Clinical ex vivo lung perfusion--pushing the limits.

Ex vivo lung perfusion (EVLP) provides the ability to evaluate donor lungs before transplantation. Yet, limited prospective clinical data exist with regard to its potential to recondition unacceptable donor lungs. This paper summarizes the results of a prospective study of lung transplantation using only initially unacceptable donor lungs, which were improved by EVLP for 2-4 h. From March 2010-June 2011, 13 lungs were evaluated ex vivo. Median donor PaO(2) at FiO(2) 1.0/PEEP5 was 216 mmHg (range 133-271). Four lungs, all with trauma history, showed no improvement and were discarded. Nine lungs improved to a ΔPO(2) higher than 350 mmHg. Median PvO(2) at final assessment in these lungs was 466 mmHg (range 434-525). These lungs were transplanted with a median total ischemic time of 577 min (range 486-678). None of the patients developed primary graft dysfunction grades 2 or 3 within 72 h after transplantation. One patient with secondary pulmonary hypertension was left on a planned prolonged extracorporeal membrane oxygenation postoperatively. Median intubation time was 2 days. Thirty-day mortality was 0%. During the observation period, 119 patients received standard lung transplantation with comparable perioperative outcome. EVLP has a significant potential to improve the quality of otherwise unacceptable donor lungs.

[Levobupivacaine for regional anesthesia. A systematic review]. / Levobupivacain in der Regionalanästhesie. Eine systematische Ubersicht der klinischen Anwendungen.

Levobupivacaine [S(-)bupivacaine], the levorotatory S-enantiomer of racemic bupivacaine, is commercially available in the U.S. and in most European countries. We performed a systematic review (MEDLINE database) and identified 88 articles on the clinical application of levobupivacaine in more than 3,000 patients. The use of levobupivacaine is described for epidural, caudal, and spinal anesthesia, for peripheral nerve blocks, for ophthalmic and dental anesthesia, for different pediatric indications and for intravenous regional anesthesia. In these regional techniques, levobupivacaine was used for all common indications in a wide range of clinical settings. Epidural levobupivacaine was combined with fentanyl, morphine, sufentanil, epinephrine, and clonidine, spinal levobupivacaine was combined with sufentanil, fentanyl, and epinephrine. In most studies, levobupivacaine was compared to bupivacaine and/or ropivacaine.

Clonidine as an adjuvant to local anaesthetic axillary brachial plexus block: a randomized, controlled study.

BACKGROUND: We compared the effects of clonidine added to levobupivacaine and bupivacaine on axillary brachial plexus block as well as the effectiveness of levobupivacaine alone compared with bupivacaine alone. METHODS: In this prospective, randomized, controlled, double-blind trial, four groups of 20 patients each were investigated, using (i) 40 ml of levobupivacaine 0.5% plus 0.150 mg of clonidine, (ii) 40 ml of levobupivacaine 0.5% plus 1 ml of NaCl 0.9%, (iii) 40 ml of bupivacaine 0.5% plus 0.150 mg of clonidine, and (iv) 40 ml of bupivacaine 0.5% plus 1 ml of NaCl 0.9%, respectively. The onset of motor and sensory block and duration of sensory block were recorded. RESULTS: There was no significant difference in duration between groups, but a significantly higher variance (P<0.001) was found in the two groups with clonidine than in the two groups without. CONCLUSIONS: These findings suggest responder and non-responder behaviour is a result of the addition of clonidine.

Vasopressors for shock.

BACKGROUND: Besides reversing the underlying cause, the first line treatment for the symptoms of shock is usually the administration of intravenous fluids. If this method is not successful, vasopressors such as dopamine, dobutamine, adrenaline, noradrenaline and vasopressin are recommended. It is unclear if there is a vasopressor of choice, either for the treatment of particular forms of shock or for the treatment of shock in general. OBJECTIVES: To assess the efficacy of vasopressors for circulatory shock in critically ill patients. Our main aim was to assess whether particular vasopressors reduce overall mortality. We also intended to identify whether the choice of vasopressor influences outcomes such as length-of-stay in the intensive care unit and health-related quality of life. SEARCH STRATEGY: We searched MEDLINE, the Cochrane Central Register of Controlled Trials, EMBASE, PASCAL BioMed, CINAHL, BIOSIS, and PsychINFO:all from inception to November 2003; for randomized controlled trials. We also asked experts in the field and searched meta-registries for ongoing trials. SELECTION CRITERIA: We included randomized controlled trials comparing various vasopressors, vasopressors with placebo or vasopressors with intravenous fluids for the treatment of any kind of circulatory failure (shock). Mortality was the main outcome. DATA COLLECTION AND ANALYSIS: Two reviewers abstracted data independently. Disagreement between two reviewers was discussed and resolved with a third reviewer. We used random effects models for combining quantitative data. MAIN RESULTS: We identified eight randomized controlled trials. Reporting of methodological details was for many items not satisfactory: only two studies reported allocation concealment, and two that the outcome assessor was blind to the intervention. Two studies compared norepinephrine plus dobutamine with epinephrine alone in patients with septic shock (52 patients, relative risk of death 0.98, 95% confidence interval 0.57 to 1.67). Three studies compared norepinephrine with dopamine in patients with septic shock (62 patients, relative risk 0.88, 0.57 to 1.36). Two studies compared vasopressin with placebo in patients with septic shock (58 patients, relative risk 1.04, 0.06 to 19.33). One study compared terlipressin with norepinephrine in patients with refractory hypotension after general anaesthesia but there were no deaths (20 patients). REVIEWERS' CONCLUSIONS: The current available evidence is not suited to inform clinical practice. We were unable to determine whether a particular vasopressor is superior to other agents in the treatment of states of shock.

[Advances in treatment of congenital gastroschisis based on personal examinations]. / Postepy w leczeniu wrodzonego wytrzewienia na podstawie badan wlasnych.

The aim of the study was the definition of standard approach to a newborn with gastroschisis. The rules of treatment introduced in 1992 enabled the closure of the abdominal wall primarily in all newborns and made it possible to decrease the mortality considerably. This was achieved despite the fact that we usually did not have influence on time and method of delivery or quality of transportation to our department. In the Department of Pediatric Surgery of Institute Mother and Child, in the years 1992-1997, twenty three newborns with gastroschisis were admitted. The standard approach in all patients was the following: insertion of the catheters to the small bowel through the appenddicocaecostomy and to the large bowel through the rectum, intraoperative irrigation of the meconium (mucosolvan), forceful stretching of the abdominal wall, returning of extraabdominal viscera under control of central venous pressure or middle airway pressure (anesthesiologic control). In the postoperative period all patients routinely had controlled ventilation, administration of analgesic drugs, catecholamines, antibiotics and total parenteral nutrition. Intestinal catheters were gradually removed every day for irrigations of all levels. Oral nutrition was started after the return of effective peristalsis. From 23 treated newborns 16 are alive. 7 children died, 4 of them were resuscitated before operation because of severe general condition. Two patients died because of sepsis in the second month of life, one because of SIDS (sudden infant death syndrome) in the third week of life. Sixteen children are followed up. The development of all children is normal.

[Women serving the sick and the wounded in nineteenth century Russia]. / Kobiety w sluzbie chorych i rannych w Rosji XIX wieku.

The genesis of women's service to the sick and the wounded dates from the 1820s. At the instigation of the tsarist court, assistance to the sick and wounded was provided by the so-called "widows of charity" recruited at the empress's command from among the inmates of an institution for poor officers' widows, then the Sisters of Charity. As early as the middle of the century, the Sisters' charity work had taken on a twofold character: during peacetime they cared for the poorest inhabitants, mainly of large and small towns; during wartime they cared for the sick and wounded in areas of armed conflict. From the time of the Crimean War, the Sisters of Charity constituted a permanent medical presence in all the wars of the Russian Empire. They were involved in the transportation of the sick and wounded, field hospitals as well as land and ship hospitals. Their activities later became institutionalised. In peacetime they served the poorest of the population, working in municipal hospitals, often founded near their convents since their organisation was modelled on Christian monastic structures. Three categories of Sisters of Charity were established: Orthodox, Catholic, though very small in number, and secular - among them the Russian Red Cross, from 1867, and their service to the sick and wounded has taken on the name of a "female profession".

[Charity in nursing the sick]. / Pojecie milosierdzia w opiece nad chorym do XIX wieku.

The need for support in case of illness or poverty has probably existed ever since. In ancient times this need was indicated by means of a mythical Aesculapius staff. The importance of charity toward one's neighbors was already emphasized by Hippocrates, also in his wording of the medical oath. In those times, however, rationalism determined actual approach towards the sick or unfortunate, and such concepts as "charitas" or "misericordia" were unfamiliar in the contemporary Greece and Rome. The care for the poor and the needy, defined as charity, was adopted by Christianity from the orthodox legislature. In Hebrew it was signified by the words "hesed" and emet". In exegesis it was expressed in terms of selfless and sympathetic attitude to other people, which was also reflected by nursing the sick. However, in Christianity, it developed from the duty into a virtue improving both the supporter and the supported person. The basis for that was thanksgiving, as the answer to the God's mercy. The subject of mercy was then all the misfortune of man, including disease, and the source of charity absolute kindness aiming at eliminating destitution. Since the Middle Ages people have believed that the failure to perform the duty of charity virtue was the abuse of the divine law of ownership. This view became a factor of social dynamics. It made a purpose for the communities predestined to nurse the sick, including the female communities e.g. the charity sisters, or the male communities such as the brothers of the order. At the same time, it resulted in the fact that the commitment of women to the organized service provided to the sick enabled their social promotion and also, indirectly, it had an impact on increasing their role in the Catholic Church. This article, based on various sources, including among others the Old and the New Testament, the rules of orders, the statutes of charity associations, etc., constitutes an attempt to present the process of developing the care for the sick as well as the terminology related to the rules of charity towards other people and the Christian charity till the 19th century.

[The origins of the Polish medical and nursing care vocabulary until 1838]. / Poczatki polskiego slownictwa w dziedzinie opieki i pielegnacji chorych do 1838 roku.

The vocabulary concerning the patient care dates back to the times of early Christianity and presents the Latin etymology. Though meager limited to a few words, the lexical range that with the course of historical development formed the terminology still provides a basic notional framework valid till the present day in many European languages. The author depicts the way the Polish onomatology developed since the early Middle Ages till 1838 (the year the term the nursing of patients was used for the first time). She searches for borrowings, relations, analogies present in other European languages, mainly in Romance, German and English. She uses in her research monastic sources (monastery rules), church materials, hospital post-visit files, hospital regulations and instructions, guides and dictionaries. Urbanek focuses on the conditions and processes that affect the development of the Polish nomenclature. She attempts to define the range of the content and functions of the terms: medical care and nursing of patients.

[Changes in psychiatric care in the lands of Poland in the 19th century]. / Przemiany w teorii i praktyce opieki psychiatrycznej na ziemiach Polskich w xix wieku.

Due to the specific political and economic conditions under which Poland found itself in the 19th century, including above all the lack of independent statehood, any attempt to identify the directions of change in psychiatric care observed in the lands of Poland in that period can be undertaken mainly through an analysis of those scientific and general-purpose medical writings of the period which point to the formation and transformation in the physicians' awareness, rather than by an assessment of the particular practical achievements the transformations in health care as such. In her search for traces of the first mentions of new ideas in psychiatric care, the author analyzes the general-purpose writings of August Ferdinande Wolff and Jozef Frank, as well as the first specialist writings in the field, by Jozef Jakubowski and Jozef Korzeniowski, which appeared in the 1830 and 1840s. She indicates the sources of inspiration and describes the emergence of the so-called psycho-moral approach in treatment. At the same time she gives a background for the new ideas, by describing the realities of the psychiatric institutions of the time, where mechanical-surgical and somatic treatment predominated. She shows the effort made by such pioneers as, e.g., Klemens Maliszewski and Damian Reykowski of Vilnius, who brought about a change in the views on the etiology and prognosis of mental illnesses, and contributed to the gradual introduction of psychologically based treatments and to the inclusion of the care of patients in their treatment, especially since the 1870s, when new forms of psychiatric care had begun to appear, including psychiatric care outside hospitals.

[Semantic development of the word "nursing" after 1883]. / Rozwoj znaczeniowy pojecia pielegnowanie po 1833 r.

The process of semantic enrichment of the word "nursing" with new features of denotation lasted half a century until it finally, at the turn of the century, acquired the denotation of actions rendered to the sick person associated so far with health prevention in to-day sense of the word. The author shows the influence of cultural-social and medical inspirations on forming of the lexical force of the word. She pays attention to the significance of the effect of the romantic cult of woman and maternity on perception of the important role of the female element and its attributes in nursing. Furthermore, the author points to the national connotations and a special role of polish women in their attending the brother soldier wounded in the fight for independence. She brings out the therapeutic role of nursing in fighting pain and of the spiritual realm of a sick person. The author presents the stages of broadening of the definition substantial range including the moment when it was broadened with the psychotherapy elements. Furthermore, the author describes the evolution of the therapeutic - nursing procedures, the stimuli-oriented procedures and the so-called energy-saving effect. Participation of nurses in the observation of a sick person became a very important factor. The author points here to certain lateness in this respect as compared to the existing regulations in Europe. Forming and enrichment of the polish onomatology was accompanied by associating of the ability to nurse with the knowledge that was becoming more and more indispensable at the turn of the century in supporting of the physicians' efforts and in guarantying of the continuity and consistency of medical therapy.

[Method of saving a sick person's strength in 19th century medical therapy]. / Metoda oszczedzania sil chorego w XIX-wiecznej terapii medycznej.

Saving a sick person's strength through limiting physical exercise has been used since the early ages. Slowing down the pace of functioning of the human body was intended to cause the decrease in the body temperature, improve general feeling and accelerate the process of recovery. However, saving patient's strength as a therapeutic method had been described only three years before the end of the 19th century. It was presented by Seweryn Sterling in the publication Krytyka Lekarska (Medical Critique) in 1897, in article entitled Care of the Sick as a Therapeutic Agent. The author presents the most important concepts of the above therapeutic method.

[Treatment of chronic viral hepatitis B with interferon alfa. Experience of the last 3 years]. / Lécba chronické virové hepatitidy B interferonem alfa. Zkusenosti poslednich 3 let.

BACKGROUND: interferon alpha is nowadays the drug of choice in the treatment of chronic viral hepatitis. The objective of the present work was to assess the effectiveness of interferon alpha in the treatment of chronic active hepatitis B in our population and to test whether the known "prognostic factors" of successful treatment are applicable in our patients. METHODS AND RESULTS: In 1991-1994 a total of 25 patients were treated (15 men, 10 women, mean age 46.1 years, range 18-69 years) suffering from chronic active hepatitis B (HBsAg and HBeAG positive) with interferon alpha 2b (Intron A, Schering-Plough International ). Seroconversion to anti-HBe and the drop of serum aminotransferase activity was achieved in 15 patients (60%). Only in one patient within one year after termination of treatment a relapse developed. In the group of successfully treated patients the activity of serum aminotransferases before treatment was significantly higher. The mean duration of the disease was surprisingly longer than in the group where treatment failed (106 vs. 62 months), but this difference was not statistically significant. Only in two successfully treated patients during the second and third month of treatment acute exacerbation of the inflammation occurred and manifestations of hepatic insufficiency with subsequent slow improvement developed. In the remainder the activities of serum aminotransferases declined slowly to normal values.

[The socio-medical journal "Dzieje Dobroczynnosci Krajowey i Zagraniczney ..." in the years 1820-1824]. / Pismo spoLeczno-medyczne: "Dzieje Dobroczynnosci Krajowey i Zagraniczney ...", w Latach 1820-1824.

"Dzieje Dobroczynnosci Krajowey i Zagraniczney z wiadomosciami ku wydoskonaleniu iey sLuzacymi ..." [The Chronicle of Domestic and Foreign Philanthropy with news serving the improvement thereof ...] was the unofficial monthly publication of the Vilna Philanthropic Society, and was published in Vilna from the beginning of 1820 until the close of 1824. Today largely forgotten, this unique journal deserves to be brought back to light in view of the considerable topicality of its contents. The author describes the circumstances in which the journal came into being, as well as the composition of its editorial board and the editorial line it followed. She points out, among other things, the conception of socio-medical work that the journal promoted with a view to restricting the scourge of beggary and infectious diseases, especially small-pox. She also stresses that the journal sought ways of organizing socio-medical care in which a part would also be played by the State. The journal often made recourse, as its title indicates, to traditions of Polish and European charitable work. Finally, the author mentions that the journal served as a forum for promoting health education (being one of the first to do so in the Vilna region) and that it had a fairly wide circulation among the local public. The views presented in the journal reflected the ideas of the Age of Enlightenment as well as the nascent Romantic Age in Poland.

[The issue of "moral" therapies in the treatment the mentally ill as presented in Polish medical writing in the 1830s and 1840s]. / Problematyka leczenia "moralnego" psychicznie chorych w polskiej literaturze lat trzydziestych i czterdziestych XIX stulecia.

The beginning of the 1830s sees the appearance of a specialist approach to psychiatric topics in Polish scientific writing. The author discusses the two first scientific works in the field. The first is the little publicized and underestimated--in Polish historiography--work by the physician Józef Jakubowski of Cracow. The dissertation, entitled O metodzie psychicnej (On the psychic method), appeared in print in 1831. The other work discussed is the hitherto unknown manuscript of the dissertation O porzadku w domu zdrowia (On order in the health-house) written by professor Józef Korzeniowski of Vilna in the 1840s. Both works describe a new direction in Polish medicine, namely the "moral therapy" in the treatment of the mentally ill, which developed against the background of reminiscences of the Enlightenment and the emerging romanticism. The article analyzes the substance of the dissertations, which illustrate the contemporary state of knowledge, and the possibilities and conditions of treatment leading to a recovery of mental health. The two works also give an idea of attempts to define the developing terminology concerned with the concept of mental illness and with diseases recognized at the time. They reflect as well the social status of the mentally ill person. Above all, however, they supply information on the recommended methods and procedures in "moral therapy".