[Definition of polytrauma in the German DRG system 2006. Up to 30% "incorrect classifications"]. / Polytraumadefinition im G-DRG-System 2006. Bis zu 30% "Fehlgruppierungen".

INTRODUCTION: Severely injured patients represent a relevant financial cost factor in the health system especially for high level trauma centres. The introduction of a"diagnosis-related group" (DRG) system in Germany further revealed the potential negative economic impact of severely injured patients for trauma centres. In recent years several changes of the specific DRG for severely injured patients occurred with the aim of a convenient reimbursement for the trauma patient. MATERIAL AND METHODS: The present study analysed 38 multiply injured patients admitted in the first half of the year 2004. These patients were analysed in terms of the respective DRG that was attributed to the patient on the basis of the definition criteria for 2004 and 2005. In addition for the same patient group the total inpatient treatment costs were calculated according to the algorithm developed by the Working Group on Polytrauma of the German Trauma Society. RESULTS: The analysis revealed three major problems in the reimbursement for severely injured patients according to the German DRG system: (1) In spite of the additional payment for blood compounds on top of the DRG reimbursement in 2005 a mean economic deficit of more than 4000 euro remains for each severely injured patient. (2) In 30% of the analysed trauma patients the combination of the diagnosis and operations did not lead to a specific polytrauma DRG or to an intensive care medicine DRG. (3) In the patients that could not be attributed to a polytrauma DRG, the economic deficit was with an average of more than 9000 euro even higher. This attribution aspect is also currently relevant, since the definition criteria for a polytrauma DRG were not changed in 2006 or 2007. CONCLUSION: We conclude that besides the recent changes in the reimbursement for polytrauma DRGs, which have been at least partly adapted to the real financial burden of these patients, the definition of a severely injured patient in the German DRG system may also need to be revised.

[Treatment of the experimental chronic digitalisintoxication by hemoperfusion (author's transl)]. / Zur Therapie der experimentellen, chronischen Digitalisintoxikation durch Hämoperfusion.

In 5 adult dogs experimental chronic digitalis intoxication was produced by oral administration of different digitalis-types (digoxin, beta-methyl-, beta-acetyl-digoxin, digitoxin). 18 to 24 hours after the last application of digitalis, charcoal hemoperfusion was performed in Dipidolor-N2O-anesthesia and serum digitalis-concentrations in the arterial and venous lines of the hemoperfusion system were determined by RIA J125. The Ecg was registered continuously as a simple clinical parameter of cardiac digitalis intoxication. Initial multiple cardiac arrhythmias (AVII degree, SAII degree, tachycardia of the atrium) subsided in the dogs with digoxin, beta-methyl- and beta-acetyl-digoxin during hemocolperfusion within 130 to 160 min. The disturbances of rhythm persisted up to 200 min after onset of hemoperfusion in the dog intoxicated by digitoxin. The clearances of digoxin and derivatives (35.8--43.1 ml/min) are higher than the digitoxin clearance (17--23.2 ml/min) which is supposed to be the reason for cardiac detoxication in the digoxin-intoxicated dogs. Hemoperfusion using polymer coated charcoal appears to be effective for the elimination of digoxin leading to a marked improvement of cardiac arrhythmias. By contrast digitoxin induced cardiac arrhythmias are not influenced during hemoperfusion.

[Permeability of dialysis membranes for hepatitis-B virus: on the prophylaxis of hepatitis in a haemodialysis centre (author's transl)]. / Permeabilität von Dialysemembranen in Hämodialysegeräten für das Hepatitis-B-Virus. Ein Beitrag zur Expositionsprophylaxe der Hepatitis in Hämodialysezentren

Dialysis fluids of two hepatitis-Bs (HBs) antigen-positive dialysis patients were tested for hepatitis-B virus. Total dialysate volume of 5.5 litres each - as obtained on haemodialysis with the Redy-recirculation system - was concentrated by ultrafiltration and trap and rate-zonal ultracentrifugation, followed by fractionation, and purified. Electron-microscopic evidence of permeability of an intact dialysis membrane for hepatitis-B was obtained. Concentration of hepatitis-B virus was at least 10(3) to 10(4) particles per total volume. Because of the potential infectiousness of the dialysis apparatus by effective heat sterilisation after every dialysis is essential.

[Side effects after stimulation of gastric secretion with pentagastrin (author's transl)]. / Nebenwirkungen nach Stimulation der Magensekretion mit Pentagastrin

Application of pentagastrin (by infusion, by intramuscular and subcutaneous injection) in the usual dose of 6 mug/kg/hr revealed a short lasting enhancement in frequency of pulse-rate and a slight rise in blood-pressure (5 to 10 mmHg), which exceeded the alteration of pulserate, in 30 healthy volunteers with normal blood-pressure. The enhancement of pulse-rate is considered as a psychogenic reaction to injection. The reason of the rise in blood-pressure, which immediately occured and was of long standing duration, is a pharmacodynamic effect obviously. An extensive increase in blood-pressure, collaps, bradycardia or tachycardia was not observed during 120 investigations. We were not able to detect any significant changes in a number of components of serum or blood. The influence on the values of SGOT, LAP, urea, the red and white blood cell count as well as on hemoglobin concentration and hematocrit cannot be excluded however.

[Clinical experimental studies in patients with asympathicotonic hypotension]. / Klinisch-experimentelle Untersuchungen bei Patienten mit asympathikotoner Hypotonie

Three patients with postural hypotension (two of the idiopathic type, one possibly due to familial dysautonomia) were found to have not only the pathognomonic postural hypotension, without rise in heart rate, cardiac output and peripheral vascular resistance, but also a similarly abnormal regulatory mechanism on ergometric stress when recumbent. There was a delayed-response to the bloodpressure fall on Valsalva a manoeuvre, and the blood volume was reduced. A combined effect of these factors explains that these patients have a more marked impairment of physical capcity than might be expected merely from the orthostatic hypotension. The actions of noradrenaline, adrenaline, phenylephrine, isoproterenol, angiotensin and tyramine on blood pressure and heart rate were different from normal. Plasma-renin activity was reduced in all three patients and could not be raised. Urinary excretion of adrenaline and noradrenaline was markedly diminished. Reactions to noradrenaline and tyramine, as well as the excretion pattern of the catecholamine metabolites suggest a disorder of active adrenaline liberation. Furthermore, different disorders of catecholamine metabolism underlie idiopathic orthostatic hypotension and familial autonomia. Therapeutic trials with fludrocortisone, beta-receptor blockers and levodopa brought improvement, but long-term results are not yet available.