Interventional ERCP in patients with cholestasis. Degree of biliary bacterial colonization and antibiotic resistance. Biliary obstruction together with bacterial colonization of the bile duct may lead to development of acute cholangitis. The aim of our prospective study was to investigate the presence and degree of biliary bacterial colonization by means of bile aspiration during ERCP in patients with biliary obstruction. Furthermore, we evaluated antibiotic therapy regimens, which would cover the bacterial species obtained by ERCP and subsequent culture in each patient. In addition, analysis of risk factors was performed that would predispose to the development of cholangitis.80 patients with clinical and laboratory evidence of biliary obstruction underwent ERCP with initial aspiration of bile via the cannulation catheter. This material was used to culture aerobic and anaerobic bacteria and determine the colony count/ml bile, followed by identification of each species and antibiotic resistance testing. The minimal inhibitory concentration for Levofloxacin, Ciprofloxacin, Piperacillin, Ampicillin, Ceftriaxone, Imipenem, Gentamycin und Metronidazole was determined. Immediately after the ERCP or if the body temperature (after ERCP) rose to > 38 degrees C blood cultures were obtained. In 45 (56 %) patients biliary colonization with bacteria could be identified (56 %). In 20 patients a single isolate was cultured, in 25 cases mixed infection was present. A total of 83 species were isolated. The most common bacteria were E. coli, Enterococcus and Klebsiella. 9.6 % of all isolates were obligatory anaerobes. In 9 of 80 patients bloodcultures tested positive for bacterial growth (rate of bacteremia: 11.3 %). 10 patients had acute cholangitis clinically before ERCP, 13 patients developed signs of infection after ERCP. Statistically significant factors contributing to the risk of infection were age of the patient, the clinical condition of the patient before ERCP and the biliary colony count. Patients with development of infection after ERCP showed a significantly higher incidence of bacterial colonization of the biliary tree and a higher colony count. In all bacterial species Imipenem (4.5 %) or Levofloxacin (2.2 %) exhibited the lowest rate of in-vitro resistance. Based on these data, the implementation of Levofloxacin in combination with anaerobic coverage is advantageous as a calculated therapy for patients with acute cholangitis.

The cause of isolated osteolysis in the femoral shaft around stem implants in patients with cemented THR has so far not been established.

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The well-documented positive effect of compression stocking therapy on the venous macro- and microhemodynamics of the legs can only be attained if the stockings fit well. In order to determine the effective pressure exerted by compression stockings, we usually deleted in US journals. One can get this out of journal and author's address have developed a new measuring method based on piezoresistant microprobes and a microprocessor unit. With our 2-mm-thick, 5-mm diameter probe, the pressure between the compression stocking and skin can be measured at any location desired. A temporal resolution of 50 Hz makes it possible to carry out dynamic measurements while the patient is walking or performing exercises on tiptoes. Here we present 4 typical cases out of a total of over 80 which we have evaluated. We have decided empirically that the pressure exerted by a class-2 compression stocking on the skin at the height of the ankles (b-position) should not exceed 70 mm Hg while resting and a peak of 110 mm Hg while exercising on tiptoes. At the middle of the calf (c-position) these values should not exceed 60 mm Hg at rest and 80 mm Hg on tiptoes. The pressure should decrease from the distal to proximal direction in order to produce a drainage gradient. We have found empirically that a pressure gradient of 30-40% from the b to the c measurement is favorable. Too high a proximal pressure or too high a pressure on a part of the lower leg causes pain and swelling. Too low a pressure, on the other hand, does not produce the desired vascular effect and alleviation of symptoms. Although dynamic pressure measurements take about 20-30 minutes per leg, they markedly improve patient compliance with compression therapy.

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