[Latest results of intensive care of sepsis, septic shock and multiple organ injuries]. / Ujabb eredmények a sepsis, a septicus shock, a SIRS és a sokszervi károsodás intenzív ellátásában.

Author is first discussing sepsis and its new categories (SIRS, MODS), its pathogenesis and symptoms. One axis of the events is the release of inflammatory and anti-inflammatory cytokines from the monocytes and macrophages, due to the precipitating injury. The other one is the activation of the polymorphonuclear leucocytes and the endothelial cells and their interaction. The basically non infectious SIRS is often maintained and worsened to MODS by the "translocation" of bacteria and endotoxins from the gut into the circulation. It is a new development the use of the serum procalcitonin level for the diagnosis, differential-diagnosis and for the evaluation of the success of the therapy. The causal therapy of the sepsis is still the surgical management of the septic focus, which should be supported by antibiotics and non-specific treatment (fluid-load, ventilation, inotropic, vasoactive and immunogenic drugs). It is new knowledge the effect of antibiotics on the immuno-system. For the treatment of SIRS, it has been tried many anti-cytokine and immunomodulating therapy; author explains the presumable causes of the failure of their majority.

[Advances in anesthesiology in the 90's]. / Fejlödés az anaesthesiologia terén az 1990-as években.

Author looks over the novelties in anaesthesiology in the 90-ies; (1) effort to relief not only the postoperative, but in general, every kind of pain; (2) publication of evidence based guidelines; (3) standpoints according to perioperative risk factors; (4) conception of preemptive analgesia; (5) usage of modern brain imaging techniques in anaesthesiology also; (6) researches about the sites, where general anaesthetics exert their effect; (7) new volatile anaesthetics (desflurane, sevoflurane); (8) researches, targeting the use of xenon; (9) new i.v. anaesthetics-analgesics (propofol, remifentanil, S(+)-ketamine, eltanolone) and their administration (TCI); (10) potential interactions between NO and anaesthetic agents; (11) new neuromuscular blocking drugs (mivacurium, rocuronium, cis-atracurium) and the new possibilities of neuromuscular monitoring; (12) question of difficult intubation (McCoy and bullard laringoscopes, laryngeal mask); (13) synthesis of the new elements for the challenges of the surgical practice: the anaesthesiological solution of laparoscopic surgery, one-day surgery, minimally invasive heart-surgery; (14) TIVA (recognition of awareness during operation); (15) closed circuit anaesthesia; (16) reduction of expenses; (17) application of computer and data management techniques; (18) organizational steps in order to achieve an integrated standard throughout the country.

[New advances and debated questions in intensive care in the 90-s]. / Néhány újabb eredmény és vitatott kérdés az intenzív betegellátásban az 1990-es években.

Author is first dealing with the debate about supranormal oxygen delivery and with the Consensus Conference, closing the debate. Author is emphasizing the significance of the regional tissue-oxygenisation, which can be measured--in the splanchnic region--indirectly by tonometry, suitable for prognostic index too. The continuous blood gas analysis became already a fact and for the estimation of the cerebral circulation are also developed new methods: the measurement of the ajvDO2 and the near infrared spectroscopy. Author outlines the new parameters, determining the oxygen-availability (px, Cx, Qx). Finally, author is discussing two new american concepts for reducing healthcare costs: flexible monitoring and subacute centers.

[Submental introduction of tracheal tube in endotracheal anesthesia. (Modified tracheal intubation method for cases of simultaneous maxillofacial injuries and osteotomies)]. / Submentalis tracheatubus bevezetése endotrachealis narcosishoz. (Módosított eljárás az egyidejü maxillomandibularis sérülések és osteotomiamütétek esetén).

This article reports the modification of laterosubmental tracheal intubation in single-step surgery of panfacial fractures or osteotomies. In the modified method--after the submental transversal midline skin incision--the tube is guided through a submental tunnel to the oral floor, just behind to caruncula sublingualis.

[Certain aspects of continuous ventilation]. / A tartós lélegeztetés néhány szempontja.

The indication of mechanical ventilation is either a failing ventilatory function of the thorax or a failing gas exchange function of the lung. The ventilation affects every organ function in more or less degree. The starting point of long term ventilation is debated, arbitrary. Some ventilatory devices are simulating the natural intrapleural negative pressure principle, but most of them applies intermittent positive pressure into the lung. For improving oxygenation, a moderate level of positive end expiratory pressure, eventually inversed or 1:1 inspiratory:expiratory ratio can be applied. The computerized electronic ventilators offer a big selection of assisting and controlling ventilatory modes, according to the requirements of the patients. For routine use, in ventilatory failure, pressure cycled controlled ventilation, in gas exchange failure, the combination of synchronized intermittent mandatory ventilation, positive end-expiratory pressure and pressure support can be recommended. For special tasks there are existing special ventilatory or other supportive means. In most of the cases some sedation of the ventilated patients is appropriate, muscle paralysing is restricted to a few situations. It is important to humidify the inhaled air. The detailed monitoring of the patients is essential during ventilation. The weaning of the patients from the ventilator is a complex procedure, which involves ventilatory, nutritional, pharmacologic and psychologic interventions.

[Monitoring respiratory mechanism and gas exchange in patients on respirators (side stream spirometry, capnography, oxigraphy, measurement of anesthetic agent concentration, pulse oximetry)]. / Lélegeztetett betegek légzésmechanikai és gázcsere monitorozása. (Oldaláramú spirometria, capnographia, oxygraphia, altatógáz/göz koncentráció mérés, pulzus-oximetria.)

Author describes the working principles of the side stream spirometry, capnography, oxygraphy, anaesthetic agent concentration measurement, pulse oximetry, all of them incorporated in a new type of monitor, as well as the informations obtained by using them, concerning lung mechanics and gas exchange. The graphic and digital data, provided by the monitor are visualizing the correlations among the components of lung mechanics and are helping in setting up optimal ventilatory parameters, both during anaesthesia and during ventilation in an intensive care unit. The monitor approaches gas exchange from several aspects, which enhances the judgement of the efficacy of ventilation.

[Clinical study of the Medicor-4 anesthesia-respirator]. / Medicor RSA-4 narkózis-respirator klinikai vizsgálata.

Authors describe the functional units of the volume-constant anaesthesia-ventilator: Medicor RSA-4 and the practical experiences with 61 patients--even of extreme parameters--furthermore give detailed advice to the use of the ventilator. They performed blood gas measurements and comparative tidal volume measurements in order to assess the accuracy of the Fleisch-tube. Authors state, that the ventilator is up to date, suitable for closed and semiclosed system, the ventilatory parameters once set, remain stable and the ventilator is equipped with the necessary safety alarms. Its operation is very silent and the consumption of the driving gas is only 40% of the minute volume.

[Isoflurane. (Comparison with halothane and fentanyl anesthesia)]. / Az izofluránról. (Halotán és fentanyl anesztéziával való összehasonlításban).

Authors carried out during one and a half year 135 anaesthesias with isoflurane. 104 of them was administered in closed, and 31 in semi-closed system. The results were compared with halothane and fentanyl anaesthesias. After brief review of the literature about isoflurane, authors evaluated their own experiences The most favourable result was the stability of the metabolic acid-base balance. One explanation of this feature is the undisturbed oxygenation of the tissues. The circulation was characterized by mild tachycardia and by transitory decrease of the systolic blood pressure. The circulatory parameters were better in closed system, than in semi-closed one, and within the former system the most stable circulation was achieved either by an empirical syringe-injection administration, or by vaporizer administration using 5 -3,8 -3,4 -3 -2,8 -2,5 -2,3 etc.% dosage schedule. The dose-related respiratory depression was of lesser degree, than with fentanyl, and was equal to that with halothane. It was found an also dose-related saving in muscle relaxants. The blood sugar level increased considerably and more prolonged, than with the control anaesthetics. The high cost of the isoflurane (and of any other inhalational agent) was partly compensated by using it in a closed system. Authors found the isoflurane--based on their own experiences and on the data of the literature--suitable for prolonged and repeated anaesthesias too, but they referred to the circumstances also, which required closer attention.

[A modified method of anesthesia without intubation in microsurgical treatment of the larynx]. / Modifiziertes Verfahren der ohne Intubation ausgeführten Anaesthesie bei laryngomikroskopischen Eingriffen.

An anaesthetic method without intubation has been used for the first time in Hungary in 107 laryngomicroscopic operations. The method includes: Vagolytic, analgetic, sedative, vasodilatator, coronary flow enhancing, antihypertensive and antitussive premedication. Administration of the sedative anaesthetic gamma-OH, void of respiratory depression, in doses of 60 mg/kg body weight (given in 2 portions), combined with diazepam, without relaxation and intubation. Supplemental analgesia and inhibition of reflexes by means of mucosal and nerve-block anaesthesia. The premedication, supplemented by endonasal nitroglycerin, reduced the increase of blood pressure, which is a characteristic feature of laryngomicroscopic operations. The combined premedication was found to be effective as well in preventing the usual cardiac arrhythmias, partly reflectory, partly due to the depression of the sinus node (sick sinus syndrome). Nevertheless, the authors emphasize the importance of continuous ECG monitoring. Operation conditions met requirements in 102 cases (intubation had to be performed in 5 patients). The method's primary field of indication includes the microsurgical manipulation of glottic synechiae, as well of lesions in the interarytenoid space or on the vocal processes. Except for the removal of bleeding papillomas, haemangiomas or cysts, the method is expedient for the microsurgical therapy of benign changes, as well as for the topical diagnosis of malignant neoplasms in other laryngeal structures. The advantages of the method are safety, maintenance of normal oxygenation, easy prevention of aspiration, as well as good visibility and photodocumentation of the free operation field, undisturbed manipulation without time limit and, last but not least, simple performance requiring no additional expensive equipment.

[The Rapeutic principles in malignant rectal polyps based on late results]. / Behandlungsgrundsätze bei malignen Mastdarmpolypen auf Grund der Spätergebnisse

The late results of various treatment of 114 patients with malignant rectal polyps were found to be similar over a 5-25-year follow-up. On this basis, the following principles of therapy were established: 1. All rectal polyps should be removed completely. 2. Local removal of a malignant polyp, looking macroscopically benign and of favorable size and location, is justified, even though a cancer - not infiltrating the stalk - is situated in the head of the polyp. In any other case a radical operation is indicated. 3. Patients should be held under a life-long supervision. 4. The control should be performed as an organized care.