In einem präoperativen Screening mit Hilfe eines standardisierten Blutungsanamnesebogens und dem PFA-100 sind primäre Hämostasestörungen häufig, sekundäre (plasmatische) selten. Nach einer positiven Blutungsanamnese können mit dem PFA-100 über 90% der Hämostasestörungen erfaßt werden. In unserer Untersuchung wären ohne den PFA-100 27% der Patienten mit Hämostasestörungen nicht erkannt worden. Wenn die standardisierte Blutungsanamnese eindeutig negativ ist, kann auf ein präoperatives Screening mit den sogenannten Routinetests (aPTT u. Quick-Wert) verzichtet werden. Wenn der Quick-Wert, die aPTT, die Thrombozytenzahl und der PFA-100: Kollagen-Epinephrin nur in den indizierten Fällen mit positiver Blutungsanamnese (11.2%) durchgeführt würden, bedeutet das in Deutschland pro Jahr eine Einsparung von 14.2 Millionen Euro. In einer eigenen ersten Untersuchung wurde die Mikroangiopathie im Bereich der nutritiven Hautkapillaren (Fingernagelfalz) erstmal beim von Willebrand-Jürgens-Syndrom systematisch mit der intravitalen Videokapillarmikroskopie diagnostiziert. Die Nachfolgeuntersuchung an über 500 Patienten mit Hämostasestörungen im Vergleich zu einer Kontrollgruppe an Gesunden (n=100) bestätigte die Meßergebnisse für das von Willebrand-Jürgens-Syndrom (Typ 1 und 2a) und zeigte eine hohen positiven predictive value von 98%. Insbesondere die einfach und schnell durchgeführte Begutachtung der Kapillarmorphologie mit Veränderungen in Form von Kapillardilatationen, Extravasaten (frische oder alte Kapillarblutungen oder Blutungssäume) und gleichzeitig vorliegender Torquierung (Schlängelung) der Kapillaren ist bereits hoch prädiktiv (98%) für das Vorliegen eines von-Willebrand-Jürgens-Syndroms (Typ 1 und Typ 2a). In dem präoperativen therapeutischen Stufenkonzept zum Management primärer Hämostasestörungen zeigt sich die gute Wirksamkeit von DDAVP. Transfusionspflichtige Blutungen können bei Patienten mit primären Hämostasestörungen durch dieses präoperative Therapieregime verhindert werden. In der Patientengruppe mit primären Hämostasestörungen ohne präoperatives blutstillendes Management steigen die durchschnittlichen Kosten für die Transfusion von Blutkomponenten um das 5-fache auf ungefähr 1700 Euro. Hierbei sind Patientengruppen aller operativen Disziplinen berücksichtigt. / In a preoperative screening using a standardized questionaire of bleeding history and the PFA-100 platelet analyzer, primary hemostatic disorders are frequently found, whereas secondary disorders are rare. In cases with a positive bleeding history more than 90% of hemostatic disorders can be identified by PFA-100 platelet analyzer. In our investigation 27% of patients with impaired hemostasis would have been missed without using the PFA-100 platelet analyzer. In cases where the standardized bleeding history is clearly negative, the "so-called" routine preoperative coagulation tests (aPTT and prothrombin time) can be left out. Assuming that PT, aPTT, platelet count and PFA-100:collagen-epinephrine would only be performed in indicated cases with positive bleeding history (11.2%), this would lead to reduction of costs of 14.2 million Euro. Our investigations started with a systematic examination of the micrangiopathy in the nutritive nailfold capillaries of patient with von Willebrand Disease (vWD) using the intravital video capillary microscopy. In a follow-up investigation microangiopathy in the nutritive nailfold capillaries was examined in more than 500 patients with hemostatic disorders and 100 healthy volunteers. The results confirmed the findings for the vWD (type 1 and type 2a) and showed a high positive predictive value of 98%. In the preoperative phased therapy plan approach in the management of primary hemostatic disorders, DDAVP shows a good drug action. In these patients, the PFA-100 platelet analyzer is able to determinate the hemostatic effect of drugs, such as DDAVP, tranexamic acid, aprotinin, conjugated estrogens and platelet transfusion. In the patient group with primary hemostatic disorders without preoperative management, the average costs for blood transfusions increases 5-fold to roughly 1700 Euro. In this consideration patients of all operative disciplines are included.

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Currently a need for auditory processing test material for the identification of auditory processing disorders in children exists in the South African context. The purpose of this study was the Afrikaans translation and cultural adaptation of the SCAN-C: Test for Auditory Processing Disorders in Children-Revised (Keith, 2000a) and to determine the appropriateness thereof for preschool children. To achieve the objective of this study the research was performed in three phases and quantitative-descriptive research was utilized, with different methods for each of the phases. In Phase I the SCAN-C (Keith, 2000a) was translated and culturally adapted into Afrikaans for learners in Grade R. In Phase II the Siftingstoets vir Ouditiewe Prosesseringsafwykings (STOPA) was reviewed by speech-language therapists and/or audiologists as well as Grade R teachers (n = 11) by means of a customized questionnaire to determine appropriateness of the STOPA. A pilot study was conducted on Grade R learners (n = 10) before the STOPA was finalized and recorded. In Phase III the STOPA was performed on Grade R learners identified with normal auditory processing (n = 16) as well as Grade R learners identified with an auditory processing disorder (n = 14) to determine the validity and accuracy of the STOPA. The results indicated that the STOPA is age and culturally appropriate but that the validity and accuracy of the STOPA could not yet be proved. Clinical implications for identification, diagnosis and intervention for children with auditory processing disorders were discussed in order to provide the audiologist and speech-language therapist with evidence-based principles for clinical practice. Implications for further research include refining the STOPA during which normative data should be obtained. This study can therefore be viewed as the first step to standardize the STOPA, as well as to develop test material for other language and culture groups for the early identification of auditory processing disorders in children. / Dissertation (M (Communication Pathology))--University of Pretoria, 2007. / Speech-Language Pathology and Audiology / Unrestricted