[Making a surgical decision: interplay between experience and clinical study].

Although the final, individual decision making in patients always has to be in the hand of the doctor, it has hitherto been much less a matter of scientific analysis than formal decision making on the basis of clinical trials. To change this, several types of individual decision making were characterized, four in the field of intuition (very fast logical decisions, consciously and unconsciously heuristic decisions using special instruments, the deep remainder of intuition which can and should not be the subject of scientific analysis) and discursive (purely logical) decision making as a fifth type. The prospective think-aloud technique including an hierarchical heuristic decision tree was presented as a method for scientific analysis of individual decision making which is open to repetition and criticism.

Histamine release and hypotensive reactions in dogs by solubilizing agents and fatty acids: analysis of various components in cremophor El and development of a compound with reduced toxicity.

Anaphylactoid reactions in man following administration of drugs solubilized with cremophor El (polyethylenglycolglycerol riconoleate) are a considerable clinical problem. Since these reactions occur in dogs on first exposure and in pigs on second exposure, the 'dog model' was used in this communication to analyse components and chemical modifications of cremophor El and its components for their clinical effects, their hypotensive actions and their histamine-releasing capacity. Two series of experiments in 1978 and 1980 were performed in 144 adult mongrel dogs of both sexes.

[Role of histamine in acute pancreatitis].

Elevated histamine concentrations of pathophysiological significance could be determined in plasma of dogs suffering from acute pancreatitis according to Pfeffer. This result was also obtained in dogs treated with aminoguanidine, a very effective diamine oxidase blocker, in addition to the duodenal blind loop preparation. Elevated histamine concentrations were found in nine out of ten dogs.

Histamine and pancreatitis: increase of plasma histamine levels in dogs with Pfeffer preparation and influence of aminoguanidine on the survival time.

Histamine release could be shown in 50% of the dogs suffering from acute haemorrhagic pancreatitis in Pfeffer's preparation. The survival time of these dogs was shorter by about 50% than that of animals without alteration of the plasma histamine levels. The powerful diamine oxidase blocker aminoguanidine diminished the incidence of severe pancreatitis in the dogs without influencing survival time.

[Storage of histamine in the blood following liberation from liver and antrum through trypsin: protective mechanism or a factor promoting pancreatic shock].

In dogs histamine was predominantly released from liver and antrum by intravenous injection of trypsin. The histamine content of the human liver was found to be high enough to allow the invasion of mg amounts of histamine into the circulation after histamine release. In blood histamine was rapidly taken up by corpuscular elements.