergewicht zusammenhangen, oder wenn eine extreme Adipositas (BMI>99,5. Perzentile) vorliegt. Die langfristige Wirksamkeit von Behandlungsprogrammen fur adipose Kinder und Jugendliche konnte bislang nicht verlasslich nachgewiesen werden. Praventionsstrategien sollten nicht versuchen, diese therapeutischen Modelle auf grosere Bevolkerungsgruppen zu ubertragen, sondern auf den Erfahrungen der Suchtpravention, Raucherentwohnung und HIV-/AIDS-Vorsorge aufbauen. Die Pravention von Ubergewicht und Adipositas ist eine Aufgabe der gesamtgesellschaftlichen Gesundheitsforderung und erfordert eine konzertierte Aktion aller Beteiligten auf allen Einflussebenen des Netzwerks kausaler Faktoren der Adipositas.

Das autoimmune lymphoproliferative Syndrom (ALPS; Synonym Canale-SmithSyndrom) tritt typischerweise bereits im Kindesalter auf und ist charakterisiert durch chronische nicht-maligne lymphoproliferative Krankheitsbilder (Lymphadenopathie, Hepatosplenomegalie), Autoimmunitat, Hypergammaglobulinamie, und eine erhohte Anzahl von CD3+CD4–CD8– “doppelt-negativer” T-Lymphozyten. Im Erwachsenenalter haben ALPS-Patienten ein erhohtes Risiko fur maligne Lymphome (M. Hodgkin, Bund T-Zell-Lymphome).

Based on previous studies on the influence of antiretroviral treatment on CD95-induced T cell apoptosis cross-sectional data on T cell apoptosis and T cell homeostasis were analysed from 29 pediatric patients treated for more than 6 months either with 2 nucleosidic inhibitors of HIV-1 reverse transcriptase (group A, 20 observations) or HAART containing at least 1 inhibitor of HIV-1 protease (group B, 16 observations). Seven patients were studied twice. The relationship between specific anti-CD95-induced apoptosis of freshly isolated peripheral blood CD4 + and CD8 + T cells with the percentage of circulating CD4 + T cells, HIV-1 RNA plasma viral load levels and the proportion of circulating resting/"naive" and primed/"memory" CD4 + T cells was assessed. Seven patients in each group had HIV-1 plasma viral load levels ≤ 3.0 log RNA-copies per ml. In group A, CD95-sensitivity of T cells increased significantly with low CD4 counts, and tended to rise with low proportions of resting/"naive" CD4 cells and high HIV-1 plasma viral load levels. In group B, the sensitivity of peripheral blood T cells towards CD95-induced apoptosis was not increased compared to controls and was not correlated with CD4 + T cell counts and CD4 + T cell subpopulations or HIV-1 plasma viral load levels. These data indicate that treatment with HAART including HIV-1 protease inhibitors has an inhibitory effect on CD95-sensitivity of circulating T cells. This effect, which is independent of the reduction of HIV-1 plasma viral load levels by HAART, may contribute to the amelioration of CD4 + T cell homeostasis frequently seen in HAART-treated patients despite virological treatment failure.

Mutations in the CD95 receptor (R) gene, a key regulator of programmed cell death (apoptosis) in lymphocytes, have been identified in patients suffering from autoimmune lymphoproliferative syndrome (ALPS) or Canale-Smith syndrome (CSS). ALPS/CSS is characterized by chronic non-malignant lymphadenopathy, hepatosplenomegaly, and autoimmune cytopenias. Twenty patients with symptoms of ALPS/CSS were screened for defects in T cell apoptosis. Specific anti-CD95-induced cell death of in vitro activated T cells was lower in ALPS/CSS patients compared to 12 healthy controls (CD4: 28 ′ 5 vs. 79 ′ 5%; CD8: 30 ′ 4 vs. 85 ′ 5%; mean ′ SEM, p < 0.001) while spontaneous cell death was slightly increased (CD4: 28 ′ 4 vs.14 ′ 1%, p < 0.01; CD8: 30 ′ 4 vs. 22 ′ 2%, p < 0.09). Specific anti-CD3 (i.e., activation)-induced cell death (AICD) was also lower in ALPS/CSS patients than in healthy controls (CD4: 1 ′ 3 vs. 20 ′ 3%; CD8: 4 ′ 3 vs. 27 ′ 3%, p < 0.001). Analysis of sequence-specific DNA conformation polymorphisms (SSCP) had a low sensitivity for detection of new mutations in the CD95-R gene since false-negative SSCP-results were obtained in 5 out of 7 patients with known CD95-R mutations.

It is not known if "hospital quality reports" (HQR) document Caesarean (C-) section rates at the hospital level accurately enough for use as a reliable data source when it comes to explaining regional variations of C-sections in Germany by factors at the hospital level. We aimed to answer this question using HQR from hospitals in Baden-Württemberg as data source.Diagnostic and procedure codes from HQR for the year 2008 (HQRdata), were used to calculate numbers of births, numbers of C-sections, and rates of births by C-section (CSR) for 94 of 97 hospitals in Baden-Württemberg. These numbers were compared to internal hospital (IH) data delivered upon request by 80 of 97 hospitals and stemming from vital statistics, birth registry forms, or external quality assurance datasets.There was no difference in the number of births between HQR data and IH data, but the number of C-sections and the CSR differed significantly (p0.05; Wilcoxon rank sum test). CSR calculated using HQR data was 4.9 ± 17.9% higher than CSR from IH data (absolute difference 1.5 ± 5.8%). The correlation between the 2 data sources was moderate (r=0.73). Only 55% of the variance in IH data-based CSR was explained by HQR data. The proportion between highest and lowest CSR in hospitals in Baden-Württemberg was 4.9 for HQR data and 3.6 for IH data.There are significant and relevant differences between C-section rates based on ei-ther HQR or IH data. This questions routine data from HQR for 2008 as a reliable data source for research work.

Die Autoren haben einen von amerikanischen Experten fur die USA erarbeiteten Konsens ausfuhrlich diskutiert und eigene Empfehlungen entwickelt, die den verantwortlichen Fachgesellschaften zur Begutachtung vorgelegt wurden. Nach diesem Konsens wird eine antiretrovirale Therapie primar entsprechend der Anzahl der HIV-Kopien im Plasma eingeleitet, sekundar entsprechend immunologischen und klinischen Kriterien. Zusatzlich mussen altersspezifische Grenzwerte fur den Einsatz der Therapie berucksichtigt werden. Kriterien fur die Effektivitat der Therapie werden definiert und fur den Fall des Scheiterns der Behandlung Alternativen aufgezeigt. Zahlreiche Medikamenteninteraktionen mussen bei der Durchfuhrung einer antiretroviralen Therapie berucksichtigt werden. Schlieslich wird aus padiatrischer Sicht eine Empfehlung zur Reduktion der vertikalen Transmission gegeben.

In the year 2009 the Federal Joint Committee (G-BA) obliged neonatal units in Germany to publish yearly data on the number of preterm infants treated and their outcome in the internet. At the same time annual minimum volumes were introduced for each level of perinatal care. The exact numbers of compulsory minimum volumes are heavily discussed both scientifically and politically.28 perinatal centres (PNC) in the state of Baden-Württemberg published data on mortality and short-term morbidity of preterm infants with a birth weight (BW)1,500 g admitted in the year 2008 (n=1,141). These data were analysed on the background of quality assessments of structures and processes in all hospitals performed by the Medical Service of Statutory Health Insurance (MDK).By the end of 2008, 8 PNC had fulfilled the quality criteria of the G-BA nearly completely and reached a numerical benchmarking value of more than 300 of 465 maximally achievable points. Introducing annual minimum volumes of 36 preterm infants with a BW1,250 g would lead to a concentration of perinatal care in 7 PNC and minimum volumes of 50 preterm infants with a BW1,500 g per year in 8 such centres.Further centralisation of clinical care for low birth-weight preterm infants in a limited number of PNC in the state of Baden-Württemberg would be economically reasonable and could be achieved either by the introduction of higher minimum volume standards or a stringent interpretation of quality criteria of the G-BA. Based on self-reported data of the PNC currently available in the Internet it is not possible to predict the effect of such a centralisation process on patient outcome.

Today, most patients who require renal-replacement therapy (RRT) are conventionally treated using dialysis membranes. To improve the outcome of chronic dialysis patients, unique developments have been made in the past decades. Cellulose membranes have been replaced by synthetic polymeric membranes with improved biocompatibility. The development of high-flux membranes and more efficient treatment modes, for example, hemodiafiltration (HDF), have resulted in improved removal rates of uremic toxins. In 2007, approximately 160 million dialyzers (with an average surface area of 1.7 m2) were manufactured for the treatment of 1.6 million dialysis patients worldwide. This large membrane-surface area requires highly automated manufacturing plants to produce high-quality and safe products. Apart from membranes used for conventional hemodialysis (HD), new membranes with increased pore size have been developed for specific treatments. These specialized membranes allow removal of higher-molecular-weight molecules, such as mediators of sepsis/inflammation, or the removal of nephro-toxic light chains of immunoglobulins derived from multiple myelomas (MMs) (bone marrow cancer). Membranes have also been utilized in cell-based extracorporeal systems to treat patients with kidney disease. In addition, specialized, highly efficient membranes have been developed for stem-cell growth in hollow fiber bioreactors as a technological prerequisite for cellular therapies and other applications.

Die Kinderkliniken des Landes Baden-Wurttemberg (n=31) hatten bis Ende des Jahres 2007 eine Selbsteinstufung in eine Stufe (Level) perinatologischer Versorgung gemas der seit 1. Januar 2006 geltenden Checkliste des Gemeinsamen Bundesausschusses (G-BA) vorgenommen. Der Medizinische Dienst der Krankenversicherung (MDK) erhielt den Auftrag, diese Selbsteinstufung auf Grundlage der Vereinbarung uber Masnahmen zur Qualitatssicherung der Versorgung von Fruh- und Neugeborenen des G-BA zu uberprufen. Von November 2007 bis Oktober 2008 wurden alle 31 Klinikstandorte visitiert. Die dabei vorgefundenen Sachverhalte wurden in einer Checkliste dokumentiert und gutachterlich bewertet. Zusatzlich erfolgte ein Standortvergleich mithilfe eines abgestuften numerischen Bewertungssystems (absolute Gesamtbewertungszahl und relativer Vergleichswert). Dazu wurden die Qualitatskriterien des G-BA in 7 Qualitatskategorien gruppiert, die gemas ihrer praktischen Bedeutung gewichtet wurden. Die Qualitatsanforderungen des G-BA fur Perinatalzentren (PNZ) Level 1 waren in 3 von 23 Kliniken „erfullt“, in 6 von 23 „nicht vollstandig erfullt“, und in 14 von 23 „nicht erfullt“. Die Anforderungen an PNZ Level 2 waren an 2 Standorten „nicht vollstandig erfullt“, in 4 Kliniken „nicht erfullt“. Perinatale Schwerpunkte (n=2) erfullten die Qualitatsanforderungen in vollem Umfang. Ein linearer Zusammenhang zwischen der Gesamtbewertungszahl oder dem prozentualen Vergleichswert und der gutachterlichen Standortbewertung bestand nicht. Bei strengerer Auslegung der G-BA-Vereinbarung ware eine flachendeckende Versorgung von Neu- und Fruhgeborenen in Baden-Wurttemberg allerdings nur schwer zu gewahrleisten.

The introduction of Diagnosis Related Groups in Germany (G-DRG) has brought forward the obligation for physicians to take into account an intricate system of medical, economical and legal implementations. Mistakes in the process of encoding the principal diagnosis or procedures may have financial consequences. Problems to determine the correct ICD-code will be most prominent for diseases with poorly defined or even inconsistent diagnostic criteria as is the case for neonatal septicemia. We decided to evaluate whether the introduction of G-DRG resulted in a change of frequency of the diagnosis "neonatal septicemia".We analysed data derived from the quality assurance program "Neonatalerhebung" in the state of Baden-Württemberg during the years of 2001 through 2004, i. e., 2 years before and 2 years during the introduction of G-DRG. During this period an annual number of 12,316 up to 13,172 newborns were admitted to the participating hospitals.The mean number of diagnoses per patient increased from 2.2 to 3.8. The frequency of the diagnosis of septicemia remained constant. The percentage of newborns receiving antibiotic therapy did not change. The ratio of cases with "septicemia yes" over "antibiotics yes" did not change. Although it is difficult to determine the diagnosis of neonatal septicemia and in spite of the economic implications of this diagnosis, no change in the frequency of this diagnosis occurred during the introduction of DRG.Assuming that the participating hospitals used an identical database for the quality assurance program "Neonatalerhebung" and for accounting, we conclude that the DRG system is stable with respect to neonatal septicemia.

During the years 1997 to 2003 the medical services of the statutory health insurance in the German Federal State of Baden-Württemberg carried out a total survey regarding structure, process and outcome with regard to the quality of care of outpatients in the German long-term care insurance system. This survey provides information on the development of the quality of care. All outpatient nursing services licensed by the statutory long-term care insurance funds in Baden-Württemberg (n (1997 - 2000) = 863; n (2000 - 2003) = 779) were subjected to a uniform assessment based on a consented concept applied in all German Federal States. Our results demonstrate a tendency to fewer but larger nursing services providing care for an increasing number of patients. Qualification of head nurses and of caregiving staff in general has significantly improved. Information for the patient/consumer on the conditions of contracts which have to be made between a nursing service and the patient is still deficient in more than 20 % of cases. Adherence to proper procedures in the process of nursing has improved, especially with respect to taking a complete medical/nursing history and defining the individual resources of a patient and aims for therapy/nursing. However, only in (1/3) of the cases could we find a documentation of continuous adaptation of the planning of therapy. Efforts of in-house quality management and internal quality assurance by the outpatient nursing services have improved. Regarding the outcome of nursing there has been a decrease in the provision of stimulating care from 87 % of cases to 75 %. The majority of patients of outpatient nursing services do not receive benefits of the long-term care insurance system but of the statutory health insurance. This fact underlines the importance of a general conceptual framework for internal and external quality assurance.

In Germany, 9 to 12 % of all children between five and seven years of age have been shown to be overweight at school entry; 2.5 to 3.5 % of them are obese. Therapeutic intervention for obese children and adolescents is considered to be indicated especially in cases where an increased body mass index (BMI) is accompanied by a disease the effective treatment of which requires weight loss. Furthermore, the child and its family must be willing to actively change their habits.A multitude of health care providers have begun to offer multidisciplinary group programme for prevention and treatment of obesity to affected individuals and their families. The Medical Service of the Statutory Health Insurance (MDK) has therefore developed a list of quality and assessment criteria for such programme.A systematic search for information in international and national publications was performed using standard methodology of evidence-based medicine. Data were extracted and assessed according to pre-defined criteria taking into consideration previously published clinical guidelines and opinions of expert panels.Nearly all available studies were of low internal validity and mostly of poor methodological quality. Therefore, no binding recommendations for the design of health education programme for overweight and obese children and adolescents can be given. Potentially successful intervention should combine the following 4 modules: nutrition, physical activity, change of eating habits, physical activity habits and life style using methods of behavioural therapy, and involvement of parents. Such combinations may have the potential to reduce or stabilise the BMI at least during a defined period of time. In younger children, the beneficial effect will be more pronounced if the parents are actively involved.Up to now informative studies have not reliably shown that the effect of ambulatory health education programmes for overweight and obese children and adolescents and their parents may last for more than one or two years. Therefore, a controlled clinical trial determining the long-term effectiveness of such programme is imperative. The decision whether a defined programmes should be included in such a study could be taken on the basis of the quality indicators and assessment criteria described here.

Previous studies suggest that early loss of membrane might account for the shortened life-span of neonatal red blood cells (RBC). The elastic area compressibility modulus describes the force required to achieve a defined expansion of the membrane and is thus a suitable intrinsic material property to describe mechanical stability of the RBC membrane. We studied RBC in eight cord blood samples (representing fetal blood), ten 5-day old full-term neonates and seven healthy adults. The RBC were suspended in hypotonic buffer solution and investigated using a modification of the micropipet technique by Evans et al. Cord blood RBC (204+/-33 dyn/cm) and neonatal RBC (209+/-11 dyn/cm) showed a 25% lower elastic area compressibility modulus than adult cells (278+/-26 dyn/cm; p0.05). Thus, less force was necessary for expansion of neonatal RBC membrane. We conclude that neonatal RBC are more susceptible to mechanical damage of their membrane than adult cells.

We report here that stress stimuli such as gamma-irradiation or the anticancer drug doxorubicin activate expression of the death-inducing ligands (DILs) CD95-L, TNF-alpha and TRAIL. Apoptosis induced by gamma-irradiation or doxorubicin engages a FADD- and caspase-dependent apoptosis pathway which is inhibited by dominant negative FADD or the caspase inhibitor zVAD. zVAD did not prevent activity of JNK/SAPKs in response to doxorubicin suggesting that JNK/SAPK activity is independent of death receptor triggering during cellular stress-induced apoptosis. In addition, JNK/SAPKs remained activated by doxorubicin in resistant cell lines in which cleavage of caspases and apoptosis was not observed. These data uncouple JNK/SAPK activation and apoptosis signaling and indicate that cellular stress-induced apoptosis involves signaling via DILs which is paralleled by activation of JNK/SAPKs. Activation of these kinases may contribute e.g., to the expression of molecules involved in apoptosis but is not sufficient for induction of the apoptosis program following cellular stress.

The CD95 system plays an important role in lymphocyte homeostasis, has been implicated in the development of lymphoid malignancies, exerts a tumour suppressor function, and contributes to drug-induced cytotoxicity. We hypothesized that mutations of CD95 may occur in childhood B-lineage acute lymphoblastic leukaemia (ALL), a disease known for its constitutive resistance towards CD95-mediated apoptosis. We investigated 32 primary B-lineage ALL of childhood and five B-lineage ALL cell lines. All primary leukaemias expressed CD9 5 and bcl-2 to a variable degree. Most of the leukaemias were resistant towards CD95-mediated apoptosis. However, using SSCP analysis, no mutations in the coding and proximal promoter region could be detected. We conclude that the resistance towards CD95-mediated apoptosis observed in most de novo B-lineage ALL is not caused by mutations of the CD95 death receptor.

Vor allem in den Entwicklungslandern werden zunehmend Frauen im gebarfahigen Alter mit dem humanen Immundefizienzvirus (HIV) infiziert. Auch in der BRD stieg der Prozentsatz der HIV-positiven Frauen an der Gesamtzahl der HIV-Infizierten von 11,3% (vor 1986) auf 21% im Jahre 1996 (AIDS/ HIV IV/1996) an. Bei einer Graviditat HIV-positiver Frauen kann das HIV perinatal auf das Kind ubertragen werden. Sowohl wegen eingewanderter HIV-positiver Frauen aus Landern mit hoher HIV-Seropravalenz als auch wegen der steigenden Anzahl einheimischer HIV-positiver Frauen werden Gynakologen zunehmend mit HIV-positiven Schwangeren und Padiater mit HIV-exponierten Kindern konfrontiert.

The influence of donor age and recipient age on outcome after renal transplantation has been investigated in numerous studies. There is some evidence that patient survival in elderly patients who receive a transplant is significantly higher compared with those, who remain on dialysis. In general, patient survival after renal transplantation is mainly dependent on recipient age and on comorbid conditions. Concerning graft survival, most studies conclude that the survival of kidneys taken from older donors (50 years) and very young donors (5 years) is reduced. Graft survival was also found to be reduced in very young recipients (5 years). Functional graft survival proved to be better in older recipients (50 years) as compared to younger recipients, due to a reduced immunologic response capability. Actual graft survival however, where cases of death with functioning graft are included, is fairly equal in both populations. The question, whether the age difference between donor and recipient has an influence on graft survival, needs to be further investigated. In conclusion, donor and recipient age are important risk factors, which may influence outcome after renal transplantation and therefore should be considered carefully.

50 premature infants with bronchopulmonary dysplasia (BPD) were treated in the Perinatal Center of the University of Heidelberg from January 1990 to December 1992. Gestational age was 24-31 weeks and birthweight was 500 to 1430 grams. 27 infants received dexamethasone only and 14 were initially given dexamethasone followed by beclomethasone inhalation. Nine infants without assisted ventilation were only treated with inhaled beclomethasone. Infants with fluid intake150 ml/kg/d andor = 150 ml/kg/d were analysed separately. Extubation in ventilated infants was possible 1 to 29 days after the beginning of dexamethasone treatment. Most infants who were not ventilated any more could be weaned from oxygen during the period of dexamethasone treatment. Inhaled beclomethasone allowed reduction in supplemental oxygen in all infants. Effects of treatment with dexamethasone and beclomethasone were similar in infants with fluid intake of150 ml/kg/d and150 ml/kg/d. Our data show that dexamethasone and inhaled beclomethasone improved the clinical course of BPD in premature infants. Fluid intake had no influence on clinical outcome. Based on our results, we suggest guidelines for the treatment of BPD.

Background and aims Benchmarking of newborn mortality needs risk-adjustment of data for heterogeneous sub-populations. To assess utility of neonatal disease severity scores CRIB, CRIB-II and PREM and impact of influenceable items (FiO2max, FiO2min, body temperature (BT) base excess (BE)) to predict mortality in VLBW infants (VLBW), ELBW infants Methods Analysis of birth cohorts of years 2003–2008 from the Baden-Wurttemberg registry. Inclusion criteria: GA Results Total of 5.340 cases, 862 cases Conclusions Standard CRIB is superior to standard CRIB-II, standard PREM, and all score modifications without influenceable items. No difference exists between the 3 scores when omitting influenceable parameters. For ELBW infants

The increased risk of hypertension during treatment of uraemic patients with recombinant human erythropoietin (rHuEpo) has been related to increased blood viscosity. We therefore studied rheological parameters determining whole blood viscosity in seven haemodialysed uraemic children and adolescents during treatment with rHuEpo (initial dose 75 IU/kg per week). Before treatment the patients were anaemic and had reduced red blood cell (RBC) deformability at low shear stress of 0.7 Pa in the rheoscope compared with six healthy control children (0.14 +/- 0.03 versus 0.19 +/- 0.02). The RBC membrane rigidity (i.e. membrane elastic shear modulus) determined in a flow channel was increased (2.04 +/- 0.26 versus 1.36 +/- 0.05 x 10(-5) N/m). After two weeks of rHuEpo, RBC deformability improved and RBC membrane rigidity decreased significantly. With increasing doses of rHuEpo the haematocrit rose steadily. After 14 weeks of therapy RBC deformability reached control values, and after 30 weeks RBC membrane rigidity became normal. RBC aggregation and plasma viscosity were similar in patients and controls and did not change significantly in response to rHuEpo. The early improvement of RBC deformability may lead to an increase in tissue oxygenation by facilitating microcirculatory blood flow.

Hemorheological risk factors for thromboembolic disease were evaluated in 25 pediatric patients with idiopathic nephrotic syndrome (NS). In patients with increased proteinuria (greater than 100 mg/m2/24 h) red blood cell (RBC) aggregation and plasma viscosity were significantly increased when compared with patients in remission (less than 100 mg/m2/24 h) and with healthy controls. RBC surface charge was normal during increased proteinuria and remission. RBC aggregation correlated positively with plasma viscosity, fibrinogen, alpha 2-macroglobulin, immunoglobulin M, and the degree of proteinuria, and negatively with plasma albumin levels. RBC aggregation showed no correlation to RBC surface charge. Hematocrit and RBC deformability (rheoscope) were similar in both patient groups and in controls. Increased RBC aggregation and plasma viscosity may contribute to the increased risk of venous thromboembolism in NS.

A rare case of chronic granulomatous disease with manifestation in the mandible is presented. A 10-year-old boy showed the clinical picture of osteomyelitis without paresthesia (Vincent syndrome). Diagnosis was done by the nitroblue tetrazolium test (NBT) and by demonstration of a complete cytochrome-b deficiency of the granulocytes. In septic granulomatosis a continuous application of Sulfamethoxazol-Trimetoprim is recommended for prophylaxis of infection. For treatment of infection further antibiotics who pass into the granulocytes like rifampicin and fosfomycin are necessary. Oral surgical procedures request a careful tissue handling and a tight wound closure.