[Anaesthesiological experience and factoid public information - effects, interactions and possible strategies for perioperative stress reduction].

Background: Preoperative stress influences perioperative complications. Their severity is influenced by advanced information and previous experience. This study evaluates the emotional effects of these factors.

[Carotid surgery in regional anesthesia--anesthesiological, neurological and surgical aspects].

Surgery of the carotid artery is justified only if it is performed with low complication rates. The essential advantages of regional anesthesia in comparison to general anesthesia are a secure neuromonitoring, hemodynamic stability and prolonged analgesia. Regional anesthesia for carotid surgery, which is described methodically in this paper, needs only a minor expenditure.

Comparison of Solvent/Detergent-Inactivated Plasma and Fresh Frozen Plasma under Routine Clinical Conditions.

Background: Reduced levels of protein S (PS) and alpha(2)-antiplasmin alpha(2)-AP) in solvent/detergent virus-inactivated plasma (S/D-VIP) might induce an imbalance of plasma coagulation factors and inhibitors in patients transfused. We investigated 40 patients (23 fresh frozen plasma (FFP), 17 S/D-VIP, random distribution by a list calculated by statisticians) who suffered from dilution coagulopathy, liver disease, disseminated intravascular coagulation (DIC), polytrauma or were connected to extracorporeal circulation. Study Design and Methods: The following markers of activated coagulation (MAC) were measured: Prothrombin fragment F1+2 (F1+2), fibrin monomers (FM), D-dimers (DD), thrombin-antithrombin (TAT) and plasmin-antiplasmin (PAP) complexes as well as fibrinogen degradation products (FgDP), and additionally antithrombin III (antithrombin), protein C (PC), PS and alpha(2)-AP.

[When should a patient with severe acute respiratory distress syndrome (ARDS) be transferred to a specialized hospital?].

The mortality rate for the advanced adult respiratory distress syndrome is still high. Nevertheless there are recent publications showing decreasing incidence and an improving survival rate. This is due to early diagnosis as well as differentiated treatment concepts.

[Knowledge-based diagnosis and therapeutic recommendations with fuzzy-set theory methods in patients with acute lung failure (ARDS)].

Objective: Since the treatment of patients with severe ARDS using the extracorporal lung assist (ECLA) methods remains a cost intensive and speculative procedure, a knowledge based computer system should be created and evaluated in order to support clinical decisions.

Methods: The model was based on the fuzzy set theory and therefore able to give decisions between yes and no, that means that a criterion could also be fulfilled to 35% or 80% for example. The development of this computer program consists of two steps: first, the entry criteria for the ECLA therapy were established within a framework of an international evaluation of clinical data from 3 centres (Berlin, Marburg, Vienna).

[Radiation exposure during thoracic radiography at the intensive care unit. Dose accumulation and risk of radiation-induced cancer in long-term therapy].

Purpose: Assessment of the additional morbidity risk due to repeated bedside chest radiography according to ICRP 60 during intensive care.

Material And Methods: Ventral surface doses were recorded by thermoluminescence dosimetry in 2 man and 7 women, mean age 36 +/- 12 years, mean height 169 +/- 5 cm, mean weight 74 +/- 8 kg, receiving long-term ventilation therapy due to Adult Respiratory Distress Syndrome (ARDS).

Results: From 18 to 126 days duration of therapy 9 patients received a total of 348 bedside chest radiographs, mean 39 +/- 22 radiographs per patient.

The spatial distribution of pulmonary lesions in severe ARDS. An autopsy study of 35 cases.

The present study was undertaken in order to describe the local distribution and temporal course of pulmonary lesions in severe ARDS. We investigated a total of 35 patients (22 females), ranging in age from 2 to 51 years, who suffered from ARDS III and IV and were treated by extracorporeal CO2 removal and low frequency positive pressure ventilation (ECCO2-R). The extent of acute and chronic diffuse alveolar damage was assessed on histologic gross sections in the ventral, central and dorsal zone of the upper and lower lobes.

[Epidemiology, clinical aspects and prognosis of severe progressive community-acquired pneumonia].

Background: Community-acquired pneumonia can lead to acute lung failure (parapneumonic ARDS) if the course is very severe. The clinical picture reflects a rapidly progressive and potentially fatal respiratory failure. Only occasional cases in which the clinical courses of community-acquired pneumonia lead to acute respiratory failure have been reported so far.

["Treatment of total atelectasis of the left lung in severe ARDS with side-separated ventilation and surfactant administration"].

Severe thoracic trauma is always an important risk factor for the development of acute pulmonary failure. The course is often complicated by barotrauma or volutrauma. We report on a 48-year-old patient who was transferred to us nine days after a bicycle accident because of a severe disturbance of gas exchange and atelectasis of the left lung refractory to therapy.

[Can preoperative lung function diagnosis detect risk of intraoperative pulmonary gas exchange insufficiency in artificial hip replacement with polymethylmethacrylate cement?].

In a study of 90 patients in whom a hipjoint had been replaced for the first time using polymethylmetacrylate cement, the extent of intraoperative pulmonary gas exchange disorders was established. The effect of a preexisting disorder of lung function was determined. We checked whether an appraisal of the risk patients who are operated on can be assisted by a preoperative analysis of lung function.

[Treatment of acute pulmonary infection in a mucoviscidosis patient with extracorporeal lung support].

This is a report on a mucoviscidosis patient of 30 years of age suffering from refractory acute failure of pulmonary function during acute exacerbation of an infection with Pseudomonas aeruginosa. To avoid further barotraumatisation of the lungs due to continually increasing artificial respiratory pressure, and to set the lung at rest until subsidence of a concomitant severe bronchial obstruction, we performed modified extracorporal lung assist (ELA). The gas exchange improved rapidly with the help of relevant accompanying measures (including negative liquid balance, administration of antibiotics, etc.

[Pulmonary function one year after extracorporeal lung assist. A long-term follow-up of patients with acute adult respiratory distress syndrome].

This retrospective follow-up studied lung function and reconvalescence in 38 young patients without primary lung disease, who suffered from severe ARDS and survived by means of extracorporeal lung assist (ELA) treatment. Over a period of 3, 6, 9 and 12-20 months dynamic and static lung volumes and the results of X-ray and CT scan of the thorax were studied. Within the third and sixth month the forced vital capacity, FEV1, and arterial blood gases reached the lower range of normal values.

[Acute respiratory failure--support of gas exchange using extracorporeal or implanted oxygenators--present status and future development].

In acute respiratory failure gas exchange can be supported or even maintained in an "alternative" way to mechanical ventilation using extracorporeal techniques (extracorporeal membrane oxygenation ECMO, extracorporeal CO2-removal ECCO2R), or intravenacaval oxygenators (IVOX). These techniques, which are currently in use in neonatology, pediatrics, and adult intensive care medicine, or techniques at present in clinical evaluation (IVOX), are reviewed with their indications, contraindications, differences, problems, worldwide results, and possible future applications.

[Determinations by indirect calorimetry need not be expensive and technically complicated. A new measurement system and its validation].

Presentation of a newly conceived measuring instrument to determine the energy expenditure of critically ill patients at the bedside by means of indirect calorimetry. The special advantages of the measuring instruments are easy handling, little maintenance and very low working expenses and prime costs. The accuracy of measurement is considerable nd is comparable with that of other measuring methods, as has been established by an extensive validation.

[The measurement of extravascular lung water--significant in the follow-up of ARDS?].

In 40 adult patients suffering from severe ARDS stage III and IV (Morel) we examined the course of the extravascular lung water (EVLW) measured by the double indicator dilution method with 858 single measurements, during mechanical ventilation with PEEP, or extracorporeal CO2 elimination (ECCO2 R). No correlation could be found between EVLW and the values of alveolar arterial oxygen difference (AaDO2) and intrapulmonary right-left shunt (Qs/Qt) or haemodynamic values such as CVP, PCWP, mean pulmonary arterial pressure, or the 24 h fluid balance. It was, therefore, not possible to estimate a prognostic trend based on a single measurement of EVLW.

Marburger concept for computer-aided acquisition, processing and documentation of patient data in the intensive care unit.

The authors report on their experience with the computer-aided acquisition, processing and documentation of patient data in an intensive care unit. The goal of an effective data and information collection system in the intensive care unit is to make therapy, and the patients respond to it, recognizable and understandable through the clear and complete representation of the patients conditions. The focal point of the data documentation is the medical record.

[Personal experiences with extracorporeal CO2 elimination in patients with severe ARDS--a current review].

The method of extracorporeal CO2 elimination (ECCO2-R) as described by Luiciano Gattinoni and Theodor Kolobow is compared with earlier extra corporeal methods such as extracorporeal membrane oxygenation. The physiological fundamentals of the method, as well as indications and contraindications are explained. - The results of more than 100 patients treated worldwide are discussed together with the present problems of the method.

[Adult respiratory distress syndrome in legionella pneumonia--successful treatment with extracorporeal CO2 elimination procedures].

We report on successful treatment of an 46-year-old patient with ARDS (Adult Respiratory Distress Syndrome), caused by legionella-pneumophilia-pneumonia. The treatment with conventional artifical mechanical ventilation had failed. The new method of extracorporeal CO2-Elimination and low frequency positive pressure ventilation (ECCO2-R-LFPPV), introduced by L.

Regression of cardiac hypertrophy: morphometric and biochemical studies in rat heart after swimming training.

There is currently little information about the morphological changes of the myocardium accompanying the reversal of cardiac hypertrophy. In this study the hypothesis was tested that myocardial alterations induced by exercise will regress within a short interval after the end of training. Rat hearts were examined using morphometric and biochemical methods at the end of a 9-week period of endurance training and also 7, 10 and 14 days after its termination.

[ARDS in Mycoplasma pneumonia].

In this paper we describe a case of bilateral broncho-pneumonia due to invasion by mycoplasma pneumoniae, leading to ARDS. A high serum level of cold agglutinins, a mild haemolysis and a rash resembling that of an erythema multiforme were noted. The initial treatment was non-specific.

[Experience with extracorporeal CO2 elimination].

The method of extracorporeal CO2-elimination (ECCO2-R) as described by L. Gattinoni [2] and Kolobow [5] is reported in ten patients with severe ARDS in whom conventional respirator therapy had failed. The method itself as well as important pulmonary function parameters, e.

[Tracheal compression caused by a paratracheal cyst: a rare cause of fatal airway obstruction].

We report on a previously asymptomatic paratracheal cyst leading to an acute airway obstruction. The possibility of clinical misinterpretation of this rare, congenital malformation is emphasised.