The German Pflegeversicherung (long-term care insurance).

The German Pflegeversicherung, introduced in January 1995, has been very successful. It has been well accepted by persons in need and by their relatives and friends, providing benefits for both parties. The insurance is financially sound and has helped to create new workplaces.

The German health-care system.

The German health-care system is characterized by a statutory health insurance based on the principle of social solidarity. Nonprofit sickness funds and regional associations of physicians are the central components of the German system. The historical development of the system for more than 100 years has been characterized by negotiations, rather than confrontation, among physicians, patients, and insurance carriers.

Early defibrillation by emergency physicians or emergency medical technicians? A controlled, prospective multi-centre study.

Unlabelled: In a controlled, prospective multi-centre study, defibrillation by emergency medical technicians (EMTs) was compared with the current standard of care in Germany--defibrillation by emergency physicians (EPs)-in order to answer the following questions: can EMTs in a two-tiered emergency medical services (EMS) system with physicians in the field defibrillate earlier than, and as safely as EPs? Does defibrillation by EMTs (study group) affect survival rate and long-term prognosis of patients in ventricular fibrillation (VF), as compared with the current national standards in resuscitation (basic cardiopulmonary resuscitation (CPR) by EMTs, and defibrillation by physicians: control group?

Methods: Prior to the onset of the study, all EMTs completed retraining in basic life support (BLS). Randomly assessed EMTs were then trained to use semi-automatic defibrillators. With the help of on-line tape recordings, the complete resuscitation sequence was evaluated.

[Initial defibrillation by emergency physicians or by first aid assistants? A prospective, comparative multicenter study in outpatients with ventricular fibrillation].

In a controlled prospective randomized study, defibrillation by emergency medical technicians (EMTs) was compared with the current standard of care in Germany (basic life support by EMTs and defibrillation by emergency physicians only) in order to answer the following questions: 1. Does EMT defibrillation improve the survival rate and long-term prognosis of patients in ventricular fibrillation as compared to the current German standards in resuscitation (basic life support by EMTs and defibrillation by emergency physicians)? 2. Are the prerequisites for the use of semiautomatic defibrillators fulfilled in the emergency medical systems (EMS) of the participating centers? METHODS.

Influence of age on the survival rate of out-of-hospital and in-hospital resuscitation.

During a 9-year period 1472 cardiopulmonary resuscitations were analysed. Five-hundred seventy-two were in-hospital and 898 out-of-hospital resuscitations. Of the out-of-hospital resuscitations 495 (55.

Evidence for the 'cardiac pump theory' in cardiopulmonary resuscitation in man by transesophageal echocardiography.

There are two theories to explain the mechanism of blood flow during cardiopulmonary resuscitation: The 'Cardiac Pump Theory' and the 'Thoracic Pump Theory'. We have performed transesophageal echocardiography during the resuscitation of a patient with cardiopulmonary arrest. By this method we could study the motion of the aortic, mitral and tricuspid valves and the changes in ventricular size during cardiopulmonary resuscitation in man.

[Opening and closing movements of the heart valves in cardiopulmonary resuscitation. Confirmation of the cardiac pump theory ].

Cardiorespiratory arrest occurred in a 64-year-old man with severe triple-vessel coronary artery disease (status after two myocardial infarctions) and heart failure (ejection fraction of 20%). After intubation and starting resuscitation measures, transoesophageal echocardiography (TE) was performed to exclude electromechanical dissociation with ventricular tamponade. During the thoracic compression of closed-chest cardiac massage the aortic valve opened, while the mitral and tricuspid valves closed.

[Myocarditis caused by Salmonella typhimurium].

A 53-year-old man died on the eight day of an acute enteritis caused by Salmonella typhimurium. Clinical signs of shock were pronounced; the electrocardiogram, initially not pathological, showed a peripheral low voltage with decreased R-amplitudes and distinct disturbances in repolarization. Laboratory findings demonstrating Salmonella typhimurium in blood cultures and stools and 45% band forms in the differential count were remarkable.

[Therapy of the bronchitic syndrome in the elderly].

The prophylactic means and general modes in the treatment of the bronchitic syndrome in geriatric patients are outlined. The therapy is discussed with respect to the use of broncholytics, secretolytics and steroids on the basics of a detailed lung function test. The altered health condition of the geriatric patient needs an intensive and detailed therapy program and must include limitations caused by the old age.

[Diagnosis of the bronchitic syndrome in the aged].

The cumulation of exogenic factors on the basis of an endogenic disposition and the addition of physiologic aging processes cause an increase of the "bronchitic syndrome" in old age. Heart insufficiency, tuberculosis, lung embolism and bronchial carcinoma are the important differential diagnostic aspects in these patients. The structural and functional changes of the lung in old people and the polypathy, resp.

[The definition of heart failure with the product of minimal transit time and heart frequency (author's transl)].

The product of minimal transit time (MTT) and heart frequency (HF) defines the number of heart beats which are necessary to transport the blood in a determined region of the circulatory system. According to own studies in physiological (stress) and pharmacological conditions this product is constant, independent from body size, length, age etc. In proportion to the degree of heart failure the MTT X HF increases.

[Syndrome of Touraine, Solente and Golé: report of two cases (author's transl)].

Report of two patients with pachydermia, clubbing of the fingers and hyperostosis. This clinical syndrome corresponds to the pachydermal periostosis. Etiologic factors, clinical and radiologic symptoms, differential diagnosis, histological alterations, prognosis and therapy are discussed.