[Project of the organization of cardiopulmonary resuscitation in the multidisciplinary hospital]. / Projekt organizacji resuscytacji krazeniowo-oddechowej w szpitalu wieloprofilowym.

The new standards of cardiopulmonary resuscitation (CPR), being the result of the World Health Organisation and the European Resuscitation Council studies, should be introduced to the hospital practice everywhere. The aim of this study is to create the project of organisation of the effective CPR system in the big, multidisciplinary hospital--Central Teaching Hospital of the Silesian University of Medicine in Katowice. We propose to establish the interdisciplinary Hospital Resuscitation Council (HRC) consisted of competent representatives of doctors and nurses from all departments with the head of department of anaesthesiology and intensive therapy as a leader of this group. The HRC will be responsible for introducing the effective teaching program of cardiac arrest assessment and basic life support for the whole hospital staff including physicians, nurses, nursing students and lay people. Clear rules of CPR-Alarm, call-system and "do not resuscitate" patients should be established and introduced. There is a need of elaboration of the uniform documentation system and continuous analysis of the effects of CPR activity in the hospital. Anticipated costs of this project are high but the safety of our patients and quality of medical service in the hospital will improve significantly.

Comparison of influence of thiopentone, propofol and midazolam on blood serum concentration of noradrenaline and cortisol in patients undergoing non-toxic struma operation.

The stress hormones plasma concentration after intravenous anesthetics (thiopentone, propofol, midazolam) administration in patients who underwent non-toxic struma operation was estimated. The goal of the study was to answer what stage of the general anesthesia and the surgery is the most dangerous for the cardiovascular system in term of stress hormones concentration and which of induction anesthetics used significantly alleviates undesirable reactions to surgical trauma and general anesthesia. 45 women aged 43 +/- 11, who underwent non-toxic struma operation and 16 women who underwent biliary gall-stones operation served as the 'study group and controls', respectively. Both groups were divided into 3 subgroups (in each a different anesthetic was used). Blood samples were taken at moments of increased stress during general anesthesia and operation. Intubation performed by laryngoscopy was found as the most stressful moment at which stress hormones are released intensively and can initiate cardiovascular disorders. According to our investigations, the suppression of the stress hormones (noradrenaline and cortisol) release was observed when propofol and midazolam were used for anesthesia induction for non-toxic struma surgery in contrast to thiopentone administration.

Effect of enflurane on selected neuropeptides and marker enzymes in rabbit brain.

The aim of this study was to evaluate the effect of 5-, 15-, and 60-min enflurane anesthesia on the levels of Met-enkephalin, Leu-enkephalin and neuropeptide Y in discrete areas of the rabbit brain. We also evaluated the effect of enflurane anesthesia on energetic, transport and catabolic processes by measuring the activities of succinate dehydrogenase, magnesium-dependent adenosine triphosphatase and acid phosphatase in the rabbit striatum and hypothalamus. Induction of anesthesia (5 min) decreased Met-enkephalin levels in the hypothalamus and striatum, and increased them in the hippocampus and mesencephalon. Induction of anesthesia increased Leu-enkephalin levels in all brain areas studied, except for the striatum, and increased neuropeptide Y content in the hippocampus. 15- and 60-min enflurane anesthesia increased Met-enkephalin content in the hypothalamus and hippocampus. After 15- and 60-min anesthesia, and after cessation of anesthesia, Leu-enkephalin levels were increased in the hypothalamus and mesencephalon, and were decreased in the striatum and hippocampus. In the striatum, neuropeptide Y content was significantly decreased during anesthesia and after cessation of anesthesia. Histochemical analysis revealed that enflurane enhanced ATP production, catabolic processes, and the rates of exchange and transport of energetic substrates in the striatum and hypothalamus. In conclusion, enflurane affects the levels of Met, Leu-enkephalins and NPY in a manner depending on the duration of anesthesia and the brain structure. Compared with isoflurane , which was studied in our previous study enflurane produces stronger alterations in the activities of enzymatic marker in the rabbit brain. This suggests that enflurane may be less safe than isoflurane.

[Spinal reflexes in the determination of brain death]. / Odruchy rdzeniowe w przypadkach z rozpoznana smiercia mózgu.

The authors present the results of spinal cord function evaluation in organ donors by examination of reflexes. The knee reflex and ankle jerk, as well as abdominal reflex and foot withdrawal reaction were tested in 31 donors. At least one of the above was seen in 25 individuals. It is suggested on the basis of data obtained not to hamper the transplant procedure in cases of tested reflex persistency when brain death is revealed on relevant examination.

Influence of isoflurane on enkephalin levels and on some indicatory enzymes in the central nervous system of rabbits.

The objective of this study was to analyse the effects of isoflurane anesthesia (lasting for 15 or 60 min) and isoflurane anesthesia termination (after 1 or 24 h) on met-enkephalin (MENK) and leu-enkephalin (LENK) levels in discrete brain areas and spinal cord segments in rabbits. Moreover histochemical analysis of activities of succinate dehydrogenase, magnesium-dependent adenosine triphosphatase (Mg++ATP-ase) and acid phosphatase in the striatum and hypothalamus were carried out to evaluate the effects of isoflurane anesthesia on energetic, transport and catabolic processes. Throughout anesthesia (15 and 60 min) and after its termination (1 h) the LENK contents were increased in hypothalamus, hippocampus, mesencephalon and lumbar segment of spinal cord. Moreover, during isoflurane anesthesia and after its termination (1 h) MENK and LENK levels decreased in cervical segment and MENK content dropped in thoracic segment of spinal cord. Histochemical data indicated, that isoflurane enhanced energetic processes as well as exchange processes in neurocytes, glial cells, capillary walls and ependymal cells of the third ventricle. Measurements of acid phosphatase activity provided evidence of no signs of toxicity of isoflurane in the examined areas. The changes in enkephalin levels observed during the isoflurane anesthesia and after its termination depended on the type of examined neuropeptides, as well as on parts of the brain and spinal cord studied. The changes observed after isoflurane administration in enkephalinergic system are discussed with regard to our earlier experiments with halothane and enflurane.

[Adrenal gland diseases--results of surgical treatment]. / Choroby nadnerczy--wyniki leczenia chirurgicznego.

The aim of the study is presentation of own remarks, related to surgical treatment of 183 patients with adrenal glands pathology in the years 1976-1996. The diagnosis was based on typical clinical symptoms and hormonal studies. The localisation of lesion was determined initially by X-ray examinations, mostly arteriography, later by ultra-sound and computer tomography, recently also by nuclear magnetic resonance and scintigraphy. The paper discusses methods of preparing the patients for surgery, tactics of surgical treatment, intra- and postoperative complications (8.2%), problem of incidentalomas.

Concentration of malonic dialdehyde in the cerebrospinal fluid as a measure of the intensity of lipid peroxidation processes in intracranial hypertension in small children.

The authors analyzed the concentration of malonic dialdehyde (MDA) in the cerebrospinal fluid (CSF) of children with intracranial hypertension. For the control group an intracranial pressure (ICP) of 250 mm H2O was taken as a reference point. The concentration of MDA was determined by a method using thiobarbituric acid. In a group of children with ICP values greater than the limiting value, the concentration of malonic dialdehyde was 0.629 mmol/mg protein, while in the control group with an ICP below 250 mm H2O, this value was 0.610 mmol/mg protein. The differences between the two groups were not statistically significant. from the results obtained it can be concluded that the concentration of MDA, as an isolated parameter, does not constitute a good measure of intensity of the lipid peroxidation processes in central nervous system (CNS) tissues, taken as an indicator of their disintegration in cases of hydrocephalus with intracranial hypertension.

[Evaluation of the usefulness of the laryngeal mask for general anesthesia in eye microsurgery--preliminary results]. / Ocena przydatnosci maski krtaniowej do znieczulenia ogólnego w mikrochirurgii oka--doniesienie wstepne.

PURPOSE: This prospective study was designed to compare intraocular pressure changes and haemodynamic response to insertion of either a laryngeal mask or an orotracheal tube during general anaesthesia for cataract surgery. MATERIAL AND METHODS: The effect of techniques (tracheal tube-TT, laryngeal mask airway-LMA) securing a clear upper airway on the heart rate changes (HR), arterial pressure (SAP, DAP), oxygen saturation (SpO2), end-tidal carbon-dioxide pressure (Et-CO2), intraocular pressure (IOP) and the incidence of coughing, stridor and sore throat was analysed in 60 patients undergoing cataract surgery during general anaesthesia. RESULTS: The mean values for HR, SAP, DAP and IOP measured before and after induction of anaesthesia were not different in both groups. After securing a clear airway, mean HR increased in TT group to 95.5/min and decreased to 75.7/min in LMA group. SAP increased in TT group to 131 mmHg, DAP to 82.6 mmHg, whilst in LMA group both values decreased to 98.6 mmHG and 66.3 mmHg, respectively. The significant difference in IOP values was observed after intubation or using laryngeal mask. In TT group, intraocular pressure increased to 15 mmHg in healthy eye and to 13.6 mmHg in ill eye whilst there was a decrease in LMA group to 5.5 and 7.43 mmHg, respectively. Furthermore, a greater incidence of such complications as coughing, stridor and sore throat in TT group was observed. CONCLUSION: The results show that using LMA in microsurgery during general anaesthesia is more advantageous and safer for patients in comparison with tracheal intubation.

[Intensive therapy of puerperal disorders with a life-threatening state caused by sepsis]. / Intensywna terapia poloznic w stanie zagrozenia zycia z powodu posocznicy.

The paper reviews intensive, complex therapeutical procedure introduced in 19 critically ill puerperal women due to severe sepsis. In 6 cases only the generative organ was the primary source of infection. It is underlined that sepsis can predispose to various complications and multiorgan failure.

[Analysis of therapeutic methods used in puerperium complicated by hemorrhagic shock]. / Analiza metod leczenia poloznic w stanie wstrzasu krwotocznego.

Methods of intensive treatment of puerperium with severe haemorrhagic shock of a dramatic course are analysed in the paper. In 20% of patients shock occurred due to non-obstetric reasons. It is stated, that haemorrhagic shock predisposes to various complications, which in turn require multidirectional treatment. It is stressed, that monitored therapy by means of adequately selected fluids should be supplemented by immediate and appropriate oxygen therapy.

[An attempt at optimization of diagnosis for patients in puerperium treated due to eclampsia and systemic complications in the Department of Anesthesiology and Intensive Therapy in the Silesian Medical Academy in Katowice]. / Próba optymalizacji diagnostyki poloznic leczonych z powodu rzucawki i powiklan narzadowych w Klinice Anestezjologii i Intensywnej Terapii Sl. AM w Katowicach.

Conditions under which episodes of eclampsia occurred in puerperal, who were than admitted to the Intensive Care Units for treatment are presentation the paper. Multidirectional diagnostic procedures introduced in those 30 patients are discussed. In the analysed group of patients various types of organ complications were diagnosed. The paper underlines value and benefits of the interdisciplinary consultation in diagnostic procedure in cases of dramatic and rapidly occurring complications overlapping existing puerperal status.

[Complex therapy of obstetric patients hospitalized for eclampsia and systemic complications in the Department of Anesthesiology and Intensive Therapy in the Silesian Medical Academy in Katowice]. / Kompleksowe leczenie poloznic hospitalizowanych z powodu rzucawki i powiklan narzadowych w Klinice Anestezjologii i Intensywnej Terapii Sl AM w Katowicach.

The paper reviews the treatment introduced to control cerebral oedema in 30 puerperal women with eclampsia, tonic-clonic seizures and symptoms of increased JcP. Methods of hypotensive treatment, introduced in 23 of 30 patients are presented. Other elements of the therapeutical management aimed at the maintenance of homeostasis, normothermia, normotension and normoglycaemia are also discussed in the paper. Patients required not only complex pharmacological therapy but also mechanical ventilation by means of respirator, often with use of special techniques.

[Malonic dialdehyde concentration in cerebrospinal fluid as an indicator of the intensity of lipid peroxidation processes in intracranial hypertension]. / Stezenie dialdehydehydu malonowego w plynie mózgowo-rdzeniowym jako wskaznik natezenia procesów peroksydacji lipidów w stanach nadcisnienia sródczaszkowego u niemowlat.

The authors of the study correlate malonic dialdehyde (MDA) concentration in the cerebrospinal fluid of infants with hydrocephalus with the values of intracranial pressure. The purpose of the study was verification of the usefulness of MDA concentration determination as an indicator of the processes of lipid peroxidation in CNS tissues in hydrocephalic children. The obtained results point out that the isolated MDA concentration is not a sufficiently precise marker of intracranial hypertension.

Influence of halothane on the level of enkephalins in discrete brain areas of rabbits.

With regard to the fact, that theory of anesthesia, based on the endogenous opioid peptides requires further investigations the aim of this paper was to measure the concentration of leucine- (LENK) or methionine-enkephalin (MENK) in discrete brain areas of rabbits during and after 1 h halothane (2% v/v) anesthesia. The level of LENK and MENK was measured in discrete brain areas using the radioimmunoassay. Animals were divided into the following groups, depending upon the duration of anesthesia: I-15 min; II-60 min; III-1 h after anesthesia termination; IV-control group of non-anesthetized animals. After halothane anesthesia evident decrease in the concentration of leu-enkephalins in hypothalamus (HT) and the opposite effect in hippocampus (H) were observed. The MENK level significantly increased after halothane (for 60 min) in hypothalamus, hippocampus and mesencephalon (M). The change in the level of LENK in the thalamus (Th), hippocampus and mesencephalon and in the level of MENK in the hypothalamus and mesencephalon persisted after withdrawal of anesthesia. It was found that the alterations in the level of enkephalins in discrete areas of rabbit's brain is a feature of halothane anesthesia. The explanation of this phenomenon is possibly important for the understanding of the mechanism of halothane anesthesia and requires further investigations.

[Assessment of anaerobic metabolism in central nervous system tissues in infants with intractable hypertension]. / Ocena przemian beztlenowych w tkankach osrodkowego ukladu nerwowego u niemowlat z nadcisnieniem sródczaszkowym.

Analogously to the blood lactate levels in conditions caused by impairment of peripheral circulation the authors sought a correlation between the concentrations of lactate, glucose and lactate dehydrogenase in the cerebrospinal fluid in children with hydrocephalus and the values of intracranial pressure as an important factor impairing oxygen supply to central nervous system tissues.

Influence of ketamine and its interactions with morphine and nalbuphine on the level of enkephalins in some parts of the brain and spinal cord.

The aim of this paper was to study the influence of ketamine in a dose of 80 or 160 mg/kg ip on the level of leu-enkephalin (LENK) or met-enkephalin (MENK) in some parts of the brain and spinal cord, as well as to examine the interaction of ketamine with morphine or nalbuphine on this effect. The influence of ketamine on enkephalins release into the brain perfusate was also studied. Ketamine decreased the spinal cord enkephalins concentration mainly in cervical and lumbar part. These effect was antagonized by naloxone. Ketamine administered in a higher dose increased LENK release, and decreased the release of MENK into the brain perfusate. Morphine (20 mg/kg ip) increased the level of LENK in the hypothalamus, decreased the concentrations of MENK in the medulla oblongata and in the cervical part of the spinal cord, and increased the level of this neuropeptide in the thoracic part of the spinal cord. These effects were antagonized by ketamine. Ketamine and morphine administered simultaneously affected the level of enkephalins in some of the studied parts of the brain and spinal cord. Nalbuphine administered in doses ranging from 1 to 20 mg/kg changed the level of enkephalins in some parts of the central nervous system. Ketamine and nalbuphine administered simultaneously changed the level of enkephalins in the spinal cord and in the hypothalamus. It is concluded that: the decrease of the level of enkephalins in the spinal cord is an evident feature of ketamine action mediated probably by opioid receptors. Ketamine affects the release of LENK and MENK from the brain in a different way.(ABSTRACT TRUNCATED AT 250 WORDS)

[A case of multiple congenital anomalies of the central nervous system with neural infection and respiratory disturbances]. / Przypadek mnogich wad wrodzonych osrodkowego ukladu nerwowego z neuroinfekcja i zaburzeniami oddychania.

The authors describe a case of an infant with hydrocephalus in whom respiratory disturbances occurred which were directly life-threatening. They present the differential diagnosis of this condition and put forward suggestions on aetiology and pathogenesis, based on the latest literature data.

[Etiologic bacterial factors of infections in patients treated at the clinical anesthesiology ward and with intensive therapy]. / Bakteryjne czynniki etiologiczne zakazen u chorych leczonych w Klinicznym Oddziale Anestezjologii i intensywnej Terapii.

Bacteriological investigations were carried on 264 patients treated in 1988-1990. 1736 samples of biological materials were taken and it amounts to 6-7 samples from each patient. Most frequently isolated microorganisms were: Pseudomonas aeruginosa (15%), Proteus mirabilis (13%), Klebsiella pneumoniae (10%) and Staphylococcus aureus (10%). Serological typing of Pseudomonas aeruginosa was performed according to Habs and domination of immunotype P16 (30%) was detected. Majority of isolated Klebsiella pneumoniae were not typable with basic and broadened phage set. One strain was susceptible to phages KI12 and KI27. This phage type was not isolated in Poland before. Staphylococci were most frequently susceptible to group II phages (29%), additional phages (19%) and 15% were not typable with the phage set used. Isolated bacteria were in majority resistant to numerous antibiotics.