215. Probleme des Verhältnisses von Ärzten zu den medizinischen Assistenzberufen

Zusammenfassung Arbeitsteilung hat zwei Aspekte: 1. den vertikalen Aspekt der Delegation von Aufgaben an geringer qualifizierte Mitarbeiter. Prinzip: Weisung und Durchführung. 2. Den horizontalen Aspekt der Teilung der Gesamtaufgabe zwischen verschieden qualifizierten Mitarbeitern. Prinzip: Partnerschaft und Kooperation. Pflegepersonal und andere Assistenzberufe sind ständig unter beiden Aspekten tätig: Sie haben ärztliche Aufträge durchzuführen wie auch autonome Aufgaben wahrzunehmen. Konflikte entstehen durch unklare Abgrenzung der Verantwortung und durch zeitliche und fachliche Cberforderung der weisungsgebundenen Mitarbeiter.     

Bindung und Wirkungen des Formaldehyds an Erythrocyten

Zusammenfassung 1. Mit Hilfe einer von Nash angegebenen Methode wird Umfang und Verlauf der Formaldehydbindung an rote Blutzellen bestimmt. Die Bindung ist innerhalb von 10 min vollendet, sie ist nu teilweise reversibel, und die Abhängigkeit der gebundenen Menge von der Aldehydkonzentration weist auf einen uneinheitlichen Bildungspartner in der Zelle hin.Die gebundene Menge ist mäßig proportional dem Zellvolumen. Sie nimmt mit steigender Wasserstoff-Ionen-Konzentration nur wenig ab.2. Es wird an Hand von einfachen Versuchen und elektronenoptischen Aufnahmen gezeigt, daß bestimmte Strukturelemente in der Zelle durch Formaldehyd fixiert werden, bevor noch erhebliche Störungen des Stoffwechsels der Zelle nachweisbar sind.Als Beispiele solcher fixierter Strukturen wird der Zellkern von Hühnererythrocyten sowie ein konkretes Struktur-bestimmendes Element von Säugererythrocyten nachgewiesen. Bei den letzteren läßt sich ferner zeigen, daß die Bindung einer permeabilitätsbestimmenden Oberflächenschicht an die darunter liegenden Zellstrukturen durch Formaldehyd verfestigt wird.3. Es wird das elektronenoptische Bild von Formaldehyd-fixierten Zellmembranen der roten Blutzellen dem Bild osmiumfixierter Blutzellen gegenübergestellt.Mit 6 Textabbildungen.     

Twenty-four hour presence of physicians in the ICU

Intensive-care units (ICUs) must be utilised in the most efficient way. Greater input of intensivists leads to better outcomes and more efficient use of resources. 'Closed' ICUs operate as functional units with a competent on-site team and their own management under the supervision of a full-time intensivist directly responsible for the treatment. Twenty-four-hour coverage by on-site physicians is mandatory to maintain the service. At night, the on-site physicians need not necessarily be specialists as long as an experienced intensivist is on call. Because of the shortage of intensivists, such standards will be difficult to maintain everywhere, but they should, at least, be mandatory for larger hospitals serving as regional centres.     

Post-malaria neurological syndrome--two cases in patients of African origin

Post-malaria neurological syndrome (PMNS) defined by a post-infective encephalopathy occurring within 2 months after an episode of Plasmodium falciparum infection is still a debated entity. We describe 2 cases of PMNS in 2 patients of African origin, born and living in France. Both patients had severe P. falciparum infection, followed by PMNS. They recovered with no sequelae. These are the first-reported cases of PMNS in patients of African ethnicity and living in France.     

Is smaller high enough? Another piece in the puzzle of stress,strain, size,and systems

Extracorporeal lung-supporting procedures open the possibility of staying within widely accepted margins of 'protective' mechanical ventilation (tidal volume of less than 6 mL per kg of predicted ideal body weight and plateau pressure of less than 30 cm H₂O) in most any case of respiratory failure or even of further reducing ventilator settings while still providing adequate gas exchange. There is evidence that, at least in some patients, a further reduction in tidal volumes might be beneficial. Extracorporeal procedures to support the lungs have undergone tremendous technical developments, thus reducing the procedure-related risks. However, what is true for ventilator settings should also be true for extracorporeal procedures: studies will have to demonstrate a convincing risk-benefit ratio. In addition, a simple reduction of the tidal volume will certainly not be the right answer. If extracorporeal support largely influences gas exchange, the 'optimal' tidal volume/positive end-expiratory pressure ratio keeping stress and strain low and avoiding alveolar derecruitment will still have to be individually defined.     

Intramyocardial electrogram recordings (IMEG) for diagnosis of cellular and humoral mediated cardiac allograft rejection.

OBJECTIVE: The purpose of this study was to prove the reliability of intramyocardial electrogram (IMEG) recordings for diagnosis and treatment monitoring of (1) cellular and (2) humoral mediated allograft rejection after heart transplantation. MATERIAL AND METHODS: Fifteen beagle dogs underwent heterotopic neck-heart transplantation. Eight of them were previously sensitized through several skin transplantations. IMEG recordings were performed daily. Donor-specific antibodies (IgG, IgM) were determinated in serum daily. Transmyocardial biopsies were performed every two days. RESULTS: In the sensitized group (group I) accelerated rejection occurred under triple drug immunosuppression with cyclosporine A, azathioprine, and cortisone on the fifth postoperative day (range: 4th-5th). All episodes were detected through IMEG diagnosis. In each case rejection could be treated successfully. In the cellular mediated group (group II), the average sensitivity for rejection diagnosis of a single lead was 24% for the unipolar and 42% for the bipolar leads. When the voltages of different leads were summed up the sensitivity rose to 36% (3 unipolar), 81% (3 bipolar) and 100% (all leads). During rejection therapy the IMEG recovered within 24-48 hours. CONCLUSION: The IMEG detects cellular and humoral mediated rejection early and with high reliability. The rejection-related changes of grade 2/3a rejection in IMEG seem to follow a Ofocal patternO similar to the histology. Therefore the recording of several, preferably bipolar, electrode configurations appears to enhance diagnostic reliability.     

Minimal-flow ECCO2R in patients needing CRRT does not facilitate lung-protective ventilation

Journal of Artificial Organs - Extracorporeal CO2 removal (ECCO2R) is intended to facilitate lung protective ventilation in patients with hypercarbia. The combination of continuous renal...     

Antibacterial properties of synovial fluid in the knee

This study evaluated antimicrobial properties of synovial fluid against 3 gram-positive organisms: Staphylococcus aureus, Streptococcus pyogenes, and Staphylococcus epidermidis. Synovial fluid was collected from the knees of 52 patients. Three gram-positive bacteria culture lines were incubated in wells containing either synovial fluid and broth, or broth alone. Fluid was plated and incubated, and colonies were counted after 1, 4, and 24 hours to determine bacterial growth. Statistically significant differences in bacterial counts were found between control and experimental groups at 0, 4, and 24 hours for all 3 bacterial species. Bacterial counts in the control specimens demonstrated exponential growth over 24 hours as would be expected in the absence of growth inhibition. In contrast, bacterial counts in all of the synovial fluid specimens decreased steadily over 24 hours. These results demonstrate synovial fluid possesses potent bactericidal activity against the most common gram-positive pathogens responsible for septic arthritis. Delineating these antimicrobial properties further may offer avenues to augment the body's protection against bacterial infections.     

Weaning beginnt bereits mit der Beatmung

Die Anaesthesiologie -