[New developments and findings in the field of opiates, opioids, opiate receptors and complete and partial opiate antagonists]. / Neue Entwicklungen und Erkenntnisse auf dem Gebiet der Opiate, Opioide, Opiatrezeptoren sowie der kompletten und partiellen Opiatantagonisten.

The historical development of the application of opiates is reviewed. After the detection and localization of opiate receptors in 1973, the clinical application of these substances has been scientifically and systematically developed. The function of the opiate system, the theory of opiate receptors, the opioid peptides, substance P as well as different opiates and analgesics are discussed in detail. The international trend in recent research efforts is aimed at finding a kappa-receptor specific opioid. The aim is to develop a selectively analgesic-acting opioid without respiratory depressant and addictive effects and without cardiovascular and excitative side-effects. Although major progress has been made in synthesizing the partial opiate agonist and opiate antagonist nalbuphine ++ (nubain), it has not yet been possible to develop a drug completely corresponding to ideal concepts.

[Catecholamines in the treatment of the low cardiac output syndrome following heart surgery with extracorporeal circulation]. / Katecholamine in der Therapie des Low-Cardiac Output Syndroms nach Herzoperationen mit extrakorporaler Zirkulation.

The aim of this study was to estimate the effectiveness of different mono- and combination therapies with catecholamines (dopamine, dobutamine, adrenaline and noradrenaline) in the treatment of low cardiac output syndrome after open-heart surgery. All together 425 patients treated at the Intensive Care Unit of the Clinic for Anaesthesiology and Intensive Care Therapy of the Martin Luther University Halle-Wittenberg after open-heart surgery from 1985-1986 were examined. The low cardiac output syndromes were characterised by the following parameters: mean arterial pressure (MAP), heart frequency (HF), central venous pressure (CVP), diuresis and mixed venous oxygen saturation (SvO2). Recommendations were given for evaluating the grade of low cardiac output syndrome and for selecting whether a mono- or a combination therapy is necessary and which dose should be given. Thus, the pretherapeutical signs MAP 50 mm Hg and presence of 3 disturbed signs characterise severe low cardiac output syndrome and make necessary the primary combined application of catecholamines. Two investigated signs connected in a mathematical formula can help to determine when during a low-cardiac output state a dopamine-monotherapy should be replaced by a combination therapy of catecholamines. It was found, that the doses of dopamine increased proportionally to the reached level of catecholamine combination. Therefore, doses of catecholamines should be kept in their recommended range with their specific receptor-mediated effect.

Cystic craniopharyngioma treated by 90yttrium silicate colloid.

UNLABELLED: Fourteen children and 3 adults with cystic craniopharyngiomas were treated with intracavitary 90Y, by the procedure described by Backlund. Their ages ranged from 2 to 65 years and postoperative follow-up ranged from 6 to 40 months. Leksell's stereotactic technique was employed to determine coordinates by CAT. Cyst volume was quantified both geometrically and isotopically with 99Tc, values differing by 7%. Dosimetry was determined by applying the formula developed by Loevinger et al., and 20,000 rads were administered throughout to the cystic wall. All 17 patients, except for 4 children, had previously received surgery, shunts or radiotherapy, alone or combined. In 4 cases, 90Y injection was the only treatment, while in 6, the cyst was evacuated at 10 days following radiocolloid injection. Skull and spinal column gamma chamber studies were carried out on all patients at 24, 48, and 72 hours post injection, but no isotope leakage could be detected. The patients returned to normal activities except one with multiple cysts who died. There were no changes in the endocrinologic profile. In one case, a decrease in visual acuity 18 months after treatment, improved following corticoid administration. CONCLUSIONS: Though preliminary, these results are encouraging since it seems that the severe neuro-endocrinologic sequelae of open surgery may be avoided.

Leucoencefalopatia multifocal progresiva y síndrome de inmunodeficiencia adquirida (SIDA) / Progressive multifocal leukoencephalopathy and acquired immunodeficiency syndrome (AIDS)

La LMP es una enfermedad infrecuente del sistema nervioso central, de tipo desmielinizante y de origen viral (Papova JC) que afecta a pacientes inmunodeprimidos. El SIDA se ha sumado a las afecciones que favorecen el desarollo de la LMP, debido al trastorno inmune que ocasiona. Se relata el caso de un enfermo de 45 años, con criterios clínicos, epidemiológicos y serológicos de infección por HIV, que padeció en su evolución un cuadro neurológico de pogresión subaguda. La clínica y los exámenes complementarios orientaron el diagnóstico de LMP. Esta presunción fue confirmada histológicamente, detectandose el agente causal en las lesiones. Se destaca, asimismo, la asociación de una entidad infrecuente (LMP), con otra de interés creciente (SIDA) en nuestro medio

Leucoencefalopatia multifocal progresiva y síndrome de inmunodeficiencia adquirida (SIDA) / Progressive multifocal leukoencephalopathy and acquired immunodeficiency syndrome (AIDS)

La LMP es una enfermedad infrecuente del sistema nervioso central, de tipo desmielinizante y de origen viral (Papova JC) que afecta a pacientes inmunodeprimidos. El SIDA se ha sumado a las afecciones que favorecen el desarollo de la LMP, debido al trastorno inmune que ocasiona. Se relata el caso de un enfermo de 45 años, con criterios clínicos, epidemiológicos y serológicos de infección por HIV, que padeció en su evolución un cuadro neurológico de pogresión subaguda. La clínica y los exámenes complementarios orientaron el diagnóstico de LMP. Esta presunción fue confirmada histológicamente, detectandose el agente causal en las lesiones. Se destaca, asimismo, la asociación de una entidad infrecuente (LMP), con otra de interés creciente (SIDA) en nuestro medio (AU)

[Determination of intrapulmonary shunt in acute lung failure and during therapy by means of extracorporeal oxygenation (author's transl)]. / Quantitative Ermittlung des intrapulmonalen Shunts bei akutem Lungenversagen und während der Therapie durch extrakorporale Oxygenierung.

The reasons for the especial importance of acute lung failure within the framework of intensive medicine are elaborated. In most cases acute lung failure can be successfully treated by timely ventilation and support for the heart-function. If conventional therapy fails, extracorporeal long-term oxygenation by means of a membrane oxygenator can be a successful technique, provided that a very critical indication is available. The magnitude of the intrapulmonary right-left shunt S is an important parameter for the assessment of the extent of acute lung failure and its prognosis, and also in the establishment of the indication for the use of extracorporeal oxygenation and the therapeutic process. The derivation of simple extended shunt equations for any form of extracorporeal oxygenation is possible on the basis of measurements of blood-flow and oxygen transport. This represents an important contribution to the mathematical description of a therapeutic technique.

[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.