[Defense mechanisms of the macro-organism in bacteriuria in chronic pyelonephritis]

In the course of 4 years we isolated 193 E. coli strains of 55 patients with chronic pyelonephritis. In patients with obstructive chronic pyelonephritis the mean value of the immunofluorescence titre (in the serum) to the E. coli strain excreted in the urine as well as the total complement were significantly increased, the serum lysozyme was significantly lower than in patients with non-obstructive chronic pyelonephritis. A relation to the activity of the disease was existing only in the non-obstructive chronic pyelonephritis, where in the active stage the total complement was significantly decreased, the complement factors C3 and C4 as well as the urine lysozyme were significantly increased in comparison to the inactive stage. 94.64% of all immunofluorescence titres obtained to the homologous strain in the patients' serum were above the border of the normal area of 1:40. A relation between level of the titre and activity of the disease could not be established. No significant differences could be proved between the titres taken to serum-sensitive and serum-resistant strains. In 32.73% of the patients we observed disturbances of the serum bactericidia against the homologous serum-sensitive E. coli urine strain at one or several points. They fall to equal shares to patients with obstructive and non-obstructive chronic pyelonephritis and were found at 66.67% in the active stage of the two forms of the disease. In patients with and without disturbances of bactericidia no significant differences in the total complement, in the complement factors C3 and C4, the C3-activator, the serum lysozyme and the immunofluorescence titres could be proved.

[Tolerance of 3.5 percent plasma protein solution]

In a prospective study we found 112 patients out of 9549 who had been given 3.5% plasma protein solution during the preceding year but no other blood derivatives and who had not received any immunosuppressive treatment. 68 patients agreed to be tested for sensitisation to 3.5% plasma protein solution. An intracutaneous test was performed as screening test. Two patients had a false positive reaction, but one of them had urticaria factitia and therefore a positive reaction to NaCl 0.9%. The other patient showed circumscribed reddening in the early phase only, whereas later readings were negative. Neither the test of total IgE by Paper Radio Immuno Sorbent Test (PRIST) nor the test for specific IgE antibodies by Radio Allergo Sorbent Test (RAST) showed any positive results. According to these findings there was no sensitisation to 3.5% plasma protein solution.

[Complications of Woodbridge tubes (spiral wire tubes)]

Flexometallic (armoured) tubes should have advantages in orofacial surgery and difficult positioning. They still have also the possibilities of tube obstruction, as shown in four case reports.

[High-dose piritramide basal anesthesia in experimental anesthesia and surgery]

On the basis of investigations of three groups of dogs (7 in each) the effects of high dosage piritramide anesthesia were analyzed. Using a standardized technique no significant changes in hemodynamics and microcirculation were found during 4 h. So variations in the "steady-state" must be attributed to additional medication or therapeutic intervention. High dosage piritramide anesthesia has been applied in more than 250 animal experiments.

[Cable attachment for wall rail systems]

A new device attachable to the wall rail systems affords tidy handling of cables in the intensive care unit or the operating theatre.

[A new weaning procedure (inspiratory flow assistance)]

Inspiratory Flow Assistance (IFA) refers to new breathing mode, able to diminish the work of breathing of a patient during spontaneous breathing with a respirator. By combination of IFA with CPAP or IMV it is especially useful during weaning from the respirator. The part of work of breathing done by the respirator. The part of work of breathing done by the respirator is only indirectly determinable. The measurements done on 10 long term ventilated patients during the weaning period show that only an IFA up to an airway pressure of 10 cm H2O above CPAP guarantees mainly spontaneous breathing, while an IFA up to higher airway pressures is more and more similar to an assisted ventilation.

[Cuff protection for nasotracheal intubation]

The passage of a tube through the nose to the epipharynx is potentially dangerous during the nasotracheal intubation because of the possibility of cuff damage, obstruction of the tube, the impossibility of advancing the tube and contamination. It seems therefore useful to protect the cuff e.g. by a finger stall, but using this procedure complications can occur which are reported. A better solution to protect the cuff will be shown.

[Adjustment of synchronized intermittent ventilation with the Drager Company's SIMV Pulmolog]

When choosing an IMV frequency in a respirator, the aim should be to guarantee a minimum of ventilation. With most respirators the "time-window" for the synchronisation of the mandatory stroke volume is within the ventilatory cycle. Thus, the IMV frequency corresponds to the adjusted minimum mechanical ventilation frequency and can be increased only by the patient's spontaneous breathing activity. With the Dräger "Pulmolog", however, the spontaneous breathing phase--not the ventilatory cycle--is already determined by choosing the IMV frequency. This difference is most important for daily clinical practice, as the minimum IMV frequency may be below the adjusted one. The manufacturer has reacted by changing the data on the manufacturer's label.

Oxygen transport during hemodilution in normoxic and hypoxic dogs treated with verapamil

In order to determine the possible limitations of acute isovolemic hemodilution in patients taking verapamil, the various factors determining oxygen availability were analyzed in an animal experiment. Twenty-four anaesthetized dogs were subjected to a gradual isovolemic hemodilution. Six dogs received a bolus injection of 0.1 mg kg-1 of verapamil followed by 0.01 mg kg-1 min-1. In 12 dogs, mild hypoxic hypoxia was induced by ventilation with 16-17% oxygen; six of them also received verapamil. Six dogs served as a control group. In the latter, due to an increase in heart rate and stroke volume, oxygen availability in the clinically relevant range of hemodilution between HC 25 and 25% was maintained at 81% of its control value. In normoxic animals treated with verapamil, oxygen availability decreased more rapidly and was below the level of the control group once HC reached 25%. Mild hypoxic hypoxia alone did not reduce oxygen availability as much as its combination with verapamil. Even though the verapamil-induced reduction in oxygen availability was similar during normoxia and hypoxia, the sharp rise in serum lactate at HC levels below 35-30% in the hypoxic verapamil group was a sign of impairment of tissue oxygenation. Hematocrit levels below 35-30% and even moderate hypoxemia should be avoided whenever the cardiovascular response to hemodilution is influenced by verapamil.

[A new modular system for respiratory therapy]

Diversification of respiratory therapy into humidification and secretolysis, oxygen therapy, augmentation of FRC, substitution of the work of breathing and changing inspiratory gas distribution is the basis of a modular device system. The basic unit of the modular system consists of an oxygen-air-mixer, a flow module and an emergency O2-supply for resuscitation bags. The system is preferably attached to the wall rail system and the modules locked into each other. The main advantages are: Reduction in the number of devices around the patient's bed, comprehensive setup; reduction of required storage capacity; cost reduction; easy integration at low cost of new therapeutical procedures; quick and easy change of therapy whilst maintaining basic parameters constant.

[Assessment of the value of sedation and mobilization in the therapy concept of mechanically ventilated patients]

Continuous improvements in intubation technology have caused a substantial change in the treatment of intubated patients. Whereas, until a few years ago, patients requiring intubation were sedated and treated by muscular relaxation for technical reasons, today sedation is no longer technically indicated. The patient is sedated so that he may be spared the potentially traumatizing psychic experience of machine ventilation. Recent investigations have shown, however, that the emotional strain to which intubated patients are subjected cannot be specifically attributed to artificial ventilation, but rather that it may occur in any severe physical illness. This strain may be eased by a positive relationship between the patient and the ICU staff. Routine sedation of intubated patients thus seems unnecessary. Nevertheless, there are some indisputable medical and psychological arguments in favour of sedation of intubated patients, including insufficiently stabilized fractures, states of restlessness, tetanus, intentional reduction of oxygen consumption, etc. Among the objectives to be achieved by mobilizing intubated patients are the following: restoration of the patient's autonomy, prevention of impaired consciousness, improved oxygenation. A meaningful performance of mobilization under both medical and psychological aspects is also described.

[Analysis of contemporary and future respiratory therapy]

Up to now there are no systematics of respiratory therapy, although those procedures of "conservative" respiratory therapy are well known since the last century. As ventilation will take over a part or the whole work of breathing of a patient this kind of respiratory therapy must be separated from the conservative therapy procedure, which is the focal point of respiratory therapy. This has been demonstrated by an analysis of respiratory therapy made on two different ICU's. From this analysis a system has been developed encompassing the whole range of respiratory therapy.

[Specific stress of intensive therapy: its analysis and suggestions for changes]

Proceeding from studies which make the environment of an intensive care unit responsible for psychopathological disturbances in thoracic patients, we made investigations on an operative intensive care unit concerning its influence on the psychical state of surgical patients. For this purpose photometry and noise measurements were made at the patient's bedside; additionally the environment of a ventilated patient was recorded continuously by means of a cine-camera. The results we obtained from noise measurements showed that all patients were affected with both sensorial monotony and sensorial overstimulation. Overstimulation results from sudden and unexpected noise (for example due to emergency admissions) on an intensive care unit. The analysis of the illumination intensity showed a day and night turn; that means, the patient was able to distinguish between daytime and nighttime but due to missing bearings no further temporal orientation was possible. The filmings demonstrated that there were numerous contacts between the patient and his environment which, however, did not last longer than 105 s on an average. These findings refer to the problem of the patient's social isolation; others show the loss of sleeping and resting stages. So the "resting stages", that means stages without visible contact, last between 1-3 min. In the light of the results, psychopathological disturbances in the patients of this intensive care unit are connected with the situational conditions of the unit. Suggestions concerning the removal of situational load-factors are deducible from these findings.