[Interim results for the Patients' Rights Act and Infection Protection Act]. / Zwischenbilanz Patientenrechtegesetz und Infektionsschutzgesetz.

BACKGROUND: The Patient Rights Act has converted court rulings into legal paragraphs. Two new aspects have been introduced: the duty to hand over a copy of the signed written consent form to the patient (in which detailed recommendations are offered) and the obligation of a thorough documentation of findings and treatments within patient files. In addition the legislators, through the Joint Federal Committee (Gemeinsamer Bundesausschuss, GBA) have made the introduction of clinical risk management mandatory. The Infection Protection Act and its regulations have elevated the prerequisites of hygiene within hospitals and private practices with a parallel increase in liability. RESULTS AND DISCUSSION: Both laws and regulations offer no reference as to who (and to what extent) is financially responsible for the excessive increase in personnel costs, which are as yet not included in the German diagnosis-related groups (G-DRG) system. Despite all additional measures within the area of risk management, mistakes (avoidable or unavoidable) will nevertheless occur. In order to avoid longstanding legal battles the authors recommend an open and rapid communication with the patient and family. The wall of silence should be a thing of the past.

[Determining the indication for primary total hip and knee replacement. Results of external quality assurance of over 270,000 primary total hip and knee replacements]. / Indikationsstellung in der primären Hüft- und Kniegelenkendoprothetik. Ergebnisse der externen Qualitätssicherung von über 270.000 primären Hüft- und Kniegelenkendoprothesen.

BACKGROUND: The German mandatory quality assurance programme collects data from all primary total hip and knee replacements. The quality of the indication is measured by clinical and radiological criteria. The results were analysed in terms of differences in establishing the indication subject to patient and hospital characteristics. MATERIALS AND METHODS: Data on more than 270,000 primary total hip and knee replacements that were operated in 2006 in Germany were analysed concerning differences in the quality of the indication subject to age, gender, hospital volume and density of population and hospitals (metropolitan vs rural areas). The statistical analysis was done by exact Fisher's test. RESULTS: The quality of the indication was statistically significantly better in men, patients 60 and older, in rural areas and in high volume hospitals (50 and more joint replacements per year). DISCUSSION: Data of this mandatory German quality assurance programme are useful to describe differences in medical care. The results are valid and complete. An exact analysis of the reasons for these differences is difficult though. Data focus is on quality assurance and represent only in-hospital results. CONCLUSION: Further analyses are necessary to ascertain whether the differences in quality of care are deficits or only variances in medical care.

[Educational curriculum and organization in the general hospital]. / Ausbildungsinhalte und -Organisation an einem Haus der Grundversorgung.

With sufficient organization and personal activity comprehensive postgraduate medical education can successfully be carried out even at a small surgical department, especially--but not exclusively--in one's early years of postgraduate education and especially if external course offers are made use of. Postgraduate education is endangered not so much because of local circumstances, but because of external influences like official regulations on working-time, the lack of offers for rotations, and restrictions on our duty to take professional care of people.

[Health care contract--position from the viewpoint of small routine health centers]. / Versorgungsauftrag--Stellungnahme aus der Sicht des Hauses der Grund- und Regelversorgung.

The position of smaller hospitals is threatened by the new legislation concerning health insurance. The improvement of quality control and the certification of medical skills are possible ways to maintain the availability of the technical armamentarium for sophisticated operations, thus providing the possibilities for emergency treatment and maintaining at the same time medical competence in the eyes of the population, which is an absolutely necessary precondition for economic survival and future prospects.

Comparative response of turkeys and chickens to avian lymphoid leukosis virus.

Response of turkeys and 151(5)x7(1) chickens to prenatal or neonatal inoculation with the avian leukosis virus RAV-1 was compared. Virus-inoculated turkeys and chickens developed viraemia and antibody to. RAV-1. Many of the chickens remained persistently viraemic through the duration of the experiment, whereas in turkeys viraemia was transient. Circulating antibodies were detected earlier in turkeys than in chickens. Inoculation of turkeys with RAV-1 resulted in a high incidence of inflammatory and lymphoproliferative, but non-neoplastic, lesions in various visceral organs, including spleen, pancreas, heart, bursa and thymus, 3 to 5 weeks after virus inoculation. The lesions in chickens were those typical after RAV-1 infection, i.e. neoplastic, and appeared after a latent period of 9 weeks.

Marek's disease in turkeys: lack of protection by vaccination.

Herpesvirus of turkeys, a highly effective vaccine against Marek's disease (MD) in chickens, was ineffective in protecting turkeys against MD. Another tissue-culture attenuated vaccine virus also protected chickens, but not turkeys, from MD. Intact and immunosuppressed turkey poults inoculated with herpesvirus of turkey developed a persistent viremia, but did not have detectable gross or microscopic lesions.

Toxicosis of mirex for chick embryos and chickens hatched from eggs inoculated with mirex.

Mirex, a hydrocarbon, was mixed with corn oil and injected into chick embryos to test its toxic effect. At a concentration of 0 05 mg mirex/egg, embryo mortality was 40%, at 0.5 mg/egg, mortality was 49%, and at 5.0 mg/egg, mortality reached 81%. Mortality of control eggs injected with corn oil alone was 36%. The body weights of newly hatched chickens and of 4-week-old chicks were not different from those of controls. No clinical signs of disease were seen during the 4 weeks of observation. However, liver weights were increased at all 3 dosages when the birds were killed at 4 weeks, but spleen and bursal weights were not. The results support the decision to discontinue the use of mirex as a pesticide in the environment for controlling the fire ant (Solenopsis sp.) until a better means of presenting it can be found.

Bone density and ash studies in avian osteopetrosis.

Bone density and ash were measured in diaphyses of osteopetrotic and normal chicken tibiotarsi. In lesions of less than one year's duration, osteopetrotic bone was less dense than disease-free bone. The new osteopetrotic bone yielded approximately the same ash content per unit bone dry weight, as did disease-free bone of comparable age, but there was consistently less ash per unit bone wet volume in the diseased bones. This indicates that, in its early stages, osteopetrosis is characterized by spongy bone that lacks dense mineral deposition.

Suppression of immunologic function and degeneration of lymphoid organs in cyclophosphamide-treated turkeys.

Neonatal administration of 8 to 20 mg of cyclophosphamide (CY) in turkey poults resulted in a marked alteration in the morphologic features of all major lymphoid organs. Cyclophosphamide induced severe deficiency in antibody response to multiple injections of Brucella abortus and sheep RBC and in vitro proliferative response of peripheral blood leukocytes to concanavalin A. The morphologic regeneration of thymus and of thymus-dependent areas was marked in all major lymphoid organs by posttreatment day 15. This regeneration preceded functional recovery of the mitogenic response of peripheral blood leukocytes. The regeneration of the bursa and bursa-dependent areas in other lymphoid organs was minimal through posttreatment day 27. Thus, CY may be used effectively in turkeys as an immunosuppressive reagent.

Induction of lymphomas and tumor antigen by Marek's disease virus in turkeys.

Pathogenic Marek's disease (MD) virus (MDV) induced a high incidence of mortality and gross and microscopic lesions in turkey poults. Inoculated turkey poults became persistently viremic with MDV, although the levels of detectable circulating MDV were generally lower in turkeys than in similarly inoculated chickens. The early lytic phase of MD characterized by lymphoid cell destruction and the appearance of viral antigen in lymphoid organ was not as prominent in turkeys as in chickens. Gross MD lesions in turkeys were most prevalent in liver and spleen; peripheral nerves were involved infrequently. MD tumors in turkeys contained cells that reacted with antiserum prepared against chicken MD-tumor-associated surface antigen (MATSA); this result indicated that MDV induced cellular transformation in turkeys and the tumor-associated antigen in chicken and turkeys cross-reacted. Several in vitro-propagating B-cell lines were developed from the turkey lymphomas. As in chickens, MD in turkeys also resulted in immunodepression. Circulating lymphocytes from turkeys that eventually died of MD or had gross tumors at the end of the experiment were deficient in mitogenic response to Concanavalin A.

Postnatal morphology and functional capacity of the kidney following prenatal treatment with dinoseb in rats.

Dinoseb has produced alterations that are suggestive of renal damage in mice and rats. Therefore it was of interest to determine the postnatal morphology and functional capacity of the kidney following prenatal treatment with dinoseb in rats. Fetal and neonatal rats treated with dinoseb on gestational d 10-12 had dilated renal pelves and ureters. Kidneys had dilated tubules and excessive mesenchymal tissue when examined perinatally. These pathological changes were reduced in incidence (kidney) or not detected (ureter) at 42 d postpartum and were not correlated with alterations in postnatal renal function. Livers from rats treated prenatally with dinoseb were vacuolated and necrotic even at 42 d postpartum. Rats treated prenatally with dinoseb had reduced body weights at 1 and 7 d postpartum. However, body weights of control and dinoseb-treated rats were not significantly different at 42 d of age. These results emphasize the need to determine the pesistence and functional consequences of anomalies detected in near-term fetuses for safety assessment of a chemical.

Viral inclusions in raccoon liver cells.

Three young raccoons (Procyon lotor), two from Michigan and one from Arizona, died suddenly from acute infections. Intranuclear inclusion bodies and viral particles typical of herpesvirus were seen in liver cells from all three. Inclusions also were seen in the nuclei of endothelial cells in the lung, liver, glomeruli and reticuloendothelial cells of the spleen. The source of the infection was not determined, but possible transmission from other species could not be ruled out.

Effects of polybrominated biphenyls on kidney function and activity of renal microsomal enzymes.

Polybrominated biphenyls (PBBs) cause hepatic microsomal enzyme stimulation and histopathological alterations in several organs, including kidney. Concern about effects of PBBs on the health of newborns has increased after the discovery of PBBs in milk of nursing mothers. Therefore, it was of interest to investigate the effects of PBBs on kidney function and the activity of renal microsomal enzymes in adult and immature animals. Seven and eleven day old pups were treated with a single IP injection of either peanut oil or 150 mg/kg PBBs (FireMaster BP-6) in peanut oil. Adult virgin rats were fed diet containing 0 or 100 ppm PBBs for 30 or 90 days. Treatment with PBBs only retarded weight gain after 90 days exposure. Kidney-to-body weight ratio was not altered by PBBs. Arylhydrocarbon hydroxylase activity was increased while epoxide hydratase activity was decreased (adults) or not affected (immature rats) in kidney following treatment with PBBs. Administration of PBBs had no effect on blood urea nitrogen, the clearance of inulin, p-aminohippurate (PAH), or fractional sodium excretion. Similarly, the in vitro accumulation of PAH and N-methylnicotinamide (NMN) by thin renal cortical slices and ammoniagenesis and gluconeogenesis in renal cortical slices were not affected by PBBs. In conclusion, treatment with PBBs resulted in modification of the activity of renal microsomal enzyme activities but had no detectable effect on renal function.

Polybrominated biphenyl toxicosis in rats fed an iodine-deficient, iodine-adequate, or iodine-excess diet.

Young male Sprague-Dawley rats were fed 0, 1, 10, or 100 ppm of polybrominated biphenyls (PBB) in iodine-deficient, iodine-adequate (0.2 ppm), or iodine-excess (1000 ppm) diets. Six rats in each of the 12 groups were killed at 30 days and the remaining six in each group at 60 days. Growth rates were similar in all rats fed diets containing 0, 1, or 10 ppm PBB but were slower from 30 to 60 days in rats given 100 ppm PBB. Results of routine hematologic examinations and urinalyses were essentially normal. Although liver weights were substantially increased by PBB, the smallest increases were in rats fed an iodine-deficient diet. Thyroid weights were increased by iodine deficiency and by 10 and 100 ppm PBB. Electropherograms of serum proteins, serum lipoproteins, and LDH isozymes at 60 days from rats given PBB indicated hepatic alterations, but changes were least dramatic in rats fed an iodine-deficient diet plus PBB and most severe in rats fed iodine-excess diets plus PBB. Hepatic lesions were basically similar to those previously described except that bile duct proliferation was seen at 60 days only in rats fed an iodine-deficient diet and 100 ppm PBB. Histologic changes in thyroid glands were associated with iodine deficiency and with PBB. The iodine-excess diet plus 100 ppm PBB induced squamous metaplasia of respiratory bronchiolar epithelium. These results indicate interrelationships between PBB and iodine which may affect the toxicosis caused by PBB.

Pathologic features of polybrominated biphenyl toxicosis in the rat and guinea pig.

Young male rats were fed a diet containing 0, 1, 10, 100, or 500 ppm of a commercial mixture of polybrominated biphenyls (PBB) that had been accidentally incorporated into a mineral mixture and fed to Michigan livestock and poultry. After 30 days, 9 of the 12 rats in each group were killed and tissues were examined. Liver weight to body weight ratios were significantly increased at all feeding levels; at 500 ppm, liver weight had more than doubled. Kidney weight was not affected. Microscopic lesions were mostly confined to the liver and consisted of extensive swelling and vacuolation of hepatocytes in rats fed diets containing 100 and 500 ppm of PBB. Slight swelling and vacuolation were seen in rats fed the diet containing 10 ppm, and lesions were not found at 0 or 1 ppm. There was a significant increase in hepatic mitochondrial size at 1 ppm, and smooth endoplasmic reticulum was markedly increased at 100 and 500 ppm. Myelin bodies were present at 100 and 500 ppm, and vacuoles were numerous. Rats killed at 60 days had similar lesions. The activity of hepatic microsomal enzymes increased at all levels of feeding of PBB. Rat pups nursing dams fed a diet containing 10 ppm of PBB had microscopic and ultrastructural hepatic lesions. When guinea pigs were fed PBB at the same amounts as were rats, the results were strikingly different. Guinea pigs fed a diet containing 500 ppm of PBB died within 15 days; at 100 ppm, only 2 of 6 survived for 30 days. Effects on liver weight were inconsistent, but 2 of 6 fed a diet containing 10 ppm had enlarged livers.