[Successful implementation of an "in-hospital resuscitation team" in a university hospital]. / Erfolgreicher Einsatz eines "In-Hospital-Reanimationsteams" in einem Universitätsklinikum.

BACKGROUND AND OBJECTIVE: Resuscitation is the most important emergency action in a life-threatening cardiopulmonary arrest. The organizational, personnel and equipment requirements for an optimal treatment of emergency patients in a university hospital are described, as well as the short- and mid-term results. PATIENTS AND METHODS: Retrospective analysis of 132 cases of cardiopulmonary resuscitation based on a two-pages reporting form whose completion by the involved physician and intensive care nurse is mandatory after each event. RESULTS: About 65 % of all events were triggered by cardiac and respiratory causes. In 50 % of all cases there was an acute life-threatening situation, requiring an intubation in 46 % and mechanical reventilation in 42 % of all cases. One third of all patients who were successfully reanimated were discharged alive from hospital after the intensive care treatment. CONCLUSION: A well organized and adequately equipped resuscitation team is the basis for achieving optimal chances of survival in life-threatening emergencies. This is especially so in large university hospitals with often care for patients with multiple morbidities.

[Process of organ donation at a maximum care hospital]. / Organspendeprozess an einem Krankenhaus mit Maximalversorgung.

BACKGROUND: A chronic shortage of organs for transplantation has developed due to the disparity between the demand for solid organs and the current supply. Improved processes for identifying potential donors could expand the pool of available organs. PATIENTS AND METHODS: All patients who died between January 1, 2006 and December 31, 2008 in the University hospital of Essen suffering from a primary or secondary cerebral injury were assessed retrospectively. Age, date of death, duration of stay in the intensive care unit, main and additional diagnoses and diagnostic test for assessing brain death as well as discussions with relatives were recorded anonymously. RESULTS: 424 deaths with primary or secondary cerebral injury (group A) were identified during the study period. 267 deaths (62.9 %) (group B) were further evaluated for organ donation after excluding absolute medical contraindications, e. g. malignancies, multiple organ failure. In 68 cases (16.0 %), diagnostic test of brain death had been completed (group C). Despite a high refusal rate, 36 (8.5 %) organ procurements were realized (group D) resulting in 140 transplanted organs (3.9 per organ donor). CONCLUSION: The first crucial step to improve the rate of organ donation is to identify any potential donor. In 8.5 % of intensive care unit deaths with primary or secondary cerebral damage, organ procurement was realized. In addition, education regarding transplant medicine and a positive attitude to organ donation among the general public as well as medical personnel is necessary to minimize the high refusal rates.

Postural responses to changing task conditions in patients with cerebellar lesions.

OBJECTIVE: To investigate the role of the cerebellum in postural adaptation for changes to the stimulus type of support surface displacements (backward translations v "toes up" rotations). METHODS: A group of 13 patients with chronic, isolated lesions of the cerebellum and 15 control subjects were tested. Automatic postural responses of the medial gastrocnemius and anterior tibial muscles were recorded. The first paradigm consisted of 10 rotational perturbations followed by 10 backward translations of the platform, and 10 backward translations followed by 10 rotations. The second paradigm consisted of 18 rotations and two randomly interposed translational perturbations, and 18 translations with two rotations randomly interposed. RESULTS: When the type of perturbation changed from an expected translation to an unexpected rotation and vice versa both control subjects and cerebellar patients showed an immediate and significant change in the response amplitude of the medial gastrocnemius and at the same time an immediate and significant change in the response amplitude of the anterior tibial muscles. Neither controls nor cerebellar patients showed effects of prediction in surface displacements of unexpected types of perturbation. Both controls and cerebellar patients showed no gradual increase in the gastrocnemius response in subsequent trials of surface translations following a block of 10 surface rotations and no gradual increase in the response amplitude of the anterior tibial muscle in subsequent trials of surface rotations following a block of 10 surface translations. CONCLUSIONS: Despite postural hypermetria, the integrity of the cerebellum does not seem critical for adaptation of postural synergies to changing stimulus types of surface displacements. The present results support previous findings suggesting that the main role of the cerebellum in automatic postural responses may be gain control.

Effects of a fixed combination of low dose nifedipine and acebutolol on essential hypertension: comparison with standard dose acebutolol.

114 patients from four clinics participated in a double blind study designed to assess the efficacy of a nifedipine-acebutolol fixed combination -10 mg + 100 mg - as compared with acebutolol -200 mg- in essential hypertension. During the ten week study the mean blood pressure readings (s.d.) 1-3 h after treatment decreased from 179.2/104.8 (10.2/6.2) to 150.3/87.7 (9.8/7.7) in the combination group and from 181.7/106.5 (14.4/7.0) to 150.4/89.0 (15.0/10.4) in the acebutolol group. The mean systolic and diastolic blood pressures were also decreased after exertion (load) and 24 hours after treatment at the end of the 6th week of the study. A doubling of the dose from week 7 to 10 did not change these figures. These results reveal the possibility of treating essential hypertension with a low dose of beta-adrenergic blocking agents in combination with 10 mg nifedipine. Both drugs were well tolerated. 3 patients (5%) in the combination group and 3 patients in the acebutolol group were withdrawn from the study because of headache and dizziness.