University Hospital Leipzig Research Articles

Implementierung einer universitären Abteilung für Plastische Chirurgie in eine Klinik für Unfallchirurgie

Since May 2012 plastic surgery for trauma patients at the University Hospital Leipzig is provided by an autonomous department. This study analyzed the effect of plastic surgery on the changes in diagnosis-related groups (DRG) at a clinic for trauma surgery. Within the first 2 years 37 patients (29 male and 8 female of which 38 were inpatient cases) were admitted to the clinic for trauma surgery and additionally received plastic surgery treatment. The appropriate DRG assignment as well as associated codes and revenues were recorded and compared with and without plastic surgery. A total of 261 operations were performed on these patients of which 71 were performed by the department of plastic surgery. The mean revenue was 22,156.44 EUR±20,578.22 EUR with a mean cost weighting of 7.2±6.7. Excluding plastic surgery treatment the mean revenue was 19,378.44 EUR±20,688.40 EUR and the mean cost weighting was 6.3±6.7. Thus, additional proceeds by the plastic surgery treatment were 2778.00 EUR±3857.01 EUR per case. The mean increase of the cost weighting was 0.9±1.3. A change of the DRG grouping occurred in 20 out of 38 cases treated. The mean length of stay (LoS) was 40.2±26.6 days. In the first year this was 17.9±22.4 days more than the mean national LoS of the appropriate DRG and 10.9±19.3 days in the second year. This means an average cost reduction of 4774.59 EUR per case. The implementation of a department for plastic surgery increased the revenues. Additional profits should be achieved by process enhancement and not by prolonged LoS.

Impact of Different Creatinine Measurement Methods on Liver Transplant Allocation

IntroductionThe model for end-stage liver disease (MELD) score is used in many countries to prioritize organ allocation for the majority of patients who require orthotopic liver transplantation. This score is calculated based on the following laboratory parameters: creatinine, bilirubin and the international normalized ratio (INR). Consequently, high measurement accuracy is essential for equitable and fair organ allocation. For serum creatinine measurements, the Jaffé method and enzymatic detection are well-established routine diagnostic tests.MethodsA total of 1,013 samples from 445 patients on the waiting list or in evaluation for liver transplantation were measured using both creatinine methods from November 2012 to September 2013 at the university hospital Leipzig, Germany. The measurements were performed in parallel according to the manufacturer’s instructions after the samples arrived at the institute of laboratory medicine. Patients who had required renal replacement therapy twice in the previous week were excluded from analyses.ResultsDespite the good correlation between the results of both creatinine quantification methods, relevant differences were observed, which led to different MELD scores. The Jaffé measurement led to greater MELD score in 163/1,013 (16.1%) samples with differences of up to 4 points in one patient, whereas differences of up to 2 points were identified in 15/1,013 (1.5%) samples using the enzymatic assay. Overall, 50/152 (32.9%) patients with MELD scores >20 had higher scores when the Jaffé method was used.DiscussionUsing the Jaffé method to measure creatinine levels in samples from patients who require liver transplantation may lead to a systematic preference in organ allocation. In this study, the differences were particularly pronounced in samples with MELD scores >20, which has clinical relevance in the context of urgency of transplantation. These data suggest that official recommendations are needed to determine which laboratory diagnostic methods should be used when calculating MELD scores.

Residents Achieve a High Patient Satisfaction in Pre-Anesthetic Patient Assessment. An Observational Study

A physician’s empathetic attitude is regarded as an important influencing factor towards patient satisfaction. However, physicians’ self-assessed empathy declines during medical school and through residency, which may limit patient satisfaction in the doctor-patient contact. In conse-quence, we hypothesized that residents might fail in generating high levels of patient satisfaction. We conducted an observational study in the setting of a pre-anesthetic assessment center, Univer-sity Hospital Leipzig, Germany. Patient satisfaction was measured using the overall ZUF-8 score (8 - 32 points; increasing with patient satisfaction). Data were collected by questionnaires (ZUF-8 items, additional satisfaction items, and items of organizational and logistical processes). Key items for patient satisfaction as primary endpoints were defined. Statistical evaluation was performed in dependency of the anesthesiologists’ level of training (residents vs. consultants) by using the Mann-Whitney-U test or the chi square test, as required. Statistical significance was accepted for p < 0.05. In total, 2565 patients were assessed for eligibility. 986 patients met the criteria of inclusion. 978 questionnaires were submitted with 517 questionnaires being excluded because of missing values. Finally, 461 questionnaires could be analysed. Both residents and consultants achieved a high level of patient satisfaction. The ZUF-8-scores were comparable between the groups (p = 0.91), whilst the quality of consultation was rated slightly better by patients being assessed by residents (p = 0.047). The results in additional satisfaction items were comparable between the groups. We found a trend in residents assessing to be rated more friendly. Residents are able to generate a high level of patient satisfaction which is comparable to that of consultants with scores ranging between “good” and “very good”. Small albeit significant differences in favor of residents underline the quality of their performance in pre-anesthetic patient assessment.

Colonization of liver transplant recipients with KPC-producing Klebsiella pneumoniae is associated with high infection rates and excess mortality: a case–control analysis

From mid-2010 to early 2013 there was a large single-center (Leipzig University Hospital, Germany) outbreak of Klebsiella pneumoniae carbapenemase (KPC) type 2 producing K. pneumoniae (KPC-2-KP) involving a total of 103 patients. The aim of this study was to compare KPC-positive liver transplant recipients (LTR) and KPC-negative controls to determine both the relative risk of infection following colonization with KPC-2-KP and the case fatality rate associated with KPC-2-KP. The study cohort of this retrospective observational study comprised nine patients who had undergone orthotopic liver transplantation (LTx) (median age of 52 years, range 28-73 years) with confirmed evidence of colonization with KPC-2-KP. The data from these nine LTR were matched to 18 LTR (1:2) in whom carbapenem-resistant pathogens were not present and compared for clinical outcomes. Of these nine cases, eight (89 %) progressed to infection due to KPC-2-KP, and five (56 %) were confirmed to have bloodstream infection with KPC-2-KP. Matched-pair analysis of KPC-positive LTR and KPC-negative controls revealed a substantially increased relative risk of 7.0 (95 % confidence interval 1.8-27.1) for fatal infection with KPC-2-producing K. pneumoniae after transplantation with a mortality rate of 78 % (vs. 11 %, p = 0.001). Colonization with KPC-2-KP in LTR leads to high infection rates and excess mortality. Therefore, frequent screening for carbapenem-resistant bacteria in patients on LTx waiting lists appears to be mandatory in an outbreak setting. Patients with evidence of persistent colonization with KPC-producing pathogens should be evaluated with extreme caution for LTx.

Rapid emergence of secondary resistance to gentamicin and colistin following selective digestive decontamination in patients with KPC-2-producing Klebsiella pneumoniae: a single-centre experience

After a single patient was transferred to Leipzig University Hospital from a hospital in Rhodes, Greece, the hospital experienced the largest outbreak due to a KPC-2-producing Klebsiella pneumoniae (KPC-2-KP) strain thus far observed in Germany. Ninety patients hospitalised between July 2010 and October 2012 were affected. In an attempt to eliminate KPC-2-KP from their digestive tracts, 14 consecutive patients (16%) were treated with a short course (7 days) of selective digestive decontamination (SDD), employing colistin (1 million units q.i.d.) and gentamicin (80mg q.i.d.) as oral solutions, and applying colistin/gentamicin gel (0.5g) to the oral cavity. In a retrospective analysis, these 14 SDD patients were compared with the remaining 76 patients harbouring KPC-2-KP. KPC-2-KP carrier status was followed in all 14 SDD patients by submitting stool samples to KPC-specific PCR. The mean follow-up period was 48 days (range 12–103 days). Successful elimination of KPC-2-KP was defined as a minimum of three consecutive negative PCR test results separated by ≥48h each. Decolonisation of KPC-2-KP was achieved in 6/14 patients (43%) after a mean of 21 days (range 12–40 days), but was also observed in 23/76 (30%) of the non-SDD controls (P=0.102). SDD treatment resulted in the development of secondary resistance to colistin (19% increase in resistance rate) and gentamicin (45% increase) in post-treatment isolates. In the control group, no secondary resistance occurred. We conclude that the SDD protocol applied in this study was not sufficiently effective for decolonisation and was associated with resistance development.

Bedside Estimation of Nonaerated Lung Tissue Using Blood Gas Analysis*

Studies correlating the arterial partial pressure of oxygen to the fraction of nonaerated lung assessed by CT shunt yielded inconsistent results. We systematically analyzed this relationship and scrutinized key methodological factors that may compromise it. We hypothesized that both physiological shunt and the ratio between PaO2 and the fraction of inspired oxygen enable estimation of CT shunt at the bedside. : Prospective observational clinical and laboratory animal investigations. ICUs (University Hospital Leipzig, Germany) and Experimental Pulmonology Laboratory (University of São Paulo, Brazil). PATIENTS, SUBJECTS AND INTERVENTIONS: Whole-lung CT and arterial blood gases were acquired simultaneously in 77 patients mechanically ventilated with pure oxygen. A subgroup of 28 patients was submitted to different Fio2. We also studied 19 patients who underwent repeat CT. Furthermore we studied ten pigs with acute lung injury at multiple airway pressures, as well as a theoretical model relating PaO2 and physiological shunt. We logarithmically transformed the PaO2/Fio2 to change this nonlinear relationship into a linear regression problem. We observed strong linear correlations between Riley's approximation of physiological shunt and CT shunt (R = 0.84) and between logarithmically transformed PaO2/Fio2 and CT shunt (R = 0.86), allowing us to construct a look-up table with prediction intervals. Strong linear correlations were also demonstrated within-patients (R = 0.95). Correlations were significantly improved by the following methodological issues: measurement of PaO2/Fio2 during pure oxygen ventilation, use of logarithmically transformed PaO2/Fio2 instead of the "raw" PaO2/Fio2, quantification of nonaerated lung as percentage of total lung mass and definition of nonaerated lung by the [-200 to +100] Hounsfield Units interval, which includes shunting units within less opacified lung regions. During pure oxygen ventilation, logarithmically transformed PaO2/Fio2 allows estimation of CT shunt and its changes in patients during systemic inflammation. Relevant intrapulmonary shunting seems to occur in lung regions with CT numbers between [-200 and +100] Hounsfield Units.

A critical review of the recent literature and selected therapy guidelines since 2006 on the use of lamotrigine in bipolar disorder

The anticonvulsant drug lamotrigine (LTG), a sodium channel blocker and inhibitor of glutamate release, has been found to have antidepressant effects in the treatment of bipolar disorder. It is recommended by certain therapy guidelines as a first-line agent for acute and maintenance therapy in bipolar depression, but there have been only some promising results of placebo-controlled trials on its acute antidepressant effects, and the recommendation in therapy guidelines has been reconsidered. On the contrary, positive results for maintenance therapy could be confirmed, and LTG is still a well-tolerated option, especially in patients with predominant depressive episodes. Antimanic effects are not shown in the literature, and its use is not advised in any guidelines that were examined. In conclusion, the findings of the present review article on treatment guidelines for bipolar disorder question the role of LTG in acute depressive states, and critically discusses its use, particularly in acute depressive states.

Serum amino acid profiles and their alterations in colorectal cancer

Mass spectrometry-based serum metabolic profiling is a promising tool to analyse complex cancer associated metabolic alterations, which may broaden our pathophysiological understanding of the disease and may function as a source of new cancer-associated biomarkers. Highly standardized serum samples of patients suffering from colon cancer (n = 59) and controls (n = 58) were collected at the University Hospital Leipzig. We based our investigations on amino acid screening profiles using electrospray tandem-mass spectrometry. Metabolic profiles were evaluated using the Analyst 1.4.2 software. General, comparative and equivalence statistics were performed by R 2.12.2. 11 out of 26 serum amino acid concentrations were significantly different between colorectal cancer patients and healthy controls. We found a model including CEA, glycine, and tyrosine as best discriminating and superior to CEA alone with an AUROC of 0.878 (95% CI 0.815–0.941). Our serum metabolic profiling in colon cancer revealed multiple significant disease-associated alterations in the amino acid profile with promising diagnostic power. Further large-scale studies are necessary to elucidate the potential of our model also to discriminate between cancer and potential differential diagnoses. In conclusion, serum glycine and tyrosine in combination with CEA are superior to CEA for the discrimination between colorectal cancer patients and controls.

Early Detection of Growth Disorders With the CrescNet System at the Leipzig Treatment Center

Growth hormone replacement therapy is more effective the earlier it is begun. This article adresses the question whether children with growth hormone deficiency (GHD) were able to begin treatment earlier through the use of the CrescNet system in the Department of Pediatrics at the Leipzig University Hospital. CrescNet is a network of pediatricians and endocrinological treatment centers, established in Leipzig in 1998, whose aim is to improve the early detection of growth disorders. Pediatricians participating in CrescNet provided anonymized data on their patients' height and weight to the CrescNet database. Each participating pediatrician received a quarterly screening report with recommendations for the work-up of children with abnormal growth. Some patients with GHD who were treated in the Leipzig treatment center were referred in response to these recommendations, while others came spontaneously from the practices of pediatricians participating or not participating in CrescNet. We determined the age at the onset of treatment for the 139 patients treated for GHD in the University Children's Hospital Leipzig from 1999 to 2005 and compared the findings with data from other treatment centers in Germany. Patients from CrescNet practices began treatment at a younger age than those from non-CrescNet practices (8.77 ± 3.40 versus 9.50 ± 3.78 years, p = 0.26). Patients from CrescNet practices whose GHD was detected by screening began treatment earlier than those for whom no data had been sent (7.67 ± 3.21 versus 9.28 ± 3.39 years, p = 0.031). In the center in Leipzig, but not in other German GHD treatment centers, the age at onset of treatment dropped significantly over the period of the study and then remained steady till 2009 in the range of 7.61 ± 3.0 years. These descriptive results imply that the linking of pediatricians' practices with the CrescNet system resulted in earlier treatment of children with GHD.

Lead Poisoning Due to Adulterated Marijuana in Leipzig

Between August and December 2007, a mass poisoning due to adulterated marijuana was uncovered in the area of Leipzig, Germany. Retrospective reports of patients with lead poisoning who were treated at Leipzig University Hospital. Analysis of data from the local health office, where marijuana consumers could have their blood lead concentration determined. At Leipzig University Hospital, 35 patients (7 female; age 24.2 +/- 4.4 years) had to be treated for lead poisoning (blood lead levels 1063.3 +/- 864.0 microg/L). Five hundred ninety-seven marijuana consumers (439 men, 158 women; age 26.9 +/- 4.8 years) had their blood lead levels measured at the local health office. Among them, 27.3% had lead levels above the HBM-II threshold, 12.2% had concentrations that required monitoring, and 60.5% had levels below the HBM-I threshold. Drug consumption should be considered in otherwise unexplained anemia and abdominal colic. Several hundred people suffered lead poisoning presumably resulting from the desire of drug dealers to maximize profits.

Successful therapy of a patient with therapy recalcitrant generalized bullous scleroderma by extracorporeal photopheresis and mycophenolate mofetil

Journal of the European Academy of Dermatology and VenereologyVolume 22, Issue 5 p. 631-633 Successful therapy of a patient with therapy recalcitrant generalized bullous scleroderma by extracorporeal photopheresis and mycophenolate mofetil M Schlaak, Corresponding Author M Schlaak *Corresponding author, University Hospital Leipzig, Department of Dermatology, Venerology and Allergology, Philipp-Rosenthal-Str. 23–25, 04103 Leipzig, Germany. tel. +49 341 97 18 750; fax +49 341 97 18 759; E-mail: [email protected]Search for more papers by this authorH Friedlein, H Friedlein Department of Dermatology, Venerology and Allergology, University Hospital Leipzig, Leipzig, GermanySearch for more papers by this authorF Kauer, F Kauer Department of Dermatology, Venerology and Allergology, University Hospital Leipzig, Leipzig, GermanySearch for more papers by this authorR Renner, R Renner Department of Dermatology, Venerology and Allergology, University Hospital Leipzig, Leipzig, GermanySearch for more papers by this authorC Rogalski, C Rogalski Department of Dermatology, Venerology and Allergology, University Hospital Leipzig, Leipzig, GermanySearch for more papers by this authorJC Simon, JC Simon Department of Dermatology, Venerology and Allergology, University Hospital Leipzig, Leipzig, GermanySearch for more papers by this author M Schlaak, Corresponding Author M Schlaak *Corresponding author, University Hospital Leipzig, Department of Dermatology, Venerology and Allergology, Philipp-Rosenthal-Str. 23–25, 04103 Leipzig, Germany. tel. +49 341 97 18 750; fax +49 341 97 18 759; E-mail: [email protected]Search for more papers by this authorH Friedlein, H Friedlein Department of Dermatology, Venerology and Allergology, University Hospital Leipzig, Leipzig, GermanySearch for more papers by this authorF Kauer, F Kauer Department of Dermatology, Venerology and Allergology, University Hospital Leipzig, Leipzig, GermanySearch for more papers by this authorR Renner, R Renner Department of Dermatology, Venerology and Allergology, University Hospital Leipzig, Leipzig, GermanySearch for more papers by this authorC Rogalski, C Rogalski Department of Dermatology, Venerology and Allergology, University Hospital Leipzig, Leipzig, GermanySearch for more papers by this authorJC Simon, JC Simon Department of Dermatology, Venerology and Allergology, University Hospital Leipzig, Leipzig, GermanySearch for more papers by this author First published: 06 August 2007 https://doi.org/10.1111/j.1468-3083.2007.02403.xCitations: 22 Dr. Schlaak had full access to all of the data and takes responsibility for the integrity of the data and the accuracy of the data analysis. Funding support should be divided between those relevant to this manuscript and all other relationships. The sponsors had no role in the design and conduct of the study, in the collection, analysis, and interpretation of data, or in the preparation of the manuscript, review, or approval of the manuscript. DOI: 10.1111/j.1468-3083.2007.02403.x Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume22, Issue5May 2008Pages 631-633 RelatedInformation

Inhousebefragung zur Patientenzufriedenheit in einem Klinikum der Maximalversorgung - Ein Praxisbericht

Since 1999, the statutory obligation of all German hospitals to establish an internal quality management system has resulted in an increase of patient surveys on inpatient care. Information on the subjective satisfaction of the patients is of particular interest because improvements may be realised. In the present paper, the objectives, the methodology and the choice of a tested survey instrument, the interpretation of the results and the practical problems in implementing a survey on patient satisfaction at the Leipzig University Hospital (a public institution comprising 1,464 beds in 2001) will be reported. This is intended to facilitate comparable projects in the future and to enable hospitals with fewer resources to organize and use such surveys. Altogether, 1,718 questionnaires (Hamburg questionnaires on patient stay in hospital, HFK) from 43 wards could be evaluated. The high satisfaction determined (mean values of the scores for 10 test parameters are between 1.72 and 2.02 on a 5-point scale) corresponds to the general tendency of patients to make socially desirable responses. Covert dissatisfaction was therefore analysed comparing the relative frequencies of complete and limited satisfaction at item level. Sociodemographic patient characteristics such as age and stay in hospital were of no substantial relevance. One important aim of the Leipzig survey project was to give detailed feedback within brief time periods. The project focussed on a differentiated and early monitoring of responses. If requested, an oral presentation of the results was made to each structural unit. This presentation included the spontaneous responses of the patient, which enhanced the acceptance of the investigation by the medical staff.

Modeling Hospital Information Systems (Part 2): Using the 3LGM2 Tool for Modeling Patient Record Management

We introduce the 3LGM(2) tool, a tool for modeling information systems, and describe the process of modeling parts of the hospital information system of the Leipzig University Hospital (UKL(a)). We modeled the sub information systems of five patient record archiving sections to support the creation of a proposal for governmental financial support for a new document management and archiving system. We explain the steps of identifying the model elements and their relations as well as the analyzing capabilities of the 3LGM(2) tool to answer questions about the information system. The 3LGM(2) tool was developed on the basis of the meta model 3LGM(2) which is described in detail in [1]. 3LGM(2) defines an ontological basis, divided into three layers and their relationships. In addition to usual meta CASE tools, the 3LGM(2) tool meets certain requirements of information management in hospitals. The model described in this article was created on the base of on-site surveys in five archiving sections of the UKL. A prototype of the 3LGM(2) tool is available and is currently tested in some projects at the UKL and partner institutions. The model presented in this article is a structured documentation about the current state of patient record archiving at the UKL. The analyzing capabilities of the 3LGM(2) tool help to use the model and to answer questions about the information system. The 3LGM(2) tool can be used to model and analyze information systems. The presentation capabilities and the reliability of the prototype have to be improved. The initial modeling effort of an institution is only valuable if the model is maintained regularly and reused in other projects. Reference catalogues and reference models are needed to decrease this effort and to support the creation of comparable models.

Modeling Hospital Information Systems (Part 1): The Revised Three-layer Graph-based Meta Model 3LGM2

Not only architects but also information managers need models and modeling tools for their subject of work. Especially for supporting strategic information management in hospitals, the meta model 3LGM2 is presented as an ontological basis for modeling the comprehensive information system of a hospital (HIS). In a case study, requirements for modeling HIS have been deduced. Accordingly 3LGM2 has been designed to describe HIS by concepts on three layers. The domain layer consists of enterprise functions and entity types, the logical tool layer focuses on application components and the physical tool layer describes physical data processing components. In contrast to other approaches a lot of inter-layer-relationships exist. 3LGM2 is defined using the Unified Modeling Language (UML). Models of HIS can be created which comprise not only technical and semantic aspects but also computer-based and paper-based information processing. A software tool supporting the creation of 3LGM2 compliant models in a graphical way has been developed. The tool supports in detecting those shortcomings at the logical or the physical tool layers which make it impossible to satisfy the information needs at the domain layer. 3LGM2 can also be used as an ontology for describing HIS in natural language. Strategic information management even in large hospitals should be and can be supported by dedicated methods and tools. Although there have been good experiences with 3LGM2 concerning digital document archiving at the Leipzig University Hospital, which are presented in part 2, the benefit of the proposed method and tool has to be further evaluated.

A season of aseptic meningitis in Germany: epidemiologic, clinical and diagnostic aspects.

We assessed epidemiologic, clinical and laboratory features of aseptic meningitis during one season of multiserotype enteroviral meningitis in East Germany in 70 consecutive patients with aseptic meningitis admitted to the Children's University Hospital Leipzig. Patients, age 1 to 16 years, typically presented with headache, emesis and fever, whereas signs of meningeal irritation were only moderately expressed in one-half of the patients. The median number of leukocytes in the CSF was 151 cells/mm(3) (range, 2 to 1,820) with a high percentage of polymorphonuclear cells (PMNs). Initial blood counts showed mild leukocytosis and pronounced PMN predominance (78.9 +/- 1.3%). The percentage of PMNs in the peripheral blood decreased in favor of mononuclear cells after 3 days to a pattern more compatible with viral infection as opposed to that suggestive for bacteria in the beginning. Mean cerebrospinal fluid values of protein, glucose and lactate and the C-reactive protein were mildly elevated or normal. Nonpolio enteroviruses were detected in 30 of 70 patients. Subsequent serotyping revealed echovirus type 13 (13 patients), type 6 (2), type 30 (1) and coxsackie B virus type 5 (2). There were no differences in demographic or clinical data between enterovirus positive and negative patients. Even though individual laboratory values do not solely allow discrimination between viral and bacterial meningitis, the combined epidemiologic, clinical and laboratory data facilitate the diagnosis of aseptic meningitis in most cases. Viral diagnostics, identifying echovirus type 13 that thus far has not been associated with epidemics of meningitis, adds important epidemiologic information.

Epidemiology and pathogenesis of cervical cancer

The majority of the estimated incidence of 471,000 new cases for invasive cervical cancer (CX) and 215,000 cancer deaths occurs in the developing countries. For Germany the CX accounts at 8th position of all cancers in women in 1997 with 5,800 newly diagnosed cases. But, every fourth woman between 25th- and 35th-year of life has been affected by CX. This counts at the upper third of the incidence in the European Union (EU). The estimated loss of live-years for women affected by CX is about nine years. The lethality for all stages of invasive cervical cancer is about 30%. For the last two decades stagnation of the reduction of mortality by CX has been reported for EU and the USA, especially affecting woman up to 35th-year of life. The percentage of this age group of all primary operative treated CX at the Leipzig University Hospital between 1979 and 1999 was 26.2%, with a mean age of 43.4 +/- 11.1 years. Improved screening for CX in the western countries and a change in environmental factors have been caused an increase of cervical precancerous (CIN-) lesions. The frequency of CIN-lesions has been estimated to be 100-times higher than the incidence of invasive cancer (21.1) in Germany. The pathogenesis of CX is multistage and CIN I and II represent highly regressive lesions, whereas CIN III requires therapeutic intervention, caused by high progression rate. The Bethesda-classification of low und high grade squamous intraepithelial lesions (SIL) cannot be recommended for biopsies or conisation specimens. Dsyplastic lesions of endocervical columnar epithelium should not be graded, the only general accepted lesion represents the adenocarcinoma in situ (ACIS). Both, CIN and ACIS represents proliferative active lesions, caused by infection with HPV. But the detection of morphologic alterations, associated with HPV, like koilocytes, are inverse correlated with the grade of the CIN-lesion.