[Therapy of cancer pain--a comprehensive therapy concept]. / Therapie des Krebsschmerzes--ein umfassendes Therapiekonzept.

A comprehensive conception for cancer pain treatment is presented. The medical analgesic drug therapy representing the main point of this conception is applied as a three steps analgesic ladder as recommend by the WHO. This kind of therapy enables an individual adaptation resp. increase of the analgesic intensity by the use of non narcotic analgetics, weak and strong opioids as well as adjuvant drugs. Besides the explanation of the principles of its application and some detailed instructions for the dosage of several drugs, possible side effects and interactions are mentioned as well as some examples for its clinical application are quoted. A further increase of the analgesic intensity is reached by the local intraspinal application of morphine. For this purpose epidural and intrathecal long-term catheters are used. Also in these cases dosage, side effects and complications are mentioned and the possibilities and advantages of the continuous analgesia with implantable systems (pain ports) and external portable or implantable pumps are discussed. Furthermore the role of the neurolytic blocks, neurosurgical treatment and radiation therapy within this conception is mentioned.

[Therapy of cancer pain--a comprehensive therapy concept]. / Therapie des Krebsschmerzes--Ein umfassendes Therapiekonzept.

A comprehensive concept for cancer pain treatment is presented. The main idea of this concept is systematic analgesic pharmacotherapy. It is carried out in three steps, such as recommended by the WHO. This kind of therapy enables an individual adaptation or an increase of analgesic intensity when using non-narcotic analgetics, weak and strong opioids and adjuvant drugs. The principles of their application are discussed, detailed information about the dosage of certain drugs, their effects, side-effects and possible interactions is given, and examples of their clinical use are presented. The local peridural or intradural application of morphine enables a further increase in analgesic intensity. It is carried out by means of peridural and intradural catheters. Also for these cases dosages, side-effects and possible complications are described. The possibilities and advantages of prolonged analgesia with implantable systems (pain ports) and external portable or implantable pumps are discussed.

[Effect of local anesthetics on ciliary activity of the human tracheobronchial mucosa (studies in vitro)]. / Einfluss der Lokalanästhetika auf die Zilienaktivität menschlicher tracheobronchialer Mukosa (Untersuchungen in vitro).

The local cellular toxicity of the local anaesthetics Tetracaine, Propipocain and Lidocaine were investigated in vitro using human tracheal and bronchial epithelium. The ciliary beat of the respiratory epithelium served as an index of the cellular activity. After bronchoscopic explanting the respiratory epithelium was incubated at 37 degrees C in tissue culture medium. The special local anaesthetic drug was added in the selected concentration. The evaluation of ciliary activity was done by light microscope. All local anesthetics tested showed local cytotoxic properties depending on their concentrations. The local toxicity decreased from Tetracaine to Propipocain and Lidocaine. Already 0.1 per cent Tetracaine (20-fold dilution of the clinical concentration) and 0.25 per cent Propipocain (4-resp. 6-fold dilution of the clinical concentration) produced an irreversible stoppage of ciliary activity which may impair the pulmonary clearance. Therefore only Lidocaine is recommended for local anaesthesia of the tracheal and bronchial mucosa because of its low toxicity and its effectiveness.

The efficiency of various humidifiers for respired gas.

Eight different breathing gas humidifiers were tested by humidity measurements using two independent methods under simulated clinical conditions. The comparison considering the influence of tidal volume and inspiratory/expiratory ratios revealed great differences between the individual devices depending on the kind of humidification and functional principles. Only four of the humidifiers tested: Ultrasonic Nebulizer NB 108, Hydrotrop 200, Bennett Cascade and Nicholas Humidifier, gave a constant performance of more than 30.75 g H2O/m3 absolute humidity or 70% relative humidity, related to 37 degrees C. However, humidification and heating of the inspired gas could be ensured only by the last three devices. The humidifiers Bird 500 cm3 Micronebulizer, Ultrasonic Nebulizer NB 100 and Draeger Compressor 660, were strongly dependent on the respiration parameters and exceeded the required minimum of 70% relative humidity only under certain conditions. The Engstroem ER-200 Vaporizer had a low performance and was not suitable as a breathing gas humidifier for longterm ventilation.

[Review of the development of air humidifiers working on the principle of evaporation with reference to their experimentally assured efficacy]. / Uberblick über die Entwicklung der nach dem Verdunsterprinzip arbeitenden Atemgasanfeuchter unter Berücksichtigung ihrer experimentell gesicherten Leistungsfähigkeit.

Basing on own measurements of the efficiency of customary water-bath humidifiers (humidifier of the ventilator RO-5 R, humidifier of the ventilator Engström ER 200, Bennett Cascade Humidifier, Hydrotrop 200 and Nicholas Humidifier) a critical review is given. As the results show only 3 of the humidifiers (Bennett Cascade Humidifier, Hydrotrop 200 and Nicholas Humidifer) make sure a really breathing air "conditioning" (moistening and rewarming). The humidifers of the ventilators RO-5 R and Engström ER 200 have only a very low efficiency, therefore they are not suitable for long term ventilation. Finally, the safety for the patient (the dangers of watercondensation, watertransport into the lungs, overheating, hypothermia and superhumidication) and the different expenditure of the clinical use of the humidifiers should be mentioned.