[Surface disinfection in the context of infection prevention in intensive care units]. / Flächendesinfektion im Kontext von Infektionsprävention auf Intensivstationen.

The highest proportion of nosocomial infections occurs on intensive care units (ICU) and infections with multiresistant pathogens are an ever increasing problem. Preventative measures should consist of a bundle of different measures including measures that address a specific problem and standard hygiene measures that are relevant in all areas. Specific measures in ICUs primarily aim at the prevention of ventilator associated pneumonia, blood vessel catheter associated infections and nosocomial urinary tract infections. Surface disinfection belongs to the standard hygiene measures and plays an inferior role compared to hand hygiene; however, surfaces come into focus in outbreak situations. The Commission on Hospital Hygiene (KRINKO) at the Robert Koch Institute (the German health protection agency) published recommendations regarding the cleaning and disinfection of surfaces. The frequency with which cleaning and/or disinfection is required varies according to defined areas of risk. The frequency and the disinfection agents used are documented in the disinfection plan.

[Prolonged survival through combined treatment with radiofrequency ablation/ethanol instillation compared with radiofrequency ablation alone in the VX2 rabbit liver tumour model]. / Uberlebensvorteil durch Kombinationsbehandlung mit Radiofrequenzablation/Alkoholinstillation im Vergleich zur alleinigen Radiofrequenzablation im VX2-Lebertumormodell am Kaninchen.

UNLABELLED: Combination of radiofrequency ablation (RFA)/ethanol instillation (EI) leads to higher survival rates compared to single RFA for the treatment of VX2 liver tumours in a rabbit tumour model. INTRODUCTION: To improve the outcome and survival rates of RFA in treatment of liver tumours, a comparative study of RFA with or without EI was performed. MATERIAL AND METHODS: We implanted a single tumour in the liver of 46 rabbits. After 20 days, animals were treated with RFA/EI or RFA alone. The animals were observed for a maximum of 110 days, after which an autopsy was conducted. RESULTS: 30 animals of the RFA group and 16 of combination therapy were analysed. After interim analysis with the Kaplan-Meier method, a significantly higher survival rate for the combination therapy was observed (P = 0.004). Following the study design, the experiment was therefore terminated ahead of schedule. Rate of metastasis (M) and local recurrence (LR) did not differ between the combination or RFA alone. CONCLUSION: RFA/EI is superior to treatment with RFA alone with regard to survival rates.

Radiofrequency ablation using perfused needle electrodes - study of intermittent and continuous triple needle application ex vivo.

To increase necrotic zones, bovine livers were treated by means of three parallel-oriented radiofrequency ablation (RFA) needles spaced at 3 cm using a puncture guide. The triple application was varied as a continuous and intermittent energy application compared to a single needle applicator. In all three study arms the applied energy (60 W) and the perfusion rate (240 ml/h) were kept constant. After treatment the smallest necrosis diameter was determined. In addition, temperature and the device's power output were monitored. Our study shows that synchronous use of three RFA application needles achieves significantly larger necrosis zones ex vivo than does single needle application. Intermittent energy application heats up the necrosis faster and more evenly with highest average temperature than continuous energy application.

Radiofrequency ablation of liver tumors: how to enlarge the necrotic zones?

In an attempt to increase necrotic zones in liver tissue by radiofrequency ablation fresh bovine liver was coagulated by means of a needle electrode continuously perfused with NaCl solution. Power output (60 W) and application time (15 min) were kept constant while the perfusion was varied in terms of saline concentration (0.9, 5.85 and 10%) and perfusion rate (40 or 80 ml/h). Our results showed that the use of higher osmolar saline solutions in radiofrequency ablation with perfused needle electrodes did not lead to significantly larger coagulation volumes. By contrast, increasing the perfusion rate produced significantly larger necrotic zones. Doubling the perfusion rate made it possible to reach higher temperatures (>60 degrees C) within significantly shorter time.

[Detection of liver metastases--comparison of contrast--enhanced ultrasound using first versus second generation contrast agents]. / Lebermetastasendetektion. Vergleich Kontrastmittel--Ultraschall mit Echosignalverstärkern der ersten versus zweiten Generation.

AIM: To compare detection rates for liver metastases for conventional ultrasound, US using tissue harmonic imaging (THI), echo-enhanced pulse inversion harmonic imaging using Optison and Levovist. METHOD: In 73 patients with histologically proven gastrointestinal tumors spiral CT (S-CT), conventional US, US in the THI-mode, echo-enhanced ultrasound in the portal venous phase (ECI Optison ) and in the liver specific late phase (ECI Levovist) were performed and reviewed by blinded readers. RESULTS: 73 patients (25 female, 48 male, age 63 +/- 11) were included. S-CT detected 158 liver metastases. Conventional US detected 117, THI 119, ECI Optison 169 and ECI Levovist 166 liver metastases. Especially for small (< 2 cm) liver metastases and metastases near the diaphragm echo-enhanced ultrasound exceeded conventional US (p < 0.001). Between both echo enhancers there was no significant difference. CONCLUSION: Using echo enhancers increases the ultrasound detection rate significantly. Examination in the portalvenous phase using a second generation enhancer (Optison) is equal to a late-phase examination using Levovist.

Relationship between microsatellite instability, response and survival in palliative patients with colorectal cancer undergoing first-line chemotherapy.

BACKGROUND AND AIMS: The aim of this work was to investigate the relationship between microsatellite instability (MSI), treatment response and survival in palliative patients with colorectal cancer (CRC) undergoing first-line treatment with weekly 24-hour infusion (24-h inf.) of high-dose 5-fluorouracil (5-FU) and folinic acid (FA). PATIENTS AND METHODS: Tumour material from the colorectal primary carcinomas was analysed for 43 patients. MSI analysis was carried out and immunohistochemistry was performed with hMLH1 and hMSH2. RESULTS: Tumours of 7 patients (16%) were highly instable (MSI-H). These patients had a better response rate (72% vs. 41%; p = 0.072) and a significantly better median survival (33 months, [95% CI 20-46] vs. 19 months, [95% CI 10-28]; p = 0.021) than microsatellite stable (MSS) patients (n = 36). Furthermore, MSI status was shown to be an independent predictive marker for survival (p = 0.037). CONCLUSION: These data provide further support for the hypothesis that MSI-H CRC might have a better response and survival than (MSS) CRC in palliative first-line treatment.

Radiofrequency ablation of hepatocellular carcinoma with a saline solution perfusion device: a pilot study.

PURPOSE: The majority of patients with hepatocellular carcinoma (HCC) cannot be treated with surgery. This study evaluated the treatment of patients with radiofrequency ablation (RFA) with use of needle applicators perfused with isotonic saline solution. MATERIALS AND METHODS: Twenty patients with a maximum of three HCCs as large as 60 mm and a contraindication to partial liver resection or orthotopic liver transplantation were enrolled in the study. They were treated with ultrasound-guided RFA with use of perfused needle applicators and followed with sonography and computed tomography. RESULTS: Twenty patients (14 men, six women) with a total of 29 HCCs were treated with RFA. In total, 56 RFA treatments were performed. Mean HCC size was 31 mm (range, 10-60 mm). Two cases of self-limiting bleeding requiring transfusion of blood products took place. Complete response (CR) was achieved in 85% of patients (17 of 20). Partial response occurred in three tumors 45 mm in diameter or larger. There was a total of six local recurrences in five patients (25% of patients, 21% of tumors). Six patients (30%) exhibited distant recurrence, two of whom also showed local recurrence. In three patients, repeat treatment led to renewed CR. After a median follow-up of 445 days (range, 114-1,071 days), 12 patients (71% of the 17 patients with initial CR) still showed CR. Twelve patients (60% of all patients, 71% of those with initial CR) survived. Three of the eight patients who died were free of viable tumor at the time of death. CONCLUSIONS: RFA with use of perfused needle applicators shows promise as an effective method for treating inoperable HCC. The most frequent complication was bleeding.

[Technique of inclusion in epoxy resin for alternative photonic and ultrastructural examination (author's transl)]. / Technique d'inclusion en résine epoxy pour examens photonique et ultrastructural alternatifs.

Fragmentation of the samples in small blocks for electron microscopy fail to allow topographic study. Therefore a method fod embedding large blocks in epon is detailed here. It provides large semi-thin sections for photomic examination and, after making a "mesa", ultrathin for ultrastructural study.