[Investigations on pain reduction during peripheral angiography (author's transl)]. / Untersuchungen zur Schmerzverminderung bei der Extremitätenangiographie.

An attempt was made to reduce pain during femoral angiography by adding 1 mg. of Lidocaine/ml. contrast medium in the course of 95 examinations. In a further 87 patients, Diazepam was injected intravenously before the injection of the contrast-Lidocaine mixture. Pain and the feeling of heat was compared with a control group who received contrast medium with 10% physiological saline. There was a highly significant reduction in pain sensation as a result of Lidocaine; pain was further reduced by additional Diazepam, which also reduced heat sensation, but resulted in a fall in blood pressure. High risk patients did not suffer any significant complications. Lidocaine is well suited for out patients, but Diazepam requires a longer period of observation. General anaesthesia has been used only if patients insisted on it or if there was known contrast reaction.

[Midazolam in combination with piritramid versus Thalamonal in premedication in ambulatory ENT interventions in childhood]. / Midazolam in Kombination mit Piritramid versus Thalamonal zur Prämedikation beim ambulanten HNO-Eingriff im Kindesalter.

70 children aged between 15 months and 8 years who had to undergo outpatient surgery (adenotomy) were divided into two groups and given different premedication. Group A received Midazolam (0.15 mg/kg) combined with Piritramid (0.1 mg/kg), group B Thalamonal (0.04 ml/kg). Based on vigilance schemes, the degree of sedation and the mood tone were rated during initiation of anaesthesia, in the awakening phase and on discharge of the patient. Cooperation during initiation (via a mask) was definitely higher in group A (72%) than in group B (44%). During the awakening phase the children in group A showed a more balanced mood tone combined with improved vigilance. For example, 3 hours postoperatively 65% of the children in group A had got up and participated in getting dressed, whereas in group B only 11% of the children did so. Intramuscular premedication with Midazolam/Piritramid must be considered as especially advantageous in outpatient ENT treatment requiring a large number of small surgical interventions in children in respect of effective preparation and with a minimum of problems regarding postoperative follow-up.

Knowledge-based scheduling of duty rosters for physicians.

Applications of artificial intelligence methods to problems of common sense in medicine are rare. Our approach deals with a special class of resource allocation problems concerning fairness in the everyday life in a hospital. We treated the construction of a duty roster in a medical environment. We developed a fairness reasoning machine embedded in the expert system PEP for constructing a duty roster. Furthermore, we elicited and generalized knowledge about fairness between physicians. PEP has been used routinely. We observed a clear short cut of work time of the user in running it, and a 'fair' long-term allocation of physicians in the duty roster.

The prognostic value of pre-procedural plasma C-reactive protein in patients undergoing elective coronary angioplasty.

AIMS: The acute phase reactant C-reactive protein is an important prognostic risk factor in patients with both stable and unstable coronary artery disease. The potential prognostic implications of an abnormal pre-procedural C-reactive protein concentration in patients undergoing elective coronary angioplasty may be relevant for subsequent treatment. METHODS AND RESULTS: Pre-procedural plasma levels of C-reactive protein were measured in 501 patients with stable coronary artery disease undergoing elective coronary angioplasty. The incidence of death or myocardial infarction during a 2-year follow-up was 10.6% (24/227) in patients with an increased C-reactive protein level (>3 mg. l(-1)) and 2.9% (8/274) in patients with a normal C-reactive protein level (RR 3.9, 95% CI 1.7-8.9). Survival without death, myocardial infarction, urgent revascularization or hospital admission for unstable angina was significantly lower in patients with an increased C-reactive protein vs patients with a normal C-reactive protein (log-rank 14.62, P<0.0001). Logistic regression analysis identified an increased C-reactive protein level as a strong independent predictor of event-free survival (RR 2.54, 95% CI: 1.44-4.47, P=0.001). CONCLUSION: Pre-procedural C-reactive protein levels are increased in 45% of patients undergoing elective coronary angioplasty. An increased C-reactive protein level is a powerful independent prognostic indicator for subsequent cardiac events, suggesting that late clinical outcome is markedly influenced by pre-procedural systemic activation of inflammation.