["Fit4You"--A Programme for Prevention and Reduction of Overweight in Apprentices in the Workplace Setting]. / "Fit4U"--ein Präventionsprogramm zur Vermeidung und Verminderung von Übergewicht bei Auszubildenden im Betrieb.

The effect of health promotion at the worksite for overweight adolescents is not known. This 2-year intervention study examined the effect of a multimodal programme including nutrition counselling, sport, and life-skill training on medical and psychological outcomes. The body mass index increased slightly less in the intervention group. Semistructured interviews at the end showed that participants are highly interested in health promotion at the worksite.

Agarose gel isoelectrofocusing of UDP-galactose pyrophosphorylase and galactose-1-phosphate uridyltransferase. Developmental aspect of UDP-galactose pyrophosphorylase.

The uridine diphosphogalactose pyrophosphorylase activity has been determined in human adult and fetal tissues as well as blood of various ages by measurement of UDP-galactose production from gal-1-p and UTP. The highest activity was found from adult liver in which the specific activity was about 5% of the gal-1-p uridyltransferase activity. In general adult tissues had a somewhat higher activity than the corresponding fetal tissues except erythrocytes in which fetuses had a 5-10 times higher activity than adults. From normal blood the pyrophosphorylase activity in erythrocytes decreased with age, but in the case of galactosemia the decrease with age was not distinct. According to agarose gel isoelectrofocusing studies, at least two isozyme forms for UDP-galactose pyrophosphorylase exist with the activity bands between pH 6.0-6.15. The patterns of AGIF bands of pyrophosphorylase varied according to the age of the samples, suggesting the development of the isozyme forms of pyrophosphorylase to be age-dependent. Uridyltransferase, on the other hand, resolved into multiple bands between pH 5.1-5.6 on agarose gels and the patterns varied according to the variants but not to the age. Significance of the decrease in the pyrophosphorylase activity in erythrocytes with age as well as of the difference in AGIF bands between normal and the galactosemic were discussed with regard to the pathology of classical galactosemia.

[Outcome quality in vascular surgery]. / Ergebnisqualität in der Gefässchirurgie.

INTRODUCTION: For the assessment of outcome quality, the acquisition and evaluation of internal and external treatment data is necessary. Vascular surgery is characterized in main topics of treatment such as carotid stenoses, aortic aneurysms, peripheral arterial disease, and varicose veins by clearly defined outcome indicators. Nevertheless, the determination of the quality of outcome is difficult because of the differing standards. METHODS: For an external, comparative quality assurance, the quality assurance commission of the German Society for Vascular Surgery has established a program, "Quality Management for the carotid TEA and the BAA" according to section 137 SGB V, and has developed a questionnaire for recording the quality of treatment of varicose veins. RESULTS: The evaluation of all the questionnaires submitted to an independent institute enables the participating departments to have a comprehensive evaluation of their own quality of outcome and provides a tool to compare it with defined quality levels (benchmarking). CONCLUSION: For every physician, the perception of his own quality of outcome represents a fundamental requirement, which continues to gain importance within the context of future health policies.

The relationship between volume and outcome following elective open repair of abdominal aortic aneurysms (AAA) in 131 German hospitals.

OBJECTIVES: Several studies indicate that high-volume hospitals have better results in open repair of unruptured abdominal aortic aneurysms (AAA). Up to now no studies had addressed this question in German hospitals. DESIGN: Post-hoc-analysis from a prospective physician-led registry. MATERIAL AND METHODS: Since 1999, the German Society for Vascular Surgery has conducted a prospective registry for open and endovascular repair of AAAs. This study includes 131 hospitals who conducted n=10163 elective open repairs for unruptured AAA between 1999 to 2004. All perioperative variables including annual volume as a continuous variable were analysed in a step-wise logistic regression model. In order to define a threshold annual volume an additional logistic regression analysis was performed by use of annual volume groups (0-9, 10-19, 20-29, 30-39, 40-49, 50 or more). The relationship between annual volume and further outcome parameters (length of procedure, blood transfusion, length of stay) were also analyzed. RESULTS: The overall mortality rate was 3.2%. The stepwise logistic regression model identified the following predictors of an increased perioperative mortality: age (OR 1.084, 95% CI 1.066-1.102), AAA diameter (OR 1.008, 95% CI 1.001-1.016), length of procedure (OR 1.008, 95% CI 1.006-1.009), ASA-Score (OR 2.636, 95% CI 2.129-3.264), suprarenal clamping (OR 1.447, 95% CI 1.008-2,078), blood transfusion (OR 1.786, 95% CI 1.268-2.514). Annual volume was moderately predictive (OR 1.003, 95% CI 1-1.006) but failed to reach statistical significance (p=0.07). The analysis of volume groups identified a significantly higher risk for hospitals with an annual volume of 1-9 AAA-repairs by comparison to hospitals with an annual volume of 50 or more AAA-repairs (OR 1.903, 95% CI 1.124-3.222). Operations at low volume hospitals were also longer (p<0.001), with an extended postoperative stay (p<0.001) and a higher transfusion rate (p<0.001). CONCLUSIONS: Patient's age, ASA classification, AAA diameter, length of procedure, suprarenal clamping and blood transfusion are predictive variables for an increased perioperative mortality in elective open AAA repair. Mortality is also increased by a low annual volume. Further studies are needed to examine whether these data are applicable to all German hospitals.

Certification of vascular centers - a project of the German Society for Vascular Surgery.

OBJECTIVES: Due to the progress vascular medicine has made in conventional vascular surgery, endovascular procedures, and conservative therapy close, interdisciplinary cooperation is required. In order to assure the contextual and structural quality of vascular centers, the German Society for Vascular Surgery established a list of criteria for certification of each interdisciplinary vascular center. MATERIAL AND METHODS: Between July 2002 and December 2005, 77 centers have submitted a written application and have been audited by the commission for quality assurance of the German Society for Vascular Surgery, 59 vascular centers were certified for a period of 3 years with one center in each in Austria and in Switzerland, 13 centers were not certified (16.8%), and the applications of 5 centers are still pending. This analysis is based on 57 German certified vascular centers. RESULTS: Each center treats a median of 1149 inpatients (11% of these are emergency admissions) and 2,159 outpatients per year. Sixty percent of the patients treated have an arterial disease. All centers have vascular surgery and radiology departments. In 11 out of 57 centers, angiology services are offered in cooperation with affiliated physicians. Each vascular center has an average of 4.2 vascular surgeons, 3 radiologists and 1 angiologist. All centers offer radiological and ultrasound diagnostics (CT angiography in 100%, MRT in 95%, duplex sonography in 100%). Each clinic executes a median of 521 (233-1436) arterial operations and 263 (37-1055) arterial interventions. In addition, they execute varicose surgeries (n=217), shunt applications/revisions (n=58), minor amputations (n=57) and major amputations (n=42). They conduct 338 (92-3606) conservative therapies per year (POAD, diabetic foot, phlebothrombosis, chronic venous insufficiency). CONCLUSIONS: The certification of interdisciplinary vascular centers is a new approach to assure the contextual and structural quality of interdisciplinary vascular centers.

[Results of the certification of vascular centers by the German Society for Vascular Surgery]. / Ergebnisse der Zertifizierung von Gefässzentren durch die Deutsche Gesellschaft für Gefässchirurgie.

INTRODUCTION: Advances in conventional vascular surgery, endovascular procedures and conservative treatment require close interdisciplinary cooperation. The term Vascular Centre indicates to patients and referring doctors optimal professional and organisational competence. METHODS: 73 applications by vascular centres for certification were made between June 2002 and December 2005, of which after audit 54 were successful for three years, including one centre each in Austria and Switzerland. 13 centres were not accepted and six are still under consideration. This analysis is based on the data of 52 certified centres in the Federal Republic of Germany. RESULTS: A mean of 1149 patients were hospitalized in these centres per year (12 % emergency admissions) and 2159 patients per year were treated as outpatients, 60 % with arterial vascular disease. All centres have vascular surgery and radiology department, 10 of the 52 centres cooperate with specialists in private practice to provide an angiology service. A mean of 460 arterial vascular operations and 239 arterial interventional procedures were performed at each centre annually. In addition there were operations for varicose veins (n = 217), shunt operations (n = 58) and major amputations (n = 42). Inpatient or outpatient conservative treatment (for peripheral vascular disease, diabetic foot syndrome, phlebothrombosis or chronic venous insufficiency) was given to a mean of 338 patients annually. CONCLUSIONS: Certification of interdisciplinary vascular centres provides structural and medical data and the beginnings of comparing such centres. A future task will be standardization of documentation and continuing assessment of the quality of results.

[Current status of amputation surgery]. / Derzeitiger Stand der Amputationschirurgie.

Limb salvage by revascularisation of occluded arterial pathways is main goal of vascular surgical activities. However, if dying or gangrenous tissue has to be removed, the question of: where to amputate--and the potential rehabilitation has to be answered. Septic amputation being an emergency operation has to be compared with elective one with definitive shaping of the stump. In major amputations knee disarticulation is preferred nowadays as being mostly "atraumatic" and well able for rehabilitation. In minor amputations bunions of the great and the little toes should be preserved especially in case the whole phalangeal and metatarsal forefoot amputation seems to have better results than removal of the first of fifth toe together with their metatarsia. A distal borderline amputation can only be performed in diabetics and after revascularisation of the feeding arterial tree.