[Clinical significance of autologous transplantation with hematopoietic stem cells in leukemia and solid tumors]. / Die klinische Bedeutung der autologen Transplantation mit hämatopoetischen Stammzellen bei Leukämien und soliden Tumoren.

Autologous Transplantation of hematopoietic tissue with frozen hematopoietic stem cells is increasingly used for leukemias and lymphomas, but also for some solid tumors. In the past, autotransplants have been performed with bone marrow as the source of hematopoietic stem cells. Circulating, blood derived hematopoietic stem cells, however, allow safe engraftment of all cell lines after supralethal chemo-radiotherapy. This survey describes the role of autologous stem cell transplantation in disorders that are currently in the center of clinical and scientific interest. This estimation is based on the proportion of protocols dealing with, and centering on, autologous stem cell transplantation in the context of treatment for leukemias and solid tumors ("Oncodisc", "PDQ").

[Fenoterol (Partusisten)-associated lung edema. A case report]. / Fenoterol (Partusisten)-assoziiertes Lungenödem. Ein Fallbericht.

The side effects of a beta 2-mimetic tocolytic therapy are of importance for anaesthesiologists who administer anaesthesia for obstetric operations, as our case report illustrates. In a healthy 28 year old pregnant woman during the 32nd week of pregnancy i.v. fenoterol was started because of premature labor. After two days severe respiratory failure developed and cesarean section was performed. The patient needed mechanical ventilation with positive endexpiratory pressure and high inspiratory oxygen concentrations (F1O2 greater than 0.7) for 5 days thereafter. The chest x-ray revealed a fluid lung. With artificial respiration and a consequent diuretic therapy with dopamine and furosemide (10 mg . h-1 continuously, negative water balance--5,000 ml on the 4th day) gas exchange improved and extubation was possible on the 6th postoperative day. After exclusion of cardiac or renal disease as well as aspiration of gastric content, the diagnosis of a fenoterol-associated pulmonary edema was thought probable. From the literature it is known that beta 2-mimetics can aggravate the increased water and sodium retention during pregnancy and cause pulmonary edema by an additional increase in pulmonary artery pressure. Therapy consists of adequate oxygenation and induction of diuresis with continuous furosemide and dopamine to achieve negative water balance. When administering anaesthesia to patients on tocolytic therapy positive water balance has to be avoided and great care must be directed to the postoperative gas exchange.

[Long-term thymoleptic management of depressive states with special reference to retarded depression]. / Zur längerfristigen thymoleptischen Behandlung depressiver Zustände unter besonderer Berücksichtigung spätdepressiver Erkrankungen.

Attention is drawn to the importance of long-term thymoleptic treatment by describing the progress of 39 patients who were continually adjusted to a thymoleptic maintenance dose for a mean duration of two years following a depressive reaction. Apart from having a direct thymoleptic effect on insufficiency phenomena lasting longer than particular phases this led to the conclusion that treatment should be related strictly to phase due to the particular proneness of such patients to relapse during postdepressive insufficiency syndromes. Special mention is made of typological features characterising the course of depressive reactions.

Presence of beta-adrenoreceptors in the hypothalamus; their importance for the pressor response to hypothalamic stimulation.

The posterior hypothalamus of cats anaesthetized with pentobarbital sodium was superfused and electrically stimulated with a push-pull cannula. Superfusion of the hypothalamus with (+/-)-, (-)-propranolol, sotalol, practolol or metoprolol caused a concentration-dependent inhibiton of the pressor response to hypothalamic stimulation. (+/-)-Propranolol and a procaine concentration equi-anaesthetic to the concentration of (+/-)- and (-)-propranolol were ineffective. Lower concentrations of propranolol and metoprolol were needed to inhibit the pressor response than of sotalol or practolol. Superfusion with practolol and tolazoline impaired the pressor response to a greater extent than did superfusion with each of the drugs alone. Hypothalamic superfusion with isoproterenol elicited a concentration-dependent enhancement of the rise of blood pressure during electrical stimulation of the hypothalamus. It is concluded that beta-adrenorecptors are present in the posterior hypothalamus and that they are involved in the pressor response elicited by electrical stimulation of the hypothalamus. Propranolol and metoprolol seemed to possess a higher affinity to the beta-receptors of the hypothalamus than sotalol or practolol.

Hypothalamic action of adrenoreceptor blocking agents.

In cats anaesthetized with pentobarbital sodium, the posterior hypothalamus was superfused and electrically stimulated with a push-pull cannula. The pressor response to stimulation of this hypothalamic area was inhibited when the hypothalamus was superfused with drugs blocking either alpha-adrenoreceptors (piperoxan, tolazoline), or beta-adrenoreceptors--(+/-)-propranolol, (-)-propranolol, practolol, sotalol, metoprolol. (+)-Propranolol and a concentration of procaine equianaesthetic to propranolol were ineffective. During superfusion with tolazoline in the presence of practolol the inhibition was twice as that when the hypothalamus was superfused with either tolazoline or practolol. In another series of experiments the push-pull cannula was inserted into the anterior hypothalamus. The depressor response to stimulation of this area was inhibited by the hypothalamic superfusion with the alpha-adrenoreceptor blocking drugs phentolamine, tolazoline, piperoxan or yohimbine. Hypothalamic superfusion with phenylephrine abolished the inhibitory effect of phentolamine on the depressor response. The results indicate that adrenoreceptors are present in the hypothalamus and that they are involved in blood pressure changes elicited by hypothalamic stimulation.