[Patient's emotional satisfaction with anaesthetic care]. / Die emotionale Zufriedenheit von Patienten mit der anästhesiologischen Betreuung.

OBJECTIVE: The evaluation of services by patients is an integral part of continuous quality improvement in anaesthesia. Patient satisfaction is affected by various objective and subjective variables. Individual experiences, impressions and needs represent an important part of overall patient satisfaction. METHODS: Data of 519 patients were collected in a standardised anonymous questionnaire independent of the post-anaesthetic visit. RESULTS: Anaesthesia staff appeared to be friendly to 97 % of patients asked, 95 % of patients wanted to be treated by the same staff in case of another anaesthesia, nearly 87 % felt relaxed and satisfied after anaesthesia. Up to 26 % of patients felt tense after pre-anaesthetic visit and 38 % before anaesthesia, 35 % felt that waiting before operation was endless and 20 % complained about loss of humaneness because of technical equipment and monitoring. Significant differences could be found between specific groups of patients: Older and male patients were in all more satisfied compared to younger and female patients, patients after regional anaesthesia were more satisfied compared to ones after general anaesthesia. CONCLUSION: The inquiry of subjective patient impressions can be performed in anaesthesia departments without much effort. The results help to identify and avoid psycho-vegetative stressing situations and to improve patient satisfaction with anaesthesia.

Gabapentin as add-on therapy in children with refractory partial seizures: a 24-week, multicentre, open-label study.

The efficacy and safety of gabapentin as add-on therapy for refractory partial seizures in 237 children, aged 3 to 12 years were evaluated over a 6-month period. All children received gabapentin at 24 to 70 mg/kg/day. Efficacy variables included the percent change in seizure frequency and the responder rate (defined as those patients who showed >50% reduction in seizure frequency). For all partial seizures, the median percent change in seizure frequency was -34% and the overall responder rate was 34%. Simple partial seizures showed a median reduction of -53%; complex partial seizures, -38%; and secondarily generalized tonic-clonic seizures, -35%. Thirteen patients (5%) withdrew during the 6-month period because of adverse events. Concurrent antiepileptic medication remained unchanged in 185 patients (78%), was decreased in 27 (11%), and increased in 25 (11%) patients. This 6-month follow-up study has demonstrated that gabapentin was well tolerated and appeared to show a sustained efficacy in a large population of children with refractory partial and secondarily generalized tonic-clonic seizures.

Gabapentin as add-on therapy in children with refractory partial seizures: a 12-week, multicentre, double-blind, placebo-controlled study. Gabapentin Paediatric Study Group.

PURPOSE: To evaluate the efficacy and safety of gabapentin (Neurontin; GBP) as add-on therapy for refractory partial seizures in paediatric patients aged 3-12 years. METHODS: After a 6-week baseline period, 247 patients (54 centres) entered a 12-week double-blind phase and were randomized to receive either GBP (t.i.d., titrated to 23-35 mg/kg/ day) or placebo. Seizure activity and type were recorded daily. Efficacy variables included Response Ratio (RRatio), responder rate, and percentage change in frequency (PCH) for all partial seizures; PCH and RRatio for individual types of partial seizures; and investigator and parent/guardian global assessments of seizure frequency and patient well-being. RESULTS: RRatio for all partial seizures was significantly lower (better) for GBP-treated patients (p = 0.0407). Responder rate favored GBP, but the difference between treatment groups was not statistically significant. Median PCH for all partial seizures for the GBP treatment group (-17.0%) was better than that for the placebo group (-6.5%). Median PCH for specific seizure types showed GBP to be most effective in controlling complex partial seizures (-35%) and secondarily generalized seizures (-28%) when compared with placebo (-12%, +13%, respectively). A greater percentage of GBP-treated patients exhibited improvement according to investigator and parent/guardian global assessments, with a statistically significant difference observed in the parent/guardian global assessment of seizure-frequency reduction (p = 0.046). Three GBP patients and one placebo patient were seizure free during the double-blind treatment period. GBP was well tolerated. CONCLUSIONS: GBP was effective and well tolerated as an add-on therapy for partial seizures in paediatric patients with previously drug-resistant seizures.

In vivo 1H-NMR microimaging with respiratory triggering for monitoring adoptive immunotherapy of metastatic mouse lymphoma.

The metastatic ESb-MP murine lymphoma in DBA/2 mice has been used as a model for investigating metastatic disease and its cure by adoptive immunotherapy (ADI) as monitored by in vivo multislice spin-echo 1H NMR microimaging at 7 T. isoflurane inhalation anesthesia facilitated long measurement sessions, and respiratory gating with a fiber-optic sensor greatly reduced motional artifacts. With T2 weighting (TR = 2 s, TE = 30 ms) mean signal-to-noise ratios of 30 and 15 for kidney and liver, respectively, were achieved in 20 min (100-micron pixels, 1-mm slices, 25-mm field of view). Without the use of contrast agents, metastases with diameters > or = 0.3 mm in the imaged plane could be detected as hyperintense lesions in kidney (contrast ratio ca. 1.4) and liver (contrast ratio ca. 2) with a confidence level of > 98%. For the first time the complete eradication of late-stage macroscopic metastases by ADI could be demonstrated noninvasively by MRI.

[The causes of perioperative mortality. A trial of the German "CEPOD study."]. / Erhebungen zur kausalen perioperativen Mortalität. Versuch einer deutschen "CEPOD-Studie".

UNLABELLED: We performed a prospective multi-center study in order to determine the causes of 30-day perioperative mortality. METHODS: In accordance with the CEPOD-Study and with the kind permission of Dr. N. Lunn, we forwarded two different questionnaires to 135 hospitals. One questionnaire was to be answered by the anaesthetist and the other one by the surgeon involved in cases o perioperative death within the first 30 days after the operation. 12 out of 135 addressed hospitals agreed to participate in the study. These included four small hospitals, six medical centres of medium capacity (about 500 beds) and two University hospitals. In order to obtain an exact description of the events leading to perioperative death, the questionnaires consisted of approximately 60 questions for the collection of demographic data and the surgical as well as anaesthesiological perioperative management. RESULTS: From 1989 to 1993 more than 300 cases of perioperative death were reported. Only 200 cases could be analyzed due to incompletely answered or unreturned questionnaires. The mean risk-classification (ASA) was 3.46, mean age 74.6 years. Approximately 40 percent of deaths occurred in patients older than 80 years. More than 80 percent of patients had at least one pre-existing cardiovascular disease with prevalence of 41% for pulmonary and gastrointestinal diseases. In the majority of cases abdominal operations were performed, followed by hip-surgery and surgery of the aorta. In 86% of the cases, the surgeon was experienced and had performed the respective operation more than 20 times. In 38.2% an anaesthetist in training was responsible for anaesthesia, but only 11.6% were without supervision of a specialist anaesthetist. The majority of patients received general anaesthesia (78%) and 8.5% had a combination of EDA and general anaesthesia. Regional anaesthesia was performed in 12.5%, local anaesthesia in only 1%. The average blood loss was approximately 1.600 ml (with a very wide range) and 42.5% of the patients needed a transfusion of blood components, primarily in the form of packed red blood cells. Seventeen serious incidents occurred intraoperatively, including three "exitus in tabula". Four patients died shortly after the operation in the ICU, the other ten incidents were managed in the operating room. In 11 of 17 incidents the patients suffered a cardiac arrest; nine patients were resuscitated. Two patients were not resuscitated in view of pre-existing diseases and inoperability. All of the hospitals had an ICU for postoperative care, but two of the smaller hospitals had no recovery rooms. In 22 cases of emergency operations, there was a delay due to a lack of personnel or to logistic problems. In five of these cases, the delay was described as a possible cofactor of perioperative mortality. The most frequent causes of perioperative death were myocardial failure (33.7%) and multi-organ-failure (19.2%), followed by respiratory insufficiency (13%) and septic shock in 9.3%. A necropsy was carried out in only 28 of 200 perioperative deaths (14%); 13% of the cases were discussed in a surgical and only 2.5% in an anaesthesiological mortality-conference. In 9 out of 12 hospitals no mortality-conferences were held. All surgeons and anaesthetists were asked for self-assessment on the basis of an analog scale ranging from 0 and 10 points. The average score was 8.52 points (surgical management) and 9.36 points (anaesthesiological management respectively), which is not always in correspondence with the information provided in the questionnaires. CONCLUSIONS: In order to further reduce perioperative mortality in critically ill patients, every hospital should aim to optimize the structure of the surgical and anaesthesiological departments. A delay due to logistical or personnel problems may be a co-factor in perioperative mortality. Recovery rooms with experienced personnel should be the standard in postoperative anaesthesiological care. (ABSTRACT TRUNCATED)

Characterization of a murine lymphoma cell line by 31P-NMR spectroscopy: in vivo monitoring of the local anti-tumor effects of systemic immune cell transfer.

The intradermal ESb-MP murine T-cell lymphoma in syngeneic DBA/2 mice has been used as a model for adoptive immunotherapy (ADI). Cultured ESb-MP cells were characterized in suspension by 31P-NMR spectroscopy (MRS) at 11.7 T, and solid primary tumors were examined by 31P-MRS in vivo at 7.0 Tesla using surface-coil techniques. Growing tumors contained relatively high levels of phosphomonoesters (PME, predominantly phosphoethanolamine), nucleotides (NTP) and Pi, low levels of phosphodiesters (PDE) and no phosphocreatine. Mean tissue pH was found to be 6.7-6.9. The spectra of ESb-MP cells cultured in RPMI medium (containing choline but no ethanolamine) also showed low PDE and no phosphocreatine at an intracellular pH of 7.4; however, only a trace amount of phosphoethanolamine was detected and significant levels of nucleoside mono- and diphosphates were observed. The complete ADI treatment protocol involved low-dose irradiation (5 Gy) followed by i.v. transfer of immune spleen cells from allogeneic B10.D2 donors and resulted in 100% remission (responders); no treatment or incomplete ADI (irradiation or immune cell transfer alone) resulted in no remissions (nonresponders). In vivo MRS could best discriminate between responders and non-responders on the basis of tissue pH, which increased in responders to 7.0 by day 5-6 after complete ADI. Following therapy, the sum of PME + Pi (both absolute and as a percent of total phosphates) decreased significantly only for responders but only after a visible decrease in tumor volume was apparent.

Effective immune rejection of advanced metastasized cancer.

A cellular cancer therapy is described with unique efficiency even in late-stage disease. in situ activated tumor-immune T cells, induced in allogeneic, tumor-resistant, MHC identical but superantigen different donor mice (B10.D2) could transfer strong graft-versus-leukemia (GvL) effects accompanied by only mild graft-versus-host (GvH) reactivity. Systemic immune cell transfer into 5 Gy irradiated DBA/2 mice bearing up to 4 week established syngeneic tumors and macrometastases led to massive infiltration of tumor tissues by CD4 and CD8 donor T lymphocytes. Upon interaction of immune CD4 donor T cells with host antigen presenting cells in synergy with immune CD8 donor T cells attacking the tumor cells directly, primary tumors (1.5 cm diameter) were encapsulated and rejected from the skin and liver metastases eradicated. For the first time, such adoptive cellular immunotherapy (ADI) was followed in individual live animals by P-31-NMR spectroscopy of primary tumors. An approximately 25,000 fold excess of metastatic tumor cells could be rejected as revealed quantitatively by FACScan analysis of lacZ gene transfected tumor cells.

Growth, photosynthesis and storage of carbohydrates and nitrogen in Phaseolus lunatus in relation to resource availability.

Growth, photosynthesis, and storage of nitrogen (N) and total non-structural carbohydrates (TNC) of a perennial wild type and an annual cultivar of lima bean (Phaseolus lunatus) were examined at different light intensities and N supplies. Relative growth rate and photosynthesis increased with light and N availability. N limitation enhanced biomass allocation into root rather than into shoot, while light limitation enhanced growth of leaf area. The TNC concentrations increased with light intensity and thus with photosynthesis, while the concentrations of organic N and nitrate decreased. Increasing N supply had the opposite effect. Therefore, TNC and organic N concentrations were negatively correlated (r=-0.90). Pool size of N or TNC increased with N and light availability when either resource was non-limiting, but increased little or remained constant when either resource was limiting. Storage reached a minimum when both resources were supplied at an equal rate.

Parapneumonic pleural effusions and empyemas: a plea for early drainage.

Parapneumonic effusions are relatively common sequelae of pneumonias. Occasionally, parapneumonic effusions will lead to empyemas. If these fluid collections are not aggressively drained in a timely manner, they will become loculated, placing the patient at risk for septic complications. Two cases of parapneumonic empyemas with delayed drainage eventually requiring thoracotomy and decortication are presented. These cases illustrate the need for early, complete drainage of parapneumonic empyemas to avoid septic complications and unnecessary surgery.

[Magnetic resonance, a means for anatomically reliable imaging and noninvasive metabolic studies of kidney transplants]. / Die Magnetresonanz, ein Instrument der anatomiegerechten Bildgebung und nichtinvasiven Stoffwechseluntersuchung zu transplantierender Nieren.

As an adjunct to the monitoring of intracellular high-energy phosphorus metabolites by 31P NMR1 for assessment of renal viability, a study of vasculature of preserved kidneys was performed by Image-Guided Volume Selective 19F MR Spectroscopy. 1H and 19F of the same preserved rat and porcine kidneys were obtained. The technique enabled the analysis of the vessel and tissue properties and opens new possibilities for pretransplant assessment of renal vasculature.

Decreased ribulose-1,5-bisphosphate carboxylase-oxygenase in transgenic tobacco transformed with "antisense" rbcS : IV. Impact on photosynthesis in conditions of altered nitrogen supply.

The effect of nitrogen supply during growth on the contribution of ribulose-1,5-bisphosphate carboxylase-oxygenase (Rubisco; EC 4.1.1.39) to the control of photosynthesis was examined in tobacco (Nicotiana tabacum L.). Transgenic plants transformed with antisense rbcS to produce a series of plants with a progressive decrease in the amount of Rubisco were used to allow the calculation of the flux-control coefficient of Rubisco for photosynthesis (CR). Several points emerged from the data: (i) The strength of Rubisco control of photosynthesis, as measured by CR, was altered by changes in the short-term environmental conditions. Generally, CR was increased in conditions of increased irradiance or decreased CO2. (ii) The amount of Rubisco in wild-type plants was reduced as the nitrogen supply during growth was reduced and this was associated with an increase in CR. This implied that there was a specific reduction in the amount of Rubisco compared with other components of the photosynthetic machinery. (iii) Plants grown with low nitrogen and which had genetically reduced levels of Rubisco had a higher chlorophyll content and a lower chlorophyll a/b ratio than wild-type plants. This indicated that the nitrogen made available by genetically reducing the amount of Rubisco had been re-allocated to other cellular components including light-harvesting and electron-transport proteins. It is argued that there is a "luxury" additional investment of nitrogen into Rubisco in tobacco plants grown in high nitrogen, and that Rubisco can also be considered a nitrogen-store, all be it one where the opportunity cost of the nitrogen storage is higher than in a non-functional storage protein (i.e. it allows for a slightly higher water-use efficiency and for photosynthesis to respond to temporarily high irradiance).

The effect of nitrogen nutrition on growth and biomass partitioning of annual plants originating from habitats of different nitrogen availability.

The hypothesis was tested that faster growth of nitrophilic plants at high nitrogen (N) nutrition is counterbalanced by faster growth of non-nitrophilic plants at low N-nutrition. Ten annual plant species were used which originated from habitats of different N-availability. The species' preference for N was quantified by the "N-number" of Ellenberg (1979), a relative measure of nitrophily. The plants were cultivated in a growth cabinet at five levels of ammonium-nitrate supply. At low N-supply, the relative growth rate (RGR) was independent of nitrophily. At high N-supply, RGR tended to be higher in nitrophilic than in non-nitrophilic species. However, the response of RGR to N-supply was strongly and positively correlated with the nitrophily of species. Increasing N-supply enhanced partitioning to leaf weight per total biomass (LWR) and increased plant leaf area per total biomass (LAR). Specific leaf weight (SLW) and LWR were both higher in non-nitrophilic than in nitrophilic species at all levels of N-nutrition. NAR (growth per leaf area or net assimilation rate) increased with nitrophily only under conditions of high N-supply. RGR correlated positively with LAR, irrespective of N-nutrition. Under conditions of high N-supply RGR correlated with SLW negatively and with NAR positively.

A Quantification of the Significance of Assimilatory Starch for Growth of Arabidopsis thaliana L. Heynh.

These studies use starch synthesis mutants to quantify the contribution of assimilatory starch to whole plant growth and form. Arabidopsis thaliana (L.) Heynh plants were used with null plastid phosphoglucomutase (T Caspar, SC Huber, CR Sommerville, [1986] Plant Physiol 79; 1-7) or 7% of wild-type ADP-glucose pyrophosphorylase (T-P Lin, T Caspar, CR Sommerville, J Preiss [1988] Plant Physiol 88; 1175-1179). The daily turnover of starch and the rate of biomass increase in the mutants and the wild type were investigated during growth in a 14 hour light/10 hour dark cycle in high irradiance (600 micromoles per square meter per second) and nitrogen (6 millimolar NH(4)NO(3)), in high irradiance and low nitrogen (0.1 millimolar NH(4)NO(3)) or in low irradiance (80 micromoles per square meter per second) and high nitrogen. There is some variability in the data, but the following conclusions can be drawn. Growth was slow in the absence of starch turnover. In high nitrogen conditions, about 1 mole of carbon per gram dry weight per day was incorporated additionally into structural biomass for every one mole of carbon turned over as starch per gram dry weight per day. In low nitrogen, the gain was much lower. This indicates that temporary storage of photosynthate is important for rapid growth in high nitrogen, but not in low nitrogen when carbohydrate is in excess. Starch-deficient plants showed the usual decrease of the shoot/root ratio in low nitrogen and increase of the ratio in low light. This shows that adjustment of plant form to nitrogen nutrition and irradiance is not mediated via regulation of photosynthate partitioning in the leaf. Starch deficient plants had lower shoot/root ratios than the wild type and the nitrogen concentration in their leaves was increased. It is discussed how interactions between carbohydrate allocation, respiration and growth at the organ and whole plant level generate these changes. We conclude that mutants with a decreased capacity to carry out a particular partial process provide a powerful tool to disect complex mutually interacting systems, and define and quantify causal interactions at the level of whole plant growth.

Xylem water flow in tropical vines as measured by a steady state heating method.

A method for determining the mass flow rate of xylem water in thin stems under natural field conditions is presented. Diurnal courses of xylem water flow and stomatal conductance of the vines Entadopsis polystachya, Cyclanthera multifoliolata, and Serjania brachycarpa were examined in a tropical deciduous forest on the west coast of Mexico. E. polystachya (leaf area 23.6 m2) had a maximum water flow rate of 6.50 kg h-1 or 1.44 kg cm-2stem basal area h-1; daily water use was 2.00 kg m-2leaf area day-1. S. brachycarpa (leaf area 4.5 m2) and C. multifoliolata (leaf area 3.6 m2) had a maximum water flow rate of 0.72 and 0.19 kg h-1 or 0.63 and 0.92 kg cm-2stem basal area h-1. Daily water use was 1.26 and 0.39 kg m-2leaf area day-1, respectively. The daily courses of xylem water flow were strongly influenced by the orientation of the leaf area to irradiance and its intensity. While leaves of E. polystachya had a constant high stomatal conductance during the day, S. brachycarpa had a maximum stomatal opening in the morning followed by continuous closure during the rest of the day. In contrast to the woody species, the herbaceous C. multifoliolata exhibited a strong midday depression of stomatal conductance and wilting of its leaves. The leaf biomass accounted for 8% (Entadopsis), 16% (Serjania), and 23% (Cyclanthera) of above-ground biomass. The relation of sapwood area to leaf area supplied (Huber value) was 0.19 (Entadopsis), 0.18 (Serjania), and 0.06 (Cyclanthera) cm2 m-2.

[Medical peculiarities and social effects of accidents with motorcycles]. / Medizinische Besonderheiten und soziale Auswirkungen der Unfälle mit motorisierten Zweirädern.

During the period 1976 until 1982, 133 accident patients with two-cycle motor vehicles were treated at the traumatological Department of the Dr. Horst Schmidt Hospital. 80% of those patients were below or 21 years of age, 58.5% were undergoing training for professional work. 23.3% had suffered severe injuries (according to the Gögler scheme), 6.8% died as a result. Six out of nine dead patients were caused by severe head injuries, five of whom did not wear protective helmets. 37.7% cover all head injuries 5% more than injuries of the lower extremities (thigh and shins). The result of these accidents causes an enormous impact on those concerned as well as on the society. 32.3% interruptions and extensions of training periods and change of training for the youth became necessary. Treatment after admissions as in-patient (for minor injuries costs ca. DM 1000, for major injuries DM 20,000) costs about DM719,368,000 excluding costs for rents and auxiliary requirements which have not been taken into consideration. The invaluation of treatment of 133 accident cases with motorcycles has resulted in the following consideration: 1. Yearly publication of motor cycle accidents and its death tolls including cost sustained or prospective costs involved. 2. Strict rules concerning covering clothing. 3. Rigorous accident theching during driving lesions. 4. Security measures and its execution enforced by law to control the construction of motorized two cycle in consideration of optical and technical performance criteria. 5. Severe criticism of advertisers in usage of words like speed, performance and freedom which influence the youth without indicating the risks of the two-cycle vehicles.

[Synthesis and spectrum of pharmacologic action of aryl-arylamino- and aryl-aryliminoacetonitriles]. / Synthese und pharmakologisches Wirkungsspektrum von Aryl-arylamino- und Aryl-aryliminoacetonitrilen.

Aminoacetonitriles were synthetized from arylaldehyde, arylamine and cyanhydrogene. Their dehydrogenation led to the iminoderivatives. The compounds were evaluated for spasmolytic activity in vitro. Some aryl-arylaminoacetonitriles showed significant inhibition of the histamine-induced contraction in guinea-pig ileum and acetylcholine-induced contraction in rat ileum. Structure-activity relationships are discussed.