[Availability of mechanical thrombectomy for acute stroke : Analysis of the health care reality in Germany]. / Verfügbarkeit der mechanischen Thrombektomie bei akutem Hirninfarkt : Analyse der Versorgungsrealität in Deutschland.

BACKGROUND: Mechanical thrombectomy (MT) has become an evidence-based therapy for stroke patients with proximal vessel occlusion of the anterior cerebral circulation. Nationwide availability of MT for all eligible patients within the shortest possible time window is a major challenge. AIM OF THE STUDY: Nationwide analysis of the rates of systemic thrombolysis (STL) and MT in Germany according to region and hospital-based evaluation. METHODS: The evaluation involved data analysis of the diagnosis-related groups (DRG) statistics and structured quality reports of hospitals for 2010 and 2014. The rates and changes of STL and MT were evaluated in the 413 German districts with reference to the corresponding case number of patients with acute ischemic stroke. RESULTS: Nationwide recanalization treatment rates increased from 2010 to 2014 both for STL (from 8.0% to 11.6%) and MT (from 0.7% to 2.3%). High variations were observed depending on the patient's place of residence (STL = 3.4-36.7%, MT = 0-7.4%). In 2014 a total of 5526 MT were coded in a total of 244,757 ischemic strokes. A total of 134 hospitals with more than 2 MT per year were identified; however, 21% of the nationwide MTs were performed in only 7 hospitals with more than 100 MT/year. In 308 (75%) of the 413 districts, not a single MT was performed. CONCLUSION: Due to a narrow net of certified stroke units with nationwide availability of STL, excellent structural conditions for treatment of acute stroke patients are already established in Germany. With regard to the nationwide availability of MT, there is still a need for optimization. Despite the increasing number of hospitals providing MT as an emergency procedure, a trend toward large intervention centers with supraregional catchment areas can be observed.

[A specific fully enzymatic method for creatinine: reference values in serum (author's transl)]. / Referenzwerte für Kreatinin im Serum, ermittelt mit einer spezifischen enzymatischen Methode.

Reference values for creatinine in serum were established using a fully enzymatic method, adapted to a discontinuous analyzer. Our reference group included 250 females and 215 males (blood donors, hospital staff and patients) aged 18-70 years. Up to 60 years, creatinine concentration did not depend on age, but there was a significant difference between the creatinine concentrations of women and men. We propose reference ranges for creatinine in serum (95% range) of 44-80 mu mol/l for women and of 44-97 mu mol/l for men.

[Enzymatic assay of creatinine in serum: comparison with Jaffé methods (author's transl)]. / Enzymatische Kreatinin-Bestimmung im Serum: Vergleich mit Jaffé-Methoden.

The creatinine concentrations in 337 sera were determined by enzymatic assay and by six different modifications of the Jaffé method. The enzymatic assay showed satisfactory precision and gave the same results as the assay after adsorption on Fuller's earth (Lloyd's reagent). All other methods using picrate gave falsely high values: the relative deviation from the enzymatic method had a median value between +20% and +50% for creatinine concentrations in the range 22-88 mu mol/l, and between +10% and 30% for creatinine concentrations in the range 89-177 mu mol/l. The study thus confirms the lack of specificity of all Jaffé methods, with the exception of the assay after adsorption on Fuller's earth.

[Creatine kinase: reference values and clinical aspects of the revised standard method (author's transl)]. / Kreatinkinase. Uberarbeitete Standardmethode: Referenzwerte und Klinik.

Reference values for the revised standard method for determining N-acetylcysteine (NAC) activated creatine kinase (CK) activity in serum are presented, based on samples from 432 out-patients and 423 in-patients of either sex. CK activity was not age-related. The suggested range of normal values for serum CK activity, measured by the revised standard method at + 25 degree C, is 10--70U/l for females and 10--80U/l for males. Where an elevation of serum CK activity is of uncertain cause, the CK/GOT ratio had been recommended, additional to the CK-MB isoenzyme, for distinguishing between damage to heart and skeletal muscle. The significance of this ratio was checked with the revised standard CK method and the optimized GOT determination. The point of separation between myocardial and skeletal muscle damage is 10 by this methods. In order to use this ratio, total CK activity must be over 150 U/l and liver disease or secondary liver involvement must have been excluded. The CK/GOT ratio gains in importance through findings which limit the specificity of CK-MB as a purely myocardial (infarct)-specific isoenzyme.

Cystic fibrosis detection by means of a test-strip.

The effectiveness of meconium screening for albumin as an indication of cystic fibrosis is examined. BM-Test Meconium was applied to 69,000 investigations. In 60 positive tests, cystic fibrosis was confirmed later. No increased albumin content was observed in four cases of cystic fibrosis.