[Not Available].

The process recommendations of the Ethics Section of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI) for ethically based decision-making in intensive care medicine are intended to create the framework for a structured procedure for seriously ill patients in intensive care. The processes require appropriate structures, e.g.

[Dealing with coercion in intensive care medicine : Recommendations from the Ethics Section of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI) in collaboration with the Ethics Section of the German Society for Internal Intensive Care and Emergency Medicine (DGIIN)].

The treatment situation in intensive care is characterised by a specific asymmetry in the relationship between patients and the team: Patients are particularly dependent on their environment and often show impaired consciousness and capacity to consent. This facilitates the use of coercion or enables and/or provokes it. The aim of this recommendation is to show ways to recognise patients with their wishes and needs and to integrate them into treatment concepts in the intensive care unit in order to reduce and avoid coercion whenever possible.

[Decision-making support in Intensive Care to facilitate organ donation : Position paper of the Ethics Section and the Organ Donation and Transplantation Section of the German Interdisciplinary Association of Critical Care and Emergency Medicine (DIVI) in collaboration with the Ethics Section of the German Society of Medical Intensive Care Medicine and Emergency Medicine (DGIIN)].

Background And Challenge: Injuries, especially traumatic brain injury, or specific illnesses and their respective sequelae can result in the demise of the patients afflicted despite all efforts of modern intensive care medicine. If in principle organ donation is an option after a patient's death, intensive therapeutic measures are regularly required in order to maintain the homeostasis of the organs. These measures, however, cannot benefit the patient afflicted anymore-which in turn might lead to an ethical conflict between dignified palliative care for him/her and expanded intensive treatment to facilitate organ donation for others, especially if the patient has opted for the limitation of life-sustaining therapies in an advance directive.

[Amendment to the documentation of decisions to withhold or withdraw life-sustaining therapies in consideration of wish to donate organs : Recommendation of the Ethics Section and the Organ Donation and Transplantation Section of the German Interdisciplinary Association of Critical Care and Emergency Medicine (DIVI) in collaboration with the Ethics Section of the German Society of Medical Intensive Care Medicine and Emergency Medicine (DGIIN)].

The Ethics Section of the German Interdisciplinary Association of Critical Care and Emergency Medicine (DIVI) recently published a documentation for decisions to withhold or withdraw life-sustaining therapies. The wish to donate organs was not considered explicitly. Therefore the Ethics Section and the Organ Donation and Transplantation Section of the DIVI together with the Ethics Section of the German Society of Medical Intensive Care Medicine and Emergency Medicine worked out a supplementary footnote for the documentation form to address the individual case of a patient's wish to donate organs.

[Change in therapy target and therapy limitations in intensive care medicine. Position paper of the Ethics Section of the German Interdisciplinary Association for Intensive Care and Emergency Medicine].

The task of physicians is to maintain life, to protect and re-establish health as well as to alleviate suffering and to accompany the dying until death, under consideration of the self-determination rights of patients. Increasingly more and differentiated options for this are becoming available in intensive care medicine. Within the framework of professional responsibility physicians must decide which of the available treatment options are indicated.

Recovery kinetics of heart rate and oxygen uptake in long-term survivors of acute leukemia in childhood.

Analysis of the recovery period following physical exercise has gained importance in evaluating cardiopulmonary capacity, not only in athletes but also in patients with proven or suspected heart failure. The purpose of this study was to apply these methods to long-term survivors of acute lymphoblastic leukemia (ALL) in childhood, who are at risk of developing anthracycline-induced cardiomyopathy. Nine children (mean age 12 years) and 10 adults (mean age 24 years) were included in the study after treatment for childhood ALL.

[Low molecular heparin for treatment of venous thrombosis in two very low-birth-weight pre-term infants with genetic risk factors].

We describe the use of low molecular weight heparin to treat venous thrombosis in two very low-birth-weight pre-term infants (GA: 30 and 27 weeks) both with genetic and acquired prothrombotic risk factors. Initially both infants were treated with unfractionated heparin. Since in one infant no effect on the thrombus size was observed and in the other infant there was an increase in size, the anticoagulation therapy was switched to subcutaneously injected low molecular heparin (Enoxaparin).

[Perinatal outcome of premature infants weighing less than 1500 g].

Background: Prematurity is a main issue in modern obstetrical care. The purpose of the present study was to evaluate the perinatal outcome of premature infants weighing less than 1500 g according to the mode of delivery.

Patients And Methods: 122 patients with infants weighing less than 1500 g were enrolled in this retrospective study (26 to 32 weeks of gestation).

[What is a Sufficient Blood Pressure in the Preterm Newborn?].

Hypotension is diagnosed in a high percentage of very low birth weight infants, particularly in the first 24 hours after birth and the resultant clinical approach is to support the blood pressure vigorously. However, the research base is not yet available to give a definite answer to the question, which blood pressure is really unacceptable in a given clinical situation. The clinical approach usually relies on reference blood pressure data or on clinical considerations.

Normal values of M mode echocardiographic measurements of more than 2000 healthy infants and children in central Europe.

Objective: To obtain normal M mode (one dimensional) echocardiographic values in a substantial sample of normal infants and children.

Design: Data were obtained over three years from a single centre in central Europe.

Patients: 2036 healthy infants and children aged one day to 18 years.

Congenital diaphragmatic hernia: ultrasonic measurement of fetal lungs to predict pulmonary hypoplasia.

Objective: The purpose of this study was to assess the value of biometric lung measurements for the prediction of severe fetal pulmonary hypoplasia in congenital diaphragmatic hernia and to determine whether a correlation between lung measurements and autopsy findings or neonatal outcome could be established.

Design: Prospective study, between 1991 and 1997.

Subjects: Nineteen fetuses with congenital diaphragmatic hernia.

[Prehospital emergencies (emergencies and acute cases) in childhood].

Objective: To determine incidence and management of prehospital emergencies in children.

Methods: Between November 15, 1994 and March 14, 1995 in the City of Mainz (200,000 inhabitants) children with the diagnosis of a prehospital emergency were identified.

Results: 390 children were discovered, 62% in the age group 0-3 years.

Physical performance in long-term survivors of acute leukaemia in childhood.

Unlabelled: The aim of this study was to assess the physical performance in long-term survivors of acute leukaemia in childhood and to evaluate the effects of anthracycline therapy. Electrocardiography, echocardiography and spiroergometry were carried out on 56 patients aged 9-28 years, of whom 44 patients had been treated with 15-483 mg/m2 doxorubicin (or equivalent). Acute leukaemia had been diagnosed 1.

Prenatal diagnosis of major malformations: quality control of routine ultrasound examinations based on a five-year study of 20,248 newborn fetuses and infants.

Antenatal ultrasound screening for birth defects is increasingly becoming a routine procedure of prenatal care. Prenatal detection of malformations and subsequent adjustment of obstetric management are essential for secondary prevention. It is unknown whether ultrasound screening is effective in all pregnant women, or should only be performed in high risk populations.

Pathophysiologic principles relevant for therapeutic procedures in persistent pulmonary hypertension of the newborn.

Though the various pathophysiologic mechanisms underlying persistent pulmonary hypertension of the newborn (PPHN) necessitate rather specific therapeutic concepts, in the majority of infants with PPHN management is mainly focused on the treatment of the symptoms respiratory failure and cardiovascular abnormalities. For the few neonates with severe PPHN who fail to respond to optimized conventional ventilatory support, high-frequency oscillatory ventilation and extracorporeal membrane oxygenation are available. Treatment of cardiovascular abnormalities should be based on knowledge of the pathophysiologic events in the heart and in the pulmonary and systemic circulation of the newborn with PPHN at least as far as these events are known or suspected based on animals studies.

[Anaphylactic shock].

Anaphylactic shock is a cardiovascular collapse that occurs after the interaction of antigen and antibody. Common causes of anaphylactic shock are drugs, foods, venoms, and heterologous serum. Mechanisms of anaphylactic shock are thought to be peripheral vasodilatation, enhanced vascular permeability, leakage of plasma, and intravascular volume depletion.