The ethics of psychopharmacological research in legal minors

Research in psychopharmacology for children and adolescents is fraught with ethical problems and tensions. This has practical consequences as it leads to a paucity of the research that is essential to support the treatment of this vulnerable group. In this article, we will discuss some of the ethical issues which are relevant to such research, and explore their implications for both research and standard care. We suggest that finding a way forward requires a willingness to acknowledge and discuss the inherent conflicts between the ethical principles involved. Furthermore, in order to facilitate more, ethically sound psychopharmacology research in children and adolescents, we suggest more ethical analysis, empirical ethics research and ethics input built into psychopharmacological research design.     

Allgemeine Aspekte der chirurgischen Therapie des nichtkleinzelligen Bronchialkarzinoms

Lung cancer is one of the most common cancers in industrialized nations, dominating in men but also increasing continuously in women. Complete surgical resection of the tumor remains the only curative therapy. A surgical approach requires precise preoperative diagnostic evaluation and staging of the carcinoma as well as the interdisciplinary discussion to determine the individual therapeutic treatment. Surgical therapy of lung cancer is stage dependent and often part of a multimodal approach including adjuvant or neoadjuvant radio- and/or chemotherapy. Close communication with associated specialties is mandatory. Surgical considerations for therapeutic strategies in different lung cancer stages are presented and indications for tumor resections are described. Furthermore, invasive staging techniques are discussed and preoperative evaluation of pulmonary function and its implications on extent of surgical resection are explained.     

Acute Hemodilution: Its Effect on Hemodynamics and Oxygen Transport in Anesthetized Man

The effects of acute normovolemic hemodilution on hemodynamics, oxygen transport, tissue perfusion and blood volume were studied. The subjects were four patients undergoing total hip replacement with prebleeding and hemodilution under fluoroxene and nitrous oxide anesthesia. The hematocrit was reduced to 29% and 21% by bleeding in two steps with simultaneous infusion of plasmanate and lactated Ringer's solution. The major compensation was a rise in CO to 123% and 136%. Systemic oxygen transport (COX arterial O(2) content) was only slightly reduced and the arteriovenous oxygen difference decreased. Tissue perfusion remained excellent. Blood volume was slightly expanded. The procedure was well tolerated by this group of selected patients, and homologous blood utilization was markedly reduced.     

Der Folien-Vakuumverband zur Behandlung infizierter Hautdefekte

Zusammenfassung Mit Hilfe einer aufgeklebten Plastikfolie und einer Redon-Saugdrainage kann das sich im Bereich osteomyelitischer Hautdefekte ansammelnde Sekret dauernd abgesaugt werden. Dadurch wird die Ausbildung von Granulationen begünstigt, welche schlie?lich eine plastische Deckung des Defekts mit Spalthaut erlauben.

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Summary Putrid secretion accumulating in osteomyelitic skin defects may be continously evacuated by suction drainage at which the defect is covered by a plastic foil. With time granulation takes place. At last skin grafting with Thiersch or Reverdin flaps will be successful.

     

Lumbar spine: pretest predictability of CT findings

Demographic and symptomatic data gathered from 460 patients referred for lumbosacral CT examinations were analyzed to determine if the prescan probability of normal or abnormal findings could be predicted accurately. We were unable to predict the presence of herniated disk on the basis of patient-supplied data alone. Age was the single most significant predictor of an abnormality and was sharply related to degenerative disease and spinal stenosis.     

Thoracentesis in the emergency department

Presented is a review of thoracentesis, a procedure with which the emergency physician should be familiar. The pathophysiology of pleural effusions is described and is followed by a review of the clinical presentation and diagnosis. Special attention is given to technique and interpretation of results.