[Transcutaneous electric stimulation of the heart]. / Transkutane elektrische Stimulation des Herzens.

Transcutaneous cardiac pacing had been introduced in the 1950s, but was given up because of severe side-effects. In the 1980s, this technique became again popular thanks to technical improvement. These are the indications: Adams-Stokes syncope, hemodynamically significant SA or AV blocks, significant bradycardias, overdrive-stimulation in tachycardiac arrhythmias. In cardiocirculatory resuscitation, this method is not very successful (as are all other techniques of cardiac stimulation), if electromechanical dissociation has occurred. This shows, that this method has to be employed without delay, especially since there are new models, which can easily be used in the ambulance. One can only conclude, that all ambulances and helicopters staffed with physicians trained in emergency medicine should carry this equipment. The article reports on the technique, the handling and the literature on transcutaneous cardiac pacing.

[Importance of cardiocirculatory and pulmonary monitoring in endoscopic retrograde cholangiopancreatography (ERCP)]. / Bedeutung der kardiozirkulatorischen und pulmonalen Uberwachung bei endoskopisch-retrograden Cholangiopankreatikographien (ERCP).

Among the side effects of endoscopy, cardiopulmonary complications are particularly important. This risk appears to be greatest in endoscopic retrograde cholangio- and pancreaticography (ERCP) because of the patient's prone position, iv sedatives and analgetics and the relatively long duration of the examination. We studied 75 patients (50 patients without and 25 patients with premedication) who were to undergo ERCP and looked at these data: age, weight, premedication, accompanying diseases, reason for this examination, blood count, oxygen saturation SaO2 (pulse oximeter), pulse, blood pressure and length of the examination. Overall, the oxygen saturation decreased considerably and two patients only had 69%. Pulse rate increased and one patient had 205 beats per minute, one 172. We looked for a correlation between SaO2, pulse rate and blood pressure and studied the patients' usual medication, the length of the ERCP, the indication for ERCP, age and hemoglobin. There was no correlation. But all patients suffering from a compromised cardiopulmonary status had received a rather heavy premedication and the ERCP was longer than in other patients. Since it is not clear which patients may develop cardiopulmonary complications, it is advisable to monitor all patients by pulse oximeter in order to avoid these complications. This seems also advisable because the rooms where the examination takes place are darkened and the patient is in a prone position so he cannot be seen clearly.

[Endoscopic balloon dilatation of benign choledochal stenosis]. / Endoskopische Ballondilatation einer benignen Choledochusstenose.

A 68-year-old woman was admitted because of septicaemia after cardiac valve replacement. Cause of the septicaemia was a proximal filiform common bile duct stenosis with recurrent gallstones and secondary cholangitis. A single pneumatic balloon dilatation widened the common bile duct. At the same time, specific antibiotic treatment cured the septicaemia. Nine months later no further dilatation has been necessary.