[Quality assurance in specialized palliative home care (QUAPS): a questionnaire's feasibility].

Background: Structure and process parameters are not sufficient for adequate quality assurance in specialized palliative home care (SAPV). Asking the patients and their relatives for their assessment is crucial. A focus group in Jena, Germany, developed the quality assurance in specialized palliative home care (QUAPS) questionnaire for this assessment of outcome parameters, which was tested in two studies.

[Nutrition and fluid management in palliative medicine: do food and drink keep body and soul together?].

Induction, implementation and continuation of an invasive nutrition or fluid administration in patients with advanced, life-limiting illnesses is an often controversial but also very emotionally discussed topic. This article summarizes the current state of knowledge based mainly on the European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines and is intended as a simple guide for clinical practice. In the early phase of disease the induction of an invasive food and fluid administration may be indicated in order to prevent undernutrition and cachexia, to enhance compliance with anti-tumor treatment, to control some adverse effects of anti-tumor therapy and to improve the quality of life.

Enhanced tactile resolution of the contralateral side after surgery and regional anesthesia of the hand.

The purpose of this study was to investigate whether enhancement of tactile resolution (measured with Grating Orientation Task) can be demonstrated for patients undergoing regional anesthesia during hand surgery compared with surgery in general anesthesia and nonoperative controls. Regional anesthesia (nine patients) induced a significant improvement in contralateral tactile resolution at 10 and 24 h after the operation (P<0.01 and <0.

Effects of arginine vasopressin on oxygenation and haemodynamics during one-lung ventilation in an animal model.

In a case of arterial hypotension during one-lung ventilation, haemodynamic support may be required to maintain adequate mean arterial pressure. Arginine vasopressin, a potent systemic vasoconstrictor with limited effects on the pulmonary artery pressure, has not been studied in this setting. Twelve female pigs were anaesthetised and ventilated and arterial, central venous and pulmonary artery catheters were inserted.

Effects of a catecholamine-induced increase in cardiac output on lung injury after experimental unilateral pulmonary acid instillation.

Objectives: Increasing pulmonary blood flow aggravated ventilation-associated lung injury in ex vivo animal experiments, but data were less consistent in an in vivo animal model and do not reflect redistributed lung perfusion seen in clinical acute lung injury. We sought to determine the effects of increased cardiac output on markers of lung injury in an in vivo model of inhomogeneous lung perfusion and injury.

Design: Prospective, controlled animal study.

PEEP has beneficial effects on inflammation in the injured and no deleterious effects on the noninjured lung after unilateral lung acid instillation.

Objective: In clinical lung injury areas of inflammation and structural alveolar alteration are unevenly distributed and interspaced between healthy or less injured lung areas. Positive end-expiratory pressure (PEEP) applied with mechanical ventilation (MV) may affect injured and healthy lung areas differently. We compared the effects of PEEP on the inflammatory response in injured and noninjured regions of the lung in an animal model of unilateral lung acid instillation.

The effects of xenon or nitrous oxide supplementation on systemic oxygenation and pulmonary perfusion during one-lung ventilation in pigs.

During experimental one-lung ventilation (OLV), the type of anesthesia may alter systemic hemodynamics, lung perfusion, and oxygenation. We studied whether xenon (Xe) or nitrous oxide (N(2)O) added to propofol anesthesia would affect oxygenation, lung perfusion, and systemic and pulmonary hemodynamics during OLV in a pig model. Nine pigs were anesthetized, tracheally intubated, and mechanically ventilated.

Measuring cardiac output in one-lung ventilation: a comparison of pulmonary artery and transpulmonary aortic measurements in pigs.

Objective: The agreement between cardiac output measurements via pulmonary artery thermodilution (CO[PA]) and transpulmonary aortic thermodilution (CO[AT]) during one-lung ventilation was studied.

Design: Animal study with repeated simultaneous measurements comparing 2 cardiac output measurement techniques.

Setting: Experimental animal facility of a university department.

Lung perfusion, shunt fraction, and oxygenation during one-lung ventilation in pigs: the effects of desflurane, isoflurane, and propofol.

Objective: To study how desflurane, isoflurane, and propofol affect pulmonary perfusion, shunt fraction, and systemic oxygenation during one-lung ventilation (OLV) in vivo.

Design: Prospective animal study with a crossover design.

Setting: Animal laboratory of a university hospital.

[The use of the infraclavicular plexus catheter for treatment of perioperative and chronic pain].

Objectives: The aim of this prospective study was to evaluate the vertical infraclavicular approach to the brachial plexus for the insertion of a catheter to achieve continuous analgesia in postoperative patients and patients with chronic upper limb pain.

Methods: The brachial plexus was identified using the technique described by Kilka et al. and a flexible catheter (diameter 0.

Loss of the guide wire: mishap or blunder?

We describe four cases of lost guide wires during central venous catheterization. Although percutaneous catheterization of central veins is a routine technique, it is a procedure requiring advanced operating skills, expert supervision, and attention to detail in order to prevent adverse effects.

Lung perfusion affects preload assessment and lung water calculation with the transpulmonary double indicator method.

Objectives: The transpulmonary double indicator method uses intra- and extravascular indicators to calculate cardiac output, intrathoracic blood volume, global end-diastolic volume, and extravascular lung water content. Since lung perfusion may be of importance during these measurements, we studied the effects of pulmonary blood flow occlusion on measurements obtained with this method.

Setting: Experimental animal facility of a University department.

The effects of increasing concentrations of isoflurane and desflurane on pulmonary perfusion and systemic oxygenation during one-lung ventilation in pigs.

Unlabelled: During one-lung ventilation (OLV), hypoxic pulmonary vasoconstriction (HPV) reduces venous admixture and attenuates the decrease in arterial oxygen tension by diverting blood from the nonventilated lung to the ventilated lung. In vitro, desflurane and isoflurane depress HPV in a dose-dependent manner. Accordingly, we studied the effects of increasing concentrations of desflurane and isoflurane on pulmonary perfusion, shunt fraction, and PaO(2) during OLV in vivo.

Effect of ketamine on the neuromagnetic mismatch field in healthy humans.

Mismatch negativity (MMN) is a component of the auditory evoked event-related potentials (ERP) that assesses automatic sound change detection and is disturbed in schizophrenic patients. Animal experimental evidence has linked the generation of MMN to the N-methyl-D-aspartate (NMDA) receptor. We investigated the neuromagnetic mismatch field (MMF) in healthy volunteers before and after intravenous application of a subanesthetic dose of the NMDA receptor antagonist ketamine (0.

Cardiovascular function and brain metabolites in normal weight and intrauterine growth restricted newborn piglets--effect of mild hypoxia.

In order to clarify the influence of intrauterine growth restriction on systemic hemodynamics, catecholamine response, and regional distribution of brain energy metabolites per se and during mild hypoxic episodes a study was performed in thirty newborns with a well-characterized state of intrauterine and intra-natal development. Thirty animals were divided into fifteen normal weight piglets (NW) and fifteen intrauterine growth restricted (IUGR) piglets according to their birth weight. Category "NW" covered animals with a birth weight of > 40th percentile; IUGR category covered animals with a birth weight of > 5th and < 10th percentiles.

Body weight distribution and organ size in newborn swine (sus scrofa domestica) -- a study describing an animal model for asymmetrical intrauterine growth retardation.

Normal growth is the expression of the genetic potential to growth which is neither abnormally constrained nor promoted by internal or external factors. Restricted fetal growth is common in human pregnancy and is associated with increased perinatal morbidity and mortality. Because of ethical restrictions, pathogenetical studies are necessarily dependent on appropriate animal models.

Changed systemic and cerebral hemodynamics and oxygen supply due to gradual hemorrhagic hypotension induced by an external PID-controller in newborn swine.

An experimental design including an external closed-loop PID-(proportional-integral-differential-)controller is presented which enables the induction of gradual hemorrhagic hypotension at different stages of blood flow reduction up to stages of critically disturbed systemic and regional hemodynamics and oxygen supply. For this purpose nine newborn piglets (12-26 hours old, body weight 1626+/-160 g) were anesthetized and artificially ventilated. Gradual hemorrhagic hypotension was induced at four different steady state stages (stage 1 = 60 mmHg; stage 2 = 50 mmHg; stage 3 = 40 mmHg; stage 4 = 35 mmHg) every 30 minutes by gradual blood withdrawal using external PID controller equipment.

Validation of the multiple colored microsphere technique for regional blood flow measurements in newborn piglets.

The use of multiple colored microspheres (CMS) for the measurement of regional blood flow (RBF) in almost all organs and tissues of newborn piglets was validated. For this purpose mixtures of different CMS and/or radio-labeled microspheres (RMS) were injected into the left ventricle of eight newborn piglets. Regional blood flows (RBF) were quantified using the reference sample method.