[Brain stem infarction, temporal headache, and elevated inflammatory parameters in a 74-year-old man]. / Hirnstamminfarkt, temporaler Kopfschmerz und erhöhte Entzündungsparameter bei einem 74-jährigen Patienten.

We report the case of a 74 year old man with a brain stem infarction, temporal headache and elevated inflammatory parameters. Giant cell arteritis with involvement of the temporal and vertebral arteries was proven by histology, duplex sonography and MRI. Although intensive immunosuppressive therapy was started, the patient developed two brain infarcts within 6 months. Initially, C­reactive protein and erythrocyte sedimentation rate were significantly elevated, but normalized over time. Involvement of the vertebral artery in giant cell arteritis is thought to be rare; steroid refractory courses are very rare. Brain stem infarction might be the consequence.

[Fulminant course of a Takayasu's arteritis and rare mesenteric arterial maninfestion]. / Fulminanter Verlauf einer Takayasu-Arteriitis und seltener mesenterialer Gefässbefall.

Takayasu's arteritis is a systemic disease, presenting as chronic inflammation of the main arteries. It usually affects the aorta and its large branches. General symptoms often include fatigue, subfebrile temperatures and weight loss. Complaints due to perfusion disorders are, for example, muscle pain, dizziness or claudication. Takayasu's arteritis is a rare disease which generally occurs in female patients under 40 years of age. We report on a patient with primary involvement of the mesenteric arteries. The disease process was fulminant and refractory to all therapeutic strategies. According to our knowledge this is the first case report from Germany of Takayasu's arteritis with mesenteric infarction.

[Methicillin-resistant Staphylococcus aureus (MRSA). Current status and significance of preventing infection in technical orthopedics]. / Methicillin-resistenter Staphylococcus aureus (MRSA). Aktuelle Situation und Bedeutung der Infektionsprävention in der Technischen Orthopädie.

Many patients of the Clinic for Technical Orthopedics and Rehabilitation of the Munster University are facing several risk factors at the same time, which have to be considered for infection registration and therapy accordingly. The interaction of the known late consequences of diabetes mellitus creates the prerequisites which give way for infections of the soft parts and bones. Very often, patients are only being transferred to special university clinics after long-lasting pre-treatments as day-patients or inpatients. The integrity of patients physiological barriers is often broken through by the already existing morphological damages, and the function of the immune systems defence possibly is affected by already existing basic diseases. Parallel to the increasing importance of Staphylococcus aureus (S. aureus) being the pathogen for nosocomial infections, the resistance situation towards a lot of antibiotics has significantly and increasingly deteriorated. The methicillin resistance of S. aureus, i.e. the resistance of the pathogen towards so-called staphylococcus-effective penicillinase-resistant penicillins (isoxazolylpenicillins), is presently creating the especially for the clinical practice problematic resistance mechanisms. The methicillin (oxacillin)-resistant S. aureus (MRSA, ORSA) stems usually present the phenomenon of multiresistance, i.e. the resistance towards substances of several classes of antibiotics, and, therefore, are not only resistant to all beta-lactamantibiotics (penicillins, cephalosporins, carbapenems). Thus, MRSA infections become a significant risk factor for the respective patients. In many cases there are only a very few options left for an antibiotic therapy. The increasing and often unquestioned use of "reserve substances" is leading to a selection of pathogens creating resistances to the corresponding substances. This results in a resistance spiral which makes an antibiotic therapy more and more difficult.

[Sanitation measures in evidence of Legionella]. / Sanierungsmassnahmen beim Nachweis von Legionellen.

Appearance of Legionella disease generally is underrated. Conclusions as to disease frequency from Legionella antibody investigations are not reliable. The number of microbes necessary to produce illness depends from individual preliminary conditions. In special areas of the hospital the rate of diseases caused by Legionella can be reduced by protection. In bathing areas generally the hitherto existing regulations of the Federal Health Authority are sufficient: Continual warm water temperature increases from 60 degrees C, chlorination if necessary, regular stepwise controls. Insufficient results are produced by intermittent temperature increases. Filters that are impermeable for microbes appear uneconomical for bathing areas.

[Toxicological assessment of exceeding of limit values]. / Toxikologische Beurteilung von Grenzwertüberschreitungen.

When assessing the effects of toxic products scientific considerations are often overshadowed by irrational fears and unqualified opinions. Political parameters often lead to policies that disregard individual health problems. Definition of health risks is particularly difficult if the official limit values are exceeded. The toxicological of formaldehyde, of crop protection agents and of dioxines are typical examples. Multifarious and complicated interactions of various toxic products result in additional difficulties in assessing health risks. Determination of toxicological equivalent values may help to compensate these factors. A catalogue of complex effects has only just been initiated. Therefore, the Public Health officer is probably the only person who can carefully assess the local influencing factors and their importance to health when limiting values are exceeded.

[Aspects of hospital hygiene in Legionella infections]. / Krankenhaushygienische Aspekte der Legionella-Infektionen.

Legionella inevitably are imported from natural reservoirs into drinking-water supplies. Bacterial growth predominantly occurs at water temperatures between 40 degrees C und 50 degrees C (104 degrees F and 122 degrees F). Heat conduction to insufficiently insulated cold water tubes implies the possibility of increased contamination also there. Problems with contamination arise in parts of the water supplies with stagnant warm water. Therefore, reservoirs should be descaled regularly. In general, for prophylaxis are recommended raising the temperature of warm water to 60 degrees C (140 degrees F), regular microbiological control of water quality and regular technical maintenance of waterworks where warm water stagnates for some time. Patients bearing a higher risk of Legionella-infections require intensified precautionary measures. The diagnosis of legionellosis should be based on the direct evidence of immunofluorescence-stained microorganisms. Finding increased antibody titers alone is not always correlated with the response to Legionella-specific therapy.

[Bacterial growth of thrombocyte preparations during storage time]. / Untersuchungen zum Keimwachstum bei Thrombozytenpräparationen während der Lagerungszeit.

Standard practice of platelet storage at room temperature may contribute to the risk of sepsis after platelet transfusion. Platelets in vitro inoculated with 10(3) or more different microorganisms showed logarithmic bacterial growth throughout the 5 days of storage. These data support the hypothesis that bacterial contamination of platelets might become clinically significant during the 5 days of storage.

The importance of different laboratory methods in Legionella diagnosis in medical care.

Legionellae an infection by contaminated water is thought to be respo environment of patients with a high risk of infection (e.g. after ki lantation, immunosuppression) prophylactic measures (rising the tempe warm water to 60 degrees C) should be combined with bacteriological c s to be taken into account, however, that only by taking a couple of he same outlet during a period of time a colonization of central inst ms (sediments, storage tanks) can be discovered. In patients with acu a of unknown origin serological tests of Legionella antibodies are no c. Antibody titers of not infected and with Legionella infected patie gnificant difference. Well suited for the diagnosis of a legionellosi f the Direct Immunofluorescent Antibody Assay (DFA) in invasively sam . In immunocompromised pneumonia patients 18.3% of bronchoalveolar 6.0% of bronchoalveolar aspirates are Legionella positive. RETURN/proces t F3/ext F4/can F5/nxt F6/ins F7/up F8/dwn F9/fin lavages and 16.0% of bronchoalveolar aspirates are Legionella positive.

[Wigs as medical aids. Selection, care and cost regulation]. / Perücken als medizinisches Hilfsmittel. Auswahl, Pflege, Kostenregelung.

In a discreet way, wigs not only cover up a disfiguring loss of hair but also chronic and suppurative diseases of the scalp. We especially deal with the problems regarding the choice of such wigs, how they are--if necessary--disinfected, cleaned, and tended, and how the expenses may be settled.