[Congenital lobar emphysema - a radiological diagnosis at first glance?]. / Das kongenitale lobäre Emphysem - eine radiologische Blickdiagnose?

Congenital lobar emphysema (CLE) is a malformation of the lung of unknown etiology. The characteristic overdistension of the affected lobe leads to compression and displacement of adjacent normal lung tissue and mediastinum. In the majority of cases, symptoms appear during the neonatal period or in early childhood. Clinically, children present with signs of respiratory distress, frequently occurring with a superimposed lower respiratory tract infection that aggravates air trapping and renders the patient symptomatic. Rarely, CLE is diagnosed in adult patients who did not experience any symptoms during childhood. Knowledge of the disease is of importance because in the majority of cases a plain chest radiograph together with clinical signs is sufficient to diagnose the disease correctly. The article draws attention to this condition by presenting two children and one adult with congenital lobar emphysema. Possible clinical symptoms and diagnostic strategies are reviewed.

Organ donation beliefs of African American women residing in a small southern community.

There is a widening gap between the supply of available human organs and the critical number needed for transplants in the United States. For African Americans, the waiting period is about twice that of non-African Americans. Contributing to this situation is that organ donation among African Americans is less frequent than that among the general population. The purpose of this study was to discover the culture care beliefs, meanings, and practices of selected African American women regarding organ donation. Using the ethnonursing research method, data were collected through lengthy community visits and in-depth interviews. Two cultural and social structure dimensions, kinship ties and religion, were discovered to be most influential for these African American women. This study focused on the significance these dimensions play in the decision to donate an organ. Cultural care modalities for the provision of culturally congruent care were developed based on these findings.

[Indications and rate of repeat studies in the color duplex department of a radiology university clinic]. / Zuweiser und Rate der Doppeluntersuchungen in der farbduplexsonographischen Abteilung einer radiologischen Universitätsklinik.

PURPOSE: Who refers patients for a color duplex ultrasonography (CDUS) in the routine work of a radiological university department and how frequent are repeat examinations? MATERIAL AND METHODS: 1110 patients had at least one CDUS examination between 5/97 and 5/98. The specialities of the referring physicians/primary examiners and the inpatient or outpatient status of the patients were documented at the first consultation. Additionally the patients were asked by the medical staff, whether, how often, and by whom ultrasonographic, CT, or MR examinations of the same organ system had been carried out during the last 4 weeks without evidence of any clinical changes. RESULTS: 97% of the 1118 patients were referred by one of the university departments. The arterial system was exclusively investigated in 58% and the venous system in 29% of the cases. 81% of the 651 arterial examinations were requested by the Departments of Vascular/Cardiac Surgery and Radiology. 75 repeated ultrasonographic examinations were documented in 67 (6%) of the 1118 consultations. Repetitions were documented in 8% of the arterial and in 3% of the venous examinations. X-ray angiographies were already done or planned in 105 of the 625 arterial CDUS (16%). Ultrasonographic referrals with parallel phlebographies (1% of 320 venous indications) as well as parallel CT and MR examinations (1% of the 1118 consultations, respectively) were the exception. CONCLUSIONS: In the described setting, CDUS was mainly used to assess the arterial vascular system prior to vascular surgery and radiological interventions. Repeat ultrasonographies alone (6%) and parallel examinations altogether (14%) were observed less frequently than expected.

[The problem of ventricular flutter and fibrillation]. / Zur Problematik des Kammerflatterns und -flimmerns.

Ventricular flutter evokes quick, haemodynamically little effective ventricular contractions. The still existing minimal circulation does not maintain the vital functions. Ventricular fibrillation is tantamount to the acute standstill of the cardiac circulation. If they are not treated, these malignant disturbances of the rhythm nearly always lead to death. Reentry processes or foci with rapid formation of impulses are discussed as responsible electrophysiological mechanisms. Warning arrhythmias are significant for the evocation of ventricular flutter and fibrillation. But the concept of the warning arrhythmias has no unrestricted validity. Thus also late involving ventricular extrasystoles can evoke ventricular fibrillation. Disturbances of intraventricular conduction are also significant for the development of ventricular fibrillation. In our own patients there were no disturbances of conduction only in 13.1% of the cases with ventricular fibrillation. Etiologically are of concern: acute myocardial infarction, chronic myocarditis, chronic ischaemic heart disease, current accidents, advanced stages of vitia and cardiomyopathies. Frequently ventricular fibrillation appears as paroxysmal form (paroxysmal uncoordinated ventricular tachycardia, "torsades de pointe") due to inhomogeneous repolarisation (prolongation of the QTU-time). Therapeutically only the immediate electro-shock therapy has a chance of success in ventricular flutter or fibrillation. Among our patients out of 61 patients with ventricular flutter and fibrillation 26 could be dismissed.

[Technic of venous access for infusion therapy and parenteral nutrition]. / Zur Frage der Technik des venösen Zuganaes für die Infusionstherapie und parenterale Ernährung.

The creation of a secure venous access is the basis of the infusion therapy and the parenteral nutrition. As ways of access are suited above all the subclavian vein, the internal jugular vein and the basilic vein. Taking into consideration the contraindications and the exact performance of the various methods early complications such as punctures of the arteries, pneumothorax, rupture of the catheter and extended haematomata may be reduced to a minimum. Abnormal positions are avoided by control of the position by means of endo-ECG via steel mandrin. As late complications are observed infections at the place of puncture, unclear, partly septic temperatures and clinically manifest thromboses. Own experiences with 3,282 central venous catheters (2,057 subclavian catheters, 63 catheter into the internal jugular vein and 1,162 central catheters with access via arm veins) are taken into consideration.

[Infusion- and microcatheterization technics at an internal medicine intensive care unit]. / Infusions- und Mikrokathetertechnik auf einer internistischen Intensivstation

It is reported on the infusion, stimulation and microcatheter technique in an internal intensive therapy ward. From July 1st 1970 to November 11th 1974 were altogether laid 1,642 superior cavacatheters, 1,057 times by puncture of the subclavian vein and 585 times through the brachial veins. Compared with the usual infusion techniques the advantages of the cava-catheter technique consist in the fact that a constant venous approach is existing and that solutions of a high percentage and medicaments may be infused relatively undangerously. Apart from this the cava-catheter gives the possibility to carry out continuous measurements of the central venous pressure and guarantees the taking of blood samples at any time. The phlebitides or thromboses, respectively, which are regularly appearing in flexules lying longer than 40 hours are avoided in most cases. Taking into consideration the contraindications and the exact performance of the various methods especially early complications such as puncture of the arteries, pneumothorax, detachment of the catheter, extended haematomas and wrong positions of the catheter may be reduced to a minimum. As late complications distinct infections in the place of puncture, unclear, partly septic temperatures and clinically manifest thromboses were observed. In these cases the cava-catheters should be removed. The temporary electrostimulation through electrode catheters plays an important part in the emergency medicine and the mastering of the various methods of the cava-catherization is taken for granted. During the period of report altogether 423 stimulation catheters were laid. The cardiac microcatheterization should be reserved for more special cases.