Rupture of the aortic wall with compression of bronchial arteries

A case of closed traumatic rupture of the aortic wall with compression of the bronchial arteries is described. No comparable case has been reported in the literature so far. The effect on pulmonary perfusion and gas exchange is demonstrated. The compression, displacement and transportation of the bronchial arteries (vasa privata) is shown is postmortem angiography.

[Therapeutic problems after massive blood transfusions]

The term of massive blood transfusion is still today not clearly defined. Through the introduction of microfilters, however, the clinical problems were decisively reduced. Nevertheless, a persistent shock may also today lead to acute respiratory disease. Further difficulties present the buffering, the slow activation of erythrocyte function in stored blood, the sufficient fluid and electrolyte substitution as well as the observation of renal function and coagulation disturbance. The problems of rewarming the patient and warming the stored blood before transfusion are discussed. Special regard must be paid to early and long enough ventilation during and after massive blood transfusion.

[Interpretation of chest roentgenograms of intensive care patients. A comparison of pathoanatomical and roentgenographic findings (author's transl)]

Chest roentgenograms made within 24 hours of death were compared to the autopsy findings. Out of 150 unselected autopsy records of the years 1973/74 and 1976/77 50 and 91 cases respectively were suitable for evaluation. Since 1973/74 the radiographic technique has been considerably changed by the introduction of powerful condenser discharge equipment and the use of highly intensifying screens. Daily discussions with the physicians in charge of the intensive care unit and routine comparison of the pathological and radiological findings were also introduced. The success of these measures is reflected in the greater diagnostic accuracy in respect of the case material for the 1976/77 period. Comparison of the findings in cases of pulmonary embolism exposed the limitation of diagnostic radiology.

[Haemodynamic effects during hypotension with sodium nitroprusside neurosurgery (author's transl)]

Haemodynamic effects during hypotension with sodium nitroprusside in the surgery of cerebral aneurysms were studied in 16 patients. Sodium Nitroprusside caused arterial hypotension by a direct vascular musculotropic effect and it was found to reduce peripheral vasculare resistance, and to lower the bloodpressure in the right atrium and pulmonary arteries. Stroke volume decreased in the presence of tachycardia while there was no change in cardiac output. Its evanescent action and easy regulation make sodium nitroprusside suitable for controlled hypotension during cerebral surgery, especially since there are no negative haemodynamic effects.