[Basic considerations for increasing flexibility of services in medical rehabilitation]. / Grundsätzliche Uberlegungen zur Flexibilisierung von Leistungen der medizinischen Rehabilitation.

Medical rehabilitation measures continue to be delivered nearly exclusively on an inpatient basis. A graded treatment concept comparable to those in place for instance in the acute or long-term care fields, is non-existent, while the medical need for a community-based ambulatory rehabilitation system is uncontested. Not least before a background of ever scacer financial resources among the rehabilitation agencies involved, non-inpatient rehabilitation has been gaining significance as it is generally hoped to achieve greater economy of service delivery. As a logical consequence, the demand for greater flexibility in delivering medical rehabilitation services and benefits is a focus of attention in the current rehabilitation policy debate. Greater flexibility in medical rehabilitation delivery means replacing portions of rehabilitation measures currently provided on an inpatient basis by partial-hospitalization or ambulatory service delivery; or continuing and complementing inpatient rehabilitation measures by non-inpatient ones; or using non-inpatient measures to provide aftercare post-discharge from inpatient rehabilitation. Moreover, ambulatory rehabilitation is intended to reach the population unamenable to attending far-away inpatient programmes. It is of utmost significance for the future evolution of ambulatory rehabilitation that the various financially responsible agencies involved in rehabilitation take a joint position on the subject of non-inpatient rehabilitation. Several proposals are submitted in this respect; for indications in the fields of neurology, orthopedics, cardiology, and geriatrics, catalogues of degrees of severity considered suitable for ambulatory rehabilitation are first presented.

Efficiency of heparin in the treatment of newborn infants with respiratory distress syndrome and disseminated intravascular coagulation.

Forty newborns with severe shock and disseminated intravascular coagulation were randomized for treatment with heparin or placebo. Mortality was equal in both groups. The heparin group required significantly shorter periods of artificial ventilation. The coagulation system improved faster, and the coagulation pattern showed normal values in the treatment group. Due to the low number of cases, these differences could not be statistically confirmed.

[Supplementary intravenous nutrition in term and preterm neonates (author's transl)]. / Supplementäre parenterale Ernährung bei Früh- und Neugeborenen.

16 term and preterm neonates received intravenous nutriton for at least three days. The dosage was 1--2 g amino acids, 1 g of fat, and 8--10 g glucose per kg body weight and day. Compatibility was investigated by daily determinations of the amino acid pattern in the serum and measurement of free fatty acids and triglycerides. All results were compared to five neonates who were fed completely orally from the first day of life. Leucine, methionine, proline, and valine levels were elevated during intravenous nutrition, but only the high methionine levels were regarded as a nutrional imbalance. Free fatty acids and triglycerides showed no significant differences as compared to the control group.

Etiopathology and classification of acquired coagulation disorders in the newborn infant.

In the newborn period low vitamin K dependent coagulation factors are frequently found in connection with normal global tests. To investigate this peculiar coagulation status studies were performed in 54 newborns who were divided into three groups according to their clinical course and the existence of bleeding. The results are compared to coagulation tests used for the diagnosis of disseminated intravascular coagulation (DIC). An early sign of an increased turnover of coagulation factors is a difference in the fibrinogen concentration determined by an immunological technique and a coagulation test which is sensible to fibrin(ogen)-degradation-products (FDP'S). At this stage factor II, V and VII levels are still within the normal range suggesting an increased production. In a more severe disturbance of the clotting system the increased turnover is no longer compensated by an increased production, and platelets and later on factor II and VII levels are lowered. At this early stage of DIC the vitamin K dependent factors are correlated to the factors I and V. Finally factors I and V drop as well. This stage in most infants is accompanied by the clinical symptom of bleeding. The clotting tests results are well correlated to the severity of the disease.

Pharmacokinetic investigations in adult humans after parenteral administration of the lysine salt of acetyl-salicylic acid.

The lysine salt of acetylsalicylic acid was administered intravenously to four volunteers and intramuscularly to three of them. The drug was tolerated without any observed side effects. Immediately after intravenous application most of the plasma salicylate was acetylsalicylic acid. The highest concentration of acetylsalicylic acid was found after 2 minutes, highest levels of salicylic acid after 60 minutes. Elimination of acetylsalicylic acid was relatively quick within the first period after intravenous administration according to a half-life of 8 minutes. Half-life of salicylic acid was determined to be 3 hours. Intramuscular application results in a constant blood level for a longer period. Bioavailability of acetylsalicylic acid was slightly lower after intramuscular application than after intravenous administration.

alpha1-Antitrypsin and alpha2-macroglobulin in newborn infants. I. The influence of perinatal complications.

The levels of alpha1-antitrypsin and alpha2-macroglobulin in the plasma of 129 newborns were determined. The infants were divided into 3 groups according to their perinatal history. In healthy newborns with an uneventful perinatal history the normal values for alpha1-antitrypsin were 1.97 +/- 0.44 g/l, and for alpha2-macroglobulin 3.11 +/- 0.69 g/l. No changes in these levels were found during the first week of life. The levels of alpha1-antitrypsin and alpha2-macroglobulin showed significant correlation to each other. In healthy newborns with different complications in the obstetric history the levels of alpha1-antitrypsin were not influenced, whereas alpha2-macroglobulin decreased slightly during the first week of life. The levels of alpha1-antitrypsin and of alpha2-macroglobulin showed no further correlation to each other. In sick term and preterm newborns (n = 18) alpha1-antitrypsin was increased in 5 of 7 babies suffering from bacterial infections and lowered in 4 of 9 cases with respiratory disturbances. Alpha2-macroglobulin was lowered in 15 babies. These results indicate different kinetics of the two antiproteases in vivo.

[The etiology of transitory hyperbilirubinemia in newborn infants]. / Zur Atiologie der transitorischen Hyperbilirubinämie des Neugeborenen

Recent investigations have shown that haemolysis plays a major role in the etiology of transitory hyperbilirubinaemia of the newborn. Our studies indicate that unconjugated bilirubin itself is in part the causative agent for this haemolysis. In vitro bilirubin causes damage of red cells which finally results in haemolysis. Newborns suffering from transitory hyperbilirubinaemia have a red cell population which is especially sensitive to the haemolytic effects of bilirubin. The initial bilirubin increase after birth is caused by relative dysfunction of the liver, causing further haemolysis of bilirubin sensitive red cells. Hyperbilirubinaemia decreases when all sensible red cells are destroyed and liver function improves.

[Problems of conductor demonstration in haemophilia A: error possibilities in the determination of factor-VIII-associated antigen]. / Zur Problematik des Konduktorinnen-Nachweises bei der Hämophilie A:Fehlermöglichkeiten bei der Bestimmung des Faktor VIII-assoziierten Antigens

Difficulties in the detection of haemophilia A carriers by the determination of the ratio factor VII coagulation activity to factor VII antigen concentration are shown in part one of our investigations. The second part evaluates methodical parameters of the quantitative immunoelectrophoretic technique. According to our results reliable data can only be obtained under the following conditions: 1. At least three determinations of each sample are required and the mean value should be used as the final result. 2. Each gel plate should be calibrated separately 3. The calibration line should include values less than 100%. Factor VIII concentrates are not suitable for determination of the calibration curve, as higer dilution results in lower calculated concentration of the undiluted concentrate. Storage of pooled normal plasma at--25 degrees C is possible without significant loss of antigen concentration over 5 months. However, plasma samples of a single person show an unpredictable variation in the antigen concentration during storage over the same time.

Effects of bilirubin on red cell metabolism.

Blirubin causes certain defects in erythrocyte metabolism, mainly in glycolysis. These effects of bilirubin were studied in vitro using a relatively physiological assay medium, which consisted of heparinized whole blood. Bilirubin was added in a small quantity of NaOH solution. In the presence of bilirubin a reduced glucose consumption of red cells and an accelerated depletion in the ATP and glycerate-2,3-bisphosphate concentration was found. Bilirubin levels lower than 50 mumol/l did not influence the glucose consumption. In agreement to other investigations it was established that bilirubin causes haemolysis of red cells. ATP-deficient cells are more sensitive to this effect.

[Retention of platelets in newborns (author's transl)]. / Retention der Thrombozyten bei Neugeborenen

In healthy, 24-72 hour-old newborns, platelet retention is significantly elevated compared to adults. A relationship could not be established between the retention and the erythrocyte count, bilirubin in the serum or the content of energy-rich phosphates in the erythrocytes. The above results indicate that the platelet function in newborns is elevated and/or comparable with the adult norm. The basic cause of the frequent symptoms of hemorrhage during the newborn period cannot be traced back to disturbed thrombocyte function.

[Heroin withdrawal syndrome in newborns (author's transl]. / Heroin Entzugssyndrom beim Neugeborenen

A case of a severe heroin withdrawal syndrom in a newborn infant is reported. Diagnostic and therapeutic aspects of the disease are reviewed.