[Effect of Soil Contamination on the Reflective Properties of Reflective Groundcovers]

The objective of the present work was to study the effects of contamination on the reflective properties of groundcovers used for enhancing fruit colouration in the orchard. Contamination also affects longevity and possible sustainable re-use of materials. A white, woven textile (polypropylene Lumilys™) and silver aluminium foil were experimentally contaminated with soil, similar to the situation after an autumn storm in a fruit orchard. Clean material served as control.Using a spectrophotometer (StellarNet; Tampa, FL, USA), vertically directed (0°) and diffuse (45°) light reflection in the range of 500-850 nm was compared from clean and contaminated groundcover in the laboratory. Reflection from vertically directed aluminium foil exceeded that of Lumilys™; however, the highest reflection in all spectral measurements was at 45° (diffuse) from the clean woven textile, i.e., in all directions, and exceeded that of aluminium foil. In contrast, the contaminated vertically directed (0°) aluminium foil reflected less light than the clear foil but, surprisingly, reflected much more light at 45° than the clean foil. Both materials showed reflection peaks at 625-640 nm; light spectra and peaks remained unchanged irrespective of soil contamination.Light reflection in the visible range (PAR, 400-700 nm) was concomitantly measured in the field at CKA Klein-Altendorf near Bonn (50°N), Germany, at 0.5 m and 1 m height using a portable TRP‑3 light sensor (PP-Systems, Amesbury, MA, USA) on sunny and cloudy days at a solar angle of 49°. Surprisingly, in these field measurements, Lumilys and aluminium foil reflected most light in both directions (0° and 45°) when slightly to moderately contaminated. Only with heavy contamination did the reflection decrease. Both groundcovers reflected more light than the grass in alleyways of fruit orchards or open soil under the trees.UV‑B reflection (280-315 nm) was examined in parallel in the field using an X1 optometer (Gigahertz Optik, Türkenfels, Deutschland), as it enhances anthocyanin biosynthesis and red fruit colouration in combination with PAR and low temperature. Straight (0°) UV‑B reflection from aluminium foil exceeded that from white woven textile (Lumilys™) on both clear and overcast autumn days. As expected, straight (0°) UV‑B reflection from aluminium foil decreased with soil contamination to a certain extent, but it unexpectedly increased from the woven textile with soil contamination.Surface roughness in dependence of contamination was measured non-destructively by a profilometer type VR5200 (Keyence, Osaka, Japan). The roughness index, Sa, increased from 22 to 28 µm with soil contamination of the woven textile and from to 2 to 11 µm with aluminium foil, possibly explaining differences in the observed reflectivity.Overall, the expected severe decline in light reflection (PAR and UV-B) was not seen. In contrast, light (2-3 g soil/m²) and moderate (4-12 g soil/m²) contamination improved light reflection of PAR (400-700 nm) and UV‑B (280-315 nm) by woven textile (Lumilys™) and aluminum foil. Thus, with slight contamination the materials can be reused, whereas severe contamination (24-51 g soil/m²) reduces light reflection.

Preanthesis changes in freeze resistance, relative water content, and ovary growth preempt bud phenology and signify dormancy release of sour cherry floral buds

Growing degree hours (GDH) predicted floral bud development of 'Montmorency' sour cherry and explained changes in lethal temperatures (LT₅₀) that preempted any visible changes in bud phenology. The gradual warming during late winter and early spring promotes floral bud development and, concomitantly, the de-acclimation of Prunus sp. flowers. In fact, once ecodormancy releases, an approximate 20 °C loss of hardiness occurs prior to any distinguishable changes in external bud phenology. The aim of the following work was to characterize the physiological changes of 'Montmorency' sour cherry floral buds as they transition from endo- and ecodormancy and resume growth, and to determine whether physiological and anatomical characteristics within the buds preempt or signify dormancy release to enable a better prediction of freeze susceptibility. Here, we present a developmental timeline of the preanthesis changes of 'Montmorency' floral buds, ovaries and anthers over 2 years following their completion of chilling and relate these changes to growing degree hours (GDH) and the lethal temperature (LT₅₀) of flowers. Changes in bud dry weight (DW), fresh weight (FW), volume, and external phenology stage including the percentage of green color development of bud scales were predicted by heat accumulation but were not early predictors of the increasing freeze susceptibility of pistils. Between endodormancy and green tip stage, ovary volume increased nearly threefold and relative water content (RWC) increased from ~ 45 to 70% in both years. A linear mixed regression model indicated that RWC and the interaction between RWC and ovary growth were significant predictors of LT₅₀. Importantly, the loss of ~ 20 °C of freeze resistance occurred between 45 and 57% RWC and preceded any detectable changes in bud phenology. Microsporogenesis was observed after dormancy release when measurable changes in the ovary and bud RWC had already occurred. A GDH model estimated freeze sensitivity of pistils and explained 93% of the variation in LT₅₀ during preanthesis development. A simple GDH model to predict critical freeze temperature of pistils should aid producers to manage frost protection.

Non-invasive, real time in-situ techniques to determine the ripening stage of banana

Bananas were examined starting from ripening stage R2 (green) to stage R7 (overripe), to identify suitable non-invasive, real time in-situ technologies to separate the ripening stages: (1) Chlorophyll degradation, measured by the DA meter, decreased from ca. 2.1 (R2) to 0.2 IAD units (R7), i.e. tenfold decline. (2) Colour CIE-Lab a values dramatically increased as indication of chlorophyll breakdown and enable differentiation between all ripening stages R2 to R7. Colour angles declined from 98.7° hue (R2), 97.3° hue (R3), 92.7° hue (R4), 89.4° hue (R5); 87.5° hue (R6) until 82.0° hue (R7). (3) Spectroscopy showed two light reflectance troughs at 494 nm and 679 nm. A novel banana ripening index (BRI) was developed and is proposed to identify and distinguish the ripening stages of banana with values starting at 4 at R1 and peaking at 8.1 at ripening stage R7. (4) Peel gloss increased from stage R2 (150 a.u.) to stage R7 (220 a.u.) in the order of ca. 50% followed by a subsequent decrease thereafter. (5) Peel softening declined as fruit firmness dropped from 82 Shore at stage R2 to 42 Shore at stage R7 (overripe), measured also at the centre of the banana fruit. (6) After a constant 90.5% water content per fresh mass (FM) in the banana peel until stage R5, the subsequent drop to 82.9% FM at R7 and 7.6% water translocation viz displacement from the peel to pulp explained this softening. All the above results identified the fruit centre (rather than the tip) as a suitable candidate due to the most advanced ripening and least curved surface region of the fruit with easy access, when a carton is opened and the hands become accessible. This novel approach based on a comparison has shown the DA-meter, colorimeter and spectrometer as suitable candidates for the identification of each ripening stage. The combination of these three devices may be suitable for monitoring of banana ripening rooms in terms of temperature and humidity in addition to the present, colour-based ripening scale.

Carbon reduction strategies for regionally produced and consumed wine: From farm to fork

I) BACKGROUND: Carbon footprint studies of locally produced and consumed wine are missing. II) PURPOSE(S): The objective of the present study was to identify management strategies and carbon reduction potentials for a sustainable wine production based on the carbon footprint and the water footprint of locally grown grapes and wine locally produced and consumed. III) METHODS: Two wineries (A and B) were investigated, both of which grow the same white (Riesling) and the same red grape (Pinot Noir/Spätburgunder) on the same rootstock in the Rhine river valley of Germany. The study was based on PAS 2050-1 (BSI) and comprised 99% primary data derived from historical farm records. System boundaries ranged from planting of the grapevines to eventual disposal of a typical 0.75 L glass bottle, which served as the functional unit (FU). IV) RESULTS: The product carbon footprint (PCF) was 1.91 ± 0.3 kg CO₂eq/bottle (A) or 1.69 ± 0.3 (B) kg CO₂eq/bottle of white wine and 1.86 ± 0.3 kg CO₂eq/bottle of red wine for both wineries. These results were attributed to the consumer behaviour (22-30%), followed by the use and production of glass bottles (20-27%). Grapevine cultivation amounted to 0.3-0.4 kg CO₂eq/bottle; grape processing caused ca. 0.05-0.06 kg CO₂eq/bottle, packaging 0.5-0.6 kg CO₂eq/bottle, distribution 0.2-0.4 kg CO₂eq/bottle, while use and disposal of the glass bottles emitted 0.5-0.6 kg CO₂eq/bottle. The plant protection chemicals caused only ca. 1.4% and organic fertilizer ca. 2.8% of the product carbon footprint (PCF). Red and white wine appeared commensurate in their PCF within 3-8% in both vineyards. The water footprint was ca. 5.7 ± 0.6 (A) and 2.1 ± 0.4 (B) L blue water/bottle for both red and white wine. V) DISCUSSION: The results are discussed with higher carbon footprint values for wine from overseas. We have identified the following reduction potentials such as the following management strategies: VI) RECOMMENDATIONS: a) reduction of fossil fuels for gas heating of the premises and for farm vehicles, b) the use of lightweight glass bottles and c) alternative means of transport for the consumer purchase at the winery when using a private vehicle.

Non-Destructive, Opto-Electronic Determination of the Freshness and Shrivel of Bell Pepper Fruits

(1) The objective of the present study was to identify suitable parameters to determine the (degree of) freshness of Bell pepper fruit of three colors (yellow, red, and green) over a two-week period including the occurrence of shrivel using non-destructive real-time measurements (2) Materials and methods: Surface glossiness was measured non-destructively with a luster sensor type CZ-H72 (Keyence Co., Osaka, Japan), a colorimeter, a spectrometer and a profilometer type VR-5200 (Keyence) to obtain RGB images. (3) Results: During storage and shelf life, bell pepper fruit of initially 230–245 g lost 2.9–4.8 g FW per day at 17 °C and 55% rh. Shriveling started at 6–8% weight loss after 4–5 days and became more pronounced. Glossiness decreased from 450–500 a.u. with fresh fruit without shrivel, 280–310 a.u. with moderately shriveled fruit to 80–90 a.u. with severely shriveled fruit irrespective of color against a background of <40 a.u. within the same color, e.g., light red and dark red. Non-invasive color measurements showed no decline in Lab values (chlorophyll content), irrespective of fruit color and degree of shrivel. RGB images, converted into false color images, showed a concomitant increase in surface roughness (Sa) from Sa = ca. 2 µm for fresh and glossy, Sa = ca. 7 µm for moderately shriveled to Sa = ca. 24 µm for severely shriveled rough surfaces of stored pepper fruit, equivalent to a 12-fold increase in surface roughness. The light reflectance peak at 630–633 nm was universal, irrespective of fruit color and freshness. Hence, a freshness index based on (a) luster values ≥ 450 a.u., (b) Sa ≤ 2 µm and (c) the difference in relative reflectance in % between 630 nm and 500 nm is suggested. The latter values declined from ca. 40% for fresh red Bell pepper, ca. 32% after 6 days when shriveling had started, to ca. 21% after 12 days, but varied with fruit color. (4) Conclusion: overall, it can be concluded that color measurements were unsuitable to determine the freshness of Bell pepper fruit, whereas profilometer, luster sensor, and light reflectance spectra were suitable candidates as a novel opto-electronic approach for defining and parametrizing fruit freshness.

Anthocyanin synthesis and light utilisation can be enhanced by reflective mulch - Visualisation of light penetration into a tree canopy

With the increasing use of hailnets and decrease in light availability in the ripening period of apple fruit, insufficient light exposure often causes poor colouration viz anthocyanin synthesis on certain parts of the fruit and on certain fruit within the tree. The aim of this study was to investigate the potential of improving anthocyanin synthesis, in terms of fruit colouration, the major incentive for a consumer. Therefore, the reflective ground cover Lumilys® was spread between 'Braeburn Mariri Red' apple rows under a crystalline hailnet seven weeks prior to harvest and colour measured on 240 attached apple fruit. The reflective ground cover increased the reflected light by 1.6 to 3.9 times 1.0 m above ground. The improved light utilization led to an improved peel colouration, especially on the shaded side of the apple fruit and fruit in the lower inner part of the canopy, A coloured visualization from orange (high light intensity), yellow (medium) to green (low light intensity) as a result of the individual PAR measurements every 20 cm inside the canopy showed how the reflective mulch influences the light penetration into the different parts of the tree canopy.

Changes in carbohydrate levels and relative water content (RWC) to distinguish dormancy phases in sweet cherry

Perennial trees require chilling, i.e. a period of cold temperature in the winter, for flowering next spring; sweet cherry is particularly prone to lack of chilling. The objective of this study is to identify possible transition points to clearly distinguish dormancy phases by relating carbohydrate and relative water content (RWC) in reproductive buds to concomitant chilling fulfilment. This contribution proposes the use of four transition points between the dormancy phases and their characterization in terms of carbohydrates, water contents in combination with chilling values and may allow upscaling to other dormancy studies in trees; two groups of cherry varieties were defined based on their different initial sorbitol and starch level in the autumn. The first separation between para- and (deep) d-endo-dormancy is characterized as a transition from a decrease (variety group 1) or a constant level (variety group 2) to a sharp increase in hexoses and sorbitol and a drop of starch content. The second transition point (d-endo- to f-endo-dormancy) is characterized as the changes in both hexoses (increase) and starch (decrease) terminate and ca. 650 Chilling Hours (CH), i.e. insufficient chilling in the concomitant forcing experiment with cut branches. This third transition point (f-endo- to eco-dormancy) was characterized by ca. 1000 CH, the minimum chilling requirement and restrained flowering (cut branches). The fourth transition point (forcing initiation) marked an increase in water content at ca. 1550 CH, optimum chilling for cherry and coincided with natural flowering. A ratio of hexoses (glucose plus fructose) to starch content (<2:1) appeared to be a potential indicator of the beginning of chilling (para-dormancy) and a ratio of 14-20:1 typical for endo-dormancy, whereas the release from dormancy was associated with a decline to less than 10:1 at the end of winter (eco-dormancy). To our knowledge, this is the first time that transition points are identified based on constituents (carbohydrates and relative water content) in floral buds related to current chilling status and dormancy phases and are also presented in a schematic diagram. The understanding of these changes in relative water content and carbohydrate levels may contribute to manage insufficient chilling in the orchard and support climate change studies with trees.

Targeted forcing improves quality, nutritional and health value of sweet cherry fruit

BACKGROUND

Trade and consumers alike require premium-quality cherries with high nutritional and health values preferably of local origin. While early fruit imports cannot supply such fruit, a new technology of forcing cherry emerged for an early local supply by covering the crop in spring. In the apparent scarcity of data on the resulting fruit quality, fruit characteristics of forced cherries were compared with those without cover.

RESULTS

Size and weight of forced cherry fruit were successfully increased by 6-14%. The less negative osmotic potential of the forced fruit (-3 to -2 MPa Ψ_π ) indicates less water stress under spring cover compared with field-grown fruit (-4 MPa Ψ_π ), as confirmed by the larger fruit size and weight. Greater antioxidative potentials in the lipophilic and hydrophilic extracts (control min. 185 mE vs max. 365 mE under cover) of forced fruit of two cultivars showed their healthier attribute in terms of bioactive compounds, supported also by an average 14% increase in phenolics, as a response to the modified environmental conditions, which has not been investigated before.

CONCLUSION

The new technology of covering cherry trees in spring to force flowering and enhance ripening can improve the synthesis of bioactive compounds and provide the consumer with early high-quality fruit. © 2017 Society of Chemical Industry.

Ethylene detection in fruit supply chains

Ethylene is a gaseous ripening phytohormone of fruits and plants. Presently, ethylene is primarily measured with stationary equipment in laboratories. Applying in situ measurement at the point of natural ethylene generation has been hampered by the lack of portable units designed to detect ethylene at necessary resolutions of a few parts per billion. Moreover, high humidity inside controlled atmosphere stores or containers complicates the realization of gas sensing systems that are sufficiently sensitive, reliable, robust and cost efficient. In particular, three measurement principles have shown promising potential for fruit supply chains and were used to develop independent mobile devices: non-dispersive infrared spectroscopy, miniaturized gas chromatography and electrochemical measurement. In this paper, the measurement systems for ethylene are compared with regard to the needs in fruit logistics; i.e. sensitivity, selectivity, long-term stability, facilitation of automated measurement and suitability for mobile application. Resolutions of 20-10 ppb can be achieved in mobile applications with state-of-the-art equipment, operating with the three methods described in the following. The prices of these systems are in a range below €10 000.

In vivo evaluation of biomechanical properties in the patellofemoral joint after matrix-associated autologous chondrocyte transplantation by means of quantitative T2 MRI

PURPOSE

To determine in vivo biomechanical properties of articular cartilage and cartilage repair tissue of the patella, using biochemical MRI by means of quantitative T2 mapping.

METHODS

Twenty MR scans were achieved at 3T MRI, using a new 8-channel multi-function coil allowing controlled bending of the knee. Multi-echo spin-echo T2 mapping was prepared in healthy volunteers and in age- and sex-matched patients after matrix-associated autologous chondrocyte transplantation (MACT) of the patella. MRI was performed at 0° and 45° of flexion of the knee after 0 min and after 1 h. A semi-automatic region-of-interest analysis was performed for the whole patella cartilage. To allow stratification with regard to the anatomical (collagen) structure, further subregional analysis was carried out (deep-middle-superficial cartilage layer). Statistical analysis of variance was performed.

RESULTS

During 0° flexion (decompression), full-thickness T2 values showed no significant difference between volunteers (43 ms) and patients (41 ms). Stratification was more pronounced for healthy cartilage compared to cartilage repair tissue. During 45° flexion (compression), full-thickness T2 values within volunteers were significantly increased (54 ms) compared to patients (44 ms) (p < 0.001). Again, stratification was more pronounced in volunteers compared to patients. The volunteer group showed no significant increase in T2 values measured in straight position and in bended position. There was no significant difference between the 0- and the 60-min MRI examination. T2 values in the patient group increased between the 0- and the 60-min examination. However, the increase was only significant in the superior cartilage layer of the straight position (p = 0.021).

CONCLUSION

During compression (at 45° flexion), healthy patellar cartilage showed a significant increase in T2-values, indicating adaptations of water content and collagen fibril orientation to mechanical load. This could not be observed within the patella cartilage after cartilage repair (MACT) of the patella, most obvious due to a lack of biomechanical adjustment.

LEVEL OF EVIDENCE

III.

A comprehensive overview of the spatial and temporal variability of apple bud dormancy release and blooming phenology in Western Europe

In the current context of global warming, an analysis is required of spatially-extensive and long-term blooming data in fruit trees to make up for insufficient information on regional-scale blooming changes and determinisms that are key to the phenological adaptation of these species. We therefore analysed blooming dates over long periods at climate-contrasted sites in Western Europe, focusing mainly on the Golden Delicious apple that is grown worldwide. On average, blooming advances were more pronounced in northern continental (10 days) than in western oceanic (6-7 days) regions, while the shortest advance was found on the Mediterranean coastline. Temporal trends toward blooming phase shortenings were also observed in continental regions. These regional differences in temporal variability across Western Europe resulted in a decrease in spatial variability, i.e. shorter time intervals between blooming dates in contrasted regions (8-10-day decrease for full bloom between Mediterranean and continental regions). Fitted sequential models were used to reproduce phenological changes. Marked trends toward shorter simulated durations of forcing period (bud growth from dormancy release to blooming) and high positive correlations between these durations and observed blooming dates support the notion that blooming advances and shortenings are mainly due to faster satisfaction of the heating requirement. However, trends toward later dormancy releases were also noted in oceanic and Mediterranean regions. This could tend toward blooming delays and explain the shorter advances in these regions despite similar or greater warming. The regional differences in simulated chilling and forcing periods were consistent with the regional differences in temperature increases.

A comprehensive overview of the spatial and temporal variability of apple bud dormancy release and blooming phenology in Western Europe

In the current context of global warming, an analysis is required of spatially-extensive and long-term blooming data in fruit trees to make up for insufficient information on regional-scale blooming changes and determinisms that are key to the phenological adaptation of these species. We therefore analysed blooming dates over long periods at climate-contrasted sites in Western Europe, focusing mainly on the Golden Delicious apple that is grown worldwide. On average, blooming advances were more pronounced in northern continental (10 days) than in western oceanic (6-7 days) regions, while the shortest advance was found on the Mediterranean coastline. Temporal trends toward blooming phase shortenings were also observed in continental regions. These regional differences in temporal variability across Western Europe resulted in a decrease in spatial variability, i.e. shorter time intervals between blooming dates in contrasted regions (8-10-day decrease for full bloom between Mediterranean and continental regions). Fitted sequential models were used to reproduce phenological changes. Marked trends toward shorter simulated durations of forcing period (bud growth from dormancy release to blooming) and high positive correlations between these durations and observed blooming dates support the notion that blooming advances and shortenings are mainly due to faster satisfaction of the heating requirement. However, trends toward later dormancy releases were also noted in oceanic and Mediterranean regions. This could tend toward blooming delays and explain the shorter advances in these regions despite similar or greater warming. The regional differences in simulated chilling and forcing periods were consistent with the regional differences in temperature increases.

Transplanted chondrocytes inhibit endochondral ossification within cartilage repair tissue

The aim of this study was to investigate the effect of transplanted chondrocytes on endochondral bone formation in cartilage repair tissue. In the knee joint of miniature pigs, cartilage lesions were treated by microfracturing and were then either left empty, covered with a collagen membrane, or treated by matrix-associated autologous chondrocyte transplantation. In control lesions, the subchondral bone plate was left intact (partial-thickness lesion). The repair tissues were analyzed after 12 weeks by histological methods focusing on bone formation and vascularization. The effect of chondrocytes on angiogenesis was assessed by in vitro assays. The presence of antiangiogenic proteins in cartilage repair tissue, including thrombospondin-1 (TSP-1) and chondromodulin-I (ChM-I), was detected immunohistochemically and their expression in chondrocytes and bone marrow stromal cells was measured by quantitative RT-PCR. Significant outgrowths of subchondral bone and excessive endochondral ossification within the repair tissue were regularly observed in lesions with an exposed or microfractured subchondral bone plate. In contrast, such excessive bone formation was significantly inhibited by the additional transplantation of chondrocytes. Cartilaginous repair tissue that resisted ossification was strongly positive for the antiangiogenic proteins, TSP-1 and ChM-I, which were, however, not detectable in vascularized osseous outgrowths. Chondrocytes were identified to be the major source of TSP-1- and ChM-I expression and were shown to counteract the angiogenic activity of endothelial cells. These data suggest that the resistance of cartilaginous repair tissue against endochondral ossification following the transplantation of chondrocytes is associated with the presence of antiangiogenic proteins whose individual relevance has yet to be further explored.

Evaluation of low-cost computer monitors for the detection of cervical spine injuries in the emergency room: an observer confidence-based study

BACKGROUND

To compare the diagnostic value of low-cost computer monitors and a Picture Archiving and Communication System (PACS) workstation for the evaluation of cervical spine fractures in the emergency room.

METHODS

Two groups of readers blinded to the diagnoses (2 radiologists and 3 orthopaedic surgeons) independently assessed-digital radiographs of the cervical spine (anterior-posterior, oblique and trans-oral-dens views). The radiographs of 57 patients who arrived consecutively to the emergency room in 2004 with clinical suspicion of a cervical spine injury were evaluated. The diagnostic values of these radiographs were scored on a 3-point scale (1 = diagnosis not possible/bad image quality, 2 = diagnosis uncertain, 3 = clear diagnosis of fracture or no fracture) on a PACS workstation and on two different liquid crystal display (LCD) personal computer monitors. The images were randomised to avoid memory effects. We used logistic mixed-effects models to determine the possible effects of monitor type on the evaluation of x ray images. To determine the overall effects of monitor type, this variable was used as a fixed effect, and the image number and reader group (radiologist or orthopaedic surgeon) were used as random effects on display quality. Group-specific effects were examined, with the reader group and additional fixed effects as terms. A significance level of 0.05 was established for assessing the contribution of each fixed effect to the model.

RESULTS

Overall, the diagnostic score did not differ significantly between standard personal computer monitors and the PACS workstation (both p values were 0.78).

CONCLUSION

Low-cost LCD personal computer monitors may be useful in establishing a diagnosis of cervical spine fractures in the emergency room.

[Evaluation of costs incurred for patients with multiple trauma particularly from the perspective of the hospital]

The aim of this study was to evaluate the costs involved in treating severely injured patients at the clinic differentiated by several characteristics (injury, age), sectors (emergency room, surgery, intensive and normal care), and kinds of costs (fixed costs, variable costs) and to determine influencing factors regarding costs based on the register of the DGU (Deutsche Gesellschaft für Unfallchirurgie). All patients were taken into account who had an injury severity score (ISS) of at least 16. On this basis costs of 3702 patients were analyzed. They were compared by using analysis of variance for different groups of patients classified according to kind of injury, severity of injury, and age. Moreover, multiple regression was performed to control the common influence of demographic factors and the type of injury on costs. The average ISS of the analyzed patients was 30.6 (+/-11.6) points. The average costs of the clinic were 32,166 (+/-25,404) EUR per patient. More than half of the costs was incurred by intensive care and about one-fourth by surgery. On average 30.6% were variable costs and 69.4% were fixed costs. The analysis of variance revealed that costs increased with advancing age and severity of injury (ISS). Multiple regression confirmed these interrelations indicating that extremities are very cost intensive. Due to the high portion of fixed costs, the overall costs strongly depend on the capacity utilization and less on hospital stay. That is why it may be necessary in the future to create centers for trauma care to maintain economic efficiency for treatment of these patients. Besides large differences of costs within closely defined groups of patients, hospitals carry a high economic risk so that a more complex reimbursement system should be discussed than implemented by the German DRGs.

[Treatment of therapy refractory squamous epithelial hyperplasia of the vulva by CO2 laser vaporization]

Mostly, older women suffer from dystrophic disease of the vulva, which develops in a chronically progressive way. The main symptoms are substantial pruritus and secondary alteration of the skin. Good results could be obtained by a combination of different conservative treatments. Relapses occurred in about 10% of the cases. In 23 patients with unsuccessfully treated disease, we tested the indication for CO2-laser therapy. The hyperplastic lesions were vaporized under colposcopic control. By this procedure, we obtained in 2/3 of the cases very good results already after the first operation. Radical interventions can be avoided almost completely by laser vaporisation of therapy-resistant squamous cell hyperplasia of the vulva.

The cytological diagnosis of Pneumocystis carinii by fluorescence microscopy of Papanicolaou stained bronchoalveolar lavage specimens

In a retrospective and prospective analysis fluorescence microscopy of Papanicolaou stained bronchoalveolar lavage specimens has been applied to the diagnosis of Pneumocystis carinii (PC) in routine cytology. The pneumocysts presented as circular structures of 5 microns in diameter and of brilliant green-yellow fluorescence surrounding two mirror image reniform structures. Fluorescent inclusions of 1-3 microns diameter within the alveolar macrophages could be identified as remnants of pneumocysts by a follow-up of all steps of degradation ending in very small irregular granules. By applying both criteria, i.e. pneumocysts with reniform bodies and degradation inclusions within macrophages, Pneumocystis carinii pneumonitis (PCP) could be detected in 100% of cases. Transbronchial biopsy permitted the correct diagnosis in only 65.2% of cases. Retrospective analysis of slides is possible after a long period as no significant loss of fluorescence occurs after 4 years. Thus fluorescence microscopy permits the diagnosis of Pneumocystis carinii without any additional staining or loss of time.

Primary malignant melanoblastosis of the meninges. Clinical, cytologic and neuropathologic findings in a case

A 66-year-old man presented with a six-month history of neurologic symptoms suggestive of a craniospinal tumor or a diffuse inflammatory process in the subarachnoid space. Cytologic examination of cerebrospinal fluid (CSF) revealed inflammatory changes and malignant melanin-containing cells, leading to a diagnosis of meningeal spread of a melanoma. There was no history of skin excisions and no clinical evidence of primary melanoma of the eye. Neuroradiologic investigations, including CT and myelography, to confirm the diagnosis were negative. Despite intrathecal cytostatic therapy, the patient died eight months after the onset of symptoms. Autopsy disclosed diffuse meningeal melanoblastosis of the spinal cord and the base of the brain, confirming the cytologic diagnosis. In addition, two micrometastases in the liver were found as only extraneural manifestation. This case emphasizes the importance of CSF cytology in the diagnosis of diffuse infiltrating processes in the subarachnoid space.