[Struma as a cause of a brachialgia]. / Struma als Ursache einer Brachialgie.

A 76-year-old woman with a great multi-nodular goitre and no neurological deficits suffered from increasing pain of the lateral upper arm. A combination of nerve blockades and physical measures was not effective in terms of continuous pain control. Subtotal thyroidectomy resulted in a long-term complete pain relief. The underlying mechanism is explained as a compression of the superior trunk of brachial plexus by a goitre. In future a goitre should be taken into consideration in the aetiology of a brachialgia.

[An accidental motor blockade of the femoral nerve following a blockade of the lateral femoral cutaneous nerve]. / Akzidentelle motorische Blockade des N. femoralis nach Blockade des N. cutaneus femoris lateralis.

One hundred fifty successful blockades of the lateral cutaneous nerve of the thigh according to the technique of Eriksson with 7-10 ml prilocaine 1% or bupivacaine 0.25% for meralgia paresthetica resulted unexpectedly in 4 cases of complete and 5 cases of partial motor block of the femoral nerve. The fully reversible paralysis or paresis of parts of the lower limb following blockade of the lateral cutaneous nerve of the thigh is explained as a partial 3-in-1 block.

[Risk assessment and preliminary treatment in patients with esophageal cancer]. / Risikoeinschätzung und Vorbehandlung bei Osophaguskarzinom-Patienten.

In 36 patients who underwent surgery for carcinoma of the oesophagus (21 patients subjected to blunt mediastinal dissection, 15 to thoracotomy) the preoperative status was determined by means of cardiopulmonary stepwise diagnosis and an individually adapted concomitant therapy was performed. A scheme for preoperative risk assessment which is equally important for both methods was evolved from the postoperative changes of VC, FEV1 and the preoperative values for RV/TLC, FEV1/VC, paO2 and paCO2 after retrospective analysis of the individual complication rates (60% cardiopulmonary). The 30-day lethality was 11%.

[Experience with extracorporeal CO2 elimination]. / Erfahrungen mit der extrakorporalen CO2-elimination.

The method of extracorporeal CO2-elimination (ECCO2-R) as described by L. Gattinoni [2] and Kolobow [5] is reported in ten patients with severe ARDS in whom conventional respirator therapy had failed. The method itself as well as important pulmonary function parameters, e.g. changes in gas exchange (Fig. 3), extravascular lung fluid (Fig. 6), and chest radiographs are explained. After 7-17 day treatment with the Life-Support System (LSS), seven patients were in satisfactory condition to allowing weaning from the ventilator (Responder). In three cases the lung mechanics and gas exchange were unchanged by the therapy with CO2 removal and high PEEP (Nonresponders). In the responders, oxygenation improved and the intrapulmonary shunt Qs/Qt (Fig. 4) decreased, followed by extravascular lung water and mean pulmonary arterial pressure (Fig. 5). Towards the end of the therapy we could find normalization of the compliance (Fig. 7) and chest X-rays, which may be interpreted as a cure. The results confirm our theory that ECCO2-R in combination with high PEEP and low-frequency ventilation seems to be an important method for future therapy of acute pulmonary failure.

[Hemodynamic effects of nalbuphine in patients with acute respiratory insufficiency]. / Hämodynamische Einflüsse von Nalbuphin bei Patienten mit akuter respiratorischer Insuffizienz.

Examination of haemodynamic changes, after 20 mg nalbuphine had been administered IV to 11 ventilated patients with acute respiratory failure, showed that on average pulmonary arterial mean pressure increased by 8% of the initial value. This increase was reversed after the test dosage was doubled from 20 mg to 40 mg nalbuphine. Regression analysis of the correlation between changes in pulmonary arterial mean pressure and patient age resulted in an increase in mean pressure by 0.1 mmHg per year after 20 mg nalbuphine. These findings suggest that nalbuphine must be carefully monitored in elderly and pulmonary risk patients.

[Bupivacaine 0.5% CO2 in spinal anesthesia]. / Bupivacain 0.5% CO2 in der Spinalanästhesie.

The clinical usage of 0.5% bupivacaine-CO2 for spinal anaesthesia was tested in 45 patients. The use of bupivacaine CO2 is safe, segmental dificits were not observed. Compared to bupivacaine-HCl the latency period is shorter (7.7 min), whereas the duration of maximal analgesic spread (105 +/- 31 min) is identical. 93% of the patients had a complete motor blockade. The solubility of bupivacaine-CO2 in CSF (1.75 mg ml-1) is more than double the solubility of bupivacaine-HCl (0.8 mg ml-1), thus lowering the risk of precipitation.

[How reliable is a hot-wire anemometer?]. / Wie zuverlässig sind Hitzdrahtanemometer?

To examine the advantage of hot-wire anemometer for clinical use, we have checked two types of this tools with respect to reliability and validity. It was found that electronic suppression of noise caused a distortion of the measurements. Furthermore changes of transducers were also responsible for deviations from true values. We require of the manufacturer to indicate the threshold of perception and the coefficient of variation for repeated measurements with several transducers. We recommend a simple rule which permits an estimation of the limits of reliable measurements for clinical use depending on the threshold of the equipment and on the parameters of ventilation.

[Blood and cerebrospinal fluid levels of bupivacaine in spinal anesthesia]. / Blut- und Liquorspiegel von Bupivacain bei Spinalanaesthesien.

Blood and liquor concentrations of bupivacaine were followed in 20 patients after spinal injection of 15 mg bupivacaine-HCl or bupivacaine-CO2; determination of the local anaesthetic was done by gas chromatography. Whole-blood concentrations of bupivacaine for both formulations lay between 0.2 and 0.3 microgram/ml. Two min after intrathecal administration of 15 mg bupivacaine, liquor concentrations averaged around 600 micrograms/ml, i.e., the precipitation threshold was not reached. Concentrations of individual patients, however, indicated that considerably higher concentrations can be attained; the possible reasons are discussed. Bupivacaine-CO2 represents a suitable preparation for spinal anesthesia, which, particularly with regard to blood levels, shows no disadvantages compared to bupivacaine-HCl.

[Continuous measurement of cations in the blood-stream of patients (author's transl)]. / Kontinuierliche kationenselektive Direktmessung im strömenden Blut am Menschen.

An electrochemical flow-through system in the blood-stream of patients is described, which allows continuous measuring of Na+-, K+- and Ca++-concentrations. The ion-selective electrodes show excellent selectivity constants. Activity potentials of greater than 97% of the theoretical measurement characteristics of the electrodes (Nernst-factor) could be achieved. This electrochemical measuring device makes it possible to measure continuously the electrolyte activities in the blood. Results of direct patient measurements are demonstrated.

[The effect of desoxycholate on the electrolyte and water absorption in the terminal ileum. Studies in conscious rats (author's transl)]. / Die Wirkung von Desoxycholat auf die Elektrolyt- und Wasserabsorption im terminalen Ileum. Perfusionsversuche an der wachen Ratte.

With an in vivo perfusion technique the influence of 10(-3) mol/l desoxycholate (DC) on the net electrolyte and volume absorption are studied in the terminal ileum of unanesthetized rats. Control experiments are performed in the same animal. The following data are observed: 1. There is a highly significant decrease in net Cl- absorption (p less than 0.002). 2. The Na+ and volume absorption is diminished or reversed into secretion. 3. The K+ secretion is enhanced (P less than 0.01). The sodium-water equivalent is reduced caused by alteration of the Na+ as well as the water permeability.

[Metabolites of bupivacaine in man (author's transl)]. / Metabolite von Bupivacain beim Menschen.

Following continuous epidural anaesthesia, the urine volumes of patients were collected. By gas-chromatographic analysis 6 metabolites of bupivacaine were identified: 1. Desbutylbupivacaine; 2. 3'-Hydroxy-bupivacaine; 3. N-Butyl-pipecolyl-2-amide; 4. and 5. monohydroxylated isomeres on the piperidine ring; 6. 4'-Hydroxy-bupivacaine.

[Regulatory mechanisms in the liver during enteral administration of hypotonic and hypertonic solutions. Studies in the waking rat]. / Regulationsmechanismen der Leber bei enteraler Zufuhr von hypotonen und hypertonen Lösungen.

The mechanisms of homeostatic regulation of the liver after enteral application of hypotonic and hypertonic fluids are studied. The experiments are carried out in unanaesthetized rats with indwelling catheters in aorta, vena portae and duodenum. A new technique of cannulating the vena hepatica in the rat is described. In this way the hepatic electrolyte clearance can be calculated. As can be estimated from the results, the liver functions as the main osmotic buffers between the enteral and the parenteral compartment. This is realized by absorption or secretion of water or electrolytes from the portal venous blood. The capacity of this homeostatic mechanism of the liver is influenced by the state of hydration of the animal.

Absorption of paraquat by rat gut in vitro. Regional differences.

The absorption of radioactively labeled paraquat was measured in rat ileum, jejunum and colon by a micro everted sac technique (Semenza and Muhlhaupt, 1969). The absorption rate increased linearly over the range of concentrations measured (10(-5) to 10(-2) M) and was enhanced by nearly 50% in the absence of sodium ions. The absorption rate decreased in the order: ileum, jejunum, colon whereby in the colon still 65% of the values of the small intestine were observed.

[The effect of unconjugated bile salts on the intestinal absorption of electrolytes and water in the proximal jejunum. Studies in conscious rats (author's transl)]. / Die Wirkung unkonjugierter Gallensäuren auf die Elektrolyt- und Wasserabsorption im proximalen Jejunum. Perfusionsversuche an der wachen Ratte.

With an in vivo-perfusion-technique the influence of unconjugated bile salts (cholate, desoxycholate) on the net electrolyte and volume absorption is studied in the jejunum of conscious rats. The applied doses correspond to physiological concentrations in the intestine of rats. Control experiments were performed in the same animal. Cholate and desoxycholate diminish the net electrolyte and volume absorption resp. cause a net secretion. The effects are largely reversible. The extent of net volume absorption depends on the applied dose of each bile salt. The possible mode of action of unconjugated bile salts on the electrolyte and water absorption in the small intestine is discussed.