[The hospice movement and palliative medicine]. / Hospizidee und Palliativmedizin.

Palliative medicine is the care of patients with an incurable disease. It includes aspects of the physical, psychological, social and spiritual welfare of the patient. In this connection the quality of life has priority over a prolongation if this entails suffering. All decisions are taken with the patient's and his family's consent. The risk of shortening life by applying necessary medication should not be a deterrent. Training and ongoing education for physicians, more hospice beds and guaranteed finances are needed.

[Restricted adenohyphophyseal function after neuroadenolysis for severe pain due to bony metastases.]. / Funktionseinschränkungen der adenohypophyse bei der neuroadenolyse zur behandlung schwerster schmerzzustände bei multiplen Knochenmetastasen.

Neuroadenolysis of the pituitary (NALP) is an efficient measure for treatment of severe pain in patients with bony metastases. It is especially recommended for primary carcinomas of the breast or prostate. The procedure, transsphenoidal puncture of the pituitary under radiographic control and instillation of up to 2 ml 95% alcohol, is simple. The pathomechanism of the analgesic effect is still unknown. Extensive determinations of the anterior pituitary hormones LH, FSH, HPRL, ACTH, and HGH were done before and up to 14 days after NALP in six consecutive patients receiving this treatment. The pituitary was stimulated with releasing hormones LHRH (100 mug) and TRH (200 mug) before and 3 days after NALP. Determinations of hormone parameters were done 25 and 60 min after injection. The results showed that hormone production by the adenohypophysis becomes unevenly suppressed. The following results are significant (P<0.05): (1) LH: poststimulation values are extremely suppressed; (2) FSH: basal values decrease; (3) ACTH: basal values decrease after the 6th day. The antalgic effect of NALP is independent of its hormonal consequences. NALP produces hormonal suppressions of various degrees, and is not a "chemical hypophysectomy".

The esophageal tracheal combitube: preliminary results with a new airway for CPR.

We developed the esophageal tracheal combitube (ETC), a plastic twin-lumen tube, one lumen resembling an esophageal obturator airway (EOA), the other resembling an endotracheal airway (ETA). Ventilation is possible after either esophageal or tracheal placement of the ETC. A specially designed pharyngeal balloon replaces the mask of the EOA and provides sufficient seal, preventing the escape of air through the mouth and nose. The effectiveness of ventilation with the ETC in esophageal position was tested in a crossover study comparing ETC and ETA during routine operations in 31 patients. Blood gas measurements showed a significantly higher (P less than .001) mean arterial oxygen tension during ventilation with the ETC. The reason for this is not yet clear. Preliminary investigations during CPR in 21 arrest patients indicate that the ETC is as effective as the ETA.

[Intrathecal alcohol neurolysis of the lower sacral roots in inoperable rectal cancer]. / Die intrathekale Alkoholneurolyse der unteren sakralen Wurzeln beim inoperablen Rektumkarzinom.

Intrathecal neurolytic blocks are performed with either 95% alcohol or with 6-8% phenol in glycerin. Alcohol is hypobaric and phenol hyperbaric compared with the cerebrospinal fluid; positioning of the patient must therefore be done accordingly. This is a report about 67 consecutive neurolytic alcohol blocks of the lower sacral roots. Although lumbar puncture is done at the lowest possible level at L5-S1, the block only affects the roots from S3 or S4 downwards. The detailed anatomy of the caudal dural sack reveals why S1 and S2 are not affected. S1 and S2 contribute to the lumbosacral plexus and are important for the innervation of the lower extremities. However in patients with very low CSF pressure, S2 and S1 might become damaged. This is the most important result of this series. To avoid an unexpected extension of the block in patients with very low CSF pressure, we now recommend that synthetic CSF be instilled prior to alcohol. The results were unsatisfactory in patients with perineal pain and pain in the lower extremities as well. In these cases S2 or S2 + S1 are already affected by the tumor. One should employ other therapeutic procedures (e.g., epidural morphine) for these patients. After careful selection of patients, alcohol neurolysis of the lower sacral roots is a useful procedure.