[Management of an elderly patient in the emergency room at the end of life : A medical ethics challenge]. / Management eines älteren Patienten in der Notaufnahme am Lebensende : Eine medizinethische Herausforderung.

A 94-year-old patient with cardiogenic shock due to myocardial infarction was admitted via the emergency room. A coronary angiography and intensive care were requested. The need for care due to dementia was known. After case discussion in the interdisciplinary and multiprofessional treatment team, the decision for a palliative care concept in the form of symptom control was made in the emergency room, taking into account the patient's medical history, the current situation, and the presumed patient consent. The integration of medical ethics aspects and palliative medicine into "geriatric emergency medicine" will present a challenge in the future.

[Palliative home care in Westfalia-Lippe--baseline study 12 and 36 months after coming into effect of the "agreement to the implementation of ambulant home palliative careforterminally ill patients"]. / Ambulante Palliativversorgung in Westfalen-Lippe--Strukturierte Bestandsaufnahme 12 und 36 Monate nach Inkrafttreten der "Vereinbarung zur Umsetzung der ambulanten palliativmedizinischen Versorgung von unheilbar Kranken im häuslichen Umfeld".

BACKGROUND: On 2009-04-01 the Association of Statutory Health Insurance Physicians Westfalia-Lippe and health insurance organizations made an agreement to implement palliative home care for terminally ill patients. Based on this agreement, family doctors and palliativecardoctorscooperate,supported by coordinators. METHOD: 12 and 36 months after coming into effect of the agreement a questionnaire was sent to the regional palliative care networks to collect data about supply structure, number of patients and their place of death. RESULTS: In the year 2011 85,410 people died in Westfalia-Lippe, 9.0% of them were included in palliative care structures. 69.5% of the included patients died at home, 9.9% in hospital (in 2010: 68.7% at home, 14.7% in hospital). A correlation between the population density or the number of included patients per palliative networkcould not be detected. CONCLUSION: Low-threshold access to palliative care networks(bothfamilydoctorand patientcancontact the palliative care team at any time) improves ambulant palliative care. Non-bureaucratic change from general home palliative care (German abbreviation: AAPV) to specialized home palliative care (SAPV) has proven successful in Westfalia-Lippe. Well-trained and experienced coordinators guarantee multidisciplinary and multiprofessional working of palliative care teams. In order to enhance palliative care in Westfalia-Lippe, data for quality assurance should be defined, periodically collected and evaluated in the future.

[Perfusion of the left ventricular myocardium in patients with aortic valve diseases using single photon emission computerized tomography]. / Untersuchungen zur Perfusion des linksventrikulären Myokards bei Patienten mit Aortenklappenvitien mittels Single-Photon-Emissions-Computertomographie.

To determine resting myocardial perfusion in 30 patients with aortic valve disease (AVD) TI-201 emission computer tomography (ECT) studies and heart catheterization were performed. 16 patients had a predominant aortic regurgitation (AR); an aortic stenosis (AS) was found in 14 patients at catheterization. Perfusion defects were documented in 10 of 16 patients with AR, and in 5 of 14 patients with AS. Regional determination demonstrated in 10 of these 15 abnormal cases at least one of the perfusion defects in the postero-basal segment. In patients with aortic valve disease and normal myocardial perfusion scintigraphy, the ejection fraction (EF) was significantly higher (p < 0.05) as compared to the patients with abnormal TI-201 ECT (EF 65.2 +/- 15.0% vs. 58.9 +/- 15.1%). Additionally, in the 15 patients with abnormal TI-201 ECT, the left ventricular end-diastolic volume index (LVEDVI) and the left ventricular end-systolic volume index (LVESVI) were both increased (LVEDVI in AVD: 130.3 +/- 15.3 ml/m2 vs. 107.4 +/- 13.6 ml/m2, LVESVI in AVD: 61.9 +/- 14.6 ml/m2 vs. 48.0 +/- 9.8 ml/m2). In conclusion, left ventricular perfusion defects at rest can be detected by TI-201 ECT in many patients with aortic valve disease. Such myocardial perfusion defects indicate left ventricular enlargement and impaired left ventricular function, especially in patients with aortic regurgitation.

On the recovery of the electroretinogram after removal of intravitreal zinc particles.

The influence of intravitreal zinc particles (1.3 mm2) in the eyes of rats caused the amplitudes of the electroretinogram to decrease to about 50% of the initial values within 24 hours, whereas the prolongation of the peak times began only on the third day after particle implantation. The removal of the zinc particles after 30 days led to only partial recovery of the amplitudes, whereas the peak times reached normal values. Dissociated behaviour of the amplitudes and peak times as described here was not found in earlier experiments with intravitreal iron, copper or lead particles of the same size. The extraction of intravitreal zinc particles (1.3 mm2) one day after implantation resulted in a recovery of the amplitudes up to 85%.

On the recovery of the electroretinogram after removal of intravitreal copper particles.

This report details the influence of the time lapse and surface area size of intravitreal copper foreign bodies on the electroretinogram (ERG) and the recovery of the potentials after removal of the particles. Pure copper wires were implanted temporarily into the vitreous body of rat eyes in the area of the ora serrata and the values of the ERG were compared with those of the intact fellow eyes. In three different procedures with groups of 12 animals each the following results were obtained: (1) The metal toxicity of small copper particles (0.3 mm2) remaining one day in the vitreous body reduced the amplitudes of the a1-, a2-, and b-wave only 10% by the end of the observation time of 260 days, (2) The loss of ERG amplitudes increased to about 25% under the influence of larger copper particles (1.3 mm2; time lapse one day); and (3) Copper particles with an active surface of 1.3 mm2 remaining two days in the vitreous body caused a permanent loss of about 50%.

[Regeneration capacity in retina and vitreous body changes following extraction of intravitreal copper particles]. / Uber die Rückbildungsfähigkeit von Netzhaut- und Glaskörperveränderungen nach Extraktion intravitrealer Kupferpartikel.

On the basis of experiments with 42 rats, quantitative statements are made regarding the influence of surface area and dwelling time of intravitreal copper particles on the electroretinogram. The influence of these factors on the extent of recovery of function after extraction of the foreign body is demonstrated. The rate of mental intoxication (metallosis retinae) is indicated separately from the mechanical damage. Ophthalmoscopic findings are also described. The practical relevance of these results to the clinical situation is discussed in detail in connection with earlier reports.