[Economic aspects of intensive care medicine--cost and reimbursement according to diagnosis related grouping].

We analyse relevant modifications of the new German diagnosis related reimbursement system for 2004. It is difficult to judge the consequences of financing intensive care systems by such flat rates. In our surgical ICU total treatment costs were 1 050.

Influence of combined intravenous and topical antibiotic prophylaxis on the incidence of infections, organ dysfunctions, and mortality in critically ill surgical patients: a prospective, stratified, randomized, double-blind, placebo-controlled clinical trial.

We prospectively studied the impact of an antibiotic prophylaxis regimen on the incidence of infections, organ dysfunctions, and mortality in a predominantly surgical and trauma intensive care unit (ICU) population. A total of 546 patients were enrolled and stratified according to Acute Physiology and Chronic Health Evaluation (APACHE)-II scores. They were then randomized to receive either 2 x 400 mg of intravenous ciprofloxacin for 4 days, together with a mixture of topical gentamicin and polymyxin applied to the nostrils, mouth, and stomach throughout their ICU stay or to receive intravenous and topical placebo.

Influence of autologous blood transfusion on natural killer and lymphokine-activated killer cell activities in cancer surgery.

Background And Objectives: Immunosuppression associated with blood transfusion may influence postoperative infection rates. It may also affect the prognosis of patients treated surgically for colorectal cancer. To control this effect, study protocols have applied autologous blood donation programs, which are thought to be immunologically neutral.

Prognostic significance of bone marrow micrometastases in patients with gastric cancer.

Background: Monoclonal antibodies (mabs) against components of the cytoskeleton such as cytokeratins allow single disseminated epithelial carcinoma cells to be detected in the bone marrow. The aim of this study was to examine the prognostic relevance of these cells in patients with gastric cancer and to evaluate by multivariate analysis their predictive value compared with conventional risk factors.

Patients And Methods: A total of 1 x 10(6) cells from bone marrow aspirates were screened immunoctochemically for the presence and absolute number of disseminated tumor cells using mab CK2 to cytokeratin component no.

Hepatitis C virus infection as a possible risk factor for ductopenic rejection (vanishing bile duct syndrome) after liver transplantation.

Irreversible ductopenic rejection (DR) after orthotopic liver transplantation (OLT) is a major cause of late hepatic allograft failure. A variety of risk factors for DR have been postulated, but they are controversial. All transplant recipients at our institution with graft survival of more than 1 month (n = 120) were examined retrospectively with a view to possible risk factors for DR.

Blood transfusion-modulated tumor recurrence: first results of a randomized study of autologous versus allogeneic blood transfusion in colorectal cancer surgery.

Purpose: Allogeneic blood transfusions have reportedly been associated with a poor prognosis in patients with curatively resected cancer. To control for immunosuppression induced by a speculatively causal allogeneic blood transfusion, we designed a randomized study in which the control group received autologous blood transfusions not related to any condition of immunosuppression.

Patients And Methods: One hundred twenty patients with potentially curative resectable colorectal cancer and the capability to predeposit autologous blood were randomly selected to receive either standard allogeneic blood transfusion or predeposited autologous blood.

The failing human heart is unable to use the Frank-Starling mechanism.

There is evidence that the failing human left ventricle in vivo subjected to additional preload is unable to use the Frank-Starling mechanism. The present study compared the force-tension relation in human nonfailing and terminally failing (heart transplants required because of dilated cardiomyopathy) myocardium. Isometric force of contraction of electrically driven left ventricular papillary muscle strips was studied under various preload conditions (2 to 20 mN).

Beneficial effect of autologous blood transfusion on infectious complications after colorectal cancer surgery.

Homologous blood transfusion has been associated with an increased risk of postoperative infectious complications. To test the clinical consequences of this apparently immunosuppressive effect of homologous blood in a controlled trial, we designed a study in which the control group deposited autologous blood before their operations for use should transfusion be needed. We enrolled 120 patients with apparently curable colorectal cancer who were able to predeposit autologous blood (haemoglobin > 12.

Effect of inotropic stimulation on the negative force-frequency relationship in the failing human heart.

Background: In severe human heart failure, an increase in frequency of stimulation is accompanied by a reduced force of contraction in vivo and in vitro. The present study was aimed to investigate whether inotropic stimulation influences the inverse force-frequency relationship in failing human myocardium.

Methods And Results: The effects of the cAMP-independent positive inotropic agents ouabain (0.

[Observations on the temporal sequence of reported pregnancy risks].

A prospective study was conducted with 383 pregnant women concerning the occurrence in respect of time, the duration, and the mutual interactions of pregnancy risks. 35 per cent of the women with hemorrhages during early pregnancy later had premature labour pain (p less than 0.01).

[Prognostic significance of risk factors in pregnancy. II. Risk status at onset of labor].

A group of 383 women with pregnancy risks were screened at the onset of labour. 70% of the EPH-Gestosis, 56% of the urinary tract infections and cervical incompetence, 48% of the anaemias, 38,6% of the premature labour, 11% of the hypotension and 4% of the antepartal haemorrhages were found still to be present at the onset of labour. In those women with EPH-Gestosis at the onset of labour, the risk of cesarean section was markedly higher.

[Prognostic significance of risk factors in pregnancy. I. Observations of onset and duration of observed pregnancy risks].

In a prospective study 383 from 712 women attending our antenatal clinic were found on examination to have pregnancy risks. These were followed with regard to the time of first occurrence, duration and time of last occurrence, as well as their relation to other risk factors occurring in both history, examination or during labour. The method of delivery, necessity for postpartal intensive pediatric care and the perinatal mortality were considered.

[Premature birth rate, incidence of cesarean section and perinatal mortality between 1945 and 1980. An analysis of 55,000 births].

56,686 single births between 1945 and 1980 were evaluated in a retrospective study. The results reflect the change which has taken place in obstetrics. Perinatal mortality dropped in a straight line from 48.

[Assessment of quality of medical activities (author's transl)].

The efforts to measure the quality of medical activities have been described in the literature a great many times. In this respect, high blood pressure, urinary tract infections and cholecystectomy are great health problems which are most frequently the objects of the investigations. This is also to be seen in the choice of the qualitative measurements used.