Zeitschrift für die gesamte innere Medizin und ihre Grenzgebiete
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Comparative Study
[In vitro modification of plasma viscosity and erythrocyte aggregation by four plasma substitutes].
We tested the haemorheological effects of the addition of 3.5% oxypolygelatine, 10% dextran 40, 6% dextran 75 or 5% albumin, respectively, to fresh donor blood of 25 healthy young persons. We examined the aggregation and the viscosity of substituent plasma mixtures in such various, but constant volume relations as may be present during intravenous infusion. Albumin reduced viscosity and aggregation, but especially dextran 75 increased both parameters significantly.
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The evidence of elevated non-invasive parameters in prediction of pulmonary hypertension was examined in 168 patients with chronic obstructive pulmonary disease (COPD). Forced vital capacity (FVC), Tiffeneau-test (FEV1), oxygen partial pressure, x-ray ascertained diameter of right descending branch of pulmonary artery (RDB), myocardial scintigraphy, and right ventricular ejection fraction showed significant differences between patients with and without pulmonary hypertension. Neither of them alone allows prediction of pulmonary pressure exactly, only in combination non-invasive parameters are usable. ⋯ To classify the patients according to normal and increased pulmonary artery pressure, FEV1, RDB and myocardial scintigraphy by a discriminant function with specificity/sensitivity of 80%, are relevant parameters. Accurate diagnosis of latent pulmonary hypertension requires right heart catheterisation. The domain of non-invasive diagnosis is screening and therapy monitoring of pulmonary hypertension, or if right heart catheterisation is contraindicated.
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The use of drugs in pain therapy is characterized by the fear of addiction. As a result strong analgesics are underused. To compensate the missing analgesic effect the additional use of psychotropic drugs is common. ⋯ In pain therapy there is no indication for these substances. In contrast opioids can be used without causing psychological dependence, presuming the guidelines of drug therapy in chronic pain (e.g. WHO guidelines) are attended.
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New results in the area of mechanical cardiopulmonary resuscitation indicate that during external cardiac massage, the blood flow is achieved both by direct cardiac compression and a generalized increase in the intrathoracic pressure. While, in accordance with the classical theory, the heart is compressed between the sternum and the vertebral column, the thoracic pump mechanism requires a consideration of all blood-carrying structures within the thorax as elastic tubes or chambers that are capable of being compressed by externally administered pressure. Only such variations of the technique presently used may be of benefit which can be achieved with simple adjuncts and which have a positive effect on both mechanisms of blood flow.
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The present paper illustrates the physiological basis of brain function as well as the pathophysiological and neurochemical cascades during cerebral ischemia and subsequent reperfusion. It is emphasized that brain resuscitation preferably focuses upon those cerebral functions or structures, respectively, which are not definitely damaged until the early period of recirculation. Finally, current experimental considerations and already clinically established concepts in treatment of ischemic brain injury are pointed out. Their principles of action and their therapeutical value in cerebral resuscitation following cardiocirculatory arrest are discussed.