Leberlebendspende

Living liver donation is a prominent and innovative method in the therapy of terminal liver disease in children and adults. Live donation of livers was first used in 1989 for children. After only 10 years, the concept was also established for application in adults. Due to the imminent lack of donor organs and the constantly increasing need of liver transplantation, this method will continue to grow in importance.     

Suppression of the immediate pressive response to unilateral nephrectomy by atrial natriuretic peptide in the rat

Unilateral nephrectomy (UNX) is associated with an immediate and transient increase in arterial pressure and in prompt natriuresis from the remaining kidney. The hypothesis that atrial natriuretic peptide (ANP) is involved in the acute adaptation to unilateral nephrectomy was tested in euvolemic anesthetized Sprague-Dawley rats. In a first series of experiments, an increase in circulating ir-ANP levels (from 23.5 +/- 3.6 to 66.3 +/- 12.8 fmol/ml; p less than 0.01) was found within 2 minutes following renal exclusion. In a second set of experiments, the ANP response was inhibited by performing a right atrial appendectomy, in order to eliminate the major source of ANP, or by intravenous administration of monoclonal antibodies directed against ANP. When UNX was performed in the control groups (sham atrial appendectomy and administration of non specific monoclonal antibodies), mean arterial pressure rose immediately (maximal about 12% within 4 minutes) and transiently (return to pre-UNX values within 20 minutes) after UNX. At the same time, central venous pressure, monitored in the right atrium, tended to decrease slightly. In rats pretreated by right atrial appendectomy or by monoclonal antibodies directed against ANP, arterial pressure increased to the same extent as observed in control groups; this increase however was significantly more prolonged. In control groups, urinary cGMP excretion, the biological marker of ANP, increased twofold in parallel with the natriuretic response. These two responses were blunted in right atrial appendectomized rats and in rats receiving antibodies against-ANP. These results suggest that atrial natriuretic peptide plays a major role in the immediate functional adaptation to unilateral nephrectomy by blunting the increase in blood pressure.(ABSTRACT TRUNCATED AT 250 WORDS)     

Total intravenous anesthesia using ketamine and midazolam. A simple technic

Forty unpremedicated patients undergoing minor gynecological surgery were anesthetized with 1 mg ketamine and 0.1 mg midazolam per kg bodyweight, if necessary supplemented later with half the initial dose. All patients continued to breathe room air spontaneously with no ventilatory support. There were no incidents of airway obstruction and only 1 case of troublesome airway secretions. The arterial blood gas sample did not show any sign of respiratory depression, but in 11 cases paO2 was lower than normal, though acceptable. The median emergence time was 6 min. The side effects of ketamine were well controlled by midazolam, and patient acceptance of the technique was high. We consider that the technique may be suitable for short procedures under primitive conditions, for example after mass casualties, and that it can, if necessary, be applied by specially trained paramedics.     

Immediate and Long-term Mental Recovery from General versus Epidural Anesthesia in Elderly Patients

The postoperative course of mental performance during the first week and at 3 months after operation was studied in 30 patients above the age of 60 , undergoing total hip replacement arthroplasty. The patients were randomly allocated to receive either general anesthesia, epidural analgesia, or general anesthesia plus epidural analgesia. The surgically induced increase in plasma Cortisol and glucose was inhibited in the two groups receiving epidural analgesia. Mental performance was studied with psychological methods. An equal degree of postoperative impairment of mental performance of 3–4 days' duration was found in all groups. Three months after surgery, mental junction had improved slightly and to the same extent in all groups. We conclude that the transient mental impairment occurring within the first postoperative week is caused by factors other than general anesthetic agents and the endocrine-metabolic response to surgery.     

Wear of ten dental restorative materials in five wear simulators--results of a round robin test.

OBJECTIVE: The purpose of the present study was to prove the hypothesis that different wear measurement methods generate different material rankings. METHODS: Ten restorative materials, eight composites (BelleGlass, Chromasit, Estenia, Heliomolar RO, SureFil, Targis cured at 95 and 130 degrees C, Tetric Ceram) an amalgam (Amalcap) and a ceramic (Empress) have been evaluated with regard to the wear with five different wear methods (IVOCLAR, ZURICH, MUNICH, OHSU, ACTA). Every center received specimens, which Ivoclar Vivadent had made using the same batch. The test centers did not know which brand they were testing. After completion of the wear test, the raw data were sent to IVOCLAR for further analysis. The statistical analysis of the data included logarithmic transformation of the data, the calculation of relative ranks of each material within each test center, measures of agreement between methods, the discrimination power and coefficient of variation of each method as well as measures of the consistency and global performance for each material. RESULTS: Relative ranks of the materials varied tremendously between the test centers. When all materials were taken into account and the test methods compared with each other, only ACTA agreed reasonably well with two other methods, i.e. OHSU and ZURICH. On the other hand, MUNICH did not agree with the other methods at all. The ZURICH method showed the lowest discrimination power, ACTA and IVOCLAR the highest. Materialwise, the best global performance was achieved by Empress, which was clearly ahead of BelleGlass, SureFil and Estenia. In contrast, Heliomolar RO, Tetric Ceram and especially Chromasit demonstrated a poor global performance. The best consistency was achieved by BelleGlass and SureFil, whereas the consistency of Amalcap and Heliomolar RO was poor. SIGNIFICANCE: As the different wear simulator settings measure different wear mechanisms, it seems reasonable to combine at least two different wear settings to assess the wear resistance of a new material.