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Description / Table of Contents: Abstract. In a controlled prospective randomized study, defibrillation by emergency medical technicians (EMTs) was compared with the current standard of care in Germany (basic life support by EMTs and defibrillation by emergency physicians only) in order to answer the following questions: 1. Does EMT defibrillation improve the survival rate and long-term prognosis of patients in ventricular fibrillation as compared to the current German standards in resuscitation (basic life support by EMTs and defibrillation by emergency physicians)? 2. Are the prerequisites for the use of semiautomatic defibrillators fulfilled in the emergency medical systems (EMS) of the participating centers? Methods. The study phase includes randomization of 121 adult patients with witnessed cardiac arrest and ventricular fibrillation (VF) as first ECG rhythm. Prior to the onset of the study, all EMTs of the participating EMS systems were retrained in basic life support (BLS) measures. In each center, randomly assessed EMT-Ds (EMTs trained in Defibrillation) were trained to use semiautomatic defibrillators. With the help of one-line tape recording, the time intervals during resuscitation and treatment steps were evaluated. Successfully resuscitated patients were followed up with the help of the Glascow Coma Scale and the Pittsburgh Cerebral and Overall Performance Categories. Results. From 1 February 1991 until 28 June 1992, 159 patients with VF were randomized. In 121 cases, collapse was witnessed. 25% (14/57) of the patients receiving defibrillation by EMT-Ds (study group=S) were discharged from the hospital alive. In the control group, 52 patients were defibrillated by emergency physicians, following BLS by EMTs [control group 1=C1; discharged: 29% (15/52)]. Fifty patients received BLS and advanced cardiac life support (ACLS) by the emergency physicians crews [control group 2=C2; discharged 18% (9/50)]. In the study group, the median time interval from collapse of the patient until initiation of BLS measures was 7.7 min, 7 min in C1 and 8 min in C2. ACLS measures were initiated significantly earlier (P〈0.05) in the control groups, as compared to the study group [S: 13 min, C1: 11 min; C2: 10.3 min]. Sixty-seven percent (30/45) of the study patients and 46% (36/76) of the control patients were defibrillated within 12 min. Study patients were defibrillated earlier (P〈0.05) (S: 9.9 min; C1: 12.2 min; C2: 12.75 min); return of spontaneous circulation (ROSC) was achieved earlier (P〈0.05) in the study group [S: 14 min; C1: 19 min; C2: 18.2 min] and the number of patients in the study group requiring no epinephrine during resuscitation was higher (P〈0.01) than in the control groups [S: 35.3% (12/34); C1: 10% (4/40); C2: 10.5% (4/38)]. Furthermore, the total amount of epinephrine [mean (±standard error)] administered in the study group [S: 2.35 (±0.49) mg; C1: 6.71 (±0.98) mg; C2: 7.71 (±1.31) mg] was significantly lower (P〈0.05). No significant differences in neurological long-term prognosis were found for the groups investigated. Conclusion. Neither the initial survival rate the number of patients discharged alive, nor the neurological long-term prognosis was significantly different for any of the groups investigated. Because of apparent differences in indirect prognostic parameters (time interval until ROSC, number of patients requiring no epinephrine) and because of the fact that the time interval to the first defibrillation was reduced by EMT defibrillation, EMT-Ds may perform defibrillation if: (a) they reach the patient before the emergency physician and (b) if they are trained intensively and supervised continuously. In order to increase the efficiency of defibrillation by EMT-Ds, far-reaching changes in our EMS are mandatory: (a) a reduction in the time interval from collapse until initiation of BCLS measures by intensifying layperson CPR training; (b) an increase in the number of emergency units equipped with semiautomatic defibrillators; (c) the consistent implementation of a tiered EMS.

Description / Table of Contents: Summary Double determinations of the cardiac output using dye dilution methods were performed in 100 subjects, normal controls and patients with various disorders. The second measurement of the cardiac output was significantly different from the first one (p〈0,001), the means were 10% lower. Investigating the hemodynamics of physiological tests or the pharmacologic action of drugs in man these spontaneous changes should be taken into consideration to avoid misinterpretation of the results.

Description / Table of Contents: Summary A simplified method for measuring the cardiac output with the indicator dilution technic is described. The area limited by the baseline, the built-up-and disappearance-slope and the vertical from the point of minimal indicator-concentration to the baseline is representative for the primary curve according to theKinsman et al. procedure. Measuring this area with an automatic integrator and comparing them with the corresponding primary curves (n=100) we found a correlation coefficientr=0,978.

Description / Table of Contents: Summary A case of spontaneous nodular panniculitis with diabetes mellitus is reported. The clinical, roentgenologic, and laboratory findings, inclusive the histology, are presented. As this case could neither be classified as Rothmann-Makai syndrome, nor as Pfeifer-Weber-Christian disease the possibility of a separate form of subcutaneous lipogranulomatosis is discussed.

Description / Table of Contents: Summary Panhypopituitarism with gigantism was described in 1963. The authors report another case with this clinical entity. The particular about this case is a pituitary dwarfism with secondary impaired function of the thyroid, gonads, adrenal cortex and of the pancreas; at the age of twenty-seven body growth starts and is still progressing. Clinical, laboratory and x-ray findings are presented. In particular endocrinologic studies with chromatographic determination of several adrenal cortex metabolites under different metabolic conditions are reported.

Description / Table of Contents: Summary Report of two cases of Wegeners' granulomatosis, who were treated with high dosis of corticosteroids. One patient died of a massive hemorrhage after rupture of an aneurysm of a kidney artery fourteen days after begin of treatment. The histological examination showed a scary-healed arteritis. Such changes were observed in other organs too. The glomerulitis was rather stationary. The second case lived for almost one year after begin of treatment. Depending on the corticosteroid dosis clinical remissions and improvement of the arteritis were seen on serial muscle biopsies. The post mortem findings were as well scary healing of the arteries, glomeruli and of the perivascular mesenchyma as necrosis of the glomeruli and of the lung tissue. The latter are considered to be the morphologic correlate to the terminal events during which the corticosteroids had no influence on the course of disease. The pathological findings are discussed with regard to the defined criteria of the disease known from the literature. These are likely altered by intensive therapy.

Description / Table of Contents: Summary Using bodyplethysmography a method for measuring cardiac output and stroke volume is described. Simultaneous determinations with the dye dilution technic showed a satisfactory correlation (r=0,9) in patients with hypertension, cardiac rhythm disturbances, functional heart disorders, patients with liver and kidney diseases and in normal controls. Only patients with marked limitations of the pulmonary function and those with a left-to-right shunt did not agree with the results of the dye dilution studies. The method seems particularly of interest in measuring directly the storke volume.

Description / Table of Contents: Summary Hemodynamic responses to the intravenous injection of heptaminol were studied in 12 subjects using dye dilution methods. The subjects (6 normal controls, 4 patients with hypertension, 2 patients with hypertension and heart failure) received heptaminol in dosis of 2–9 mg/kg body weight. The cardiac output rose significantly, which was mainly due to an increase of the stroke volume, as the heart rate remained rather unchanged. There was also a moderate increase of the mean arterial pressure, while the total peripheral resistance was not significantly altered. The hypertensives with heart failure did show the strongest response with regard to the cardiac output and blood pressure. According to further clinical studies heptaminol seems to be a valuable adjunct in the treatment of heart failure in chronic cor pulmonale.

Description / Table of Contents: We present the plan of action on which the Guidelines of the European Resuscitation Council for ”Adult Basic Life Support” is based (algorithm: ”Basic Life-Support Measures for Adults). The plan of action is primarily intended for ”one-person reanimation” procedures in adults.