Bibliothek

Beschreibung / Inhaltsverzeichnis: Zusammenfassung Es wird über die Behandlungsergebnisse von 252 Coloncarcinomen aboral der linken Flexur und 60 Rectumresektionen mit zum Teil abdominellen, zum Teil sacralen Anastomosen berichtet, die zwischen 1955 und 1967 an der Chirurgischen Universitäts-Klinik Tübingen stationär aufgenommen wurden. Von 168 radikal möglichen Kontinuitätsresektionen wurden 139 dreizeitig nach Schloffer, 29 einzeitig vorgenommen. Nach 139 dreizeitigen Resektionen verstarb 1 Patient (= 0,7% prim. Op.-Letalität), nach 29 prim. Resektionen kamen 3 Kranke ad exitum (=10% Letalität). Aus Vergleichen mit entsprechenden Literaturangaben ergibt sich, daß die umständliche Schloffersche Methode maximale Sicherheit bietet bei einer hohen Gesamtresektionsquote (72,5%). Die Spätergebnisse wurden in Abhängigkeit vom Tumorstadium (nach der TNM-Klassifikation) anhand der 5-Jahresüberlebenskurven dargestellt: 73% der in Stadium I und II operierten Patienten überlebten die 5-Jahresgrenze, aber nur 40% der in Stadium III und 16% der in Stadium IV behandelten Fälle. 55% aller radikal Resezierten erreichten die 5-Jahresgrenze.

Beschreibung / Inhaltsverzeichnis: Modern Europe/L'Europe moderne

Beschreibung / Inhaltsverzeichnis: Abstract. Efficient analgesia may be the major objective in the cardiovascular risk patient following myocardial infarction, acute occlusion of peripheral vessels, or dissection/perforation of major abdominal vessels. It was the purpose of the study to investigate the haemodynamic and respiratory side effects of eight different opioids in 57 circulatory risk patients prior to major vascular surgery. Methods. Patients were randomly allocated to eight groups, each receiving a different opioid within a clinical, equipotent dose range (buprenorphine, fentanyl, morphine, nalbuphine, pentazocine, pethidine, tramadol, alfentanil). A complete haemodynamic and blood gas status was obtained prior to as well as 5, 10, 15, and 20 min following opioid administration. Monitoring included a complete invasive haemodynamic and blood gas status. Statistical evaluation was performed by 1- and 2-factorial ANOVA (P〈0.05). Results. Significant time effects (changes from baseline at the time of measurement) were observed for heart rate and total peripheral resistance, while significant group (group-specific differences in the course of values at the different times of measurements) and time effects were noted for mean pulmonary artery pressure, pulmonary capillary wedge pressure, stroke volume index, and PaO2. No major effects were observed following morphine, fentanyl, alfentanil, tramadol, and nalbuphine. Buprenorphine caused distinct respiratory depression accompanied by an increase in pulmonary vascular tone. Pentazocine and pethidine caused a significant increase in MPAP and peripheral vascular resistance while pethidine also produced marked respiratory depression. Conclusions. For interpretation of the results, factors such as respiratory depression, histamine release, secretion of endogenous catecholamines, and hypoxia-induced pulmonary vasoconstriction have to be discussed. Tramadol, an opioid with moderate potency, seems to offer some advantages due to its minor cardiovascular and respiratory side effects.

Beschreibung / Inhaltsverzeichnis: Abstract. There is no doubt that a single emergency phone number is desirable, but in contrast to other countries, in Germany different emergency phone numbers and dispatching centers exist for the fire brigade (FB), the emergency medical service system (EMS), and the general practitioners' emergency service (GPS). Due to this fact, valuable time is often wasted by connecting or transferring emergency calls from one dispatching center to another. The purpose of this study was to analyse all calls received by the different dispatching centers in the city and county area of Mainz with respect to total number, fraction of emergency calls, and specificity. Further, the total number of calls potentially referring to a hypothetic single dispatching center with a general emergency phone number (112) was calculated. During a 4-month period, all telephone calls were registered and related to day, time, and origin of the call (city or county) and classified as non-urgent or emergency calls, calls appropriate to the dispatching center dialed, emergency calls to be transferred, or unspecific calls. A total of 80 987 calls were received (city area 84.3%, county area 15.7%), most of them directed to the FB of Mainz (33 086). The EMS dispatching center received 31 286 calls, the five GPS-centers 15 256 calls; 1359 emergency calls that were directed to the police or FB needed transfer to the EMS. During weekdays the EMS and FB received the most calls, with a reduced frequency on Saturdays and Sundays (Table 2). Nevertheless, the highest total numbers of calls were received on Saturdays due to multiple calls directed to the GPS. The FB had the highest specificity of calls; more than 50% of the calls to the GPS were unspecific (Fig. 1). Of all calls, 4.37% were classified as emergency calls; two-thirds of these came from the area of Mainz during the daytime. During off-duty hours of the GPS in the city, 51% of the emergency calls reached the EMS directly; 49% had to be connected by the police or FB. During duty hours of the GPS, the fraction of calls directed to the EMS decreased significantly to 35%. During duty hours of the GPS centers in the county area, only 14% of the urgent emergency calls reached the EMS dispatcher directly (Fig. 2). Compared to the multiple-center mode, a hypothetic single dispatching center for all systems would probably be followed by a slight increase in total number of calls due to the fact that the GPS numbers would be answered 24 h a day, but there would be only minimal differences in the total number received on most days; only on Sundays would a decrease be expected. The EMS area of Mainz, with a total of 13 different telephone numbers for 7 dispatching centers, can be regarded as typical of the German situation. The high number of emergency calls to be transferred (up to 86% under special circumstances) demonstrated that this weak point in the German EMS system must be eliminated by introducing a single emergency number. This should occur when a Europe-wide three-digit number "112" will be instituted, probably in 1995. Additionally, the continued existence of 5- or 10-digit telephone numbers for non-urgent calls may be useful for allowing non-verbal differentiation of calls. In any case, all telephone numbers, including the latter calls, have to enter one dispatching center. The main advantage of a single dispatching center would be avoidance of the time-consuming transfer of emergency calls from one dispatching center to the other.