[An improved model of a catheterised human bladder for screening bactericidal agents]. / Verbessertes Modell der humanen katheterisierten Blase für das Screening antibakteriell wirksamer Agenzien.

PURPOSE: Catheter encrustation and associated blockage by a crystalline Proteus mirabilis biofilm constitute a continuous problem in long-term catheterised patients. The objective of the present work was to verify a new, physiological bladder model possessing the ability to show that triclosan-blocking solutions exert bactericidal and bacteriostatic activities. MATERIAL AND METHODS: Catheterised sterile infusion bags served as human bladder models. Artificial urine inoculated with Proteus mirabilis was administered by a further aperture. Samples for measurement of pH value and microbial count were collected at intervals of 24 h. Upon completion of testing catheter encrustation was assessed and visualised by scanning electron microscopy. RESULTS: In contrast to the application of placebo solution, in models filled with triclosan-blocking solution the catheters drained freely for the experimental period. Similar results were obtained for pH values and microbial count. The pH of the artificial urine did not exceed a critical value of pH 7 and the numbers of organisms correspond approximately to the initially inoculated number of organisms. CONCLUSION: In the model developed here, triclosan inhibits the growth of Proteus mirabilis over the test period by diffusing into the artificial urine through the catheter balloon. Thus, triclosan acts against the pH increase as well as the formation of a crystalline biofilm. Taken together, the adaptability of this new, physiological model of the human bladder could be shown.

[Clinical utility of an antimicrobial blocking solution in patients with an indwelling catheter]. / Klinischer Nutzen einer antimikrobiellen Blockerlösung bei Patienten mit Dauerkatheter.

OBJECTIVE: Patients with indwelling catheters have a substantial long-term risk for catheter incrustation and blockage. Chronic bacteriuria is regarded as a risk factor for this complication. Until today, there are no effective prophylactic measures. We evaluated the effect of a triclosan-containing fluid for inflation of the catheter balloons (Farco-fill® Protect) on the extent of bacteriuria in a clinical setting. PATIENTS AND METHODS: In a prospective multicentre study, between 7 / 2009 and 3 / 2010, the effect of Farco-fill® Protect on urine culture was evaluated in 62 patients with indwelling catheters. RESULTS: 55 patients could be completely evaluated. With use of Farco-fill® Protect, urinary pH, and urine volume / 24 hours remained unchanged. The number of patients with > 10 (5) colony forming units / mL was reduced from 70.9 % to 45.5 %. In 34.5 % the extent of catheter incrustations could be reduced. CONCLUSION: This study is the first to demonstrate a marked reduction of bacteriuria and catheter incrustations with the help of a triclosan-containing fluid in a clinical setting. Long-term studies are necessary to determine whether or not the afore-mentioned effect leads to less catheter occlusions.This finding would have positive medical as well as economic aspects.

[Anti-inflammatory action of a hyaluronic acid-chondroitin sulfate preparation in an in vitro bladder model]. / Antientzündliche Wirkung einer Hyaluronsäure-Chondroitinsulfat-Präparation im In-vitro-Blasenmodell.

PURPOSE: Interstitial cystitis and BPS (bladder pain syndrome) are chronic inflammatory diseases of the bladder. They are as yet imperfectly understood diseases, possibly originating from damage to the glycosaminoglycan layer of the bladder epithelium . Hyaluronic acid-containing preparations are currently utilised for palliation of the symptoms and protection of the bladder epithelium . The aim of the work described here was the evaluation of one of these preparations containing chondroitin sulfate together with hyaluronic acid. MATERIAL AND METHODS: The preparation was evaluated for its anti-inflammatory potential as well as regarding the tolerance by the bladder epithelium. The urothelial cell line T24 was employed as an in vitro model of the human bladder because of its ability to react to adequate stimuli with the release of interleukin 6. To this end the cells were treated with hyaluronic acid and chondroitin sulfate. Subsequently, TNF-alpha was applied to induce inflammation. The severity of inflammation was measured on the basis of the IL-6 released by the cells in comparison to untreated control cultures. RESULTS: A reduction of TNF-alpha-induced IL-6 release after treatment with hyaluronic acid and chondroitin sulfate was observed, indicating the anti-inflammatory action of the preparation. As shown by the large number of living cells after treatment the test preparation did not affect cell viability even in high concentrations. These data suggest a good tolerance of the product by the patients. CONCLUSION: The administration of the preparation in patients suffering from interstitial cystitis or BPS appears promising. In additional, the presented work demonstrates the feasibility of the cell culture model for the screening of new therapeutic approaches.

[Analysis of therapeutic failures of three surgical concepts for treatment of duodenal ulcer-results of a prospective consecutive study (author's transl)]. / Therapieversager als Beurteilungsgrundlage für 3 chirurgisch-therapeutische Konzepte zur Behandlung des chronischen Ulcus duodeni.

In a prospective study 3 surgical concepts were used to treat patients with chronic duodenal ulcer. In concept I 64 patients were treated with "individual ulcer surgery", i.e. depending on the general condition of the patient, the local intraoperative situation and preoperative acid output, either selective vagotomy with pyloroplasty, with antrectomy (B-I) or B-II gastrectomy were used. In concept II 62 patients were treated with selective vagotomy and pyloroplasty. In concept II 110 patients with highly selective vagotomy and treated without drainage. The conditions were diagnosed and the patients were treated in a standardized manner. Follow-up rates were 90% and above and the results were analyzed according to Troidl's definition of operative failures after 1-year follow-up. Lethality was 0% in all concepts (I-III). Recurrent ulcer: I=0%, II=3%, III=4.5%. Complaints with Visick-classifications III and IV: I=14%, II=12.8%, III=45%. Changing symptoms: I=0%, II=0%, III=1%. No acid reduction: I=0%, II=4.9%, III=l6,4%. The lowest recurrence rate and best acid reduction was concept I, the best overall clinical outcome concept III. Highly selective vagotomy without drainage is preferred as the least major and most careful procedure at the moment.

[In vitro activity of Mercurius cyanatus complex against relevant pathogenic bacterial isolates]. / In-vitro-Aktivität von Mercurius cyanatus-Komplex gegenüber relevanten pathogenen Bakterienisolaten.

The antimicrobial activity of mercurius cyanatus complex (Oligoplex) and its components Mercurius cyanatus D5, Echinacea angustifolia D1, Ailanthus glandulosa D3, Ammonium bromatum D3, Baptisia tinctoria D3, Euspongia officinalis D2, alcohol 5% (dilution: D1 = 1: 10, D2 = 1 : 100 etc.) was tested in vitro by serial dilution tests against 105 clinical isolates (grampositive/negative, aerobes and anaerobes with relevance for pharyngitis). The bactericidal activity was compared with that of vancomycin when appropriate. One component of the composition (Mercurius cyanatus) exerted a considerable bactericidal activity against S. pyogenes, S. agalactiae, S. pneumoniae, S. aureus, E. faecalis in serial dilutions of the clinical relevant concentration D5. However, growth of H. influenzae, Bacteriodes sp. and Actinobacillus actinomycetemcomitans was not inhibited by Mercurius cyanatus and any other component of the composition. The composition, however, exerted a bactericidal range similar to that of Mercurius cyanatus, but less efficient. Analysis of the bactericidal effect of Mercurius cyanatus and vancomycin revealed comparability for S. pyogenes, S. agalactiae, S. pneumoniae, S. aureus and E. faecalis for vancomycin concentrations of 0.063-2 mg/l, which are clinically relevant.