Ionizing radiation in secret services' conspirative actions.

INTRODUCTION: The death of Litvinenko has been reported by the media. It has raised the question whether this case had been unique. The fall of the wall has allowed a glimpse in the planning and comporting of a secret service. MATERIAL AND METHOD: Documents of the secret service of the former German democratic republic (GDR), books of defectors, and media reports about secret service actions with radiating substances have been analyzed. RESULTS: Since decades, secret services have been using radioactive nuclides and radiation for their tasks. Several killings with radiation have been reported. A complicated logistic had been developed. CONCLUSION: Only singular cases of the employment of radiating substances have become known. It is probable that the majority rests unknown. Government support seems necessary in secret services' conspirative actions with radiating substance.

Continuous positive airway pressure effect on functional residual capacity, vital capacity and its subdivisions.

Thirty-four otherwise healthy patients having to undergo elective upper abdominal surgery were randomly assigned to two equal groups. In the treatment group, constant positive airway pressure (CPAP) with an expiratory pressure of 12 cm H2O was applied at one hour following extubation, and at daily intervals for the first five days following surgery for a continuous period of three hours. The control group received no CPAP treatment. All patients were given postoperative physiotherapy. In patients who received postoperative CPAP with an end-expiratory pressure of 12 cm H2O, marked normalization of pulmonary function was noted.

Carotid-cavernous sinus fistulas and venous thrombosis.

Radiographic signs of cavernous sinus thrombosis were found in eight consecutive patients with an angiographic diagnosis of carotid-cavernous sinus fistula; six were of the dural type and the ninth case was of a shunt from a cerebral hemisphere vascular malformation. Diagnostic features consisted of filling defects within the cavernous sinus and its tributaries, an abnormal shape of the cavernous sinus, an atypical pattern of venous drainage, and venous stasis. Progression of thrombosis was demonstrated in five patients who underwent follow-up angiography. Because of a high incidence of spontaneous resolution, patients with dural-cavernous sinus fistulas who show signs of venous thrombosis at angiography should be followed conservatively.

Atheromatous pseudo-occlusion of the internal carotid artery.

In the past year, three patients were referred for microvascular bypass surgery for relief of symptoms secondary to an apparently occluded internal carotid artery (ICA). Careful review of the late films of their initial arteriographic series or repeat arteriography with a specialized technique revealed a thin trickle of contrast medium flowing antegrade through a region of extreme stenosis. This thin line of contrast material ascended slowly to meet the column of contrast medium in the cavernous carotid segment that was filling by collateral circulation. Surgical exploration of the neck in these patients revealed a patent but collapsed ICA distal to a localized atheromatous plaque. These patients have been asymptomatic following carotid endarterectomy. This distinctive angiographic appearance may be described as "atheromatous pseudo-occlusion." Once recognized, carotid endarterectomy is the logical treatment of choice.

The influence of different ventilatory patterns on oxygenation and gas exchange after near-drowning.

After positive end-expiratory pressure (PEEP) valves for manually operated resuscitators became available it was of interest to find out whether PEEP should be applied at the scene of accident in nearly drowned patients. In 27 young pigs 25 ml of fresh water/kg body weight was instilled into the lungs via an endotracheal tube. After a period of apnoea (4 min) the pigs were ventilated artificially with 100% oxygen with either 5 cm PEEP or zero end-expiratory pressure (ZEEP). Within the PEEP group the AaDO2 returned to normal within the first 10 min after resuscitation, whereas the AaDO2 did not reach normal values for 2 h in the ZEEP group. The same observations were true for the PO2 values. Although the cardiac output decreased by almost 30% in the PEEP group, mean arterial pressures and heart rates remained unchanged. Lung weights and blood lactate concentrations confirmed that the same degree of water absorption and hypoxia had taken place in both groups. The conclusions from these experiments are that the application of 5 cm PEEP is part of the immediate measures of emergency treatment in nearly drowned victims.

The delayed use of positive end-expiratory pressure (PEEP) during respiratory resuscitation following near drowning with fresh or salt water.

Investigations on the delayed use of positive end-expiratory pressure (PEEP) following a standardized form of near drowning with 12.5 ml/kg body weight of either fresh or salt water were carried out on 14 anaesthetized and ventilated young pigs. After a 3-min period of apnoea the animals were ventilated with 100% oxygen and with either the same or an increased tidal volume, and a PEEP of 5 cmH2O delayed to 20 min, over a period of 2 h. In both fresh and salt water, initial values of PaO2 and AaDo2 were regained by the end of the period of observation when a delayed PEEP was applied. The intrapulmonary right to left shunt, which increased to 40% of the cardiac output, fell by a half within 10 min of beginning PEEP ventilation, initial values being regained after 120 min. During the period of apnoea the arterial partial pressure of carbon dioxide almost doubled, and, when the tidal volume remained unaltered, was still some 20-30% above initial values at the end of 2 h, despite the use of PEEP. Normal PaCO2 levels were achieved on increasing the tidal volume by a factor of 1.4. The larger tidal volume had no influence on either the degree of shunt or the PaO2. The effective compliance, which was considerably reduced after near drowning, increased again with the use of delayed PEEP ventilation. On beginning respiratory resuscitation there was an initial tachycardia and, despite a fall in stroke volume, an increase in mean arterial pressure and cardiac output because of the previous hypoxia. Only minimal cardiocirculatory changes, and no change in oxygen availability, occurred secondary to the use of PEEP.

A new positive end-expiratory pressure valve for manually operated artificial ventilation.

The application of positive end-expiratory pressure (PEEP) as part of artificial ventilation is currently considered a basic provision to provide adequate treatment of critically ill patients in intensive care units. Hitherto only the application of intermittent positive pressure ventilation (IPPV) with an end-expiratory pressure of 0 cm water was possible during manually operated artificial ventilation. A new PEEP valve which can be attached to manually operated resuscitators has been developed in co-operation with industry to meet this need. The technical details and experimental testing of the new valve have been presented in this paper. It may be connected via special adaptors to existing Ambu resuscitators, either for use on adults or on neonates, babies and infants. The valve has the characteristics of normal PEEP devices in that the resistances with various PEEP levels remain relatively independent of the flow and thus presents a true positive end-expiratory pressure rather than just an increase of expiratory resistance. The valve can be connected simply to nearly all types of simple and advanced respirators, such as those used for assisting respiration, physiotherapy etc., as well as being used with manually operated resuscitators.

The early use of positive end expiratory pressure (PEEP) ventilation in emergency medicine, and some experiments on pigs.

The effects on near drowning of young pigs of positive end expiratory pressure and zero end expiratory pressure were studied. The arterial PO2 and blood gases were examined during recovery from near drowning and after haemorrhagic shock. The cardiovascular parameters were measured after shock. The findings were considered in relation to the use of positive and expiratory pressure in patients. It was recommended that it be only administered by experienced staff in hospitals, and should not exceed 10 mbars, while 5 mbar was adequate and avoided complications in most cases.

Neurologic disorders: the many new uses of CT.

Every patient being evaluated for dementia deserves at least one CT study in the hope of discovering a treatable cause. Although many treatable causes of dementia are not necessarily diagnosable by CT, a careful observer may detect suggestions of such disorders in the CT findings. Presentations that prompt CT is rule out neoplasm in the brain include progressive neurologic deficits of insidious onset, new onset of seizures, and increased intracranial pressure.

[New animal experiments on aerobic and anareobic inner ear metabolism]. / Neue Tierexperiment zum Aeroben und Anaeroben Innenohrstoffwechsel

The inner-ear function is bound up with a permanent oxygen supply. The evidence of it are the patterns of the LDH subunits in inner-ear of eight species. The inner-ear energy turnover of glycolysis post-mortem was demonstrated at those species possessing glycogen storages. The MP2 are alterated by perfusion of glucose or iodoacetic acid. During oxygen respiration the MP are not decreased by iodoacetic acid.

The metabolic reaction of the cochlea to unphysiological noise exposure.

Guinea pigs were exposed to continuous white noise of 120 dB SPL. The performance included a recording of CM, pO2, and metabolites in the perfusate of the perilymphatic spaces. The metabolic reactions observed following the exposure are limited. No evidence of an overstimulation or of an insufficiency of the energy metabolism in the cochlea could be found. The results suggest the metabolic processes to be secondary to the sound-dependent damage of the organ of Corti after irreversible mechanical destructions in the hair cells.

[Clinical and experimental use of ATP in internal ear diseases]. / ATP-Anwendung bei Innenohrerkrankungen in der Klinik und im Experiment

Intra-arterial ATP infusions with glucose and hyaluronidase were successful in 267 patients suffering from various inner ear disturbances but particularly in sudden deafness. Good clinical results were noted not only in early-treated but also in later cases. Recently, we have also used ATP with hyperbaric oxygen, being successful in cases which were previously treated without improvement. Investigations in guinea-pigs, using artificial hypoxia as a model for human sudden deafness failed because the patterns are not the same. So long as an increase of ATP in the cochlear cells cannot be demonstrated after the i.a. infusions, only an unspecific mechanism can be held responsible for the undoubted clinical successes.

Demand as a driving force in medical innovation.

On the basis of two case histories of medical device innovation, two aspects of demand are identified: (a) the prospect of new markets and (b) information about user needs. Conditions for direct interaction between the user and producer in the innovation process are identified. The article concludes with some normative implications for the publicly designed generation of new medical technology.

Intracranial delivery of metrizamide from the lumbar subarachnoid space: prone versus supine positioning.

Forty patients undergoing metrizamide computed tomographic cisternography (MCTC) were prospectively evaluated for the relative merits of prone and supine positioning for the intracranial delivery of the subarachnoid contrast material. Twenty patients were prone and 20 supine when tilted head downward. The degree of opacification was deemed satisfactory or unsatisfactory in each case for the various ventricles and for the suprasellar, quadrigeminal, perimesencephalic, and cerebellopontine angle cisterns. The visualization of the suprasellar and perimesencephalic cisterns was much more often satisfactory using a prone delivery (p less than or equal to 0.05 by Fisher exact test). None of these structures was opacified significantly better with the patient supine. A prone delivery is therefore recommended for most of the common indications for MCTC.