[Early contributions from Erlangen to the theory and practice of ether and chloroform anesthesia. 1. Heyfelder's clinical trial with ether and chloroform]. / Frühe Erlanger Beiträge zur Theorie und Praxis der Ather- und Chloroformnnarkose.

The era of modern anaesthesia in Germany began on January 24th, 1847. This day, professor in ordinary Johann Ferdinand Heyfelder anaesthetized a patient with sulphuric ether in the clinic of surgery and ophthalmology of the University of Erlangen. By March 17th, 1847, Heyfelder had performed 121 surgical procedures under ether. The operations in majority were teeth-extractions, and a few more complex operations such as the treatment of a harelip or of lip cancer or the resection of the shoulder joint. Heyfelder described in detail 108 of these inhalations in a little book entitled The experiments with sulphuric ether. This monograph published in March, 1847, represents one of the first complete dissertations on sulphuric ether in the German literature. In a special chapter he analyzed the development of various physiological and psychological parameters during etherization. Heyfelder also examined blood and urine of some etherized patients and reported that he did not find any important or specific alterations. In 1847, Heyfelder was probably the first to apply salt-ether in man. After 4 administrations he concluded that salt ether acted more quickly but shorter than sulphuric ether. Advantageous were its application without problems and ease of induction. Disadvantageous were its high volatility, its price and the difficulty of getting it in a pure form. From December, 1847, on Heyfelder started to use chloroform. He was now able to perform more major operations, for example, the total resection of the hip-joint. In his book The experiments with sulphuric ether, salt ether, and chloroform he describes a great number of anaesthetic administrations using these 3 agents. In his summary Heyfelder concluded, that chloroform was undoubtly superior to sulphuric ether mainly because it was a quicker acting and longer lasting agent and leads to deeper narcosis. Moreover its application was much easier for it needed no special apparatus. However, because of its great anaesthetic potency, Heyfelder particularly demanded great caution in the application of chloroform. Explicitely he expected an assistant for chloroformizations, whose only duty was to supervise the inhalations and the patient--a forerunner of the modern specialized anaesthesiologist.

Phospholipase A--a parameter of sepsis? A comparison of PLA and Stevens' Sepsis Severity Score.

Phospholipase A (PLA) and Sepsis Severity Score (SSS) were measured regularly in 28 patients with sepsis (n = 11), pancreatic operations (n = 7), or multitrauma combined with contused abdominal trauma (n = 10). No linear correlation was found between these two parameters. A statistical correlation could be shown for the paired values PLAmax/SSS or PLA/SSSmax. They lie together above or below their "critical value" of 20 points SSS or 30 U/l PLA (alpha less than 0.05). The evaluation of mortality shows a distinctly higher significance for the SSS (P less than 0.01) in comparison with the PLA (P less than 0.05). In certain cases PLA was the first parameter which could have shown the beginning of a septic process.