[Indicators of structural quality in palliative care for cancer pain patients in Lower-Saxony].

Introduction: Palliative care in Germany fails to reach established standards. To improve this situation the Chamber of Physicians of Lower-Saxony initiated SUPPORT in 1995. Prior to interventions structural quality of care was evaluated, specifically the rate of availability of opioid-prescription-forms and the ability to treat chronic pain (defined as a construct of knowledge, attitudes and skills) were examined.

[Improvement of palliative outpatient treatment of terminally ill cancer patients - SUPPORT as example - The ethically preferable alternative to euthanasia].

Introduction: Industrial countries are experiencing substantial increases in cancer prevalence. While advanced cancer therapies resulted in prolonged survival most neoplasms still are incurable. Especially advanced stages of cancer are often accompanied by severe pain and other disabling symptoms.

[Basics of drug therapy of cancer pain].

Industrial countries experience a significant increase of cancer prevalence. Despite recent advances in the treatment of various types of cancer still most of the patients cannot be cured. Especially the advanced incurable stages of cancer, however, often are accompanied by severe pain.

[Pain therapy in tumor patients and in palliative medicine. 2: Invasive measures].

Anesthesiological and neurosurgical methods in the treatment of cancer pain have to be considered as parts of a holistic approach. To treat cancer pain patients appropriately, an interdisciplinary setting is essential. In the eyes of experienced pain specialists as well as physicians in palliative medicine invasive procedures are only of minor importance.

[Pain therapy in tumor patients and in palliative medicine. 1: Drug therapy].

Like other industrial countries Germany experiences a significant increase of cancer prevalence. Recent advances in the treatment of various types of cancer resulted in prolonged survivaltimes of patients. Cancer--especially in advanced incurable stages--often is accompanied by severe pain.

[Isokinetic strength of lumbar muscles in patients with chronic backache].

Lumbar isokinetic strength and the influence of age, bodyweight and testing velocity in patients with chronic low back pain in comparison with persons without pain. Lumbar isokinetic strength parameters of 80 patients with chronic low back pain and 70 persons without pain were compared and the influence of age, bodyweight and testing velocity was evaluated. The patients with chronic low back pain showed less strength than the persons without pain.

[Interrater studies of evaluating the reliability of somatic findings].

20 patients (11 female, 9 male) without low back pain were included in two interrater studies carried out by three physical therapists. The following variables were investigated: shape of the spine, iliac crest heights, twisting of the pelvis, spine test, length of legs, Patrick sign, Schober test, fingertip-to-floor measurements, flexion and extension of the lumbar spine, straight-leg raising, and length of the iliopsoas and the rectus muscles. Intraclass coefficients for the ordinal variables, and kappa coefficients for the nominal variables were calculated for evaluation of interrater agreement.

Myocardial extraction of bupivacaine in anaesthetized sheep and by hearts of sheep and rats in vitro.

We observed the in vivo kinetics of bupivacaine in the cardiopulmonary system, particularly in the pulmonary artery, the upper part of the descending aorta and the coronary sinus of anaesthetized sheep, each of which received a high dose infusion into the central vein. In some experiments dilution curves were monitored for the non-extracted dye, indocyanine green. Concentrations of bupivacaine were approximately 20% lower in the aorta than in the pulmonary artery.

Lumbar range of motion: influence of time of day and individual factors on measurements.

Study Design: Influence of time of day and individual factors on the measurements of the lumbar range of motion was investigated.

Objectives: To investigate factors that influence lumbar range of motion.

Summary Of Background Data: Twenty-nine patients with chronic low back pain participated in the study.

Lumbar range of motion: reliability and validity of the inclinometer technique in the clinical measurement of trunk flexibility.

Study Design: This study examines the reliability and validity of measuring lumbar range of motion with an inclinometer.

Objectives: To find out whether a manual determination of the reference points for measuring lumbar range of motion is as reliable as radiologic determination for positioning the inclinometers, lumbar range of motion was determined in degrees by evaluating radiographs and by using the inclinometer technique of Loebl.

Summary Of Background Data: Reliability and validity of the inclinometer technique as a clinical measurement of trunk flexibility were investigated.

[Diagnosis of magnesium deficiency in intensive care patients].

Aim: Magnesium deficiency was investigated in critically ill patients, comparing measurements of plasma concentrations with the results obtained by the magnesium tolerance test.

Design And Methods: 20 critically ill patients (5 females, 15 males) between the ages of 27 and 86 were investigated. Magnesium plasma concentrations were determined before the magnesium tolerance test according to Ryzen was performed.

[Interactions between renal and general hemodynamics in fentanyl, droperidol, ketamine, thiopental and in peridural anesthesia--animal studies].

The main focus of this paper is to show regulative interactions between cardiac index (CI) and renal blood flow (RBF) with various intravenous anaesthetics under steady state conditions. Several experimental series were carried out on dogs with the following anaesthetic doses (as given per hour and per kilogram body weight-h-1 x kg-1): fentanyl 50 micrograms, ketamine 4 and 10 mg, and thiopentone 10 and 20 mg. The basic anaesthesia used was halothane (0.

[Prevalence of migraine in Germany.].

Introduction: There are no valid data available for Germany on the prevalence of migraine using the new diagnostic and classification criteria of the International Headache Society (IHS).

Sample And Methods: Therefore, a survey on migraine prevalence was carried out on a representative sample of 2000 residents aged 16 to 69 years of the states of the former West Germany. The questionnaire incorporated the new criteria of the IHS and the diagnosis of migraine was based on the corresponding classification.

Subcutaneous sumatriptan during the migraine aura. Sumatriptan Aura Study Group.

This double-blind, placebo-controlled, multicenter, parallel-group study assessed whether subcutaneous sumatriptan administered during the migraine aura would prolong or modify the aura and prevent or delay development of the headache. One hundred seventy-one patients (88 receiving 6 mg sumatriptan, 83 receiving placebo) treated a single attack of migraine with typical aura at home, by self-injection. The median duration of aura following the first injection was 25 minutes for the sumatriptan group and 30 minutes for the placebo group (NS).

Comparison of the determination of magnesium by methylthymol blue spectrophotometry and atomic absorption spectrophotometry.

Plasma samples (n = 155) of 30 patients on an intensive ward were analysed for magnesium simultaneously by atomic absorption spectrophotometry (AAS) and methylthymol blue spectrophotometry. Methylthymol blue spectrophotometry was performed at the bedside, using two different multianalysers, Easy ST 1 and Easy ST 2, Merck, D-Darmstadt. Precision was 12.

Exteroceptive suppression of temporalis muscle activity during migraine attack and migraine interval before and after treatment with sumatriptan.

We compared the early (ES1) and late (ES2) exteroceptive suppression (ES) periods of temporalis muscle activity in 18 migraine patients during both the migraine interval and migraine attack and investigated the effect of sumatriptan and placebo on ES parameters. The measurements were performed in a balanced sequence at four different times on each patient, twice during the migraine interval and once in each of two migraine attacks. First ES1 and ES2 were measured (stimulus intensity 20 mA, stimulus duration 0.

A new paediatric metabolic monitor.

Objective: A paediatric option for the measurement of VO2 and VCO2 (20 to 150 ml/min) has recently been introduced for the adult Deltatrac metabolic monitor (Datex Instrumentarium, Finland) to use in ventilated and spontaneously breathing children. This paper describes a laboratory validation of the paediatric option for ventilated children with regard to the influence of respiratory variables.

Design: Respiratory variables were varied within the following ranges: FIO2 0.

[Neurolytic block of the lumbar sympathetic trunk in advanced stages of peripheral arterial occlusive disease].

Unlabelled: Neurolytic blocks of the lumbar sympathetic trunk enable a less invasive sympathetic denervation if compared to standard surgical procedures.

Methods: 34 patients undergoing chemical lumbar sympathectomy (CLS) for advanced arterial occlusive disease were prospectively studied. An actual indication for reconstructive vascular surgical intervention had been excluded in all patients.

Comparison of contingent negative variation between migraine interval and migraine attack before and after treatment with sumatriptan.

We compared in a placebo controlled, double blind, crossover within-subject design, the amplitude and area integral of contingent negative variation (CNV) using a 2 second interstimulus interval in migraine patients between attack and interval before and after treatment. The study was conducted on 14 female subjects suffering from migraine without aura. The measurements were performed in a balanced sequence at four different times on each patient, twice during the migraine interval and once in each of two migraine attacks.

Cluster arousal analysis in chronic pain-disturbed sleep.

A new cluster arousal analysis system was developed to quantify microdisturbances in the sleep architecture. The system was evaluated in 10 healthy volunteers and the sleep of 23 outpatients with chronic low back pain was investigated before and after a special rehabilitative training. The comparison of sleep parameters before and after the treatment showed a significant reduction of the cluster disturbed sleep (CDS), whereas sleep efficiency and the number of stage shifts remained unchanged.

[Problems in the treatment of back pain].

Back pain is a common disease causing tremendous costs for treatment, rehabilitation, litigation and work-loss. The reasons for back pain vary considerably and are often not clear. The effectiveness of current treatment concepts like epidural injection of steroids, blocks of facet joints, transcutaneous electrical nerve stimulation and antidepressants has not been proven.

[Postoperative analgesia--a comparative study in laparoscopic cholecystectomy and lower abdominal laparotomy].

From September 1992 through February 1993 27 randomly chosen female patients were evaluated for differences in postoperative pain intensity (as determined by visual-analogue-scale (VAS)) and analgesic requirements via patient-controlled-analgesia (PCA), either after open lower-abdominal-laparotomy (n = 16, group 1) or after minimal-invasive-cholecystectomy (n = 11, group 2). The type of anaesthesia has been standardized, either as balanced or total intravenous anaesthesia. There were no statistically significant differences between the groups regarding to age, height, weight, intraoperative anaesthetic drug consumption, or duration of anaesthesia and surgery (205.