[Does morphine have a life-shortening effect?]. / Hat Morphin eine lebensverkürzende Wirkung?

Morphine is a standard medication in pain therapy; opioids are grouped in step two and three of the WHO analgesic ladder. In palliative medicine, morphine is the preferred drug and is used for alleviating pain and reducing anxiety. When dosed correctly, a life-shortening effect can be definitely excluded today. Hence, the administration of morphine at the end of life cannot be called assisted suicide from a legal standpoint.

[Early recognition of brain death--a contribution to organ explantation]. / Früherkennung des Hirntodes--Ein Beitrag zur Organexplantation.

The criteria for brain death are presented and reference is made to the legally required observation period. To shorten the observation period, the Federal Medical Council (Bundesärztekammer) set out in 1986 possible aids to making decisions. The time at which extensive additional investigations should start makes it necessary to approximately determine the moment of brain death. The tear secretion test presented in this paper could be a further decision aid.

Interactions of liposomes with human erythrocyte ghosts.

Interactions between human erythrocyte ghosts and small unilamellar vesicles consisting of various lipids and containing high intravesicular concentrations of calcein were studied. The entrapped marker leaked out under the influence of erythrocyte ghost in dependence on ghost and vesicle concentration, phospholipid composition as well as cholesterol content of the liposomes. Small unilamellar vesicles composed of sphingomyelin/cholesterol mixtures at a molar ratio of 1:1 are less permeable than those prepared from other phospholipids in the presence of erythrocyte ghosts. The amount of ghost associated liposomal lipid was measured by addition of cholesteryl [14C]oleate. It was shown to be minimal compared to the transfer of [14C]cholesterol between liposomes and ghosts. The half-time of the transfer process was also increased by incorporation of sphingomyelin into the liposomes, the retarding effect being apparent at levels of 5 mol% sphingomyelin.

[Conflicting decisions in the border zone of dying and death]. / Entscheidungskonflikte im Grenzbereich Sterben und Tod.

Due to the success of reanimation, intensive medicine and organ transplants, new decision criteria and situations in medical care have arisen which can be determined legally and ethically, but without sufficiently considering related traditional human behavior. A particular aspect, the determination of brain death in connection with organ transplants, requires a further and better clarification. The current stage of dialogue is critically examined and recommendations for medical care and decisions are given.

[The cooperation between anesthesiologists and surgeons]. / Die Zusammenarbeit von Anästhesiologen und Operateuren.

With the development of anaesthesiology as an independent medical field, the anaesthesiologists were structurally brought together as an autonomous unit. They are not included in the leadership structure of the surgical institutions in which they work. Between surgeons and anaesthesiologists there is no system of super- or subordination. They participate in the operation on an equal footing. This requires regulation or responsibility in all phases of the operation and the postoperative therapy as well as an atmosphere of good team-work. In the interest of the patient, vital decisions are to be made jointly.

A survey of abomasal ulceration in veal calves.

Abomasal ulceration was found in 264 of 304 commercially reared veal calves at slaughter. The incidence and severity of lesions were greatest in loose housed calves with access to straw and fed milk substitute ad libitum. The majority of lesions were located in the distal pylorus. There was no evidence that the abomasal erosions and ulcers found in the majority of veal calves affected their growth rate or were deleterious to their welfare. It is suggested that pyloric ulceration may be related to the diet of veal calves.

Modulation of bone loss during calcium insufficiency by controlled dynamic loading.

Changes in the midshaft cross-sectional area of the ulna were measured in egg-laying turkeys on a diet insufficient in calcium. Left:right comparisons were used to assess the bone loss over a six-week period due to 1) calcium insufficiency, 2) calcium insufficiency plus disuse, and 3) calcium insufficiency and disuse interrupted by a short daily period of intermittent loading applied from an external device. Calcium insufficiency alone in the intact ulna resulted in a 15% reduction in cross-sectional area. In the functionally deprived bones this loss was increased to 32%. In bones where the disuse was interrupted by a single short daily period of loading, the degree of bone loss was significantly modified (P less than 0.006) to 25%. No significant difference in the modulating effect of loading was achieved by varying the peak strain from 0.0015 to 0.003, the strain rate from 0.01 to 0.05, or the duration of the single loading period from 100 sec per day to 25 minutes. All the loading regimes employed had been demonstrated to be osteogenic in mature male birds on a diet sufficient in calcium.

[Multiple organic replacement in intensive care medicine seen from anaesthesiological view (author's transl)]. / Mehrfachorganersatz in der Intensivmedizin aus anaesthesiologischer Sicht

Additional effective methods have to be studied for in order to improve further the treatment of life threatening conditions which are accompanied by reversible breakdown of organic functions. The development and the recent state of different technical and biological replacement functions are presented and their advantages and disadvantages are described. Temporary multiple organic replacement (lung, kidney, liver) by way of peripheral vessels offers a therapeutic procedure capable of development. This procedure is based on the knowledge that in different endogenous and exogenous intoxications, and also after shock symptomatology generally, several vital functions are simultaneously disturbed or become acutely insufficient. This coincidental breakdown requires a simultaneous, effective, multilateral therapy. First partial successes by means of equipment for multiple organic replacement are critically analysed and conclusions for further improvement of its function are discussed.

[Studies on the functional ability of swine liver perfused with human blood in machine recirculation attempt. 2. Behavior of serochemical parameters]. / Untersuchungen zur Funktionstüchtigkeit mit Humanblut perfundierter Schweinelebern im maschinellen Rezirkulationsversuch. 2. Mitteilung: Verhalten serochemischer Parameter

In the present paper is reported on the behavior of different serochemical parameters in heterologous perfusion of the liver of pigs. The perfusion of the animal livers was carried out with preserved human blood in 11 recirculation experiments (closed machine circulations). In addition to this an empty circulation with human blood without attachment to an animal liver was carried out, whereby otherwise the arrangement of the experiment was the same, in order to take into consideration the effects of the blood traumatisation in the interpretation of the results. The enzymes GOT and LAP proved as sensible indicators of the lesion of the liver cells occurring in the perfusion of the liver of the pigs. The behavior of the mitochondrial GDH as well as of the lysosomal enzymes SP and BETA-GC which scarcely increased during the recirculations in the perfusate blood, however, allows the conclusion that there did not appear a severe lesion of the liver cells (necrobiosis) during several hours of perfusion. A cholestasis did not develop during the perfusions, when one takes as basis the behavior of the enzymes AP, GGTP and AAP indicating cholestasis. Compared with GOT the enzyme GPT showed by far less elevations in the perfusate blood so that with increasing duration of the perfusion the De-Ritis-quotient significantly increased. Increased LDH-activities above all revealed the increasing during perfusion haemolysis and less reliably a lesion of the liver of the pig. The increase of ADA in the perfusate blood proved as nearly exclusively conditioned by haemolysis. Total protein, albumins, immunoglobulins, cholinesterase and thymol turbidity test remained unchanged in the course of the perfusions.

[Studies on the functional ability of swine liver perfused with human blood in machine recirculation attempt. Experiment design, elimination of indocyanine green, galactose, bilirubin and ammonia, synthesis of urea, bile secretion]. / Untersuchungen zur Funktionstüchtigkeit mit Humanblut perfundierter Schweinelebern im maschinellen Rezirkulationsversuch. 1. Mitteilung: Versuchsanordnung, Elimination von Indozyaningrün, Galaktose, Bilirubin und Ammoniak, Harnstoffsynthese, Gallensekretion

In 11 machine experiments of recirculation the abilities of survival and functioning of livers of dwarf pigs perfused with human preserved blood were tested with the help of the eliminations of indocyanine green, galactose, bilirubin and ammonia from a closed circulation. Further urea-nitrogen were measured as indicator of the urea synthesis and bile secretion. The perfusion of the animal livers was carried out in 9 cases only through the portal vein. The values of the blood flow were between 0.4 and 1.0ml pro g liver tissue and minute in portal pressure values about 15 cm water column. Two recirculations were carried out with additional flow through the hepatic artery with about 1/5 of the whole blood flow. The results of the experiments described prove a pretty good functional performance of the perfused with human blood livers of dwarf pigs during several hours. The different animal livers, however, showed at the beginning as well as during the further course of the perfusion clear differences concerning their functional capacity. Decrease of the blood flow values below 0.5 ml pro g liver tissue lead to functional loss. The additional flow through the hepatic artery yielded no better results, compared with the only perfusion of the animal liver through the portal vein.

[Simultaneous extra-corporeal oxygenation and haemodialysis in intesive medicine (a case report) (author's transl)]. / Simultane extrakorporale Oxygenierung and Hämodialyse in der Intensivmedizin (Fallbericht)

In the field of intensive care there is a rise in the number of patients with distrubed or defunct vital functions, in whom multilateral therapy on traditional lines fails. The necessity of introducing new forms of treatment has been the occasion for the development of a universal perfusion device for temporary artificial multiple-organ substitution in the Faculty of Medicine at the Martin Luther University Halle-Wittenberg. This apparatus makes possible the substitution of, or support for, the functions of lungs, kidneys and liver singly or combined, via the extracorporeal treatment of the blood. The shortterm use of the apparatus is intended to provide, in addition to functional substitution of the organs, the best possible conditions for the regeneration of damaged organs. A critical account is given of the clinical application of the apparatus.

[Experimental and clinical use of the mini-size bubble-bag thermooxygenator by the Rygg-Kyvsgaard method]. / Experimenteller und klinischer Einsatz des Mini-size-bubble-bag-Thermooxygenators nach Rygg-Kyvsgaard

The authors report on experimental and clinical use of the Mini-size-bubble-bag-thermooxygenator according to Rygg-Kyvsgaard. The advantages and possible applications are demonstrated. The Mini-size-bubble-bag-thermooxygenator is recommended for routine cardiosurgery on infants. The authors point at possibilities to use it in systems of extracorporeal circulation beyond cardiac surgery.

Laser modification to an x-ray collimator: an aid in positioning patients for neurosurgical and radiographic procedures.

In high-ambient-light levels such as are found in operating rooms, and at long target-to-patient distances, the cross lines and light field projected from conventional x-ray collimators are not easily visible and proper patient positioning is difficult. The collimators on two mutually perpendicular x-ray units have been modified by replacing the incandescent bulbs with lasers and adjusting the lasers to be coaxial with the x-ray beams. These modifications have been coupled with a third wall-mounted laser to facilitate patient positioning for stereotaxic thermal hypophysectomy. The use of the laser-modified collimators has resulted in considerable saving of time for the operating team and has markedly reduced patient anesthesia time. The laser-modified collimator has also been found useful in positioning patients for other radiographic procedures in the operating room and has virtually eliminated retakes due to malpositioning.