[Preoperative risk factors and intraoperative and postoperative risk management in 11,890 anesthesias. Initial results of a prospective study]. / Präoperative Risikofaktoren und intra- und postoperative Risikoverwirklichung bei 11890 Anästhesien. Erste Ergebnisse einer prospektiven Studie.

OBJECTIVE: The relation of the frequency and severity of pitfalls, events and complications (PECs) was analysed in respect of preoperative risk factors. The epidemiological data were gathered as a contribution to a current project of the German Society for Anaesthesiology and Intensive Care. METHOD: Preoperative data (age, sex, preexisting diseases, pathological findings, grade of urgency and ASA-class) were integrated in a paper record, as well as the perioperative interventions and directly postoperative events, type of anaesthesia, and kind of operation. The automatically readable paper records were routinely in use for every patient. After control and correction the data were stored in a modern data base. MAIN RESULTS: From October 1, 91 to May 20, 92 11,890 anaesthesias were recorded. 2,959 of them with a total of 4,184 PECs. 2,397 PECs were cardiovascular, 875 respiratory. PECs of grade I (no impact on treatment in the recovery room [RR]) occurred in 14% of patients, grade II (impact on treatment in RR, but no impact on discharge to ward) 7.2%, grade III (prolonged stay in RR or special monitoring in the ward) 2.88%; grade IV (PEC leads to transfer to the ICU) 0.63%, and grade V (PEC leads to disabling damage or death) 0.13%. 13 of 15 patients suffering from PECs grade V were of ASA class 4 or 5. PECs had a certain relation to the ASA-classification of anaesthetic risk. But this relation is quite different in several surgical disciplines. CONCLUSIONS: Preoperatively known risk factors of the patient and the measures taken by specialists of various disciplines contribute to the incidence of PECs. Available data could be processed multicentrally and in standard form for producing prognostic data for risk prediction. Since PECs of grade II or higher are cost- relevant, requiring an interdisciplinary approach, it appears meaningful to base costing on such an interdisciplinary approach in accordance with the requirements of diagnosis and treatment.

Phagocytosis of opsonized Treponema pallidum subsp. pallidum proceeds slowly.

Macrophages were found to phagocytize Treponema pallidum subsp. pallidum attached to polycarbonate filters. This environment simulated the in vivo interaction of surface-adherent treponemes with macrophages. The phagocytosis of T. pallidum subsp. pallidum was found to proceed slowly. Heat-killed T. pallidum subsp. pallidum were susceptible to opsonization with 2% immune serum, whereas live treponemes were resistant to this concentration of antibody. High concentrations of immune serum were found to increase phagocytosis of the spirochetes. Live T. pallidum subsp. pallidum had bound limited quantities of immunoglobulin G in vivo, and only opsonization with 20% immune serum resulted in a detectable increase in surface-bound immunoglobulin in vitro. Kinetic studies suggested a steady rate of phagocytosis that is considerably slower than with other bacteria. Scanning electron microscopy studies of the phagocytizing macrophages showed that the treponemes were detached from the membrane filters and scooped onto the ruffled portion of the macrophage surface. This lengthy physical process, along with the lack of a dramatic increase in ingestion after opsonization, may account for the slow rate of phagocytosis.