[Preoperative autologous blood donation, effect of hydroxyethyl starch on the reticuloendothelial system and opsonins]. / Präoperative Eigenblutspende, der Einfluss von Hydroxyäthylstärke auf Retikuloendothelialsystem und Opsonine.

The effect of 6% low molecular weight (LMW) HES (MW 270,000) on reticuloendothelial function was studied in 9 male patients, median of age 50 years, who were scheduled for vascular surgery. An erythrocyte clearance test (Anti Rh) labeled with 99 mTc, evaluating primarily the splenic section of the RES, showed a considerable variation (37-87%) prior to hemodilution. 24 hours after replacement of 15 ml/kg body weight of blood, there was no significant change of the clearance rate, a follow up weeks later approached the base line values. Plasma opsonins like fibronectin, complement fraction 3, complement fraction 4 and immunoglobulin G showed a proportional decrease following hemodilution, and after 24 hours approached control levels. Changes at this time seemed to be independent from the course of the hematocrit. It is concluded that LMW HES does not adversely influence the spleen dependent phagocytic capacity of the RES system.

[Nifedipine and vecuronium bromide. How does a patient treated with calcium antagonists react to nondepolarizing muscle relaxants? Brief scientific communication]. / Nifedipin und Vecuroniumbromid. Wie reagiert der mit Ca-Antagonisten behandelte Patient auf nichtdepolarisierende Muskelrelaxantien? Kurze wissenschaftliche Mitteilung.

The muscle-relaxation reactions of Ca-antagonist (nifedipine) pretreated patients and a control group (5 in each group) were observed after administration of vecuronium bromide using the "priming principle." Twitch depression induced by the "priming dose" of vecuronium bromide (20 micrograms/kg body weight and T4/T1 ratio in the Ca-antagonist-treated patients (35 +/- 13% and 0.42 +/- 0.14%, respectively), was significantly different (P less than 0.01) when compared with the control group (1.2 +/- 2.7% and 0.75 +/- 0.15%). Similarly, the onset time to maximum blockade after the intubating dose of vecuronium bromide (60 micrograms/kg body wt.) was significantly shorter in the nifedipine group (40 +/- 21 s) when compared with the controls (100 +/- 17 s). The duration of the effect observed clinically (until 25% recovery) in the nifedipine group 32.9 +/- 7.3 min versus 25 +/- 8.15 min was enhanced; however, the difference between the treated group and the control group was not significant.

Rapid tracheal intubation with vecuronium: the priming principle.

Following the administration of a single 0.1 mg/kg dose of vecuronium bromide, satisfactory conditions for tracheal intubation developed in 156 +/- 12 s (mean +/- SEM), and the clinical duration of the initial dose was 36 +/- 2 min. When the initial dose of vecuronium was administered in two increments, a 0.015 mg/kg "priming" dose, followed 6 min later by a 0.050 mg/kg "intubating" dose, intubation time decreased to 61 +/- 3 s and clinical duration to 21 +/- 1 min. The priming dose that had no unpleasant effect on premedicated, awake patients could be administered 3-4 min before, and the intubating dose 2 to 3 min after induction of anesthesia. With the described technique, comparable intubating conditions could be obtained just as rapidly with vecuronium as with succinylcholine chloride, without subjecting the patients to the side effects of and the complications occasionally encountered with succinylcholine. An added advantage of the use of a priming dose is that it will reveal undiagnosed, pathologic, or idiopathic increase of sensitivity to nondepolarizing muscle relaxants.

[Behavior of renal filtration performance in the massive intraoperative administration of crystalloid solutions]. / Das Verhalten der renalen Filtrationsleistung bei grosszügiger intraoperativer Zufuhr von kristalloiden Lösungen.

Renal function of 12 adult patients was studied pre- and postoperatively using tracer techniques in a black-box model. Chrom 51 EDTA was employed to determine extracellular fluid volume and glomerular filtration rate, Iodine 125-albumin to measure plasma volume. These patients who received during two 4-h periods pre- and postoperatively 3 ml/kg/h of a salt-sugar solution had a significantly increased extracellular fluid volume postoperatively. Glomerular filtration rate was also increased, plasma volume was significantly reduced and colloidosmotic pressure in spite of attempts to supplement albumin solution intraoperatively was found to be postoperatively reduced. Hemodynamic parameters were virtually unchanged postoperatively with the exception of a small but significant increase of cardiac index. It is concluded, that these patients who received 12 ml/kg/h of crystalloid solutions apart from colloid replacement of measured bloodloss intraoperatively through natural regulation were about to excrete this extra amount of fluid, which had been relocated in the extracellular space. This regime, however, might help to decrease the rate of oliguric perioperative renal function failure, which has a high mortality.

[Multiple-stage treatment of malignant melanoma (author's transl)]. / 78. Die Mehrschritt-Therapie des Melanomalignoms

The paper reports on 11 patients with very advanced melanoma, who were treated with a modified version of multiple-stage cancer therapy. No improvement in the course of the illness resulted, but survival may have been slightly prolonged.

[Observations on the course of leucocytes in cardiac surgery under acupuncture-analgesia (author's transl)]. / Beobachtungen zum Verhalten der Leucozyten bei Herzoperationen in Akurunktur-Analgesie (Elektrostimulation)

In 11 cardiosurgical patients leucocyte and differential counts were made performed during and after surgery. In some cases Lymphocyte transformation and migration inhibitiontest was studied. Comparing cases under conventional neurolept anaesthesia with those who had acupuncture Analgesia (electrostimulation) it appeared that the number of leucocytes was rising significantly higher in the latter, although the total number of lymphocytes remained constant. In lymphocyte transformation and mirgration inhibitiontest the observed decrease seemed to be less pronounced. Because a trial applying acupuncture in healthy persons resulted in no change in the number of leucocytes, it is suggested that the surgical trauma and related catecholamine release might be of importance. No definite result could be obtained.

[Evaluation of exanthemas following high-dosage intravenous penicillin combinations in intensive care]. / Zur Wertung von Exanthemen nach hochdosierten intravenösen Penicillinkombinationen in der Intensivpflege

118 patients of a non specialized intensive care unit have been studied, all of them under high dose bactericidal cover (10 MIU of Na-Penicillin G and 2,0 Ciclacillin q 12 hrs.) for a period of days to 4 weeks. In 17 (14,4%) a skin rash was observed. 10 of these could be studied using special techniques (radial immunodiffusion, passive hemagglutination, RIST and RAST), however in none of these cases there was a hint of the existence of penicillin specific antibodies. In 6 patients also skin tests were performed. There was no immediate type reaction, only twice delayed type reactions occured to Na Pencillin G.6 patients had continuing treatment on spite of the rash and without further steps the effluorescences vanished within 3-6 days. Therefore continuation of the antibiotic therapy in spite of rash along with strict clinical and laboratory monitoring seems to be preferable to a hastened change of antibiotic regime

[The treatment of respiratory failure in severe chest injury (author's transl)]. / Die Therapie der Atemstörung beim schweren Thoraxtrauma

The use of artificial ventilation versus conservative treatment in 101 patients with severe chest injuries is reconsidered, because major ventilation therapy carries a high incidence of complications. This technique within the past few years has increasingly been replaced by differentiated conservative respiratory treatment. On the basis of a retrospective study it is concluded that under special conditions even the unstable chest accompanied by respiratory insufficiency may be treated successfully by this technique.