[Analgesia in colon surgery. Can the use of NSAIDs reduce the opioid consumption following conventional and laparoscopic interventions?]. / Analgesie in der Kolonchirurgie. Kann die Verwendung von Nichtopoidanalgetika den Opioidbedarf nach konventioneller und laparoskopischer Kolonchirurgie senken?

BACKGROUND: The goal of our study was to evaluate the morphine-sparing effect of nonsteroidal anti-inflammatory drugs (NSAIDs) following both conventional and laparoscopic colon surgery. MATERIALS AND METHODS: In this prospective, randomized clinical trial, 180 patients were assigned to three groups. Two groups received either paracetamol or parecoxib/valdecoxib in addition to piritramid via patient-controlled or nurse-controlled analgesia pump. Patients in the control group received piritramid only. The total piritramid consumption during hospital stay was recorded. RESULTS: Total opioid consumption was significantly lower in the two groups who received NSAIDs. Comparing conventional and laparoscopic surgery, the latter group had much lower opioid consumption. CONCLUSION: The use of NSAIDs following colon surgery significantly reduces postoperative opioid consumption.

Pefloxacin in the treatment of nosocomial lower respiratory tract infections in intensive care patients.

Pefloxacin was used to treat nosocomial pulmonary infections in 46 mechanically ventilated patients. All patients had one or more underlying diseases and were given pefloxacin at a dose of 800 mg or 1200 mg daily in two or three divided doses. The commonest bacterial isolates were Staphylococcus aureus, Pseudomonas aeruginosa and enterobacteria. Of these patients, 33 (72%) showed a favourable response, one patient relapsed and 12 (26%) were considered failures. Superinfections occurred in 10 (22%). Of the 62 isolated potential pathogens, 53 (85%) were completely eradicated. Side effects were mild and treatment was withdrawn in only three patients. Pefloxacin can be considered as a possible therapeutic agent for the treatment of nosocomial pulmonary infections.

[Indications and diagnostic criteria for early ventilation of trauma patients]. / Indikation und diagnostische Kriterien zur Frühbeatmung von Unfallverletzten.

Mechanical ventilation is the potential therapeutic approach to traumatic brain lesion and acute adult respiratory distress syndrome (ARDS) in the wake of severe injury in an accident. Aggravating cerebral symptoms, such as non-targeted defence reactions in coma, hemiplegia, synergism of extension, convulsions, pontine respiratory disorders, and intracerebral pressure beyond 30 Torr are diagnostic criteria for immediate mechanical ventilation of patients with brain trauma. The same action is indicated for cases of ARDS exhibiting, on top of the typical constellation of causes, hypoxia below 60 Torr paO2 and vital capacity below 15 ml/kg body weight or respiratory rates in excess of 30/min.

[Anaphylactic shock during excision of an intraosseous Echinococcus granulosus cyst]. / Anaphylaktischer Schock beim Ausräumen einer intraossären Echinococcus granulosus-Zyste.

During the excision of a cystic tumor of the left proximal thigh under general anesthesia a severe anaphylactic shock was observed in a patient. This severe allergic reaction was due to the puncture of an Echinococcus granulosus hydatid during the preparation of a bone-plate covering the bony cyst of the left thigh.

[Use of Pseudomonas immunoglobulin in artificially respirated patients at an interdisciplinary surgical intensive care unit]. / Einsatz von Pseudomonas-Immunglobulin bei beatmeten Patienten einer interdisziplinären chirurgischen Intensivstation.

The clinical efficacy and safety of a new pseudomonas hyperimmune globulin for intravenous administration were examined in 30 patients in a prospective randomized study. Although the statistical evaluation of the measurable parameters did not show relevant differences between the therapy group (n = 15) and the controls (n = 15), the clinical course of the disease was markedly better in patients treated with hyperimmune globulin. In the control group, three patients died from Pseudomonas aeruginosa infections, but none in the therapy group. The preparation was very well tolerated.

[Use of pseudomonas immunoglobulin in ventilated patients at an interdisciplinary surgical intensive care station]. / Einsatz von Pseudomonas-Immunglobulin bei beatmeten Patienten einer interdisziplinären chirurgischen Intensivstation.

The clinical efficacy and safety of a new pseudomonas hyperimmune globulin for intravenous administration were examined in 30 patients in a prospective randomized study. Although the statistical evaluation of the measurable parameters did not show relevant differences between the therapy group (n = 15) and the controls (n = 15), the clinical course of the disease was markedly better in patients treated with hyperimmune globulin. In the control group, three patients died from Pseudomonas aeruginosa infections, but none in the therapy group. The preparation was very well tolerated.

[The "trend magnifier"--a methodological tool for patient monitoring]. / Die "Trendlupe"--ein methodisches Hilfsmittel für die Patientenüberwachung.

In different fields of patient monitoring there is an increasing knowledge about the clinical importance of variations of short-term patterns in the courses of vital parameters. They can be used as diagnostic hints and warning signs as well as means for therapy control. This paper first gives a critical survey of methods suitable to meet the resulting requirements in the operation theater and the postoperative intensive care unit. Then it presents a methodological tool which gives improved possibilities for detecting and analyzing meaningful patterns. Minicomputers or microcomputers are used to sample and to display both the primary signals and the courses of vital parameters (courses of extracted features) in three steps: The first step corresponds to the trend registration in conventional monitoring systems. The vital parameters are registered with sampling intervals between 10 and 30 seconds, and are held for the whole staying period of the patient. In the second step the same parameters are registered for a limited time span with sampling intervals in the order of a beat-to-beat registration. In the third step the primary signals are registered for a certain time span (in a ringbuffer). The sampling interval depends on the individual signal. It should be in the order of 10 ms. After having detected an interesting event, it can be located and studied in more detail by using the second- and third-step-display. From each display, a hardcopy on a multi-color plotter may be produced to overcome the display limitations of the CRT and to obtain legal documents.

An unusual sample of irregular anti-A1, probably causing an early delayed transfusion reaction.

An unusual case of a 37 degrees C-active irregular anti-A1 is reported. Apparently consisting mainly of IgG, the antibody appeared in an A2B recipient only two days after massive transfusion of A1-cells in absence of previous transfusion. It was associated with severe hemolysis and renal failure which was reversed after exchange transfusion.