[Importance of home care personally to individuals with advanced cancer and their families]. / Persönliche Bedeutung der Home Care für Kranke mit fortgeschrittenen Malignomen und deren Familien.

OBJECTIVE: The objective of the study is to evaluate the importance of home care for patients with advanced tumor diseases and for their families. METHODS: The analysis was based on structured interviews with relatives of patients with terminal tumor diseases. They had participated in the home care of 50 consecutively treated patients 2 years previously. The value of home care was evaluated on the basis of the personal experience of those concerned. RESULTS: The answers were largely consistent. The holistic concept of palliative therapy could be implemented by a specialized home care team at a high quality level. Under the favorable conditions of the familiar surroundings, an atmosphere of trust developed as a result of the cooperation with the family members, people close to the patients and with family doctors. It contributed to a relatively high quality of life and to alleviate the emotional stress. Most of those involved were able to accept the hand of fate. On this basis, the terminal phase could be satisfactorily arranged and preparations made for a good quality of death. During the home care, appreciation of the value of the family increased. The intensified family relations were mostly sustained after the patient's death. The results document the great personal importance of home care for patients, their caretakers and families. CONCLUSION: The positive experience and the awareness of having contributed substantially to coping with the life crisis made it easier for the bereaved to grieve and to rearrange their life.

[Therapeutic recommendations for the resuscitation of children]. / Therapieempfehlungen in der Reanimation von Kindern.

The general management and steps of cardiopulmonary cerebral resuscitation are the same for infants, children and adults: Airway management; Breathing, Cardiac compressions and Drugs to restart circulation and maintain cerebral and myocardial oxygen supply. However, priorities and techniques differ somewhat because of variations in size, physiology and cause of circulatory arrest. In pharmacological support there are several new aspects: The immediate correction of acidosis is not necessary in CPR and iatrogenic alkalosis has deleterious effects. Beta-receptor stimulators and calcium should not be used furthermore in CPR after cardiac arrest. Epinephrine was and is still the drug of choice in resuscitation. Drugs for cerebral resuscitation are still in a state of development.

[Orciprenaline (Alupent) in resuscitation for circulatory arrest? Experimental comparison between orciprenaline and adrenaline in dogs]. / Orciprenalin (Alupent) in der Reanimation nach Kreislaufstillstand? Experimenteller Vergleich zwischen Orciprenalin und Adrenalin an Hunden.

This study compares CPR with orciprenaline (8 dogs), with epinephrine (11 dogs) and without any drug (8 dogs) in cardiac arrest caused by anoxia. Resuscitation was successful in all animals of the epinephrine group and in 2 of the orciprenaline group. Spontaneous circulation could not be restored in any of the control animals. There was no difference in the occurrence of ventricular fibrillation between the drug groups. No fibrillation occurred in the controls. On the other hand, the incidence of successful defibrillation was significantly higher with epinephrine. The superiority of epinephrine was due to its having effected a significantly higher diastolic pressure during cardiac massage. The diastolic pressure decreased after orciprenaline injection to such an extent that coronary underperfusion resulted with consequent rise of serum CPK. We conclude that the use of orciprenaline is contraindicated in cardiac arrest.

[Treatment of severe febrile neutropenia (author's transl)]. / Zur Behandlung der schweren febrilen Neutropenie.

Random allocation of 22 patients with benign and malignant diseases with neutrophil counts of up to 1 X 10(9)/l blood and probably infection-caused fever of more than 38 degrees C to intravenous treatment with one of the following antibiotic combinations was performed: carbenicillin (6 g/m(2) . 6 h) plus sisomicin (45 g/m2 . 6 h) or mezlocillin (3 g/m2 . 6 h) plus sisomicin (45 g/m2 . 6 h). Both combinations were tolerated equally well. Patients became afebrile in 16 out of 23 treatment periods. Seven out of 11 patients responded to carbenicillin - sisomicin, and 9 out of 12 to mezlocillin - sisomicin. Mezlocillin thus leads to equal success of treatment in febrile neutropenia as the double dose of carbenicillin when both antibiotics are combined with the same aminoglycoside.

Intravascular fate of granulocytes administered by granujlocyte transfusions.

Granulocytes were harvested from hematologically normal individuals using continuous flow centrifugation (CFC) or filtration leukapheresis (FL). The isolated granulocytes were labeled in vitro by 3H-diisopropyl fluorophosphate (3H-DFP) and autotransfused. Their intravascular fate was analyzed by autoradiography. Immediately after autotransfusion the majority of granulocytes administered, collected in the marginal granulocyte pool. Margination was particularly prominent in granulocytes isolated by FL. The distribution of transfused granulocytes between the circulating and the marginal granulocyte pool showed wide and irregular fluctuations in time. Margination of transfused granulocytes was counterbalanced, and its fluctuation between the two intravascular pools was stabilized by prednisone treatment. The transit of transfused granulocytes from blood to tissue seemed to be governed by a random process, the half-disappearance time being either normal or prolonged. Compatible granulocytes administered to hematologically normal recipients circulated for at least 20 h.